Gonococcal endocarditis: a case report and literature review.

Gonococcal endocarditis is rarely encountered in the post-antibiotic era. This case report describes a case of a previously healthy male who presented with double quotidian fever, chills, cough, and urethral symptoms. The presence of a cardiac mitral valvular vegetation along with positive blood cultures for Neisseria gonorrhoeae were diagnostic for gonococcal endocarditis. This case was, to our knowledge, the first reported gonococcal endocarditis case in China.

The role of self-injury in the organisation of behaviour.

BACKGROUND: Self-injuring acts are among the most dramatic behaviours exhibited by human beings. There is no known single cause and there is no universally agreed upon treatment. Sophisticated sequential and temporal analysis of behaviour has provided alternative descriptions of self-injury that provide new insights into its initiation and maintenance. METHOD: Forty hours of observations for each of 32 participants were collected in a contiguous 2-week period. Twenty categories of behavioural and environmental events were recorded electronically that captured the precise time each observation occurred. Temporal behavioural/environmental patterns associated with self-injurious events were revealed with a method (t-patterns; THEME) for detecting non-linear, real-time patterns. RESULTS: Results indicated that acts of self-injury contributed both to more patterns and to more complex patterns. Moreover, self-injury left its imprint on the organisation of behaviour even when counts of self-injury were expelled from the continuous record. CONCLUSIONS: Behaviour of participants was organised in a more diverse array of patterns when self-injurious behaviour was present. Self-injuring acts may function as singular points, increasing coherence within self-organising patterns of behaviour.

Reassessment of the microcytic anemia of lead poisoning.

Hematologic abnormalities in childhood lead poisoning may be due, in part, to the presence of other disorders, such as iron deficiency or thalassemia minor. In order to reassess increased lead burden as a cause of microcytic anemia, we studied 58 children with class III or IV lead poisoning, normal iron stores, and no inherited hemoglobinopathy. Anemia occurred in 12% and microcytosis in 21% of these children. The combination of anemia and microcytosis was found in only one of 58 patients (2%). When only children with class IV lead poisoning were studied, the occurrence of microcytosis increased to 46%. However, the combination of microcytosis and anemia was found in only one of these 13 more severely affected patients. Microcytic anemia was similarly uncommon in children with either blood lead concentration greater than or equal to 50 microgram/100 ml. These data indicate that microcytosis and anemia occur much less commonly than previously reported in childhood lead poisoning uncomplicated by other hematologic disorders.

Oral propafenone in the suppression of chronic stable ventricular arrhythmias.

The efficacy of propafenone hydrochloride, a new antiarrhythmic agent, was evaluated in the treatment of chronic stable ventricular arrhythmias. Twenty-five patients who had suffered a myocardial infarction three months or longer before the trial were studied. All exhibited a minimum mean frequency of 30 ventricular ectopic beats per hour over at least two 24-hour Holter monitoring periods with the last recorded tape serving as a control. The mean decrease in ventricular ectopic activity with propafenone was 65.62 percent (p = less than 0.001). Side effects were infrequent, minimal, and of no clinical consequence. Oral propafenone was found to be an effective drug for reducing the level of chronic ventricular ectopy, as reflected by a short-term trial.

Trophic mechanisms regulate mitotic neuronal precursors: role of vasoactive intestinal peptide (VIP).

While trophic support from targets depends on innervation, recent evidence suggests that local VIP promotes survival of sympathetic neuroblasts prior to target interactions, during the period of neurogenesis. Developmental studies now indicate that VIP expression peaks at embryonic day 15.5 (E15.5) in sympathetic ganglia in vivo, decreasing 3-fold by birth. The expression pattern in vivo paralleled the time course of ganglion neuroblast mitosis and peptide promotion of survival in culture. In contrast, nerve growth factor (NGF) exhibited a reciprocal trophic relationship, primarily supporting older neurons that were unresponsive to VIP. To define relationships of trophism to mitosis, serial time-lapse photography was employed to document the fate of neuroblasts produced by cytokinesis in vitro. In the absence of trophic factors, up to 80% of newly born cells died by 48 h, while virtually all neuroblasts survived in response to VIP plus NGF. In addition, trophic factors elicited multiple rounds of precursor division and an increase in absolute cell number, indicating that both trophic and mitogenic mechanisms contribute to proliferation. In aggregate, these observations suggest that VIP is expressed locally during a critical fetal period, providing trophic support to dividing ganglion neuroblasts prior to the action of target-derived NGF.

Role of voltage-sensitive calcium channels in mitogenic stimulation of neuroblasts.

