Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review.

We report three cases of external ventricular derivation infections caused by multidrug-resistant Gram-negative rods and treated successfully with intraventricular colistin. The intrathecal or intraventricular use of colistin have been reported in more than 100 cases without any consensus on dosage, duration and type (monotherapy or combination therapy) of treatment. Based on our comprehensive review of the relevant literature relating to both clinical and pharmacokinetic data, we conclude that the intrathecal/intraventricular administration of colistin is a safe and effective option to treat central nervous system infections caused by multidrug-resistant Gram-negative bacteria.

Correction to: Transsphenoidal surgery for pituitary adenomas: early results from a single center.

Unfortunately in the original publication, the affiliation of the author Paolo Marzullo was incorrect. The author inadvertently missed out to include his second affiliation.

Transsphenoidal surgery for pituitary adenomas: early results from a single center.

OBJECTIVE: To evaluate early results of transsphenoidal surgery for pituitary adenomas. DESIGN: Retrospective evaluation of 90 consecutive patients undergoing endoscopic pituitary adenoma surgery (2007-2016) at "Maggiore della Carità" Hospital in Novara, Italy. Age at diagnosis, sex, symptoms at presentation, hormonal and radiological data, complications of surgery, and short-term follow-up information were collected. RESULTS: The majority of patients were male (M/F: 1.5/1, mean age at diagnosis 62.1 ± 1.5 years mean ± SEM). Most patients (91.1%) presented with a macroadenoma (27.4 mm ± 1.1 mm mean ± SEM), while 77.8% were non-functioning pituitary adenomas. Clinical presentations related to mass effect were visual impairment (74.0%) and/or hypopituitarism (55.1%). The main surgery complication was insipidus diabetes (12.2%), followed by cerebral hemorrhage (4.4%), cerebrospinal fluid (CSF) leaks (4.4%), syndrome of inappropriate antidiuresis (SIAD) (2.2%), and epistaxis (2.2%); only one patient died because of stroke. Risk of complications was not associated with tumor size (OR = 0.588, 95% CI 0.967-1.081, p = 0.443). Visual function improved in 70.6% of patients, while recovery of normal pituitary function occurred in 48.1%. Early neuroimaging studies demonstrated no residual tumor in 27.6% of patients. Invasion of cavernous sinus (OR = 3.293, 95% CI 0.897-16.738, p = 0.05) and maximum tumor diameter (OR = 6.857, 95% CI 1.039-1.309, p < 0.01) were associated with an unfavorable surgical outcome. CONCLUSIONS: Transsphenoidal endoscopic surgery for pituitary adenomas is safe and is frequently followed by improvement in visual symptoms, whereas recovery of pituitary function is less common. In our patients, complete surgical removal of adenomas is comparable to that of other series, but further investigations will be necessary to clarify the long-term risk of tumor recurrence.

Studies of retention and stability of a horizontally polymerized bonded phase for reversed-phase liquid chromatography.

We have studied the novel horizontally polymerized mixed trichloropropyl-trichlorooctadecyl silane bonded phase described by Wirth. These materials can be reproducibly prepared and give very high bonded phase density (>7.5 micromol m(-2)). They show significantly improved alkaline stability and chromatographic selectivity towards PAHs similar to conventional monomeric phases. Study of retention by the Linear Solvation Energy Relationship approach as well as measurement of dead volume and retention of methanol indicate that less mobile phase is sorbed by a horizontally polymerized phase than by conventional phases. Silanophilic interaction of amines are decidedly weaker on a silica modified by horizontal polymerization compared to a conventionally modified phase. In addition, this work provides additional support for the "partition-like" retention mechanism of bonded phase RPLC.

Transbasal approaches to aneurysms of the vertebro-basilar junction.

The most difficult aneurysms to be surgically treated are those of the vertebro-basilar junction area. This is due to their deep location and the proximity of brain stem and cranial nerves. Recently, new transbasal surgical approaches have been developed in order to realize a shorter and more direct access. Clival lesions, such as neoplasms, angiomas, and aneurysms, can now be safely faced through these routes. In this paper, we report our recent experience in transbasal approaches for the management of six consecutive patients, with aneurysms in this area. In four of these patients, the initial treatment consisted of an attempt at endovascular aneurysm obliteration using the Guglielmi Detachable Coil system, whereas, in the other two patients (basing on age, aneurysm size and neurological conditions), surgery was considered as the treatment of choice. Unfortunately, the endovascular treatment failed in all cases, and all patients had to be eventually operated on. In all cases, surgical clipping was performed through the combination of a transmastoid (asterional) approach with the suboccipital lateral approach. By this route, in all cases, parent arteries proved well delineated, the aneurysms could always be correctly clipped. Good long-term results were achieved in all cases but one. When surgery is to be performed, the importance of a thorough wide exposure of the whole vertebro-basilar junction area, as well as the importance of having multiple accesses to the lesion, cannot be overemphasized.

