Bacteriology of the marine environment: implications for clinical therapy

Ocean water and tissue samples were obtained from a variety of sources with phylogenetic and geographic diversity. Purified bacterial colonies were isolated and identification procedures were performed. A total of 67 isolates were recovered. Thirty-eight isolates belonged to the genus Vibrio and included six species. Twenty-four non-fermentative bacteria and four Gram-positive isolates were recovered. Antibiotic susceptibility testing showed that while the non-fermentative marine bacteria generally were susceptible to the antibiotics tested, marine Vibrio species were relatively resistant to a wide variety of antimicrobials. Antibiotics effective against all species included imipenem, trimethoprim/sulfamethoxazole, and chloramphenicol. Further recommendations for treatment are based on sensitivity in culture. Some isolates failed to grow in the medium used for susceptibility testing. Because commercial test kits may not yield accurate identifications of bacteria, the acquisition of antimicrobial susceptibility data gains added importance.     

Problems associated with the use of immediately dangerous to life and health (IDLH) values for estimating the hazard of accidental chemical releases

The possibility of accidental industrial chemical releases has generated considerable recent attention. One area requiring research for emergency planning is the development of safe exposure concentrations for the public in the event of an inadvertent release. The United States Environmental Protection Agency (EPA) has established a list of extremely hazardous substances and suggested that the toxicity ranking for 92 hazardous materials could be based on the "immediately dangerous to life or health" (IDLH) values developed by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). Eighty-four compounds with IDLH values for which published toxicologic data were available were reviewed to assess the appropriateness of applying such values to accidental release situations. When compared with 30-min animal median lethal concentrations (LC50s), 18 of the IDLHs reviewed were in the same range as lethal levels for animals. For 45 compounds the IDLH values were comparable to concentrations producing severe toxic effects (specifically, unconsciousness, incapacitation, or intolerable irritation). Where available, emergency planning guidelines for the military were compared to IDLHs, and in all 31 cases, the IDLHs exceeded the military exposure guidelines. Twenty compounds also were found to pose a potential cancer risk according to common regulatory guidelines, even under the assumption of a single, 30-min exposure at the IDLH concentration. In addition, the high degree of variability (four orders of magnitude) in the relationship of IDLH values to outcomes of lethality or severe toxicity suggests that the use of IDLH values as emergency planning guidelines for accidental releases is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impaired platelet function associated with parenteral nafcillin

A 44-year-old Caucasian female was admitted with a subarachnoid hemorrhage owing to a multilobular tubular anterior communicating artery aneurysm. Eleven days after the original craniotomy, an epidural hematoma was evacuated. The patient was placed on empiric nafcillin antimicrobial coverage (two g every six hours). Within 24 hours, the onset of epistaxis and oozing of blood from the endotracheal tube and craniotomy site was noted. Recurrent subdural and epidural hematomas necessitated a third emergent craniotomy. The development of an acquired qualitative platelet defect was suggested by the findings of a prolonged template bleeding time and markedly abnormal platelet aggregation/ATP release studies despite a normal platelet count. Nafcillin therapy was immediately discontinued. Clinical bleeding resolved. Subsequent bleeding times and platelet aggregation studies confirmed the nafcillin-induced platelet dysfunction.     

ACSM Symposium: Former Athletes in Later Life

Wrist pain in an active patient is a physician's cue to look for specific clues in the history, physical exam, and diagnostic tests. Without prompt diagnosis and accurate treatment, the chronic pain can impair sports participation and performance. And in certain instances, a misdiagnosed condition, such as a carpal dislocation or distal radial physeal fracture, can lead to deformity or disability from lack of adequate treatment.