Chemical composition and antimicrobial effects of essential oils of Eucalyptus globulus, Myrtus communis and Satureja hortensis against Escherichia coli O157:H7 and Staphylococcus aureus in minced beef.

Essential oils (EOs) extracted by hydrodistillation from leaf parts of Algerian Eucalyptus globulus, Myrtus communis and Satureja hortensis were analyzed by gas chromatography/mass spectrometry (GC/MS). The main components of EOs obtained were γ-terpinene (94.48%), 1,8-cineole (46.98%) and carvacrol (46.10%), respectively, for E. globulus, M. communis and S. hortensis. The in vitro antimicrobial activity of the EOs was evaluated against Staphylococcus aureus CECT 4459 and Escherichia coli O157:H7 CECT 4267 using the agar diffusion technique. Results revealed that E. globulus and S. hortensis EOs had more antibacterial effects than that from M. communis. Minimal inhibitory concentrations (MIC) showed a range of 0.05-0.22% (volume by volume [v/v]). Sensitivity of gram-positive S. aureus was much higher than that of gram-negative E. coli. Plant EOs were added to minced beef (two-fold MIC value) at 0.10-0.44%, experimentally inoculated with the same pathogens at a level of 5 × 10(5) colony forming units (cfu)/g and stored at 5 ± 2 °C. Results showed that the EOs of E. globulus and S. hortensis had remarkable antibacterial properties, higher than that of M. communis, against S. aureus and E. coli. Indeed, a reduction of 5.8 log cfu/g (70.74% of reduction) was recorded after 7 days of storage for S. hortensis against E. coli. However, regarding S. aureus, both S. hortensis and E. globulus caused a highly significant (p < 0.05) decrease of microbial counts, most evident after 5 days of storage; S. aureus numbers were 3.50 and 2.50 cfu/g, respectively, corresponding to a reduction of 2.20 and 3.20 log cfu/g (38.60 and 56.14% of reduction) after 1 week of storage. Sensory evaluation revealed that the aroma of minced beef meat treated with EOs was acceptable by panelists at the levels used.

Primary trochlear headache: a new cephalgia generated and modulated on the trochlear region.

BACKGROUND: The authors have observed a group of patients complaining of periorbital pain, emanating from the trochlear area, in absence of trochleitis or other orbital or systemic disease. All were previously diagnosed and treated as different types of headaches, but pain was not controlled until local treatment on the sore trochlea was performed. The authors have investigated the role of the trochlear area in causing and modulating headache. METHODS: Observational case series. Trochlear pain was defined as pain on this area, exacerbated upon examination and looking in supraduction. Pain was studied after trochlear injections of lidocaine, corticosteroids, and placebo. Secondary orbital pain was ruled out. RESULTS: Seventeen women and one man were evaluated (mean age: 44 years). All presented unilateral pain in the trochlear area (60% reported more extended headache), for more than 1 year in 70%. Neither ocular autonomic signs nor motility restrictions were observed. Imaging examinations were normal in 100%. The temporal pattern was either chronic or remitting, with acute exacerbations. Pain increased at night in 55%. A total of 62% presented concurrent headaches. Locally injected corticosteroids relieved the pain within 48 hours in 95% and also improved concurrent headaches, by decreasing attack frequency and analgesics intake. Placebo was not helpful. Relapses were observed in 45% (average 8 months). CONCLUSIONS: The trochlear region is the origin of a specific and unrecognized headache, which we have named primary trochlear headache. Local treatment on the trochlear area is also useful for other concurrent primary headaches with inadequate response to oral therapy.

Cluster headache: interictal asymmetric increment in intraocular pressure elicited by Valsalva manoeuvre.

Changes in intraocular pressure (IOP) elicited by a Valsalva manoeuvre were studied in 11 male patients (mean age 39.8 years) suffering from episodic cluster headache (CH), and 12 healthy male controls (mean age 39.9 years). The tests were performed at rest and while exhaling hard through a mouthpiece connected to a mercury manometer. In the CH group, during symptomatic periods, between attacks, Valsalva manoeuvre elicited an asymmetric increase in IOP with significantly higher values on the symptomatic side (P = 0011), whereas no asymmetric increments in IOP were found during asymptomatic periods. Outside the cluster period the IOP values both baseline and with Valsalva manoeuvre did not differ from controls. The increment in IOP took place within a few seconds, as in spontaneous CH attacks, thus pointing to a rapid increase in intraocular blood volume or vasodilatation. These findings may reflect a latent increased vascular reactivity of the symptomatic orbit during CH period.

Anaesthesia-related diplopia after cataract surgery.

