Faculty Bibliography

Myocarditis secondary to H1N1 influenza has been described in children, but only very rarely in adults. We describe a 36-year-old man with no significant medical history who presented with flu-like symptoms of 3-week duration. When he sought medical attention, he was already manifesting heart failure secondary to fulminant myocarditis, along with multiorgan failure. Despite aggressive management, including circulatory support with a catheter-based mechanical cardiac assist device (Impella 2.5 Cardiac Assist Device, Abiomed, Danvers, MA) as a bridge to cardiac transplant, and aggressive antiviral and antibacterial therapy, the patient died of cardiac arrest. An H1N1 polymerase chain reaction postmortem assay produced positive results, and a diagnosis of fulminant viral myocarditis and multiorgan system failure was established.

PURPOSE OF REVIEW/OBJECTIVE:Bronchiectasis is an under-appreciated cause of chronic lung disease in the USA. We highlight developments in diagnosis and treatment of this debilitating disease. RECENT FINDINGS/RESULTS:A possible link between gastroesophageal reflux and development of nontuberculous mycobacterial lung disease was highlighted. Reflux is more common in patients with nontuberculous mycobacterial lung disease, and among those with established bronchiectasis more extensive disease was observed in those patients who also had reflux. Long-term mortality in bronchiectasis was significantly associated with age, lower body mass index, dyspnea, lack of vaccination, hypoxemia, hypercapnia, and other functional parameters. In a large, randomized clinical trial, addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas infection produced microbiologic improvement correlating with clinical outcomes but not overall improvement. A review noted that five macrolide trials reported reduced sputum volume, improved lung function, and better symptom control. Finally, articles suggested benefit from inhaled hyperosmolar agents (e.g. hypertonic saline and inhaled mannitol). SUMMARY/CONCLUSIONS:The possible link between gastroesophageal reflux and nontuberculous mycobacterial lung disease, and the microbiology and resistance patterns of bacteria observed in these patients were clarified. A large study of inhaled tobramycin for exacerbations was inconclusive, but macrolide therapy and hyperosmolar agents hold promise.

This study examines the possibility that social support operates as a moderator of cardiovascular reactivity in women. Two models by which social support may operate were examined: the direct effects and buffering models. Twenty-six subjects were exposed to four conditions while playing a video game: two levels of stress (low, high) and two levels of social support (alone, together). Blood pressure and heart rate were monitored continuously. Ratings of stress were obtained for each condition. Results indicated that the support manipulation produced significant main effects for diastolic blood pressure and stress ratings, with lower diastolic blood pressure and ratings observed in the "together" condition, and that the interaction between support and stress produced lower reactivity for the cardiovascular measures in the high stress (but not the low stress) condition. No interaction was found for the stress ratings. We conclude that the results provide support for both the buffering and direct effects models. Implications concerning the (within-subjects) design of the study and the stress ratings are discussed.