Enterococcal bacteremia in a medical center

BACKGROUND: The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS: There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS: One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS: Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.     

Anti-D in a D-positive renal transplant patient

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.     

Using a cost-construction model to assess the cost of educating undergraduate medical students at the University of Texas--Houston Medical School

Spontaneous resolution of deformities after excision of facial skin lesions has been known and used for a long time by plastic surgeons. The resorption mechanism of deformity is based on natural skin expansion, and seems to be directly related to the action of the muscles of facial expression and their skin relations. Natural expansion has been shown to be effective in children. Between 1990 and 1994 excision of skin lesions, including congenital nevi, leading to postoperative deformity of the cheek, labial commissure, nose, eyelid and forehead, was performed on 35 patients, aged from 3 month to 12 years. The average follow-up is 24 months. For 26 patients (74%), natural resorption was observed 4 or 6 weeks later with good aesthetic results. For 6 patients (17%), the deformity persisted 3 or 6 months later, but did not require any further surgery. For 3 patients (9%), a second operation was necessary. Using the skins natural capacity for expansion in the treatment of facial skin defects in children is a method of reconstruction which has already been used for excision in enforced position. The platysma and muscles of facial expression by their action on skin mobilisation, allow natural expansion. A better knowledge of cutaneous biomechanical properties enables plastic surgeons to find an alternative to other classical methods.     

Evaluating generalized predictive control for a brushless DC drive

This paper proposes a new control approach for a brushless DC motor drive using the generalized predictive control (GPC) algorithm. Based on the same least-squares framework as in the controller design, we further develop the method to design an observer. The GPC algorithm uses the receding horizon approach whereby the control signals are determined by minimizing a quadratic cost function. Our study shows that the rise time and settling time of the servo system have an approximate linear relationship with the prediction horizon. Thus, it is used to tune the controller of the drive. Moreover, the control weighting factor can be used to smooth the controller output. The proposed algorithm has been implemented using a digital signal processor (DSP) and tested in real time with a prototype system. The performance and robustness of the algorithms have been evaluated both in simulation and experiment. The results show that the drive performs reasonably well despite load changes and step changes in the position setpoint. Furthermore, it is fairly robust against motor parameters change     

点阴极电场辅助阳极连接中的紧密接触面积和电流

用等效电路的方法研究了点阴极情况下的电场辅助阳极连接效应，计算了连接电流，连接孕育期和紧密接触面积，本文结果表明，连接初期电流迅速衰减，随后缓慢变小，直至某一稳定值，孕育期随温度上升指数下降，连接温度高时，孕育期将难以观察到；待连接表面之间紧密接触面积随时间延长而非线性扩展，紧密接触区域增大时，其边界向外推进速度渐小，而接触面积增加渐快。     

Off-Site Exposure to Respirable Aerosols Produced during the Disk-Incorporation of Class B Biosolids

Field experiments were conducted at a Class B biosolids land application site in central Arizona to measure, model, and source-track the off-site transport of aerosols emitted when biosolids were disk-incorporated into soils. Real-time PM10 monitoring provided time-resolved aerosol information sufficient for verifying both off-site concentration and off-site exposure time model results. Under the conditions considered and at a distance of 165?m from the aerosol source, biosolids disk-incorporation resulted in an intermittent exposure to biosolids-derived aerosol concentration between 15 and 40?μg/m3 and an inhalable biosolids dose between 2 and 8?μg. Transport modeling predicted that these doses will decrease with increasing wind speed. In addition, three DNA sequence-based biosolids source tracking methods were applied to aerosol samples and confirmed the presence of biosolids in aerosols at 5, 65, and 165?m from the aerosol source. Field measurements and modeling indicate that the nature of biosolids-derived aerosol exposure is a series of intermittent high concentration puffs, rather than a continuous low concentration.