BACKGROUND: We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. METHODS: This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. RESULTS: During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. CONCLUSIONS: Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.

Objective assessment of autonomic signs during triggered first division trigeminal neuralgia.

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 +/- 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.

Vertigo and Parinaud's syndrome as presentation of Churg-Strauss syndrome.

Intracranial complications are rare in Churg-Strauss syndrome (CSS). Cerebral infarctions are the most common intracranial presentation, usually after the clinical diagnosis of CSS had been established. We present a case of vertigo and Parinaud's syndrome as presentation of CSS in an asthmatic patient. Clinical examination revealed upward gaze limitation and bilateral midriasis. A cranial computed tomography scan showed a small round hypoattenuating lesion located in the right thalamic-mesencephalic region, which was later confirmed by magnetic resonance imaging. There was eosinophilia of more than 50%, and p-ANCA were positive. After steroid treatment was started, vertigo and diplopia resolved, and eosinophilia was reduced. After 24 months follow-up, the patient remains stable, with negative p-ANCA, taking 20 mg prednisone daily. Further magnetic resonance exams have shown findings that were similar to those of previous studies. This case shows how vertigo and transient diplopia may be the first symptoms of neurological complications in patients with CSS.

[Pseudotumor cerebri associated with maxillary sinusitis: clinico-pathological study]. / Pseudotumor cerebral asociado a sinusitis maxilar y pleocitosis en líquido cefalorraquídeo.

INTRODUCTION: The pseudotumor cerebri is characterized by increased intracranial pressure in the absence of a space occupying lesions or obstruction to the circulation of cerebrospinal fluid (CSF). Increased pressure but normal composition of the CSF is the diagnostic criterion. Ear infections and other infections such as sinusitis have been cited as possible, but rare, causes. CLINICAL CASE: A 12 year old girl presented with diplopia 10 days after starting treatment for sinusitis. On examination there was paresia of the VI cranial nerve to the left eye and marked bilateral papilledema. She had normal visual acuity with visual field measurements showing increased blind spot field in both eyes. Resonance studies only showed maxillary sinusitis. CSF pressure was 35 cm H2O, with 40 lymphomonocytes and normal biochemical findings. After 15 cm of CSF had been removed treatment was started with acetazolamide, dexamethasone and cefotaxime. A week later the diplopia had disappeared and the CSF pressure was 25, with no cells present. Two months later the visual fields and fundus oculi were normal. After follow-up for one year there was no recurrence. CONCLUSIONS: We describe a case of pseudotumor cerebri associated with maxillary sinusitis. We do not know whether this is a chance association or whether there was a pathophysiological basis. The possibility should be considered so as to treat the cause or predisposing factor. The initial CSF pleocytosis would support the possibility of a relationship of the pseudotumor with an infectious condition (meningeal irritation or para-infectious pleocytosis meningeal irritation or para-infections pleocytosis in the context of an ENT infection), which might have precipitated the problem by interfering with the reabsorption of CSF.

Potential virulence determinants of Salmonella serovars from poultry and human sources in Spain.

A total of 173 Salmonella strains of different serovars isolated during 1992 from poultry and human sources in Zaragoza (NE Spain) were investigated for potential virulence factors. Parameters studied included production of aerobactin, enterobactin, colicin (including colicin V) and hemolysin, serum resistance against serum from man, sheep, cattle and chicken, binding of Congo red and crystal violet, auto-agglutination and calcium dependency at 37 degrees C and double colony morphology. Preliminary studies showed tests with completely negative results (colicins and hemolysin production, double colony morphology, auto-agglutination and calcium dependency at 37 degrees C) and tests with completely positive results (enterobactin production and binding of Congo red). The tests with variability of results were production of aerobactin, serum resistance and crystal violet binding. Aerobactin production was detected in 80% of Salmonella strains of clinical human origin and in 30% of Salmonella strains isolated from healthy slaughtered chickens. Sixty-five per cent of patient isolates were human serum resistant, 73% were ovine serum resistant, 85% were bovine serum resistant and 98% were chicken serum resistant. The percentages of poultry isolates serum resistant were 61, 86, 60 and 89% in human, ovine, bovine and chicken serum, respectively. Crystal violet binding was detected in 22.5% of Salmonella isolates from human origin and in 32.3% of Salmonella strains from poultry origin. This study can form a marker for the prevalence of strains with various characteristics (production of aerobactin, serum resistance and crystal violet binding) for comparison in future epidemiological studies. Furthermore, the data of this work suggested that strains causing enteric salmonellosis in man are partially identical to strains isolated from carrier broilers.

