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Background Radiosurgery has been widely used to treat cerebral AVMs, providing angiographic evidence of obliteration of the malformation in 80% to 95% of patients, after a latency period of 2 to 5 years. Case Description We describe a case of hemorrhage, 6 years after radiosurgery and 4 years after complete angiographic obliteration of an AVM that had not previously bled and that persisted angiographically, obliterated after bleeding. Results Several treatment options have been reported for patients with completely obliterated AVMs that bled, including conservative treatment, repeated radiosurgery, and open surgery with resection of AVM remnants. In the present case, the decision to perform surgery based on the probable association of the enhancing area observed on the MRI and the histologic findings was finally confirmed. Conclusions Magnetic resonance imaging enhancement areas on the obliterated AVMs may have a histopathologic correlation with persistence of permeable vessels and can be used as a guide for surgery and postoperative control. The follow-up of angiographically obliterated AVMs that bleed remains a matter of discussion twofold: regarding timing and use of a proper diagnostic test.

Peritonitis is a surgical problem with a high mortality rate attributable to various complications, including respiratory infection. This complication is more common under certain conditions reflective of the origin of peritonitis, suggesting that the composition of the peritoneal fluid exerts an influence on the intensity of the macrophage and peritoneal response. To establish a correlation among macrophage function, absorption of bacteria from the peritoneal cavity, and the pH of the peritoneal fluid, we carried out this study.Thirty female Wistar rats were divided into three equal groups, all of which received infusions of 0.9% saline by parietal puncture. In group A (control), the saline pH was 7.0; in group B, it was 2.5; and in group C, it was 8.5. After 40 min, 0.25 mL of a suspension containing 10(11) colony-forming units of (99m)Tc-labeled Escherichia coli was infused by the same route. After another 40 min, samples of vena caval blood, spleen, liver, and lung were removed; the radioactivity was counted; bacterial absorption was determined; and the proportional radioactivity/g of tissue was calculated. The values were compared among the groups by the Student t-test, with the level of significance set at p0.05.There was significantly greater bacterial absorption in group B than in group C (p = 0.004) but no differences in the numbers of bacteria in the liver and spleen. Bacteria were significantly more numerous in the peripheral blood in group B than in groups A and C (p = 0.04 for both). Pulmonary phagocytosis was significantly reduced in group B compared with group A (p = 0.008) and group C (p = 0.005).Peritonitis associated with acidic conditions in the peritoneal cavity is correlated with a reduction in pulmonary phagocytosis and an increase in the numbers of nonphagocytized bacteria in the peripheral blood, possibly representing a direct or indirect cause of the higher incidence of pneumonia and sepsis in these individuals.

The association between Helicobacter pylori infection and gastric motility abnormalities is still controversial, partly because of the lack of an appropriate animal model. H. heilmannii type 1 (Hh1), a spiral bacterium that infects the stomach of both man and pigs, easily colonises and induces an inflammatory response in the gastric mucosa of rodents. For these reasons, the present study investigated the relationship between gastric motility in rats experimentally infected with Hh1 and correlated the results with serum gastrin and gastric somatostatin concentrations, as these hormones seem to be involved in gastric motility. Ten rats were inoculated with gastric mucus from an Hh1-positive pig and 10 animals with gastric mucus from an Hh1-negative pig (control group). After 56 days, gastric emptying was studied in vivo by scintigraphy. The animals were then killed, blood samples were collected for serum gastrin measurement, strips of the gastric wall were obtained for an in-vitro motor study and fragments of the gastric antrum were obtained for somatostatin content evaluation, Hh1 diagnosis and histological study. There was a significant increase in gastric emptying in the test group compared with the controls as demonstrated by the in-vivo and in-vitro studies. Serum gastrin levels were significantly higher and somatostatin levels were lower in the test group than in the controls. In addition, infected animals showed evidence of gastritis on histological examination. Gastric motility is altered in rats infected with Hh1, a fact possibly related to concurrent abnormalities of gastrin and somatostatin secretion.

