The Methods of Reserving Integrity of Seriously Damaged Cavernous Carotid in the Management of Traumatic Carotid-Cavernous Fistula.

BACKGROUND: The A type of carotid-cavernous fistulas (CCF-A) is characterized by direct communication between the internal carotid artery (ICA) with a very low incidence. But it severely endangers the health and even the life of patients, not only causes insufferable symptoms but also can induce fatal epistaxis, intracranial hemorrhages or even death. So, this disease needs therapy as early as possible. The ideal treatment for CCF-A is to exclude the fistula from circulation, preserving the carotid flow. Interventional therapy has become the chief method for CCF-A especially in recent years, but the prerequisite, that the microwire or and microcatheter in ICA can be navigated across the orificium fistulae and into distal ICA, is necessary. Otherwise it is difficult to reserve the communication of seriously injured ICA and the orificium fistulae could simultaneously be reliably closed. The authors used a series of new and novel CCF with good result. METHODS: The authors experienced a patient of TCCF-A, whose ICA was seriously injured and customary method failed in the first treatment because the microwire and microcatheter could not cross the segment of orificium fistulae. Then, the authors applied military (outflanking techniques, aerial refueling, and retrograde navigation) to manage this case. RESULTS: Finally, the CCF-A was completely cured and the parent artery was perfect preserved without any complication. CONCLUSIONS: For patients of TCCF-A with severe ICA injury, these strategies may be very important for some patients whose affected ICA cannot tolerant to be blocked.

Plasma and Intrapulmonary Pharmacokinetics, and Dosage Regimen Optimization of Linezolid for Treatment of Gram-Positive Cocci Infections in Patients with Pulmonary Infection After Cerebral Hemorrhage.

Purpose: The objective of this study was to perform pharmacokinetics/pharmacodynamics (PK/PD) analysis of linezolid in patients with intracerebral hemorrhage and to provide suggestions regarding dosing and treatment regimens. Patients and Methods: Ten patients with cerebral hemorrhage and pulmonary infection were enrolled in this study. Plasma and sputum samples were obtained at specific time points after the seventh infusion. Linezolid concentration was measured using HPLC, and PK parameters were calculated using the non-compartmental model. The probability of target attainment (PTA) and the cumulative fraction of response (CFR) in response to different dosing regimens (1200 mg/900 mg/600 mg/300 mg, q12h) were calculated based on the ratio of area under the curve to minimum inhibitory concentration (AUC/MIC). Results: The Cmax and AUC of linezolid were 12.89 µg/mL and 70.42 h·µg/mL for plasma, and 16.48 µg/mL and 92.95 h·µg/mL for sputum. The average penetration rate of linezolid in sputum, as represented by the ratio of AUC, was 131.99%. In response to the conventional dosing regimen (600mg, q12h), the PTA in the plasma or sputum was >90% only when MIC was ≤1 mg/L. Linezolid had the highest CFR against Streptococcus pneumoniae, followed by Enterococcus faecalis and Enterococcus faecium, with the lowest value for MRSA. Conclusion: This was the first study to evaluate PK/PD of linezolid in plasma and in the lungs of patients with cerebral hemorrhage and may assist in selecting appropriate dosing regimens for linezolid in these patients.