"Fishing for Burn Prevention": a novel approach to burn and fire safety

"Fishing for Burn Prevention" is an interactive educational burn and fire safety program designed to stimulate family involvement at health fairs, and it provides an alternative to handing out safety information. The program attracts preschoolers through preteens and is staffed by burn center personnel. The design consists of a small pool, a wooden fishing rod, several cutout fish, and hook-and-loop fasteners. Words that will stimulate interaction between the presenter and the participant are written on the fish; these can include "smoke detector," "cool the burn," "fire escape plan," "matches," "grease fire," and "120 degrees F." Providing an interactive, hands-on activity at health fairs can increase burn and fire safety awareness for the entire family.

Role of serology in the diagnosis of Lyme disease

Numerous concerns regarding the potential for misdiagnosis of Lyme disease using commercial assays have been voiced by the US Food and Drug Administration (FDA). We attempted to clarify the clinical value of serologic testing for Lyme disease using the results of commonly marketed assays for detecting antibody to Borrelia burgdorferi, the organism that causes Lyme disease. We reviewed published studies on B burgdorferi test performance published through 1998, package insert labeling from FDA-cleared test kits for B burgdorferi, and Lyme Disease Survey Set LY-A from the College of American Pathologists. We assessed the sensitivity and specificity of commercial serologic tests (enzyme-linked immunosorbent assay [ELISA], immunofluorescence antibody [IFA], and immunodot) for diagnosis of Lyme disease. To reduce this risk of misdiagnosis, it is important that clinicians understand the performance characteristics and limitations of these tests. These tests, in common use in clinical or commercial laboratories, should be used only to support a clinical diagnosis of Lyme disease, not as the primary basis for making diagnostic or treatment decisions. Serologic testing is not useful early in the course of Lyme disease because of the low sensitivity of tests in early disease. Serologic testing may be more useful in later disease, at which time sensitivity and specificity of the test are improved. Positive or equivocal results on an ELISA, IFA, or immunodot assay requires supplemental testing with a Western blot assay. A negative result on the Western blot or ELISA indicates that there is no serologic evidence of infection by B burgdorferi at the time the sample was drawn.

Design of scytalone dehydratase inhibitors as rice blast fungicides: (N-phenoxypropyl)-carboxamides

Insights gained from a crystal structure of scytalone dehydratase led to the design of carboxamide inhibitors with a phenoxypropyl group substituted on the nitrogen atom Potent enzyme inhibitors were synthesized around this motif, the best of which provided excellent control of rice blast disease in greenhouse assays and outdoor field trials.

Differential blockade of gamma-aminobutyric acid type A receptors by the neuroactive steroid dehydroepiandrosterone sulfate in posterior and intermediate pituitary

Dehydroepiandrosterone sulfate (DHEAS) is a neuroactive steroid with antagonist action at gamma-aminobutyric acid type A (GABAA) receptors. Patch-clamp techniques were used to investigate DHEAS actions at GABAA receptors of the rat pituitary gland at two distinct loci: posterior pituitary nerve terminals and intermediate pituitary endocrine cells. The GABA responses in these two regions were quite different, with posterior pituitary responses having smaller amplitudes and desensitizing more rapidly and more completely. DHEAS blockade of GABAA receptors in the two regions also was different. In posterior pituitary, a site with an apparent dissociation constant of 15 microM accounted for most of the blockade, but a small fraction of blockade may be related to a site with a dissociation constant in the nanomolar range. In the intermediate lobe, DHEAS sensitivities in the nanomolar and micromolar ranges were clearly evident, in proportions that varied widely from cell to cell. Regardless of whether the GABA response of a cell was highly sensitive or weakly sensitive to DHEAS, GABA alone evoked currents that were indistinguishable in terms of amplitude, desensitization kinetics, and GABA sensitivity. Thus, the structural elements responsible for DHEAS blockade have a highly selective impact on receptor function. GABAA receptors with nanomolar sensitivity to DHEAS have not been described previously. This suggests that DHEAS may have an important role in the modulation of neuropeptide secretion, and the diverse properties of GABAA receptors in the rat pituitary provide mechanisms for selective regulation of the different peptidergic systems of this gland.

