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Much of the progress in Astronomy has been driven by instrumental developments, from the first telescopes to fiber fed spectrographs. In this review we describe the field of astrophotonics, a combination of photonics and astronomical instrumentation that has the potential to drive the next generation of developements. We begin with the science cases that have been identified as possibly benefiting from astrophotonic devices. We then discuss devices, methods and developments in the field along with the advantages they provide. We conclude by describing possible future developments in the field and their influence on astronomy., 99 pages, 7 figures - Invited review article for The Astronomy and Astrophysics Review. Submitted on 9 Nov 2018, Resubmission 8 Nov 2020

Context. The inner few au region of planet-forming disks is a complex environment. High angular resolution observations have a key role in understanding the disk structure and the dynamical processes at work. Aims. In this study we aim to characterize the mid-infrared brightness distribution of the inner disk of the young intermediate-mass star HD 163296, from VLTI/MATISSE observations. Methods. We use geometric models to fit the data. Our models include a smoothed ring, a flat disk with inner cavity, and a 2D Gaussian. The models can account for disk inclination and for azimuthal asymmetries as well. We also perform numerical hydro-dynamical simulations of the inner edge of the disk. Results. Our modeling reveals a significant brightness asymmetry in the L-band disk emission. The brightness maximum of the asymmetry is located at the NW part of the disk image, nearly at the position angle of the semimajor axis. The surface brightness ratio in the azimuthal variation is $3.5 \pm 0.2$. Comparing our result on the location of the asymmetry with other interferometric measurements, we confirm that the morphology of the $r, accepted for publication in A&A

The nature of circumstellar envelopes (CSE) around Cepheids is still a matter of debate. The physical origin of their infrared (IR) excess could be either a shell of ionized gas, or a dust envelope, or both. This study aims at constraining the geometry and the IR excess of the environment of the long-period Cepheid $\ell$ Car (P=35.5 days) at mid-IR wavelengths to understand its physical nature. We first use photometric observations in various bands and Spitzer Space Telescope spectroscopy to constrain the IR excess of $\ell$ Car. Then, we analyze the VLTI/MATISSE measurements at a specific phase of observation, in order to determine the flux contribution, the size and shape of the environment of the star in the L band. We finally test the hypothesis of a shell of ionized gas in order to model the IR excess. We report the first detection in the L band of a centro-symmetric extended emission around l Car, of about 1.7$R_\star$ in FWHM, producing an excess of about 7.0\% in this band. In the N band, there is no clear evidence for dust emission from VLTI/MATISSE correlated flux and Spitzer data. On the other side, the modeled shell of ionized gas implies a more compact CSE ($1.13\pm0.02\,R_\star$) and fainter (IR excess of 1\% in the L band). We provide new evidences for a compact CSE of $\ell$ Car and we demonstrate the capabilities of VLTI/MATISSE for determining common properties of CSEs. While the compact CSE of $\ell$ Car is probably of gaseous nature, the tested model of a shell of ionized gas is not able to simultaneously reproduce the IR excess and the interferometric observations. Further Galactic Cepheids observations with VLTI/MATISSE are necessary for determining the properties of CSEs, which may also depend on both the pulsation period and the evolutionary state of the stars., Comment: 13 pages, 8 figures, accepted in Astronomy and Astrophysics

