A rare case of neonatal sepsis/meningitis caused by Pasteurella multocida complicated with status epilepticus and focal cerebritis.

Pasteurella multocida is normally present in respiratory and digestive tract of many domestic and wild animals, but is a rare pathogen in neonatal infection. Here we describe for the first time a case of meningitis complicated by status epilepticus and right parietal lobe cerebritis. The patient showed a dramatic clinical onset characterized by septic appearance and prolonged seizures. Multidrug anticonvulsivant therapy was used to control the status epilepticus, but despite the aggressive treatment electrical crises were still evident 24 hours after the admission. Furthermore, a brain MRI, performed to investigate a persistent intermittent fever even if CSF became sterile, showed a focus cerebritis in the right parietal lobe, early stage of the cerebral abscess. Prolonged antibiotic therapy with steroids was requested to solve the cerebritis area. Interestingly, direct contact between the patient and domestic animals was denied by the family, but the father reported a contact with a rooster, killed and cooked few days before, suggesting, as previously described, that Pasteurella may also be transmitted through asymptomatic human carrier. The patient had a favourable outcome with no medium-term sequelae one month after discharge, but the severity of the clinical course and the unpredictable way of transmission highlight the importance of hygiene measures approaching infants.

Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center.

Despite increasing experience and improved material, endovascular treatment of cerebral aneurysms still has risks linked to the technique itself and to the specificity of the pathology treated. The purpose of this report is to examine procedural technical and clinical negative events, even minimal ones, occurring in this type of treatment. We considered 557 procedures carried out from January 1994 to December 2005 in 533 patients harboring 550 aneurysms. Of the patients, 448 presented with SAH and 85 with unruptured aneurysms. All procedures were performed under general anesthesia. The GDC-10 system was routinely used. Additional devices like the balloon remodeling technique, Trispan and stents were also occasionally used. Every procedural complication occurring during or soon after treatment was registered. Endovascular treatment was completed in 539 out of 557 procedures. There were 18 failures (3.3%). Occlusion of the aneurysm was judged complete in 343 (64%), near complete in 184 (34%) and incomplete in 12 (2%). Procedural complications occurred in 72 (13%) of the cases. The most frequent negative events were thromboembolisms (6.6%) and ruptures (3.9%). Other types (coil migration, transient occlusions of the parent vessel, dissections and early rebleeding) were rarer (2.5%). In the majority of cases there were no clinical consequences. Procedural morbidity and mortality were 1.1 and 1.8%, respectively. Considering the 449 procedures performed in ruptured and the 90 in the unruptured aneurysms separately, morbidity and mortality were 1.1 and 2.2% in the former group and 1.1 and 0% in the latter. Many factors influence the risk of complications. Being progressively aware of this and with increasing experience, the frequency can be limited. Negative events linked to the procedure have more significant serious clinical consequences in patients admitted in a critical clinical condition after SAH, because of the already present changes involving the brain parenchyma and cerebral circulation.

Bilateral Gasser's ganglion sarcoidosis: diagnosis, treatment and unsolved questions.

Magnetic resonance imaging is currently the best means for confirming clinical suspicion of neurosarcoidosis as well as being useful in the follow-up of corticosteroid-treated patients. We report the case of a 34 year old male presenting suspected Heerfordt's syndrome with concentric facial hypesthesia. Mediastinal and parotid sarcoidosis was diagnosed and magnetic resonance imaging showed bilateral sarcoid involvement of Gasser's ganglion cisternae (such involvement was not revealed by computed tomography). The patient received corticosteroid therapy, with a clinical and radiological improvement. Magnetic resonance imaging showed disappearance of Gasser's ganglion lesions despite the persistence of mild facial hypesthesia. This case is noteworthy for its extremely rare lesion site. Post-treatment discrepancy between the clinical picture and imaging results is probably due to low MRI resolution threshold. 18-FDG positron emission tomography imaging might perhaps overcome the limits of magnetic resonance imaging.

Effects of environmental and organizational factors on the health of shiftworkers of a printing company.

