Pulmonary infiltrates and fever induced by isoniazid

An 88 year old woman with bacteriologically confirmed pulmonary tuberculosis was first treated with isoniazid, rifampicin and pyrazinamide. Two weeks later she developed pulmonary infiltrates with fever. A drug-induced reaction was suspected but the reaction recurred three times until isoniazid was identified as the cause. The reaction became worse each time, finally being nearly fatal.     

Sublethal effects of simulated pulp mill effluents on the respiration and energy metabolism of rainbow trout (Salmo gairdneri)

Rainbow trout were exposed to 0.08 X 96-hr LC50 concentration of simulated unbleached (KME-Sa) and bleached (KME-Sa + CP) kraft pulp mill effluents. A sulfate soap preparation (Sa) with and without added chlorophenols (CP) was used as the toxicant mixture. The lipid content of white muscle increased in both test groups, and its protein content decreased in the KME-Sa-treated group. The ammonia excretion rate also decreased in both test groups. These results show that there was a shift from protein to lipid metabolism. On the other hand, apart from a slight hypoglycemia, only minor changes were observed in the carbohydrate metabolism. The overall effects on blood respiratory properties were functionally insignificant. However, the effects of kraft mill effluent with and without chlorophenols were qualitatively dissimilar in several respects.     

Measles virus hemagglutinin mediates monocyte aggregation and increased adherence to measles-infected endothelial cells

The effect of measles virus (MV) infection on monocyte adhesion was studied using human peripheral blood monocytes and monocytic and endothelial cell lines. The infection of monocytic U-937 cells led to the formation of large cellular aggregates. Aggregation was independent of intercellular adhesion molecule-1 (ICAM-1)/ lymphocyte function-associated antigen-1 (LFA-1), but could be inhibited by monoclonal antibodies (mAb) against the MV hemagglutinin glycoprotein (MV-H). mAb against the MV receptor, CD46, also blocked aggregation. No significant changes in the cell surface expression of adhesion molecules CD11a, CD11b, CD11c, CD18, CD54, CD44, CD49d (α4-integrin) and CD62L (L-selectin) were observed on MV-infected monocytes. Infection of a human endothelial cell line, EAhy 926 (HEC), with MV led to a two-fold increase in ICAM-1 expression and a two-fold increase in monocyte adherence to the HEC (from 22±1.6% to 42±4.8%). However, ICAM-1 mAb reduced monocyte adhesion to the control and MV-infected HEC to a similar degree, whereas anti-MV-H antibodies abolished the difference between binding to infected and control HEC. We conclude that MV hemagglutinin mediated both the homotypic aggregation in infected monocyte cultures and increased monocyte adherence to the infected endothelial cells. Received: 14 February 1996     

Assessment of activity of ocular sarcoidosis by gallium scanning.

Gallium (67Ga) citrate uptake over the orbits, parotid glands, and lungs was examined in six newly detected patients with sarcoidosis and 17 with chronic sarcoidosis. Six of 23 (26%) had uveitis, 18/23 (78%) decreased lacrimal secretion, and 13/16 (81%) epithelioid cell granulomas in conjunctival biopsies. Ten patients with other diseases served as controls. Only five patients had ocular complaints and two had enlarged parotid glands. 67Ga uptake over the orbits and parotids was measured by a quantitative computer based method. Gallium uptake was significantly higher over the orbits (p less than 0.001) and parotids (p less than 0.01) in the newly detected patients and in the parotids (p less than 0.01) in the chronic group than the corresponding uptake in the controls. We suggest that in sarcoidosis an increased 67Ga uptake in the orbital and parotid areas may be a phenomenon comparable to an increased 67Ga uptake in the lungs in active alveolitis. Gallium scan is a good method for revealing even symptomless ophthalmic sarcoid changes. However, in chronic sarcoidosis an equal or only slightly increased gallium uptake over the orbits compared with background activity does not exclude ocular sarcoid disease.     

Elevated Serum Inhibin and Tumor-Associated Trypsin Inhibitor Concentrations in a Young Woman with Dysgerminoma of the Ovary

We describe a patient with dysgerminoma who had elevated serum inhibin, tumor-associated trypsin inhibitor (TATI), and CA 125 concentrations, which increased progressively during follow-up of the advancing disease. Inhibin levels correlated closely with disease behavior. In contrast to inhibin, serum TATI and CA 125 failed to reveal the presence of silent disease.     

