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Background and Purpose: Fibrocartilaginous embolism from the nucleus pulposus has been reported as a rare cause of spinal cord ischemia. We were unable to find previous reports of embolism from this source to cerebral arteries.Case Description: A previously healthy 17-year-old girl fell during a basketball game. Left hemiparesis and unresponsiveness developed followed by signs of right uncal herniation and death over a 3-day period. There was no evidence of neck, head, or spine trauma, and cardiac evaluation was normal. Neuropathological examination showed extensive ischemic infarction of the right middle cerebral artery territory, brain edema, and herniation. Complete embolic occlusion of the right middle cerebral artery by fibrocartilaginous material, consistent with nucleus pulposus, was documented. Small, terminal coronary artery branches also showed embolism by the same material and limited areas of myocardial infarction.Conclusions: Acute cerebral embolism after minor trauma in a young patient may be rarely due to fibrocartilaginous embolism from the nucleus pulposus. The pathogenesis of this problem remains poorly understood, but systemic embolism appeared to have occurred in this case. (Stroke 1993;24:738-740 when she fell, apparently with brief loss of consciousness. Two to 3 hours later, she presented with progressive weakness of the left side of her body along with decrease in the level of consciousness and was then admitted to a rural hospital. Three days later, after she failed to regain consciousness, transfer to the National University Hospital in Bogotai, Colombia, was obtained. Review of systems, past medical history, and family history were unremarkable. On admission, physical examination disclosed a well-nourished girl who was afebrile with a blood pressure of 120/70 mm Hg, a pulse of 75 beats per minute, and respirations at 26 breaths per minute. There were no skin lesions and no evidence of head, neck, or spine trauma. Cardiopulmonary examination was normal, as was the remainder of her physical examination. Neurological examination showed a comatose patient responding to painful stimulation with decerebrate rigidity. The right pupil was dilated and fixed with complete right oculomotor paralysis. A left hemiplegia was present with spontaneous bilateral Babinski's sign. The patient was diagnosed as having suffered from the possible rupture of an intracranial aneurysm. A number of laboratory tests were noncontributory. Computerized tomography of the brain could not be obtained. Cardiorespiratory arrest ensued promptly, and she died after unsuccessful resuscitation maneuvers.Postmortem examination showed an extensive ischemic infarction in the territory of the right middle cerebral artery caused by embolism and total occlusion of the initial segment of the artery (Figure 1). On sectioning the stem of the right middle cerebral artery was totally occluded, extending beyond the origin of its first branches. 1,875 g. Flattening of the convolutions and bilateral uncal herniation, more severe on the r...

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Introduction: The microbiological diagnosis of leptospirosis comprises bacteriological and serological methods. The former ones allow the direct detection of leptospires and are considered presumptive with the exception of culture. Therefore, they constitute invaluable tools for rapid diagnosis, mainly in samples from deceased subjects. Objective: To evaluate a modified Fontana silver staining method in experimentally infected samples. Material and methods: Human and animal (hamster) urine samples were experimentally infected with different strains of Leptospira interrogans sensu lato. Liquid culture medium, leptospira cultures, experimentally infected and non-infected human urine samples, clarified and non-clarified imprints, and clarified and non-clarified suspension smears from tissues of experimentally infected and non-infected hamsters were applied for the ass essment of silver staining. The analytical sensitivity of the assay was compared with dark field microscopy and culture. Other bacterial and fungi species were also used. Results: The modified Fontana silver staining allowed the accurate observation of the well-defined leptospire helical structure. On leptospire cultures from infected human samples, we could observe until (1-10) × 10 3 leptospires/ml, higher sensitivity in comparison with direct dark field microscopy and lower in comparison with culture. The best results in tissues were obtained on clarified imprints and non-clarified suspension smears. Morphological and stainable structures compatible with leptospires were not observed in the samples without them. Conclusion: This procedure allowed differentiating the characteristic morphology of leptospires. As its application suggests, it consists of a simple and easily conducted procedure with stable reagents.

El embarazo es un estado fisiológico en el que se producen múltiples adaptaciones en el sistema cardiovascular, inmunológico y renal con la finalidad de satisfacer la demanda metabólica y proteger al feto. La enfermedad renal puede manifestarse o descubrirse incidentalmente en el transcurso de la gestación y clínicamente puede contemplarse desde tres escenarios: el desarrollo de lesión renal aguda, el diagnóstico de enfermedad renal crónica (nefropatía previa no diagnosticada) y el antecedente conocido (nefropatía subyacente) de enfermedad renal crónica que precede a la gestación. Cualquiera que sea el escenario, la presencia de enfermedad renal crónica ensombrece el pronóstico fetal, aumenta el riesgo de retardo de crecimiento intrauterino, parto prematuro, muerte fetal y acelera la pérdida de función renal de la gestante por lo que se constituye en un desafío en la atención clínica, de ahí que el reconocimiento temprano y el inicio de la terapia es esencial para impactar en el desenlace materno-fetal. A pesar de que esta asociación se ha descrito desde hace varios años y de que el desenlace obstétrico ha mejorado en las dos últimas décadas, sigue siendo una entidad con alta morbimortalidad para el binomio madre-hijo. En este trabajo se describe ocho casos de enfermedad renal crónica y embarazo, su presentación clínica y el desenlace obstétrico.