ESBL Escherichia coli Ventriculitis after Aneurysm Clipping: A Rare and Difficult Therapeutic Challenge

Background. Extended spectrum beta-lactamase (ESBL) produced Escherichia coli (E. coli) ventriculitis is a rare infection of the central nervous system, with increasing rarity in the adult population. The therapeutic strategy to achieve cure may need to involve a combination of intraventricular and intravenous (IV) therapy. Objective. To describe a case of ESBL E. coli meningitis/ventriculitis in an adult and outline the antimicrobial therapy that leads to cure. Methods. We retrospectively reviewed the records of a patient admitted to the neurosurgical department for aneurysmal subarachnoid hemorrhage, who developed ESBL E. coli ventriculitis. Results. A 55-year-old female, admitted for a Fisher grade 3, World Federation of Neurological Surgeons grade 1, subarachnoid hemorrhage, developed ESBL E. coli ventriculitis requiring a combination of intraventricular gentamicin and high dose intravenous meropenem for clearance. Cerebrospinal fluid clearance occurred at 7 days after initiation of combined therapy. The patient remained shunt dependent. Conclusions. Meningitis and ventriculitis caused by ESBL E. coli species are rare and pose significant challenges to the treating physician. Early consideration for combined intraventricular and IV therapy should be made

Socio-acoustic survey and soundscape analysis in urban parks in Rome

The Directive 2002/49/EC of the European Parliament and of the Council relating to the assessment and management of environmental noise and the Italian decree of transposition D.Lgs. 194/2005 introduce the concept of “quiet areas”, either in agglomeration or in open country. Unfortunately, metrological criteria to identify such areas have not been defined yet, mainly due to the lack of knowledge of the effect of noise on their perceived soundscape quality (Nilsson 2007). Several studies carried out over the last decade have shown that it’s more realistic and useful an approach aimed to analyze the perception of the acoustic quality of the environment, rather than using noise indicators describing the sound environment only, i.e. the equivalent sound pressure level (LAeq) or the day-evening-night level (Lden) (Schulte-Fortkamp 2006; Brown 2006, Kang 2007). The importance of “quiet areas”, or even better “areas of high acoustic quality” (Brown 2006), is widely recognized as they provide, at least temporarily, opportunities for relaxation and stress recovery from noise pollution to which the population is exposed in the everyday life. This health-promoting function should be preserved and improved, especially for the urban parks, as they can be easily accessed by the users but, meanwhile, are often surrounded by noisy areas due to the sound emission of road traffic, industries and other sources. This paper describes a socio-acoustic survey carried out in three urban parks in Rome aimed to investigate the users’ perception of the acoustic quality in the parks and its relationship with some acoustic parameters. The study is the first one in the urban green areas in Rome having structure and methodology comparable with the previously surveys carried out in urban parks in Naples and Milan (Brambilla, Maffei & Zambon 2006). A preliminary survey on the web was performed to provide information useful to design the questionnaire to be used in the field survey and to identify the areas to be investigated. The in situ surveys were carried out taking binaural recordings of the sound environment and simultaneous interviews to people in the park. The results of the surveys have been related to the acoustic data determined from the recordings

ANALISI DEL PAESAGGIO SONORO IN TRE PARCHI URBANI DELLA CITTA’ DI ROMA

La direttiva europea 2002/49/CE, e il successivo D.Lgs. 194/2005 di recepimento nel nostro Paese, individuano tra i molteplici obiettivi da conseguire la tutela delle aree con buona qualità acustica ma non indicano alcun criterio metrologico per la definizione delle “aree quiete”. Per l’identificazione di queste ultime le numerose ricerche condotte nell’ultimo decennio [1] mostrano come sia più realistico e proficuo adottare un approc-cio orientato alla percezione della qualità acustica dell’ambiente sonoro, piuttosto che impiegare parametri descriventi esclusivamente il fenomeno sonoro, come ad esempio il livello equivalente LAeq o il più recente livello giorno-sera-notte Lden [1, 2]. L’importanza delle “aree quiete” è, peraltro, ampiamente riconosciuta e condivisa in quanto rivestono la funzione insostituibile di luoghi di ristoro nei quali interrompere, almeno temporaneamente, l’assedio sonoro a cui la popolazione è esposta nella vita quotidiana. Questa funzione dovrebbe essere tutelata soprattutto per i parchi urbani che sono di più immediata fruizione ma, purtroppo, sempre più spesso circondati da aree ad elevato rumore ambientale. Nell’ambito di un’attività promossa da ISPRA, in collaborazione con CIRIAF e CNR-IDASC, è stata condotta nel corso del 2010 una indagine socio-acustica in tre grandi parchi urbani di Roma, ossia Villa Borghese, Villa Doria-Pamphili e Parco della Caffarella. Lo studio rappresenta la prima indagine socio-acustica svolta in aree verdi urbane a Roma comparabile, per struttura e metodologia, a indagini precedentemente realizzate in parchi urbani a Napoli e Milano [3, 4]

