Disseminated Mycobacterium abscessus Infection in a Burn Patient.

Disseminated infection caused by nontuberculous mycobacteria (NTM) is very rare, with an incidence of 1.0 to 1.8 cases per 100,000 persons, and typically only occurs in severely immunocompromised hosts. Burn patients suffer a loss of the natural cutaneous barrier as well as injury-induced immune dysfunction, and as a result, commonly develop infections, especially with multidrug-resistant organisms. However, very few NTM infections in burn patients have been reported in the literature. Disseminated NTM infection, in particular, can be a challenge to diagnose in burn patients due to burn-related physiology such as hyperpyrexia and widespread skin injury. We present a case of disseminated infection leading to bacteremia caused by Mycobacterium abscessus in a critically ill burn patient with a 74% total body surface area burn. M. abscessus belongs to the subgroup of NTM known as rapidly growing mycobacteria, which are notable for their ability to form colonies in a matter of days, rather than weeks, and because they are often highly drug-resistant, which complicates antimicrobial therapy. This is the third reported case of bacteremia caused by NTM in a burn patient and the second case that was successfully transitioned from intravenous antimicrobials to an oral regimen.

Two-Year Evaluation of the X-STOP Interspinous Spacer in Different Primary Patient Populations With Neurogenic Intermittent Claudication Because of Lumbar Spinal Stenosis.

STUDY DESIGN: Multicenter, prospective single-arm study in patients diagnosed with neurogenic intermittent claudication because of lumbar spinal stenosis. OBJECTIVE: To collect data from 2 different primary patient populations, new participants meeting entry criteria [Continued Access Program (CAP)], or subjects who had been randomly assigned to nonsurgical management in the pivotal Investigational Device Exemption study and failed to respond upon study completion [Crossover Study (COS)]. SUMMARY OF BACKGROUND DATA: The X-STOP interspinous spacer is a minimally invasive treatment option for neurogenic intermittent claudication shown to improve pain, physical functioning, and/or overall quality of life. METHODS: Fifty-five subjects were enrolled, 42 in CAP and 13 in COS. Zurich Claudication Questionnaire (ZCQ) success rates were obtained based on the number of subjects achieving a threshold level of success. Mean SF-36 domain scores were compared with baseline using repeated measures analysis of variance. RESULTS: Eighty percent of subjects completed the study. At 2 years, 26/43 subjects (60.5%) achieved clinically significant improvement in the Symptom Severity domain, 25/43 (58.1%) achieved clinically significant improvement in the Physical Function domain, and 31/44 (70.5%) achieved clinically significant improvement in the Patient Satisfaction domain of the ZCQ. Statistically significant improvement in mean scores was obtained in all physical domains of the SF-36 (with the exception of General Health) at 24 months. Mean improvement in ZCQ and SF-36 scores was not as pronounced in the COS cohort compared with the CAP cohort. The most frequently reported device-related or treatment-related adverse event was stenosis pain reported by 3 subjects. CONCLUSIONS: Overall data are consistent with the randomized pivotal Investigational Device Exemption trial. On the basis of the COS cohort which was subject to several additional years of failed conservative treatment, overall success rates do not improve as greatly in patients with long-standing lumbar spinal stenosis symptoms.

The amygdala mediates memory consolidation for an amphetamine conditioned place preference.

Drug-induced conditioned place preference (CPP) behavior requires memory for an association between environmental cues and the affective state produced by the drug treatment. The present study investigated whether memory consolidation underlying an amphetamine CPP could be modulated by post-training intra-amygdala infusion of the local anesthetic drug bupivacaine. On 4 alternating days adult male Long-Evans rats received peripheral injections of amphetamine (2.0 mg/kg) or saline vehicle prior to confinement for 30 min to one of two compartments of a place preference apparatus, followed by post-training intra-amygdala infusions of bupivacaine (0.75% solution/1.0 microl) or saline. On day 5 the rats were given a drug-free 20-min test session, and the amount of time spent in each of the pairing compartments of the apparatus was recorded. On the test day, rats receiving post-training intra-amygdala saline injections displayed an amphetamine conditioned place preference. Post-training intra-amygdala infusions of bupivacaine blocked amphetamine CPP. Intra-amygdala infusions of bupivacaine that were delayed 1 h post-training did not block amphetamine CPP, indicating a time-dependent effect of the treatment on memory storage processes. Pre-training or pre-retention test intra-amygdala infusions of bupivacaine also blocked acquisition and expression of an amphetamine CPP, respectively. The findings indicate that the mechanism(s) by which amphetamine elicits conditioned approach responses to environmental cues can be manipulated post-training, and suggest a role for the amygdala in acquisition, consolidation, and expression of amphetamine CPP behavior.