Cat-scratch disease with paravertebral mass and osteomyelitis.

The case of a 9-year-old girl with cat-scratch disease (CSD) complicated by development of a paravertebral mass and osteomyelitis is presented. Following multiple scratches and inguinal lymphadenopathy, she developed back pain, and imaging demonstrated a paravertebral mass with evidence of osteomyelitis involving vertebra T9. The diagnosis was made on the basis of detection of Bartonella henselae by use of molecular techniques on an aspirate from the vertebral column and supportive serology for infection with B. henselae. Eleven other cases of this unusual manifestation associated with CSD have been reported in the literature and are reviewed. The patient was treated with gentamicin, followed by rifampicin and trimethoprim-sulfamethoxazole, orally and made a favorable recovery over 7 months. This is comparable with other case reports, regardless of the choice of antibiotic therapy. CSD in immunocompetent hosts is not always self-limiting, and tissues beyond the lymph nodes can be involved.

Population pharmacokinetic modeling in very premature infants receiving midazolam during mechanical ventilation: midazolam neonatal pharmacokinetics.

BACKGROUND: Midazolam is used widely as a sedative to facilitate mechanical ventilation. This prospective study investigated the population pharmacokinetics of midazolam in very premature infants. METHODS: Midazolam (100 microg/kg) was administered as a rapid intravenous bolus dose every 4-6 h to 60 very premature neonates with a mean (range) gestational age of 27 weeks (24-31 weeks), a birth weight of 965 g (523-1,470 g), and an age of 4.5 days (2-15 days). A median (range) of four (one to four) blood samples, 0.2 ml each, were drawn at random times after the first dose or during continuous treatment, and concentrations of midazolam in serum were assayed by high-performance liquid chromatography. A population analysis was conducted using a two-compartment pharmacokinetic model using the NONMEM program. RESULTS: Average parameter values (interpatient percent coefficient of variation) for infants with birth weights 1,000 g or less were total systemic clearance (Cl(T)) = 0.783 ml/min (83%), intercompartmental clearance (Cl(Q)) = 6.53 ml/min (116%), volume of distribution of the central compartment (V1) = 473 ml (70%), and volume of distribution of the peripheral compartment (V2) = 513 ml (146%). For infants with birth weights more than 1,000 g they were as follows: Cl(T) = 1.24 ml/min (78%), Cl(Q) = 9.82 ml/min (98%), V1 = 823 ml (43%), and V2 = 1,040 ml (193%). The intrapatient variability (percent coefficient of variation) in the data was 4.5% at the mean concentration midazolam in serum of 121 ng/mL. CONCLUSIONS: Serum concentration-time data were used in modeling the population pharmacokinetics of midazolam in very premature, ventilated neonates. Clearance of midazolam was markedly decreased compared with previous data from term infants and older patients. Infants weighing less than 1,000 g at birth had significantly lower clearance than those weighing more than 1,000 g.

Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates.

OBJECTIVE: To evaluate the effects of intravenous midazolam on haemodynamic variables and cerebral blood flow velocity (CBFV) and to determine the pharmacokinetics using a population approach in very low birthweight (VLBW) ventilated infants. METHODOLOGY: Physiological variables were measured at predetermined times in 10 infants with birthweight < or = 1500 g following a bolus dose of intravenous midazolam (0.1 mg/kg). Heart rate, mean arterial blood pressure (MAP) and transcutaneous CO2 (TcPCO2) were recorded and CBFV was assessed by Doppler ultrasound. Midazolam concentrations were also measured and pharmacokinetic parameters determined using a population modelling package. RESULTS: No change in heart rate occurred during the study period, while the MAP decreased by 3 mmHg 5 min after midazolam administration compared to baseline values. A non-significant fall in TcPCO2 was seen at 20 min. Mean CBFV decreased from the baseline by 12% at 5 min, then returning to predose values. Midazolam concentrations were in the range shown to be effective in sedation of paediatric intensive care infants with the elimination being delayed in comparison to older children. CONCLUSIONS: As only minor cerebral and haemodynamic effects were found with the use of midazolam in stable ventilated preterm infants, it appears to be a safe, short-term sedative agent.

1994 William J. Stickel Bronze Award. Amino acids, dipeptides, and leg skeletal muscle wound healing in diabetes.

The authors determined the effects of active amino acids and dipeptides as anabolic agents on surgically induced wound healing in lower extremity skeletal muscles in diabetic and normal rats. In order to induce diabetes, adult male Sprague-Dawley rats (200 g; 10 to 12 animals per group) were injected with streptozotocin (65 mg/kg) 30 days before the onset of the experiment. Their blood sugars were checked at this time. Each group of rats was injected with either one stimulatory amino acid or dipeptide (150 mg/kg body weight) subcutaneously in saline for 7 days and their anabolic effects (RNA, DNA, protein, and collagen contents) on lower extremity skeletal muscle wound healing determined in both diabetic and normal control groups. It is hoped that a treatment regimen will be developed using synergistic anabolic agents locally to decrease the lower extremity muscle healing time. This will enable the diabetic patient to become mobile sooner after surgery.

Emergency monitoring procedures at Central Electricity Generating Board nuclear power stations : Developments since the Three Mile Island accident

Following a brief review of Central Electricity Generating Board emergency arrngements prior to the 1979 Three Mile Island accident, the paper discusses the technical bases of subsequent developments in monitoring procedures. Some of these result from experience gained form the Three Mile Island accident, while others arise from the ongoing review of emergency arrangements in order to take account of advances in knowledge and improved equipment. In particular, continuously recording gamma monitoring systems have been installed at power station sites in order to assist in the estimation of the temporal pattern of any release of radioactivity. Futher passive thermoluminescent detector system have been deployed around powe stations in order to improve estimates of external radiation doses from the plume, while methods of assesing potential doses due to consumption of contaminated foodstuffs have also been improved. The range of emergency survey data available during an accident is described and their interpretation to provide early estimates and ongoing summaries of both individual and population doses is discussed. (AU)