Acute myocardial infarction associated with amphetamine use.

Myocardial infarction is a rarely reported complication of amphetamine use. We report the case of a healthy 31-year-old man who presented to our emergency department with no clinical evidence of an acute coronary event after intravenous injection of amphetamines. However, he subsequently experienced a non-Q-wave anterior wall myocardial infarction associated with the use of amphetamines.

Mechanisms of the contractile effects of flosequinoxan.

In guinea-pig papillary muscles the positive inotropic effect of flosequinoxan (BTS) starting at 100 mumol/l amounted to 287.6 +/- 34.2% at 300 mumol/l without any effects on time to peak tension (103.9 +/- 2%) and relaxation time (107.1 +/- 6.7% of predrug value, respectively). 10 mumol/l carbachol attenuated the positive inotropic effect of 300 mumol/l to 166.5 +/- 11.6% (n = 10). The phosphorylation state of the inhibitory subunit of troponin (TnI) and phospholamban (PLB) in [32P]-labeled guinea-pig ventricular myocytes was increased starting at 100 mumol/l amounting to 142.5 +/- 12.6% and 130.9 +/- 2.2% at 300 mumol/l, respectively (n = 5). Furthermore, BTS (300 mumol/l) decreased phosphorylase phosphatase activity by 23.1%. It is concluded that the contractile effects of BTS are accompanied by enhanced phosphorylation of regulatory proteins which could in part be due to inhibition of phosphorylase phosphatase activity.

Mitral valve anomalies obstructing left ventricular outflow.

This paper reports on two cases of more uncommon types of subaortic stenosis. A 2-year-old boy was found with accessory mitral valve leaflet (AMVL) attaching to the anterior leaflet, ballooning into the subaortic ventricular septum associated with a discrete subaortic membrane. The obstruction was successfully relieved by removal of the AMVL and resection of the membrane. A 19-day-old newborn with accessory tissue on the mitral valve (AMVT) causing subaortic stenosis, subaortic ventricular septal defect (VSD) and patent ductus arteriosus was operated on successfully. Accessory tissue excision through the VSD, VSD patch closure and ductus ligation were performed.

Impact of managed care on the economics of laboratory operation in an academic medical center.

BACKGROUND: Throughout the 1980s, the number of laboratory tests performed in the United States grew at an annual rate of over 10%, and laboratory costs accounted for approximately 10% of overall health care expenditures. Recently, the influence of capitation, emphasis on cost-effectiveness, and changing roles among specialists and primary care physicians have begun to affect the growth of laboratory testing. We examined the impact of managed care on the economics of the clinical chemistry laboratory at Vanderbilt University Medical Center, Nashville, Tenn, to define the relative position of the clinical laboratory in the managed care environment of an academic medical center. METHODS: The following data were prospectively collected between fiscal years 1984/1985 and 1995/1996: number of inpatients and outpatients, average length of stay, number of laboratory tests, total laboratory revenue, direct costs (consisting of salary and consumable costs), and number of full-time-equivalent (FTE) personnel. Using these data, we derived the following parameters: revenue and direct cost per patient, and revenue and productivity per FTE. RESULTS: Between 1984/1985 and 1995/1996 the number of inpatients and outpatients increased 33% and 155%, respectively. Laboratory utilization, expressed as tests per patient, increased from 17 to 22 for inpatients between 1984/1985 and 1991/1992, and then sharply declined to 14.5 tests by 1995/1996, a 34% decrease compared with the 1991/1992 level. Laboratory utilization for outpatients increased from 0.23 in 1984/1985 to 0.45 tests in 1991/1992, decreased to 0.38 in 1993/1994, but then rose again to 0.43 in 1995/1996. Total revenue more than doubled between 1984/1985 and 1991/1992, mostly owing to increased inpatient revenue. Since 1992/1993, inpatient revenue has steadily declined, leading to a decrease in total revenue, which was partially offset by a continuous increase in outpatient revenue. In 1995/1996, outpatient revenue accounted for 32.1% of total revenue, compared with 7.7% in 1984/1985. Direct test cost per patient increased approximately 20% between 1984/1985 and 1991/1992, followed by a decline below the 1984/1985 level. The number of FTEs increased in parallel to the rising test volume through 1991/1992 and subsequently was reduced in response to the decrease in test volume and productivity. In 1995/1996, a 22.7% reduction in staff was imposed despite an upward trend in test volume, resulting in a sharp increase in revenue and productivity per FTE. The staff reduction did not decrease direct laboratory costs, which have remained constant since 1992/1993. CONCLUSIONS: After three decades of continued growth, managed care has caused a sharp reversal in the upward trend in the number of laboratory tests, the number of tests per inpatient, test costs per patient, laboratory revenue, and productivity. A recent staff reduction significantly increased revenue and productivity per FTE, but showed no effect on direct laboratory costs.

