Pseudomonas aeruginosa compared with Escherichia coli produces less endotoxemia but more cardiovascular dysfunction and mortality in a canine model of septic shock

We investigated the effects of two different Gram-negative bacteria and radiation-induced leukopenia on endotoxemia, cardiovascular abnormalities, and mortality in a canine model of septic shock. Serial hemodynamics were measured in conscious dogs using radionuclide heart scans and thermodilution cardiac output catheters. Plasma endotoxin concentrations were determined with a chromogenic Limulus amebocyte lysate assay. Viable Pseudomonas aeruginosa or Escherichia coli implanted intraperitoneally produced concordant hemodynamic patterns of septic shock (p less than 0.01). Endotoxin concentrations were more than tenfold lower in dogs infected with P aeruginosa compared with E coli (p less than 0.0001). Despite lower endotoxin levels, P aeruginosa-infected dogs had a higher mortality (p less than 0.01), more severe hypotension (p less than 0.05), and greater depression of the left ventricular ejection fraction (p less than 0.05) than dogs with E coli sepsis. A nonlethal E coli challenge combined with leukopenia (induced by a nonlethal dose of radiation) resulted in a mortality of 60 percent (p less than 0.01) without greater cardiovascular dysfunction or higher endotoxin concentrations. These findings suggest that bacterial products other than endotoxin and host-related factors may be important contributors to the toxicity, cardiovascular instability, and mortality of Gram-negative septic shock. Quantitative determinations of plasma endotoxin are unlikely to correlate with the clinical severity of septicemia in heterogeneous patient populations infected with different Gram-negative organisms.     

Associations between socioeconomic status,atrial fibrillation,and outcomes: a systematic review

ABSTRACT

Background: Atrial fibrillation (AF) is a growing epidemic and evidence of a relationship to socioeconomic status (SES) is inconsistent. We aimed to summarize the literature about SES and AF and defined two objectives: (1) To examine the association between SES and the risk of AF; (2) To examine the association between SES and AF-related outcomes in an AF-population.

Methods: We performed a separate search for each objective in Ovid-MEDLINE and Ovid-Embase. For objective 1, the population included was healthy participants and outcome of interest was AF. For objective 2, the population included were patients with AF and outcome of interest was mortality, treatment, ablation for AF, knowledge about AF, and morbidity.

Results: For objective 1, 12 studies were included. No consistent pattern for an association between SES and the risk of AF was discovered. For objective 2, 39 studies comprising 42 outcomes were included. The majority of studies showed an association between low SES and increased mortality and morbidity.

Conclusion: Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.     

Quantitative magnesium analysis of mononuclear cells: Electron probe x-ray microanalysis and atomic absorption spectroscopy methods compared

We quantitated magnesium concentration of pooled human peripheral mononuclear blood cell populations and individual human peripheral mononuclear blood cells by flame atomic absorption spectroscopy and electron probe X-ray microanalysis, respectively. We found no significant difference (p > .1) between the mean cell magnesium concentrations (61.4 ± 10.9 and 51.2 ± 11.2 mmol/kg dry weight) determined by electron probe X-ray microanalysis and flame atomic absorption spectroscopy, respectively. Using electron probe X-ray microanalysis, we found a 20% variation in magnesium concentration among individual cells. The cell magnesium concentration was independent of cell size, but the cell magnesium content increased with cell volume. We discuss the analytical limitations and artifacts of flame atomic absorption spectroscopy and electron probe X-ray microanalysis for determination of mononuclear blood cell magnesium.     

Evaluation of bacterial contamination in blood processing

In the routine deglycerolization of frozen red blood cells, a bottle of solution intended as a final wash (0.8% NaCl, 0.2% dextrose) was found to be abnormally colored and slightly turbid. Close inspection revealed a small crack in the base of the bottle. A pure growth of Klebsiella pneumoniae was cultured. The rabbit pyrogen test on the solution was positive using 2.5 mul as was the limulus amebocyte lysate (LAL) test at a dilution of 1:10-5 for endotoxin. Studies of the growth of this organism are described and the clinical implications are discussed.     

Surgical Treatment of Dislocations of the Sternoclavicular Joint

Six patients with dislocation of the sternoclavicular joint are presented. Their main complaints were chronic recurrent spontaneous dislocation and local tenderness and discomfort during normal use of the shoulder. Two patients were treated according to Brown's modified procedure while four patients were operated with Burrow's technique. Ten weeks immobilization postoperatively is recommended to obtain a satisfactory result.     

Epiduro-sacral anesthesia in proctology

The experience with 1023 epidural-sacral anesthesias for hemorrhoids, paraproctites, chronic anal fissures, anal papillomas has shown the method to be effective, technically simple, safe and parsimonious. The epidural-sacral anesthesia can be widely used in small proctology.     

Comparison of creatinine as determined with the Ames Seralyzer and by three Jaffé-based methods

We compared results for urinary creatinine, serum creatinine, and creatinine clearance, as determined with the Ames Seralyzer, with results determined with the Beckman ASTRA, the DuPont aca, and Technicon's AutoAnalyzer and SMAC. Results for urinary creatinine from the Seralyzer differed significantly (p less than 0.05) from those obtained with the ASTRA and AutoAnalyzer, but not with the aca. The Seralyzer results for serum creatinine were at least 1.0 mg/L higher (p less than 0.05) than by the other three methods. Results for creatinine clearance from the Seralyzer were 8 to 11 mL/min lower (p less than 0.05) than results by the other three methods. These differences are related to the positive interference by bilirubin in the Seralyzer creatinine method. We also evaluated 23 other compounds for interference with these methods for creatinine.