Context: FS Canis Majoris (FS CMa, HD 45677) is an unclassified B[e] star surrounded by an inclined dust disk. The evolutionary stage of FS CMa is still debated. Perpendicular to the circumstellar disk, a bipolar outflow was detected. Infrared aperture-synthesis imaging provides us with a unique opportunity to study the disk structure. Aims: Our aim is to study the intensity distribution of the disk of FS CMa in the mid-infrared L and N bands. Methods: We performed aperture-synthesis imaging of FS CMa with the MATISSE instrument (Multi AperTure mid-Infrared SpectroScopic Experiment) in the low spectral resolution mode to obtain images in the L and N bands. We computed radiative transfer models that reproduce the L- and N-band intensity distributions of the resolved disks. Results: We present L- and N-band aperture-synthesis images of FS CMa reconstructed in the wavelength bands of 3.4-3.8 and 8.6-9.0 micrometer. In the L-band image, the inner rim region of an inclined circumstellar disk and the central object can be seen with a spatial resolution of 2.7 milliarcsec (mas). An inner disk cavity with an angular diameter of 6x12mas is resolved. The L-band disk consists of a bright northwestern (NW) disk region and a much fainter southeastern (SE) region. The images suggest that we are looking at the bright inner wall of the NW disk rim, which is on the far side of the disk. In the N band, only the bright NW disk region is seen. In addition to deriving the inclination and the inner disk radius, fitting the reconstructed brightness distributions via radiative transfer modeling allows one to constrain the innermost disk structure, in particular the shape of the inner disk rim., Comment: accepted for publication in A&A

Hi-5 is a high-contrast (or high dynamic range) infrared imager project for the VLTI. Its main goal is to characterize young extra-solar planetary systems and exozodiacal dust around southern main-sequence stars. In this paper, we present an update of the project and key technology pathways to improve the contrast achieved by the VLTI. In particular, we discuss the possibility to use integrated optics, proven in the near-infrared, in the thermal near-infrared (L and M bands, 3-5~$\mu$m) and advanced fringe tracking strategies. We also address the strong exoplanet science case (young exoplanets, planet formation, and exozodiacal disks) offered by this wavelength regime as well as other possible science cases such as stellar physics (fundamental parameters and multiplicity) and extragalactic astrophysics (active galactic nuclei and fundamental constants). Synergies and scientific preparation for other potential future instruments such as the Planet Formation Imager are also briefly discussed., Comment: 15 pages, 3 figures, SPIE proceedings, based on arXiv:1801.04148

MATISSE is the second-generation mid-infrared spectrograph and imager for the Very Large Telescope Interferometer (VLTI) at Paranal. This new interferometric instrument will allow significant advances by opening new avenues in various fundamental research fields: studying the planet-forming region of disks around young stellar objects, understanding the surface structures and mass loss phenomena affecting evolved stars, and probing the environments of black holes in active galactic nuclei. As a first breakthrough, MATISSE will enlarge the spectral domain of current optical interferometers by offering the L and M bands in addition to the N band. This will open a wide wavelength domain, ranging from 2.8 to 13 um, exploring angular scales as small as 3 mas (L band) / 10 mas (N band). As a second breakthrough, MATISSE will allow mid-infrared imaging - closure-phase aperture-synthesis imaging - with up to four Unit Telescopes (UT) or Auxiliary Telescopes (AT) of the VLTI. Moreover, MATISSE will offer a spectral resolution range from R ~ 30 to R ~ 5000. Here, we present one of the main science objectives, the study of protoplanetary disks, that has driven the instrument design and motivated several VLTI upgrades (GRA4MAT and NAOMI). We introduce the physical concept of MATISSE including a description of the signal on the detectors and an evaluation of the expected performances. We also discuss the current status of the MATISSE instrument, which is entering its testing phase, and the foreseen schedule for the next two years that will lead to the first light at Paranal., Comment: SPIE Astronomical Telescopes and Instrumentation conference, June 2016, 11 pages, 6 Figures

The potential of combining Adaptive Optics (AO) and Lucky Imaging (LI) to achieve high precision astrometry and differential photometry in the optical is investigated by conducting observations of the close 0\farcs1 brown dwarf binary GJ569Bab. We took 50000 $I$-band images with our LI instrument FastCam attached to NAOMI, the 4.2-m William Herschel Telescope (WHT) AO facility. In order to extract the most of the astrometry and photometry of the GJ569Bab system we have resorted to a PSF fitting technique using the primary star GJ569A as a suitable PSF reference which exhibits an $I$-band magnitude of $7.78\pm0.03$. The AO+LI observations at WHT were able to resolve the binary system GJ569Bab located at $4\farcs 92 \pm 0\farcs05$ from GJ569A. We measure a separation of $98.4 \pm 1.1$ mas and $I$-band magnitudes of $13.86 \pm 0.03$ and $14.48 \pm 0.03$ and $I-J$ colors of 2.72$\pm$0.08 and 2.83$\pm$0.08 for the Ba and Bb components, respectively. Our study rules out the presence of any other companion to GJ569A down to magnitude I$\sim$ 17 at distances larger than 1\arcsec. The $I-J$ colors measured are consistent with M8.5-M9 spectral types for the Ba and Bb components. The available dynamical, photometric and spectroscopic data are consistent with a binary system with Ba being slightly (10-20%) more massive than Bb. We obtain new orbital parameters which are in good agreement with those in the literature.