Identification and quantitation of volatile compounds in two heated model compounds, trilinolein and linoleic acid esterified propoxylated glycerol

Static headspace (HS) and capillary gas chromatography/infrared spectroscopy-mass spectrometry (GC/IR-MS) were used to collect, separate, identify, and quantitate the oxidative and thermal decomposition products in two heated model compounds, linoleic acid esterified propoxylated glycerol (EPG-08 linoleate) and trilinoleylglycerol, both without added antioxidants. Approximately 4 L of EPG-08 linoleate or trilinoleylglycerol was heated in a deep-fat fryer at 192 +/- 8 degrees C for 12 h each day until the oil sample contained > or =20% polymeric material, which occurred after 24 h of heating. The major volatile compounds both in heated EPG-08 linoleate and in heated trilinoleylglycerol were pentane, hexanal, 2-heptenal, 1-octen-3-ol, 2-pentylfuran, 2-octenal, and 2, 4-decadienal. The identified volatile compounds from heated EPG-08 linoleate are those generally expected from the oxidative and thermal decomposition of fats and oils containing linoleic acid, except acetoxyacetone (1-acetoxy-2-propanone). Acetoxyacetone was found at 2.1, 3, and 2.4 ppm in the unheated, 12 h heated, and 24 h heated samples, respectively.

Transferrin receptor mutation analysis in hereditary hemochromatosis patients

The Cys282-->Tyr mutation in the HFE gene is carried by the majority of hereditary hemochromatosis patient chromosomes, yet some patients do not seem to harbor any mutation in this gene. This suggests a possibility that these patients may have a mutation in other genes in the same pathway as HFE. We analyzed the cDNA sequences of transferrin receptor (TFR), which was recently shown to interact with HFE, in twenty-one hereditary hemochromatosis patients including sixteen individuals who did not carry a Cys282-->Tyr mutation. A nucleotide substitution (424A-->G), which resulted in the Ser142-->Gly amino acid substitution, was the only amino acid polymorphism detected in the open reading frame of the TFR gene in these patients. This amino acid substitution was a rather common polymorphism in the general population (49%) and its frequency did not significantly differ in the hereditary hemochromatosis (HH) patients regardless of the HFE genotype. Thus, amino acid changes in the TFR gene do not appear to play a role in HH even when the patients do not have a HFE mutation. However, this study does not rule out the possibility of the involvement of mutations in non-coding regions.

Case report: oxaprozin and fatal toxic epidermal necrolysis

We have presented a case of fulminating TEN with a fatal outcome. We believe there is strong probability that the TEN was caused by a propionic acid NSAID oxaprozin. This is the first reported case of TEN related to this particular agent. Toxic epidermal necrolysis has been reported with all types of NSAIDs. It appears from this case that switching from one class of nonsteroidal anti-inflammatories to another is not always without risk. Despite the class of nonsteroidal anti-inflammatory agent used, the possibility of systemic reaction cannot be excluded.

Post-traumatic regeneration, neurogenesis and neuronal migration in the adult mammalian brain

