Basal cisternostomy for traumatic brain injury: A case report of unexpected good recovery

In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.

Surgical management of a penetrating drill bit injury to the skull base

Background:

Low-energy penetrating brain injuries are rarely encountered in neurosurgical practice. Immediate surgical management remains the primary treatment strategy to control potential bleeding and prevents infectious complications.

Case Description:

A 28-year-old man presented with an orbital injury with left-sided chemosis, amaurosis, and ophthalmoplegia following an assault. Cranial CT revealed an industrial drill bit causing a penetrating injury to the skull base. The tip of the object reached the petrous apex. CT angiography showed no signs of cerebrovascular damage. The drill bit was visualized through a frontotemporal craniotomy. It was then carefully removed under direct microscopic vision. Postoperative ceftriaxone was administered. The patient was discharged in good condition on postoperative day 6. His vision impairment remained.

Conclusion:

Timely access to neuroimaging diagnostics and microneurosurgical facilities allows for good outcomes in the surgical treatment of low-velocity penetrating brain injuries.

Effects of dietary yeast cell wall on faecal bacteria and fermentation products in adult cats

This study evaluated the effects of increasing concentrations of spray-dried yeast cell wall (YCW) in diets for healthy adult cats on apparent nutrient digestibility and on bacterial composition and fermentation products in the stool. Fourteen cats with an average weight of 4.40 ± 1.05 kg and an average age of 6.2 ± 0.54 years were used and assigned to treatments in an unbalanced randomized block design (by experimental period) with two blocks and three or four cats per diet in each block. Treatments included: control (0% YCW), 0.2% YCW, 0.4% YCW and 0.6% YCW, totalling seven animals per experimental diet. We found that YCW did not affect body weight, nutrient and food intake, faecal production, faecal score, faecal pH or urine output (p > .05). Regarding faecal bacteria, we observed a linear reduction in Clostridium perfringens, a quadratic reduction in Escherichia coli, and linear increases in Bifidobacterium spp. and Lactobacillus spp. (p < .05) with the inclusion of YCW. Regarding the faecal short-chain fatty acid profile, butyrate, valerate, total biogenic amines, putrescine, cadaverine and histamine increased linearly (p < .05) with the inclusion of YCW. It was concluded that in healthy adult cats, consumption of YCW modulates the faecal bacterial populations, with an increased presence of beneficial bacteria and a reduction in some potentially pathogenic bacteria. It was concluded that YCW modulated the levels of fermentation products. There was an increase in fermentation products coming from carbohydrate metabolism, an important effect that can potentially benefit the intestinal health of cats. The consumption of YCW also increased the fermentation of nitrogen compounds, which have not yet been defined as deleterious or beneficial. The fermentability of carbohydrates and nitrogen compounds may be associated. Therefore, YCW may cause rapid fermentation of both classes of compounds by enhancing the fermentability of one class.

Seven years' experience in medical care at Mexico City International Airport

This paper describes our experience in the medical care of patients at Mexico City International Airport during the period 1981-87. Our medical staff treated 39,320 of the 84,359,212 passengers who used the airport during this 7-year period, an average of 5,617 patients per year. The most frequently observed medical disorders included: traumatic (8,852 cases; 22.5%), gastrointestinal (8,622; 22%), respiratory (5,503; 14%), cardiovascular (4,410; 11%), neurologic (3,876; 10%), toxicologic (1,273; 3%), gynecologic (833; 2%), urologic (773; 2%), endocrinologic (592; 1.5%) and others (4,586; 12%). There were 62 deaths, 244 false alarms, and 67 patients transported by air ambulance and 1,955 by ground ambulance. The main causes of death included extensive traumatic injuries and burns, acute myocardial infarctions, cerebrovascular accidents, and severe cases of intoxication. The annual trends with respect to morbidity, patient population and passenger population are discussed.

The mechanism of activation of hormone-sensitive lipase in human adipose tissue

A partially purified hormone-sensitive triglyceride lipase of human adipose tissue was found to be activated twofold by the addition of cyclic 3',5'-AMP, ATP, and magnesium ions. Lipase activities against diolein and monoolein were not affected. Addition of protein kinase inhibitor at zero time completely inhibited activation, and this inhibition was prevented by prior addition of an excess of exogenous protein kinase (from rabbit skeletal muscle). Addition of protein kinase inhibitor during the activation step blocked the activation process without a time lag, suggesting that protein kinase operates directly on hormone-sensitive lipase. Further purification yielded a fraction free of protein kinase, and lipase activation in this fraction depended absolutely on addition of exogenous kinase. Incubation of human fat with epinephrine or isoproterenol stimulated lipolysis and caused conversion of nonactivated hormone-sensitive lipase to its activated form, as indicated by a decrease in the activation subsequently obtainable in fractions prepared from such hormone-treated tissues. These findings strongly suggest that the stimulation of lipolysis by hormonal treatment is the consequence of the activation of hormone-sensitive triglyceride lipase by cyclic 3',5'-AMP-dependent protein kinase.