A case of Capnocytophaga canimorsus meningitis and bacteraemia.

Capnocytophaga canimorsus is a commonly detectable commensal in the oral flora of dogs and cats, found in 25.5% and 15%, respectively, by culture and 70% and 55%, respectively, by molecular methods [1]. Formerly known as dysgonic fermenter 2 (DF-2), it was first reported in 1976 as a Gram-negative bacillus causing septicaemia and meningitis following dog bites [2]. It causes a spectrum of clinical syndromes from wound infections to bacteraemia and meningitis, especially in those with hyposplenism and alcoholism. We report a case of C. canimorsus meningitis and bacteraemia, and give a review of the relevant literature.

A qualitative study exploring the psychosocial value of weekend camping experiences for children and adolescents with complex heart defects.

BACKGROUND: Children living with complex heart defects (CHD) are likely to have ongoing social, emotional, physical, and health concerns, and are in need of additional psychosocial support. Summer camps can provide therapeutic benefits. Little research exists regarding the value of shorter camping experiences from the perspectives of children with CHD. The aim of our study was to explore what children and adolescents with CHD considered meaningful when attending a therapeutic camping weekend in the company of peers with similar medical diagnoses. METHODS: Engaging a phenomenological approach we used participant generated photography and reflective semi-structured interviews to explore participants' lived experience and value derived from their weekend camping experiences. The study was completed with thirteen participants ranging in age from 9 to 16 years. Interviews were recorded and transcribed verbatim. Data were analysed using Van Manen's guidelines. RESULTS: Three themes reflecting the camp experiences were generated from the data. Meaningful experiences spanned three outcomes which had some overlapping influences: (i) Developing relationships and feeling accepted by peers and counsellors at camp; (ii) Enjoying and learning during the weekend; and (iii) Experiencing the natural and human-built therapeutic environmental features of camp. The camping programme features, inputs, and processes as identified by the participants in contributing to these outcomes are described. CONCLUSION: This qualitative study showed that children living with complex CHD valued the opportunity for participating in weekend camping experiences in the company of peers with similar heart defects. Findings contribute to a better understanding of what programme features and processes were considered meaningful. Given the scarcity of resources to devote to such social support activities, the findings may help professionals to plan effective interventions to maximize benefits during a shorter camping experience.

Delayed prescriptions: attitudes and experiences of general practitioners in the Midwest.

141 questionnaires were posted to GPs randomly selected in the Mid-West. 103 responses were received. 32 GPs (31%) strongly agreed and 65 GPs (63%) agreed that antibiotics are over used in general practice. 35 GPs (34%) felt under pressure to prescribe an antibiotic at least once a day. 41 GPs (40%) agreed that delayed prescriptions are a safe prescribing strategy. 53 GPs (51%) agreed that delayed prescriptions have the potential to reduce antibiotic use. 33 GPs (32%) disagreed that giving delayed prescriptions increases the duration of the consultation. 49 GPs (47%) agreed that delayed prescriptions decrease the likelihood of return visit in the same illness. 55 GPs (53%) agreed that delayed prescriptions help to involve patients in managing their own illness. 46 GPs (45%) disagreed that patients find delayed prescriptions confusing. The majority of GPs (41/39.8%) use delayed prescriptions once a week or at least once a day (34/33%).

Heart murmurs in pediatric patients: when do you refer?

Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist.

Interactive telecardiology for the evaluation of heart murmurs in children.

OBJECTIVE: To study the accuracy, patient satisfaction, and cost of telecardiographic evaluations of pediatric patients. MATERIALS AND METHODS: Patients referred to a rural pediatric cardiology outreach clinic were examined in person by a pediatric cardiologist. A second pediatric cardiologist who had no knowledge of the findings of face-to-face examination reevaluated the same patients utilizing a 768-Kbps telemedicine system. Any additional testing was performed by personnel who had no knowledge of the face-to-face evaluation. The main outcome measures included the final cardiac diagnosis, frequency of additional tests such as electrocardiography, (ECG) echocardiography (ECHO), and patient satisfaction. RESULTS: The diagnosis was agreed upon in 19 of the 21 patients studied. Two patients with small ventricular septal defects were missed during the telemedicine evaluation. The utilization rates of additional studies for both the face-to-face cardiologist and the telemedicine cardiologist were not significantly different. Patient satisfaction with the telemedicine encounter was good. CONCLUSIONS: Telemedicine appears to be effective and useful for the cardiac evaluation of pediatric patients. In spite of high data-transfer rates, differences between telemedicine and face-to-face patient encounters were observed.

Fatal obliterative coronary vasculitis in Kawasaki disease.