Unlike the peripheral nervous system (PNS), the mammalian central nervous system (CNS) clearly lacks the robust regenerative characteristics and capacity of the former. Despite this fact, two unique regions of the adult mammalian CNS possess such regenerative potential and are capable of active regeneration following injury or structural compromise. These unique areas are the olfactory system and the neurohypophyseal system of the endocrine hypothalamus. Furthermore, it has been clearly demonstrated that primordial neuroblasts regarded as stem cells emerge from the subependymal parenchyma of the walls and floor of the third cerebral ventricle, migrate to the ventricular surface and undergo compensatory synaptogenesis within one week following hypophysectomy. In situ hybridization studies have unequivocally demonstrated that the up-regulation of nitric oxide synthase (NOS) is essential for neural (axonal) regeneration and neuronal (stem cell) migration to occur. Moreover, neuronal migration is reliably inhibited following the administration of the NO antagonist, nitroarginine. The current investigation serves to confirm a remarkable degree of plasticity and regeneration in the adult mammalian neurohypophyseal system coupled with the emergence of primordial neuroblasts that undergo apparent differentiation, migration and compensatory synaptogenesis in response to the up-regulation of NO that occurs following the trauma of hypophysectomy. Evidence from the current investigation appears to confirm that specialized glia of the neurohypophyseal system, the so-called pituicyte, proliferate following hypophysectomy and may serve as a growth matrix or structural template that may target and direct regenerating Supraoptic (SON) and Paraventricular (PVN) axons toward endothelial primordia in the regenerating neural stem and lobe.

HLA class II haplotype and sequence analysis support a role for DQ in narcolepsy

A systematic haplotype and sequencing analysis of the HLA-DR and -DQ region in patients with narcolepsy was performed. Five new (CA)n microsatellite markers were generated and positioned on the physical map across the HLA-DQB1-DQA1-DRB1 interval. Haplotypes for these new markers and the three HLA loci were established using somatic cell hybrids generated from patients. A four-marker haplotype surrounding the DQB1(*)0602 gene was found in all narcolepsy patients, and was identical to haplotypes observed on random chromosomes harboring the DQB1(*)0602 allele. Eighty-six kilobases of contiguous genomic sequence across the region did not reveal new genes, and analysis of this sequence for single nucleotide polymorphisms did not reveal sequence variation among DQB1(*)0602 chromosomes. These results are consistent with other studies, suggesting that the HLA-DQ genes themselves are among the predisposing factors in narcolepsy.

Treatment outcome following radiotherapy in elderly patients with bladder cancer

BACKGROUND AND PURPOSE

The optimal treatment of elderly patients with bladder cancer is not established. This study aimed to evaluate prognostic variables for survival and morbidity, which may be important for treatment strategy.

MATERIAL AND METHODS

The medical records of 94 patients aged > or = 75 years receiving curatively intended radiotherapy for bladder cancer were reviewed retrospectively.

RESULTS

Median age was 78 years (range 75-93 years). Fifty patients had T1-2 tumors, and 42 patients had T3-4 tumors. The total planned dose was 57.6-62.6 Gy in 24-30 fractions in 6 weeks. In 76 patients, a 2 week rest period was planned after 16 fractions (split course). Half of the patients were hospitalized during or after the treatment because of gastrointestinal or urogenital side effects. Median survival was 13.9 months (range 0.6-150.0 + months), 29% survived for 2 years and 7% survived for 5 years. Patients aged > 78 years survived for a shorter period than patients aged 75-78 years (13.4 versus 16.1 months). Univariate survival analysis revealed that low stage (T1-2), good performance status (PS < or = 1), split course treatment, no treatment interruption due to side effects, and no hospitalization during treatment were associated with long survival. In multivariate analyses, T-stage, split course treatment, and performance status were independent prognostic factors.

CONCLUSION

The results confirm that curative intended radiotherapy is feasible in elderly patients, but patients with stage T3-4 and PS > 1 have a short survival. These patients should be offered palliative treatment.

