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Combined administration of amiloride and small-volume resuscitation with hypertonic saline may be a strategy worthy of further evaluation in the therapy of shock-induced distant organ injury.

BackgroundCapnocytophaga canimorsus is an oral commensal bacteria in dogs and may cause severe infection following a dog bite. This is a case of fatal C. canimorsus sepsis with acute infectious purpura fulminans (AIPF) in a healthy patient with splenic hypoplasia.Case PresentationA healthy 49‐year‐old man was admitted to the intensive care unit (ICU) for septic shock and AIPF 4 days after a dog bite to his mouth. Computed tomography revealed a small spleen measuring 53 cm3 but no other source of infection. Despite intensive care, the patient died of multiple organ failure and progressive shock on the fifth ICU day. Polymerase chain reaction of blood samples identified the C. canimorsus gene on a later day.ConclusionCapnocytophaga canimorsus from dog bites may cause fatal AIPF. Splenic hypoplasia and bite wounds in well‐perfused areas such as the oral cavity are possible risk factors for sepsis. All dog bites should warrant medical attention.

Salivary secretion of the rat submandibular gland exhibits two phases upon administration of acetylcholine (ACh, 10(-6) M): an immediate initial transient phase of rapid secretion lasting 5 min followed by a longer steady phase of slower secretion. Application of an anoxic perfusate bubbled with 100% N2 for 10-20 min had no effect on the initial phase of secretion, but caused a marked decrease in secretion in the steady phase following stimulation with 10(-6) M ACh. After secretion under the anoxic condition, a recovery period without stimulation was performed for 30 min by perfusion with HEPES Ringer's solution bubbled with 100% O2 and containing various potassium concentrations. The initial secretion rate measured with application of an anoxic perfusate was markedly increased by the high-K+ recovery perfusate (25 mM) and decreased by the K(+)-free recovery perfusate. Administration of 10(-3) M ouabain in the normal perfusate resulted in inhibition of secretion during the steady phase similar to that seen under the anoxic condition, while the secretory rate during the initial phase remained unchanged. We concluded that the initial phase of secretion is relatively resistant to anoxia, and that oxygen supply and Na(+)-K+ pump activity were essential for maintaining the steady phase of secretion.

Development of reliable non-contact unrestrained respiratory monitoring is capable of augmenting the safety of hospitalized patients in the recovery phase. We previously discovered respiratory-related centroid shifts along the long axis of the bed with load cells under the bed legs (bed sensor system: BSS). This prospective exploratory observational study examined whether non-contact measurements of respiratory-related tidal centroid shift amplitude (TA-BSS: primary variable) and respiratory rate (RR-BSS: secondary variable) were correlated with tidal volume (TV-PN) and respiratory rate (RR-PN), respectively measured by pneumotachograph in 14 ICU patients under mechanical ventilation. Among the 10-minute average data automatically obtained for a 48-hour period, 14 data were randomly selected from each patient. Successfully and evenly selected 196 data points for each variable were used for the purpose of this study. A good agreement between TA-BSS and TV-PN (Pearson's r = 0.669) and an excellent agreement between RR-BSS and RR-PN (r = 0.982) were observed. Estimated minute ventilatory volume as 3.86*TA-BSS*RR-BSS (MV-BSS) was found to be in very good agreement with true minute volume (MV-PN) (r = 0.836). Although Bland-Altman analysis evidenced accuracy of MV-BSS by a small insignificant fixed bias (-0.02 liter/min), a significant proportional bias of MV-BSS (r = -0.664) appeared to produce larger precision (1.9 liter/min) of MV-BSS. We conclude that contact-free unconstraint respiratory monitoring with load cells under the bed legs may serve as a new clinical monitoring system, when improved.