Atrial infarction complicating an acute inferior myocardial infarction.

Atrial fibrillation, coronary sinus rhythm, and slow atrial flutter developed in a patient with ECG findings of an acute inferior myocardial infarction. Hemodynamic measurements were suggestive of predominantly right ventricular involvement. A gated cardiac blood pool study demonstrated normal right and left ventricular wall motion with an enlarged, non-contracting right atrium. This led to the antemortem diagnosis of atrial fibrillation.

Asymptomatic perianal shedding of herpes simplex virus in patients with acquired immunodeficiency syndrome.

OBJECTIVE: To determine the frequency of asymptomatic perianal shedding of herpes simplex virus (HSV) in adult patients with acquired immunodeficiency syndrome (AIDS). DESIGN: Cross-sectional study. SETTING: A 1000-bed, state-supported hospital in Brazil that provides comprehensive health care. PATIENTS: Eighty-two consecutively hospitalized patients with AIDS (Centers for Disease Control and Prevention class C). MAIN OUTCOME MEASUREMENT: Specimens for HSV culture were obtained with premoistened swabs of the perianal region at approximately 7-day intervals during the hospitalization of each patient. After the specimens were inoculated into cultures of human foreskin and Vero cells, supernatants of cultures showing the cytopathic effect characteristic of HSV infection were tested for virus in a confirmatory immunoenzymatic assay. Typing of HSV was performed by polymerase chain reaction amplification of HSV-1- and HSV-2-specific DNA polymerase sequences. RESULTS: On early into the study, 12 (15%) of 82 patients had perianal ulceration and 70 did not. None of the patients in the latter group developed perianal ulcers during the study period, but HSV was isolated at least once from 17 (24%) of them. Nine of the 17 asymptomatic perianal shedders had a mean of 3 perianal swabs collected before the first HSV isolation, and 11 (65%) of 17 had a total of 18 perianal swabs collected 8 to 62 days after the HSV isolation. All postpositive samples were negative for HSV except 1 obtained from a patient 13 days after the first positive sample. Twelve of the 17 asymptomatic perianal shedders of HSV were followed up clinically for 8 to 62 days after the first episode of shedding and none developed perianal ulceration. CONCLUSIONS: We conclude that asymptomatic perianal shedding of HSV is common in patients with AIDS, even among those without a history of perianal HSV lesions. This shedding appears to be short-lived, intermittent, and not associated with early subsequent development of perianal ulcers. These findings present a new perspective on the natural course of perianal HSV infection in patients with AIDS.

Medication effects in the classroom: three naturalistic indicators.

Hyperactive and comparison boys participated in 5-week summer enrichment programs that included classroom activities and structured assessments of peer interaction patterns. During the 3rd and 4th weeks of these programs, a double-blind, methylphenidate-placebo crossover design was implemented within the hyperactive group. Three heterogeneous indicators of everyday behaviors were obtained: number of negative incidents noted by staff, quality of handwriting, and number of times the teacher called the boys' names aloud in the classroom. Medication effects emerged for each of these indicators. When hyperactive boys were taking placebos, they were involved in more negative incidents, their handwriting was poorer, and their names were called more-frequently than when the boys were taking methylphenidate. Interrelationships among the measures suggest moderate cross-situational generality of medication responsiveness. Discussion focused on the bandwidth of medication effects and the need to examine the social ramifications of child treatments.

A social ecology of hyperactive boys: medication effects in structured classroom environments.

Hyperactive boys on methylphenidate (Ritalin), hyperactive boys on placebo, and comparison boys were observed in quasi-naturalistic classroom settings. Ambient stimulation (quiet versus noisy conditions) and source of regulation (self-paced versus other-paced activities) were varied in a 2 x 2 design. Compared to their peers, hyperactive boys on placebo showed lower rates of task attention and higher rates of gross motor movement, regular and negative verbalization, noise-making, physical contact, social initiation, disruption, and acts that were perceived as energetic, inappropriate, or unexpected. Self-paced activities resulted in increased rates of verbalization, social initiation, and high-energy episodes. High ambient noise levels reduced task attention and increased the rates of many other behaviors including verbalization, physical contact, gross motor movement, and high-energy acts. Medication-by-situation interactions emerged for both classroom dimensions, with hyperactive boys on placebo being readily distinguishable from their peers under some classroom conditions and indistinguishable under other conditions. Moderate relationships were found between teacher ratings and many individual behavior categories. Discussion focused on (a) the merits and limitations of a social ecological research perspective, and (b) the implications of these findings for the design of intervention strategies.

Chromium supplementation alters the performance and health of feedlot cattle during the receiving period and enhances their metabolic response to a lipopolysaccharide challenge.

