Cardiac involvement in Lyme disease: manifestations and management

Cardiac involvement in Lyme disease may manifest as atrioventricular block, myopericarditis, and left ventricular dysfunction. Diagnosis depends on recognition of the systemic nature of Lyme disease, including cardiac involvement, and its natural history. Serologic tests that are both sensitive and specific may aid in diagnosis. Although current recommendations for the treatment of Lyme disease with carditis include antibiotics and salicylates or corticosteroids, these types of therapy have not been unequivocally demonstrated to alter the natural history of cardiac involvement. Supportive therapy may necessitate temporary transvenous cardiac pacing in symptomatic patients.     

Fragment length polymorphisms among independent isolates of Epstein-Barr virus from immunocompromised and normal hosts

DNA restriction fragment length polymorphisms of Epstein-Barr virus (EBV) DNA were used as a molecular epidemiological tool to study multiple isolates of virus from the same and different individuals. We studied 35 EBV isolates: 19 from seven immunocompromised children and 16 from seven college students with mononucleosis. Analysis of the fragment length polymorphisms in this collection of isolates permitted several conclusions. Sites of polymorphism were most often encountered in regions with repetitive DNA. Epidemiologically unrelated patients harbored viruses that could be readily distinguished; by contrast, two infants and their mothers harbored similar viruses. Isolates from different sites in the same patient were similar. Variations between different clinical isolates of EBV mimic those found between different laboratory strains of the virus. Fragment length polymorphisms thus provide a useful marker for studying transmission and pathogenesis of EBV infections.     

Mechanism of persistent infection associated with peritoneal implants.

The ability of rabbits to clear an intraperitoneal injection of Pseudomonas aeruginosa in the presence or absence of a surgically implanted peritoneal device was investigated. Sham-operated rabbits without an implant eliminated a P. aeruginosa challenge of 5 x 10(6) cfu/ml; lavage fluid and peritoneal tissues became culture-negative within 96 h. However, peritonitis developed in rabbits that were given the same number of bacteria in the presence of an implant; high bacterial counts were recovered from the lavage fluid and the device itself. Scanning and transmission electronmicroscopy revealed bacterial biofilms on the surface of the device. Insertion of pre-colonised devices demonstrated a rapid multiplication of sessile organisms within the resulting bacterial biofilm. Counts reached a plateau of about 1 x 10(7) cfu/cm2 of Silastic by day 16 and fluctuated around this level until the end of the study. Pre-immunisation with formalin-killed whole cells of P. aeruginosa did not reduce this bacterial growth despite high levels of specific IgG. The results confirm the failure of peritoneal defences to clear an infection in the presence of an implant following either challenge with planktonic bacteria or insertion of a pre-colonised device, and demonstrate the rapid development of bacterial biofilms on the surface of the implant which appear to protect the bacteria from host defences, even when primed by pre-immunisation.     

MMPI subtypes for cocaine abusers.

The MMPIs of 104 cocaine abusers in treatment were subjected to a hierarchical cluster analysis and two basic profile types emerged. Type I consisted of a spike on Pd and a subspike on Hyp, reflecting a rebellious, acting out character-disordered style with narcissistic traits. Type II consisted of a high-ranging, floating profile consisting of marked elevations on F, Sc, Dep, Pt, Pd, and Pa, reflecting a psychiatric patient who concurrently abused cocaine. These findings were contrasted to other MMPI typological studies, and the similarities and differences were discussed.     

Brain tissue reaction following intracerebral injection of free or liposomally encapsulated BSH

Boron neutron capture therapy (BNCT) is a potentially valuable treatment of malignant brain gliomas. A primary requirement for successful BNCT is achieving high local concentration of boron drugs in tumors. Intratumoral injection of liposomes containing boron drug has potential to meet this requirement and could prove to be of significance for BNCT. The brain tissue reaction following the intracerebral injection of a boron drug, BSH, either in solution form or in liposomally encapsulated form, was studied in rats. On histological examination, no evidence of tissue reaction was found after injecting BSH solution, suggesting that high local concentration of BSH was well tolerated. Injection of liposomal BSH was characterized by phagocytic activity at the site of injection, which was regressing by 24 h. Neither group of animals exhibited any signs of abnormal behavior or neurologic deficit. Direct intracerebral injection of BSH liposomes as per-formed in this report could be regarded as tolerable.     

Lumbar Puncture Ordering and Results in the Pediatric Population: A Promising Data Source for Surveillance Systems

Background: The Centers for Disease Control and Prevention is incorporating laboratory data into real-time surveillance systems. When normal patterns of laboratory test orders and results are modeled, aberrations can be detected. Because many test orders are available electronically well before results, atypical patterns of test ordering may signal outbreaks.
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends.     

Thorotrast-associated hepatic leiomyosarcoma and cholangiocarcinoma in a single patient

A 66-year-old man developed two distinct primary malignant hepatic neoplasms (leiomyosarcoma and cholangiocarcinoma) 50 years after Thorotrast administration. This is the first case report of Thorotrast-associated primary hepatic leiomyosarcoma. Ultrastructural and immunohistochemical studies are discussed.     

The epidemiology of nosocomial Pseudomonas cepacia infections: Endemic infections

Pseudomonas cepacia has recently emerged as an important nosocomial pathogen. We analyzed a national nosocomial infections database, the National Nosocomial Infections Surveillance (NNIS) system, to describe the epidemiology of endemic nosocomial P. cepacia infections. Between 1980 and 1985, the P. cepacia nosocomial infection rate was 2.4 per 100,000 patient discharges. During this period, there was a significant increase in the P. cepacia infection rate. The highest infection rate was reported from large medical school-affiliated hospitals. Over 90% of the infections were reported from medicine and surgery services. The most frequently reported site of infection was the lower respiratory tract (31%), followed by blood (20%) and the urinary tract (20%). Nosocomial P. cepacia infections are often associated with mortality, particularly when they involve the lung. These data confirm the hypothesis that P. cepacia is an emerging nosocomial pathogen and suggest that the epidemiology of endemic infections differs from that reported for epidemic inflections.     

Accurate patient history contributes to differentiating diabetes insipidus: a case study.

This case study highlights the important contribution of nursing in obtaining an accurate health history. The case discussed herein initially appeared to be neurogenic diabetes insipidus (DI) secondary to a traumatic brain injury. The nursing staff, by reviewing the patient's health history with his family, discovered a history of polydipsia and long-standing lithium use. Lithium is implicated in drug-induced nephrogenic DI, and because the patient had not received lithium since being admitted to the hospital, his treatment changed to focus on nephrogenic DI. By combining information from the patient history, the physical examination, and radiologic and laboratory studies, the critical care team demonstrated that the patient had been self-treating his lithium-induced nephrogenic DI and developed neurogenic DI secondary to brain trauma. Thus successful treatment required that nephrogenic and neurogenic DI be treated concomitantly.