Cerebrospinal fluid:serum glucose ratio in the ventricular and lumbar compartments: implications for clinical practice.

BACKGROUND AND PURPOSE: Calculation of the cerebrospinal fluid:serum glucose (CSF:SGlu ) ratio is part of the routine cerebrospinal fluid (CSF) work-up. Reference values have been defined for lumbar CSF, but are lacking for ventricular CSF. The objective of this study was to investigate whether the CSF:SGlu ratio is similar in lumbar and ventricular compartments, and to determine cut-off values for CSF:SGlu ratio in ventricular CSF. METHODS: We included CSF samples that were collected by either lumbar puncture or ventricular drainage, with a red blood cell count <500/µL, normal white blood cell count and age-related normal total protein content, with simultaneously withdrawn serum sample and time to laboratory processing of ≤2 h. This resulted in 1808 sample pairs. Glucose concentrations in CSF and serum were measured by enzymatic spectrophotometry. RESULTS: The CSF:SGlu ratio was similar in ventricular and lumbar compartments after controlling for age, sex, time between sample withdrawal and laboratory processing, CSF white blood cell and red blood cell count, CSF total protein and serum glucose concentration using a multiple linear regression model. Lower limits for CSF:SGlu ratio in the ventricular compartment, defined as 5th percentile, were 0.51 for patients with serum glucose concentration < 100 mg/dL, 0.45 for those with serum glucose concentration ≥ 100 mg/dL and <150 mg/dL, and 0.36 for those with serum glucose concentration ≥150 mg/dL. CONCLUSIONS: The CSF:SGlu ratio was similar in the ventricular and lumbar compartments, and depended mainly on time to laboratory processing and absolute serum glucose levels. Previously established lower limits for CSF:SGlu ratio in lumbar CSF can be also applied for ventricular CSF.

Lactic acid and methane: improved exploitation of biowaste potential.

This feasibility study investigated a two-step biorefining approach to increase the value gained by recycling of organic municipal solid waste. Firstly, lactic acid was produced via batch fermentation at 37°C using the indigenous microbiome. Experiments revealed an optimal fermentation period of 24h resulting in high yields of lactic acid (up to 37gkg(-1)). The lactic acid proportion of total volatile fatty acid content reached up to 83%. Lactobacilli were selectively enriched to up to 75% of the bacterial community. Additionally conversion of organic matter to lactic acid was increased from 22% to 30% through counteracting end product inhibition by continuous lactic acid extraction. Secondly, fermentation residues were used as co-substrate in biomethane production yielding up to 618±41Nmlbiomethaneg(-1) volatile solids. Digestate, the only end product of this process can be used as organic fertilizer.

Diagnosis of abdominal tuberculosis by transabdominal ultrasound-guided needle biopsy.

Laparotomy and laparoscopy have been used for biopsy of pelvic masses in the differential diagnosis between abdominal tuberculosis and ovarian cancer. We suggest the use of transabdominal needle biopsy under ultrasound guidance in such cases. Two women developed abdominal distention, one of whom had been receiving medical treatment for known tuberculosis. In both cases, ultrasonography showed a pelvic mass and ascites associated with high levels of CA 125. A transabdominal ultrasonographically-guided biopsy of the masses with a trucut needle established their tuberculous origin. The transabdominal sonographic needle biopsy is a reliable diagnostic procedure in the differential diagnosis between abdominal tuberculosis and ovarian malignancy. This minimally invasive procedure saves the patient with tuberculosis from unnecessary laparotomy.

Nitrofurantoin-induced immune-mediated lung and liver disease.

A 60-year-old woman with multiple sclerosis and recurrent urinary tract infections (UTI) was evaluated for the recent onset of a dry cough, dyspnea on exertion, and jaundice. Investigation demonstrated interstitial lung disease with bilateral infiltrates and unilateral effusion, as well as a severe chronic active hepatitis with marked fibrosis. Other notable features were positive antinuclear antibodies and anti-smooth-muscle antibodies and the absence of any possible cause except for nitrofurantoin treatment (Macrodantin, 100 mg/day), which the patient had been taking for the previous 3 years as a prophylactic measure against UTI. The patient died of pneumococcal septicemia less than 30 days after presentation. Pulmonary or hepatic injury caused by nitrofurantoin treatment is rare; their combined occurrence is hardly ever described. Combined drug-induced pulmonary and hepatic toxicity is reviewed and should be considered early in the differential diagnosis to allow reversibility and avoid serious outcomes.

Idiopathic calcitriol-induced hypercalcemia. A new disease entity?

We describe 3 patients with a prolonged history of hypercalcemia. The patients did not take any vitamin supplements. All patients had low parathyroid hormone (PTH), high calcitriol (1,25(OH)2D3), and high angiotensin-converting enzyme (ACE) blood levels. There was no evidence of sarcoidosis of any other underlying disease in the results of an extensive workup. Treatment with prednisone resulted in normalization of calcium levels in all patients. They remained dependent on low-dose prednisone on a subsequent prolonged follow-up.

[Sweet's syndrome in a young woman].

Sweet's syndrome is an uncommon and dramatic skin disease associated with systemic symptoms such as fever, headache and arthralgia. Since it is also accompanied by an increased erythrocyte sedimentation rate and leukocytosis, it may be confused with severe systemic infections and other systemic illnesses. We describe a 30-year-old woman who presented with typical features of the disease. They included high fever, headache, sore throat, increased sedimentation rate, and a painful violaceous, nodular and papular rash on her limbs and upper trunk. Histologic features included dense neutrophilic infiltration and edema of the dermis, with foci of leukocytoclasia, but without leukocytoclastic vasculitis. There was a dramatic repose to treatment with prednisone.