Inhibitors of polyamine biosynthesis. 3. (+/-)-5-Amino-2-hydrazine-2-methylpentanoic acid, an inhibitor of ornithine decarboxylase.

(+/-)-5-Amino-2-hydrazino-2-methylpentanoic acid [alpha-hydrazino-alpha-methyl-(+/-)-ornithine] was obtained from 1-phthalimidopentan-4-one by treatment with hydrazine and KCN followed by acid hydrolysis. The title compound was found in vitro to be a potent competitive inhibitor of ornithine decarboxylase obtained from the prostate glands of rats. This inhibition was abolished at high concentrations of pyridoxal phosphate. The title compound also blocked the increase in putrescine levels normally observed in bovine lymphocytes transformed by conconavalin A.     

Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients

BACKGROUND: An unplanned admission to the intensive care unit within 24 h of a procedure (UIA) is a recommended clinical indicator in surgical patients. Often regarded as a surrogate marker of adverse events, it has potential as a direct measure of patient safety. Its true validity for such use is currently unknown. METHODS: The authors validated UIA as an indicator of safety in surgical patients in a prospective cohort study of 44,130 patients admitted to their hospital. They assessed the association of UIA with intraoperative incidents and near misses, increased hospital length of stay, and 30-day mortality as three constructs of patient safety. RESULTS: The authors identified 201 patients with a UIA; 104 (52.2%) had at least one incident or near miss. After adjusting for confounders, these incidents were significantly associated with UIA in all categories of surgical procedures analyzed; odds ratios were 12.21 (95% confidence interval [CI], 6.33-23.58), 4.06 (95% CI, 2.74-6.03), and 2.13 (95% CI, 1.02-4.42), respectively. The 30-day mortality for patients with UIA was 10.9%, compared with 1.1% in non-UIA patients. After risk adjustment, UIA was associated with excess mortality in several types of surgical procedures (odds ratio, 3.89; 95% CI, 2.14-7.04). The median length of stay was increased if UIA occurred: 16 days (interquartile range, 10-31) versus 2 days (interquartile range, 0.5-9) (P < 0.001). For patients with a UIA, the likelihood of discharge from hospital was significantly decreased in most surgical categories analyzed, with adjusted hazard ratios of 0.41 (95% CI, 0.23-0.77) to 0.58 (95% CI, 0.37-0.93). CONCLUSIONS: These findings provide strong support for the construct validity of UIA as a measure of patient safety.     

Corneal distribution of subconjunctival antibiotics.

Radioactive carbon-labeled penicillin G, chloramphenicol, or gentamicin were injected subconjunctivally into rabbit eyes. The distribution of antibiotics throughout the cornea was determined in relation to the injection site; aqueous humor levels were also measured. For chloramphenicol, the highest drug concentrations in the cornea were adjacent to the injection site; levels decreased as the distance from the injection site increased. For penicillin G and gentamicin, highest corneal levels were adjacent to the injection site. Levels were lowest in the central cornea but increased in the peripheral cornea, 180 degrees opposite the injection site. For all antibiotics, therapeutic levels were reached throughout the cornea irrespective of the injection site. Corneal values for all drugs were consistently higher than aqueous humor values. These results suggest that in the treatment of corneal ulcers the choice of subconjunctival injection site is not important.     

Local therapeutic treatments for focal liver disease

Patients diagnosed with primary hepatic malignancies or metastases to the liver remain a difficult population to treat. A small percentage of these people can undergo surgical resection or transplantation. The remaining nonsurgical aggregate does not often benefit from conventional radiation and chemotherapy; minimally invasive means either to cure or palliate these patients are a requirement for complete cancer care. This article discusses image-guided local therapies used to treat this difficult patient population, focusing predominantly on radiofrequency ablation.     

Phaeohyphomycotic soft tissue infections caused by the coelomycetous fungus Microsphaeropsis arundinis

Microsphaeropsis arundinis is an anamorphic fungal plant inhabitant belonging to the form class Coelomycetes. We describe two cases of M. arundinis soft tissue infections in immunosuppressed patients. This organism has not previously been described as causing disease in humans. It was identified on the basis of its typical ostiolate pycnidial conidiomata, ampulliform conidiogenous cells, and small, smooth-walled, brown, cylindrical conidia.