Polynuclear lanthanide hydroxo complexes: new chemical precursors for coordination polymers.

The synthesis of hexanuclear lanthanide hydroxo complexes by controlled hydrolysis led to polymorphic compounds. The hexanuclear entities crystallize in four different ways that depend on the extent of their hydration. The four structures can be described as hexanuclear lanthanide entities with formula [Ln(6)(mu(6)-O)(mu(3)-OH)(8)(NO(3))(6)(H(2)O)(12)](2+). Two additional NO(3)(-) ions intercalate between the hexanuclear entities in order to ensure the electroneutrality of the crystal structure. Some crystallization water molecules fill the intermolecular space. The three first families of compounds (1-3) exhibit crystal structures that have previously been reported. The fourth family of compounds (4) is described here for the first time. Its chemical formula is [Ln(6)(mu(6)-O)(mu(3)-OH)(8)(NO(3))(6)(H(2)O)(12)](NO(3))(2).2H(2)O (Ln = Gd, Er, and Y). In this paper, the chemical and thermal stabilities of the hexanuclear lanthanide compounds are reported together with the magnetic properties of the Gd(III)-containing species. To use these entities as precursors for new materials, the substitution of the nitrato groups by chloride ions has been studied. Two byproduct compounds have so been obtained: The first (compound 5) is a nitrato/chloride hexanuclear compound of chemical formula [Er(6)(mu(6)-O)(mu(3)-OH)(8)(NO(3))(6)(H(2)O)(12)](NO(3))Cl.2H(2)O. The second one (compound 6) is a polymeric compound in which the hexanuclear entities are linked by an unexpected and original N(2)O(4) bridge. Its chemical formula is [Er(6)(mu(6)-O)(mu(3)-OH)(8)(NO(3))(4)(H(2)O)(11)(OH)(ONONO(2))]Cl(3).2H(2)O. Its crystal structure can be described as the juxtaposition of chainlike molecular motifs. To the best of our knowledge, this is the first example of a coordination polymer synthesized from an isolated polylanthanide hydroxo complex.

Delayed complications of ethmoid fractures: a "growing fracture" phenomenon.

Delayed complications of ethmoid fractures are considered relatively rare. However, meningitis, recurrence of previously ceased cerebrospinal fluid rhinorrhea and delayed onset of cerebrospinal fluid rhinorrhea are possible even years after trauma. We report 10 consecutive patients with delayed complications of ethmoid fractures, whom we treated over the past 11 years. All patients had previously sustained a closed head injury and had remained anosmic. Variously after trauma (ranging from 2 months to 31 years), these patients were re-admitted because of meningitis (6 cases), recurrence of previously ceased cerebrospinal fluid rhinorrhea (3 cases), and delayed onset of cerebrospinal fluid rhinorrhea (1 case). In all cases the delayed complications were associated with relatively large defects of the ethmoid bone. These bone lesions were now evident even in those patients whose radiological assessments had been normal after trauma. All patients underwent a successful surgical repair and remained well during the follow-up. We discuss the possibility that delayed complications of ethmoid fractures are due to a mechanism like that of "growing fractures" in children.

Prognostic meaning of temporary clipping in patients with intracranial aneurysm.

The prognostic meaning of the routine use of the methods of temporary clipping of the afferent vessel in patients with intracranial aneurysm (Grading 0-III) was the aim of the analysis in this study. In the period 1 January, 1991-31 December 1997, 304 patients underwent surgery for non-giant intracranial aneurysm and a follow-up angiography. 157 patients were operated by routinely using the temporary clipping of the afferent vessel, whereas in 147 patients the surgical procedure was performed by traditional methods. The statistical analysis showed a significant reduction (p < 0.001) in terms of risk of surgical complications in the patients who underwent surgery with the temporary clip method compared to those operated with the traditional method, with a relative risk of such complications about three times greater in the latter. The routine use of temporary clipping offers, therefore, the possibility of a significant improvement of the surgical results, not influenced by a further involvement for the structure, due to the short application time.