A novel approach to the synthesis of molecularly imprinted polymers via covalent or non-covalent linkages was studied. It relies on the use of thermotropic side-chain liquid-crystal polymer networks. The polysiloxane networks obtained after extraction of the template preserved the mesomorphic organisation set up in the presence of the guest molecule. Batch rebinding analysis were performed: this study revealed that the imprinted polymer has a much greater affinity for the template molecule than the unimprinted one, and a significant selectivity.

This article reviews the basics of blood and blood component therapy, focusing on pretransfusion compatibility testing and the complications of blood transfusion (both infectious and noninfectious). Issues surrounding the massive transfusion of blood and alternatives to traditional chemotherapy also are discussed.

Astrophotonics offers a solution to some of the problems of building instruments for the next generation of telescopes through the use of photonic devices to miniaturise and simplify instruments. It has already proved its worth in interferometry over the last decade and is now being applied to nightsky background suppression. Astrophotonics offers a radically different approach to highly-multiplexed spectroscopy to the benefit of galaxy surveys such as are required to determine the evolution of the cosmic equation of state. The Astrophotonica Europa partnership funded by the EU via OPTICON is undertaking a wide-ranging survey of the technological opportunities and their applicability to high-priority astrophysical goals of the next generation of observatories. Here we summarise some of the conclusions.

In this paper, we present an original observational approach, which combines, for the first time, traditional speckle imaging with image post-processing to obtain in the optical domain diffraction-limited images with high contrast (1e-5) within 0.5 to 2 arcseconds around a bright star. The post-processing step is based on wavelet filtering an has analogy with edge enhancement and high-pass filtering. Our I-band on-sky results with the 2.5-m Nordic Telescope (NOT) and the lucky imaging instrument FASTCAM show that we are able to detect L-type brown dwarf companions around a solar-type star with a contrast DI~12 at 2" and with no use of any coronographic capability, which greatly simplifies the instrumental and hardware approach. This object has been detected from the ground in J and H bands so far only with AO-assisted 8-10 m class telescopes (Gemini, Keck), although more recently detected with small-class telescopes in the K band. Discussing the advantage and disadvantage of the optical regime for the detection of faint intrinsic fluxes close to bright stars, we develop some perspectives for other fields, including the study of dense cores in globular clusters. To the best of our knowledge this is the first time that high contrast considerations are included in optical speckle imaging approach., Comment: Proceedings of SPIE conference - Ground-based and Airborne Instrumentation for Astronomy III (Conference 7735), San Diego 2010

In the astrophysical context of the search for Earth-like extrasolar planets, an important research effort has been done for the realization of single-mode integrated optics devices for mid-infrared space-based interferometry. Preparatory projects like FKSI [3], where rejection of high order modes is required to a level better than 40dB, will need photonic devices that achieve modal filtering and beam combination in the mid-IR band. In this context, we present results on midinfrared planar integrated optic beam combiners characterized at LAOG using chalcogenide and silver halide materials. We show results on FTS measurements, allowing to determine the single mode spectral domain, as well as interference fringes obtained from Y-junctions realized on these materials.

