Mycobacterium thermoresistible recovered from a cutaneous lesion in an otherwise healthy individual.

This is the first report of coinfection by Mycobacterium thermoresistible and Mycobacterium fortuitum and only the fifth case of human infection by M. thermoresistible reported in the world literature.

Multiple lower extremity and penile spindle cell hemangioendotheliomas.

Spindle cell hemangioendothelioma (SCH) is a rare vascular neoplasm characterized by cavernous spaces, thrombi, phleboliths, and spindle cells. The lesions may arise at sites of vascular injury. We describe a 38-year-old man with multiple subcutaneous and penile SCHs. Patients with SCH should be screened for Maffucci's syndrome.

Structure-activity relationships (SAR) of some tetracyclic heterocycles related to the immunosuppressive agent Brequinar Sodium.

The structure-activity relationships of some tetracyclic heterocycles related to Brequinar were explored. Activities as inhibitors of dihydroorotate dehydrogenase and the mixed lymphocyte reaction are related to ring system, heteroatom placement, and pendant ring substitution.

Imaging quiz: a foot rash with a foul odor.

A 24-year-old man presented to a dermatology clinic complaining of a "smelly" rash on his feet. The rash had developed during a period of intense training for a 20-km forced road march. He reported that the rash was asymptomatic, but that the odor was embarrassing at times.

Painful papulovesicles produced by the puss caterpillar.

A residential gardener complained of immediate stinging when a "fuzzy tan caterpillar" fell across his fingers. He presented with painful hemorrhagic papules on the dorsal aspect of his right hand. Lepidopterism from contact with Megalopyge opercularis is described.

The dose-response pharmacology of intrathecal sufentanil in female volunteers.

The pharmacologic effects of intrathecal sufentanil (ITS) beyond what is clinically administered (10 microg) are not known. We observed 18 healthy, young, adult female volunteers who received 12.5, 25, or 50 microg of ITS in a randomized, double-blind fashion for 11 h. Analgesia was assessed by pressure algometry at the tibia. Respiratory function was assessed by pulse oximetry, respiratory rate, arterial blood gas, the ventilatory response to CO2, and a respiratory intervention score (RIS). The incidence and severity of side effects also were documented. Serum sufentanil levels were measured for 4 h after ITS administration. We found that ITS produced statistically significant changes in algometry, doubling the pressure required to produce moderate pain. However, doses of ITS greater than 12.5 microg failed to produce proportionate increases in the duration or intensity of analgesia. All doses of ITS produced significant respiratory depression, but only the RIS was significantly related to ITS dose. Neither respiratory rate nor sedation reliably predicted hypoxemia. Supplemental oxygen by nasal cannula consistently prevented pulse oximeter readings below 90%. Serum sufentanil concentrations were related to ITS dose in a statistically significant manner, reached clinically significant concentrations, and followed a time course similar to analgesia and measures of respiratory depression. However, there was no significant increase in measured analgesia associated with the increases in serum sufentanil concentrations. We conclude that in our volunteer model of lower extremity pain, administering ITS in doses larger than 12.5 microg does not improve the speed of onset, magnitude, or duration of analgesia and only causes dose-related increases in serum sufentanil concentrations, which may augment respiratory depression.

Anabolic implant effects on steer performance, carcass traits, subprimal yields, and longissimus muscle properties.

