Andre J. Ognibene

In vitro susceptibility of Mycobacterium avium complex to antibacterial agents

In vitro agar dilution susceptibility studies were performed utilizing 20 isolates (24 against rifamycin) of Mycobacterium avium complex against several antimicrobial agents not routinely tested in the mycobacteriology laboratory. Thirteen strains were susceptible to gentamicin at 4 micrograms/ml, 20 to amikacin at 8 micrograms/ml, 18 to streptomycin at 8 micrograms/ml, 20 to kanamycin at 8 micrograms/ml, 20 to trimethoprim/sulfamethoxazole at 2 micrograms/ml, 12 to sulfisoxazole at 10 micrograms/ml, 14 to rifabutin at 1 microgram/ml. No activity was found with penicillin G, cephapirin, moxalactam, vancomycin, clindamycin, erythromycin, trimethoprim, or minocycline. This data suggests a potential use of trimethoprim/sulfamethoxazole, sulfisoxazole, amikacin, gentamicin, and kanamycin in the treatment of infections caused by this group of organisms.

Adrenal Hemorrhage: A Complication of Anticoagulant Therapy—A Case History:

A seventy-five year-old woman developed adrenal hemorrhage and acute adrenal insufficiency while receiving anticoagulant therapy. Abdominal CT scan was consistent with bilateral adrenal hemorrhage and was an important contribution to diagnosis and therapy. Acute adrenal hemorrhage should be suspected in patients, especially the elderly, who have recently begun anticoagu lant therapy and develop upper abdominal pain followed by decreased senso rium, high fever, hypotension, and hyponatremia. Any consideration of the diagnosis of sepsis with shock in a recently anticoagulated elderly hospital pa tient should suggest the possibility of acute adrenal hemorrhage. Abdominal CT scan and a cosyntropin stimulation test should be performed to confirm the diagnosis. Failure of diagnosis has generally been associated with death in most patients, whereas prognosis in patients treated with corticosteroids is excellent.

Left ventricular pseudoaneurysm presenting twenty-eight months after myocardial infarction : A case report

The authors report an unusually late presentation of a ventricular pseudoaneurysm more than two years after an inferior lateral myocardial infarction and the first case evaluated by Cine loop magnetic resonance imaging.

Elapsed time from symptom onset and acute myocardial infarction in a community hospital

STUDY OBJECTIVE Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN Observational cohort study based on reviewing medical records and emergency department service logs. SETTING 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.