Anaerobic bacteremia was studied in 32 medical patients (mean age 72 years) in a four-year retrospective analysis. Malignancy was the most common underlying disease and probable portal of entry. The gastrointestinal tract was affected most often, followed by the respiratory and urinary tracts. Bacteremia occurred either following invasive (non surgical) procedures or spontaneously. The clinical course ranged from asymptomatic bacteremia, to mild febrile illness, to sepsis and septic shock (two, 12, 16 and two patients, respectively). The case fatality rate was 25%. The causative organisms were Clostridium and Bacteroides species. All organisms isolated were susceptible to chloramphenicol. Early diagnosis and prompt treatment may reduce mortality in cases of anaerobic sepsis.

Adult↗

PubMedDate not supplied

Implantable cardioverter defibrillator therapy in children with long QT syndrome.

We report our experience with implantable cardioverter defibrillator (ICD) implantation and follow-up in high-risk patients with congenital long QT syndrome (LQTS). Congenital LQTS is associated with significant risk of malignant ventricular arrhythmias and sudden cardiac death (SCD). ICD implant is recommended for prevention of SCD in this patient population, but there are few published data regarding the efficacy and side effects of such therapy. We report our experience with 12 patients who underwent ICD implant for high-risk LQTS at our center in the past 5 years with respect to implant complications, appropriate and inappropriate therapies, device follow-up, and the impact on lifestyle. During a follow-up of 34.7+/-16.6 months, appropriate therapies were noted in 5, inappropriate therapies in 4, and no therapies in 3 patients. Clusters of appropriate therapies were seen in 3 patients, 1 of whom subsequently died. Female sex and congenital deafness appear to be associated with a higher risk of appropriate therapies. One patient experienced two complications at implant that were successfully treated. ICD implantation in LQTS patients presenting with SCD or recurrent syncope despite beta-blocker therapy appears to be justified in preventing SCD risk. In asymptomatic siblings of SCD patients, the benefits of ICD implant are not clear from our data.

Adolescent↗

PubMedDate not supplied

Cost-effectiveness of Project ADAM: a project to prevent sudden cardiac death in high school students.

Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.

Adolescent↗

PubMedDate not supplied

Reproducibility of head-up tilt-table testing in pediatric patients with neurocardiogenic syncope.

The aim of this study is to assess the reproducibility of a head-up tilt-table test protocol so it may be used to more accurately evaluate the effectiveness of a treatment protocol. Children between the ages of 10 and 18 years presenting to the cardiology department at Children's Hospital of Wisconsin with a diagnosis of neurocardiogenic syncope were eligible for the study. The patients were tilted to 70 degrees for 30 minutes or until a positive test occurred. Patients with a positive test were retilted using the same protocol. Parameters measured included heart rate, blood pressure, and the presence or absence of syncope or presyncope. Twenty-two patients were enrolled in the study. Seventeen patients had a positive test on first tilt. Fifteen had a positive tilt test on the second tilt. There were no significant differences between the two tilts with regard to mean differences of baseline heart rate, systolic blood pressure, or mean arterial pressure. There were no significant differences between the two tilts with regard to mean differences in time until symptoms, heart rate, systolic blood pressure, or mean arterial blood pressure at time of symptoms. This study shows that the head-up tilt-table test protocol used is reproducible in adolescents with the diagnosis of neurocardiogenic syncope.

Adolescent↗

PubMedDate not supplied

Prospective identification of anomalous origin of left coronary artery from the right sinus of valsalva using transthoracic echocardiography: importance of color Doppler flow mapping.

Four cases are discussed in which anomalous origin of the left coronary artery from the right sinus of Valsalva was identified prospectively by transthoracic echocardiography when the anomalous coronary passed between the great arteries. Color Doppler flow mapping was a critical component in identifying the anomalous coronary, particularly when the proximal course of the left main coronary was intramural.

Adolescent↗

PubMedDate not supplied

Defect in fatty acid oxidation: laboratory and pathologic findings in a patient.

The clinical, laboratory, and pathologic findings in a patient with a previously undescribed deficiency in fatty acid oxidation are summarized. The patient had a fatal defect in fatty acid metabolism profoundly affecting heart, skeletal muscle, liver, and kidney. Oxidation of palmitate was 38-51% of controls. Complementation assays demonstrated that the patient's fibroblasts complemented fibroblast lines from all known defects in fatty acid oxidation except long-chain acyl-CoA dehydrogenase deficiency. Urine and serum carnitine profiles also were indicative of a defect in the oxidation of long-chain substrate; however, the palmitoyl-CoA dehydrogenase activity was actually increased. This finding indicates that the patient had a defect that was distinct from, but possibly related to, long-chain acyl-CoA dehydrogenase deficiency. This patient demonstrates the laboratory and pathologic findings in defects in fatty acid oxidation and how they differ from those in Reye syndrome.

