Right ventricular outflow obstruction with intact ventricular septum in adults.

Cardiothoracic surgeons whose practice is limited to adults rarely see patients with right ventricular outflow obstruction and an intact ventricular septum. Of more than 10,000 open-heart procedures performed at our institution from 1983 to 1993 (in patients 18 to 75 years old), only 5 procedures were for correction of this problem. Both the pulmonary valve and the subvalvular area were abnormal in these 5 patients, and 4 of the 5 had subvalvular stenosis.

The effects of cyclosporin A on transplanted rat allografts.

Since 1983, Cyclosporin A (CsA) has been the most successful primary drug in preventing rejection of organ transplants. This study was designed to determine the efficacy and dose response of CsA in preventing rejection of LBNF-1 rat allografts to Lewis recipients. Four groups of animals were studied.

Normothermic retrograde continuous cardioplegia for myocardial protection during cardiopulmonary bypass. A modified technique.

Normothermic retrograde continuous cardioplegia is a revolutionary development for myocardial preservation in cardiac surgery. Despite excellent reports regarding this technique, the surgical community has expressed concern over technical problems encountered. The method of normothermic retrograde continuous cardioplegia in current use requires both large total crystalloid volumes and large potassium loads to deliver adequate cardioplegia.

Histopathologic correlates of acute laryngeal allograft rejection in a rat model.

This study used both clinical and histopathologic criteria to define the sequence and time parameters of rejection in histoincompatible vascularized rat laryngeal allografts. Clinical onset of rejection was characterized at 1 week by graft edema. Pathologic examination at this time revealed arterial wall thickening and a diffuse lymphocytic and macrophage mucosal infiltrate.

Comparative in vitro activity of daptomycin (LY146032) and vancomycin against gram-positive cocci determined using a pharmacokinetic model.

The activity of daptomycin (LY146032) and vancomycin was compared for methicillin-sensitive and methicillin-resistant (MRSA) strains of Staphylococcus aureus and for Enterococcus faecalis, using a semi-automated model that allows examination of time-kill curves with diminishing drug concentrations, thus reflecting in vivo pharmacokinetics. Exposure to daptomycin resulted in rapid killing of all strains of staphylococci and Enterococcus faecalis tested. Methicillin-sensitive staphylococcal strains appeared marginally more susceptible than MRSA.

Ceftazidime as first-line therapy for fever in acute leukaemia.

Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low.

Oral ketoconazole and amphotericin B for the prevention of yeast colonization in patients with acute leukaemia.

Forty-eight neutropenic patients with acute leukaemia were randomly allocated to receive, as antifungal prophylaxis, either ketoconazole, 400 mg once daily (K), or amphotericin B tablets and lozenges (A), or both ketoconazole and amphotericin B together (K + A). Antifungal prophylaxis was considered to have failed if (1) there was evidence of increasing colonization of the oropharynx or faeces with Candida spp. or other yeasts, or (2) if systemic antifungal therapy was begun empirically.

Piperacillin in early neonatal infection.

Seventy infants with suspected bacterial infection in the first 48 hours of life were treated either with piperacillin and flucloxacillin or with penicillin and gentamicin. Infection was confirmed and successfully eradicated in 6 of the 35 infants receiving piperacillin and flucloxacillin. Four infants treated with penicillin and gentamicin had confirmed infection and one deteriorated initially but then recovered when treated with piperacillin.

Contamination of specimen container surfaces during sputum collection.

Sputum specimens from culture-positive tuberculosis patients were examined for the presence of Myobacterium tuberculosis on container surfaces. Although specimens were in transit for several days, M tuberculosis was isolated from 18 (6.5%) of 279 containers examined.

Use of the Phoenix system for bacteriology.

A dedicated microbiology data processing system with remote batched job entry to an obsolete computer, has been superseded by the inclusion of bacteriology in an on-line interactive clinical pathology system which had previously incorporated chemical pathology and haematology. The original Phoenix system has been adapted to allow for the entry of bacteriology data using mnemonic codes and to deal with the problems caused by the longer processing time of bacteriology specimens. Particular advantages of the new system include the immediate linkage of all specimens for each patient and an easy recall and display of results in the laboratories and on the wards.

Co-trimoxazole alone for prevention of bacterial infection in patients with acute leukaemia.

43 patients undergoing treatment for acute leukaemia were randomised to receive either co-trimoxazole alone or co-trimoxazole with framycetin and colistin as antibacterial prophylaxis during periods of neutropenia. There were no significant differences between the two treatment groups in the time before the onset of the first fever, the number of episodes of fever or of septicaemia per patient, the number of neutropenic days during which patients remained afebrile or did not require systemic antibiotics, or the number of resistant organisms acquired. Co-trimoxazole alone is cheaper and easier to take than co-trimoxazole with framycetin and colistin, and it is therefore preferable to the three-drug combination for the prophylaxis of bacterial infection.

Prophylactic cefuroxime in total joint replacement.

Cefuroxime was given during operation to 95 patients undergoing 106 total joint replacements (hip 69: knee 37). Two regimes were used. Either 1 g was given intravenously with induction of anaesthesia and then two intramuscular injections of 1 g 6 and 12 h later, or 1.

Extrapulmonary tuberculosis: a potential source of laboratory-acquired infection.

A three-year retrospective study has demonstrated the effect of extrapulmonary tuberculosis on safety within a routine bacteriology laboratory. The investigation showed that, from 112 patients, 162 specimens considered to present a risk to laboratory staff were processed outside of the B1 protective area. However, it was estimated that only 51 of those specimens were heavily positive.

A comparison of two prophylactic antibiotic regimes for open-heart surgery.

Two groups of patients undergoing open-heart surgery were given prophylactic courses of antibiotic lasting five days. One group (61 patients) received a cephalosporin and the second (57 patients) received a combination of penicillin, flucloxacillin and streptomycin. The overall major infection rate was low (3--4%), particularly so in the cephalosporin group (1.

Peroperative antibiotics in the prevention of chest infection following cardiac operations.

Seventy-nine patients about to undergo cardiac operations were randomly allocated to two treatment groups in an attempt to reduce postoperative chest infections. The group receiving a short peroperative course of cefamandole, an antibiotic effective against both the pneumococcus and Haemophilus influenzae, had a significantly lower postoperative chest infection rate than the group receiving a 3-day course of cephradine, an antibiotic previously chosen to prevent intracardiac infection during the operation. By selecting an appropriate antibiotic it is possible, using a short peroperative course, to reduce the postoperative chest infection rate in patients undergoing cardiac operations.

Amikacin dosage in the preterm newborn.

Twenty-two preterm infants of gestational age 26 to 34 weeks were treated with amikacin for suspected bacterial infection, using a dose of 7.5 mg/kg, 12-hourly, intra muscularly. Blood levels were measured using a radio-immunoassay kit capable of giving results within 4 h.