Pulmonary sporotrichosis treated with itraconazole.

A 62-year-old woman had chronic cavitary pulmonary sporotrichosis refractory to medical management over an 8-year period. She was treated with oral itraconazole and had an apparent microbiologic and clinical response; however, the patient succumbed to progressive pulmonary hypertension. The early use of oral itraconazole for treatment of pulmonary sporotrichosis is advocated.

Preventability of emergent hospital readmission.

To determine whether emergent readmissions within 30 days of discharge are potentially preventable, we prospectively studied all readmissions to the medical service of a university teaching hospital during a 4-month period. The 327 readmissions, including 42 patients who were readmitted more than once during the study period, accounted for 12% of medical admissions. Nearly 75% of readmissions were due to previously diagnosed medical conditions; complications of drugs or therapeutic procedures caused 29%, and patient compliance contributed to 11%. Three reviewers judged 28 (9%) readmissions to be potentially preventable. These 28 readmissions constituted 1% of all admissions to the medical service and did not result in any fatalities, indicating that the quality of care was generally very good. One third of the potentially preventable readmissions were thought to be related to medical system failures, one third to an unfulfilled hope that the patient would improve after discharge, and one third to other suboptimal judgements in evaluation or treatment. Of the 28 potentially preventable readmissions, 89% occurred within 10 days of discharge. We conclude that potentially preventable readmissions would nearly always be detected by review of readmissions within 10 days of discharge and that many may be amenable to systematic interventions such as standardized predischarge assessment and better coordination of post-discharge follow-up.

Bacteroides vulgatus outer membrane antigens associated with carrageenan-induced colitis in guinea pigs.

Previous experiments with the carrageenan model for ulcerative colitis demonstrated that the inflammatory response in guinea pigs can be enhanced by immunization with Bacteroides vulgatus and subsequent feeding of this organism to experimental animals. The studies reported here show that antigens extractable from the bacterial outer membrane by EDTA are responsible for this effect. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to analyze the outer membrane proteins from various strains as well as the lipopolysaccharides (LPS) extractable by the phenol-water method. Although the observed pattern of outer membrane proteins was complex, the strains could be divided into two electrophoretic types (phenons) on the basis of immunoblotting against a panel of antisera. Cross-absorbed antisera used in immunoblotting experiments identified four outer membrane proteins uniquely associated with the phenon capable of enhancing the colitis inflammatory response. These proteins had molecular weights of 100,000, 57,000, 34,000, and 21,000 when measured in 8% to 12% acrylamide gradient sodium dodecyl sulfate gels. Other antigens identified included at least one type of smooth LPS, three types of rough LPS, and a common antigen of 30,000 molecular weight among the strains of B. vulgatus tested. The outer membrane preparations were used in animal immunization and challenge experiments, and the severity of colitis was correlated with one electrophoresis type. The potential role of membrane proteins in the enhancement of colitis is discussed.