1/7. Ommaya-catheter-related staphylococcus epidermidis cerebritis and recurrent bacteremia documented by molecular typing.A 26-year-old woman receiving intrathecal chemotherapy for acute leukemia developed Ommaya-catheter-associated cerebritis and bacteremia caused by two clones of staphylococcus epidermidis. Genomic fingerprinting of 19 staphylococcal isolates from the cerebrospinal fluid, blood, catheter and skull biopsy was necessary to establish the etiologic diagnosis and to guide medical and surgical therapy.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/7. Cell index--a new parameter for the early diagnosis of ventriculostomy (external ventricular drainage)-related ventriculitis in patients with intraventricular hemorrhage?Temporary intraventricular catheters for managing acute obstructive hydrocephalus caused by intraventricular haemorrhage carry a high risk of developing ventriculostomy-related ventriculitis (VRV). The aim of this prospective study was to validate a new parameter for the early detection of an intraventricular infection. methods: patients with external ventricular drainage due to intraventricular haemorrhage were enrolled in this prospective study. Leucocytes and erythrocytes in cerebrospinal fluid (CSF) and peripheral blood as well as bacteriological and chemical analysis of both were examined daily. The ratio of leucocytes to erythrocytes in CSF and leucocytes to erythrocytes in peripheral blood was calculated (so called cell index (CI)) and these values were compared with the "conventionally diagnosed" drain-associated ventriculitis. Furthermore, the CI values of the non-ventriculitis and ventriculitis group were compared using the t-test with adjustment for unequal variances (Welch test). RESULTS: Thirteen patients with an external ventricular drainage (EVD) expected to be in place for more than seven days were enrolled. Seven patients developed a bacteriologically proven VRV (time 0) within 12 days (mean 8.57). Diagnosis of VRV by CI was possible up to 3 days (mean 2.28) prior to conventional diagnosis. P values (Welch test) showed a significant difference on days -3 (P = 0.03), -2 (P = 0.03) and -1 (P = 0.012) - i.e. 3, 2 or 1 day, respectively, prior to the time point when the CSF culture grew staphylococci -, when compared with the mean cell indices of the controls, and a highly significant difference on time 0 (P < 0.001). CONCLUSION: The calculated CI allows the diagnosis of nosocomial VRV in patients with intraventricular haemorrhage at a very early point of time.- - - - - - - - - - ranking = 0.16666666666667keywords = catheter (Clic here for more details about this article) |
3/7. Antimicrobial therapy and local toxicity of intraventricular administration of vancomycin in a neonate with ventriculitis.infection is the most common complication and cause of failure of cerebrospinal fluid (CSF) shunt devices used to control hydrocephalus. A male newborn was admitted for treatment of congenital occlusive hydrocephalus by means of a ventriculo-peritoneal shunt. A day later, the skin area around the site of insertion of ventriculo-peritoneal catheter was red and edematous. Intravenous ceftazidime and vancomycin were initiated. The shunt was removed but the external ventricular drain was preserved. blood and CSF cultures showed enterococcus faecalis sensitive to vancomycin, ciprofloxacin and gentamicin, but resistant to ampicillin. Intraventricular administration of vancomycin 10 mg/24 h was initiated through the external ventricular drain. Before the first dose of vancomycin intraventricularly, CSF levels were 19 mg/dL as a result of administration. On the third day of intraventricular dosing, vancomycin levels in CSF reached 388 mg/dL and protein levels were 1160 mg/dL. On the fifth day of intraventricular treatment the patient had clinically improved and was bacteriologically cured. However, in CSF, protein levels were 3300 mg/dL and vancomycin levels 201 mg/dL. In an attempt to prevent high and potentially toxic levels in CSF, the intraventricular dose of vancomycin should be individualized according to clinical response, bacteriological cultures, vancomycin levels in CSF, and surrogate markers of neurotoxicity, that is, eosinophilia and high protein levels in CSF.- - - - - - - - - - ranking = 0.16666666666667keywords = catheter (Clic here for more details about this article) |
4/7. Stereotactic removal of a migrating ventricular catheter.Retained ventricular catheters are usually well tolerated but, when infection is present, their removal becomes imperative because such catheters serve as a nidus for persistent infection. Minimally invasive methods for the removal of retained catheters are desirable. The removal of an infected, retained, subcortical ventricular catheter using stereotactic techniques is described. The authors think that this method is a safe and effective first step in dealing with this difficult problem.- - - - - - - - - - ranking = 1.3333333333333keywords = catheter (Clic here for more details about this article) |
5/7. Ventricular shunt therapy of the brain: long-term rubber-catheter-induced inflammation.Three cases of catheter-induced inflammation are presented, two of which involved brain parenchyma and the ventricular system and one that involved the soft tissues of the scalp. All of the catheters were composed of natural rubber and had been in place for several years. Abnormalities seen on computed tomographic scans in these patients were variable but included mass effect, vasogenic edema, catheter destruction, calcification, and abnormal contrast enhancement of the parenchyma adjacent to the catheters. Certain features on the scans of the two patients with intracranial disease, however, were common to both cases, allowing the correct preoperative diagnosis to be made in the second patient encountered.- - - - - - - - - - ranking = 1.3333333333333keywords = catheter (Clic here for more details about this article) |
6/7. Neuropathology of fatal varicella.Pathological examination of the CNS was carried out in the cases of 32 children who died of varicella. Twelve had acute encephalopathy with fatty degeneration of liver. Eighteen children had underlying disease; two thirds of them had received steroids. Two children had neonatal varicella. Only two brains of the total number of children had demonstrable inclusion bodies, and these were unique cases. One infant brain had focal encephalitis in an area of necrosis around a ventricular catheter, and the other, a case of neonatal varicella, had multiple disseminated necrotic foci. These observations suggest that true encephalitis is a rare event in fatal varicella.- - - - - - - - - - ranking = 0.16666666666667keywords = catheter (Clic here for more details about this article) |
7/7. Intracerebral sepsis due to intestinal perforation by ventriculo-peritoneal shunts: two cases.Two cases of ventriculo-peritoneal (V-P) shunt infection attributable to intestinal perforation are reported. One patient developed a brain abscess, the other ventriculitis. microbiology consisted of faecal flora and the peritoneal catheter was found to be faecally stained in both cases. There were no abdominal symptoms or signs. It is likely that infection developed via the ascending route.- - - - - - - - - - ranking = 0.16666666666667keywords = catheter (Clic here for more details about this article) |