Ascites and other extracardiac manifestations associated with right atrial myxoma: a case report.

Right atrial myxomas are rare intracardiac tumors that often pose difficulties in diagnosis. Right ventricular failure and ascites ensuing from tricuspid valve orifice obstruction are potentially dangerous complications. Early diagnosis of cardiac myxoma is important since surgical treatment leads to disappearance of all symptoms with a low rate of recurrence and good long-term survival. Nonspecific extracardiac symptoms, signs, complications, and laboratory findings may be the initial manifestations contributing to misdiagnosis of these rare but totally treatable atrial tumors.

Acute massive rhabdomyolysis due to prolonged inhalation of liquid gas.

A very rare case of non-fatal acute massive rhabdomyolysis caused by unintentional prolonged inhalation of liquid gas (consisting of butane and propane) in a previously healthy adult is presented. The immediate diagnosis and intensive symptomatic therapy prevented any other severe complications of rhabdomyolysis, and the patient made a complete recovery without any sequelae.

The effect of hyperoxaemia on erythropoietin secretion in anaemic patients.

Erythropoietin (EPO) controls red cell production. Hypoxaemia, reduced blood oxygen-carrying capacity and increased affinity of haemoglobin (Hb) for oxygen are the primary stimuli for EPO secretion. The effect of hyperoxaemia (arterial oxygen tension (Pa,O2) > 13.3 kPa) on EPO secretion has not been thoroughly studied and is not fully understood. The primary purpose of this study was to evaluate EPO production in patients with acute respiratory failure as well as to determine the effect of hyperoxaemia on EPO secretion in patients with and without anaemia. A prospective clinical study was carried out in a 14-bed general (medical and surgical) intensive care unit in a university hospital. Twenty-one patients with acute or acute on chronic respiratory failure, requiring mechanical ventilation, were included in this study. The patients were divided into two groups; group I comprised patients who developed anaemia, and group II patients who did not. EPO levels and haematological parameters were measured in venous blood under three oxygenation conditions: hypoxaemia, hyperoxaemia and normoxaemia. All patients exhibited high EPO levels during hypoxaemia (mean value 108.7 +/- 27 mU.mL-1 (+/- SD)). During hyperoxaemia, EPO levels decreased in both groups (mean value 21.6 +/- 15.2 mU.mL-1 in group I, 36.8 +/- 19 mU.mL-1 in group II). During normoxaemia, EPO levels increased again in group I patients, but in group II patients EPO production remained stable. In conclusion, hyperoxaemia inhibits erythropoietin secretion in spite of anaemia and low arterial oxygen tension. Hyperoxaemia may be a contributing factor to anaemia in intensive care unit patients under oxygen therapy.

Cisapride decreases gastric content aspiration in mechanically ventilated patients.

OBJECTIVE: To determine the effect of the prokinetic agent cisapride in the prevention of aspiration of gastric contents. DESIGN: A prospective randomized two-period crossover study. SETTING: Fourteen-bed polyvalent intensive care unit in a University Hospital. PATIENTS: Eighteen intubated, mechanically ventilated patients who were seated in a semirecumbent position were studied. METHOD: Tc-99 m sulfur colloid (80 megabecquerels) was administered via nasogastric tube on 2 consecutive days. Patients randomly received cisapride (10 mg, via nasogastric tube) one day and a placebo the other. Bronchial secretions were obtained before and for 5 consecutive h after Tc-99 m administration. The radioactivity was measured in a standard amount (1ml) of bronchial fluid using a gamma counter and expressed as counts per min (cpm) after correction for decay. RESULTS: Sixteen out of 18 (88%) patients had increased radioactivity in bronchial secretions. The radioactivity increased over time both with and without cisapride, although it was lower in patients receiving cisapride than in those receiving a placebo. The cumulative bronchial secretion radioactivity obtained when patients received cisapride was significantly lower than when patients received a placebo: 7540 +/- 5330 and 21965 +/- 16080 cpm, respectively (P <0.05). CONCLUSION: Our results suggest that aspiration of gastric contents exists even in patients who are kept in a semirecumbent position. Moreover, cisapride decreases the amount of gastric contents aspiration in intubated and mechanically ventilated patients and may play a role in the prevention of ventilator associated pneumonia. Cisapride, even with the patient in the semirecumbent position, did not completely prevent gastric content aspiration.