Crossbred steers (n = 180; 230 ± 6 kg) were fed during a 56-d receiving period to determine if supplementing chromium (Cr; KemTRACE Chromium Propionate 0.04%, Kemin Industries) would improve feedlot performance and health of newly-received cattle. A completely randomized block design (36 pens; 9 pens/treatment; 5 steers/pen) was used. Chromium premixes were supplemented to add 0 (Con), 0.1, 0.2, or 0.3 mg/kg of Cr to the total diet on a DM basis. No differences were detected on d 0 or after the first 14 d on feed. From d 0 to d 28, DMI (P = 0.07) and ADG increased linearly (P = 0.04) as Cr concentrations increased. From d 0 to d 56, BW (P = 0.08) displayed a tendency to increase linearly, and consequently ADG and G:F increased linearly (P ≤ 0.05) as Cr concentrations increased. The number of steers treated at least once for respiratory symptoms tended (P = 0.07) to linearly decrease as Cr concentrations increased. Twenty additional steers (235 ± 4 kg) were fed 56 d to determine if supplementing Cr (Con or 0.2 mg/kg Cr) would alter the metabolic response of newly-received cattle to a lipopolysaccharide (LPS) challenge. Cattle were fitted with jugular catheters on d 52. On d 55, blood samples were collected at 0.5-h intervals from -2 to 8 h, and again at 24 h relative to a LPS challenge (0.5 µg/kg BW) at 0 h. Serum glucose, insulin, and NEFA concentrations were determined from blood samples. Steer BW was also measured at cannulation, and 24 h and 8 d post-LPS. Steer BW did not differ at cannulation (P = 0.37), but 24 h post-LPS, Cr-supplemented steers had lost less BW (P = 0.03). Pre-LPS glucose concentration did not differ (P = 0.97). Post-LPS, there was a time × treatment interaction (P < 0.01) such that glucose concentration peaked earlier (0.5 h) and at a greater concentrations in Cr-supplemented steers (P < 0.01). Insulin concentration did not differ between treatments pre- or post-LPS (P > 0.13). Concentration of NEFA did not differ pre-LPS (P = 0.54); but 0.5 h post-LPS Cr-treated steers produced a greater peak NEFA concentration (P < 0.04). Results of this study indicate that supplementation of Cr to the basal diet can have beneficial effects on the performance and health of newly-received steers. These data also suggest that supplementation of Cr attenuated BW loss and allowed for a quicker recovery after a LPS challenge.

Chromium supplementation alters both glucose and lipid metabolism in feedlot cattle during the receiving period.

Crossbred steers (n = 20; 235 ± 4 kg) were fed for 53 d during a receiving period to determine if supplementing chromium (Cr; KemTRACE Chromium Propionate 0.04%, Kemin Industries, Des Moines, IA) would alter glucose or lipid metabolism of newly received cattle. Chromium premixes were supplemented to add 0 (Con) or 0.2 mg/kg of Cr to the total diet on a DM basis. Cattle were fitted with jugular catheters on d 52. A glucose tolerance test (GTT) and an insulin sensitivity test (IST) were conducted on d 53. Blood samples were collected from -60 to 150 min relative to each infusion. Serum was isolated to determine glucose, insulin, and NEFA concentrations. Throughout GTT, no differences were detected in glucose concentrations, glucose clearance rates (k), or preinfusion insulin concentrations (P > 0.50), but insulin concentrations postinfusion tended (P = 0.06) to be greater for the Cr-supplemented steers. This caused an increase in the insulin to glucose ratio (I:G) from 0 to 150 min postinfusion for the Cr-supplemented steers (P = 0.03). In addition, NEFA concentrations during GTT were lower (P ≤ 0.01) for Cr-supplemented steers both preinfusion and postinfusion. During IST, there was no treatment effect on glucose concentrations preinfusion (P = 0.38), but postinfusion glucose concentrations were greater (P< 0.01) in the Cr-supplemented steers. The k of Cr-supplemented steers tended (P = 0.06) to be faster than Con steers from 30 to 45 min postinfusion. During the same test, there was no treatment effect detected for insulin concentrations (P > 0.33). The I:G were not affected by treatment (P > 0.40).Concentrations of NEFA were reduced (P < 0.01) both preinfusion and postinfusion during IST for Cr-supplemented steers. Results of this study indicate that supplementation of Cr can significantly alter lipid metabolism. This suggests that these steers had less dependence on lipid metabolism for energy or sensitivity of adipose tissue to antilipolytic signals was reduced. Results of glucose and insulin metabolism were inconsistently modified after a GTT and an IST.

ECT in the treatment of status epilepticus.

INTRODUCTION: Owing to its potent anticonvulsant actions, electroconvulsive therapy (ECT) has been proposed as an intervention for treatment-resistant seizure disorders. METHOD: We review the literature on the use of ECT in treatment-resistant epilepsy and status epilepticus (SE) and present a case of a patient who was in nonconvulsive SE for 26 days and then treated with ECT after all standard pharmacological strategies were exhausted. Because of skull defects, a novel electrode placement was used. RESULTS: Owing to massively elevated seizure threshold attributable to concomitant anticonvulsant medications, extraordinarily high electrical dosage was needed for ECT to elicit generalized seizures. Status was terminated after three successful ECT-induced seizures. However, the long-term functional outcome of the patient was poor. DISCUSSION: The role of ECT in the treatment algorithm for SE is discussed.