Legionnaire's disease in postoperative neurosurgical patients

1983 ◽  
Vol 59 (4) ◽  
pp. 596-600 ◽  
Author(s):  
Mark C. Glazier ◽  
Richard B. Kohler ◽  
Robert L. Campbell
Keyword(s):  
Legionella Pneumophila ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Surgical Patients ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Legionnaires Disease ◽  
High Doses ◽  
Fine Print

✓ Legionella pneumophila postoperative pneumonia may be an important cause of morbidity and mortality in selected surgical patients. This report presents five postoperative neurosurgical patients in whom the diagnosis of Legionnaires' disease was made. Their clinical course and treatment are presented. Clinical manifestations, methods of diagnosis, and treatment of L. pneumophila pneumonia are discussed. It is pointed out that neurosurgical patients who have received high doses of corticosteroids and who develop nosocomial postoperative pneumonias should be suspected of having Legionnaires' disease.

Pulmonary embolism in neurosurgical patients: diagnosis and treatment

1984 ◽  
Vol 60 (5) ◽  
pp. 972-975 ◽  
Author(s):  
Giorgio Di Ricco ◽  
Carlo Marini ◽  
Maurizio Rindi ◽  
Vitale Ravelli ◽  
Lodovico Lutzemberger ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Course ◽  
Early Stage ◽  
Respiratory Alkalosis ◽  
Content Type ◽  
Anticoagulant Drugs ◽  
Neurosurgical Patients ◽  
Lung Scanning ◽  
Fine Print ◽  
Better Than

✓ Pulmonary embolism was suspected in 45 neurosurgical patients who were treated between January, 1980, and December, 1981. Hypoxemia with respiratory alkalosis and sudden tachycardia gave rise to this suspicion more often than any other sign or symptom. Perfusion lung scanning confirmed the presence of pulmonary embolism in 23 of these cases. A retrospective analysis of the clinical course of these 23 patients suggested that one or more previous episodes of pulmonary embolism had occurred in 16 cases (69.6%), and had been either overlooked or misdiagnosed. Treatment was started immediately after diagnosis. Twenty-one patients were given heparin; however, two could not be treated because of contraindication to using anticoagulant drugs. Two patients died during treatment. The 21 surviving patients were assessed and 11 of them submitted again to perfusion lung scanning 1 week after diagnosis: 14 had improved, but seven did not show significant changes either clinically or on perfusion lung scanning. Nine treated patients developed hemorrhage, but it was readily controlled. In two of the nine patients, hemorrhage involved the surgical area. It is stressed that pulmonary embolism may be suspected and diagnosed in neurosurgical patients at an early stage. Heparin may be given and the survival rate appears to be better than previously reported figures.

scholarly journals Clinical case of effective treatment of gestational pemphigoid with intravenous immunoglobulins

2020 ◽  
pp. 87-91
Author(s):  
V.S. Yavir ◽  
◽  
K.O. Spichak ◽  
V.О. Berestovoy ◽  
A.M. Martych ◽  
...  
Keyword(s):  
Clinical Course ◽  
Clinical Manifestations ◽  
Intravenous Immunoglobulins ◽  
Diagnosis And Treatment ◽  
Laboratory Findings ◽  
Corticosteroid Hormones ◽  
Mucous Membranes ◽  
Autoimmune Condition ◽  
High Doses ◽  
First Time

Gestational pemphigus — is a rare autoimmune condition that manifest during pregnancy. This pathology was described for the first time in 1827 by the Karl Martius, but until now remains insufficiently studied and as a result, difficulties arise in the differential diagnosis and treatment. Clinical manifestations of the disease characterized by the appearance of a polymorphic rash on the skin and mucous membranes. In patients with impaired immune tolerance pemphigus can be complicated by hyperactivation of the immune system. To date, pregnancy is not considered as a factor that can aggravate the course of pemphigus, since during pregnancy the disease can worsen, enter into complete remission, or remain unchanged. In the literature, there is information about the manifestation of pemphigus in puerperium after rapid decrease of corticosteroid hormones in serum. The clinical course of gestational pemphigus is variable and can lead to diagnostic failures. The diagnosis usually made according to the clinic, histopathology and laboratory findings. In this case report we describe a case of diagnosis and treatment of gestational pemphigoid, refractory to corticosteroid therapy. Clinical improvement and recovery achieved after a course of high doses of intravenous immunoglobulins. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pemphigoid, pregnancy, autoimmune disease, intravenous immunoglobulin.

Cushing's Case XLV: Minnie G.

