Development of a Coroner-Based Surveillance System for Drug-Related Deaths in Los Angeles County

Existing data sources do not provide comprehensive and timely information to adequately monitor drug-related mortality in Los Angeles County. To fill this gap, a surveillance system using coroner data was developed to examine patterns in drug-related deaths. The coroner provided data on all injury deaths in Los Angeles County. A list of keywords that indicate a death was caused by drug use was developed. The cause of death variables in the coroner data were searched for mentions of one of the keywords; if a keyword was detected, that death was classified as drug related. The effectiveness of the keyword list in classifying drug-related deaths was evaluated by matching records in the coroner death data to records in the state death files. Then, the drug-related deaths identified using the keywords were compared to drug-related deaths in the state mortality files identified using International Classification of Death codes. Toxicological test results were used to categorize drug-related deaths based on the type and legality of the drug(s) ingested. Mortality rates were calculated for each category of drug and legal status and for different demographic groups. Compared to the gold standard state mortality files, the coroner data had a sensitivity of 95.6% for identifying drug-related deaths. Over three quarters of all drug-related deaths tested positive for opiates and/or stimulants. Males, Whites, and 35–54-year-olds each accounted for more than half of all drug-related deaths. The surveillance of drug-related deaths using coroner data has several advantages: data are available in a timely fashion, the data include information about the specific substances each victim ingested, and the data can be broken down to compare mortality among specific subpopulations.     

Time Course and Role of Morphine Dose and Concentration in Intrathecal Granuloma Formation in Dogs: A Combined Magnetic Resonance Imaging and Histopathology Investigation

Background: Intrathecal morphine infusion leads to intrathecal granulomas. In dogs, the authors examined time course of granuloma formation and the role of concentration in granuloma development.

Methods: Dogs were prepared with lumbar intrathecal catheters and vest-mounted pumps. To define the time course of granuloma formation, serial magnetic resonance imaging was performed in animals receiving 10 or 31 days of morphine infusion (12.5 mg/ml at 40 [mu]l/h). At these times, morphine was removed from the infusate, and further magnetic resonance images were acquired over 14-35 additional days. To assess dose versus concentration, dogs received 28-day infusions of vehicle, 12 mg morphine/day as 12.5 mg/ml at 40 [mu]l/h, or 1.5 mg/ml at 334 [mu]l/h (12 mg/day) for 28 days. Additional dogs received 3 mg/day as 12.5 mg/ml at 10 [mu]l/h.

Results: Serial magnetic resonance images in dogs receiving morphine (12.5 mg/ml at 40 [mu]l/h) revealed pericatheter-enhancing tissues as early as 3 days with a prominent signal by 10 days. Removal of morphine reduced the mass volume within 7 days. At a fixed infusion rate, the incidence of granuloma formation with the continuous intrathecal infusion of morphine ranged from 0 in vehicle-treated dogs to 100% in dogs treated with 12.5 mg/ml at 40 [mu]l/h (12 mg/day). Infusion of 12 mg/day at 1.5 mg/ml (334 [mu]l/h) resulted in granuloma in one of four animals. The authors found that infusion of morphine in different concentrations at a fixed rate resulted in a dose-dependent increase in concentration, with the granuloma-producing, dose-yielding lumbar cerebrospinal fluid morphine concentrations around 40 [mu]g/ml.     

Microangiopathy with retinopathy, encephalopathy, and deafness (RED-M) and systemic features.

The case of a young woman with a rare syndrome of acute encephalopathy followed by deafness and retinopathy developing over 1 year is reported. Unlike previously described similar cases, she had considerable systemic symptoms and signs including polyarthralgia-arthritis, diffuse myalgia, malar rash, livedo reticularis, night sweats, and fatigue suggestive of systemic lupus erythematosus. However, results of most immunological investigations were repeatedly normal, including antinuclear antibodies. Anticardiolipin antibodies were elevated on one occasion. Cyclophosphamide has been the most effective treatment for exacerbations of the disease, which have continued to occur over 6 years. This microangiopathic syndrome more likely relates to an immunologically mediated vasculitis of small blood vessels than to a thromboembolic etiology.     

Colour-flow Doppler imaging of a carotid-cavernous fistula.

