Left ventricular assist device infections: three case reports and a review of the literature.

Left ventricular assist device (LVAD) infections are a major device complication and are associated with significant morbidity. We report three cases of LVAD infections in our institution and review the literature to assess clinical parameters associated with infection, causative organisms, treatment modalities, and patient outcomes. A total of 46 cases were reviewed.

Motor block in regional anaesthesia. Quantification by muscle strength at the ankle joint.

A device based on a load cell was constructed to measure the strength of foot dorsiflexion and plantarflexion. Performance of the device was evaluated for both movements. The influence of foot position within the device, its use over a 30-min period at 30-s intervals and the effect of the removal and reapplication of the device on measured force of dorsiflexion and plantarflexion was studied in six volunteers.

Benefits of treating hypertension in the elderly: should age affect treatment decisions?

Do the benefits of treating hypertension extend equally to all age groups, particularly the very elderly? Several large controlled trials have been published in recent years that confirm the benefits of the treatment of hypertension in terms of morbidity and mortality. However, these trials included only relatively small numbers of patients aged > or = 80 years. Data regarding such patients have been extracted and subjected to meta-analysis, but with inconclusive results.

Isolation of single-chain antibody fragments against Venezuelan equine encephalomyelitis virus from two different immune sources.

Venezuelan equine encephalomyelitis (VEE) virus is an important human and veterinary pathogen of Central and South America. The virus can cause widespread epidemics, affecting hundreds of thousands of horses, and thousands of humans. Detection of the virus early in infection and in mosquito populations may allow epidemics to be predicted such that suitable prophylaxis, such as vaccination, can be used to reduce disease severity and transmission.

Review article: transfusion in gastrointestinal haemorrhage--if, when and how much?

Despite the conventional wisdom that blood transfusion is of use in acute upper gastrointestinal haemorrhage, this review proposes that there is considerable doubt about the optimal timing and intensity of transfusion of blood and crystalloids in this setting. It advocates the need for controlled trials to identify the most appropriate timing and intensity of transfusion of patients with acute gastrointestinal haemorrhage.

Tsl and LP-BM5: a comparison of two murine retrovirus models for HIV.

The ts1 murine leukemia virus produces an immunodeficiency state in mice that parallels human immunodeficiency virus (HIV) infection in humans. Other murine leukemia viruses, such as LP-BM5 used in the murine acquired immune deficiency virus (MAIDS) model, have been studied extensively as a small animal model for HIV research, but lack many key similarities to HIV. Mice infected with ts1, however, utilize CD4 target cells for infection, undergo neuronal loss and demyelination, and develop clinical immunodeficiency.

The efficacy of subsurface flow reed bed treatment in the removal of Campylobacter spp., faecal coliforms and Escherichia coli from poultry litter.

The use of poultry waste as a fertiliser on arable land is an accepted method of waste treatment. However, run-off from such practices may result in contamination of the watercourse by human pathogens. In this study the effectiveness of using constructed wetlands as an alternative treatment for poultry manure waste was evaluated.

Colorectal cancer screening: potential pitfalls.

The National Health and Medical Research Council has recently issued guidelines on colo-rectal cancer, and given significant support to Colorectal Cancer Screening. However, the evidence of cost-effectiveness is inconclusive according to the Cochrane Centre. I argue that it would be wise to undertake trials that are appropriately funded.

Use of complementary and alternative therapies in HIV-infected patients.

The use of complementary and alternative medicine (CAM) therapies is widespread in many chronic illnesses, including human immunodeficiency virus (HIV) infection. The objective of this study was to determine the impact of increasingly effective antiretroviral therapy on the use of CAM in an HIV-positive patient population. A written survey was given to 191 HIV-positive outpatients.

Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy.

Background: This study assessed agreement between provisional and endoscopic diagnoses for patients with dyspepsia undergoing initial endoscopy, and examined variation between clinicians at 2 hospitals.

Methods: This was a retrospective review of 423 consecutive patients.

Results: Crude percentage agreement ranged from 55% to 97%.

Group C streptococcal infection in a prosthetic joint.

We present possibly the first reported case of prosthetic joint infection due to group C Streptococcus in a 53-year-old man. The patient was treated with surgical debridement along with extended intravenous antibiotics and long-term oral penicillin therapy. He was able to retain the prosthesis and at 4-year follow-up had no symptoms or evidence of recurrent clinical infection.

