Acute subdural hematoma after spinal anesthesia in an obstetric patient.

Intracranial subdural hematoma is a serious complication of spinal anesthesia. We report the case of a 31-year-old woman who presented with headache and neurologic localizing signs after spinal anesthesia for cesarean delivery. She was subsequently diagnosed with a right temporoparietal subdural hematoma. The hematoma was evacuated, and she had good recovery.

[How to measure intra-abdominal pressure, the bladder pressure method]. / Medir la presión intraabdominal. Méthodo intravesical.

Abdominal pressure, abdominal hypertension and abdominal compartment syndrome are not synonyms but well-differentiated entities which have been studied over the last century in patients who have medical or surgical problems and in those who have undergone laparotomies to control abdominal damage. There are numerous bibliographical references and studies which have been carried out in this field by medical personnel to provide evidence of a tight relationship among abdominal hypertension and secondary physio-pathological alterations related to abdominal hypertension; therefore, it is important to monitor patients which will help to prevent abdominal compartment syndrome. The indirect intra-abdominal pressure measurement technique based on bladder pressure measurement is a useful procedure which nursing personnel administer and can even be practiced in doctors' offices. This technique is easy, well-known in surgical emergency wards and in reanimation wards; it is minimally invasive, has few side effects and its results can benefit patients; at present time, it is the preferred method to determine intra-abdominal pressure. The authors describe this technique, the materials necessary to administer it, and some of the aforementioned concepts to provide knowledge about abdominal compartment syndrome. Prevention, diagnosis and early measurement of bladder pressure and a timely decompression are the keys to decrease the death rate in patients affected by this syndrome.

Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials.

INTRODUCTION: Inhaled antibiotics are probably the safest and most effective therapy for Pseudomonas aeruginosa chronic lung infection in cystic fibrosis (CF) patients. AREAS COVERED: To summarise the available evidence, a systematic review of the three currently available inhaled antibiotics (aztreonam lysine (AZLI), colistin (COL) and tobramycin (TOB)) was performed. The three AZLI placebo-controlled studies showed that the improvements in FEV1 and mean sputum P. aeruginosa density were statistically significant better than with placebo. The two COL placebo-controlled studies involved few patients but showed that COL was better than placebo in terms of maintenance of some pulmonary function parameters. The tobramycin inhalation solution (TIS) and tobramycin inhalation powder studies showed that the efficacy of both formulations was similar but significantly better than placebo. In the comparative studies, TIS showed more efficacy than COL solution, colistin inhalation powder showed non-inferiority to TIS and AZLI was superior to TIS. EXPERT OPINION: Placebo-controlled and comparative clinical trials have shown that clinical evidence of inhaled antibiotics is very different. The choice of treatment for each individual CF patient must be based on the features of the drug (clinical evidence on efficacy and safety), the inhalation system and the patient characteristics. Development of new inhaled antibiotics will allow new end points of efficacy and therapy regimens to be assessed.

CHOP plays a pivotal role in the astrocyte death induced by oxygen and glucose deprivation.

Ischemia has different consequences on the survival of astrocytes and neurons. Thus, astrocytes show a remarkable resistance to short periods of ischemia that are well known to cause neuronal death. We have used a cell culture model of stroke, oxygen, and glucose deprivation (OGD), to clarify the mechanisms responsible for the exclusive resistance of astrocytes to ischemia. The expression of genes implicated in both ischemia-induced astrocyte death and post-ischemic survival was analysed by the RNA differential display technique. Our study revealed that the expression of the CEBP homologous protein (CHOP)-coding gene is promptly an intensely upregulated following astrocyte oxygen and glucose deprivation. CHOP mRNA induction was accompanied by the activation of other genes (grp78, grp95) that, alike CHOP, are involved in the endoplasmic reticulum (ER) stress response. In addition, drugs that cause ER calcium depletion or protein N-glycosylation inhibition mimicked the effects of OGD on astrocyte survival, further supporting the involvement of ER in the astrocyte responses to OGD. Our experiments also demonstrated that upregulation of CHOP during the ER stress response is required for ischemia to cause astrocyte death. Not only the levels of CHOP mRNA and protein correlate perfectly with the degree of OGD-triggered cell injury, but also astrocyte death induced by OGD is significantly overcome by CHOP antisense oligonucleotide treatment. Nevertheless, we observed that astrocytes undergo apoptosis only when CHOP is permanently upregulated, and not when CHOP increases are transient. Finally, we found that the extent of CHOP induction is determined by the length of the ischemic stimulus. Taken together, our results indicate that permanent upregulation of CHOP is decisive for the induction of astrocyte death by OGD.