Traditionally thought as alternatives of each other, it has not been until very recently when Adaptive Optics (AO) and lucky imaging (LI) have been put to work together to achieve angular resolutions in the visible wavelengths comparable to those acquired with an ideal telescope. In this work the mutual benefits of combining fast frame selection (a.k.a. Lucky Imaging, LI) with Adaptive Optics (AO) on a 10-m class telescope are investigated by means of detailed Monte-Carlo numerical simulations. We investigate the expected image quality by looking at the Strehl Ratio (SR) at the optical R and I bands (around 650 and 800nm, respectively) and the potential of the technique to conduct high-contrast imaging. From our numerical simulations we are able to assess whether there is a net gain in the high-contrast capabilities when applying wavelet-based filtering techniques. As a test bench for what we should expect by moving on a 10-m class telescope we present recent results achieved with AO+LI at the 4-m William Herschel Telescope (WHT) by looking at the brown dwarf binary GJ569Bab.

Laboratory and on-sky experience suggests that the integration of big astronomical instruments, specially of a complex interferometric system, is a challenging process. LINC-NIRVANA is the Fizeau interferometric imager for the Large Binocular Telescope (LBT). Simulating the final operating environment of every system component has shown how critical is the presence of flexures, vibrations and thermal expansion. Assembling and aligning the opto-mechanical sub-systems will require an absolute reference which is not affected by static displacements or positioning errors. A multi-purpose calibration unit has been designed to ensure the quality of the alignment of optics and detectors and the reliability of the mechanical setup. This new compact and light-weighted unit is characterized by sophisticated kinematics, simple mechanical design and composite materials. In addition, the reduced number of motorized axis improves the stiffness and lowers the angular displacements due to moving parts. The modular concept integrates several light sources to provide the proper calibration reference for the different sub-systems of LINC-NIRVANA. For the standard alignment of the optics an absolute reference fiber will be used. For flatfielding of the detectors the unit provides an integrating sphere, and a special rotating multi-fiber plate (infrared and visible) is used to calibrate the advanced adaptive optics and the fringe-tracking systems. A module to control non-common path aberrations (Flattening of Deformable Mirrors) is also provided.

A flat waveguide for the middle infrared was made by co-extrusion of two silver halide crystals of different chemical compositions. The transmission of the waveguide and its modal behavior was studied using a Fourier Transform Spectrometer and a dedicated optical bench. Analyzing this spectrum, we were able to obtain the cut-off wavelength of the waveguide. We observed a single mode behavior for wavelengths longer than 8.83mum, in good agreement with the theoretically expected values. This novel procedure is ideal for tailoring the properties of the waveguide for specific applications, in particular the spectral range where it exhibits a single-mode behavior. It can thus be applied to achieve modal filtering for mid-IR astronomical interferometers (e.g. beam combiners, nullers, etc.).

A 40-year-old man had an acute ischemic event affecting the pons. He had no cardiac illness or vasculitis and was not diabetic or hypertensive. The contrast-enhanced computed tomographic scan disclosed nothing abnormal, and a vertebral angiogram showed an avascular mass markedly displacing the basilar artery and pons posteriorly and toward the right. A magnetic resonance image clearly delineated a homogeneous arachnoid cyst containing cerebrospinal fluid. To avoid manipulating posterior fossa arteries, after the recent pontine stroke, this arachnoid cyst with unusually favorable anatomical landmarks was approached stereotactically through the vertex. Fenestration and drainage of the cyst was accomplished under local anesthesia and benzodiazepine sedation with low morbidity. The procedure was well tolerated, and the patient returned to gainful employment shortly afterward. He remains asymptomatic at 3 years' follow-up. The successful outcome of this case suggests that in carefully selected symptomatic arachnoid cysts, stereotactic interventions could become a useful surgical alternative. Stereotaxis may also be helpful in other cumbersome surgical cases in which a second port for contrast injection or simple manipulation would be advantageous.

Planar waveguides were obtained by deposition of Te 2 As 3 Se 5 films on polished As 2 S 3 glass substrates by RF-sputtering or thermal evaporation. The RF-sputtered films were porous and had a column-like structure. By contrast, the thermal evaporated films were homogeneous and dense. They were adhesive, transparent up to 18 μm and characterized by a refractive index of 2.821 ± 0.005 at 10.6 μm. M-lines measurements highlighted the existence of several guided mode lines, proving that the manufactured structures behaved as waveguides. The geometry of the film was modified by physical or reactive ion etching. Some quasi vertical ribs up to 2.11 μm in depth were etched by reactive ion etching under a CF 4 /O 2 atmosphere.