We report a unique case of Kawasaki disease with late sudden death from obliteration of the lumen of the full length of the left anterior descending coronary artery. Sequential echocardiograms showed early uniform coronary dilatation that resolved before sudden death. The implications of obliterative "healing" of coronary ectasia are unknown.

Normal fetal cardiac dimensions obtained by perpendicular imaging.

This study provides normal fetal cardiac dimensional data in a large patient group over a wide range of gestational ages. Perpendicular imaging decreased lateral resolution error, resulting in normal values with narrower confidence limits than in prior studies.

Psychophysical evidence for losses in rod sensitivity in the aging visual system.

Rod sensitivity was measured with a criterion-free psychophysical method at 10 deg in the horizontal meridian of the nasal field of the left eye on 26 young (mean age, 24.1 yr) and 14 older (mean age 72.6 yr) observers in good ocular health. A 1 deg, 90 msec stimulus was delivered by means of a free-viewing optical system under computer control. Stimulus wavelengths were chosen to have either significant (406 nm) or minimal (560 nm) absorption by the older lens. After correction for senile miosis and lens density, 0.39 log unit higher thresholds for the older observers remained and are interpreted as being due to neural factors.

Plasma volume responses to consecutive anaerobic exercise tests.

This study examined the change in plasma volume (% delta PV) in response to consecutive Wingate tests (30 sec Anaerobic Power test). Twelve active men (21 +/- 1.6 yr, 81.3 +/- 6.6 kg) performed two Wingate tests (W1 and W2, separated by 10 min) on three occasions (T1-T3, tests were two weeks apart). Exercise resistance was maintained at 75 g.kg-1 body weight during testing. Blood samples were taken immediately before (Pre) and after (IP) W1 and W2. There were no significant differences in hematocrit, hemoglobin, mean power (MP) or peak power (PP) between T1-T3. There was a marked hemoconcentration in response to W1 (IP W1, -17.4 +/- 2.6% delta PV), with a further, but not significantly greater, hemoconcentration following W2 (IP W2, -8.2 +/- 1.1% delta PV). The % delta PV, between PRE W1 and IP W2 was-20.1 +/- 3.1%. These results suggest that an existing hemoconcentration (W1) may affect the magnitude of the % delta PV response to subsequent supramaximal exercise (W2).

[Congenital diseases of the aorta]. / Enfermedades congénitas de la aorta.

Congenital diseases of the aorta may be divided into three main groups. The most common group includes diseases which obstruct blood flow to the distal circulatory system. The second category includes those diseases which obstruct either the trachea or the esophagus. A third category of congenital diseases of the aorta includes abnormalities of the mechanical composition of the aorta. The major clinical manifestations included in each of these groups will be discussed.

Dietary supplementation and improved anaerobic performance.

In the present study, the effects of an increased daily dose of a dietary supplement (ATP-E, 0.2 g.kg-1.day-1) on Wingate test performance were examined in 12 men (21 +/- 1.6 years) prior to and following 14 days of supplement and placebo ingestion. A double-blind and counterbalanced design was used. Results revealed higher (p < .007) preexercise blood ATP (95.4 +/- 10.5 mumol.dl-1) for the entire group following 14 days of ATP-E ingestion compared to placebo measures (87.6 +/- 10.9 mumol.dl-1). Mean power (667 +/- 73 W) was higher (p < .008) after 14 days of ATP-E ingestion versus placebo (619 +/- 67 W). Peak plasma lactate was lower (p < .07) after 14 days of ATP-E ingestion (14.9 +/- 2.8 mmol.L-1) compared to placebo (16.3 +/- 1.6 mmol.L-1). These data suggested that the improvement in 30-s Wingate test performance in this group may be related to the increased dose of ATP-E.

Evaluation of a topical iron chelator in animals and in human beings: short-term photoprotection by 2-furildioxime.

BACKGROUND: In previous work we found that iron is a factor in skin photodamage, apparently by way of its participation in oxygen radical production. Here we report topical photoprotection with the iron chelator 2-furildioxime (FDO). OBJECTIVE: Our purpose was to determine the level of photoprotection provided by FDO in both animal and human testing. METHODS: Mice, guinea pigs, and human beings were treated topically with 5% simple vehicle solutions of FDO versus vehicle. The skin was then exposed to doses of simulated solar UV radiation greater than the minimal erythema dose. Mouse skin was harvested for analysis of ornithine decarboxylase (ODC); guinea pig skin was graded for erythema; and human skin was graded for erythema and biopsy specimens taken for analysis of ODC and for histologic evaluation. RESULTS: In animal testing with simulated solar UV radiation, topical 5% FDO provided 90% protection against induction of ODC in the hairless mouse and sun protection factor 3.5 against erythema in the guinea pig. In a double-blind, paired-comparison, vehicle-controlled clinical test, 5% FDO applied topically before a single dose of simulated solar radiation at three times minimal erythema dose prevented UV-induced erythema, sunburn cell formation, epidermal thickening, infiltration of inflammatory cells, and induction of epidermal ODC. CONCLUSION: The high level of protection provided by FDO indicates that metal chelation is a significant approach to providing photoprotection.