[Presence of Listeria monocytogenes and Listeria sp. in fresh and cured sausages. Use of different conditions of time and temperature for incubation]. / Presencia de Listeria monocytogenes y Listeria sp. en longanizas frescas y curadas. Utilización de distintas condiciones de tiempo y temperatura de incubación.

Two different temperatures for enrichment of Listeria monocytogenes and related species have been studied (1) cold enrichment at 4 degrees C (2) enrichment at 30 degrees C (FDA method). Also, two selective media for isolation were tested: Acriflavine-Ceftazidime agar (A.C.) and Palcam agar. We have studied 72 samples of dry-cured sausage (called 'longaniza') at different stages of maturation: fresh, semi-cured and cured samples. The most efficient method was cold enrichment at 4 degrees C during 5 days followed by isolation in Palcam agar, but results were only significant for fresh sausages (P < 0.05).

[Seroepidemiologic study of hepatitis C virus infection in a general population from the region of La Rioja, Spain]. / Infección por el virus de la hepatitis C. Estudio seroepidemiológico en población general de La Rioja.

BACKGROUND: To assess the prevalence of hepatitis C virus (HCV) infection in a general population and to identify risk factors for acquiring infection. POBLATION AND METHODS: A cross section of the general urban population of La Rioja aged between 14 and 65, was studied by choosing a random sample (n = 890). Serum samples were screened for HCV antibodies by second-generation enzyme-linked immunosorbent assays and recombinant immunoblot assays. We investigated the relationship between HCV serostatus and age, intravenous drug use, tattoos, blood transfusion, history of hepatitis, previous surgical operations, the administration of parenteral treatment and the number of sexual partners. RESULTS: The overall prevalence of anti-HCV antibodies was 2%. The logistic regression analysis confirmed a statistically significant association between anti-HCV positivity and intravenous drug use (OR = 169.67; CI 95%: 21.1-1,364.75), exposure to a blood transfusion (OR = 10.41; CI 95%: 3.03-35.75); tattoos (OR = 9.04; CI 95%: 1.25-65.36), and male sex (OR = 5.35; CI 95%: 1.34-21.42). However, that 38% of subjects had no risk factors for HCV infection. CONCLUSIONS: These results show a high proportion of people were found to have anti-HCV antibodies. The possible mode of infection in one third of these subjects is not known. In the half of these cases the infection was found have been acquired by an intravenous mechanism: blood transfusion or drug use.

Evaluation of the clinical usefulness of APACHE II and SAPS systems in the initial prognostic classification of acute pancreatitis: a multicenter study.

The clinical usefulness of the APACHE II and SAPS systems in the early prognostic classification of patients with acute pancreatitis has been evaluated in a prospective multicenter study. We aimed to identify early those patients with acute pancreatitis who should be monitored closely to expedite the detection and treatment of complications. One hundred eighty-two patients with acute pancreatitis were included; 28 were classified as severe, having developed at least one major complication of the disease. The scores obtained through the APACHE II and SAPS systems in these severe cases were significantly higher than the scores in the mild cases of acute pancreatitis (p < 0.001). The sensitivity of these systems in the prognostic classification of acute pancreatitis was 70.4% for APACHE II and 66.7% for SAPS, and the specificity was 79.1% for both. When applying APACHE II and SAPS systems in the early phase of acute pancreatitis, the possibility of misdiagnosing the severity exists, thus limiting the application of these systems in the initial assessment of prognostic classification. In conclusion, APACHE II and SAPS systems are of limited clinical utility in the early prognostic evaluation of acute pancreatitis because of their low positive predictive value.

Monitoring of serum proteinase--antiproteinase balance and systemic inflammatory response in prognostic evaluation of acute pancreatitis. Results of a prospective multicenter study.

With the aim of studying the clinical usefulness and applicability of circulating levels of protease inhibitors, complement factors, acute phase reactants, and leukocytic enzymes in the prognostic evaluation of acute pancreatitis (AP), the present prospective multicenter study has been carried out. A total of 182 patients with AP have been included, to whom an exhaustive evolutive protocol has been applied from the time of their hospital admission (2-12 hr from the onset of the disease) until the 15th day of evolution in order to clearly define them. The severe episodes exhibit a greater consumption of alpha 2-macroglobulin, and C3 and C4 complement factors, as well as a greater increase of alpha 1-protease inhibitor, C-reactive protein and polymorphonuclear elastase than mild events, with regards to the underlying pathophysiological condition. The determination of the plasma levels of leukocytic elastase in the first hours of evolution allows a prediction of the severity of the acute pancreatitis event with a high reliability (predictive values that become higher than 90%). The clinical value of the remaining parameters analyzed, in this aspect, is less, being applicable to the monitoring of the disease.

