The presenting ECG pattern in survivors of cardiac arrest and its relation to the subsequent long-term survival

In a prospective multi-center study, 262 patients were given general intensive care therapy following cardiopulmonary resuscitation if they were still comatose and unresponsive to pain 10 min after restored spontaneous circulation. Mortality (mainly cardiac) was 53.4% over the first 10 days, and 49% of the remaining survivors died between 10 days and 6 months. In the subsequent 6 months few patients died. Presenting electrocardiograms (ECG) showed ventricular fibrillation (VF) in 54.2%, asystole in 29.8% and electromechanical dissociation (EMD) in 9.2% of the patients. One-year survival, 14.1% for asystole, 4.2% for EMD and 26.0% for VF and VT (ventricular tachycardia), differed significantly (P less than 0.01). VF/VT patients were older and had more cardiovascular disease. Adjustments of these and other covariates increased the significance of difference between ECG groups. Successful resuscitations from asystole or EMD appeared to be more common than has previously been reported, but this group of patients experienced an extremely high cardiac mortality over the first 6 months following resuscitation.     

Exocrine contamination impairs implantation of pancreatic islets transplanted beneath the kidney capsule

The effect of exocrine contamination on islets implanted under the kidney capsule has been studied by histological examination of pure or exocrine-contamination human, monkey, or rat islets transplanted to the kidney capsule of the nude rat, monkey, or rat, respectively. Exocrine contamination resulted in an appearance suggestive of impaired islet implantation, due to tissue necrosis and subsequent fibrosis. The effect of exocrine contamination was examined quantitatively in a rat islet isograft model in which handpicked DA rat islets were transplanted under the kidney capsule of normal DA rats. The islets were either pure or deliberately recontaminated with exocrine tissue (50 or 90% contamination). Four hundred pure islets were placed under one kidney capsule and 400 islets (of similar size and from the same islet preparation) were contaminated and then placed under the contralateral kidney capsule. After 2 weeks the kidneys were removed and extracted for insulin content. The insulin content of kidneys bearing islets contaminated by either 50 or 90% exocrine tissue was significantly reduced when compared to the contralateral kidney bearing pure islets. These findings support the view that exocrine contamination of islets resulted in impaired islet implantation when transplanted to a confined site such as the kidney subcapsule.     

Performance of Diltiazem Tablet and Multiparticulate Osmotic Formulations in the Dog

The in vivo performance of two extended-release (ER) osmotic formulations of diltiazem were evaluated in the beagle dog. Both ER formulations had similar bioavailabilities (F) as the diltiazem solution. Although F was somewhat variable following ER administration, this variability may be related to the drug entity since intra- and interanimal variability of orally administered diltiazem solutions was substantial. Deconvolution of the ER plasma diltiazem data with absorption data from the orally administered diltiazem solutions provided an estimate of the in vivo drug release from the ER formulations. The two ER formulations, designed with different in vitro release profiles, reflected these differences in vivo, with nearly identical respective in vivo and in vitro release profiles.     

Giardiasis with protein-losing enteropathy

Generalized edema and ascites were the main presenting features of giardiasis in a 3-year-old boy. Hypoalbuminemia, jejunal villous atrophy, Giardia lamblia in the duodenal aspirate, and abnormal gastrointestinal protein loss were present before therapy with metronidazole. Eradication of parasites resulted in complete clinical, histological, and biochemical remission. Giardiasis must now be included in the etiology of protein-losing enteropathy.     

Pulmonary changes associated with dead filariae (Dirofilaria immitis) and concurrent antigenic exposure in dogs

Initially, a group of 5 dogs had their left pulmonary artery ligated 7 months prior to the insertion of filariae (Dirofilaria immitis). A second group of 3 dogs was used as controls for the various components of the experiment. Antigen (D. immitis) was injected subcutaneously on 3 occasions and necropsy was performed 5 weeks after insertion of filariae. These results were then compared to those from the control dogs. With exposure to antigen, severe pulmonary arterial and parenchymal disease was produced in association with the insertion of dead D. immitis filariae into the pulmonary artery. In the dogs receiving antigen, the arterial and peri-arterial pathology was generally more intense and at a more advanced stage of organization than in the control animals. Interstitial pneumonitis was also more prominent in the antigen-stimulated dogs. The advanced nature of the reaction was also reflected in the skin histology of the injection sites. The pathology was similar to that reported for natural dirofilariasis and it appears that most of the pathology of dirofilariasis is associated with reactions to dead filariae or filarial by-products and concurrent antigenic experience.     

Effect of hyperbaric oxygen on the blood: cerebrospinal fluid transfer of tobramycin

The blood:cerebrospinal fluid (CSF) transfer of the aminoglycoside antibiotic, tobramycin (TOB) was assessed in rabbits. The CSF:blood ratio of TOB, 90 min after a subcutaneous injection, was approximately 1:100 as measured by an agar disc diffusion bioassay. Hyperbaric oxygen therapy at a pressure of 3 ATA caused a slight, non-significant, increase in this ratio, while high dose carbon dioxide, a treatment known to damage the blood:brain barrier, more than doubled this ratio. Thus, hyperbaric oxygen has no significant effect on CSF concentration of TOB in rabbits with intact meninges.     

Group B streptococcal necrotizing fasciitis arising from an episiotomy

A case of extensive necrotizing fasciitis arising from an episiotomy is presented. Group B beta-hemolytic streptococcus and Staphylococcus aureus were isolated. Prompt recognition and aggressive therapy resulted in a favorable outcome despite significant morbidity. Salient clinical features of this rare postpartum complication are discussed and previous cases are reviewed. In addition to wide surgical resection, therapy included aggressive volume resuscitation with Swan-Ganz catheter monitoring, the use of military antishock trousers (MAST suit) to control diffuse hemorrhage, and temporary application of porcine xenografts.     

Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.