Hemophilus influenza infection of an implantable insulin-pump pocket.

OBJECTIVE: To increase awareness of adverse events associated with the use of implantable insulin pumps. RESEARCH DESIGN AND METHODS: A descriptive case report of a pump implant infection. RESULTS: This is a case report of one implanted insulin pump-pocket infection among a series of 15 patients. After exposure to a child with a respiratory infection on PID 30, V.L.C. (the patient) developed a fulminant pump-pocket infection. H. influenza was recovered from it. Despite aggressive antibiotic therapy, the infection could not be controlled. Insulin delivery ceased, and the pump was explanted. The pump-pocket infection rapidly resolved with pump removal, permitting later reimplantation. CONCLUSIONS: We have adopted the American Heart Association indications and antimicrobial prophylaxis regimens recommended for prevention of endocarditis in patients with prosthetic values for patients with implanted insulin pumps.

Pulmonary hemodynamic responses during superior mesenteric artery occlusion.

We investigated the possibility that the reestablishment of blood flow to the intestine after a 2-h occlusion of the superior mesenteric artery (SMA) may liberate vasoactive substances in quantities sufficient to cause pulmonary vasoconstriction. Experiments were conducted in dogs in which we compared the hemodynamic responses of the animal's left lower lung lobe (LLL), which was perfused at constant flow with blood pumped from the animal's pulmonary artery, with those of its intact right lung. Changes in systemic hemodynamics were similar to those reported by others for this stress. By 1 h after the release of the occlusion, cardiac output and stroke volume had fallen by 41.1 and 50.0%, respectively. Comparable changes were not observed in sham-operated control animals. Following the release of the occlusion, we observed an average 0.9 torr (P less than 0.10) increase in LLL arterial pressure, no significant changes in left atrial pressure, and a 11.9% increase (P less than 0.025) in LLL vascular resistance. In the intact right lung, no significant changes in pulmonary arterial pressure were observed at this time. Although the responses of the LLL suggested that some very small increase in vasomotor tone may have occurred, the small magnitude of the response indicated that the lung vasculature is only minimally affected during the early phases of this stress.