[Non-excisional treatment of spontaneous rupture of the esophagus]. / Tratamiento no exerético de la rotura espontánea del esófago.

We present 7 personal cases of Boerhaave syndrome, 6 treated surgically and one managed with conservative measures. Boerhaave's syndrome is one of the most serious gastro-intestinal perforation pictures. Although its frequency is scant, because of its seriousness it is important to be aware of it for early diagnosis. While a prompt diagnosis is important in any pathology, it is even more so in this syndrome since there is a clear relationship between the time lapse from perforation to the onset of treatment and the rate of survival. Although we present one case cured medically, this is exceptional and treatment is eminently surgical and should be as early as possible. The technique that provides the best results and an excellent morbimortality rate in relation to efficacy is primary suture followed by a fundal patch. In delayed cases with patients in deteriorated condition, other techniques can be considered. Due to its initial severity and a tendency to postoperative complications, the patient should be closely controlled, and correct antibiotic therapy and complete parenteral support nutrition are very important in treatment.

[Immediate prognosis factors in total gastrectomy in cancer]. / Factores pronósticos inmediatos en la gastrectomía total por cáncer.

We present a series of 76 patients operated over a period of nine years, diagnosed as gastric cancer (CG), in whom radical oncologic total gastrectomy (GT) with esophago-jejunal anastomosis (EY) on a Roux-en-Y loop (Y-R) was performed. The tumor was located in the cardias in 27 patients, body in 37, fornix in 3, gastric stump in 7 and over plastic linitis in 2. We performed total gastrectomy enlarged to the spleen in 63 patients, to the pancreas in 28, to the colon in 5 and to the liver in 4. We describe the most salient technical details of the surgical intervention. Twenty-six percent of the patients presented postoperative complications, which we divided into two groups: anastomosis failures, among which are emphasized 4 severe esophagojejunal fistulas, a fistula of the duodenal stump (MD) and respiratory complications. The mortality was 7.8%, corresponding to 4 esophago-jejunal fistulas, 1 fistula of the duodenal stump and 1 bilateral bronchopneumonia. We analyzed various parameters that we consider important prognostic indicators of postoperative morbi-mortality. Applying the Fischer test, we attempted to assign statistical significance to these parameters. Age over 60 years increased postoperative mortality. Super-radical surgery did not increase mortality. On the other hand, patients in stages IIIb and IV have a worse prognosis, with a mortality in the first 30 days of 28.5%. Esophago-jejunal anastomosis on a Roux-en-Y loop is the procedure of choice used by our center after total gastrectomy for gastric cancer, yielding the most acceptable morbi-mortality figures.

[Results of extended resections in colorectal cancer]. / Resultados de las resecciones ampliadas por cáncer colorrectal.

We present 50 cases of super-radical surgery in cancer of the colon and rectum with tumoral spread. In the same period of time a total of 426 colorectal neoplasms were operated on, which represents 11% of the total. The mean age was 65.7 years, with a predominance of females (29/21). In every case the primitive tumor and contiguous organ affected were excised with an oncologic criterion; the principal location was the rectum, with 14 cases, and the viscus most affected was the female genital tract. The mean hospital stay was slightly longer than that of the general series (20.9/14); the mortality was 4%, a figure similar to that of the general series; the index of morbidity did not rise, survival was comparable and the patient's comfort was enhanced. In our opinion, this technique is indicated in all cases in which the tumor invades contiguous regions when local and/or general conditions permit.

[Carcinoma of the colon in La Rioja. Study of incidence in the period 1978-87]. / Carcinoma del colon en La Rioja. Estudio de la incidencia en el período 1978-87.

A study was made of the incidence of colonorectal tumors in the Autonomous Community of La Rioja (Spain) over 10-year period between 1978 and 1987, inclusive. An increased incidence of these tumors is confirmed, with no decline in the age of presentation or in the frequency of detection of early tumors, which suggests that this disease is on the rise. In view of these results, measures leading to the early diagnosis of colonic tumors are needed, such as screening of the general population, particularly groups at risk.

[Complications of acute gastroenteritis caused by Salmonella no typhi]. / Complicaciones de la gastroenteritis aguda por Salmonella no typhi.

A review was made of the histories of 125 adult patients admitted for acute gastroenteritis (GEA) due to Salmonella no typhi. The complications that appeared in the series are analyzed. A total of 16 patients (12.8%) presented complications: the most common was bacteremia, 3 had renal tubular necrosis, 2 alithiasic cholecystitis that required surgery, 2 toxic megacolon, 2 rectal hemorrhage, 1 erythema nodosum and 1 intestinal perforation. The authors review the features of each complication.