Subarachnoid ketamine in swine--pathological findings after repeated doses: acute toxicity study.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate whether 5% ketamine with and without preservative, administered intrathecally to swine, produced a clinical anesthetic effect and caused direct subacute neurotoxicity. METHODS: Twenty pigs were used. Under general anesthesia, a subarachnoid catheter was placed at L5-L6 or L6-S1 spinal interspace. Five animals were used for initial clinical evaluation of the anesthetic effects of subarachnoid ketamine (12.5 and 25.0, and 500 mg). Two animals were excluded because of bloody taps, two served as controls (catheterization without drug administration), four received ketamine racemate (25.0 mg/d), four received ketamine racemate preservative free (25.0 mg/d), and three received benzethonium chloride, the ketamine excipient (0.05 mg/d). All drugs were administered for 7 days. The catheters were withdrawn at the end of the treatment period. After 35 days, the pigs were euthanized and the spinal cord removed and preserved for histopathologic study with hematoxilyn-eosin and luxol-fast blue myelin staining. Histopathologic effects were defined as absent/minimal, mild, or severe by a pathologist, unaware of group allocation, by evaluating the presence and intensity of peripheral and/or central chromatolysis, spongiosis, neuronal loss, perivascular neuroglia, neuronolysis, and myelin degeneration. RESULTS: All doses of ketamine produced immediate cutaneous anesthesia and motor block; benzethonium chloride did not. Histopathologic examination showed no neurotoxic effect of ketamine without preservative; ketamine with preservative showed a discrete neurotoxic effect, and the preservative alone produced a moderate neurotoxic effect. CONCLUSIONS: Clinically, in swine, subarachnoid ketamine without preservative is a safe and effective anesthetic and did not show significant neurotoxic effects. However, ketamine with preservative produces minimal changes, and benzethonium chloride alone produces moderate neurotoxic effects.

Angiostrongyliasis in a European patient: a rare cause of gangrenous ischemic enterocolitis.

Angiostrongylus costaricensis causes a clinicopathologic disease first observed in Costa Rica, mainly in children characterized by highly symptomatic eosinophilic gastroenteritis involving the terminal ileum, cecum, appendix, and ascending colon. A case of angiostrongyliasis in an adult Spaniard infected during a brief stay in Nicaragua is reported. We examined the macro-microscopic features of a right ileocolic resection of a 52-year-old patient. In the surgical specimen, multiple confluent ulcers, some perforated, were observed particularly in the terminal ileum. The intestinal wall was thickened, and the arterial branches presented necrotizing arteritis with thrombosis and a heavy infiltrate of eosinophils around the vessels. In addition, some granulomas were observed. Adult male and female forms of A. costaricensis were found in the lumen of many arterial branches and in the tissue of the omentum, surrounded by dense eosinophilic infiltrate. A. costaricensis causes an intense eosinophilic, necrotizing arteritis associated with thrombosis leading to severe ischemic lesions. This is the first case to be diagnosed in Europe. Incubation time was able to be established within a period of at least 14 days.

[Dementia as a presentation symptom of giant cell arteritis]. / Demencia como síntoma de presentación de la arteritis de células gigantes.

Giant Cells Arteritis (GCA) can be presented sometimes with atypical manifestations which greatly difficult its diagnosis. We present a case of GCA in a 58-year-old man with dementia as first symptom. In the anamnesis, signs of rheumatic polymyalgia were observed, as well as a recently started dementia with a very disturbed mini-mental test. The analytic study showed anemia (Hb of 7.44 nmol/l, with 3.2 x 10(12) red cells and a GSR of 85 mm). The diagnosis of GCA was supported by a temporal biopsy. In a study of magnetic resonance, there were no evidences of brain infarct areas. After treatment with prednisone, normalization of GSR and a significant improvement of cortical functions were observed. GCA must be considered in the initial diagnosis of a patient with mental disorders, given that it is one of the curable causes of dementia.

[Renal liposarcoma: diagnostic and therapeutic considerations]. / Liposarcoma renal: consideraciones diagnósticas y terapéuticas.

We report on two cases of renal liposarcoma. The clinical features of this tumor type are described and diagnostic and therapeutic considerations are put forward. The usefulness of CT in the diagnosis of this disease entity is underscored. This permits us to evaluate the response to treatment and furthermore, it permits early detection of recurrence.