Crossbred steers (n = 140; 353 kg) were implanted as follows: (C) control, no implant; (S) Synovex-S (20 mg estradiol benzoate + 200 mg progesterone); (R) Revalor (20 mg estradiol + 140 mg trenbolone acetate [TBA]; international dosage); (ST) S + finaplix-S (140 mg TBA); (STT) S + finaplix-S with finaplix-S reimplanted on d 58. Steers were harvested after 119 to 126 d on feed. Left sides of 40 carcasses were fabricated into boneless subprimals for two s.c. fat levels: 2.5 and .64 cm. Steers administered an estrogen (estradiol benzoate or estradiol) plus TBA gained more rapidly (P < .05) than C or S steers. Feed efficiency was improved (P < .05) with an estrogen plus TBA. No differences (P > .05) were noted among treatments for carcass s.c. fat thickness, percentage internal fat, or lean color. Carcasses from steers receiving TBA had larger (P < .05) longissimus areas and tended to have lower (P < .10) marbling scores and yield grades than C or S steers. Steers implanted with R had a lower (P < .05) percentage of U. S. Choice carcasses (51.8%) than C, S, and ST steers (82 to 86%). Shear force values for implanted steers tended to be higher (P < .10) than for controls. Implants increased (P < .05) subprimal and total side lean yields (.64 cm) compared to controls; the largest increases of 2.3 and 2.8%, respectively, occurred in steers receiving TBA plus an estrogen. Estrogen plus TBA exhibited favorable effects on gain, efficiency, and composition; however, the single estradiol plus TBA implant (R) decreased quality grade.

Differences between prescribed and dispensed medications.

AIMS: To describe differences between general practice prescribed and dispensed medications in terms of patient characteristics and category of drug. METHODS: Computerised prescribing records and prescriptions presented to pharmacies were retrospectively reviewed. All prescriptions generated from the computers of 13 practices over a 12 week period in 1992 were compared with prescriptions dispensed. Data from the two sources were matched and unmatched items were analysed to determine whether patient demography or category of drug prescribed influenced the rate of prescription dispensing. The nine most commonly prescribed drug categories were examined in detail. RESULTS: A total of 49 756 items were prescribed to 19 299 people and 43 302 (87.0%) of these were dispensed. Antibiotics were the most commonly prescribed category of the drug accounting for 17.6% of nondispensed items. There was no significant difference by gender in the proportion of people (9.8%) failing to claim prescribed items, nor in the number of items (13.0%) prescribed but not dispensed. Differences in dispensing rates by community services card (CSC) status of patients were statistically significant for both numbers of people failing to uplift their medications and for numbers of items not dispensed (p<0.001). There were also significant differences by high user health card (HUH) eligibility (p<0.005) and age (p<0.001). CONCLUSIONS: There is a high rate of nondispensing of medicines prescribed in general practice. Patients eligible for government subsidies are more likely than other patients to have their prescriptions filled. Current pharmaceutical subsidies may be inadequately targeted. There are no gender differences, while increasing age is associated with lower nondispensing rates. General practitioners need to be aware of these factors when making prescribing decisions.

Sonographic diagnosis of peritoneal inclusion cysts.

Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.

Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery.

The present study was designed to test the hypothesis that i.v. nitroglycerin is as effective as sodium nitroprusside for managing acute hypertension early after coronary artery bypass surgery. Seventeen patients received both nitroglycerin and nitroprusside in a randomized crossover protocol. Infusion rates were increased stepwise to lower mean arterial pressures comparably with each drug. In 14 of 17 patients, similar infusion rates of the two vasodilators resulted in equal lowering of both blood pressure and systemic vascular resistance. In the remaining three patients, very high infusion rates of nitroglycerin were required and achieved only 20-50% of nitroprusside's response in two of three. Hemodynamic responses to the two vasodilators were similar, except that nitroglycerin increased cardiac output more than nitroprusside did. In contrast, pulmonary gas exchange responses differed in that nitroglycerin improved intrapulmonary shunting, while nitroprusside worsened it. Similarly, nitroglycerin resulted in a significantly smaller increase in the alveolar arterial oxygen gradient than did nitroprusside. These results suggest that in the majority of patients, i.v. nitroglycerin was as effective as nitroprusside in controlling acute hypertension after coronary artery bypass surgery. In addition, nitroglycerin appeared to have more favorable effects on pulmonary gas exchange. Because nitroglycerin has more beneficial effects on intercoronary collateral blood flow in the setting of regional ischemia, it may be preferable to nitroprusside in patients with ischemic heart disease.