Tuncer Turhan

Moxifloxacin versus ampicillin + gentamicin in the therapy of experimental Listeria monocytogenes meningitis

OBJECTIVES This study aimed to compare the antibacterial activity of moxifloxacin and ampicillin + gentamicin in the treatment of Listeria monocytogenes meningitis in a rabbit meningitis model. METHODS Meningitis was induced by direct inoculation of a clinical strain isolated from an immunocompromised patient (10(7) cfu/mL) into the cisterna magna of New Zealand rabbits. After 16 h of incubation, rabbits were separated into four groups: moxifloxacin (M), ampicillin + gentamicin (A), ampicillin + gentamicin 2 (A2) and control (C). Group M received 20 mg/kg moxifloxacin at the end of the incubation time and 5 h later by intravenous (i.v.) route. Group A received ampicillin (30 mg/kg/h) and gentamicin (2.5 mg/kg/h) by i.v. route with continuous infusion for 8 h in 36 mL of 0.9% NaCl, group A2 received the same dosage of gentamicin and ampicillin in two different 36 mL 0.9% NaCl solutions and group C did not receive any treatment. Cerebrospinal fluid (CSF) samples (0.1-0.25 mL) were obtained 16 and 24 h after induction of meningitis. RESULTS At the end of the 16 h of incubation, CSF bacterial counts were similar in all groups (P > 0.05). At the final stage of the study (24 h after induction of meningitis), bacterial counts in all treatment groups were significantly lower than the control group (P < 0.05). When the three treatment groups were compared, bacterial counts were found to be similar (P > 0.05). CONCLUSIONS These data suggest that antibacterial activity of moxifloxacin is similar to ampicillin + gentamicin in the treatment of experimental L. monocytogenes meningitis of rabbits.

Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: A series of 17 cases

Abstract Background: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fluid penetration. The aim of this study was to evaluate the efficacy of linezolid in methicillin-resistant staphylococcal (methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS)) meningitis. Methods: We extracted data and outcomes for all adult patients (age > 18 y) with culture-proven MRSA or MRCoNS meningitis treated with linezolid between January 2006 and September 2010 in our hospital. Demographic, clinical, and laboratory data and predisposing factors, as well as information on response to treatment and outcome were obtained by regular visits. Results: A total of 17 cases (9 MRCoNS, 7 MRSA, and 1 MRCoNS and MRSA mixed) fulfilled the inclusion criteria. All patients had hospital-acquired meningitis and had undergone neurosurgery. Cumulative microbiological success on day 5 was 88%. There was 1 staphylococcal meningitis-related death. There were no severe adverse events. Conclusions: Our experience with linezolid suggests that it can be an alternative for the treatment of MRCoNS- and MRSA-related meningitis.

Excellent response to deep brain stimulation in a young girl with GNAO1-related progressive choreoathetosis.

Dear Editor: GNAO1 (guanine nucleotide-binding protein, alpha-other) gene, located on chromosome 16q12.2, encodes the alpha subunit of the heterotrimeric guanine nucleotide binding proteins (G proteins). Three functional G-protein subtypes are defined, inhibitory G-proteins (Gi), stimulatory G-proteins (Gs), and other (Go). Go proteins modulate neurotransmitter release by mediating the presynaptic auto-inhibitory effect of several neurotransmitters on their receptors. Gαo subunit encoded by GNAO1 is expressed in brain tissue and has an important role in brain function [1]. GNAO1 mutation was described firstly in the patients with Ohtahara syndrome and epilepsy [2]. Up to date, about 20 cases were reported. The clinical spectrum of the disorder has broadened and movement disorders and psychomotor retardation were also reported. Nine of these cases had solely movement disorders without epilepsy (Table 1). Kulkarni et al. [3] reported the first two cases of GNAO1 mutations who presented with isolated movement disorder and improved after deep brain stimulation. Saitsu et al. [4] and Ananth et al. [5] reported seven additional cases with isolated dyskinesia very recently. But none of those cases had deep brain stimulation and two of them died secondary to infections. The present case firstly referred to the hospital at 13 months of age with marked hypotonia. Insignificant dyskinesia was noted at that time. The parents were nonconsanguineous and her perinatal history was unremarkable. Her brother with the same clinical findings died at the age of three without a definite diagnosis. Cranial magnetic resonance imaging (MRI) of the case was normal as well as creatine kinase levels, extended metabolic analyses and genetic study for spinal muscular atrophy. Electromyography and electroencephalography were unremarkable. Cerebrospinal fluid (CSF) analysis was normal including CSF glucose level, and CSF/serum glucose ratio and CSF neurotransmitters. At the age of two, insignificant choreoathetosis appeared and she started to display a progressive course of involuntary movements at the age of three. Many drugs including clonazepam, haloperidol, carbamazepine, acetazolamide, and diazepam were given without any success. Her movement disorder was triggered with fever and infections. In course of time, her choreoathetosis with marked orofacial dyskinesias were progressed (Video 1). She developed dysphagia and gastrostomy tube was inserted. Mutation analysis of methyl-CpG binding protein-2 (MECP2) and forkhead box G1 (FOXG1) genes were also negative. She was hospitalized in intensive care units for several times requiring entubation after the age of four. Tracheostomy was performed due to prolonged mechanical ventilation. She had persistent hypertermia reaching 42 °C (107.6 °F) and elevated creatine kinase levels due to severe involuntary movements. Ketogenic diet had no benefit and the Electronic supplementary material The online version of this article (doi:10.1007/s00381-016-3139-6) contains supplementary material, which is available to authorized users.

Daptomycin versus Vancomycin in Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis in an Experimental Rabbit Model

ABSTRACT In this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P < 0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.

