IMPORTANT contributions to our knowledge and understanding of infective endocarditis were made by a number of students of this disease in the first third of this century. Thayer,1 among others, preferred the term infective endocarditis for this disorder, giving it equal emphasis with the more common designation bacterial endocarditis. We have chosen to employ Thayer's terminology because a significant aspect of the changing picture of this disease is an increasing involvement of agents such as fungi and even rickettsias; the term bacterial endocarditis, therefore, is not strictly applicable. In 1955 Kerr2 summarized all the significant information concerning subacute bacterial . . .

Infective endocarditis in the antibiotic era.

• To determine whether cancer patients with fever and neutropenia differ in their medical stability, 261 medical records of 184 cancer patients who were hospitalized with fever and neutropenia and treated with conventional antibiotic therapy were studied to determine whether their presenting clinical characteristics influenced the likelihood of subsequent clinical events thought to require urgent medical attention. Overall, serious medical complications, including those without an obvious relationship to infection, occurred in 56 patient courses (21%). We distinguished three clinically determined subgroups of our study population at significantly higher risk than the remaining patient group, which seemed to be at low risk. Major complications occurred in 34 (34%) of 101 inpatients, 12 (55%) of 22 outpatients with concurrent comorbidity requiring inpatient care, and eight (31%) of 26 outpatients without concurrent comorbidity requiring inpatient care but with uncontrolled cancer. However, the remaining patients, who presented as outpatients without significant comorbidity or uncontrolled cancer, had major complications in only 2% of 112 hospitalizations. These results suggest that it may be possible to assess the medical stability of patients with fever and neutropenia based on presenting clinical features. If confirmed prospectively, these results may enable clinicians to identify groups of medically stable patients for whom conventional supportive care, including appropriately administered antibiotics, may be given safely under medical supervision of less intensity or of shorter duration than conventional treatment in the acute-care hospital setting. (Arch Intern Med1988;148:2561-2568)

The Medical Course of Cancer Patients With Fever and Neutropenia Clinical Identification of a Low-Risk Subgroup at Presentation

https://www.safeminds.org/wp-content/uploads/2013/04/Bernard-et-al-2001.pdf

Autism: a novel form of mercury poisoning

Objective: To determine the relationship between cerebral white matter lesions (WML) and subjective cognitive dysfunction. Background: Subjective cognitive dysfunction is present when a person perceives failures of cognitive function. When annoying enough, these failures will be expressed as complaints. Subjective cognitive dysfunction may be a prelude to or coincide with objective cognitive impairment. WML have been related to objective cognitive impairment and dementia, but their relationship with subjective cognitive dysfunction is not clear. Previous population-based studies on the latter relationship have been limited in sample size, recording of subjective cognitive function, and assessment of WML severity. Methods: We randomly sampled 1,049 elderly nondemented participants from the general population. Data on subjective cognitive dysfunction and its progression were derived from a 15-item questionnaire. Objective cognitive performance was assessed using a series of neuropsychological tests. WML were scored on MRI for periventricular and subcortical regions separately. Results: WML were associated with more subjective cognitive failures. WML were more severe for participants reporting progression of these failures compared with participants without these failures, especially within participants with better than average cognitive performance (p = 0.008, for periventricular WML). Participants with severe WML reported progression of cognitive failures more than twice as often than did those with little or no WML. The relationship between the severity of WML and subjective cognitive failures was present for periventricular and subcortical WML. Conclusions: WML are associated with subjective cognitive failures and in particular with reporting progression of these failures, even in the absence of objective cognitive impairment.

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Cerebral white matter lesions and subjective cognitive dysfunction The Rotterdam Scan Study

A ruling by the European Union heralds the demise of those useful clinical instruments, the mercury thermometer and the mercury sphygmomanometer. The new laws have been passed because of worries about mercury poisoning. Yet you can drink metallic mercury and come to no harm. What does it all mean? There are three forms of mercury from a toxicological point of view: inorganic mercury salts; organic mercury compounds; and metallic mercury. Inorganic mercury salts are water soluble, irritate the gut, and cause severe kidney damage. Organic mercury compounds, which are fat soluble, can cross the blood brain barrier and cause neurological damage. Mercury metal poses two dangers. It can be vaporised: the vapour pressure at room temperature is about 100 times the safe amount, so poisoning can occur if mercury metal is spilled into crevices or cracks in the floorboards. Dentists are occasionally poisoned this way. Mercury easily crosses into the brain, and causes tremor, depression, and behavioural disturbances. A second danger from metallic mercury is that it is biotransformed into organic mercury, by bacteria at the bottom of lakes. This can be passed along the food chain and eventually to man. It was this process that led to the Japanese tragedy at Minimata Bay in the late 1950s when over 800 people were poisoned. It is the need to reduce mercury contamination of the environment which should encourage us to cut the usage of metallic mercury. However, much more metallic mercury is spilled as waste by the chemical industry than is dropped on the floor in the clinic.

Toxicity of mercury.

A review of the medical toxicology of cadmium, cobalt, selenium, arsenic, nickel, copper, manganese, tellurium, vanadium, molybdenum, zinc, and tin; emphasis is on industrial sources of in...

The Human Toxicity of Certain Trace Elements

Excerpt Fever is often a manifestation of neoplastic disease, and the literature is replete with case reports of patients who were febrile for months and even years before exhaustive investigation ...

The Significance of Fever in Neoplastic Disease

The recent recognition of mercury as a widespread environmental pollutant has presented practitioners with a new problem whose medical aspects they may be ill prepared to evaluate. Extensive background information on human toxicity is available from studies of the effects of occupational exposures. Such exposures have generally been to concentrations considerably greater than those found environmentally and have been mostly to inorganic mercury or compounds that readily decomposed to inorganic mercury. The organic forms of mercury, particularly the monomethyl mercury compounds, are far more toxic and are the type likely to be encountered in community exposures, as, for example, in foodstuffs. Characteristics of mercurialism originating from the absorption of both inorganic and organic mercury compounds are reviewed, and current problems concerning the risks of human exposure at environmental levels are presented. 149 references, 2 figures.

Mercurialism: Environmental and Occupational Aspects

The problem of lead poisoning

The cerebral dural sinuses of 215 specimens of dura obtained at autopsy were studied and diagrammed. Particular attention was accorded the anatomic arrangement of the major sinuses that converge to form the torcular. In 57 per cent of the specimens there was free communication between the superior sagittal, the straight, the occipital, and the transverse sinuses at the torcular. In 43 per cent there was maldevelopment of one or more of these major sinuses at or near the torcular. Consideration is given to the clinical import of these variations subsequent to ablation of a part or all of the jugular venous system in the neck.

Ann A. Browder

Papers

The Human Toxicity of Certain Trace Elements

The Significance of Fever in Neoplastic Disease

Mercurialism: Environmental and Occupational Aspects

The problem of lead poisoning

Variations of the cerebral dural sinuses at the torcular herophili: Importance in radical neck dissection