Right-sided bacterial endocarditis. New concepts in the treatment of the uncontrollable infection

Our experience with 25 patients with right-sided bacterial endocarditis is described; 23 were heroin addicts. The clinical manifestations of right-sided endocarditis are primarily related to septic pulmonary embolism.When the infection was due to gram-positive cocci, antibiotics always cured the patient. However, if the infection was due to Pseudomonas aeruginosa resistant to therapy, excision of the infected tricuspid or tricuspid and pulmonary valves without prosthetic replacement effected a cure. Nine out of 10 long-term survivors treated in this manner have had no significant hemodynamic difficulties.Antibiotic therapy must be limited to six weeks or less, because if the infection persists beyond this period it may also spread to the left side of the heart, where valve excision without replacement is impossible.     

Epidural Hematoma as a Cause of Postpneumonectomy Paraplegia

Postpneumonectomy paraplegia developed in a woman admitted for resection of bronchogenic carcinoma. Postpneumonectomy paraplegia is an uncommon, but catastrophic, event that is thought to be caused primarily by ischemia to the spinal cord; in this instance an epidural hematoma was the cause. Recommendations for prevention are presented.     

Measuring Stigma in Chronic Pain: Preliminary Investigation of Instrument Psychometrics,Correlates, and Magnitude of Change in a Prospective Cohort Attending Interdisciplinary Treatment

Chronic pain is a potentially stigmatizing condition. However, stigma has received limited empirical investigation in people with chronic pain. Therefore, we examined the psychometric properties of a self-report questionnaire of stigma in people with chronic pain attending interdisciplinary treatment. Secondarily, we undertook an exploratory examination of the magnitude of change in stigma associated with interdisciplinary treatment in a prospective observational cohort. Participants attending interdisciplinary treatment based on acceptance and commitment therapy completed the Stigma Scale for Chronic Illness 8-item version (SSCI-8; previously developed and validated in neurological samples), and measures of perceived injustice, pain acceptance, and standard pain outcomes before (n = 300) and after treatment (n = 247). A unidimensional factor structure and good internal consistency were found for the SSCI-8. Total SSCI-8 scores were correlated with pain intensity, indices of functioning, and depression in bivariate analyses. Stigma scores were uniquely associated with functioning and depression in multiple regression analyses controlling for demographic factors, pain intensity, pain acceptance, and perceived injustice at baseline. SSCI-8 total scores did not significantly improve after treatment, although an exploratory subscale analysis showed a small improvement on internalized stigma. In contrast, scores on perceived injustice, pain acceptance, and pain outcomes improved significantly. Taken together, these data support the reliability and validity of the SSCI-8 for use in samples with chronic pain. Further research is needed optimize interventions to target stigma at both the individual and societal levels.PerspectiveThis study supports the use of the SSCI-8 to measure stigma in chronic pain. Stigma is uniquely associated with worse depression and pain-related disability. Research is needed to identify how to best target pain-related stigma from individual and societal perspectives.     

Human growth hormone release. Comparison of provocative test procedures

Twenty normal adult volunteers were systematically tested with five known provocative agents of human growth hormone (HGH) release in order to ascertain which procedure was the most effective stimulus for pituitary testing purposes. Ninety-five per cent responded normally (5 ng/ml increment) to levodopa (l-dopa) and 90 per cent to insulin-hypoglycemia. Arginine, vasopressin and glucagon were less potent stimuli; however, arginine (80 per cent response rate) was superior to vasopressin and glucagon (60 and 55 per cent, respectively).Nine subjects were retested with the same stimuli. Again, the incidence of normal HGH responses was highest with the l-dopa and insulin tolerance tests (100 and 89 per cent, respectively). Results with arginine, vasopressin and glucagon were significantly less consistent.Because of the important additional features of greater simplicity and safety, and until hypothalamic releasing substances become generally available, the routine use of l-dopa as a pituitary test agent warrants great attention.     

A procedure for the kinetic colorimetric determination of serum cholinesterase activity

A choline oxidase-peroxidase coupled enzyme procedure is proposed for the determination of cholinesterase activity in human serum. This system is not only kinetic and colorimetric but is also relatively quick and simple to perform. The initial comparisons suggest that this method correlates well with a commonly used propionylthiocholine-dinitrobis-(nitro-benzoic acid) technique. Large amounts of bilirubin in the sample appear to have only minor deleterious effects on the assay. Since there are only two reagents that may be premixed, the procedure appears to be amenable to automation.The use of a mixture of sodium 2-hydroxy-3,5-dichlorobenzenesulfonate and 4-aminoantipyrene in the peroxidase catalyzed indicator reaction provides for a marked increase in sensitivity over previously reported 4-aminoantipyrene-phenol systems. This augmented sensitivity provides for a relatively large reagent to sample ratio. In addition, the reagents lend themselves toward lyophilization or ‘dry-fill’.     

Determination of the proximate teratogen of the mouse fetal alcohol syndrome: 1. Teratogenicity of ethanol and acetaldehyde

The proximate teratogen of the fetal alcohol syndrome is unknown. CD-1 mice were treated ip on Day 10 of gestation with 2, 4, 6, or 7 g/kg ethanol. The percentage of resorptions and malformed fetuses was increased and mean fetal weight was decreased in a dose-related manner. Treatment with 7 g/kg ethanol ip on one of gestational Days 7, 8, 9, 10, or 11 significantly increased the percentage of malformed fetuses and decreased fetal weight. In addition, treatment on Days 10 or 11 significantly increased the percentage of resorptions. Coadministration of 100 mg/kg of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, orally with 6 g/kg ethanol ip on Day 10 of gestation dramatically increased the embryotoxicity of ethanol. Five ip treatments of 200 mg/kg acetaldehyde at 2-hr intervals on Day 10 of gestation did not significantly increase the percentage of resorptions and malformed fetuses or decrease fetal weight. These data suggest that ethanol is the proximate teratogen of the fetal alcohol syndrome in CD-1 mice.     

Determination of the proximate teratogen of the mouse fetal alcohol syndrome: 2. Pharmacokinetics of the placental transfer of ethanol and acetaldehyde

CD-1 mice were treated ip on Day 10 of gestation with 4, 6, or 7 g/kg ethanol. Maternal and embryonic tissues were analyzed for ethanol and acetaldehyde levels by head-space gas chromatography 5 min to 24 hr after treatment. Dose-dependent ethanol concentrations were observed in maternal blood and liver. Ethanol rapidly crossed the placenta and appeared in the embryo 5 min after treatment. Acetaldehyde was detectable in maternal blood following all treatments and in maternal liver and embryos following treatment with 7 g/kg ethanol. Coadministration of 100 mg/kg 4-methylpyrazole, an alcohol dehydrogenase inhibitor, with 4 or 6 g/kg ethanol on Day 10 of gestation significantly reduced the rate of ethanol elimination in all tissues examined. This reduction was manifested as a prolongation in the half-life of ethanol detectable in maternal and embryonic tissues but not in an increase in maximum ethanol concentrations. Within 5 min of maternal ip treatment with 200 mg/kg acetaldehyde on Day 10 of gestation, acetaldehyde was detectable in the embryo. These data suggest that both ethanol and acetaldehyde are accessible to the embryo during a critical period of development.