1/4. Rapid method for beta2-transferrin in cerebrospinal fluid leakage using an automated immunofixation electrophoresis system.BACKGROUND: Beta(2)-transferrin (beta-2 trf) is a desialated isoform of transferrin found only in cerebrospinal fluid (CSF), ocular fluids, and perilymph. In aural, nasal, and wound drainages, this protein is an important marker of CSF leakage. Immunofixation electrophoresis (IFE) on agarose gels is a widely accepted qualitative technique for detection of small amounts of beta-2 trf, but disadvantages include lengthy transfer immunoblotting techniques or the requirement of at least 2 mL of sample. methods: Using eight applications of unconcentrated sample on high-resolution agarose gels with an automated electrophoresis system (Helena SPIFE 3000), we developed a rapid method for beta-2 trf. evaluation studies included reproducibility of migration distance (mm), limit of detection, specificity, and concordance of results compared with those reported by a reference laboratory. neuraminidase-treated serum was the source of beta-2 trf for our sensitivity and specificity studies. transferrin was measured by rate nephelometry. RESULTS: The 2.5-h procedure demonstrated reproducible migration (CV <2.5%) on five lots of gels. Detection of beta-2 trf at 0.002 g/L in an unconcentrated sample was attributed to reproducible application, quality of the anti-trf antiserum, and a sensitive acid violet stain. Our beta-2 trf findings (two negative and five positive) in seven available clinical samples agreed with the reference laboratory results. In 12 months after its inception, this test was ordered 48 times vs 13 in the previous year when testing was sent out. CONCLUSION: This method provides physicians with a rapid, reliable aid in the diagnosis of suspected CSF leakage, as described in a case report.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Coronal computerized tomography and cerebrospinal fluid rhinorrhea.Accurate diagnosis of cerebrospinal fluid rhinorrhea (CSFR) is a challenge for physicians caring for patients with traumatic brain injury. Failure to recognize this condition may result in significant medical complications and prolong hospitalization. Two male patients who developed CSFR within 2 months of severe head injury are described. A clear nasal discharge was noted on examination approximately 30 and 35 days after head injury in both patients and a CSF fistula was suspected. High-resolution computerized tomography (CT) with coronal sections confirmed the diagnosis. Both patients underwent neurosurgical intervention to repair the fistulous tracts without recurrence. Sequelae of CSFR in one case included meningitis and pneumocephalus. literature review shows water-soluble contrast CT cisternography (CTC) to be the gold standard for the diagnosis of CSFR. However, other diagnostic studies may include immunoelectrophoresis of rhinorrhea, use of isotope tracers, plain x-rays, tomography, and noncontrast high-resolution CT. More invasive studies like CTC are often recommended in the diagnosis of this condition, but are more costly, painful, and carry a small risk of infection. Our two case reports emphasize that high-resolution CT may be performed as a primary noninvasive diagnostic procedure before more invasive studies, and the results obtained may be sufficient for therapeutic planning.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. glucose oxidase sticks and cerebrospinal fluid rhinorrhea.The recognition of cerebrospinal leakage from a fistula is an important consideration for any physician caring for a head-injured population. Several procedures including radiographic, intrathecal dye, nuclear medicine tracer studies, computerized tomography with metrizamide injection, and immunological fixation have been reported to help in the diagnosis. Introduction of glucose oxidase test sticks has been traditionally touted to be a reliable bedside indicator of CSF rhinorrhea; this case study demonstrates a falsely negative result from glucose oxidase sticks.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Rhinorrhea associated with intracranial cholesteatomas and an "empty sella.".Three related disorders in the same patient, namely bilateral primary intracranial cholesteatomas, an "empty sella" syndrome, and a cerebrospinal rhinorrhea are reported. No previous report of bilateral symmetrical cholesteatomas has been made, though single intracranial cholesteatomas have frequently been recorded in medical literature. The "empty sella" syndrome is generally considered to be from a herniation of the subarachnoid into the sella through a deficient diaphragma sella, and was first defined by Ommaya in 1968. Non-traumatic (spontaneous) rhinorrhea remains an uncommon disease initially described in 1826. Experience of the individual otolaryngologist is limited in this region because of infrequent occurrence and because definitive treatment is directed to other specialties. On the other hand, the ear, nose and throat physician may be the first to interpret a drainage from the nose. With this in mind, the etiologic, clinical and management factors in the present case are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |