Reversible renal failure in a patient with the hypereosinophilia syndrome during therapy with alpha interferon.

Human recombinant interferon (IFN)-alpha (alpha)-2b was given to a 57-year-old man with hypereosinophilia syndrome refractory to prednisone and hydroxyurea. One year later, he developed progressive renal failure and nephrotic-range proteinuria. Percutaneous kidney biopsy showed focal and segmental glomerular and mesangial sclerosis, chronic interstitial nephritis, and focal tubular necrosis. Discontinuation of cytokine therapy led to marked improvement in renal function and significant reduction in proteinuria. The potential role of IFN-alpha as the cause of renal failure and nephrotic-range proteinuria is discussed. The spectrum of renal disease attributed to IFN-alpha and the proposed pathogenic mechanisms are reviewed.

Cardiac nociceptive reflexes after transmyocardial laser revascularization: implications for the neural hypothesis of angina relief.

OBJECTIVE: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain. METHODS: Experiments were performed in 13 chloralose-anesthetized dogs with sinoaortic denervation and vagotomy. Left ventricular receptors with sympathetic afferent fibers were activated by epicardial and intracoronary bradykinin before and 45 minutes after transmyocardial laser revascularization. Reflex responses elicited by bradykinin were quantitated by direct recording of efferent renal sympathetic nerve activity. Transmyocardial laser revascularization was performed in the open-chest model with a hand-held holmium:YAG laser (2.1-microm wavelength). RESULTS: An average of 44.5 +/- 1.0 channels were created. Before transmyocardial laser revascularization, reflex increases in renal sympathetic nerve activity were elicited by both epicardial and intracoronary bradykinin. After transmyocardial laser revascularization, there was no significant attenuation in the reflex responses to either epicardial (before, 66% +/- 8%; after, 100% +/- 24%; P =.19) or intracoronary (before, 124% +/- 37%; after, 108% +/- 25%; P =.44) bradykinin. CONCLUSIONS: Transmyocardial laser revascularization has no significant short-term effect on reflexes mediated by left ventricular receptors with sympathetic afferent fibers in anesthetized dogs. These results indicate that transmyocardial laser revascularization does not acutely interrupt the afferent nerves, which are believed to transmit the perception of anginal pain.

Isolation of Stomatococcus mucilaginosus from drug user with endocarditis.

Stomatococcus mucilaginosus was isolated from the blood of a patient with endocarditis and a past history of drug abuse and aortic valve replacement. At autopsy, Gram stain of the aortic valve revealed gram-positive cocci. Our isolate was atypical for S. mucilaginosus in that colonies were nonmucoid and nonadherent to agar surfaces. Cellular capsules were demonstrated by light and electron microscopy. Phenotypic characteristics identified by conventional methods as well as profile numbers obtained by using two commercial identification systems for staphylococci, the API Staph-Ident and the dms Staph Trac, are presented. Practical tests that differentiate S. mucilaginosus from the genera Micrococcus and Staphylococcus include growth on nutrient agar containing salt and lysostaphin susceptibility. Additional tests that helped differentiate our isolate from group D streptococci included hydrolysis of L-pyrrolidonyl-beta-naphthylamide and streptococcal serogrouping.