Allergic reactions to local glyceryl trinitrate administration.

To assess the exact cause and extent of transdermal glyceryl trinitrate (GTN)-induced allergic reactions, a study of continuous and intermittent use of GTN patches was conducted in 320 patients with New York Heart Association (NYHA) class II and III angina pectoris. Three commercially available GTN patch systems were used. Twenty-one patients (6.5%) developed cutaneous reactions. In 17 patients (5.3%), the reactions were confined to the area of application and were characterised as irritant reactions. Four patients (1.2%) developed both localised and remote from the area of application lesions and one patient developed a generalised anaphylactic reaction. The rate of discontinuation of therapy was 3.4%. The irritant skin reactions were mainly due to contaminants and additives. Changing to a different transdermal system reduced the incidence of local reactions--a particularly desirable effect in patients who respond well to GTN therapy.

Dose-dependent appearance and disappearance of amiodarone-induced skin pigmentation.

A 66-year-old man suffering from atrial flutter developed cutaneous blue-gray pigmentation while receiving 600 mg of amiodarone daily for 15 months. With reduction of the dose to 100 mg, skin discoloration disappeared within 16 months, to reappear within 7 months after increasing the dose to 400 mg. Finally, the discoloration disappeared within 13 months with a dose reduction to 200 mg daily. It seems that a tissue threshold level for amiodarone exists in this patient, above which skin discoloration appears and below which it fades. Dose, duration, metabolism, macrophage transfer, and spillover saturation-excretion may be relevant in amiodarone-induced skin pigmentation.

Diaphragmatic herniation of the large bowel associated with unusual clinical and electrocardiographic presentation.

This is the first case reported of combined hiatus hernia of the stomach and herniation of the splenic flexure of the colon through the oesophageal hiatus. It was associated with unusual clinical and electrocardiographic findings. We postulate that these were the result of an increase in intrathoracic pressure induced by the herniating structures.

Identity of macromolecules present in the extracellular slime layer of Staphylococcus epidermidis.

The extracellular slime layer of Staphylococcus epidermidis ATCC 35983 contains: a) two non-anionic carbohydrate containing proteins degradable with papain of molecular masses 250 and 125 kDa; b) a polydisperse but homogeneously-charged acidic population with M(r) ranging from 120,000 to 35,000 (average M(r) (80,000) containing a polysaccharide covalently bound to a small peptide; c) a papain degradable macromolecule (molecular mass 60 kDa) bearing acidic carbohydrates covalently bound to protein; and c) two acidic polysaccharides strongly retained by the anion-exchange column; one polysaccharide is sulphated and has a molecular mass of 20 kDa; the other has a higher charge density and a molecular mass of 12.5 kDa. The results obtained clearly demonstrate the presence of discrete macromolecules in the extracellular material of slime-producing S epidermidis, the majority of which contain acidic carbohydrates, whose biological role remains to be elucidated.

Anticoagulant-induced shoulder hematoma producing brachial plexus neuropathy--case reports.

Hemorrhagic complications from anticoagulants are common and may manifest in any part of the human body. Skin discoloration, pain, tenderness, and soft-tissue swelling may be the main clinical features. The authors present 3 extraordinary cases of brachial plexus neuropathy associated with anticoagulant-induced hemorrhage. The signs, symptoms, important differentials, and clinical treatment are described with regard to the pathologic anatomy.

Nonfatal bacteremia caused by a mucoid, alginate-producing strain of Pseudomonas aeruginosa.

The first case of mucoid Pseudomonas aeruginosa bacteremia is reported in a hospitalized 78-yr-old woman with drug-induced hepatitis attributed to antituberculous therapy. The bacteremia was successfully treated with tobramycin and carbenicillin. Furthermore, the extracellular material of this mucoid strain was extracted, purified, and characterized as an alginate of high molecular weight, similar to that of mucoid Pseudomonas aeruginosa strains from cystic fibrosis.