Head injury mortality in two centers with different emergency medical services and intensive care

The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p less than 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p less than 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with "moderate" head injuries.     

Das Verhalten von Blutdruck und Nierendurchblutung während des Carotissinus-Reflexes am wachen Hund

Zusammenfassung An 15 Bastardhunden wurde der Einfluß einer Na-Pentobarbital-Narkose sowei einer zusätzlichen chirurgischen Präparation auf die Ruhewerte von Blutdruck und Nierendurchblutung und deren Änderung nach doppelseitigem Carotisverschluß im Vergleich zum wachen Tier untersucht.Barbiturat-Injektion (30 mg/kg i.v.) allein erhöhte die Herzfrequenz, den systolischen und diastolischen Blutdruck, änderte jedoch nicht die mittlere Nierendurchblutung. Zusätzliche chirurgische Präparation verstärkte diese Veränderungen mit Ausnahme vom systolischen Blutdruck und der Nierendurchblutung.Bei Carotisverschuluß kam es im steady state zu einer vermehrten reflektorischen Herzfrequenzsteigerung nach Barbiturat-Injektion sowie nach Barbiturat mit chirurgischer Präparation. In Barbiturat-Narkose stieg der mittlere Blutdruck stärker an als am wachen Tier; diese Veränderung war nach chirurgischer Präparation noch deutlicher ausgeprägt. Die mittlere Nierendurchblutung wurde im steady state in keiner der 3 Gruppen signifikant verändert. Der reflektorische Herzfrequenz- und Blutdruckanstieg erfolgte im Wachzustand rascher als nach Barbiturat und Barbiturat mit chirurgischem Trauma. Unter letzteren Bedingungen fehlte auch das im Wachzustand beobachtete Unterschießen der Herzfrequenz nach Öffnen der Carotismanschetten. Der druckpassive overshoot der Nierendurchblutung am wachen Tier fehlte sowohl nach Barbiturat als auch nach zusätzlicher chirurgischer Präparation.Die Ergebnisse zeigen, daß der mit Na-Pentobarbitural narkotisierte und der narkotisierte, akut operierte Hund gegenüber dem Wachzustand betreffend der Ruhewerte und der reflektorischen Veränderungen der Herzfrequenz und des Blutdrucks im steady state des Carotissinus-Reflexes zwei quantitativ unterschiedlich reagierende Kreilaufpräparate liefert. Gemessen an der Beseitigung sowohl der raschen Herzfrequenz- und Blutdruckveränderungen als auch des phasischen Einschwingvorganges der Nierendurchblutung durch Narkose und Narkose mit Trauma unterscheiden sich solche Präparate auch qualitativ vom Wachzustand.Mit Unterstützung der Deutschen Forschungsgemeinschaft.     

New provisional serovar (E10163) of Shigella boydii

A long-term outbreak of urinary tract-associated multiply resistant Providencia stuartii occurred in a large medical facility that included a 513-bed chronic care unit. The unique characteristics of this outbreak were that from within a single medical facility, P. stuartii with multiple serotypes, biotypes, and antibiograms could be identified. The organisms isolated had five different biotypes, seven different antibiograms, and two major serotypes. All of the organisms were susceptible to amikacin, cefamandole, and cefoxitin. Application of standard infection control measures impeded the spread of this outbreak, and it slowly terminated 16 months later.     

Nitric oxide participates in the intestinal pathology associated with murine syngeneic graft-versus-host disease

Syngeneic graft-versus-host disease (SGVHD) develops following lethal irradiation, reconstitution with syngeneic bone marrow, and treatment with a short course of cyclosporin A (CsA) therapy. The disease is characterized by the development of a T helper cell type 1-like cytokine response [interleukin (IL)-12, interferon-gamma (IFN-gamma), and tumor necrosis factor alpha], and macrophage activation is central to development of the syndrome. It has been shown that nitric oxide (NO) participates significantly in the development of allogeneic GVHD. Studies were initiated to determine if NO participates in the pathology associated with SGVHD. Significant increases in inducible NO synthase (iNOS) mRNA and circulating NO were found in the tissues of SGVHD versus control animals. Treatment of SGVHD animals with the iNOS inhibitor aminoguanidine (AG) reversed the pathology associated with this disease. Furthermore, AG treatment reduced the production of IL-12 and IFN-gamma mRNA in the colons of CsA-treated mice. These studies demonstrate that NO participates in the pathological processes that are associated with the development of murine SGVHD.     

Improvement in ischemic myocardial blood flow following a new calcium antagonist

The effect of FR 7534, a new dihydropyridine CA2+ antagonist, nitroglycerin, and dipyridamole have been compared on coronary collateral function in pentobarbital-anesthetized open-chest dogs following acute ligation of the left anterior descending coronary artery. Measurements of tissue blood flow using radioactive microspheres were made 60 min postligation after low and high doses of each drug and at the higher dose with methoxamine added to to return mean aortic pressure. FR 7534 treatment increased subepicardial, subendocardial, and transmural tissue flow by 100% in the central ischemic zone when perfusion pressure was controlled by methoxamine. Nitroglycerin also increased ischemic tissue flow, but to a lesser degree, 18% transmurally. Dipyridamole produced no significant change. Tissue flow in normal myocardium was similarly increased by FR 7534 and dipyridamole but slightly reduced by nitroglycerin. FR 7534 and nitroglycerin also increased retrograde coronary pressure when aortic presure was maintained constant. FR 7534, but not nitroglycerin, increased ischemic contractile force. In this model, FR 7534 may produce greater effects than nitroglycerin in increasing blood supply to ischemic myocardium delivered by endogenous collaterals especially when aortic perfusion pressure was controlled.     