Biofilm formation on external ventricular drainages (EVDs) has been postulated as the main pathogenic mechanism for EVD-associated ventriculitis. However, biofilm on EVDs has never been systematically studied and the in vivo effect of antibiotic-impregnated EVDs on biofilm has not been assessed. The aim of this study was to measure the prevalence of biofilm formation on EVDs and to analyze the influence of antibiotic-impregnated EVD on the risk of biofilm formation and ventriculitis. Consecutive patients with EVDs were included in the study. Surveillance cerebrospinal fluid (CSF) cultures were performed twice a week. Withdrawn EVDs were cultured using standard bacteriologic techniques and examined under a scanning electron microscope. We collected 32 EVDs, 18 of which (56 %) were antibiotic-impregnated EVDs. Biofilm was present on 24 EVDs (75 %), ventriculitis was diagnosed in 6 patients (19 %), and colonization occurred in 12 patients (38 %). All cases of ventriculitis were due to Gram-negative bacteria. Biofilm was more frequent on EVDs originating from patients with ventriculitis or bacterial colonization. Impregnated EVDs did not avoid ventriculitis or colonization, but biofilm development on these devices depended on the time from insertion and varied from 67 % for those used for

AIM: To evaluate inflammatory activity in patients with Crohn’s disease (CD) using technetium-99m-hexamethylpropyleneamine oxime (99mTc-HMPAO) granulocyte scintigraphy. METHODS: Twenty patients (7 male and 13 female) with CD and five healthy volunteers were selected for 99mTc-HMPAO granulocyte scintigraphy. The Crohn’s Disease Activity Index (CDAI), blood tests and C-reactive protein (CRP) of each patient were performed 7 d before the scintigraphic images. The leukocytes were labeled according to the International Society of Radiolabeled Blood Elements (ISORBE) consensus protocol and the scintigraphic images, including single photon emission computed tomography, were obtained 30 min and 2 h after injection of the radiolabeled leukocytes. RESULTS: The labeling yield of the leukocytes with the lipophilic complex 99mTc-HMPAO was 55.0% ± 10%. Six of the 20 patients (30%) presented congruent results for the three parameters investigated (CDAI, Scintigraphic Index and CRP). On the other hand, 14 patients (70%) did not show congruent results. There was no significant correlation between the indices analyzed according to the Spearman test (P > 0.05, n = 20). CONCLUSION: The results suggest that 99mTc-HMPAO-labeled leukocyte scintigraphy could be important for determining inflammatory activity in CD even in the absence of clinical symptoms.

Objectives: The purpose of the study was toevaluate the outcome of prenatally detectedureteropelvic junction obstruction (UPJO)managed with a more conservative protocol.Methods: The records and imaging studies of 77consecutive neonates with UPJO identified by fetal hydronephrosis werereviewed. A nonoperative approach wasattempted in patients with mild/moderate pelvicdilatation, renal units with good functionas ascertained by DMSA scan and anon-obstructed pattern on DTPA. Otherwise, thepatients were managed surgically bypyeloplasty. Both groups were prospectivelyfollowed and the imaging studies were performedbefore and after the initial approachand at one-year intervals thereafter.Results: Of the 77 infants (85 units), 39 weresubmitted to surgery (33 pyeloplasty and 7 nephrectomy) and 38 were conservativelymanaged. During follow-up, 9 (24%) of 38 patients in the non-operative group presentedrenal function deterioration and 3 presented with urinary infections and were submitted topyeloplasty. Of the 39 patients surgically managed, 76% presented improvement ofhydronephrosis and 90% showed a non-obstructed pattern on diuretic renography. Thedifferential renal uptake, as measured by DMSA scan, remained stable in the three groupsanalyzed (conservative, initial pyeloplasty, and delayed pyeloplasty). Therewas a minimal improvement in those units submitted to pyeloplasty with impairedrenal function at baseline (< 40%). Mean renal uptake was 28.6% at admission and33.9% at the end of follow-up. Conclusion: There was a wide spectrum ofureteropelvic junction stenosis. Surgical intervention in a subgroup of patients withsevere hydronephrosis and impaired function may possibly improve or preserve renalparenchyma. Conversely, conservative management and clinical follow-up are safe anddesirable for the subgroup with mild/moderate pelvic dilatation and preservedrenal function.

We studied 13 children with 21-hydroxyalse deficiency to explore the immediate potential suppressive effect of hydrocortisone dose schedule on the adrenal cortex. They were given 20 mg/m2 daily in a controlled trial. After random administration of a greater dose in the morning (7 patients) or at night (6 patients), we measured plasma levels of 17-hydroxyprogesterone, testosterone, and androstenedione at times-24, 0, 2, 4, and 6h. Considerable fluctuation of the steroid levels, unrelated to the drug intake, was observed. There was no statistically significant differences between the “morning dose” and “night dose” groups for any steroid. We conclude that; (i) the greater night dose did not avoid the 17-hydroxyprogesterone morning peaks, and (ii) the variation in plasma steroid levels is so marked that a single morning sample is unreliable to reflect the degree of adrenal suppression.