Fibrin structures during tissue-type plasminogen activator-mediated fibrinolysis studied by laser light scattering: relation to fibrin enhancement of plasminogen activation

The aim was to relate fibrin structure and the stimulatory effect of fibrin on plasminogen activation during t-PA-mediated fibrinolysis using Lys78-plasminogen as activator substrate. Structural studies were undertaken by static and dynamic laser light scattering, cryo transmission electron microscopy and by the measurement of conversion of fibrin to X-, Y- and D-fragments. The kinetics of plasmin formation were monitored by measurement of the rate of pNA-release from Val-Leu-Lys-pNA. The process of fibrin formation and degradation comprised three phases. In the first phase, protofibrils with an average length of about 10 times that of fibrinogen were formed. The duration of this phase decreased with increasing t-PA concentration. The second phase was characterized by a sudden elongation and lateral aggregation of fibrin fibers, most pronounced at low levels of t-PA, and by formation of fragment X-polymer. The third phase was dominated by fragmentation of fibers and by formation of Y- and D-fragments. Plasmin degraded the fibers from within, resulting in the formation of long loose bundles, which subsequently disintegrated into thin filaments with a length of less than 10 and a mass per length close to one relative to fibrinogen. Plasmin generation at high t-PA concentrations sets in just prior to (and at low t-PA concentrations shortly after) the onset of the rapid second phase of elongation and lateral aggregation of fibrin fibers. The maximal rate of plasmin formation per mol t-PA was the same at all concentrations of activator and was achieved close to the time of the peak level of fragment X-polymer. Plasmin formation ceased after formation of substantial amounts of Y- and D-fragments. At this stage the length was between 300 and 3 and the mass per length close to 1, both relative to fibrinogen. In conclusion our results indicate that (1) formation of short fibrin protofibrils is the minimal requirement for the onset of the stimulatory effect of fibrin on plasminogen activation by t-PA, (2) formation of fragment X protofibrils is sufficient to induce optimal stimulation of plasminogen activation, and (3) plasmin degrades laterally aggregated fibrin fibers from within, resulting in the conversion of the fibers into long loose bundles, which later disintegrate into thin filaments.

Correlation between college students' driving offenses and their risks for alcohol problems

This study was designed to investigate the correlation between college students' driving offenses and their risk for alcohol problems. The CORE Alcohol and Drug Survey was administered to 22 undergraduate students enrolled in an alcohol and drug education program. Participants had committed an offense of driving under the influence of alcohol (DUI) or a non-DUI alcohol-related offense. The authors examined the relationship between DUI and non-DUI offenses and the following variables: age of first use, binge drinking, average number of drinks, and grade point average. The DUI group engaged in binge drinking more often and had been younger at the time of first use of alcohol than the non-DUI group. The high overall consumption and frequency of binge drinking among DUI and non-DUI offenders appears to validate alcohol and drug education programs that focus on reducing high-risk behaviors.

Ophthalmoplegic migraine: diagnostic criteria, incidence of hospitalization and possible etiology

Charts from patients admitted from April 1976 to March 1986 to the departments of neurology, neurosurgery, ophthalmology and pediatrics serving a population of 615,000 inhabitants in Copenhagen County were surveyed. We then examined patients with coexisting headache and ophthalmoplegia at follow-up. Many diseases may mimic a single attack of ophthalmoplegic migraine. We found 4 cases of ophthalmoplegic migraine, i.e. an annual incidence of 0.7 per million inhabitants. We added another 4 cases from the same area, but diagnosed before or after the study period. Only in 2 of the 8 cases did the ophthalmoplegic episodes fulfil criteria for pain and associated symptoms required for migraine without aura (common migraine). In contrast, the clinical characteristics of the attacks are typical of the Tolosa-Hunt syndrome. When this inflammatory disease strikes a migraineur it is likely to elicit headache with migrainous features. We postulate that such cases have been diagnosed as ophthalmoplegic migraine, whereas the proper diagnosis of Tolosa-Hunt syndrome has been made in non-migraineurs.

