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CASE An 82-year-old white woman was admitted to the hospital after shortness of breath of one day's duration and a fever of 101(deg) F (38.3 C). She had previously been [...]

Blood transfusions are increasingly being given directly to anemic fetuses and those with other blood disorders. Complications have been reported to occur from this procedure, including bradycardia (an abnormally slow heart rate) and massive blood clots in the umbilical cord. This study examined the complications arising in the case of a fetus given a blood transfusion because of problems of blood-type incompatibility with the mother. A 28-year-old woman was examined in the 12th week of her pregnancy. She had previously delivered by cesarean because of fetal distress. Fetal blood was sampled at 21 weeks and 24 weeks of gestation. Hematocrit (the proportion of blood volume made up by cells) was 34.9 percent and 28.8 percent, respectively. Five days later the hematocrit had fallen to 17 percent, necessitating a blood transfusion. Hematocrit rose to 55 percent and fetal bradycardia occurred at the end of the transfusion, lasting only a short time. Ultrasonography, a diagnostic imaging technique using high-frequency sound, was performed in the 27th week of gestation. An enlargement in the left side of the brain was found. Transfusions were given four more times, but the brain abnormality did not get larger. A baby girl was born at 36 weeks of gestation. The brain abnormality was still present upon examination, but the infant exhibited no neurological problems. This case showed a congenital malformation resulting from a vascular accident caused by an intrauterine transfusion. Such transfusions should be performed only when necessary because of the possible complications that can result. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasonography is a diagnostic technique in which sound waves are used to visualize internal body structures. This imaging technique is frequently utilized to examine the fetus for abnormalities during pregnancy. With ultrasonography, tumors within the chest wall of the fetus have been diagnosed before birth. However, the detection of tumors on the outside of the chest wall of the fetus using ultrasonographic techniques has not previously been reported. A modified ultrasonographic method called Doppler velocimetry is used to assess blood flow, and can distinguish between different types of tumors based on blood flow characteristics. A case is described of a male infant with a growth on the outside of the right chest wall, which was detected by ultrasonography before birth. Doppler ultrasonography showed that the tumor had a low-resistance blood flow, which is characteristic of a hemangioma, a benign tumor of blood vessels that are dilated. The infant was delivered by cesarean section at 35 weeks gestation, to reduce the risk that the mass would rupture. On the fifth day after birth, the mass was removed. Examination of the tumor confirmed that the mass was a hemangioma. The infant was discharged two days after the operation and was doing well at follow-up at six months of age. It is interesting to note that the baby's father had a similar right chest wall mass diagnosed at birth and removed at the age of six years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Factor XIa (FXIa) is a blood coagulation enzyme that is involved in the amplification of thrombin generation. Mounting evidence suggests that direct inhibition of FXIa can block pathologic thrombus formation while preserving normal hemostasis. Preclinical studies using a variety of approaches to reduce FXIa activity, including direct inhibitors of FXIa, have demonstrated good antithrombotic efficacy without increasing bleeding. On the basis of this potential, we targeted our efforts at identifying potent inhibitors of FXIa with a focus on discovering an acute antithrombotic agent for use in a hospital setting. Herein we describe the discovery of a potent FXIa clinical candidate, 55(FXIa Ki= 0.7 nM), with excellent preclinical efficacy in thrombosis models and aqueous solubility suitable for intravenous administration. BMS-962212 is a reversible, direct, and highly selective small molecule inhibitor of FXIa.

The article discusses about shared on LinkedIn about a previous article on potholes. Topic include comments highlight that recent efforts on pavement aesthetics might have neglected foundational issues, potentially leading to potholes, and emphasize the need for stronger road foundations like the Hi-Lab method to address the problem effectively.

