Disseminated Melioidosis with Spinal Intraosseous Abscess.

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

Necrotising pneumonia: A pneumonia that may need surgical intervention.

Pneumonia is primarily a disease that is usually managed medically with antibiotics. However, in rare cases it may progress to necrotising pneumonia, which is an uncommon but severe complication of bacterial pneumonia. This case illustrates a typical case of necrotising pneumonia complicated with parenchymal and pleural complication such as empyema, pneumothorax with possible bronchopleural fistula. Early consultation with thoracic surgeon can be life-saving.

Cardiac and vascular responses in deoxycorticosterone acetate-salt hypertensive rats.

1. Hypertension leads to ventricular hypertrophy and, eventually, to heart failure. The present study has investigated the functional consequences of deoxycorticosterone acetate (DOCA)-salt hypertension in rats by defining the inotropic, chronotropic and vascular responses to noradrenaline (NA; beta1-adrenoceptor agonist), forskolin (adenylate cyclase activator) and theophylline (phosphodiesterase inhibitor). 2. Administration of DOCA (25 mg, s.c., every 4th day) and excess salt (1% NaCl in drinking water) to uninephrectomized rats increased left ventricular wet weight by 35 and 71% after 4 and 8 weeks, respectively. Addition of KCl (0.4%) or CaCl2 (1%) in the drinking water for 4 weeks attenuated blood pressure increases, but not ventricular weight increases (46 and 28%, respectively). 3. Positive inotropic responses in papillary muscles from uninephrectomized rats to NA (-log EC50 6.73+/-0.38; n = 7), forskolin (-log EC50 6.15+/-0.31; n = 7) and CaCl2 (-log EC50 2.40+/-0.02; n = 14) were unchanged in hypertrophied left ventricles of DOCA and DOCA-CaCl2 rats, although maximal responses to NA were decreased in DOCA-KCI rats (1.2+/-0.6 mN, n = 8; DOCA-salt 2.9+/-0.5 mN, n = 6); theophylline was less potent in DOCA-salt rats. Positive chronotropic responses to NA, forskolin and theophylline in right atria and negative inotropic responses to carbachol in papillary muscles were unchanged. 4. Maximal vasoconstrictor responses to NA in thoracic aortic rings were reduced in DOCA-KCI rats to 2.4+/-0.9 mN (n = 5), but were increased in DOCA-CaCl2 rats to 26.6+/-2.2 mN (n = 7; DOCA-salt 7.8+/-2.2 mN, n = 9). Vasorelaxant responses to forskolin and theophylline were unchanged. 5. These results show that cardiac responses are only minimally affected during the development of DOCA-salt hypertension-induced hypertrophy, despite the reported decreases in adenylate cyclase activity, in these rats. This is in contrast with the decreased responses reported in other rat models of cardiac hypertrophy and in the failing human heart. Thus, hypertrophy in hearts of DOCA-salt hypertensive rats does not produce similar changes to the failing human heart.