Postbacterial sepsis and disseminated candidiasis

The effect of gram-negative sepsis (Escherichia coli) on the capacity of polymorphonuclear leucocytes (PMN) to phagocytize and kill Candida albicans was assessed. The PMN's from septic dogs phagocytized C. albicans as well as PMN's from non-septic dogs. The PMN's from septic dogs that phagocytized C. albicans underwent a spontaneous lysis at a much higher rate than PMN's from non-septic dogs. A functional difference in PMN's from normal and septic dogs is indicated.

Inhalation injury--an increasing problem

Inhalation injury is a common complication of thermal accidents occurring in one-third of patients burned. The routine use of fiberoptic bronchoscopy on all patients incurring thermal burns provides an accurate and safe means for diagnosis. Although complications for inhalation injury are common, the mortality can be reduced by early diagnosis and attention to careful fluid resuscitation, aggressive pulmonary therapy and the avoidance of prophylatic steroids.

Management of septic thrombosis of the inferior vena cava caused by Candida

Septic thrombosis of central veins is rarely diagnosed during life and nearly always proves fatal. We have recently successfully treated a patient with a 75% body surface burn in whom septic thrombosis of the inferior vena cava developed associated with high-grade candidemia as a complication of parenteral nutrition. Signs of venous thrombosis and candidemia persisted after catheter removal. Prompt and intensive therapy with amphotericin B, monitored by fungicidal assays of serum, resulted in cure. Generous hydration and directed supplementation of sodium bicarbonate permitted us to administer a large total dose of amphotericin over a relatively brief period of time with no nephrototoxic effect whatsoever. Septic central venous thrombosis mandates a pharmacologic approach to therapy similar to that used for infective endocarditis, with the addition of anticoagulation. Should sepsis prove refractory to this program of it pulmonary embolization occurs, operative intervention is indicated despite the high risks involved.

Inhibition of granulocyte phagocytosis of Candida albicans by amphotericin B

Phagocytic activity of PMN's in five healthy and five burned patients were measured in vitro. Addition of 1 microgram per millilitre of amphotericin B to the assay produced a marked inhibitory effect of the phagocytic activity of PMN against C. albicans.

Proper management of hepatic adenoma associated with oral contraceptives

Four patients with oral contraceptive associated hepatic adenoma have been studied and the literature reviewed. Clinically, these patients can be divided into ruptured and nonruptured hepatoma groups. In instances of ruptured hepatomas, resection only sufficient to control hemorrhage definitely is recommended. In instances of nonruptured hepatomas, major resection should only be attempted by skilled surgeons, and small multiple lesions should be observed. These management principles will deserve re-evaluation as more experience with these tumors accumulates. Until then, a conservative approach is indicated. This includes the avoidance of oral contraception until the biochemistry of these tumors is better clarified.

Acute leukopenia as an allergic reaction to silver sulfadiazine in burn patients

Of 68 burn patients at the University of Wisoncsin Burn Center treated with silver sulfadiazine cream over 2 years, two (about 3%) developed fever and marked leukopenia. The symptoms disappeared 1-2 days after discontinuation of the cream. The two cases are described and possible mechanisms of allergic response to this agent are discussed.