Infective endocarditis due to Staphylococcus aureus involving three cardiac valves. A case study.

A 20-year-old woman, diagnosed with coarctation of the aorta, situs viscerum inversus, and bicuspid aortic valve, underwent corrective surgery for the coarctation. After a postoperative neurological state that suggested a spinal lesion, corticosteroid therapy was initiated and the patient was discharged early from the unit to begin a motor rehabilitation program. Following the dehiscence of the thoracotomy surgical wound, a severe infective clinical picture, sustained by methicillin-resistant S. Aureus (MRSA), became evident with a diagnosis of bacterial endocarditis involving the aortic, mitral and tricuspid valves and caused the patient's death due to septic shock complicated by ARDS. According to the authors, the early discharge of the patients after such a complex operation, the eccessive lengthening of the steroid therapy that would have contribuited to delay the diagnosis, causing the lack of preventing identification of the first signs of infection and the impossibility for the patient to have another operation (involving 3 valves) are conclusive elements that led to the above mentioned complications.

Influence of peripheral and central targets on subpopulations of sensory neurons expressing calbindin immunoreactivity in the dorsal root ganglion of the chick embryo.

The influence of central and peripheral target tissues on the expression of calbindin D-28k by sensory neurons of the chick dorsal root ganglia was tested under various experimental conditions. Firstly, dorsal root ganglia of chick embryos were transplanted at two stages of development onto the chorioallantoic membrane of a host embryo for a period of 4 or 8 days. In dorsal root ganglia grafted at E12, 20% of the ganglion cell bodies were immunoreactive to calbindin 4 and 8 days later; the percentage of calbindin-immunostained neurons in grafted dorsal root ganglia was similar to that observed in control dorsal root ganglia of the same embryonic age (E16 or 20). In contrast, when grafted dorsal root ganglia were taken from a donor embryo at E8, no calbindin-immunoreactive neuron was found 4 or 8 days later. However, when dorsal root ganglia at E8 were cotransplanted with musculature cells, 14% of the grafted ganglion cell bodies were again immunoreactive to calbindin 4 or 8 days later. Secondly, peripheral targets of sensory neurons were suppressed by excision of one hindlimb. After excision at E6, virtually all the ipsilateral dorsal root ganglia cells were free of calbindin immunoreaction after 6 days of reincubation. In contrast, when the excision was performed at E11, calbindin was expressed in about 9% of the nerve cell bodies. Thirdly, central connections were destroyed by cauterization of the lumbosacral spinal cord at E6 or E11. Six days after deprivation of central connections, the percentage of calbindin-immunoreactive ganglion cells was the same as in control dorsal root ganglia of the same age.(ABSTRACT TRUNCATED AT 250 WORDS)

Poststimulatory endocytosis, microvesicle repopulation and changes in smooth endoplasmic reticulum in nerve endings of the median eminence superfused in vitro.

Mediobasal hypothalami of adult rats were superfused in vitro. A single 5 min pulse of 60 mM KCl-containing medium was infused, followed by either 15, 30, 45, 60 or 75 min superfusions with standard medium. In some experiments, 5 or 10% dextran was added followed by a 15 min recovery. Morphologically, two recovery phases were recognized. The early phase (15-30 min) was characterized by two features: (1) A clear-cut increase in the quantity of large, pleomorphic vacuoles occupying the axoplasm of nerve endings; these vacuoles were observed to be connected to caveolae of the same diameter in the axolemma and they were either coated or uncoated. (2) Progressive increase in the quantity of microvesicles (synaptic vesicles) from an initial depleted state. The vacuoles were found to contain dextran aggregates. Microvesicle-like protrusions bulged from the membrane of vacuoles. The late phase, from 45 min poststimulation onward, was typically identified after the appearance of tubules of smooth endoplasmic reticulum at the most distal segments of the nerve terminals. During this period, large vacuoles tended to decrease in quantity. Granular vesicles remained scant during the entire observation period. Images suggesting formation of microvesicles from tubules of smooth endoplasmic reticulum were observed. These results open the possibility that endocytosis of patches of membranes forming large vacuoles be an important mechanism for retrieving the membranes belonging to microvesicles and granular vesicles. Some of these large vacuoles may contribute to the early regeneration of microvesicles. More microvesicles could later be produced from the smooth endoplasmic reticulum.