Management of the deformed rheumatoid forefoot. A comparison of conservative and surgical methods

In a retrospective survey of 65 patients who had rheumatoid arthritis, the late results of excision arthroplasty of the forefoot were investigated and compared with nonoperative management. Subjective assessment of foot shape and severity of pain as well as objective changes in gait and deformity were considered. Surgery relieved pain initially, but the recurrence rate of metatarsalgia was high. In those who wore surgical shoes, lack of cosmesis was the most important factor in determining poor compliance. The operation was recommended at random, and there was little difference in the outcomes of nonoperative and surgical treatments. A long-term randomized prospective trial is required to establish the criteria for selection of a management regime.

Variation in Counts, Enterotoxin Levels and TNase in Swiss-Type Cheese Contaminated with Staphylococcus aureus

In 1977, a number of staphylococcal intoxications occurred as a result of several lots of Swiss-type cheese being contaminated with Staphylococcus aureus . Blocks of cheese representing 59 of the recalled lots manufactured between January 5 and April 25, 1977, were examined for S. aureus counts and for staphylococcal thermonuclease (TNase), enterotoxin and pH. Counts ranged from <25 to 10⁸ S. aureus /g, with most blocks containing between 10⁴ and 10⁶/g. Enterotoxin B was present in 72.6% of 186 samples and TNase in 52.5% of 122 samples tested. The pH was generally between 5.5 and 5.7 with some samples as high as 6.2; normal pH for Swiss-type cheese is 5.7. Variations in levels of these parameters occurred within lots and even within blocks, as well as between lots. Within blocks there seemed to be differences between samples at the center and the periphery. The activity and degree of contamination of the starter cultures, temperatures of cooking and ripening and the speed of salt penetration could be factors causing these variations. TNase was not detectable in all samples containing enterotoxin, especially those with <0.5 μg/100 g. Therefore, cheese suspected of being a health hazard, such as being manufactured under unsanitary conditions or suspected of being contaminated with S. aureus , should be sampled at the center and periphery of blocks, if these are available, and analyzed for S. aureus counts, TNase and enterotoxin.

Tunguska Meteor Fall of 1908: Effects on Stratospheric Ozone

In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparentiy by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +/- 15 percent. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall indicates that the event may provide a test of current ozone depletion theories.

Growth of human mammary epithelial cells on collagen gel surfaces

We have developed a method for sustained growth of human mammary epithelial cells in monolayer cultures. Epithelial organoids derived from solid breast tissues were grown on the surface of thin (approximately 1 mm) collagen gel layers in an enriched growth medium supplemented with hormones, growth factors, fetal calf serum, and horse serum. To transfer the cultures, the collagen layers were dislodged and digested with collagenase. The monolayers of cells released into suspension were then dissociated into single cells using trypsin-ethylene-diaminetetraacetate. Dissociated single cells were repleted with 75 to 95% efficiency onto collagen layers or tissue culture plastic surfaces. The dissociated cells could also be cryopreserved and reactivated with greater than 80% plating efficiency on collagen layers. Normal human mammary epithelial cells grown under these conditions progressed through 12 to 15 population doublings. The population-doubling times for normal and malignant mammary cells on collagen layers were 34 and 65 hr, respectively. After reaching confluence, cells in some cultures, derived from either normal or malignant tissues, penetrated the gel surface and grew into the collagen. Within the gels, the cells became organized into three-dimensional tubular structures. The use of collagen layers eliminates a major problem in growth of human mammary epithelial cells in culture, difficulty in efficient dissociation, and cell transfer from monolayers.

Surgical footwear in rheumatoid arthritis--a patient acceptability study

One hundred patients wih rheumatoid arthritis were questioned about the acceptability of the surgical shoes that they had been prescribed for their foot problems. The approach was made from the records of a surgical supplies manufacturer. While 90 per cent experienced good alleviation of symptoms, 50 per cent had complaints regarding fit, comfort and styling. The implications of changes in the supply of shoes and the staffing of orthotic concerns are discussed, and suggestions are made for the direction of future research.

Stereophotogrammetry and relief photography in the assessment of foot disorders

Expanded polyethylene foam (Plastazote) is used in the treatment of rheumatoid, diabetic, and leprotic foot disorders. This paper describes a diagnostic use for this material. Two photographic techniques combine to give vivid and quantitative representations of foot deformities which are easily applicable to clinical use. Relief photography uses illumination to create an illusion of solidity in a 2-dimensional photography. Stereophotogrammetry produces contour plots from stereopairs of photographs of the Plastazote footprint. After use the impressions are trimmed and slipped into the patient's shoes in the same way as any other foam insole.

Systemic Haemophilus influenzae infections in a community hospital: prevalence of ampicillin resistance

Ampicillin-resistant strains are presently known to account for 10% to 20% of type b Haemophilus influenzae infections in the United States. To determine whether the incidence in a community hospital parallels that of several university hospitals, we reviewed medical records of the 99 children with type b Haemophilus systemic infections for the period 1976 to 1979. These cass represented 1.8% of all pediatric medical admissions. In 1976-1977, 5% of those infections were caused by resistant strains; the incidence increased to 19% for the period 1978-1979. This increase on a community hospital level parallels the increase in ampicillin resistance in Haemophilus noted in university hospitals and underscores the need for chloramphenicol (alone or in combination with ampicillin) as initial treatment for systemic Haemophilus infections.

Pathophysiological studies on hypertension induced in rats by kidney extract and salt

The renin-angiotensin-aldosterone system, electrolyte and water balance, body fluid, and neurogenic tone and reactivity of the vasculature were studied in hypertension induced in uninephrectomized rats by repeated injection of renin-rich kidney extract and 1% saline drinking. The control rats were injected with physiological saline. Various measurements were made in conscious rats on the 10th day of the treatment. As compared with the control, plasma renin concentration and serum sodium increased significantly, while plasma aldosterone and renal excretory function did not differ. Blood volume (BV) expressed as per body weight increased significantly, but absolute BV, absolute or body weight-related plasma volume and hematocrit were not significantly different. The hypotensive effect of 1-Sar-8-Ile-angiotensin II was negligible 12 hours after the preceding injection of kidney extract. It was small but significant 1 hour after the injection. Increase in water turn-over and fractional sodium excretion occurred during the development of hypertension. Spironolactone did not significantly modify the developmental course. We observed increased depressor response to hexamethonium and increased reactivities to noradrenaline and angiotensin II (A II); these response curves relatively resembled those of spontaneously hypertensive rats. Hypertensive vascular changes were seen in the kidney and heart by histology. Thus, it was suggested that a direct vascular action of A II played a partial role in this hypertensive process while aldosterone played little role. The significance of BV increase and possible contribution of A II's other actions were discussed.

Zymogram analyses of various organs, glands and tissues from spontaneously hypertensive rats (SHR) and DOCA hypertensive rats

Esterase and Acid phosphatase isozymes were examined in a number of organs, glands and tissues from Spontaneously Hypertensive Rats (SHR) and kidney and liver from DOCA hypertensive rats at various stages in comparison with those of normotensive rats (CR). In SHR, the abnormalities in the patterns of esterase isozyme were demonstrated in endocrine glands and respiratory tracts as well as in the kidney, liver and digestive tracts throughout the whole life span, and abnormalities in the patterns of acid phosphatase isozyme was also demonstrated in the liver after seven days of age. Moreover, in DOCA hypertensive Rats, minute alterations in esterase isozyme were demonstrated in the kidney and liver after seventh month of the duration of hypertension.