Darwin is one of the most challenging space projects ever considered by the European Space Agency (ESA). Its principal objectives are to detect Earth-like planets around nearby stars and to characterize their atmospheres. Darwin is conceived as a space "nulling interferometer" which makes use of on-axis destructive interferences to extinguish the stellar light while keeping the off-axis signal of the orbiting planet. Within the frame of the Darwin program, the European Space Agency (ESA) and the European Southern Observatory (ESO) intend to build a ground-based technology demonstrator called GENIE (Ground based European Nulling Interferometry Experiment). Such a ground-based demonstrator built around the Very Large Telescope Interferometer (VLTI) in Paranal will test some of the key technologies required for the Darwin Infrared Space Interferometer. It will demonstrate that nulling interferometry can be achieved in a broad mid-IR band as a precursor to the next phase of the Darwin program. The present paper will describe the objectives and the status of the project.

This article reviews the basics of blood and blood component therapy, focusing on pretransfusion compatibility testing and the complications of blood transfusion (both infectious and noninfectious). Issues surrounding the massive transfusion of blood and alternatives to traditional chemotherapy also are discussed.

The feasibility of chalcogenide rib waveguides working at lambda = 10.6 microns has been demonstrated. The waveguides comprised a several microns thick Te2As3Se5 film deposited by thermal evaporation on a polished As2S3 glass substrate and further etched by physical etching in Ar or CF4/O2 atmosphere. Output images at 10.6 microns and some propagation losses roughly estimated at 10dB/cm proved that the obtained structures behaved as channel waveguides with a good lateral confinement of the light. The work opens the doors to the realisation of components able to work in the mid and thermal infrared up to 20 microns and even more., The following article appeared in Vigreux-Bercovici et al., Appl. Phys. Lett. 90, 011110 (2007) and may be found at http://link.aip.org/link/?apl/90/011110

Narcolepsy has been defined as a disorder of excessive sleep often associated with cataplexy, sleep paralysis and hypnagogic hallucinations. Although the pathophysiology of the narcoleptic syndrome is not well understood, derangement in the functions of CNS catecholamines and serotonin (5-HT) have been implicated. In the present paper we summarize evidence to suggest a role for the endogenous opioids in the regulation of normal sleep and in the pathophysiology of the narcoleptic syndrome.

This study evaluates the effect of blood volume and hematocrit changes on brain tissue during temporary global ischemia. Normal saline was administered intravenously to 55 gerbils to achieve hypo-, normo-, and hypervolemic hemodilution and uniform 30% hematocrit reduction. Each group had unilateral carotid artery ligation and temporary (20 minute) contralateral carotid occlusion. After ten days or death, brains were harvested, preserved in formalin, sectioned in a manner which provided adequate samples of both cortex and hippocampus, and stained with H&E and iuxol fast blue. They were then examined and staged microscopically for white and gray matter infarction, edema, and neuronal injury and loss. Histologic studies were performed in a randomized and blinded manner and were classified by one of four categories: normal, minimal, moderate, and severe changes. Three of ten (30%) controls survived ten days but had severe neuronal loss, minimal cerebral edema and a minimal to moderate number of white matter strokes. Survival was best in animals treated with hypovolemic hemodilution (43%). Other rates were: normovolemic (33%), controls (30%), and hypervolemic (8.3%). The degree of brain tissue damage was markedly less in the normovolemic group. In this model, normovolemic hemodilution followed by hypovolemic hemodilution offered the best overall cerebral protection during global Ischemia.

