Between December, 1974, and August 1975, intestinal illness occurred in 55 of 205 infants admitted to the special-care nurseries of a large children's hospital. Escherichia coli serotype 078:K80:H12, which produced a heat-stable enterotoxin, was isolated from 18 of 25 symptomatic infants as compared with 14 of 55 asymptomatic infants (P less than 0.001). Colistin administered prophylactically to 24 culture-negative asymptomatic infants did not prevent colonization in 10, whereas colonization did occur in 22 of 56 not receiving colistin (P = 1.0). This outbreak provides laboratory and epidemiologic evidence that heat-stable enterotoxigenic Esch. coli is pathogenic in human beings and produces infantile diarrhea.
We investigated coronary-artery spasm in six patents who had had unexpected hemodynamic collapse within two hours after cardiopulmonary bypass for myocardial revascularization. All six had profound hypotension and recurrent ST-segment elevation in electrocardiographic Leads II, III, and aVF. All had either normal or noncritical luminal irregularities of dominant right coronary arteries and more than 75 per cent occlusions in the left coronary circulation. Right-coronary-artery spasm, which was reversed after intracoronary nitroglycerin, was demonstrated angiographically in one patient; a patent right coronary artery was found at autopsy in another patient. Three patients died despite large intravenous doses of nitroglycerin. Two patients who had been unresponsive to intravenous nitroglycerin recovered after direct infusion of nitroglycerin into the right coronary artery. Coronary-artery spasm immediately after myocardial revascularization may cause circulatory collapse and death; although the spasm may be refractory to usual therapy, it may respond to intracoronary nitroglycerin.
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