A removable silicone elastomer seal reduces granulation tissue growth and maintains the sterility of recording chambers for primate neurophysiology.

The maintenance of the sterility of craniotomies for serial acute neurophysiological recordings is exacting and time consuming yet is vital to the health of valuable experimental animals. We have developed a method to seal the craniotomy with surgical grade silicone elastomer (Silastic) in a hermetically sealed chamber. Under these conditions the tissues in the craniotomy and the inside surface of the chamber remain unpopulated by bacteria. The silicone elastomer sealant retarded the growth of granulation tissue on the dura and reduced the procedures required to maintain ideal conditions for neurophysiological recordings.

[Meningitis is a rare complication of spinal anesthesia. Good hygiene and face masks are simple preventive measures]. / Meningit ovanlig komplikation i samband med spinalanestesi. God hygien och munskydd enkla förebyggande åtgärder.

Although bacterial meningitis is a rare sequela of spinal anaesthesia, occasional case reports continue to appear in anaesthesiological literature. The article presents nine cases of iatrogenic meningitis reported to the treatment injury claims authority. Eight of these patients had undergone spinal anaesthesia, and one myelography. Alpha-haemolytic streptococci were isolated in cerebrospinal fluid culture in seven cases, the remaining two cases being culture-negative. Although alpha-haemolytic streptococci are normal commensals of the upper respiratory tract and mouth and rarely cause spontaneous meningitis, they have been implicated in several reported cases of iatrogenic meningitis. The risk of such infection raises the issue of the widespread habit of omitting face masks when performing dural puncture. As these bacteria are not known to cause infection in general surgery, the necessity of using face masks in the operating theatre has been questioned. However, the use of face masks has been shown to reduce the risk of bacterial contamination from the upper airway; and as available documentation on iatrogenic meningitis suggests oral commensals to be responsible, the use of face masks should be mandatory whenever any kind of lumbar puncture is performed.

Fractura de base de cráneo en recién nacidos: caso clínico / Basal fracture of the skull in a newborn: case report and review of the literature

Introduction: Reported incidence of cranial lesions in childbirth is about 1.7 to 59 per 10,000 births. Among these, fracture of the base of the skull is rare but serious due to sequelae and mortality. Objective: Describe a case of a newborn with a fracture of the temporal bone, review diagnosis and management of skull fractures. Clinical Case: The patient was born with assistance, use of forceps, showed deviation of the buccal commisure and otorrhagia on the left side during puerperium. CT Sean detected fracture of the base of the cranium at the level of the temporal bone. Hemogram, cultures and spinal fluid studies were done. Prophylactic therapy was initiated. All blood studies were negative and follow up studies were normal. Discussion: Literature reviews support the diagnosis to be confirmed through a CT sean, and an active search for meningitis be started through hemocultures, hemogram, and Cerebrospinal Fluid. Management should be conservative, evaluating the need for an LR Evidence shows that antibiotic prophylaxis for meningitis has little indication in these cases.

Introducción: La incidencia de lesiones de cráneo en recién nacidos reportadas son del orden de 1,7 a 59 por 10 000 nacimientos. Dentro de estas, las fracturas de base de cráneo son eventos poco frecuentes, pero de consideración dado su potencial gravedad en cuanto a mortalidad y secuelas. Objetivo: Relatar el caso de un recién nacido con una fractura de peñasco y revisar el diagnóstico y manejo de las lesiones de cráneo. Caso Clínico: El paciente, tras parto instrumentalizado por fórceps, presentó desviación de comisura bucal y otorragia durante su estadía en puerperio. La TAC de cerebro con reconstrucción ósea fue compatible con una fractura de base de cráneo (peñasco izquierdo). Se tomaron hemocultivo, hemograma y PCR y se inició antibioticoterapia profiláctica para meningitis. Evolucionó favorablemente con hemocultivos negativos, hemograma y PCR normales, TAC de control sin cambios y examen neurológico normal. Discusión: La literatura recomienda que el diagnóstico de fractura de base de cráneo debe ser confirmado por medio de TAC de cerebro y que debe realizarse una búsqueda activa de meningitis por medio de hemocultivos, hemograma y PCR, evaluar la necesidad de punción lumbar y manejar en forma conservadora. La evidencia señala que la profilaxis antibiótica para meningitis en estos pacientes no tiene indicación.

Surgical face masks are effective in reducing bacterial contamination caused by dispersal from the upper airway.

We have studied the effectiveness of surgical face masks in reducing bacterial contamination of a surface, produced by dispersal of organisms from the upper airway. Twenty-five volunteers were asked to speak at blood agar plates positioned in close proximity to the mouth, initially whilst not wearing a face mask and then wearing a surgical face mask over the mouth and nose. A fresh face mask almost completely abolished bacterial contamination of agar plates 30 cm from the mouth. After 15 min there was an increase in the level of contamination which was statistically insignificant.

In vitro and in vivo efficacy of a rifampin-loaded silicone catheter for the prevention of CSF shunt infections.

Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system. We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model. On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more. In a stationary bacterial adherence assay using S. epidermidis as test strain, the colonization resistance of the device was demonstrated. To assess the capability of the catheter to prevent CSF shunt infections, a rabbit model was developed which allowed the establishment of a reliable and reproducible CSF infection by implantation of silicone catheters into the ventricle and inoculating S. epidermidis (minimal dose 10(6) cfu) or S. aureus (minimal dose 10(3) cfu). Rifampin-loaded catheters (12 animals inoculated with S. epidermidis, 8 animals inoculated with S. aureus) were compared with non-loaded (14 animals inoculated with S. epidermidis, 19 animals inoculated with S. aureus) control catheters, and infection was documented by clinical, microbiological and histological methods. In contrast to the control group, none of the animals with rifampin-loaded catheters showed clinical signs of infection. Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue. The histological examination of catheter-adjacent tissue supported these findings. We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials.