The dog mummy, the ticks and the louse fly: Archaeological report of severe ectoparasitosis in Ancient Egypt.

The authors report the first archaeological case of dog ectoparasitosis in Ancient Egypt. The study of a mummified young dog dated to the Roman period suggests a significant infestation by two blood sucking ectoparasites, respectively the brown dog tick Rhipicephalus sanguineus Latreille, 1806 (Acari: Ixodidae), the louse fly Hippobosca longipennis Fabricius, 1805 (Diptera: Hippoboscidae) as well as puparia of sarcosaprophagous flies (Diptera: Sarcophagidae and Calliphoridae), a potential source of myiasis. All of these species are known to be potential vectors of different pathogens which may be responsible for the premature death of the dog.

Piercing and tattooing in patients with congenital heart disease: patient and physician perspectives.

PURPOSE: The frequency and safety of ear piercing and tattooing were assessed in a group of children, adolescents, and adults with congenital heart disease (CHD). Also, a group of physicians who care for adolescents and adults with CHD were surveyed for opinions and experiences regarding piercing and tattooing. METHODS: An eight-question survey was mailed to 445 patients (181 adults and 264 children) from one center. A different five-question survey was mailed to 176 physician members of the International Society of Adult Congenital Cardiac Disease. RESULTS: The patient survey was completed by 152 of 445 (34%) patients (mean age +/- standard deviation 19.8 +/- 16.2 years; range 0.25-67 years). Eighty-eight of 152 (58%) patients were female. Ear piercing occurred in 65 of 152 (43%) patients (mean age 12.4 +/- 8.7 years; range 0.25-45 years). Prior to piercing, only 4 of 65 (6%) patients took antibiotics, but 15 of 65 (23%) had piercing-related infections. No patient had endocarditis. Infections occurred 1 week to 3 years after piercing. All were local skin infections. Tattoos were placed in 8 of 152 (5%) patients (median age 17.5 years; range 13-56 years). No antibiotic use or infections were reported in patients with tattoos. The physician survey was completed by 118 of 176 (67%) physicians. The majority of physicians did not approve of patients having piercing or tattooing performed. However, 60% of physicians believed that antibiotic prophylaxis is indicated for these procedures. CONCLUSIONS: Despite the opinion of many physicians, most patients do not take antibiotic prophylaxis for piercing and tattooing. Patients apparently do not suffer serious sequelae. The efficacy of standard antibiotic regimes as applied to ear piercing and tattooing requires further study, since these procedures are increasingly popular in modern society.

Effective oral ganciclovir prophylaxis against cytomegalovirus disease in heart transplant recipients.

The presented data show the combined sequential use of i.v. G for 14 days followed by PO G for 90 days is a much more effective prophylaxis for CMVD after heart transplantation than use of i.v. G for 14 days followed by PO A for 90 days. A need for hospitalization due to CMVD is significantly reduced by this new strategy. The follow-up in group II is shorter than in group I but is now at least 6 months in group II, without any new cases in the first 6 months after cardiac transplantation. Some currently unknown adverse effect of prolonged PO G, which may be present, is not identified in this analysis.

Cost-effectiveness of transaxillary muscle-sparing same-day operative closure of patent ductus arteriosus.

Transaxillary muscle-sparing patent ductus arteriosus closure performed as same-day surgery is described in 10 patients. This approach provides a superb cosmetic result while obviating the need for thoracostomy tube placement.

Role of maximal oxygen consumption in establishment of heart transplant candidacy for heart failure patients with intermediate exercise tolerance.

Maximal exercise oxygen consumption (VO2max) was measured in patients with chronic congestive heart failure undergoing evaluation for heart transplantation. Although VO2max correlated with survival for the group as a whole, it did not demonstrate survival discrimination for patients in the intermediate range (VO2max = 12 to 17 ml/kg/min) and should therefore not be used as a benchmark test for determination of appropriateness for cardiac transplantation in this group of patients.

Anatomic correction of dextrotransposition of the great arteries in a 36-year-old patient.

During the 1960s, the Mustard or Senning operation was the conventional palliative therapy for patients with transposition of the great arteries. Many of these patients are now adults, and the durability of the morphologic right ventricle to function as the systemic ventricle is being questioned. Surgical options for such adult patients have traditionally been limited to cardiac transplantation. More recently, an arterial switch operation with take-down of the Mustard or Senning baffles has been reported. Herein we describe the clinical course of a 36-year-old woman who underwent a successful single-stage Mustard take-down, atrial reconstruction, and arterial switch operation.

Insulin-stimulated glucose transport inhibits Ca2+ influx and contraction in vascular smooth muscle.

BACKGROUND: Insulin attenuates serotonin-induced Ca2+ influx, the intracellular Ca2+ transient, and contraction of cultured vascular smooth muscle cells from dog femoral artery. These studies were designed to test whether insulin-induced glucose transport was an early event leading to the inhibitory effects of insulin on Ca2+ influx, intracellular Ca2+ concentration, and contraction in these cells. METHODS AND RESULTS: Insulin 1 nmol/L stimulated the 30-minute uptake of [3H]2-deoxyglucose in these cells via a phloridzin-inhibitable mechanism. Contraction of individual cells was measured by photomicroscopy, intracellular Ca2+ concentration was monitored by measuring fura 2 fluorescence by use of Ca(2+)-sensitive excitation wavelengths, and Ca2+ influx was estimated by the rate of Mn2+ quenching of intracellular fura 2 fluorescence when excited at a Ca(2+)-insensitive wave-length. In the presence of 5 mmol/L glucose, preincubation of cells for 30 minutes with 1 nmol/L insulin inhibited 10(-5) mol/L serotonin-induced contraction of individual cells by 62% (P < .01) and decreased the serotonin-stimulated component of Mn2+ influx by 78% (P < .05). Removing glucose from the preincubation medium or adding 1 mmol/L phloridzin completely eliminated these effects of insulin. Insulin lowered the serotonin-induced intracellular Ca2+ peak by 37% (P < .05), and phloridzin blocked this effect of insulin. When glucose uptake was increased to the insulin-stimulated level by preincubation of the cells for 30 minutes with 25 mmol/L glucose in the absence of insulin, serotonin failed to stimulate Mn2+ influx, the serotonin-induced Ca2+ peak was decreased by 46% (P < .05), serotonin-induced contraction was inhibited by 60% (P < .01), and addition of insulin did not further inhibit contraction. CONCLUSIONS: Since the effects of insulin on serotonin-stimulated Ca2+ transport, intracellular Ca2+ concentration, and contraction were dependent on glucose transport and were duplicated when glucose transport was stimulated by high extracellular glucose concentration rather than insulin per se, it is concluded that insulin-stimulated glucose transport is an early event that leads to decreased Ca2+ influx and contraction in vascular smooth muscle.

High-resolution CT of mastoid sinus pneumocele with external auditory canal stenosis.

A 34-year-old man presented with tinnitus and conductive hearing loss. CT demonstrated an expansile, air-containing cavity contiguous with mastoid air cells, narrowing the external auditory canal. This is a case of symptomatic pneumocele resulting in an air collection beneath external canal lining, possibly related to an abnormality in mastoid fusion.

Effect of an inelastic aortic synthetic vascular graft on exercise hemodynamics.

This study compared aortic input impedance characteristics between patients with aortic interposition Dacron grafts placed for traumatic aortic injury and normal age-matched control subjects. All subjects were examined at rest and after treadmill exercise. Magnetic resonance imaging was conducted to rule out anatomic (stenosis) effects. Exercise increased characteristic impedance (ie, reduced aortic distensibility) by 29% and decreased total systemic arterial compliance by 21% in the patient group, whereas the normal control group showed insignificant change in these variables after exercise. Peripheral pressure wave reflection was reduced substantially with exercise (27%) in the control group, with much less reduction observed in the patient group. These abnormal vascular hemodynamics were associated with significantly high cardiac energetic costs in the patient group. A plausible explanation for the observed differences lies in the exaggerated vascular impedance mismatch between compliant aorta and inelastic graft, when cardiac output increases dramatically.

Anti-lipid A monoclonal antibodies and anti-LPS antiserum effects on limulus activity of LPS.

Anti-lipid A monoclonal antibodies (A78S1 and A523) and anti-LPS antiserum can decrease the mortality due to endotoxic shock in the newborn rat. However, in vitro LPS detoxification of anti-lipid A monoclonal antibodies is not known. Thus, we studied in vivo effects of A78S1 (IgG), A523 (IgM), and anti-LPS antiserum on Limulus activity. Anti-LPS antiserum decreased Limulus activity of S. enteritidis, E. coli and S. typhosa LPS. However, neither A78S1 nor A523 decreased the Limulus activity of E. coli and S. typhosa LPS. A78S1 or A523 incubation with S. enteritidis LPS at different doses (0.1 to 100 ng/ml) did not alter the Limulus activity. Perchloric acid treatment after LPS incubation with A78S1 or A523 significantly decreased Limulus activity. Therefore, antilipid A monoclonal antibodies (A78S1 and A523) can bind LPS, but do not decrease Limulus activity.

Disruption of sutured pulmonary valve in Fontan operation.

Two patients who had undergone a Fontan operation presented late with considerable disruption of a sutured pulmonary valve. Both patients had increasing ascites, decreased exercise tolerance, atrial arrhythmias, high right atrial pressure, and a large ratio of pulmonary blood flow to systemic blood flow. At operation, the main pulmonary artery was closed either by suturing the anterior and posterior walls together immediately distal to the pulmonary valve or by reinforcing the resutured pulmonary valve with a polytetrafluoroethylene patch. Both patients had an uneventful postoperative course, with disappearance of the symptoms and return of sinus rhythm. Although it is tempting to simply suture the usually thickened pulmonary valve in the Fontan operation, approximation of the pulmonary artery walls or patch reinforcement is necessary to minimize disruption.

Decreased gluconeogenesis and increased glucose disposal without hyperinsulinemia in 10-day-old rats with endotoxic shock.

Glucose dyshomeostasis is a common and life-threatening sign of endotoxic shock in the newborn. In this study, liver gluconeogenesis was evaluated in 10-day-old rats with endotoxic shock using the isolated perfused liver. Phosphoenolpyruvate carboxykinase (PEPCK) activity and PEPCK mRNA abundance were measured to confirm altered gluconeogenesis. Glucose disposal was also evaluated by a glucose tolerance test. Twenty-four-hour-fasted rats were studied to enhance gluconeogenesis and decrease glucose disposal. Rats received an intraperitoneal (IP) injection as follows: group 1 (fed-saline), 0.2 mL saline in fed rats; group 2 (fed-LPS), 0.1 mg/kg Salmonella enteritidis lipopolysaccharide (LPS) in fed rats; group 3 (fasted-saline), 0.2 mL saline in fasted rats; and group 4 (fasted-LPS), 0.1 mg/kg LPS in fasted rats. Isolated liver perfusion, determination of liver PEPCK activity and liver PEPCK mRNA abundance, and a glucose tolerance test were performed at 4 hours in fed rats and at 6 hours in fasted rats. LPS induced hypoglycemia (1.62 +/- 0.33 mmol/L, P < .05) at 6 hours in group 2 (fed-LPS), but not in group 4 (fasted-LPS). Hyperinsulinemia was not observed in either group 2 (fed-LPS) or group 4 (fasted-LPS). In group 2 (fed-LPS), liver gluconeogenesis decreased (3.0 +/- 0.3 mg/g liver, P < .01). PEPCK activity decreased from 0.65 +/- 0.07 (group 1) to 0.23 +/- 0.02 U (P < .01). PEPCK mRNA abundance also decreased from 100% +/- 10% to 40% +/- 10%. The glucose disappearance rate (t1/2) increased (P < .05) in group 2 (fed-LPS) and group 4 (fasted-LPS).(ABSTRACT TRUNCATED AT 250 WORDS)

Dyshematopoiesis in combined immune deficiency with congenital neutropenia.

This report describes a patient with combined immune deficiency associated with congenital neutropenia (CID/CN) and reports a partial characterization of his hematopoietic abnormalities. The CID/CN syndrome described is characterized by neutropenia and by deficiencies in B-lymphoid and T-lymphoid cell number and function. Red cell and platelet counts were normal. In vitro assays indicate that the myeloid lineage was developmentally arrested at the level of the committed monocyte/granulocyte progenitor (CFU-GM), while precursors to the CFU-GM progenitor were normal. In vitro studies showed that the defect in myeloid development was not corrected with G-CSF or GM-CSF. However, combinations of cytokines present in conditioned media from the T-cell lines MO or C5MJ, or defined multiple cytokine combinations containing IL-1, IL-3, GM-CSF, kit ligand, IL-6, and IL-9, restored myelopoiesis in-vitro. In contrast, C5MJ-conditioned media did not correct deficiencies in immune function in the patient's lymphocytes and accessory cells. No abnormalities in the production of G-CSF, GM-CSF, M-CSF, or IL-1 from the patient could be identified to account for the defects in myelopoiesis orimmune function.

Macrophage treatment in suckling rat endotoxic shock.

Gram-negative sepsis/septic shock in the human newborn continues to be a severe medical problem because of significant mortality and morbidity. Since macrophages detoxify endotoxin, a decreased number of macrophages may contribute to the newborn's sensitivity to endotoxin. In this study, peritoneal macrophages were used for the treatment of endotoxic shock in 10-day-old rats, and 24-hr mortality, plasma glucose, and lactate concentrations were monitored. Peritoneal macrophages were harvested from adult or 10-day-old rats. Caseinate-stimulated macrophages from adult and 10-day-old rats significantly decreased the mortality of 10-day-old rat endotoxic shock from 90% to 37.5% and 44.4%, respectively. Resident macrophages from adult and 10-day-old rats also decreased the mortality from 90% to 12.5% and 45.4%, respectively. Peritoneal macrophages from adult rats significantly ameliorated hypoglycemia during endotoxic shock in a dose-dependent manner. Macrophage treatment decreased plasma endotoxin concentration (P < 0.05). Macrophage treatment was important for host defense.

Lactic acid changes during and after hypothermic cardiopulmonary bypass in infants.

Infants undergoing open-heart surgery with hypothermic cardiopulmonary bypass experience markedly elevated lactate and glucose levels. Reports in infants less than 10 kg show the elevated lactate to be progressive during the operative period. The pathogenesis of the hyperglycemia is not clear but may be caused by excess glucose administration, inadequate insulin response, or glucose regulatory hormone levels of glucagon, cortisol, and growth hormone. The purpose of this study is to confirm these findings and to investigate their pathogenesis. Serial blood samples were taken preoperatively, intraoperatively, and postoperatively during hypothermic cardiopulmonary bypass in nine infants of less than 10 kg. Samples were analyzed for levels of lactate, glucose, and regulatory hormones insulin, growth hormone, glucagon, and cortisol. Our study did not show a progressive accumulation of lactate. The elevated lactate level appears to come from the pump prime solution. The hyperglycemia is also from the pump prime solution, and there do not appear to be elevated levels of regulatory hormones intraoperatively. Insulin response during hypothermia is blunted; however, on rewarming the patient in the immediate postoperative period, a brisk insulin response is seen. The changes in levels of lactate and glucose and the regulatory hormones return to baseline at 24 hours with no further significant changes in the next 48 hours.

Cardiovascular effects of lightning strikes.

OBJECTIVES: The purpose of this study was to investigate the effects of lightning strikes on the cardiovascular system. BACKGROUND: A lightning strike can attack its victims in one of three ways: direct hit, splash or ground strike. The cardiovascular system can be affected directly by mechanical or electrical trauma during a direct hit or can be indirectly affected through effects on the total body with extensive catecholamine release or autonomic stimulation. Reported effects include hypertension, tachycardia, nonspecific electrocardiographic (ECG) changes including prolongation of the corrected QT (QTc) interval, transient T wave inversion and myocardial necrosis with creatine kinase-MB (CK-MB) fraction release. METHODS: Nineteen victims from five separate lightning strikes were studied over a 2-month period. Each patient was evaluated by serial ECG, CK-MB determinations and echocardiography. RESULTS: The early (0 to 72 h) effects of lightning were demonstrated on the ECG by ST segment elevation consistent with acute current of injury, prolonged QTc interval with direct hits and nonspecific ST and T wave changes. On echocardiography, segmental or global ventricular dysfunction was seen, and pericardial effusion was also detected. During the intermediate (3- to 14-day) period, new and often marked ECG changes consistent with pericarditis or ischemia were seen. No new echocardiographic changes were detected, however, and the early abnormalities including severe left ventricular dysfunction with cardiogenic shock have reversed. The late (1 to 12 months) period revealed only one patient with long-term sequelae (recurrent pericarditis that persisted for 5 months). CONCLUSIONS: Unless both entrance and exit sites are limited to the lower limbs, direct and splash lightning strikes cause myocardial damage as assessed by abnormal serum enzyme determinations or abnormal echocardiographic findings. Only direct hits resulted in echocardiographic abnormalities or a prolonged QTc interval. The degree of myocardial injury can be severe with left and right ventricular ejection fraction < 15% and can be reversible.

Diltiazem treatment of endotoxic shock in suckling rats.

Gram-negative sepsis septic shock continues to produce significant mortality and therefore remains a major medical problem. Vasodilators have been studied in the treatment of circulatory shock. However, the effectiveness of calcium channel blockers in the treatment of newborn endotoxic shock has not been well documented. In the present study, diltiazem, a calcium channel blocker, and nitroprusside, a vasodilator, were used for the treatment of endotoxic shock in 10-day-old rats. Mortality rate, hemodynamics, and glucose metabolism were monitored. Diltiazem at a dose of 0.3 mg/kg attenuated the hypotension, bradycardia, hypoglycemia, and lactacidemia in newborn endotoxic shock. Diltiazem treatment resulted in reduced 24-hour mortality. However, 0.6 mg/kg diltiazem enhanced the hypotension, bradycardia, and lactacidemia in endotoxic shock. Nitroprusside blunted the hypoglycemia and decreased the mortality rate among rats with endotoxic shock. Afterload reduction may be responsible for the beneficial effects of 0.3 mg/kg diltiazem and nitroprusside. Diltiazem at a dose of 0.3 mg/kg reduced the lactacidemia of endotoxic shock more than nitroprusside. Therefore the effects of diltiazem may be due not only to afterload reduction but also to inhibition of cellular calcium influx. We conclude that 0.3 mg/kg diltiazem and 1.0 mg/kg nitroprusside are beneficial for the treatment of endotoxic shock in newborn rats.