Cardiovascular morbidity in high-risk patients during ECT.

OBJECTIVE: Cardiovascular events are the principal cause of medical morbidity in patients receiving ECT. To assess the risks of ECT for individuals with preexisting cardiovascular disease, the authors examined medical complications in older patients treated with ECT during a 1-year period. METHOD: A case-control design was used in a review of the charts of 80 consecutive patients who received ECT from August 1990 to August 1991. On the basis of accepted clinical criteria, patients over 50 years of age were divided into two groups: one at increased risk for cardiac complications (N = 26) and one at standard cardiac risk (N = 27). Outcome was measured with a scale designed to assess clinically relevant medical complications. RESULTS: The risk group was older and had received more medical consultations before ECT than the nonrisk group. Although patients in the risk group were more likely to develop minor complications during ECT, they did not differ significantly from the comparison group in the rate of major complications. No patients died or sustained permanent cardiac morbidity during ECT. CONCLUSIONS: In contrast to a similar study at the same site 15 years earlier, the current study found ECT to be relatively safe in an unselected study group of elderly patients with preexisting cardiac risk factors. The findings underscore the advances in ECT technique over the past 15 years and the importance of identifying and carefully managing patients with cardiac risk factors before and during ECT.

Tricarbon monoxide in TMC-1.

We report the measurement of three new lines of C3O in TMC-1. The observed peak antenna temperatures, appropriately corrected for atmospheric and telescope losses, are found to be consistent with a large velocity gradient radiative transfer model whose parameters span the range of standard values for this cloud. The derived fractional abundance for C3O is 1.4 x 10(-10), comparable with the results predicted from a model calculation based on a gas-phase ion-molecule reaction scheme. The results of negative searches for C3O in six other sources are not inconsistent with expected conditions in these clouds.

Common antigens among systemic disease fungi analyzed by two-dimensional immunoelectrophoresis.

The interpretation of immunological results in systemic mycoses has been complicated by cross-reactions among specimens from patients with blastomycosis, coccidioidomycosis, and histoplasmosis. The fungal preparations used in these tests evidently contained one or more antigens in common. Two-dimensional immunoelectrophoresis techniques were used to determine the number of antigens contained in several soluble extracts from Blastomyces dermatitidis and Histoplasma capsulatum that were common with those demonstrable in a coccidiodin-anticoccidioidin reference system. A total of 12 and 10 common antigens were found in preparations from B. dermatitidis and H. capsulatum, respectively. In addition, the crude preparations from each species of fungus exhibited some qualitative and quantitative differences in composition of antigens. Use of two-dimensional immunoelectrophoresis for standardization of fungus extracts, for monitoring separation of species-specific antigens, and for testing humoral antibody response should add further refinement to correlations with clinical disease.

Specificity of exoantigens for identifying cultures of Coccidioides immitis.

Forty-nine isolates of arthroconidial fungi other than Coccidioides immitis did not produce immunodiffusion lines of identity with the reference system for that fungus.

Antigenic analysis of coccidioidin and spherulin determined by two-dimensional immunoelectrophoresis.

Immunological tests are valuable aids for diagnosis of mycotic infections and, in some cases, as objective guides for clinical management and prognosis. The usefulness of these procedures is limited to the extents that crude antigen preparations are employed, that these are difficult to standardize uniformly, and that they contain antigens common to several species of pathogenic fungi. Analysis by two-dimensional immunoelectrophoresis methods of the two crude preparations used for coccidioidomycosis demonstrated that coccidioidin contained at least 26 antigens, with 10 of these found also in spherulin. In addition, spherulin contained two antigens not demonstrated in coccidioidin. No single test detected all antigens present, and multiple procedures were required to display the complete array of antigens. A reference system was established for coccidioidin and precipitated immunoglobulins from a burro hyperimmunized with coccidioidin. Evaluation of the reference system demonstrated that it was highly reproducible with respect to the reagents used, to repeated tests by the same person, and to comparative tests by two individuals using the same reagents. Applications of this reference system for standardization of reagents, for detecting common antigens, for monitoring successive steps during fractionation of crude preparations, and for fingerprinting strains for ecological and epidemiological studies are presented.

Comparison of coccidioidin and spherulin in complement fixation tests for coccidioidomycosis.

Coccidioidin, an extract from the saprophytic mycelial form of Coccidioides immitis, has been a very useful antigen preparation in serological tests for coccidioidomycosis. Its sensitivity has been very good for detecting most types of clinical disease, but tests with coccidioidin have been negative for 40% or more of patients with chronic pulmonary disease, the clinical entity which must be differentiated from other cavitary, nodular, or fibrotic pulmonary disease, e.g., tuberculosis and cancer. The specificity of coccidioidin has also been good although it results in positive tests for an average of 16% among patients with noncoccidioidal mycoses. Recently spherulin, an extract from the parasitic endosporulating spherule form of C. immitis, was reported to be more sensitive than coccidioidin in concurrent complement fixation tests with sera from selected cases. We have compared coccidioidin and spherulin in concurrent complement fixation tests with 614 sera submitted routinely for coccidioidal serology and with 159 selected sera from patients with noncoccidioidal mycoses. Among the former, spherulin was positive with 25% and coccidioidin with 23%, and correlation of titer scores was highly significant. Statistical analysis revealed no significant differences with respect to frequency of positive specimens, titer scores, or diagnosis for current coccidioidomycosis. The results with sera from noncoccidioidal mycoses revealed marked differences. Coccidioidin was positive with 20%, and spherulin was positive with 48%. The titer scores with spherulin were consistently and significantly higher, and there was no correlation for results with the two antigens. Thus, coccidioidin and spherulin were equally sensitive, but spherulin was considerably less specific.