2002 ◽  
Vol 97 (1) ◽  
pp. 231-234 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Niki F. Maartens ◽  
Edward R. Laws
Keyword(s):  
Pituitary Gland ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Low Grade ◽  
Content Type ◽  
Secondary Sexual Characteristics ◽  
Harvey Cushing ◽  
First Case ◽  
Sexual Characteristics ◽  
Fine Print

✓ A 23-year-old patient who was examined in 1910 by Harvey Cushing triggered his lifelong interest in the syndrome that bears his name. “Minnie G.,” as she became historically known, presented with a “… syndrome of painful obesity, hypertrichosis, and amenorrhea with overdevelopment of secondary sexual characteristics accompanying a low grade of hydrocephalus and increased cerebral tension.” This case stimulated Harvey Cushing's inquisitive mind and sparked an interest that 20 years later culminated in his seminal report, “The basophil adenomas of the pituitary gland and their clinical manifestations (pituitary basophilism).” In this classic work, Cushing reported in detail the cases of two patients encountered from his own practice and 10 similar cases collected from the literature. Minnie G. was the first case that Cushing reported. The clinical course of that case is briefly reviewed in this article.

scholarly journals Human Lung Tissue Explants Reveal Novel Interactions during Legionella pneumophila Infections

2013 ◽  
Vol 82 (1) ◽  
pp. 275-285 ◽  
Author(s):  
Jens Jäger ◽  
Sebastian Marwitz ◽  
Jana Tiefenau ◽  
Janine Rasch ◽  
Olga Shevchuk ◽  
...  
Keyword(s):  
Lung Tissue ◽  
Legionella Pneumophila ◽  
Human Lung ◽  
Transcriptional Response ◽  
Human Infection ◽  
Bacterial Invasion ◽  
Human Lung Tissue ◽  
Content Type ◽  
Tissue Explants ◽  
Legionnaires Disease

ABSTRACTHistological and clinical investigations describe late stages of Legionnaires' disease but cannot characterize early events of human infection. Cellular or rodent infection models lack the complexity of tissue or have nonhuman backgrounds. Therefore, we developed and applied a novel model forLegionella pneumophilainfection comprising living human lung tissue. We stimulated lung explants withL. pneumophilastrains and outer membrane vesicles (OMVs) to analyze tissue damage, bacterial replication, and localization as well as the transcriptional response of infected tissue. Interestingly, we found that extracellular adhesion ofL. pneumophilato the entire alveolar lining precedes bacterial invasion and replication in recruited macrophages. In contrast, OMVs predominantly bound to alveolar macrophages. Specific damage to septa and epithelia increased over 48 h and was stronger in wild-type-infected and OMV-treated samples than in samples infected with the replication-deficient, type IVB secretion-deficient DotA−strain. Transcriptome analysis of lung tissue explants revealed a differential regulation of 2,499 genes after infection. The transcriptional response included the upregulation of uteroglobin and the downregulation of the macrophage receptor with collagenous structure (MARCO). Immunohistochemistry confirmed the downregulation of MARCO at sites of pathogen-induced tissue destruction. Neither host factor has ever been described in the context ofL. pneumophilainfections. This work demonstrates that the tissue explant model reproduces realistic features of Legionnaires' disease and reveals new functions for bacterial OMVs during infection. Our model allows us to characterize early steps of human infection which otherwise are not feasible for investigations.

Brain-stem hemangioma calcificans

1983 ◽  
Vol 59 (1) ◽  
pp. 150-152 ◽  
Author(s):  
Michele Occhiogrosso ◽  
Aristide Carella ◽  
Paola D'aprile ◽  
Giacomo Vailati
Keyword(s):  
Brain Stem ◽  
Cavernous Hemangioma ◽  
Diagnosis And Treatment ◽  
Review Of The Literature ◽  
Content Type ◽  
Fine Print

✓ A case of brain-stem hemangioma calcificans is described. The few cases reported in the literature prove the rarity of this tumor, which is considered a benign variant of cerebral cavernous hemangioma. Diagnosis and treatment of these tumors are briefly discussed with a review of the literature including 11 previous cases.

scholarly journals Peptidyl-Prolyl-cis/trans-Isomerases Mip and PpiB ofLegionella pneumophilaContribute to Surface Translocation, Growth at Suboptimal Temperature, and Infection

2018 ◽  
Vol 87 (1) ◽  
Author(s):  
J. Rasch ◽  
C. M. Ünal ◽  
A. Klages ◽  
Ü. Karsli ◽  
N. Heinsohn ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Acanthamoeba Castellanii ◽  
Temperature Tolerance ◽  
Lung Damage ◽  
Atypical Pneumonia ◽  
Content Type ◽  
Wide Range ◽  
Legionnaires Disease ◽  
Environmental Fitness ◽  
Sliding Motility