[Diagnostic and therapeutic experiences with purulent meningitis in adults]. / Diagnosztikus és terápiás tapasztalatok felnöttkori gennyes agyhártyalobban.

The authors reviewed data of 137 patients with purulent meningitis treated in the period of 10 years. Attention was paid to the frequency of predisposing and associated diseases, to the factors helping and delaying the diagnosis and to those altering the prognosis. The importance of effective supportive care, particulary covering pressure of the CNS as well as specific therapy was stressed. The circumstances and the conditions of management depending on the condition of the patient was emphasized. Thirty eight of patients (27%) has died.

[Prevention of rabies (experience of the past, possibilities of the future)]. / A rabies prevenciója (a múlt tapasztalatai és a jövö lehetöségei).

The authors review the history of rabies prevention, the current national and international data. Neurologic adverse effects of the Hempt vaccine are discussed. Medical histories of two patients are demonstrated, one suffered of serious complication of the vaccine; the other died of rabies. Indications of vaccine Rabivac and issues about it's administration are outlined. The possibilities of the therapy are discussed in brief.

[Total cavo-pulmonary anastomosis in heart surgery for the correction of univentricular heart]. / Teljes cavopulmonalis anasztomózis az univentricularis szív sebészi korrekciójában.

The total cavopulmonary anastomosis is one of the alternative surgical procedures which can be performed in the management of the most complicated congenital heart diseases. It was the first time in Hungary that this surgical management was performed successfully in a girl with univentricular heart, pulmonary valve stenosis, malposition of the great arteries, who was operated on palliative procedure previously.

[Successful multi-step management of developmental heart defects after intrauterine diagnosis]. / Intrauterin diagnosztizált összetett szívfejlódési rendellenesség többlépcsós sikeres sebészi korrigálása.

At 28th week of gestation a conotruncal malformation with ventricular septal defect was diagnosed by fetal echocardiography. Postnatal echocardiographic and angiocardiographic examinations confirmed the diagnosis of conotruncal malformation (pulmonary atresia, ventricular septal defect, patent ductus arteriosus, aortopulmonary collateral arteries). The unifocalization (age: 11 months) and total correction with aortic homograft (age: 7 years) were performed. To our knowledge our case is the first whose intrauterine diagnosis of complex congenital heart disease was confirmed after delivery and had successful two-stage surgical management.

CA-125 concentrations in malignant and nonmalignant disease.

CA-125 is a high-molecular-mass glycoprotein expressed on the cell surface of some derivatives of embryonic coelomic epithelium. This tumor-associated antigen widely used to monitor ovarian carcinomas has been suggested as a promising noninvasive test that could differentiate benign from malignant conditions. Based on results of various studies, CA-125 measurement appears to be very useful in monitoring the response to therapy of ovarian carcinoma and for detecting tumor recurrence as exemplified in Case 1. However, because of the high frequency of false-positive results associated with many benign conditions, CA-125 is of little value as a screening test for ovarian carcinoma. A brief list of the most common benign conditions associated with CA-125 increase includes menstruation, pregnancy, benign pelvic tumors, pelvic inflammatory diseases, ovarian hyperstimulation syndrome, peritonitis, and many diseases leading to pleural effusion or ascites. According to several studies, a marked increase in CA-125 of greater than 1000 units/mL, as seen in Case 2, and even up to 5000 units/mL, could be seen in some benign conditions. This finding further limits the value of CA-125 as a potential noninvasive procedure to differentiate benign from malignant diseases. Although values up to 10,000 units/mL are occasionally seen in patients with ovarian carcinoma, we are reluctant to state that any concentration of CA-125 can be clearly diagnostic of malignancy.

Variations in abundance of the molecular ion of the derivatized cocaine metabolite benzoylecgonine.

Benzoylecgonine (BEG) is the principal urinary metabolite of cocaine. For forensic drug testing, the presence of BEG in urine, suggested by a positive result for a screening immunoassay, must be confirmed by quantitative gas chromatographic/mass spectrometric (GC/MS) analysis, i.e., stable isotope dilution with a deuterium-labeled internal standard. GC/MS criteria for positivity also require appropriate relative abundances of qualifier ions, including the molecular ion, but there is little published information on the observed absolute values for qualifier ion ratios or on the variability of these values. This lack of information creates uncertainty for laboratories initiating programs testing urine for drugs of abuse as to performance criteria for run acceptability and sample positivity. We have observed substantial variability (CV = 50%) in the abundance of the molecular ion of derivatized BEG relative to the base ion in reference materials. This variability can result in a high rate of repetition of runs and generate confusion in the defense of forensic drug-testing results. Normalization of the abundance of the molecular ion of derivatized BEG to that of the deuterium-labeled internal standard in the same sample greatly reduces the apparent variability in this measurement; it is also more reliable than the absolute value of the relative abundance of the molecular ion in determining run acceptability and positive or negative results for a sample.