Acute bacterial endocarditis due to Hemophilus parainfluenzae. Response to ceftizoxime in an ampicillin-allergic patient

Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.     

Segmental intestinal muscular thinning: a possible cause of intestinal obstruction in the newborn

Intestinal obstruction proximal to a transition zone without an interposed physical barrier usually indicates Hirschsprung disease. The authors report one case of focal small bowel muscular thinning just distal to a transition zone that produced clinical and radiographic findings that simulated long-segment Hirschsprung disease in a 2-day-old infant.     

Abnormalities of the liver evaluated by 31P MRS

Clinical phosphorus-31 magnetic resonance spectroscopy (31P MRS) of the liver requires the use of whole-body magnets and of spectroscopy techniques that acquire signal from defined volumes-of-interest within the liver. Such localization techniques and recent clinical studies are briefly reviewed. These studies indicate that (1) high phosphomonoester levels are present in liver diseases involving structural damage, and (2) that MRS of liver tumors may provide a sensitive and rapid indication of response to cancer therapy. Abnormalities of the liver such as alcoholic liver disease, viral hepatitis, and metastasis were analyzed to determine hepatic acid/base status (pH) and to derive absolute molar concentrations of hepatic phosphorus metabolites rather than metabolite ratios. These parameters allow diagnosis and differentiation of several liver pathologies, suggesting an increasing future role of MRS in medical investigation, clinical diagnosis, and patient treatment.     

Anterior ischemic optic neuropathy: Classification of field defects by Octopus™ automated static perimetry

Visual fields of patients with anterior ischemic optic neuropathy (AION) were classified according to quantitative criteria, using the Octopus perimeter. Although a significant altitudinal pattern of field loss was found in 55% of perimetric examinations, the "spared" hemifields routinely showed some loss of sensitivity. This finding, along with the diffuse loss of sensitivity in a high percentage of visual fields, indicates more extensive involvement of the circulation of the anterior optic nerve head than has previously been suggested. Furthermore, patients with diabetes mellitus alone were found to have a statistically separable pattern of visual field loss. The pathophysiologic implications of the visual fields in AION and their relationship to the clinical findings were investigated.     

Immunostimulatory oligodeoxynucleotides induce apoptosis of B cell chronic lymphocytic leukemia cells

Immunostimulatory oligodeoxynucleotides (IS ODN) can mediate a number of immunologic effects. We previously demonstrated that treatment of B cell chronic lymphocytic leukemia (B-CLL) cells with one class of IS ODN, CpG ODN, alters their phenotype and increases their immunogenicity. Here, we demonstrate that in contrast to the classic understanding of CpG ODN as inhibitors of B cell apoptosis, IS ODN including CpG ODN induce apoptosis in B-CLL cells. It is important that these changes are seen not only with CpG ODN but with ODN that lack the classical CpG motif. B-CLL cells from 20 subjects were treated in vitro with IS ODN for up to 7 days. IS ODN treatment resulted in increased numbers of apoptotic cells in 13 out of 20 B-CLL samples. IS ODN enhanced apoptosis in samples with 13q deletion as a single aberration and had a heterogeneous effect on apoptosis in samples with other aberrations including 17p deletion, 11q deletion, or trisomy 12. Induction of apoptosis did not correlate with expression of the CpG ODN receptor Toll-like receptor 9. Apoptosis was dependent on the activation of caspases and was accompanied by up-regulation of CD95/Fas and its ligand. We conclude that IS ODN including CpG ODN can induce apoptosis of most B-CLL samples. The ability of IS ODN to induce apoptosis differs based on cytogenetic status. Up-regulation of CD95/Fas may play a role in IS ODN-induced apoptosis of B-CLL.