Recent studies using sequence data from eight sequence loci and coalescent-based species delimitation methods have revealed several species-level lineages of Tulasnellaassociated with the orchid genera Arthrochilus, Caleana, Chiloglottis, and Drakaeain Australia. Here we formally describe three of those species, Tulasnella prima, T. secunda, and T. warcupiispp. nov, as well as an additional Tulasnellaspecies associated with Chiloglottisgrowing in Sphagnum, T sphagnetisp. nov. Species were identified by phylogenetic analyses of the ITS with up to 1.3 % sequence divergence within taxa and a minimum of 7.6 % intraspecific divergence. These new Tulasnella (Tulasnellaceae, Cantharellales)species are currently only known from orchid hosts, with each fungal species showing a strong relationship with an orchid genus. In this study, T. primaand T. sphagnetiassociate with Chiloglottis, while T. secundaassociates with Drakaeaand Caleana, and T. warcupiiassociates with Arthrochilus oreophilus.

CASE A 12-year-old white female develops a large, nonpainful carbuncle on the light buttock seven days after being given an imported Pakistani horseback saddle made with camel hair. The child's [...]

You give a good summary of the current position relating to long-term care of the elderly (Leader, 4 July). However, one important omission from this piece is any reference to [...]

CASE A 20-year-old white man cut a finger on his left hand while filleting bluefish. Soon after, he noticed that his entire hand was swelling. Several hours later, the swelling [...]

CASE A newborn infant is hospitalized with a one-day history of fever and chills. She was a full-term baby, weighed 8 lb at birth, and the prenatal and perinatal courses [...]

A 45-year-old man receiving immunosuppressive therapy presented with a headache and low-grade fever of three weeks' duration. He was a retired film projectionist who never smoked but who had been [...]

CASE A previously healthy 61-year-old Puerto Rican woman arrived at the emergency department with a two-day history of chills, arthralgias, progressive dysphagia, and finally difficulty breathing. Her temperature was 101 [...]

An increase in fluid surrounding the fetus, a condition known as polyhydramnios, is associated with some chromosomal abnormalities. Amniotic fluid is produced by the cells located in the fetal membrane. The fluid balance is maintained by the fetus when it swallows the fluid and excretes it as urine. A case is discussed of a 33-year-old woman who developed abdominal swelling during her 26th week of pregnancy. All the patient's prenatal examinations were normal, with the exception of a lower-than-normal level of alpha-fetoprotein, indicating possible fetal abnormalities. Fetal ultrasonography was normal and amniocentesis was performed. Chromosomal analysis detected one extra chromosome in most of the fetal cells. The patient was given 25 milligrams of indomethacin, a drug used to decrease the amount of amniotic fluid during pregnancy, every four hours. When serial ultrasound was performed, a decrease in urine output was noted. Indomethacin was continued until spontaneous labor began at 36 weeks of pregnancy. A structurally normal female infant was born. At six months of age, however, the infant was hospitalized for failure to thrive, a condition of halted growth and development because of poor feeding. The infant had a fever of 101 degrees F. and became dehydrated. Blood and urine analysis indicated that she had diabetes insipidus, a condition caused by a defect in the kidneys that prevents the tubules from responding to the hormone that regulates body fluids. A diagnosis of congenital nephrogenic diabetes insipidus (diabetes insipidus caused by a defective kidney as opposed to inadequate hormone production) was confirmed. Congenital nephrogenic diabetes insipidus should be suspected in cases of polyhydramnios. The infant remains on indomethacin therapy to control fluid and electrolyte imbalance. (Consumer Summary produced by Reliance Medical Information, Inc.)

The development of nanoparticle agents for MRI-guided radiotherapy is growing at an increasing pace, with clinical trials now underway and many pre-clinical evaluation studies ongoing. Gadolinium and iron-oxide-based nanoparticles remain the most clinically advanced nanoparticles to date, although several promising candidates are currently under varying stages of development. Goals of current and future generation nanoparticle-based contrast agents for MRI-guided radiotherapy include achieving positive signal contrast on T1-weighted MRI scans, local radiation enhancement at clinically relevant concentrations and, where applicable, avoidance of uptake by the reticuloendothelial system. Exploiting the enhanced permeability and retention effect or the use of active targeting ligands on nanoparticle surfaces is utilised to promote tumour uptake. This review outlines the current status of promising nanoparticle agents for MRI-guided radiation therapy, including several platforms currently undergoing clinical evaluation or at various stages of the pre-clinical development process. Challenges facing nanoparticle agents and possible avenues for current and future development are discussed.