The present study examines the role of Ca2+ in the regulation of sympathetic neuroblast mitosis. Employing a fully defined neuroblast culture system, we previously found that insulin growth factors (IGFs), depolarization and vasoactive intestinal peptide (VIP) regulated precursor mitosis. We now report that Ca2+ entry via voltage-sensitive channels was required for depolarization-stimulated mitogenesis. Ca2+ channel blockade with nitrendipine completely inhibited the increase in [3H]thymidine incorporation elicited by depolarizing stimuli including 30 mM KCl and the Na+ channel agonist veratridine. However, Ca2+ channel activity was not involved in the stimulation of DNA synthesis by IGFs or VIP. Thus, neuroblast mitosis may be regulated by multiple intracellular as well as extracellular signals.

Vasoactive intestinal peptide regulation of neuroblast mitosis and survival: role of cAMP.

The role of adenosine 3':5'-cyclic monophosphate (cAMP) in the regulation of neuroblast mitosis and survival by vasoactive intestinal peptide (VIP) was examined. VIP increased the cAMP content of cultured rat sympathetic neuroblasts. Further, cAMP stimulated DNA synthesis and survival in neuroblast cultures, replicating the effects of VIP. Thus, the VIP-cAMP signaling pathway may be involved in the regulation of neuronal development.

Mapping of secondary somatosensory cortex activation induced by vibrational stimulation: an fMRI study.

Sensory functional MRI was performed in seven normal volunteers at 1. 5 T using a vibratory stimulus applied to the pad of the first finger of the left hand. The data was normalized to a standard atlas, and individual and group statistical parametric maps were computed. Robust bilateral activation was demonstrated in the secondary somatosensory cortex (SII), indicating a bilateral representation of SII in humans. Greater maxima and activation volumes were achieved in contralateral SII as compared to SI. Sensory fMRI can provide a sensitive assay for probing the nature and function of SII in vivo.

Chronobiology and chronotherapy of asthma.

There is no doubt that many pathophysiologic conditions change over a 24-hour period and thus therapy needs to be directed at these changes. In particular, asthma has been one of the better-studied disease processes in regard to circadian changes in pathophysiology. As we continue to learn more about circadian changes, better approaches to treating the disease with the same medications will emerge. It should be remembered that many asthmatics do not perceive their degree of bronchoconstriction. This was brought forth in Turner-Warwick's epidemiologic study in that less than one half of the asthmatic individuals who had problems with their asthma every night describe their asthma as being severe. The majority stated they either had mild or moderate asthma. Therefore, it is important that we use objective criteria such as peak flow meters in determining an individual patient's day-to-night changes in lung function. Then, any therapeutic intervention can be objectively determined at home with both the patient and physician gaining knowledge about the ongoing asthmatic process.

Neural stem and progenitor cells: a strategy for gene therapy and brain repair.

The damaged adult mammalian brain is incapable of significant structural self-repair. Although varying degrees of recovery from injury are possible, this is largely because of synaptic and functional plasticity rather than the frank regeneration of neural tissues. The lack of structural plasticity of the adult brain is partly because of its inability to generate new neurons, a limitation that has severely hindered the development of therapies for neurological injury or degeneration. However, a variety of experimental studies, as well as moderately successful clinical engraftment of fetal tissue into the adult parkinsonian brain, suggests that cell replacement is evolving as a valuable treatment modality. Neural stem cells, which are the self-renewing precursors of neurons and glia, have been isolated from both the embryonic and adult mammalian central nervous system. In the adult human brain, both neuronal and oligodendroglial precursors have been identified, and methods for their harvest and enrichment have been established. Neural precursors have several characteristics that make them ideal vectors for brain repair. They may be clonally expanded in tissue culture, providing a renewable supply of material for transplantation. Moreover, progenitors are ideal for genetic manipulation and may be engineered to express exogenous genes for neurotransmitters, neurotrophic factors, and metabolic enzymes. Thus, the persistence of neuronal precursors in the adult mammalian brain may permit us to design novel and effective strategies for central nervous system repair, by which we may yet challenge the irreparability of the structurally damaged adult nervous system.

Pathogenicity of Candida paratropicalis.

A new Candida species, Candida paratropicalis, was recently described. Four cases of infections due to C paratropicalis are reviewed in detail and an additional five cases are reviewed to establish the clinical relevance of this species of yeast. Candida paratropicalis was isolated from blood and several other body sites. Although the isolates tested were sensitive in vitro to amphotericin B and fluocytosine, significant morbidity and mortality were associated with the infections.

Distinguishing lies from jokes: theory of mind deficits and discourse interpretation in right hemisphere brain-damaged patients.