This study explored the effects of environmental and organizational stressors on the health of shiftworkers in a printing company (n = 124). A questionnaire was used to gather data on work history, organizational factors, psychosocial characteristics, medical history, present health, occupational and non-occupational exposures, and lifestyle factors. The perception of environmental and organizational conditions was associated (P < 0.05) with chronic back pain (odds ratio [OR], 1.29), varicose veins (OR, 1.35), allergic rhinitis (OR, 1.27), depression (OR, 1.45), and gastritis (OR, 1.15). Anxiety scores were associated with allergic rhinitis (OR, 1.14) and skin allergy (OR, 1.09). Shiftwork was a significantly risk factor for conjunctivitis (OR, 3.68), depression (OR, 0.23), cardiac arrhythmia (OR, 7.13), and gastritis (OR, 4.38). Other associations included tenure and chronic back pain (OR, 4.89), toluene exposure and skin allergy (OR, 3.76), worksite and conjunctivitis (OR, 7.0), and worksite and dermatitis (OR, 1.24 to 4.95). The number of hours of exercise per week was associated with varicose veins (OR, 4.33), and alcohol intake was associated with cardiac arrhythmia (OR, 6.74).

Indium-111 labelled white blood cell scintigraphy in cranial and spinal septic lesions.

Cranial and spinal infections are severe events that require timely diagnosis and treatment. Physical and neurological examination, laboratory tests and radiological imaging may be insufficient for assessing cranial and spinal septic lesions. This study aimed to evaluate the accuracy of indium-111 white blood cell (WBC) scan in assessing the presence of leucocytes in intracranial and spinal lesions, and in the diagnosis, management and follow-up of primary, post-traumatic and post-surgical infections. One hundred and twenty-four subjects were included in the study (48 with post-traumatic or post-surgical lesions, 73 with primary cerebral lesions, and 3 with spinal lesions). All patients underwent a diagnostic work-up including planar scans with 111In-labelled WBCs, at 4 and 24 h post tracer injection. All subjects underwent surgical treatment. Patients who did not recover from the infection as suggested by clinical evolution underwent further treatment (up to three times) and further WBC scans (up to four times). WBC scintigraphy correctly identified all the areas of leucocyte accumulation, as confirmed after surgery. WBC scintigraphy also correctly excluded the presence of leucocytes in all other lesions, as demonstrated at surgery. The results of this study confirm the accuracy of WBC scan for the assessment of patients with cranial and spinal lesions, in whom the demonstration of leucocyte accumulation can ease the diagnosis of infection, and indicate that the method is also accurate for the follow-up and management of neurosurgical patients.

Toluene-induced hearing loss among rotogravure printing workers.

OBJECTIVES: This study explored the effects of occupational exposure to solvents and noise on the hearing of rotogravure printing workers from São Paulo, Brazil. METHODS: The study group comprised 124 workers exposed to various levels of noise and an organic solvent mixture of toluene, ethyl acetate, and ethanol. Data on work history, psychosocial aspects of the job, medical history, present health, stress, occupational and nonoccupational exposures to noise or chemicals, and life-style factors were collected through an interview. The participants underwent pure-tone audiometry and immittance audiometry testing. Their exposures to noise and solvents were assessed. RESULTS: Forty-nine percent of the workers had hearing loss. From the numerous variables that were analyzed for their contribution to the development of hearing loss (age, tenure, noise dose, solvent concentrations in air, biological marker for toluene, job category, work and medical history items, smoking, alcohol consumption, work perception scores, nonoccupational exposures), age and hippuric acid (the biologic marker for toluene in urine) were the only variables that met the significance level criterion in the final multiple logistic regression model. The odds ratio estimates for hearing loss were 1.07 times greater for each increment of 1 year of age [95% confidence interval (95% CI) 1.03-1.11] and 1.76 times greater for each gram of hippuric acid per gram of creatinine (95% CI 1.00-2.98). CONCLUSIONS: The findings suggest that exposure to toluene has a toxic effect on the auditory system. Further research is needed on the mechanisms underlying the effects of toluene and on the adequacy of current recommended exposure limits.

[Computerized tomography in surgically treated lumbar disk hernia. Multicenter study]. / La TC nelle ernie discali lombari operate. Studio multicentrico.

Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47.7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4.7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19.5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply further resolutive diagnostic elements, while Myelo-CT is sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often difficult, which gives way to contrasting therapeutic attitudes.

[CT study of the carpal tunnel. Normal anatomy]. / Studio TC del canale del carpo. Anatomia normale.

The standard technique for CT investigation of the carpal tunnel and its normal anatomy were studied. Ten healthy asymptomatic volunteers, age 25-45, underwent wrist CT. The hand is placed in prone position with the third metacarpus in line with the radius. Digital radiograph and four axial CT scans are performed respectively: at the distal end of the radius, at the scaphoid tubercle level, at the hamate hook level and at the carpal-metacarpal joint. Standard carpal tunnel diameters are thus available with good reliability and repeatability when correct technique is adopted. The results permit a morphological description of the osseous walls, transverse ligament, flexor tendons with synovial sheets and median nerve. Gujon's canal and its content can also be investigated.