YANKEE DOODLE DANDY: I attended a Yankees/Athletics game in Kansas City, Mo., in 1956, and I was close enough to the field to briefly talk with Mickey Mantle, who was [...]

I just wanted to write a short note to say thank you for a job well done with your Earl Anthony tribute ["Snapshots of a Legend," December 2001]. As a […]

CASE A 20-year-old male college student seeks medical attention for a severe, generalized headache, low-grade fever, and joint and muscle pain. About a week ago, he underwent splenectomy after sustaining [...]

CASE Fever, chills, and splinter hemorrhages develop in a 60-year-old man three months after a number of bowel polyps are removed by colonoscopy. Shortly thereafter, the patient's fever spikes to [...]

CASE A 60-year-old white taxi driver is in acute distress, with fever and edematous necrosis from the testicles to the anterior abdominal wall. A black, necrotic lesion had developed about [...]

CASE An obese 42-year-old man is hospitalized for right upper quadrant pain of 13 days' duration. He has been taking chlorpropamide for type II diabetes mellitus, but for the two [...]

The case study of a 35-year-old woman who suffered from severe vomiting and diarrhea is presented. Physicians diagnosed Jamaican vomiting sickness, which is caused by the Dengue virus and can be life-threatening. The cause of the illness was ingestion of an unripe ackee fruit., CASE A 35-year-old woman was stricken with severe vomiting and diarrhea on a plane returning from Jamaica a few hours after eating swordfish and ackee, a West Indian vegetable similar [...]

CASE A 46-year-old white homosexual man is hospitalized with multiple pruritic, dark skin lesions on his legs. First noted by the patient eight weeks earlier, they have slowly grown in [...]

CASE A 60-year-old man hospitalized with a low-grade fever has insulin-dependent diabetes mellitus and underwent a transurethral prostatic resection (TURP) 10 months ago. For the past five months he has [...]

AIDS patients usually suffer a host of diseases throughout their illness. The death of a 21-year-old AIDS patients is attributed to extrapulmonary pneumocystosis. The condition is caused by the organism that causes pneumocystis pneumonia., CASE A 21-year-old white homosexual man with AIDS was hospitalized after a fever of one week. He had been HIV-seropositive since 1987 and had bouts of rectal herpes, candidal esophagitis, [...]

CASE A 33-year-old black man with AIDS has been hospitalized because of skin lesions appearing on his right foot and ankle. One arose about a month after a minor trauma [...]

ABSTRACTLinezolid, an oxazolidinone antibiotic, has 100% oral bioavailability and favorable activities against gram-positive pathogens including multidrug-resistant staphylococci, enterococci, and pneumococci. Safety assessments were conducted for 2,046 linezolid-treated patients and 2,001 comparator drug-treated patients from seven controlled clinical trials comparing the activities of linezolid and comparator drugs against nosocomial and community-acquired pneumonia, skin and skin structure infections, and methicillin-resistant staphylococcal infections. Drug-related adverse events were primarily transient. The most frequent (≥2%) adverse events caused by linezolid and the comparator drugs were diarrhea (4.3 and 3.2%, respectively; P= 0.074), nausea (3.4 and 2.3%, respectively; P= 0.036), and headache (2.2 and 1.3%, respectively; P= 0.047). Treatment discontinuations due to drug-related events (2.4 and 1.9%, respectively), serious adverse events (11.4 and 10.6%, respectively), and deaths (4.8 and 4.9%, respectively) were similar. No clinically significant drug-related hematologic events were reported, and laboratory safety data were comparable. In the first 6 months of postmarketing surveillance, hematologic abnormalities were reported in 0.1% of linezolid-treated patients, but no irreversible blood dyscrasias were documented. The risk for transient, reversible hematologic effects from treatment with linezolid should be considered together with the clinical benefits associated with its use.

CASE A 49-year-old woman was admitted to a New York hospital for evaluation of fever and rash. She had been in her usual state of good health until two weeks [...]

Zebras at the Bronx Zoo CASE A 47-year-old veterinarian at the Bronx Zoo was admitted to the hospital after a generalized seizure that occurred while he was playing basketball. He [...]

ABSTRACTThis randomized, double-blind, multicenter trial compared the efficacy and safety of linezolid, an oxazolidinone, with those of oxacillin-dicloxacillin in patients with complicated skin and soft tissue infections. A total of 826 hospitalized adult patients were randomized to receive linezolid (600 mg intravenously [i.v.]) every 12 h or oxacillin (2 g i.v.) every 6 h; following sufficient clinical improvement, patients were switched to the respective oral agents (linezolid [600 mg orally] every 12 h or dicloxacillin [500 mg orally] every 6 hours). Primary efficacy variables were clinical cure rates in both the intent-to-treat (ITT) population and clinically evaluable (CE) patients and microbiological success rate in microbiologically evaluable (ME) patients. Safety and tolerability were evaluated in the ITT population. Demographics and baseline characteristics were similar across treatment groups in the 819 ITT patients. In the ITT population, the clinical cure rates were 69.8 and 64.9% in the linezolid and oxacillin-dicloxacillin groups, respectively (P= 0.141; 95% confidence interval −1.58 to 11.25). In 298 CE linezolid-treated patients, the clinical cure rate was 88.6%, compared with a cure rate of 85.8% in 302 CE patients who received oxacillin-dicloxacillin. In 143 ME linezolid-treated patients, the microbiological success rate was 88.1%, compared with a success rate of 86.1% in 151 ME patients who received oxacillin-dicloxacillin. Both agents were well tolerated; most adverse events were of mild-to-moderate intensity. No serious drug-related adverse events were reported in the linezolid group. These data support the use of linezolid for the treatment of adults with complicated skin and soft tissue infections.

A double-blind, placebo-controlled trial of efficacy and safety of thalidomide in AIDS-associated wasting was carried out. Ninety-nine of 103 male patients had at least one on-study measurement (intent-to-treat [ITT] cohort). Patients were randomized to thalidomide at 100 mg/day (T100) or 200 mg/day (T200), or placebo for 8 weeks. By ITT analysis, the mean change in body weight of the placebo, T100, and T200 treatment groups was 0.3 kg (0.4%), 2.0 kg (3.0%), and 0.9 kg (1.4%), respectively (p = 0.021 for T100 versus placebo; p = 0.53 for T200 versus placebo). Of the 64 patients who completed the 8 weeks of study treatment, significant weight gain was observed in both the T100 group (2.2 kg, [33%]; p = 0.008 versus placebo) and the T200 group (1.5 kg [2.5%]; p = 0.019 versus placebo). Approximately half the weight gain was fat-free mass (bioimpedance analysis). Patients in the T100 or T200 groups had no significant change in CD4+ cell counts, neutrophil counts, or TNF-α levels, compared with placebo. HIV viral load measured as log10 copies/ml decreased by a median of 0.07 in the placebo group, and increased by a median of 0.29 (T100 group) and 0.23 (T200 group) (p = 0.024 and p = 0.018 versus placebo, respectively). Thalidomide therapy was associated with mild to moderate rashes and fevers, but not peripheral neuropathy. Although the anabolic benefits of high-dose thalidomide are limited by drug intolerance, 8 weeks of low-dose thalidomide results in significant weight gain in patients with AIDS-associated wasting.

Cough in a woman from Guatemala CASE A 66-year-old Guatemala-born woman with a history of diabetes and hypertension developed a vague cough in early December. The cough was nonproductive and [...]

24 hemiplegic patients completed patterned functional electrical stimulation (PFES) upon the afflicted arm and leg. The multichannel PFES program was mathematically derived from the EMG agonist/antagonist pattern recorded from each subject's unaffected limbs during a series of monitored, voluntary movements. The average improvement in volitional range of motion for the group's paralyzed limbs was 90% for the upper extremities and 69% for the lower extremities. For partially paralyzed limbs, there was an average increase in range of movement of 68% for the upper extremities and 26% for the lower extremities. These findings support the relearning-based, PFES open-loop theory which uses individualized therapeutic PFES-derived from EMG coordination patterns modeled from specific, ballistic limb movements to rehabilitate patients who have been immobilized after stroke.