The authors describe a case of carotid-cavernous fistula evaluated with both conventional carotid angiography and colour-flow Doppler ultrasonography. The findings in the colour-flow Doppler images correlated well with those from angiography; in addition, Doppler imaging supplied extra information about the direction and the velocity of flow. After embolization, colour-flow Doppler imaging demonstrated a marked decrease in the flow. The authors conclude that colour-flow Doppler imaging may be useful for noninvasively detecting and evaluating a carotid-cavernous fistula, as well as for monitoring the patient's progress after therapy.     

Effect of subinhibitory antimicrobial concentrations (sub-MICs) on in-vitro bacterial adherence to uroepithelial cells.

Subinhibitory antimicrobial concentrations have been reported to alter the adherence of bacteria to uroepithelial cells. Most investigators assessing the influence of subinhibitory antimicrobial concentrations on bacterial adherence in the urinary tract have employed in-vitro techniques using voided uroepithelial cells. These cells are incubated with bacteria previously exposed to antimicrobials and adherence is assessed by light microscopy. Most investigators have studied urinary Escherichia coli isolates. beta-Lactams, tetracyclines, aminoglycosides, nitrofurantoin, chloramphenicol, quinolones, trimethoprim and sulphonamides have been studied in concentrations ranging from 1/32-1/2x MIC. The following effects of subinhibitory antimicrobial concentrations on bacterial adherence have been reported: penicillins consistently reduce bacterial adherence at concentrations 1/4-1/2x MIC; nitrofurantoin and chloramphenicol demonstrate variable effects on bacterial adherence at 1/4x MIC; tetracyclines, but not doxycycline, decrease adherence at high concentrations (1/4-1/2x MIC) and increase it at low concentrations (1/8-1/32x MIC); both trimethoprim and sulphonamides consistently decrease bacterial adherence at concentrations ranging from 1/32-1/2x MIC and 1/4-1/2x MIC, respectively, but it is unclear whether the combination of trimethoprim and a sulphonamide decreases bacterial adherence to a greater extent than either agent alone; aminoglycosides decrease adherence at 1/2x MIC; and quinolones decrease adherence at 1/4x MIC, with variable effects at 1/8x MIC and 1/16x MIC. Subinhibitory antimicrobial concentrations may exert their antiadhesive effects through suppression of formation and/or expression on the surface adhesin, the formation of functionally aberrant adhesins, or a direct effect on the bacterial surface. Presently, the clinical significance of the alterations in bacterial adherence to uroepithelial cells is not fully understood.     

Open capsulotomy by the transaxillary approach

The release of capsular contracture through the axillary approach is presented. The technique is used in cases that have previously undergone breast augmentation, through the same approach and using the same blunt instrumentation for dissection.     

Effect of hyperbaric oxygen and vitamin C and E supplementation on biomarkers of oxidative stress in healthy men

The objectives of the present study were to evaluate the effect of normobaric and hyperbaric O2 (HBO) on plasma antioxidants and biomarkers of oxidative stress in plasma and urine and to investigate the effect of a 4-week vitamin C plus E supplementation on HBO-induced oxidative stress. Nineteen healthy men were exposed to HBO (100 % O2; 240 kPa) before and after 4 weeks' supplementation with 500 mg vitamin C plus 165 mg alpha-tocopherol equivalents. Exposure to 21 % O2 at 100 kPa served as intra-individual controls (control). Samples for the analysis of plasma antioxidants and oxidative stress biomarkers were collected before and immediately after each treatment. The present results showed that when compared with 'control', a single exposure to HBO resulted in a decrease of plasma vitamin C (P = 0.027) and an increase of lipid peroxides (P = 0.0008) and urinary 8-oxo-deoxyguanosine (8-oxodG) excretion (P = 0.006). Oxidative stress was not prevented by a 4-week supplementation with vitamins C and E. HBO-induced changes in plasma parameters correlated with basal antioxidant levels. The increase of urinary 8-oxodG after HBO plus supplementation correlated negatively with vitamin E intake (P = 0.023). We concluded that in healthy men HBO caused oxidative stress, which could not be prevented by dietary vitamin C plus E supplementation. The present data support the idea that HBO is a suitable model for oxidative stress in healthy volunteers.