Right-hemisphere brain damaged (RHD) patients and a normal control group were tested for their ability to infer first- and second-order mental states and to understand the communicative intentions underlying ironic jokes and lies. Subjects listened to stories involving a character who had either a true or a false belief about another character's knowledge. Stories ended either with an ironic joke or a lie by this character. In the joke stories, the speaker knew that the listener knew the truth (a true second-order belief) and did not expect the listener to believe what was said; in the lie stories, the speaker did not know that the listener actually knew the truth (a false second-order belief) and thus did expect the listener to believe what was said. RHD patients performed significantly worse than control subjects on one of two measures of second-order belief, which suggests that the ability to make second-order mental state attributions is fragile and unreliable following right-hemisphere damage. RHD patients in addition performed worse than controls when asked to distinguish lies from jokes, confirming their known difficulties with discourse interpretation. For both groups, the ability to distinguish lies from jokes was strongly correlated with two measures of the ability to attribute correctly second-order beliefs. These results suggest that the fragility of RHD patients' understanding of second-order mental states underlies a portion of their difficulties in discourse comprehension, but that the underlying impairment is not restricted to right hemisphere dysfunction.

The effects of right-hemisphere brain damage on patients' use of terms of personal reference.

Successful communication depends on social as well as linguistic factors. In conversation, for example, a speaker must often refer to another person. Choosing an appropriate term of personal reference requires a speaker to consider several features of the discourse context, including properties of the persons being referred to and what knowledge is shared between the speaker and his or her addressee. In a pair of similar studies, we examined how right-hemisphere brain-damaged (RHD) patients and nonbrain-damaged control subjects use these different kinds of information in choosing formal (e.g., "Mr. Harding") versus informal ("Oliver") terms of reference for an absent third person. Stimulus vignettes manipulated three variables: the occupational status of the referent, the speaker's familiarity with the referent (i.e., the degree to which the speaker and referent were personally acquainted), and the addressee's familiarity (i.e., the degree to which the addressee and referent were personally acquainted). Relative to the control subjects, the RHD patients showed decreased use of both familiarity variables when choosing formal over informal labels, but apparently preserved sensitivity to the status variable. These results suggest how decreased use of the knowledge shared between a speaker and addressee disrupts RHD patients' discourse and thus contributes to these patients' aberrant interpersonal behavior. In addition. In addition, the results from the second study demonstrated an asymmetry in how female versus male subjects responded to the status manipulation.

When and why I use pethidine.

Pethidine is a valuable drug in general practice. It is useful in the acute pain of trauma and renal or biliary colic. It should be used by intramuscular injection, not orally. It should not be used for chronic pain, malignancy, head injury, heart failure, undiagnosed acute abdominal pain and if opiate addiction is suspected.

Incidence patterns of respiratory illness in Queensland estimated from sentinel general practice.

Incidence rates of six respiratory infections were calculated from sentinel practice data of 33,407 reports coming from 31 general practitioners in Queensland over 34 months in 1986/1988. Upper respiratory tract infection had an annual incidence of 301 per 1000 people, most in children aged under five, and a winter rate twice the summer rate. Sore throat (incidence 112:1000) and Infectious mononucleosis (incidence 2.7:1000) had little seasonal variation and were maximal among those aged 15-19 (in whom there was one case of Infectious mononucleosis for every 14 sore throats). Influenza (incidence 44:1000) underwent a prominent epidemic in the winter of 1988. Measles (incidence 1.9:1000), and pertussis and pertussis-like syndrome (incidence 0.8:1000) were most commonly reported in the under-fives, and rarely among adults. Sentinel practices networks collect useful epidemiological data from which disease incidences can be calculated.

Coronary bypass surgery. Indications and methods of selection.

Coronary artery bypass surgery has a survival rate of 98 to 99 per cent. Recent statistics demonstrate that it offers an increased life span and long term relief (or improvement) of symptoms; the efficacy of surgery is proven, especially in those with left main and multiple coronary vessel disease. For most patients the indications for referral are clear; for some they are not. Risk factors (before and after surgery) must be reduced.

A population-based assessment of the drug interaction between levothyroxine and warfarin.

Most drug interaction resources suggest that levothyroxine can dramatically potentiate the effect of warfarin. However, the mechanistic basis of the interaction is speculative, and little evidence supports a meaningful drug interaction. We conducted a population-based nested case-control study to examine the risk of hospitalization for hemorrhage following the initiation of levothyroxine in a cohort of 260,076 older patients receiving warfarin. In this group, we identified 10,532 case subjects hospitalized for hemorrhage and 40,595 controls. In the primary analysis, we found no association between hospitalization for hemorrhage during warfarin therapy and initiation of levothyroxine in the preceding 30 days (adjusted odds ratio 1.11, 95% confidence interval 0.67-1.86). Secondary analyses using more remote initiation of levothyroxine also found no association. These findings suggest that concerns about a clinically meaningful levothyroxine-warfarin drug interaction are not justified. Drug interaction resources that presently characterize this interaction as important should reevaluate this classification.