Clinical presentation of CADASIL in an Italian patient with a rare Gly528Cys exon 10 Notch3 gene mutation

CADASIL is an autosomal dominant arteriopathy characterised by diffuse white matter lesions and small subcortical infarcts on neuroimaging and a variable combination of recurrent cerebral ischaemic episodes, cognitive deficits, migraine with aura and psychiatric symptoms. It is caused by mutations in the NOTCH3 gene encoding a NOTCH3 receptor protein. Here, we describe the genetical, clinical, neuropsychological and neuroimaging findings in an Italian CADASIL patient with a rare mutation in exon 10 leading to a Gly528Cys substitution

Motor cortex cholinergic dysfunction in CADASIL: a transcranial magnetic demonstration.

OBJECTIVE: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary small vessel disease responsible for an early onset cognitive impairment. Aim of our study was to test the cortical cholinergic innervation in CADASIL by short latency afferent inhibition (SAI) technique. METHODS: We applied SAI in ten CADASIL patients and in ten age-matched normal controls. SAI is a phenomenon observed on motor evoked potential when transcranial magnetic stimulation is delivered after a time ranging from 2 to 8 ms longer than the time needed by the peripheral nerve afferent input to reach the somatosensory cortex. RESULTS: The amount of short latency afferent inhibition was significantly smaller in CADASIL patients than in controls (79.5+/-21.7% Vs 42.7+/-14.1% of test size; p<0.001, two tailed Mann-Whitney test). The mean resting motor threshold (RMT) was significantly lower in CADASIL patients than in controls (49.4+/-14.4% Vs 65.6+/-15.4%; p=0.02). CONCLUSIONS: We demonstrated by SAI technique a central cholinergic impairment in CADASIL. SIGNIFICANCE: SAI could be used to evaluate the cholinergic dysfunction and potentially the efficacy of cholinomimetic therapy in CADASIL

Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy

Objective: Antiphospholipid (a-PL) antibodies, especially IgG isotype, have been associated with a variety of neurological manifestations related to thrombotic mechanism and reactivity against nervous tissues. Furthermore, high titre of a-PL antibodies has been also correlated to chronic thromboembolic pulmonary hypertension (CTEPH) and, therefore, is frequently reported in patients undergoing pulmonary endarterectomy (PEA). The impact of a-PL antibodies in postoperative outcome following PEA, however, has not been clearly evaluated yet. In this paper, we investigated the impact of a high a-PL IgG titre (HAPT) on postoperative outcome following PEA. Methods: From April 1994 to October 2008, out of 204 patients undergoing PEA at our centre, 184 were prospectively screened for a-PL antibodies. According to the preoperative IgG titre, patients were divided into two groups: Group A (high a-PL antibodies titre – HAPT) with a-PL IgG titre >10 U/ml and Group B (low a-PL antibodies titre – LAPT) with a-PL IgG titre ≤10 U/ml. Early outcomes were compared between the two groups. Results: Twenty-eight patients (15%) were included in Group A, whereas 156 (85%) patients were included in Group B. HAPT influenced preoperative parameters as patients of Group A were younger compared to those of Group B (42±16 and 52±16 for Group A and B, respectively, P=0.001) and presented more frequently a previous history of deep venous thrombosis (DVT) (96% and 62% for Group A and B, respectively, P=0.001). The two groups were homogeneous for all other operative parameters. As far as postoperative outcome, in terms of mortality and major complications, there were no differences between the two groups. Incidence of transient neurological complications, however, was significantly different (32% and 10% for Group A and B, respectively, P=0.023). Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA