Decompressive craniectomy can effectively decrease ICP and increase CPP in patients with TBI and refractory elevated ICP. Further studies are necessary to define the group of patients that can benefit most from this procedure.

No abstract

OSA patients presented subclinical manifestations of abnormal swallowing, when analyzed using nasal fibroscopy, possibly associated with neuromuscular injury caused by snoring.

We bacteriologically analyzed 156 species of Enterobacteriaceae, isolated from 138 patients with community-acquired diabetic foot ulcers, in a prospective study made at a diabetic center and at the Federal University of Ceará, Brazil, from March, 2000, to November, 2001.The samples were cultured using selective media, and identification, susceptibility tests and detection of plasmidmediated-extended-spectrum-β β β β β-lactamase (ESBL) producing strains were made with conventional and automated methods. The most frequently occurring pathogens were K. pneumoniae (21.2%), Morganella morganii (19.9%) and E. coli (15.4%). High resistance rates were noted for ampicillin, first generation cephalosporin, trimethoprim/sulfamethoxazole, tetracycline, amoxicillin-clavulanic acid and chloramphenicol. ESBL-producing strains were detected in 6% of the patients. Resistance among gram-negative bacteria has become increasingly common, even in community-acquired infections.

Therapeutic trials of pharmacological treatment for Kleine-Levin syndrome with a double-blind, placebo-controlled design are needed.

Van den Ende–Gupta Syndrome (VDEGS) is an autosomal recessive disorder characterized by blepharophimosis, distinctive nose, hypoplastic maxilla, and skeletal abnormalities. Using homozygosity mapping in four VDEGS patients from three consanguineous families, Anastacio et al. [Anastacio et al. (2010); Am J Hum Genet 87:553–559] identified homozygous mutations in SCARF2, located at 22q11.2. Bedeschi et al. [2011] described a VDEGS patient with sclerocornea and cataracts with compound heterozygosity for the common 22q11.2 microdeletion and a hemizygous SCARF2 mutation. Because sclerocornea had been described in DiGeorge-velo-cardio-facial syndrome but not in VDEGS, they suggested that the ocular abnormalities were caused by the 22q11.2 microdeletion. We report on a 23-year-old male who presented with bilateral sclerocornea and the VDGEGS phenotype who was subsequently found to be homozygous for a 17 bp deletion in exon 4 of SCARF2. The occurrence of bilateral sclerocornea in our patient together with that of Bedeschi et al., suggests that the full VDEGS phenotype may include sclerocornea resulting from homozygosity or compound heterozygosity for loss of function variants in SCARF2.

Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7 to 5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.

Twenty-one adult patients with urinary tract infections caused by penicillinresistant bacteria completed treatment with amoxicillin alone or amoxicillin plus clavulanic acid in a randomized double-blind clinical trial. Of the 13 patients treated with amoxicilhin plus clavulanic acid, the absence of bacteriuria within 7 days of therapy was observed in 85%, as compared with only 25% of the 8 patients receiving amoxicillin only. There were no significant side effects nor any clinical, biochemical, or hematological abnormalities related to either treatment. It was concluded that the combination of clavulanic acid and amoxicillin could be useful in the treatment of uncomplicated urinary tract infection caused by penicillinresistant bacteria.Clavulanic acid, a natural product of Streptomyces clavuligerus, is a potent, irreversible inhibitor of a wide variety of 8-lactamase enzymes (5, 7). Although it has little inherent antibacterial activity, it protects the labile penicillins and cephalosporins from destruction by bacterial ,8-lactamase (4, 6, 8, 9, 13). In vitro studies have demonstrated that clavulanic acid possesses a very wide spectrum of inhibition (3), which results in marked enhancement of,-lactam antibiotics against many 8-lactamase-producing organisms (3, 9, 13), including staphylococci and enterobacteria.Urinary tract infections caused by ,8-lactamase-producing species are common and often require treatment with antibiotics which are potentially toxic. Since clavulanic acid protects the ,8-lactam-sensitive antibiotics from enzymatic destruction, it should serve as a useful adjunct to therapy with those agents. Therefore, the purpose of this initial clinical trial was to determine the efficacy and safety of amoxicilhin plus clavulanic acid in the treatment of uncomplicated urinary tract infection caused by penicillin-resistant organisms. MATERIALS AND METHODSTwenty-one patients presenting with uncomplicated urinary tract infections caused by bacteria resistant to both ampicillin and amoxicillin were considered suitable for this trial. Urinary tract infection was defined as the presence of at least 105 bacteria per ml in patients complaining of dysuria, urgency, frequency, and back pain, or by two consecutive urine cultures containing 105 or more bacteria per ml of the same species in asymptomatic patients. There was no attempt to differentiate between upper and lower urinary tract infection for the purpose of this trial. All bacterial isolates were identified by standard procedures (2) and tested for susceptibility with a 10-,.g ampicillin disk by the Bauer-Kirby method (1). If the isolate was found to be resistant to ampicillin, a tube dilution minimum inhibitory concentration (MIC) to amoxicilhin was determined. All patients who were found to have infecting strains with amoxicillin MICs above 10 ug/ml were considered for enrollment in the study. In addition, a further MIC of amoxicilhin was obtained in the presence of 10 ug of clavulanic acid per ml. This concentration of clavulanic acid has been shown to...