Both Doppler supraorbital examination (OSM) and oculoplethysmography (OPG) were administered to 101 patients (202 arteries) to document the presence or absence of hemodynamically significant lesions of the internal carotid artery prior to angiography. There was no significant difference between the OSM and OPG with respect to diagnostic sensitivity or specificity, incidence of false-negative or false-positive results, and overall diagnostic accuracy. The diagnostic accuracy for the OSM and the OPG were 94.2% and 91.6%, respectively. In 171/202 (84.6%) arteries, the OSM and OPG were in diagnostic agreement, and the overall diagnostic accuracy of the combined tests was 97%. However, when the OSM and OPG did not agree (31/202 arteries, 15.4%), the diagnostic accuracy of neither the OSM nor the OPG was acceptable. Although the best diagnostic accuracy was obtained using two means of noninvasive cerebrovascular testing, in those instances where only one test may be available, the OPG would appear to be the test of choice. In those laboratories in which high diagnostic accuracy is obtained with the OSM, the addition of OPG testing will increase the overall diagnostic accuracy to a very high level. The presence of a midcervical bruit was found to have a very poor correlation with the incidence of hemodynamically significant stenoses of the internal carotid artery. Although both the OSM and OPG have minimal value in patients with symptomatic cerebrovascular disease, these tests play a very important role in screening patients for asymptomatic carotid stenosis or atypical cerebrovascular symptoms.

Energy dispersive x-ray microanalysis measured the Na, K, Cl, P, Mg, S, and Ca contents (mM/kg dry weight) in the nucleus, yolk-free cytoplasm, and yolk platelets of Rana pipiens oocytes quick frozen in the ovary. The data revealed that significant content changes occur in frog oocytes during intraovarian growth. All elements but Ca changed in content in the nucleus and cytoplasm, while in the yolk platelet only Na content did not change. A nucleus to cytoplasm K gradient develops and increases in magnitude during oocyte growth. The data from this and previous reports lead to the hypothesis that intra-oocytic water and elements undergo changes in state during oocyte growth and that three subcellular Na compartments exist.

The scope of this article includes disorders ranging from simple vaginitis to a perspective on acquired immunodeficiency syndrome. Gynecologic infections are an extremely common cause of visits to the Emergency Department, especially those in large inner cities. Pelvic inflammatory disease is the most serious of the infectious presentations. Vulvovaginitis, although not as serious, can be quite debilitating and is extremely common. Acquired immunodeficiency syndrome (HIV), although not necessarily a gynecologic infection, is included herein because of its sexually transmitted disease potential, and a perspective on protection for the Emergency Department worker is given.

• Nine patients presented with sudden falling events to one side while sitting, standing, or walking. All were initially unaware of their severe postural deficit, and five were obfuscated. The observed falls were a distinctly slow, tilting motion in a stereotypic lateral or diagonal trajectory, literally "like a falling log." The events occurred with eyes opened and were exacerbated with eye closure, but no patient had evidence of cerebellar, vestibular, or posterior column dysfunction or significant motor weakness. Unilateral basal ganglia hemorrhages or lacunar infarcts contralateral to the side of the fall were demonstrated by computed tomographic scans. The overall prognosis was favorable; eight of nine patients regained independent ambulation within 3 to 6 weeks. Our findings indicate that a distinct loss of postural balance arises contralaterally to unilateral pallidal-putaminal lesions.

✓ A previously described experimental hematoma model, achieved by the subcutaneous injection of 12 ml of autologous hemolyzed blood clotted in situ, was made in 33 rats. Seventeen animals served as controls; the other 16 received daily intramuscular injections of dexamethasone. After an initial decrease in size, 47% of the lesions in the control animals enlarged to a mean weight of 12.1 ± 2.5 gm, while the lesions in the 16 steroid-treated rats weighed 3.2 ± 0.70 gm (p < 0.01). Histologically, lesions from the steroid group showed absence of neomembrane formation. These data offer further support to the theory that the neomembrane development and subsequent enlargement of subdural hematomas is due to inflammatory reactions of tissues in contact with large blood clots.

A patient with pseudomonas osteomyelitis of the base of the left posterior fossa is reported. His clinical course was one of progressive paresis of the left 8th, 10th, and 11th cranial nerves. There have been three prior reports of osteomyelitis of the base of the skull not in contiguity with an infected paranasal sinus. Our patient subsequently developed osteomyelitis in the 3rd to 5th cervical vertebrae.