Enterotoxigenic Escherichia coli in central Canada.

During epidemiological studies carried out in urban and rural areas of the midwestern Canadian province of Manitoba, we cultured enterotoxigenic Escherichia coli (ETEC) from 16 (1.7%) of 945 diarrheal stools and 4 (0.3%) of 1,282 normal stools. ETEC was found in not more than 2.3% of diarrheal stools obtained from any population during any season. Diarrhea associated with ETEC persisted for a mean of 9 days. Two children were dehydrated and required intravenous fluid therapy, and one adult suffered a cholera-like syndrome. Half of the children required hospitalization for management of their diarrhea. Two adults and two children who harbored ETEC were completely asymptomatic. The pattern of toxin production correlated with serotype and the serotypes encountered were (with a few exceptions) similar to those found in other areas. We conclude that ETEC is an uncommon cause of diarrhea, both in rural and urban areas of central Canada. However, the possibility that ETEC might cause severe sporadic cases or epidemics of gastroenteritis remains.     

Threshold pressure for the pressure-dependent renin release in the autoregulating kidney of conscious dogs

1. The effect of varying renal artery pressure between 160 and 40 mm Hg on renal blood flow and renin release was studied in seven conscious foxhounds under β-adrenergic blockade receiving a normal sodium diet (4.1 mmol/kg/day). Pressure was either increased by bilateral common carotid occlusion or reduced in steps and maintained constant by a control-system using an inflatable renal artery cuff. Carotid occlusion itself had no influence on renal blood flow and renin release when renal artery pressure was kept constant and the β-receptors in the kidney were blocked.
2. Between 160 mm Hg and resting pressure there was no change in renal blood flow; between resting blood pressure and the lower limit of autoregulation (average 63.9 mm Hg) renal blood flow increased slightly (average 7%) indicating a high efficiency of renal blood flow autoregulation.
3. The relationship between renal artery pressure and renin release could be approximated by two linear sections:a low sensitivity to a pressure change (average slope: ?0.69 ±0.26ng AI/min/mm Hg) was found above a threshold pressure (average: 89.8±3.3 mm Hg) and a high sensitivity to a pressure change (average slope: ?64.4±20.8 ng AI/ min/mm Hg) was observed between threshold pressure and 60 mm Hg. There was no further increase of renin release between 60 and 40 mm Hg.
4. It is concluded that within the autoregulatory plateau the kidney of a conscious β-blocked dog receiving a normal sodium diet releases only negligible amounts of renin until renal artery pressure falls below a threshold pressure of 90 mm Hg which is close to the animals resting systemic pressure. Since beyond that a decrease of systemic pressure by as little as 1.3 mm Hg below threshold can raise resting renin release (84.8±29.8 ng/min) by 100%, it is suggested that systemic blood pressure tends to stabilize at a level at which renin release is minimal.

     

Differentiation between mouse-virulent and -avirulent strains of Toxoplasma gondii by a monoclonal antibody recognizing a 27-kilodalton antigen.

Using a murine monoclonal antibody, we were able to differentiate between mouse-virulent and -avirulent strains of Toxoplasma gondii. Monoclonal antibody TB6G5 was reactive with eight clinical mouse-avirulent isolates but not with mouse-virulent laboratory strains RH and BK. The antibody-reactive antigen was identified by indirect immunofluorescence and immunoblot as a 27-kDa cytoplasmic protein expressed by tachyzoites as well as by bradyzoites.     

Colonization and maintenance of murine embryonic stem cells on poly(alpha-hydroxy esters)

The aim of this study was to determine the ability of various poly(alpha-hydroxy esters) to support the in vitro propagation of murine embryonic stem (ES) cells in an undifferentiated state. To this end, ES cell colonization, growth and Oct-4 immunoreactivity following a 48 h culture period upon poly((D,L)-lactide), poly((L)-lactide), poly(glycolide) and poly((D,L)-lactide-co-glycolide) (PLGA) were assessed. By the analysis of live and dead cell number indices and Oct-4 immunoreactivity, ES cell colonization rate during a 48 h culture period was found to be significantly greater on PLGA compared to all the other unmodified poly(alpha-hydroxy esters) tested. Surface treatment of all polymers with 0.1m potassium hydroxide revealed a significant increase in ES cell live numbers when compared to all unmodified polymers, thus revealing a correlation between polymer content, hydrophilicity and colonization rate. These data suggest that surface treated poly(alpha-hydroxy esters) may be employed for ES cell scale up procedures and in tissue engineering applications requiring the colonization of scaffolds by ES cells in an undifferentiated state. According to such applications, once the designated scaffold has been colonized, ES cell directed differentiation into the desired and fully differentiated, functional adult tissue may then be effected.