Subject(s)
Adenocarcinoma/pathology , Lung Neoplasms/pathology , Adenocarcinoma/metabolism , Aged , Aged, 80 and over , Carcinoma, Endometrioid/metabolism , Carcinoma, Endometrioid/pathology , Female , Humans , Immunohistochemistry , Keratin-7 , Keratins/analysis , Lung Neoplasms/metabolism , Male , Middle Aged , Nuclear Proteins/analysis , Thyroid Nuclear Factor 1 , Transcription Factors/analysisABSTRACT
We review the history of vancomycin-resistant enterococci (VRE) and propose a causal model illustrating the roles of exposure to VRE reservoirs, patient characteristics, antimicrobial exposure, and prevalence of VRE in the progression from potential VRE reservoirs to active disease in hospitalized patients. Differences in VRE colonization and VRE infection are discussed with respect to hospital surveillance methodology and implications for interventions. We further document clonal transmission of VRE in a large, urban, teaching hospital and demonstrate VRE susceptibility to a wide array of antimicrobial agents. This model can guide the identification of mutable factors that are focal points for intervention.
Subject(s)
Cross Infection/epidemiology , Cross Infection/microbiology , Enterococcus , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Vancomycin Resistance , Carrier State/epidemiology , Carrier State/microbiology , Carrier State/prevention & control , Causality , Cross Infection/prevention & control , Cross Infection/transmission , DNA, Bacterial/analysis , DNA, Bacterial/genetics , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Disease Reservoirs , Electrophoresis, Gel, Pulsed-Field , Enterococcus/classification , Enterococcus/genetics , Enterococcus/pathogenicity , Gram-Positive Bacterial Infections/prevention & control , Gram-Positive Bacterial Infections/transmission , Humans , Incidence , Phylogeny , Population Surveillance/methods , SerotypingABSTRACT
Isolated, spontaneous dissection of the coronary arteries in the absence of trauma is an unusual but well-documented occurrence. Fewer than 50 cases have been reported in males in the English language literature, and only one case, nonfatal, was associated with cocaine use. We present the second overall and the first fatal case of cocaine-associated spontaneous coronary artery dissection and a brief review of the literature on coronary dissection and the cardiovascular effects of cocaine use. The mechanism of cocaine's toxicity on the heart and vasculature is complex, multifactorial, and predominantly related to cocaine's adrenergic properties. The increased arterial blood pressure from cocaine's inotropic and chronotropic effects combined with its direct vasoconstrictive effect leads to increased shear forces on the coronary endothelium. This elevated stress may be responsible for the formation of an intimal tear and the subsequent dissection of the coronary artery. If the dissected portion of the arterial wall is displaced enough to significantly occlude the true lumen, infarction can result. In light of this possibility, coronary artery dissection must be considered in young patients presenting with symptoms of cardiac ischemia and a history of cocaine use.
