The differentiation of left ventricular pseudoaneurysm from true aneurysm is sometimes difficult. Given the propensity for pseudoaneurysms to rupture leading to cardiac tamponade, shock, and death, ...compared with a more benign natural history for true aneurysms, accurate diagnosis of these conditions is clinically important. Clinical symptoms, physical examination findings, electrocardiograms, and routine x-rays are not sensitive or specific for diagnosing left ventricular aneurysms nor for distinguishing true from pseudoaneurysm once detected. Our aim is to present a case report demonstrating these difficulties and to review the use of various cardiac imaging modalities in differentiating between these 2 entities.
Green tea (Camellia sinensis)-associated hepatotoxicity is reported. However, the presence of alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated drug-induced liver ...injury (DILI) is unknown. A previously healthy woman with alpha-1 antitrypsin MZ phenotype who took SlimQuick?, an herbal supplement containing green tea extract, developed severe hepatotoxicity requiring corticosteroid treatment. Green tea-associated hepatotoxicity is reviewed and alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated DILI is discussed. Liver biopsy demonstrated marked inflammation with necrosis suggestive of toxic injury with diffuse alpha-1 antitrypsin globule deposition on immunostaining. Corticosteroid therapy resulted in rapid clinical improvement. Alpha-1 antitrypsin MZ phenotype may increase vulnerability to herbal hepatotoxicity.
There is the paperless society promised 20 years ago as computers began to appear in our offices and eventually our homes? Tax returns, bank loan agreements and court documents, among others, ...continue to use hard paper copy because of the legal requirement of a signed writing and concerns regarding authenticity. Electronic commerce in goods is similarly hampered by the lack of a trustworthy system to verify the identities of the purchaser and the seller. Digital signatures, backed by digital signature legislation, answer these concerns.
It is difficult to assess which heavy-chain (C$\sb{\rm H}$) genes are expressed by Peyer's patch (PP) germinal-center (GC) B-cells by assaying these cells either in vivo, or in in vitro cultures. ...Therefore, we examined the mRNAs they produce for various C$\sb{\rm H}$ transcripts by in situ hybridization. We found that approximately 50% of PP GC B-cells contain mRNA$\mu$, and of the remaining cells, 40% contain mRNA$\alpha$. Northern blot analysis showed that the messages correspond to sizes known to encode the membrane and secretory forms of IgM and IgA. None of the message was for C$\alpha$ germ-line transcripts. Finally, GC and sIgA$\sp+$ PP B-cells lack C$\sb{\rm H}$ genomic DNA 5$\sp\prime$ of C$\alpha$. Therefore, we believe most GC cells expressing mRNA$\alpha$ have undergone a DNA rearrangement as they switch to IgA expression. Our findings reflect the preference of PP GC B-cells to switch to IgA. The expression of IgA by PP GC B-cells in conventionally reared mice has been suggested to be due to either the chronic state of PP GCs or the GC microenvironment. To test these two alternative hypotheses, we attempted to raise GCs de novo in PPs of germ-free mice following oral administration of reovirus Type1/Lang, and in lymph-nodes (LNs) of conventionally reared mice after local parenteral infection. Transient GC responses occurred in each tissue following primary infection and secondary challenge. After reovirus infection, sIgA$\sp+$ B-cells were detected in PPs. In LNs, sIgG1$\sp+$ B-cells comprised the principle non-IgM$\sp+$/IgD$\sp+$ B-cell population. PP fragment cultures initiated following primary infection and secondary challenge produced reovirus-specific IgA, whereas LN cultures elaborated IgG1, but not IgA. Northern blot analysis detected C$\alpha$ germ-line transcripts in PPs, but not LNs; further substantiating a site-related bias in non-IgM$\sp+$/IgD$\sp+$ isotype expression. In conclusion, the transient nature of PP GCs in germ-free mice given reovirus orally suggests that a continual array of antigens may be required to maintain the chronic GCs found in conventionally reared mice. In addition, the preference for generating sIgA$\sp+$ B-cells in PPs appears to result from intrinsic features of the PP GC microenvironment, and not the persistence of the GC.
Background. Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection ...(ARI). Methods. A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI. Results. In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from $18,588 to $29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4–12.7 days, and attributable mortality was 6.5%. The societal costs were $10.7–$15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort. Conclusions. The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.
Background: Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) ...and conduct a sensitivity analysis comparing analytic methods. Methods: A random sample of high-risk adults hospitalized in the year 2000 was selected. Measurements included total and variable medical costs, length of stay (LOS), HAI site, APACHE III score, antimicrobial resistance, and mortality. Medical costs were measured from the hospital perspective. Analytic methods included ordinary least squares linear regression and median quantile regression, Winsorizing, propensity score case matching, attributable LOS multiplied by mean daily cost, semi-log transformation, and generalized linear modeling. Three-state proportional hazards modeling was also used for LOS estimation. Attributable mortality was estimated using logistic regression. Results: Among 1253 patients, 159 (12.7%) developed HAI. Using different methods, attributable total costs ranged between $9310 to $21,013, variable costs were $1581 to $6824, LOS was 5.9 to 9.6 days, and attributable mortality was 6.1%. The semi-log transformation regression indicated that HAI doubles hospital cost. The totals for 159 patients were $1.48 to $3.34 million in medical cost and $5.27 million for premature death. Excess LOS totaled 844 to 1373 hospital days. Conclusions: Costs for HAI were considerable from hospital and societal perspectives. This suggests that HAI prevention expenditures would be balanced by savings in medical costs, lives saved and available hospital days that could be used by overcrowded hospitals to enhance available services. Our results obtained by applying different economic methods to a single detailed dataset may inform future cost analyses.
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