✓ An elderly man presented with signs of normotensive hydrocephalus. Elevated protein content in the spinal fluid led to the diagnosis of an “asymptomatic” cauda equina neurilemoma and its removal. Within 6 weeks the patient's mental status had dramatically improved. Chronic transudation of plasma proteins including fibrinogen into the subarachnoid space had probably impeded spinal fluid reabsorption. It is suggested that the leakage of fibrinogen into the cerebrospinal fluid may be the cause of hydrocephalus in other clinical settings in which there is an elevation of the spinal fluid protein.

The unusual case of spontaneous hypoliquorrheic headache reported here was clinically identical to that originally described by Schaltenbrand. This is the first case to be studied by radioisotope cisternography, which showed that the cerebrospinal fluid flow was essentially normal. However, the radioactivity counts percent decreased rapidly, with simultaneous appearance of high isotope concentration in the urinary bladder. Scan images did not show cerebrospinal fluid (CSF) leakage at the puncture sites. Our data suggest that this postural headache syndrome is not caused by decreased CSF production, but by a very rapid absorption or unusual CSF leakage.

Over the past six years, many new agents have become available for the treatment of bacterial central nervous system (CNS) infections. Certain principles guide the use of these agents for CNS infections: first, an antimicrobial agent must be able to penetrate the CNS to be effective; second, the CNS is a “relatively immunoincompetent site” so that an antimicrobial must achieve levels within the CNS capable of killing the offending bacterium. The lack of efficacy of chloramphenicol for meningitis due to gram-negative aerobes is probably due to its failure to achieve such killing levels, whereas the success of the newer cephalosporins, such as cefotaxime and ceftriaxone, is due to their very high killing activity against these organisms. Penicillin remains the first choice for pneumococcal and meningococcal meningitis. Ampicillin plus chloramphenicol is still recommended as initial therapy for meningitis due to Hemophilus influenzae. The newer cephalosporins are now the first choice for the treatment of meningitis due to many gram-negative bacilli. Trimethoprim-sulfamethoxazole may also be useful in some of these infections and those due to Listeria monocytogenes. In the treatment of severe CNS infections, a team approach is advised to ensure optimal therapy.

✓ Three unusual cases of fatal meningitis secondary to undetected bacterial psoas abscess occurred at this institution over an 11-year period. All three patients had suffered chronic debilitating disorders before the abscess formation. The superimposed variable clinical presentations led to the initial diagnosis of a progressing cerebrovascular accident in one case, herniated nucleus pulposus at the L3–4 level in another, and osteomyelitis of the hip joint in the third. Analysis of these cases revealed that before the meningeal dissemination, all of the patients had shown evidence of intra-abdominal pathology with positive psoas signs. Diagnostic and therapeutic guidelines are discussed.

Multiple chemical and coagulation determinations were undertaken on the subdural hematoma fluid from the reformed effusions of two patients. It was found that plasma or blood repeatedly reentered the subdural cavity. Coagulation studies compared the in vitro effects of subdural fluid with those of cerebrospinal fluid, serum, and a buffer control. Despite some chemical differences, the subdural fluids from both patients behaved similarly by (1) accelerating the intrinsic clotting system, (2) producing defective clot formation, and (3) accelerating the fibrinolytic system. It is presumed that these continuous hemostatic-fibrinolytic alterations, acting in the subdural sac, may have important implications in the growth and reformation of subdural hematomas, and a hypothesis of the mechanisms involved is presented.

One month after having a right upper lobectomy to remove a squamous cell carcinoma, a 43-year-old man presented with a 4-day history of postural headache, worsened by standing and relieved by lying. Skull films showed prominent ventricular pneumocephalus. lophendylate myelography was unrewarding, but isotope cisternography revealed a CSF fistula at the T4 level, extending into the thoracic cavity. Thoracoplastic removal of the first four ribs successfully prevented air passage and the patient had a rapid uneventful recovery.