Citrate synthase has been purified to homogeneity from the thermophilic archaebacteria Thermoplasma acidophilumand Sulfolobus acidocaldarius. From the relative molecular masses of the native proteins (85 and 83 kDa, respectively) and of their polypeptide chains (43 and 41 kDa, respectively) it is established that they are dimeric enzymes. The N‐terminal sequence of the Thermoplasmacitrate synthase was determined to be P‐E‐T‐E‐E‐I‐S‐K‐G‐L‐E‐D‐V‐N‐I‐K. These properties are compared with those of citrate synthases from eubacteria and eukaryotes to extend the pattern of structural and functional diversity previously observed for this enzyme in non‐archaebacterial species.

Ten hemiplegic subjects completed 20 rapid dorsiflexions of their afflicted and nonafflicted limbs. Electrodes were attached to the tibialis anterior and the gastrocnemius muscles and electromyograms were recorded for their premotor time, motor time, and simple reaction time during ankle dorsiflexion and plantar flexion of their lower limbs. The fractionated components of reaction time, namely, premotor time and motor time, of both legs were statistically compared. It was found that the premotor time of the subject's stroke-affected limb was significantly slower than the premotor time of the nonaffected limb (control), with no differences between their associated mean motor times. These results supported the hypothesis that a stroke has a deleterious affect upon the central, premotor time processing centers and has no disruptive influence upon the peripheral motor time. Comparing the fractionated components of reaction time (premotor time and motor time), with simple reaction time, the former provided a more sensitive and valid method to detect possible injurious side effects of a stroke upon the brain's neuromotor transmission centers and subcenters, and their peripheral, stimulus, response network.

Jejunal atresia with “apple peel” deformity is a rare congenital malformation that is generally believed to result from in utero vascular accidents. We report this case due to the rare occurrence of jejunal atresia with “apple peel” deformity affecting both members of a set of twins in whom no apparent cause for the atresia exists.

• Abdominal computed tomographic scans were performed In 25 consecutive patients with bacterial endocarditis. Six patients had splenic infarcts, only two of whom had symptoms. Three of the six patients had no evidence of emboli to other organs. In patients with endocarditis who have had clinically apparent emboli or who are, for other reasons, being considered for valvular surgery, a computed tomographic scan of the abdomen may help in decision making.(Arch Intern Med 1988;148:193-197)

Pneumocystis cariniipneumonia carries a high morbidity and mortality. Prophylaxis has proved to have a significant impact on survival and quality of life in patients infected with the HIV virus. The economic impact of prophylaxis is well recognized. Every effort should be directed at early institution of Pneumocystis cariniipneumonia prophylaxis. It is the standard of care to employ one of the acceptable means of prophylaxis discussed in this review.

Spontaneous hepatic rupture secondary to severe pregnancy-induced hypertension is associated with a high rate of maternal and fetal mortality. Numerous types of surgical management have been described, but a uniform surgical approach has not been accepted. The purpose of this review was to examine modes of surgical therapy reported in the literature since 1976, as well as the 11-year experience at our institution. Twenty-eight cases were extracted from the literature and seven more were identified at our institution. The incidence in our population was one per 45,145 live births. Among 27 cases managed by packing and drainage, an 82 overall survival was achieved, whereas only 25 of eight patients undergoing hepatic lobectomy survived (P.006). Hepatic hemorrhage with persistent hypotension unresponsive to blood products should be managed by evacuating the hematoma, packing the damaged liver, and draining the operative site. More aggressive surgical techniques, such as hepatic artery ligation or hepatic lobectomy, should be reserved for refractory cases.

We describe a new and efficient synthesis of the aza analogs of tacrine based upon the chemistry of the anionically activated trifluoromethyl group. We identify four sites ( A–D) which can be successfully altered to afford the desired fused tricyclic heterocycles in high yield (63–82%). The reaction is believed to proceed through the formation of a quinone methide intermediate.