Endocarditis due to Streptococcus mitis with high-level resistance to penicillin and ceftriaxone.
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Ceftriaxone↗
Biomedical subjects
J Drummond-Webb
Publications and source records attributed to J Drummond-Webb.
Transcatheter coil occlusion of perivalvular mitral leaks associated with severe hemolysis.
A 6-year-old malnourished child had persisting hemolysis after attempted valve repair and two surgeries for mitral valve replacement due to partial dehiscence of the valve ring. A modified catheter delivery system was utilized to deploy a total of six Gianturco coils. The hemolysis resolved and the patient was doing well 17 months later. The technique may be helpful in other patients with perivalvular mitral leaks. Cathet. Cardiovasc. Intervent. 49:64-67, 2000.
Cardiac Catheterization↗
Neuroprotective, anesthetic, and cardiovascular effects of the NMDA antagonist, CNS 5161A, in isoflurane-anesthetized lambs.
BACKGROUND: N-methyl-d-aspartate (NMDA) receptor antagonists are neuroprotective in animal models of cerebral ischemia, but adverse cardiovascular and neurobehavioral effects have precluded their clinical use. The authors present the neuroprotective, anesthetic, and cardiovascular effects of a novel NMDA antagonist, CNS 5161A. METHODS: Lambs, 4.0-6.5 kg, were anesthetized with isoflurane, intubated, and ventilated and had thermodilution catheters placed in the pulmonary artery and 20-g catheters placed in the femoral artery. The minimum alveolar concentration (MAC) of isoflurane was determined using the "bracketing technique." CNS 5161A was given as a bolus and then as an infusion at three doses. Cardiovascular measurements were determined every 15 min. Other lambs (n = 25) were subjected to cardiopulmonary bypass (CPB) with hypothermic circulatory arrest (HCA) for 120 min. Eighteen received CNS 5161A, and seven received saline vehicle. One hour after CPB, brains were perfusion-fixed and removed for in situ hybridization and immunohistochemistry analysis in half of the animals. The other half survived 48 h before their brains were examined for neuronal degeneration. RESULTS: Isoflurane at MAC significantly decreased blood pressure, heart rate, cardiac output, and systemic vascular resistance by 30-48% (n = 16; P < 0.05). CNS 5161A (n = 12) had no significant cardiovascular effects. All concentrations of CNS 5161A caused a significant reduction (21-29%) of the MAC of isoflurane (n = 12; P < 0.05). CNS 5161A, at serum concentrations greater than 25 ng/ml, completely inhibited c-fosmRNA and c-FOS protein expression in hippocampal neurons after 120 min of HCA, attenuated neuronal degeneration, and improved functional outcome by 47% (P < 0.05). CONCLUSIONS: CNS 5161A at neuroprotective concentrations before CPB-HCA significantly reduces the MAC of isoflurane without cardiovascular effects.
Anesthesia, Inhalation↗
Delayed post-traumatic cauda equina compression syndrome.
Acute lumbosacral fracture-dislocation is an unusual injury. A delayed cauda equina injury accompanying the fracture-dislocation is seldom encountered. We report a cauda equina lesion complicating an acute lumbosacral fracture-dislocation 3 weeks postinjury. The patient had been trapped in a knee-elbow position under an overturned vehicle. Symptoms were relieved following posterior decompression and fusion from L5 to S1.
Adult↗