P300 and CT scan in patients with chronic schizophrenia.

Twenty chronic male schizophrenic subjects aged 30-50 years were examined by an auditory event-related potential procedure for the evaluation of the P300 component, a CT scan and a neuropsychological test battery. The P300 latency was increased and its amplitude was reduced. CT scan measures showed lateral and third ventricle enlargement, and there was a global neuropsychological impairment. Poor neuropsychological performances were consistently associated with delayed P300 latencies, but not with CT scan measures. Ventricular enlargement was more pronounced among subjects with a negative family history for major psychiatric disorders.

A clinical, EEG and CT study in 21 cases of chronic respiratory failure.

A clinical, EEG and CT study was carried out on 21 patients with chronic stable respiratory failure. The neurological disturbances and mental deterioration observed were of a mild degree, and no severe alterations were detected at EEG. CT showed cerebral atrophy, but the type and prevalence did not differ substantially between patients studied and normal sex- and age-matched control subjects. The data gave evidence that in chronic stable respiratory failure cerebral function is only slightly affected.

Multiple meningiomas evaluated by computed tomography.

The authors report ten cases of multiple meningiomas in a series of 227 intracranial meningiomas from 1977 to 1984. The incidence of multiple meningiomas was 4.4% (according to Cushing and Eisenhardt's [1938] concept of "multiplicity" of such tumours). These results are comparable to those obtained by other authors. All patients were females and all underwent CT scan before operation. Clinical symptoms are presented along with location and size of the tumours. Pathogenetic theories and research prospects are discussed.

[Neuroradiology of spontaneous cerebral hematomas]. / Neuroradiologia degli ematomi intracerebrali spontanei.

Computed Tomography plays a fundamental role in the diagnosis of spontaneous intracerebral haemorrhage, providing important informations relevant to prognosis and therapy. Therefore angiography should be planned on the basis of the CT finding and of some clinical data such as age, presence of risk factors, etc. Also the neurosurgical approach, besides clinical status, will depend on the neuroradiological evaluation.

[Neuroradiology of primary and secondary spinal tumors]. / Neuroradiologia dei tumori spinali primitivi e secondari.

The recent availability of spinal CT has modified the classic diagnostic algorithm of spinal and spinal cord tumors. The most important diagnostic signs given by traditional radiologic study of the spine (postural defects, signs of dysraphism, alterations of peduncles and neural foramina , soft paraspinal tissue changes, intra- and extra-vertebral calcifications, etc.), by myelography with hydrosoluble non ionic contrast medium and by spinal angiography are described. Their complementary indications and their up-to-date role in the diagnosis of site, size and nature of spinal neoplasms are discussed. The neuroradiological pictures of the most frequent spinal and vertebral tumors are summarized.

[Correlations between EEG and CT in 79 cases of dementia]. / Correlazioni EEG-TC in 79 casi di demenza.

An EEG and CT study was carried out on 79 patients affected by dementia (24 SDAT and 55 MID). The EEG and CT patterns were compared with those of an age-matched control group. Statistical analysis of the CT findings between the demented and normal subjects showed significant differences only for severe atrophy. As far as EEG findings are concerned, no EEG pattern indicative of a specific type of dementia was observed even though a greater number of abnormal EEGs occurred in demented patients than in the control group. Finally, a poor EEG-CT correlation was found in demented patients.

Prognostic value of CT in head-injury coma.

The brain CT findings in 54 patients in coma 1-5 (Bozza-Marrubini scale) following craniocerebral trauma are analysed retrospectively. Attention is focused on those of the CT features that constitute indirect signs of brainstem involvement: obliteration of the suprasellar cisterns, distortion of the perimesencephalic and quadrigeminal cisterns, dilatation of the temporal horn and widening of the cerebellopontine angle cistern on the lesion side, considered anatomically and clinically responsible for coma. The patients fell into three groups: 7 with negative CT, 31 with intracranial lesions not affecting the brainstem and 16 with CT evidence of descending transtentorial herniation. The CT signs correlated significantly with coma level and survival. These CT signs can be used alongside the clinical and other instrumental data -- EEG, VEP and intracranial pressure -- as a further criterion of severity in head-injury coma.

Cerebral atrophy in motor neuron disease evaluated by computed tomography.

Thirty-two (64%) of 50 patients with motor neuron disease showed various patterns of cerebral atrophy (cortical, ventricular or both) at CT examination. The incidence of cerebral atrophy, particularly cortical atrophy, in motor neuron disease was greater than in a matched control group.