Use of adenosine for diagnosis and treatment of tachyarrhythmias in pediatric patients.

This report reviews our experience with the use of adenosine for diagnosis and treatment of narrow QRS complex tachyarrhythmias in children. All electrocardiograms obtained since the introduction of adenosine for clinical use at one pediatric tertiary care institution during an 18-month period were reviewed, and those patients receiving adenosine were included for study. Of the 24 patients who received adenosine, the median age was 4 years; four neonates were included. Adenosine produced atrioventricular block in 21 (88%) of 24 patients. It terminated the tachyarrhythmia in 11 patients and produced atrioventricular block but did not terminate the tachyarrhythmia in 10 patients. The mechanism of the arrhythmia was known in three patients before adenosine administration. Adenosine was useful in establishing the mechanism of the tachyarrhythmia in 17 of the remaining 18 patients but was not useful in one patient, in whom the arrhythmia was successfully terminated because a good-quality electrocardiogram was not obtained during adenosine administration. Therefore the mechanism of the supraventricular tachycardia was ultimately determined for all patients in whom adenosine successfully produced atrioventricular block and had acceptable electrocardiographic tracings. Side effects were limited and transient. We conclude that adenosine was a safe and effective agent for the pharmacologic treatment of narrow QRS complex tachyarrhythmias in our patients, including those less than 1 year of age. If proper electrocardiographic recordings are performed during adenosine administration, it is also helpful in establishing the cause of the tachyarrhythmia.

Murine monoclonal CD3 antibody (OKT3)-based early rejection prophylaxis in pediatric heart transplantation.

The purpose of this study was to review our experience with the use of OKT3 (a murine monoclonal CD3 antibody) used as immune prophylaxis for pediatric heart transplant recipients. Orthotopic heart transplantation was performed in 18 pediatric patients, 8 girls and 10 boys, ranging in age from 17 days to 17 years. OKT3 therapy was initiated intraoperatively at a dose of approximately 0.2 mg/kg and was administered at a dose of approximately 0.1 to 0.2 mg/kg/day for a period of 11.5 +/- 2.5 days. Daily average OKT3 levels were 1132 +/- 469 ng/ml. Side effects that occurred during OKT3 therapy were fever (59%), diarrhea (24%), headaches (24%), vomiting (18%), encephalopathy (12%), pulmonary edema (6%), and rash (6%). Infections occurred in 24% of patients, all within 6 months of transplantation. In the first year after transplantation, patients experienced 3.4 +/- 2.4 episodes of mild rejection and 1.0 +/- 0.8 episodes of moderate rejection. No patient experienced severe rejection. Five of the surviving 14 patients (36%) have been weaned from chronic steroid therapy, and 42% are being maintained on alternate-day prednisone at a dose of 0.06 +/- 0.02 mg/kg/day. Coronary artery disease developed in three patients; two of whom died. Actuarial survival was 83% at 1 year and 73% at 2 years. This report shows that OKT3 prophylaxis in pediatric heart transplantation can be used with acceptable short-term adverse side effects and overall survival.

Anaerobic power responses to amino acid nutritional supplementation.

To examine the effect of a nutritional supplement (ATP-E) on high intensity exercise performance, 23 physically active males volunteered to perform six Wingate Anaerobic Power tests. Tests were performed prior to and at 14 and 21 days during ATP-E or placebo ingestion. The experiment followed a double-blind and random-order design. Twelve subjects (responders, R) showed an increase in preexercise blood ATP on Day 14 of ATP-E ingestion compared to control measures. The remaining 11 subjects (nonresponders, NR) had no change in preexercise blood ATP. Peak power and mean power were unchanged for both R and NR subjects across the exercise tests, but R experienced a decrease (p < 0.05) in immediate post-exercise plasma lactate on Day 14 of ATP-E testing compared to their control measures. NR had no change in peak plasma lactate at any time during the study. The results suggest that short-term high intensity exercise performance was maintained in R with less reliance on anaerobic metabolism, and that response was evident following 14 days of ATP-E ingestion.