Acyl-CoA Dehydrogenase, Long-Chain↗

PubMedDate not supplied

Distinct antigen-induced cytokine pattern upon stimulation with antibody-complexed antigen consistent with a Th1-->Th2-shift.

The consequences of complexing an antigen with specific antibodies upon the antigen-induced immune response were studied with respect to secretion of interleukin-2 (IL2), interleukin-6 (IL6), interleukin-10 (IL10) and interferon-gamma (IFN gamma). We found that the tetanus toxoid antigen-induced cytokine pattern was mainly dependent on the antigen/antibody ratio. While tetanus toxoid antigen alone induced a typical Th1-like cytokine pattern with high levels of IL2 and IFN gamma, equivalent or antibody-excess immune complexes induced a marked secretion of IL6 and IL10 while failing to induce IL2 and IFN gamma secretion. As the cytokine pattern plays a crucial role in the development of specific immune responses towards infectious agents, our results indicate that immune complexes--typically occurring during the course of chronic infectious diseases--may play an important role in the modulation of immune responses. Since a shift from Th1 to Th2 immune responses has been discussed as a pathogenetic factor in HIV-induced immunodeficiency, the role of circulating immune complexes as a possible cause for this shift should be considered.

Adult↗

PubMedDate not supplied

Donor employment of vasopressors and its impact on allograft survival after transplantation.

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Brain Death↗

PubMedDate not supplied

Pope John Paul II's address to the International Conference on Nutrition: introductory remarks.

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Famous Persons↗

PubMedDate not supplied

Distribution and infection of Langerhans cells in the skin of HIV-infected healthy subjects and AIDS patients.

The in situ content of cells of the reticuloendothelial system and lymphatic cells was examined in the skin of eight symptom-free HIV-positive individuals, three AIDS patients and eleven healthy immunocompetent volunteers. The epidermis was obtained in vivo by the suction blister technique. The numbers of CD68+, CD3+, CD8+, CD25-(IL2R)+ and HLA-DR+ intraepidermal cells proved to be independent of the number of CD4+ peripheral blood lymphocytes. At the same time, the intraepidermal concentrations of these cells were generally low in symptom-free HIV-infected individuals. The strong inverse correlation between the number of epidermal Langerhans cells (LC) and the severity of immunodeficiency was quantitatively confirmed; an increase in LC in symptom-free HIV-infected individuals was found. Thus, the reduction in these cells which was observed in the epidermis of AIDS patients began at a significantly elevated level. In contrast to results from other studies, in AIDS patients, in the present study, the concentration of epidermal LC did not differ significantly from that of healthy immunocompetent volunteers. The immunohistochemical technique can be as effective as in situ hybridization for the detection of HIV in the skin. Our results suggest that the viral load of the skin is rather low in HIV-infected subjects. HIV was demonstrated in one cell of one AIDS case by in situ techniques and this result was confirmed by a polymerase chain reaction examination using the same amount of tissue as for the in situ techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Signs of Kupffer cell involvement in productive simian immunodeficiency virus infection in monkey liver.

The livers of 21 rhesus monkeys inoculated with SIVmac251 were examined at 4 days to 39 months after infection. SIV antigens were detected in the cytoplasm of Kupffer cells (KC), macrophages and lymphocytes in two-thirds of the livers tested. The number of cells containing viral proteins substantially increased during the development of the disease, and KC were the main cell type displaying SIV proteins at an advanced stage of infection. Mature and immature lentiviral particles were found in cytoplasmic vacuoles or associated with worm-like structures in KC, indicating that SIV replication could occur within resident liver macrophages. Another sign of the permissiveness of KC was the formation of multinucleated giant cells within the hepatic sinusoids. Some of these cells containing 3-6 nuclei still retained ultrastructural features of KC. Most of them contained a high quantity of viral particles. Numerous lymphocytes displaying signs of apoptosis were taken up by KC, especially at the beginning of infection. Hyperplasia and hypertrophy of KC were noted in the course of SIV disease in the liver. The present data indicate that KC can be infected in vivo and may serve as a reservoir for SIV during the progression of the disease.

Animals↗