Biomedical subjects
Publications and source records attributed to M Fisher.
In this article we review the concept of ischemic penumbra and emphasize the potentially reversible aspect as a function of time, which is the basis of the concept of a therapeutic window. Also, we briefly consider the physiopathology of the ischemic cascade, emphasizing the levels at which the different neuroprotector drugs under investigation have their effect.
A patient developed endophthalmitis 15 days after uncomplicated cataract extraction. Excised infectious material sequestered in the capsular bag revealed Nocardia on culture. She required multiple intravitreal injections of Amikacin and dexamethasone, pars plana vitrectomies with explantation of the lens, and chronic topical and oral sulfonamide antibiotics to control the infection. Clinicians should also consider Nocardia when the suspicion of fungal endophthalmitis is entertained, as Nocardia are resistant to antifungals, but respond to intravitreal amikacin and chronic topical and oral sulfonamides.
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Currently, the only therapy approved for the treatment of acute ischemic stroke is intravenous recombinant tissue-type plasminogen activator (rt-PA) initiated within 3 hours of symptom onset. This therapy is only used in a very small percentage of stroke patients even in experienced centers. There have been many other clinical trials of thrombolytic drugs beyond the 3-hour time window and neuroprotective drugs, but none of these trials have been positive. There are many potential explanations for these unsuccessful stroke trials and many valuable lessons have been learned. Using imagging technology such as diffusion/perfusion magnetic resonance imaging (MRI) and perfusion computerised tomography (CT) will likely enhance the enhances for success in future acute stroke trials when combined with appropriate trial design and patient selection. Developing new acute stroke therapies will be a difficult but necessary task to meet the large unmet need for this important and under treated disorder.
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We describe the envenomation of three patients by Hadronyche versuta, Hadronyche infensa and Hadronyche cerberea (which all are species of funnel-web spider) and the reversal of symptoms by funnel-web spider antivenom. The importance of continuing to administer antivenom until symptoms are reversed is emphasized; all three patients required further doses of antivenom to reverse the symptoms completely. None of the patients had received first aid.
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D-penicillamine therapy can produce an unusual variety of skin lesions: Some are acute sensitivity reactions; some are caused by metabolic effects of the drug; some are due to autoimmune phenomena or to unknown mechanisms. The type and incidence of side effects depend on the original disease and on penicillamine dosage and duration of treatment.
The diagnosis and management of ovarian hemorrhage complicating anticoagulant therapy is discussed and a case presented. The patient, who had undergone mitral valve replacement and was receiving chronic anticoagulation treatment, was admitted with signs of intraperitoneal bleeding from a ruptured ovarian hematoma. This complication must be considered in the menstruating female who is receiving anticoagulant therapy. Long-term anovulatory therapy could possibly avoid this potential ovarian hemorrhage.
The structural and electrophysiological characteristics of the crista terminalis (CT) in the right atrium of the rabbit have been analyzed. The myocardial cells of the CT show a longitudinal and parallel arrangement corresponding to the long axis of the CT and can be divided into two distinct groups, i.e.: (1) smaller cells, that resemble those of the atrial common myocardium and constitute a thin superficial (subendocardial) layer; (2) larger clear cells, that are organized in a homogeneous thick and deeper row and display an extended T-tubular system. The action potentials of the surface of the whole CT preparation were heterogeneous and could be grouped into three main types. Such heterogeneity was possibly related to electrotonic coupling between atrial cells. The action potentials recorded from the deep cells of the CT were homogeneous, displaying high amplitude, very high maximum rate of rise and relatively long duration. The above data supply a correlation between morphological and electrophysiological findings. They suggest that the deep layer of the CT could be responsible for the high conduction rate.
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Eikenella corrodens is a gram negative rod considered normal mouth flora and is commonly linked to human bite injuries. In rare cases, E. corrodens can cause systemic infections. This article describes the case of a 30-year-old injection drug user who presented with a serious polymicrobial infection of the arm. Usual empiric antibiotic coverage resulted in little improvement, and eventually 300 milliliters of purulent material was drained from his upper arm. Cultures of the drainage grew E. corrodens as well as other oral flora. After surgical drainage, specific antibiotic therapy directed towards E. corrodens was added to his antimicrobial therapy and the patient fully recovered. We conclude that E. corrodens is common in the injection drug user population as part of mixed infections, and that empiric antibiotic coverage for this organism, namely penicillin, may be warranted in certain clinical situations.
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In the U.S., malaria predominately occurs in travelers and immigrants. We report a series of 40 cases at West Virginia University Hospital, and 24 of whom were students who had visited areas of East Africa, West Africa and Asia usually in either December, January, August or September. Most patients (79%) reported a previous episode of malaria, and P. falciparum was identified in 60%. Fever, chills and rigors were the most common symptoms. Correct use of malaria prophylaxis was recorded in five patients, and only two of these were students. Successful outcomes were recorded in all but one patient. Our series suggests that international students would benefit from the proper use of chemoprophylaxis, thus decreasing the number of cases of malaria seen in university settings.