Legionnaires' disease in a renal transplant recipient: nosocomial or home-grown?

Legionnaires' disease is a community-acquired or hospital-acquired pneumonia, and the immunocompromised patient is at particular risk. We report a case of serogroup 1 pneumonia in a renal transplant patient shortly after grafting. No source of infection was identified in the hospital unit, but an extended investigation located patient exposure to a shower during a weekend home stay. Sampling at the hospital, in the patient's flat, other flats, and the laundry of the same building returned only one positive result from the patient's showerhead. Strain identity was confirmed by pulsed-field electrophoresis and amplified fragment length polymorphism. Guidelines recommend -free water for transplant units, but further epidemiologic evidence is required before extending this preventive approach to the patient's home.     

The effects of hydroxyethyl starches on intracellular calcium in platelets

Hydroxyethyl starch (HES) solutions impair platelet function. To determine whether this effect is achieved through interference of HES with intracellular activation processes, in which calcium is the key second messenger, we evaluated the agonist-induced increase of the cytoplasmic calcium concentration in the presence of HES of different molecular weights. Aliquots of citrated whole blood of 12 volunteers were incubated in vitr. with saline, HES 450 (molecular weight in kilodalton), HES 130, and HES 70, resulting in 20% hemodilution. An undiluted sample served as control. The samples were stained with Fluo-3 as the calcium-sensitive fluorescent probe with subsequent flow cytometric analysis. After determination of a baseline, platelets were activated with thrombin receptor activator peptide 6. Platelet activation with thrombin receptor activator peptide 6 resulted in a fast increase in fluorescence (approximately eightfold), representing intracellular calcium mobilization. None of the tested HES solutions exerted a statistically significant effect on the cytoplasmic calcium concentration compared with samples that were incubated with saline or that remained undiluted. These results indicate that the known inhibiting effect of HES on platelets is not achieved through interference with intracellular activation processes. IMPLICATIONS: Hydroxyethyl starch does not exert its known inhibitory effect on platelet function by interfering with intracellular activation processes.     

Treatment of persistent tachycardia with dexmedetomidine during off-pump cardiac surgery

IMPLICATIONS: After unsuccessful treatment of intraoperative tachycardia with esmolol during off-pump revascularization, heart rate was successfully reduced with a bolus and infusion of dexmedetomidine.     

Growth factor regulation of enterocyte nutrient transport during intestinal adaptation

BACKGROUND: Intestinal adaptation occurs in response to injury or alteration in nutrient availability. It is both morphologic and physiologic in nature and can be mediated by growth factors and nutrients. Pathologic conditions such as short-bowel syndrome and inflammatory bowel disease lead to derangements in nutrient absorption that may exceed the body's regenerative and adaptive capacity. Failure to fully adapt often results in long-term dependence on parenteral nutrition, leading to decreased quality of life and excessive medical expenses. The therapeutic use of appropriate growth factors may increase the adaptive capabilities of the gut. DATA SOURCE: Medline and current literature review. CONCLUSIONS: The major known nutrient transporters present in the gut and the mechanisms by which growth factors alter transport activity during intestinal adaptation are summarized. Growth factors have the potential to improve nutrient absorption in some bowel diseases.     

Peroxide als Pflanzeninhaltsstoffe, 12. Mitt.: Peroxide vom Davanon-Typ aus der Eberraute (Artemisia abrotanum) und ihre Darstellung

Peroxides as Plant Constituents, XII: Davanone Type Peroxides from Artemisia abrotanum and Their Preparation From the aerial parts of Artemisia abrotanum L. (Asteraceae), besides (+)-Davanone ( 1 ) and Arteincultone ( 2 ), the known peroxy-semiketals 2 , 5 , and 7 were isolated. In addition, the previously unknown davanone type peroxides epi-arteincultone ( 4 ) and spiro-arteincultone ( 6 ) were identified in A. abrotanum by TLC. By means of singlet oxygen oxidation of 1 , compounds 2, 3, 4, 5 , and 7 are formed, by triplet oxygen oxydation compounds 2, 3, 5, 6, 7 as well as hydroxy-davanone.