Salmonella endarteritis, about two cases and their management

Mycotic aneurysms due to Salmonella are a classical but uncommon complication of Salmonella infections. We report two cases of such aneurysms, the first one having developed two successive aneurysms of the iliac arteries due to Salmonella typhimurium. The literature on Salmonella endarteritis is briefly reviewed. The importance of an aggressive surgical approach of the mycotic aneurysm, with removal of all infected material and extra-anatomic bypass through contaminated tissue is emphasized. The role of antibiotic treatment is also discussed.     

Assessment of fracture healing by spectral analysis

The 'in vivo' impulse response of long bones was investigated with the object of assessing the reliability of data taken under various conditions. The ultimate goal of the research is to develop a non-invasive method of monitoring the healing of long bones. A spectrum analyser was developed specifically for this investigation and is presented here.     

Effects of physiological manipulations on locus coeruleus neuronal activity in freely moving cats. III. Glucoregulatory challenge

Insulin-induced hypoglycemia and the subsequent administration of glucose were examined for their effects on single unit activity of locus coeruleus noradrenergic (LC-NE) neurons in unanesthetized, unrestrained cats. LC-NE neuronal activity showed an inverse relationship to blood glucose levels. The activity of most cells increased during sustained hypoglycemia, and then decreased following glucose administration. Some neurons were unaffected by hypoglycemia, but were inhibited following glucose. The activation of LC-NE neurons in response to insulin administration generally paralleled the increase in plasma epinephrine, although the adrenal response was more sensitive. These data, together with those reported in the preceding papers, suggest the following general conclusions: (1) physiological stimuli can influence the activity of LC-NE neurons in unanesthetized subjects (although they do so less strongly than environmental stimuli); (2) these effects of physiological stimuli upon LC-NE neurons can be exerted independent of changes in behavioral state; (3) LC-NE neurons do not appear to play a specific role in the regulation of any of the systems examined, but may instead play a more global role in the response to physiological challenges in general; (4) LC-NE neurons are generally co-activated with both the neural and hormonal components of the sympatho-adrenal system, although sympathetic activation can occur in the absence of increased LC-NE activity. A previously hypothesized role for LC-NE neurons in facilitating the behavioral response to environmental stressors may thus be extended to include the response to physiological challenges, and perhaps facilitation of the physiological as well as the behavioral components of the stress response.     

Capillary microscopy in patients with vasospastic and arterial occlusive diseases

Capillary microscopy and its application for diagnosis and therapeutic evaluation in patients with vasospastic and arterial occlusive disease are described in this report. Capillary microscopy is a noninvasive technique for measuring red blood cell velocity and for determining nutritional blood flow in the capillaries of the skin. This method can be applied in distinguishing patients with Raynaud's phenomenon from those with other disorders involving ischemia of the hand. In patients with atherosclerotic disease of the lower limb, microcirculatory observations can help determine how temperature increases and posturally induced microvascular constriction affect limbs with different degrees of ischemia. Capillary microscopy can also be used to help distinguish between patients who respond and those who do not respond to prolonged treatment for such disorders. Because capillary microscopy can be used to assess microcirculatory hemodynamics and autoregulatory mechanisms in cases of severe ischemia, it should be regarded as an essential tool in the evaluation of patients with upper- and lower-limb ischemia.     

Accuracy of decisions to withdraw therapy in critically ill patients: clinical judgment versus a computer model

Two clinicians and the nursing sisters working in the ICU evaluated the chance of survival of ICU patients every day. Patients were assessed either as "outcome unknown or will die." These predictions were compared with those made by computerized trend analysis of daily acute physiology and chronic health evaluation (APACHE II) scores corrected for the presence and duration of major organ system failure. The predictions were not acted upon during the study. Comparing the predictions with actual hospital outcome, the doctors and nurses had a false-positive diagnosis rate for dying of between 7.7% and 16.7%, while there were no false predictions by the computer model. The patients predicted to die by the doctors and nurses were not completely identical to those predicted by the computer. Predictions of doctors and nurses that were confirmed by the computer had a sensitivity of 20% and no false predictions of death.     

Autonomic control of acid phosphatase exocrine secretion by the rat prostate

Summary In vivo prostatic secretion was collected from retired breeder Sprague Dawley rats using a method for isolated perfusion of the rat prostatic urethra. Enzymatic acid phosphatase determination was performed on the collected effluent. Control acid phosphatase secretion was 24.2±2.7 nm over 30 minutes. Intravenous phenylephrine 5 mg/kg stimulated a 10 fold increase in acid phosphatase secretion. The secretion seen with phenylephrine was dose dependent and could be blocked with prazosin, but not yohimbine, atropine, or propranolol. Intravenous -adrenergic agonist isoproterenol caused no increase in the secretion of rat prostatic acid phosphatese. Intravenous administration of the cholinergic agonist pilocarpine also resulted in a dose dependent rise in acid phosphatase secretion. The stimulation seen could be blocked by atropine but not phentolamine or propranolol. The stimulation of acid phosphatase secretion seen with ₁ adrenergic or cholinergic agonists was not additive. Intravenous vasoactive intestinal peptide did not stimulate acid phosphatase secretion nor did it augment the secretion induced by ₁ adrenergic or cholinergic agonists. Release of acid phosphatase into rat prostatic exocrine secretion is under both ₁ adrenergic and cholinergic control.Supported by the US Veterans Administration     

Effect of defocus on visual acuity as measured by source and observer methods

The relation between refractive error and visual acuity has been measured by two very different methods. In one called "source methods," emmetropes or corrected ametropes view defocused stimuli presented on projection screens or photographs. In the type called "observer methods," focused stimuli are presented to the observers who are either uncorrected ametropes or emmetropes defocused by lenses placed (usually), in the spectacle plane. The study reported in this paper demonstrates for the first time that these two methods of defocusing retinal images and their effects on visual acuity can be correlated. Results show that the source method of producing defocus could be used interchangeably with the observer method in investigating the rates of change of visual acuity with defocus for young normal observers. The angular diameter of the defocused image of a point, the blur disc diameter in object space, allows the two methods to be compared. Although the results show that the two methods are highly correlated, they show that the source method gives a statistically but not clinically significant lower acuity. The results of both methods are used to derive an equation linking refractive error, visual acuity, and pupil diameter.