Cardiac involvement in pheochromocytoma

We report the details of a 40-year-old farmer, a cigarette smoker, who was admitted with general malaise, nausea, vomiting, upper abdominal pain, with ST-elevation on ECG suggestive of an acute anterolateral myocardial infarction. He was treated with nitrates, heparin, beta-blockade and angiotensin-converting enzyme (ACE) inhibitors. Because of the presence of some blood while vomiting no thrombolysis was given and abdominal echography was performed. This revealed a nodular mass at the right adrenal gland. Urinary catecholamines and abdominal magnetic resonance imaging confirmed the suspected diagnosis of pheochromocytoma. Before adrenectomy, a coronary angiography under alpha blocker therapy was performed, which demonstrated no significant coronary artery disease, although the patient showed ST-elevations on ECG. Pathological examination of the adrenal tumor was compatible with a diagnosis of pheochromocytoma. Postoperatively urinary catecholamines dropped dramatically, and the ECG normalised slowly over time. After 8 months the patient is still well. Blood pressure is well controlled with no antihypertensive drugs and exercise testing shows no evidence of myocardial ischaemia.     

Pediatric Prevention Network: a multicenter collaboration to improve health care outcomes

Nosocomial infections and antimicrobial resistance are major causes of mortality and morbidity and have become a major public health focus. To date, most national and international nosocomial infection surveillance and prevention activities have been focused on adults, despite the fact that pediatric patients are at high risk for nosocomial infections because of their immature immune systems and prevalent device usage. In 1997 the Hospital Infections Program at the Centers for Disease Control and Prevention and the National Association of Children's Hospitals and Related Institutions partnered to establish a Pediatric Prevention Network. Infection control professionals and their hospital administrators at all children's hospitals were invited to participate. The objectives of the network are to establish baseline infection rates; design, implement, and evaluate prevention interventions; establish benchmark rates and best practices; and serve as a site for multicenter studies to improve outcomes for hospitalized children. This network serves as a model for quality improvement systems in health care.     

Bacterial evasion of the antibody response: human IgG antibodies neutralize soluble but not bacteria-associated group B streptococcal C5a-ase.

Most strains of group B streptococci (GBS) possess an enzyme that inactivates the human anaphylatoxin C5a by cleaving a heptapeptide from the carboxyl terminus of C5a. This enzyme, called GBS C5a-ase, has been purified to homogeneity and cleaves and inactivates C5a in physiologic buffer. The enzymatic activity of soluble C5a-ase is completely inhibited, however, in the presence of plasma or serum from normal human adults. The neutralization of soluble C5a-ase by plasma and serum results largely from naturally occurring IgG antibodies directed against C5a-ase. IgG does not neutralize C5a-ase present on intact encapsulated type III GBS but does neutralize the C5a-ase activity associated with a transposon-induced mutant strain of type III GBS that lacks capsule. The location of GBS C5a-ase on the surface of encapsulated type III GBS permits the C5a-ase to inactivate C5a while evading neutralization by IgG antibodies.     

Cone‐Beam Computed Tomography for Detection of Intrabony and Furcation Defects: A Systematic Review Based on a Hierarchical Model for Diagnostic Efficacy

Background: The aim of this review is to assess the diagnostic efficacy of cone‐beam computed tomography (CBCT) for the diagnosis of and/or treatment planning for intrabony and furcation defects, using a well‐known six‐tiered hierarchical model for diagnostic efficacy. Methods: The MEDLINE, EMBASE, and Cochrane Library bibliographic databases were searched until August 2015 for studies evaluating CBCT imaging for the diagnosis of and/or treatment planning for intrabony and/or furcation defects. The search strategy was restricted to English language publications using the combination of MeSH terms, free terms, and key words. Results: The search strategy yielded 16 publications that qualitatively or quantitatively evaluated the use of CBCT for the detection of intrabony and/or furcation defects and how CBCT influenced the diagnosis and/or treatment plan. According to Quality Assessment of Studies of Diagnostic Accuracy‐2, all included studies were medium to low risk of bias. The review identified only one study that investigated the societal efficacy, and none evaluated the patient outcome efficacy or therapeutic efficacy. One study investigated the diagnostic thinking efficacy. All other included studies investigated the diagnostic accuracy of CBCT. Conclusions: From the assessed studies, it can be concluded that there is not sufficient scientific evidence to justify the use of CBCT for the diagnosis of and/or treatment planning for intrabony and furcation defects. Furthermore, the effectiveness of CBCT for such diagnostic tasks has been assessed only at low diagnostic efficacy levels.     

Preventing angiographic progression of coronary atherosclerosis with pravastatin

We conducted a prospective study to investigate the relationship between the decrease of serum lipid levels during pravastatin therapy and changes of coronary angiography parameters in Japanese patients with coronary atherosclerosis. The patients were predominantly male, aged between 18 and 75 years (mean: 58 years), had at least 25% stenosis of one or more major coronary arteries, and had a serum total cholesterol ( TC) level > or = 200 mg/dl (5.18 mM/l). Treatment with pravastatin (10 mg/day) was continued for 3 years. Coronary angiography was performed before and 3 years after the start of pravastatin therapy to assess the relationship between the mean segment diameter (MSD), the minimal lumen diameter (MLD), and the annual changes of percent stenosis and TC levels. of 265 patients who were initially registered, 129 were followed for an average of 35 months. Consequently, second angiograms were only obtained in 68 patients for various reasons, so this group was used for analysis. During pravastatin therapy, the TC level significantly decreased from 239 mg/dl (6.19 mM/l) to 210 mg/dl (5.44 mM/l) (a 12% reduction; p<0.001). In addition, HDL-cholesterol increased by 5% (p=0.007), but the triglyceride level did not show a significant change. Both MSD and MLD were significantly improved on follow-up angiography, increasing from 2.67 mm to 2.76 mm and from 2.09 mm to 2.13 mm, respectively. However, no change of percent stenosis was observed. The mean TC level during treatment did not show any significant correlation with the changes of angiography parameters. However, a significant correlation was observed between the percent reduction of TC and the annual change of MSD (r=-0.272, p=0.027). A similar relationship was also found between the change of MLD and the percent reduction of TC (r=-0.260, p=0.035). In conclusion, the percent decrease of serum cholesterol may be a better indicator of clinical efficacy than the absolute cholesterol level during pravastatin therapy.