Case report: penetrating cardiac injury secondary to a terrorism-related nail bomb explosion

Penetrating cardiac injuries commonly occur secondary to gunshot or stab wounds. This is a report an unusual case of a patient who sustained a penetrating cardiac injury due to a nail from a terrorism-related, nail-bomb explosion. Associated problems included pericardial tamponade, penetrating cardiac injuries, acute, traumatic, myocardial infarction, and a penetrating lung injury. Prompt diagnosis and aggressive surgical intervention resulted in full recovery of the patient.     

Feeding back surveillance data to prevent hospital-acquired infections

We describe the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Elements of the system critical for successful reduction of nosocomial infection rates include voluntary participation and confidentiality; standard definitions and protocols; identification of populations at high risk; site-specific, risk- adjusted infection rates comparable across institutions; adequate numbers of trained infection control professionals; dissemination of data to health-care providers; and a link between monitored rates and prevention efforts.     

Nephrogenic Diabetes Insipidus and Dwarfism: Rare Combination in a Female Patient

A young girl with perinatal history of breech presentation and Caesarian section delivery exhibited symptoms of diabetes insipidus and marked shortness of stature. Possibility of anti-diuretic hormone and growth hormone deficiencies was ruled out completely by extensive endocrinological studies, which instead demonstrated the existence of nephrogenic diabetes insipidus (NDI) in this patient. Turner's syndrome was denied by normal female karyotype. Her dwarfism could not be explained by other causes than NDI. Review of the literature, however, shows that combination of NDI and dwarfism is extremely rare condition in a female case of the disease.     

The influence of aging on renal blood flow in human beings

Object: We studied the relationship between age and renal blood flow parameters to determine the clinical significance of using Doppler color flow imaging (CFI) in their measurement.Subjects and Methods: One hundred forty-four healthy subjects with no renal or circulatory diseases took part in this study. All subjects were placed in the prone position and examined with CFI. The kidney was visualized in a longitudinal view, and blood flow in the interlobar arteries was studied. Peak systolic flow velocity (Vmax), end-diastolic flow velocity (Vmin), and resistive index (RI) were used as blood flow parameters.Results: Age and Vmax were not significantly associated (p=0.03) in the interlobar artery. Vmin decreased significantly (p<0.01) with age, while RI increased significantly (p<0.01) with age. No statistically significant sex-related renal blood flow parameters were found.Discussion: Ishimura et al have reported that RI was significantly correlated with age in diabetic patients. Here the same result was obtained in healthy subjects. The incidence of arteriosclerosis is known to increase with age. In general, RI is influenced by vascular resistance. Increase in RI with age in this study was explained by the effect of arteriosclerosis on age-related vascular resistance. These results suggest that age should be considered in the study of blood flow in the kidney.     

P-Glycoprotein-Mediated Transport of Itraconazole across the Blood-Brain Barrier

The mechanism for the accumulation of itraconazole (ITZ) in its elimination from the brain was studied in rats and mice. The concentration of ITZ in liver tissue declined in parallel with the plasma ITZ concentration until 24 h after intravenous injection of the drug (half-life, 5 h); however, the ITZ in brain tissue rapidly disappeared (half-life, 0.4 h). The time profiles of the brain/plasma ITZ concentration ratio (K_p value) showed a marked overshooting, and the K_p value increased with increasing dose; these phenomena were not observed in the liver tissue. This finding indicates the occurrence of a nonlinear efflux of ITZ from the brain to the blood. Moreover, based on a pharmacokinetic model which hypothesized processes for both nonlinear and linear effluxes of ITZ from the brain to the blood, we found that the efflux rate constant in the saturable process was approximately sevenfold larger than that in the nonsaturable process. The K_p value for the brain tissue was significantly increased in the presence of ketoconazole or verapamil. The brain K_p value for mdr1a knockout mice was also significantly increased compared with that of control mice. Moreover, the uptake of vincristine or vinblastine, both of which are substrates of the P glycoprotein (P-gp), into mouse brain capillary endothelial cells was also significantly increased by ITZ or verapamil. In conclusion, P-gp in the brain capillary endothelial cells participates in a process of active efflux of ITZ from the brain to the blood at the blood-brain barrier, and ITZ can be an inhibitor of various substrates of P-gp.