The Ventilatory Cost of Exercise Compared in Chronic Heart Failure and Chronic Renal Anaemia

The cardiorespiratory responses to maximal treadmill exercisewere compared in matched groups of patients with chronic renalanaemia or treated chronic heart failure, and in normal controls.Exercise capacity was similarly reduced in both patient groupscompared to normal controls, the raised respiratory exchangeratio at peak exercise implying anaerobic metabolism due tolimited oxygen delivery in heart failure and limited oxygencarrying capacity in anaemia. Minute ventilation (V_F) was relatedlinearly to minute CO₂ production (VCO₂) in all subjects (eachr>0.92) from all three groups. The slope of the V_E/VCO₂ relationshipwas normal in anaemia but steeper in heart failure, reflectingventilation/perfusion mismatching in chronic heart failure.     

Native-valve endocarditis caused by Staphylococcus lugdunensis

Coagulase-negative staphylococci cause about 5% of native-valve endocarditis. Staphylococcus lugdunensis, a recently-described species of coagulase-negative staphylococci, has been reported to cause destructive native-valve endocarditis with a high mortality. We report four consecutive cases of definite Staphylococcus lugdunensis native- valve endocarditis by the Duke criteria over a 4-year period. All patients required urgent aortic valve replacement 1-5 days after admission, and recovered. An intriguing, aspect in the presentation of these patients was a history of vasectomy and inguinal skin breaks in the immediate period preceding the occurrence of endocarditis.      

The Basic Knowledge Assessment Tool: Is It Useful?

Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT).Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p=0.02) and those possessing ICU qualifications (p=0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.     

Leaking mycotic abdominal aortic aneurysm

A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes.     

Mouse mutants carrying deletions that remove the genes mutated in Coffin-Lowry syndrome and lactic acidosis

The mouse X-linked mutants lined and stripey are associated with lethality of affected males in utero and a striping of the coat in carrier females. We demonstrate that the underlying mutations are nested deletions which lie in the Phex-Amelx chromosomal segment conserved between man and mouse. The lined deletion contains less than approximately 0.7 cM of genetic material and includes the growth factor- regulated protein kinase gene, Rsk2. Stripey carries a larger deletion which removes approximately 2.0 cM of genetic material, including Rsk2 and the pyruvate dehydrogenase E1alpha subunit gene, Pdha1 . Since Coffin-Lowry syndrome and neonatal lactic acidosis are associated with mutations in the human homologues of Rsk2 and Pdha1 respectively, lined and stripey provide models for gene deficiencies in these disorders.      

Complications affecting preterm neonates from 1991 to 2006: what have we gained?

Aim: In this study, we determined whether outcome of preterm neonates has improved over a period of 16 years. Study design: Inborn neonates with a gestational age of 25.0–29.9 weeks were included. Patients with severe congenital malformations were excluded. Mortality and morbidity (chronic lung disease; CLD, intraventricular haemorrhage: IVH grade III or IV, cystic periventricular leukomalacia: cPVL, perforated necrotizing enterocolitis: NEC, severe retinopathy of prematurity needing surgery: ROP and cerebral palsy: CP) were compared in three periods (period 1: 1991–1996 n = 434; period 2: 1997–2001 n = 356; period 3: 2002–2006 n = 422). Results: Infant mortality decreased from 15.2% to 10.9%. CLD did not differ significantly between periods (14.1–14.8%). Perforated NEC decreased from 2.8% to 1.6%. IVH grade III and IV both remained at 5.7% in period 3, whereas cPVL decreased significantly from 4.5% to 1.6%. Cerebral palsy decreased from 5.8% to 3.5% in period 3. Two neonates in each period were in need of surgery for ROP. Conclusion: Inborn preterm patients showed an improved survival and a significant reduction in cPVL and CP. Perforated NEC showed a trend to decrease. CLD and IVH grade III and IV remain a matter of concern.