Effects of XAD-8 fractions of dissolved organic carbon on the sorption and bioavailability of organic micropollutants

The dissolved organic carbon (DOC) from a stream water near a peat deposit was fractionated into hydrophobic-acid (HbA), hydrophobic-neutral (HbN), and hydrophilic (Hl) subcomponents by XAD-8 chromatography. The capacity of these fractions and the total (unfractionated) water to bind hydrophobic organic contaminants was measured by equilibrium dialysis, and the effect of binding on contaminant bioavailability was measured inDaphnia magna. Model contaminants were the poly cyclic aromatic hydrocarbons, naphthalene (NPH) and benzo(a)pyrene (BaP), and the polychlorinated biphenyl, 2,2,5,5-tetrachlorobiphenyl (TCB).Both BaP and TCB exhibited high partition coefficients (Kp's) for binding to both the total DOC and the hydrophobic components of the DOC. BaP had a higher affinity for binding to the HbA fraction, while TCB (and 3 other PCB's had a higher affinity for the HbN fraction. The K_p's for binding to the Hl fraction were twofold to tenfold lower than for binding to the hydrophobic fractions. The less hydrophobic compound, NPH, had a much lower K_p, and little difference was seen between the fractions. The total water and the different DOC fractions reduced the uptake and accumulation of BaP and TCB byD. magna in proportion to the capacity of the DOC for binding the contaminants. Data were consistent with the hypothesis that a contaminant bound to DOC (total water or any of the fractions) is unavailable for uptake by biota. Uptake of NPH was not substantially affected by the DOC, consistent with its lower K_p.     

One-year mortality,quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure

Introduction  

High daily intensive care unit (ICU) costs are associated with the use of mechanical ventilation (MV) to treat acute respiratory failure (ARF), and assessment of quality of life (QOL) after critical illness and cost-effectiveness analyses are warranted.     

Jejunal luminal microdialysate lactate in cardiac tamponade--effect of low systemic blood flow on gut mucosa

OBJECTIVE: To assess gut mucosal metabolic response and susceptibility to dysoxia during low systemic blood flow induced by cardiac tamponade. DESIGN: A randomized, controlled animal experiment. SETTING: National laboratory animal center. INTERVENTIONS: Cardiac tamponade was induced in six pigs, while six additional pigs served as controls. In the tamponade group, fluid was injected into the pericardial space to reduce aortic flow, aiming first at a flow of 50 ml/kg per min and then at 30 ml/kg per min. Each step lasted for 60 min. MEASUREMENTS AND RESULTS: We measured luminal lactate by microdialysis and mucosal PCO(2) by tonometry in the mid-jejunum. Aortic and superior mesenteric artery blood flow, arterial and mesenteric venous lactate, pyruvate and ketone bodies and regional lactate exchange were measured. The distribution of aortic blood flow to superior mesenteric artery remained unchanged (baseline 14 (12-16)%; median (interquartile range), stepwise flow reduction 11 (10-17)% and 13 (12-19)%, NS) during reduction of aortic blood flow from 81 (61-95) ml/kg per min to 49 (47-49) ml/kg per min and 23 (21-27) ml/kg per min. Systemic hyperlactatemia developed early, whereas gut luminal lactate increased only after 60 min of hypoperfusion and could be largely explained by arterial hyperlactatemia. Mesenteric venous lactate-to-pyruvate (L/P) ratio increased after 30 min of tamponade, but both venous-arterial lactate and pyruvate gradients turned negative (gut lactate and pyruvate uptake). Mesenteric venous ss-hydroxybutyrate to acetoacetate ratio increased after 60 min. No changes were observed in the controls. CONCLUSIONS: Jejunal mucosal dysoxia and anaerobic metabolism occurs late during low systemic blood flow induced by experimental cardiac tamponade.     

Splanchnic oxygen transport after cardiac surgery: evidence for inadequate tissue perfusion after stabilization of hemodynamics

Objective To evaluate the adequacy of visceral oxygen transport and gastric pH_i after open heart surgery in patients with stable hemodynamics.Design Nonrandomized control trial.Setting A general intensive care unit in a tertiary care center.Patients Sixteen postoperative cardiac surgery patients were studied after stabilization of systemic hemodynamics.Interventions The effect of dobutamine infusion (6 g kg^–1 min^–1) on systemic and regional oxygen transport was studied in ten patients, with six patients serving as controls. Systemic oxygen consumption was measured by indirect calorimetry and splanchnic and femoral blood flow, by continuous infusion of indocyanine green using regional catheters and gastric mucosal pH_i by gastric tonometer.Measurements and results Gastric mucosal acidosis was observed in half of the patients. Dobutamine increased cardiac output (3.2±0.6 vs 4.4±0.7l· min^–1·m^–2;P<0.05), splanchnic blood flow (0.68±0.28 vs 0.91±0.281· min^–1·m^–2;p<0.05) and femoral blood flow (0.25±0.08 vs 0.32±0.11l·min^–1·m^–2;p<0.05). Changes in splanchnic oxygen delivery and consumption were parallel in the two study groups. In response to dobutamine, gastric pH_i did not change (7.30±0.08 vs 7.31±0.06; NS), while in the control group, gastric pH_i tended to decrease (7.32±0.04 vs 7.28±0.06; NS). Systemic oxygen consumption increased in response to dobutamine (141±11 vs 149±11 ml· min^–1·m^–2;P<0.05) but did not change in the control group.Conclusions We conclude that a mismatch between splanchnic oxygen delivery and demand may be present despite stabilization of systemic hemodynamics after cardiac surgery. This is suggested by the parallel changes in splanchnic oxygen delivery and consumption. Dobutamine is likely to improve splanchnic tissue perfusion at this phase.This study was supported in part by the senior researcher's grant no. 1945/3015/92 to Dr. Takala from the Academy of Finland