Does Heart Failure Mask Candida Tricuspid Endocarditis?

Infective endocarditis (IE) carries high morbidity and mortality. Although minimal in incidence, fungal causes (mostly species) carry the highest mortality among all cases of infective endocarditis. We describe a rare case of a 47-year-old male with a past medical history of cerebral vascular accident (CVA), heart failure with reduced ejection fraction status post (SP) automated implantable cardioverter defibrillator (AICD) placement, paroxysmal atrial fibrillation, coronary artery disease (CAD), infective endocarditis with mitral valve replacement and tricuspid valve replacement, and pulmonary hypertension who presented to the emergency department (ED) with complaints of shortness of breath and weakness for four days.

Substituted Diarylnorbornadienes and Quadricyclanes: Synthesis, Photochemical Properties, and Effect of Substituent on the Kinetic Stability of Quadricyclanes.

In this Article, we present a new method for the synthesis of diarylnorbornadiene derivatives. Through the use of a two-step procedure consisting of a tandem alkene insertion-Suzuki coupling reaction followed by a DDQ dehydrogenation, we have been able to synthesize derivatives with a wide variety of substituents. We also present the results of UV-visible spectroscopy studies and kinetics experiments that show the effect of substituent on light absorption properties of the norbornadienes as well as the kinetic stability of the quadricyclanes that result from their photochemical conversion.

Stereoselective Synthesis of Trisubstituted Vinyl Bromides by Addition of Alkynes to Oxocarbenium Ions.

We have developed an efficient method for the synthesis of (E)-trisubstituted vinyl bromides via a Friedel-Crafts-type addition of alkynes to oxocarbenium ions formed in situ from acetals. The success of this reaction relies on identification of MgBr·OEt as both a Lewis acid promoter and bromide source. This reaction employs simple, inexpensive starting materials and proceeds under mild conditions to allow the preparation of a range of vinyl bromide products in high yields and E:Z selectivities.

Nickel(0)-catalyzed Heck cross-coupling via activation of aryl C-OPiv bonds.

Using a Ni(dppf) catalyst generated in situ, Heck cross-coupling of aryl pivalates with a variety of olefin partners has been accomplished. This method represents one of the first examples of a C-C cross-coupling via activation of a strong C-O bond with a nonorganometallic coupling partner. It enables the transformation of phenol-based substrates into styrenyl products without generation of a halogenated byproduct or the use of expensive triflate groups.

Hemiparkinsonism as a complication of an Ommaya reservoir. Case report.

The authors describe the case of a 28-year-old woman who developed the following symptoms in her right hand: a lasting resting tremor, transient focal rigidity, and paresthesia. These deficits occurred following treatment with intrathecal methotrexate via an Ommaya reservoir which was placed too deeply, resulting in trauma to the contralateral mesencephalon.

Evaluation of the Ames Seralyzer for the determination of carbamazepine, phenobarbital, and phenytoin concentrations in saliva.

The performance of the dry-phase apoenzyme reactivation immunoassay system (ARIS) for the measurement of carbamazepine (CBZ), phenobarbital (PB), and phenytoin (PHT) concentrations in saliva was compared with fluorescence polarization immunoassay (FPIA). Blood and saliva samples were collected from 163 adult and pediatric epilepsy patients, then analyzed using both methods. Regressions between ARIS saliva CBZ, PB, and PHT concentrations, and FPIA unbound and total serum concentrations were highly correlated, but the ARIS technique was somewhat less precise than the FPIA.

Neuropsychological effect of lead in occupationally exposed workers: a critical review.

In their discussion of field testing of health effects of environmental and industrial toxins, Gullion and Eckerman make the following observations which can be applied to the current literature survey: "The general inattention to methodological consistency makes it difficult to integrate the research to date into a clear picture of what is known and not known about the effects of toxic substances on human behavior. In view of the variation in methods of subject selection, measurement, and statistical analysis, the completion of a series of studies of a particular toxic substance does not assure that there has been a concurrent accumulation of reliable knowledge about the effects of that substance. Apparent replications or failures to replicate a significant relationship must be evaluated carefully, since different studies may have measured different things in different populations.

Increased nerve conduction in diabetics after a year of improved glucoregulation.

We studied median, ulnar and peroneal motor nerve conduction velocity (NCV) and median sensory action potential (SAP) latency and amplitude in 18 insulin-dependent diabetic patients who were begun on a continuous subcutaneous insulin infusion (CSII) program. With institution of this therapy, significant decreases in mean blood glucose and glycosylated hemoglobin occurred. After 12 months of CSII treatment, median, peroneal, and ulnar motor NCVs all increased significantly.

Lead neuropathy and electrophysiological studies in low level lead exposure: a critical review.

The literature on nerve conduction velocity (NCV) studies and electromyography in lead exposed populations was reviewed. All studies revealed some degree of defect in their experimental design. Disregarding these limitations, a consensus of the studies indicates that a mild slowing (7%) of motor and sensory NCV may be present in the median and posterior tibial nerves, but that ulnar and peroneal NCVs are not slowed in subjects with blood lead levels of less than 60 micrograms/dl.

Evoked potentials in non-convulsive status epilepticus.

To verify the results from previous studies, we performed EPs on 2 patients with nonconvulsive status epilepticus who demonstrated ictal behavioral changes and bilateral, often diffuse electrographic abnormalities. The EP modalities which were used, PVERs, BAERs, and SSERs, are highly reproducible in normal subjects. In contrast to previous findings, the ictal EPs were normal.

Evoked potentials in Huntington's disease. A comparative and longitudinal study.

Pattern-reversal visual (PRVEPs), brain-stem auditory (BAEPs), and somatosensory (SSEPs) evoked potentials were studied in 12 patients with Huntington's disease (HD) and were repeated in eight at one and two years. The mean cortical SSEP amplitude was decreased compared with that of age-matched controls, with a trend of decreasing amplitude with increasing duration and severity of illness. The SSEP latency was not significantly different from that of controls.

Normal checkerboard pattern reversal evoked potentials in parkinsonism.

The utility of checkerboard pattern reversal visual evoked potentials in the evaluation of Parkinson disease (Pd) was studied in 25 patients and controls without eye pathology. The results did not reveal differences in potential latency but the amplitude appeared slightly larger in PD than controls. Major intraocular differences were observed only in Pd patients with glaucoma, cataracts or retinal degeneration.

Plasmapheresis in multiple sclerosis: prospective trial of pheresis and immunosuppression versus immunosuppression alone.

A prospective trial of plasmapheresis and azathioprine or azathioprine alone was carrier out on 20 patients with chronic progressive MS. Seven of 10 patients in each group continued therapy for 12 months. When the groups were compared by disability ratings, the combination of plasmapheresis and azathioprine was no better than azathioprine alone.

Clinical correlates of midline spikes. An analysis of 21 patients.

Twenty-one children had interictal EEGs showing spikes located at the Fz, Cz, and Pz electrodes; their EEGs were compared with those of age-matched children referred to our laboratory (group 1, 63 children) and children with C3 and C4 spikes (group 2, 41 children). Midline spikes correlated well with a history of seizures (91% vs 73% in group 1 and 76% in group 2) and neurologic abnormality (38% vs 29% in group 1 and 22% in group 2). No patient had progressive neurologic disease or brain tumor.

Familial spastic paraplegia, peroneal neuropathy, and crural hypopigmentation: a new neurocutaneous syndrome.

A neurocutaneous syndrome is described in which spastic paraplegia, peroneal neuropathy, and crural hypopigmentation are inherited in a dominant pattern. Spastic paraplegia becomes clinically apparent during adolescence or in childhood and progresses slowly throughout the adult years with a variability in severity of expression. Peroneal neuropathy is documented clinically and by slowing on nerve conduction studies.

Osmotic blood-brain barrier disruption: pharmacodynamic studies in dogs and a clinical phase I trial in patients with malignant brain tumors.

Infusion of 25% mannitol in saline into the internal carotid artery of dogs disrupts the blood-brain barrier (BBB) in a controlled and reproducible manner (osmotic disruption), whereas mannitol infused through the common carotid artery produces variable disruption of the BBB. Compared to controls, infusion of methotrexate in dogs after osmotic disruption produced significantly higher drug levels in brain. We report very preliminary data on the effects of osmotic disruption with mannitol in five patients harboring malignant brain tumors.

Changes in nerve conduction velocity after six weeks of glucoregulation with portable insulin infusion pumps.

Near normal glucoregulation was maintained in 10 patients with insulin-dependent (type I) diabetes mellitus for 6 wk with preprogrammed continuous subcutaneous insulin infusion using a portable battery-powered infusion pump (CSII). This form of therapy resulted in a statistically significant increase in motor nerve conduction velocity in the median and peroneal nerves compared with baseline values. There was no significant change in the motor nerve conduction velocity in the ulnar nerve or in the sensory nerve conduction studies.

Effects of phenytoin on amygdaloid kindled seizures in the rat.

The effects of oral phenytoin (0.25 g/kg) on the evolution of amygdaloid seizures were investigated using the kindling technique in rats. By utilizing low intensity stimulation at threshold for after-discharge, it was found that phenytoin produced a 23% increase in threshold for after-discharge and generalized seizures in fully kindled rats with blood levels in the human therapeutic range.

Visual evoked potentials in infants with hydrocephalus.

Visual evoked potentials to flash stimuli were recorded in 15 infants with hydrocephalus. All demonstrated increased latencies for the prominent positive component (P2) of the response, compared to the mean value for age-matched controls. In nine infants studied prior to and 1 week after shunt procedure, the P2 latency decreased.

Visual evoked potentials: a noninvasive technique to monitor patients with shunted hydrocephalus.

Visual evoked potentials (VEPs) to repetitive flash stimuli were abnormal in 10 patients with documented hydrocephalus. Abnormalities included latency delays, fatigability, and asymmetries. Both latency and wave form disturbances improved in the postshunt period.

Plasma growth hormone and cortisol changes following limbic stimulation in conscious monkeys.

Electrical stimulation of the amygdaloid nuclei in conscious monkeys sufficient to produce after-discharge was found also to produce a prompt and usually large increase in plasma growth hormone (GH) levels if prestimulation values were low and stable. Plasma GH responses were observed to parallel and slightly precede changes in serum cortisol. Stimulation of the temporal tip of the hippocampus, just posterior to the amygdala, did not produce elevations of GH or cortisol despite the spread of after-discharge activity to the amygdala.