ABSTRACTThe gammaproteobacteriumLegionella pneumophilais the causative agent of Legionnaires’ disease, an atypical pneumonia that manifests itself with severe lung damage.L. pneumophila, a common inhabitant of freshwater environments, replicates in free-living amoebae and persists in biofilms in natural and man-made water systems. Its environmental versatility is reflected in its ability to survive and grow within a broad temperature range as well as its capability to colonize and infect a wide range of hosts, including protozoa and humans. Peptidyl-prolyl-cis/trans-isomerases (PPIases) are multifunctional proteins that are mainly involved in protein folding and secretion in bacteria. InL. pneumophilathe surface-associated PPIase Mip was shown to facilitate the establishment of the intracellular infection cycle in its early stages. The cytoplasmic PpiB was shown to promote cold tolerance. Here, we set out to analyze the interrelationship of these two relevant PPIases in the context of environmental fitness and infection. We demonstrate that the PPIases Mip and PpiB are important for surfactant-dependent sliding motility and adaptation to suboptimal temperatures, features that contribute to the environmental fitness ofL. pneumophila. Furthermore, they contribute to infection of the natural hostAcanthamoeba castellaniias well as human macrophages and human explanted lung tissue. These effects were additive in the case of sliding motility or synergistic in the case of temperature tolerance and infection, as assessed by the behavior of the double mutant. Accordingly, we propose that Mip and PpiB are virulence modulators ofL. pneumophilawith compensatory action and pleiotropic effects.

Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study

1989 ◽  
Vol 70 (4) ◽  
pp. 530-535 ◽  
Author(s):  
Ludwig M. Auer ◽  
Wolfgang Deinsberger ◽  
Kurt Niederkorn ◽  
Günther Gell ◽  
Reinhold Kleinert ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Medical Treatment ◽  
Functional Recovery ◽  
Randomized Study ◽  
Treated Group ◽  
Surgical Patients ◽  
Lower Mortality ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Fine Print

✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage. Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.

Terminal ventriculostomy for syringomyelia

1977 ◽  
Vol 46 (5) ◽  
pp. 609-617 ◽  
Author(s):  
W. James Gardner ◽  
Herbert S. Bell ◽  
Pete N. Poolos ◽  
Donald F. Dohn ◽  
Marta Steinberg
Keyword(s):  
Clinical Course ◽  
Adult Life ◽  
Central Canal ◽  
Conus Medullaris ◽  
Fetal Life ◽  
Filum Terminale ◽  
Content Type ◽  
Fine Print

✓ The clinical course of 12 patients who underwent terminal ventriculostomy for syringomyelia is presented. Opening the central canal at the tip of the conus medullaris is a relatively benign procedure that improves the symptoms of syringomyelia and syringobulbia. This canal normally terminates at the tip of the conus, but in each of the 12 surgical specimens it continued into the filum terminale for distances up to 8 cm. In most cases the tip of the conus was located more caudally than normal, indicating some degree of tethering in fetal life. This belief is supported by the fact that the newborn, whose conus is tethered to a lipoma at the sacral level, may develop syringomyelia in adult life.

Angioplasty for basilar artery atherosclerosis

1992 ◽  
Vol 77 (6) ◽  
pp. 941-944 ◽  
Author(s):  
Arvind Ahuja ◽  
Lee R. Guterman ◽  
Leo N. Hopkins
Keyword(s):  
Basilar Artery ◽  
Balloon Angioplasty ◽  
Medical Management ◽  
Clinical Course ◽  
Anticoagulation Therapy ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Severe Atherosclerosis ◽  
Percutaneous Transluminal ◽  
Fine Print

✓ A case is presented of severe atherosclerosis of the basilar artery, successfully treated with percutaneous transluminal balloon angioplasty. Crescendo daily transient ischemic attacks consisted of alternating hemiplegia and were refractory to medical management, including anticoagulation therapy. The clinical course, endovascular treatment, and results are described. Prior published experiences with this condition are reviewed.

Systemic candidiasis and endophthalmitis in neurosurgical patients

1976 ◽  
Vol 45 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Arthur R. Cushman ◽  
Gerald Friedman ◽  
John Capsavage
Keyword(s):  
Broad Spectrum ◽  
Opportunistic Infections ◽  
Systemic Candidiasis ◽  
High Susceptibility ◽  
Content Type ◽  
Broad Spectrum Antibiotics ◽  
Neurosurgical Patients ◽  
Fine Print

✓ Three cases of systemic candidiasis in neurosurgical patients are presented. Two of the three patients also had endophthalmitis. All of the cases were treated with broad-spectrum antibiotics and glucocorticoids prior to the appearance of candidiasis. The authors stress the high susceptibility of neurosurgical patients to opportunistic infections of this type.

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