Fungal endocarditis — a report on seven cases and a brief review

Summary Candida endocarditis is an unusual but severe complication of systemic infection caused byCandida albicans and occasionally by other fungal species. We describe seven cases that occurred during a period of 20 years in western Sweden. In four cases infections were located on prosthetic valves and in three cases native valves were involved. Three patients died of the disease in the acute phase. A definite diagnosis was established in one of four survivors. This patient had an aortic valve endocarditis and a saddle embolisation and was treated with immediate surgery, followed by intensive treatment with liposomal amphotericin B + flucytosine. Fungal endocarditis is still a serious disease with a high mortality and whenever the diagnosis is suspected, antifungal therapy must be started and transesophageal sonography should be performed to visualize vegetations. Immediate surgery should be considered.

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Pilzendokarditis — Bericht über sieben Fälle und kurze Literaturübersicht

Zusammenfassung DieCandida-Endokarditis ist eine seltene, aber schwere Komplikation einer systemischen Infektion durchCandida albicans und gelegentlich auch durch andere Pilzspezies. Wir berichten über sieben Fälle, die in einem Zeitraum von 20 Jahren in Westschweden beobachtet wurden. In vier Fällen waren Klappenprothesen und in drei Fällen natürliche Klappen betroffen. Drei Patienten starben in der akuten Phase an der Krankheit. Bei einem der vier überlebenden Patienten konnte die Diagnose eindeutig gesichert werden. Dieser Patient hatte eine Aortenklappenendokarditis und einen reitenden Embolus. Er wurde sofort operiert und hochdosiert mit liposomalem Amphotericin B und mit Flucytosin behandelt. Die Pilzendokarditis ist nach wie vor eine ernste, mit hoher Letalität belastete Krankheit. Die antimykotische Therapie muß bereits beim ersten Verdacht begonnen werden. Um Vegetationen nachzuweisen, sollte die transösophageale Sonographie durchgeführt werden. Ein sofortiges chirurgisches Eingreifen ist zu erwägen.

     

After the Intensive Care Nursery Experience: Families' Perceptions of Their Well Being

This article describes family well being after a child's intensive care nursery experience. Thirty families of children who were graduates of intensive care nurseries participated in the study. Fifteen families of children with identifiable disabilities and 15 families of children with no identifiable disabilities were interviewed and completed standardized questionnaires. A comparison of family well being was done across three dimensions: the child's characteristics and caregiving needs, the family's support resources and needs, and the family's values and beliefs regarding their child's hospitalization and resulting special needs. Both groups of families had realized a renewed sense of meaning concerning family, children, and life itself due to their child's medical crises or disability. Families of children with disabilities, however, noted their financial concerns, burdens with their child's caregiving, and their difficulty in locating services for their child. These families' experiences underscore the need for a coordinated transition from the hospital to the community for the family and child.     

Development of subcutaneous wound oxygen measurement in humans: Contributions of Thomas K. Hunt, MD

When, in the early 1960s, Thomas K. Hunt, MD began investigating the role of oxygen in wound healing, he recognized that translation to humans would require the ability to measure oxygen tension in human wounds. This article will review his contributions to the development of subcutaneous tissue oxygen measurement and to the understanding of wound physiology and oxygen delivery, particularly through use of oxygen measurement. Hunt's major contributions to the field include the observations that all wounds show some degree of hypoxia, while many are severely hypoxic; the degree of hypoxia in wounds is sufficient to impair wound healing, and particularly bacterial killing by neutrophils, collagen deposition, angiogenesis, and epithelization; the sympathetic nervous system plays a central role in decreasing wound oxygen supply; and wound oxygen delivery and wound healing capacity can be increased by controlling the sympathetic nervous system. All these observations required tissue oxygen measurement, and, in particular, translation of basic scientific observations to clinical research required a method of measuring wound oxygen tension in humans.     

Oxygen Reverses Deficits of Cognitive Function and Memory and Increased Heart Rate Induced by Acute Severe Isovolemic Anemia

Background: Erythrocytes are transfused to improve oxygen delivery and prevent or treat inadequate oxygenation of tissues. Acute isovolemic anemia subtly slows human data processing and degrades memory, increases heart rate, and decreases self-assessed energy level. Erythrocyte transfusion is efficacious in reversing these effects of acute anemia. We tested the hypothesis that increasing arterial oxygen pressure (Pao2) to 350 mmHg or greater would supply sufficient oxygen to be equivalent to augmenting hemoglobin concentration by 2-3 g/dl and thus reverse the effects of acute anemia.

Methods: Thirty-one healthy volunteers, aged 28 +/- 4 yr (mean +/- SD), were tested with verbal memory and standard, computerized neuropsychologic tests before and twice after acute isovolemic reduction of their hemoglobin concentration to 5.7 +/- 0.3 g/dl. Two sets of tests were performed in randomized order at the lower hemoglobin concentration: with the volunteer breathing room air or oxygen. The subject and those administering the tests and recording the results were unaware which gas was administered. As an additional control for duration of the experiment, 10 of these volunteers also completed the same tests on a separate day, without alteration of hemoglobin concentration, at times of the day similar to those on the experimental day. Heart rate, mean arterial blood pressure, and self-assessed sense of energy were recorded at the time of each test.

Results: Reaction time for digit-symbol substitution test increased, delayed memory was degraded, mean arterial pressure and energy level decreased, and heart rate increased at a hemoglobin concentration of 5.7 g/dl (all P < 0.05). Increasing Pao2 to 406 +/- 47 mmHg reversed the digit-symbol substitution test result and the delayed memory changes to values not different from those at the baseline hemoglobin concentration of 12.7 +/- 1.0 g/dl, and decreased heart rate (P < 0.05). However, mean arterial pressure and energy level changes were not altered with increased Pao2 during acute anemia.     

Hyperpolarizing action of cromakalim on the rat aorta

Cromakalim alone at 1 microM had no effect and at 10 microM hyperpolarized the rat aorta. The rat aorta was depolarized by KCl (20 mM), noradrenaline (0.3 microM) and 5-hydroxytryptamine (1 microM). In the presence of depolarization with KCl, noradrenaline or 5-hydroxytryptamine, cromakalim at 1 and 10 microM hyperpolarized the rat aorta. Thus the antispasmogenic actions of modest concentrations of cromakalim is compatible with potassium channel opening.