Vaccine era measles in an adult.

Measles should be included in the differential diagnosis of patients with fever and the characteristic viral exanthem, even if a history of adequate immunization is obtained. We present the case of a 23-year-old white female who developed high fever (103 degrees F), brightly erythematous eruptions on the face, sore throat, dry cough, and myalgia 5 days after her return to the United States following a trip to Calcutta, India. The patient had extensive facial erythema from the hairline to the neck, but some areas beneath the chin were spared.

The interrelationship between chloride ions and endothelium on alpha(1)-adrenoceptor-mediated contractions in aortic rings from Dahl normotensive and hypertensive rats.

Objectives: The effects of chloride-free buffer in the absence or presence of the nitric oxide synthase inhibitor, N(omega)-nitro-L-arginine methyl ester (L-NAME), or chloride channel antagonist, indanyloxyacetic acid 94 (IAA-94) on alpha(1)-adrenoceptor mediated contractions were investigated in aortic rings from Dahl salt-resistant normotensive (SRN) and salt-sensitive hypertensive (SSH) rats on a 4% salt diet.

Methods: Systolic and diastolic blood pressure were measured via intra-arterial catheters under halothane anesthesia. Subsequently, the aorta was removed and cirazoline-induced contractions were recorded in normal Krebs and chloride-free buffer using ring preparation.

Connective tissue growth factor: potential role in glomerulosclerosis and tubulointerstitial fibrosis.

Transforming growth factor beta (TGF-beta) is a pivotal driver of glomerulosclerosis and tubulointerstitial fibrosis in renal diseases. Because TGF-beta also plays important anti-inflammatory and antiproliferative roles in mammalian systems, there has been a recent drive to elucidate downstream mediators of TGF-beta's pro-fibrotic effects with the ultimate goal of developing new anti-fibrotic strategies for treatment of chronic diseases. Connective tissue growth factor (CTGF) belongs to the CCN family of immediate early response genes.

Influence of T-type Ca2+ (mibefradil) and Cl- (indanyloxyacetic acid 94) channel antagonists on alpha1-adrenoceptor mediated contractions in rat aorta.

The effects of the T-type and L-type Ca2+ channel antagonists, mibefradil and nifedipine, respectively, and those of a Cl- channel antagonist, indanyloxyacetic acid 94, on mechanical responses elicited by selective activation of alpha1-adrenoceptors using cirazoline were examined in rat isolated aortic rings. The presence of mibefradil (300 nM), indanyloxyacetic acid, 94 (30 microM) and nifedipine (300 nM) alone inhibited mechanical responses elicited by cirazoline. The concentration-response curves to cirazoline were displaced to the right with significant increases in the EC50 and significant depressions of the maximal responses in the presence of the individual agents mibefradil, indanyloxyacetic acid 94, or nifedipine.

Long-term survival among patients operated upon for peptic ulcer disease.

Background: Although surgery has been used widely for treating peptic ulcer disease, there is conflicting evidence with respect to subsequent life expectancy and the determinants of mortality. Our aim was to compare long-term survival in a large, population-based cohort of operated patients with that expected in the general population.

Methods: We followed 471 Rochester, Minnesota residents who had surgery for peptic ulcer at the Mayo Clinic during 1956-85 for a total of 6174 person-years.

Reproductive issues in HIV-seropositive women: a survey regarding counseling, contraception, safer sex, and pregnancy choices.

Sixty-nine HIV-seropositive women were surveyed with regard to the reproductive counseling they had received, contraception, safer sex practices, pregnancy histories, and pregnancy plans. Of the women surveyed, 84% and 90%, respectively, felt that they had access to the birth control and safer sex methods of their choice. Less than half felt that their physician had adequately counseled them about birth control.

Renal-dose (low-dose) dopamine for the treatment of sepsis-related and other forms of acute renal failure: ineffective and probably dangerous.

1. Low-dose ('renal-dose') dopamine (i.e.

Cricoid pressure: knowledge and performance amongst anaesthetic assistants.

We investigated the cricoid pressure technique of 135 anaesthetic assistants attending the annual conference of the British Association of Operating Department Assistants in May 1997. Their knowledge and training were assessed using a structured interview. Technique was assessed using a simulator measuring applied force during sham cricoid pressure.