Hemodynamic and electrolyte changes in patients undergoing neuroendoscopic procedures

ObjectsIntraoperative hemodynamic alterations and postoperative electrolyte disturbances related to endoscopic third ventriculostomy (E3V) have been reported. We aimed to evaluate prospectively those changes in patients undergoing neuroendoscopic procedures.MethodsThis study was carried out in 24 patients who underwent neuroendoscopic intervention. Sevoflurane was used for the induction and maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation, end-tidal CO2, and body temperature values were recorded according to the stages of the operation. Blood gas and blood chemistry analyses were performed before and after endoscopic procedure and were repeated on the third postoperative day.ConclusionsThere were no significant differences in intraoperative HR and MAP. Bradycardia occurred only in 1 of the 24 patients during the dilatation. In conclusion, we suggest the use of 0.9% NaCl for intravenous fluid replacement and a warm lactated ringer solution for ventricular irrigation during E3V to prevent intraoperative hemodynamic changes and postoperative electrolyte disturbances.

Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis.

BACKGROUND Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis. METHODS We extracted data and outcomes for all adult patients (age >18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600 mg q12h and vancomycin IV at 500 mg q6h. RESULTS A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean±SD] 61.6±13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1±15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p=0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolid-treated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L. CONCLUSION Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2 mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question.

Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis in an experimental rabbit model

Summary Background The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) meningitis. Material/Methods Meningitis was induced by intracisternal inoculation of ATCC 43300 strain. After 16 h incubation time and development of meningitis, the vancomycin group received vancomycin 20 mg/kg every 12 h. The linezolid-10 and linezolid-20 groups received linezolid in 10 and 20 mg/kg dosages every 12 h, respectively. The control group did not receive any antibiotics. Cerebrospinal fluid bacterial counts were measured at the end of 16-h incubation time and at the end of 24-h treatment. Results Bacterial counts were similar in all groups at 16 h. At the end of treatment the decrease in bacterial counts in the vancomycin group was approximately 2 logs higher than the linezolid-20 group (p>0.05) and approximately 4 logs higher than in the linezolid-10 group (p: 0.037) (Vancomycin group: −2.860±4.495 versus Linezolid-20: −0.724±4.360, versus Linezolid-10: 1.39±3.37). Full or partial bacteriological response was higher in vancomycin versus linezolid-10 (p: 0.01), but not vancomycin versus linezolid-20 or linezolid-10 versus-linezolid-20 groups. Conclusions Our results suggest that linezolid is not statistically inferior to vancomycin in the treatment of MRSA meningitis in an experimental rabbit model in 20 mg/kg q12 h dosage; however, it is inferior in 10 mg/kg q12 h dosage. Additional data should gathered to confirm these findings in advance of clinical trials to assess efficacy in humans.

Cerebro-spinal fluid shunt revisions, importance of the symptoms and shunt structure.

AIM CSF shunt failure is still a frequent problem in children. This prospective study was designed for focusing symptoms and reasons of shunt failure. We also especially focused on the mechanical reasons of shunt failure. MATERIAL AND METHODS We focused on the causes of shunt failures, and the symptoms and signs in patients who were operated for shunt malfunction between January 1, 2001 and December 31, 2005 in the neurosurgery department. All examination and operative data were collected prospectively. Evaluation of these data was with the chi-square and Fisher exact tests. RESULTS After the evaluation of data on 111 patients and 153 revision procedures, the major symptoms in this group were vomiting (62.16%), somnolence (59.45%) and headache (48.64%). In the majority of the shunt revisions (115 operations, 75.2% of the all 153 procedures), one or more mechanical problems of the shunt systems were identified in surgery. CONCLUSION Shunt failures in children sometimes appear with very unusual symptoms. Also, probable structural problems of the shunt systems seem very important for shunt failure according to patient characteristics and etiology of the hydrocephalus. A systematic approach including CT, shunt series and abdominal ultrasound is needed to rule out shunt malfunction.

The Association of Alagille Syndrome and Craniosynostosis

Alagille syndrome is associated with various ocular abnormalities, including pseudopapilledema or optic disk edema due to increased intracranial pressure. Several mechanisms have been proposed to explain the mechanism of intracranial hypertension in Alagille syndrome. Craniosynostosis is an unusual but significant cause of increased intracranial hypertension in Alagille syndrome. It has recently been demonstrated in animal models that Jagged1 gene in which mutations are responsible for Alagille syndrome may also take part in cranial suture formation. We report a child with Alagille syndrome and craniosynostosis who presented with pruritus, elevated liver enzymes, and suspected increased intracranial pressure.

Intraventricular migration of the bone dust. Is a second operation for removal necessary? Case report and review of the literature.

PurposeAs the number of endoscopic third ventriculostomy (E3V) operations increase, new rare complications are encountered. In this article, a complication caused by bone particles that migrated into the third ventricle will be described. Additionally, the methods of avoidance as well as the necessity of a new approach will be discussed.MethodsAfter the video images of the first and second operations of a patient who was subjected to E3V twice were compared, it was discovered that one of the bone particles within the ventricle had occluded the ostium after the second operation. Most of the bones were removed and their pathological investigations were performed.ResultsVideo images of the patient, surgical observations of the second operation, emergence of the time of dysfunction, and other similar cases in the literature were assessed, and it was concluded that the bones that localized intraventricularly were living tissues.DiscussionAbandoning usage of bone dust for sealing burr holes is a solution to avoid this complication. In addition, it should be kept in mind that intraventricular bone particles might grow and lead to obstructions. If such particles are detected, removal of the bones in certain locations before formation of neovascularization can be an option.