Stress response and platelet function in minor surgery during epidural bupivacaine and general anaesthesia: effect of epidural morphine addition

In a randomized study, thirty patients submitted to transarthroscopic meniscectomy were allocated to general or epidural anaesthesia with or without epidural morphine. Threshold concentration of collagen for platelet aggregation did not differ between the groups, but showed a similar pattern of increase, which was significant in the general anaesthesia group. Collagen-induced thromboxane-B2 synthesis was significantly lower in the epidural anaesthesia groups compared with the general anaesthesia group, and the addition of morphine caused a significant fall in thromboxane-B2 synthesis. The mean serum cortisol concentration increased in the general anaesthesia group, and decreased in the epidural groups. The difference between the groups was significant. Epidural morphine administration significantly decreased serum cortisol. During operation a thigh tourniquet was used. The removal of the tourniquet did not influence any of the measured variables. It can be concluded that the adrenocortical system is activated during general and inhibited during epidural anaesthesia. The addition of morphine during epidural anaesthesia further decreases the activity of the adrenocortical system, and the combined regime has an inhibiting effect on platelet function.

Treatment of solitary enchondromas in fingers

The results after operative treatment of 21 solitary enchondromas of finger bones are described. 15 cases were treated by curettage and cancellous bone grafting, five by curettage alone, and one with amputation. One case did not heal after curettage and grafting. When symptoms are present or the cortical strength is decreased, we recommend operation. We find that the eccentric type of enchondroma can be treated adequately by curettage alone, while curettage and filling of the cavity with cancellous bone should be preferred in the central and polycentric forms. It is important that all material is removed from the cyst, which has to be packed completely with bone chips. The possibility of malignant change in enchondromas should be borne in mind, but we did not see this.

[Whipple's resection in cancer of Vater's ampulla and the pancreatic head]

A review is presented of 62 Whipple's resections between 1962 and 1984 for adenocarcinoma of the choledocho-duodenal junction (CDJ) and pancreatic head (PH). The operation was radical in 17 patients with CDJ (94%) and in 34 patients with PH cancer (77%). The cumulative 5-year survival rates were 22% and 9%, respectively. The overall perioperative mortality was 23%, but was lowered to 11% during the last five years. Histology, size of tumour and age also influenced survival. Sixteen of the 32 radically operated patients who survived more than three months had a period without pain. Whipple's resection is still the only hope for cure in otherwise fit patients with CDJ or PH cancer, estimated to be radically resectable by pre- and peroperative investigations. The operation should be centralized in a few departments.

Collaborative investigation of the accuracy and reproducibility of Sceptor Breakpoint susceptibility panels

A combination Sceptor Breakpoint/ID panel (Johnston Laboratories, Inc., Towson, Md.), which determines interpretive susceptibility results (susceptible, moderately susceptible, and resistant) using two to three selected concentrations of antimicrobial agents, was tested in comparison with full-range Sceptor microdilution MIC panels. The inter- and intralaboratory interpretive reproducibilities for 24 control strains tested in three laboratories on three consecutive days were 97.0 and 95.7%, respectively. The equivalency of breakpoint results to category results obtained by the microdilution MIC procedure for 10,368 control organism-antimicrobial agent comparisons was 94.1%. The level of interpretive agreement between breakpoint and MIC category results using 101 fresh clinical isolates was 97.0% for 51 gram-negative and 50 gram-positive bacteria. Among the total 4,872 clinical organism-antimicrobial agent comparisons, major and very major discrepancies were seen in 0.2% of gram-negative bacteria and very major discrepancies were seen in 0.9% of gram-positive bacteria. All very major discrepancies with gram-positive organisms were associated with trailing endpoints using trimethoprim or sulfisoxazole and staphylococci. The breakpoint concept of testing selective antimicrobial agent concentrations was highly reproducible and accurate and allows for placement of more antimicrobial agents into a panel than is possible with full-dilution MIC testing.

Dual-photon absorptiometry of the proximal tibia

Dual-photon absorptiometric bone-mineral assay, penetration tests, and axial compression tests of the proximal tibial epiphyses were carried out in 18 human cadaver knees. The reproducibility of bone mineral assay was within +/- 12% (95% tolerance limits). Linear regression analysis with bone-mineral content as the independent variable showed a good correlation to the ultimate force obtained from the compression tests on the medial (r = 0.81) and the lateral (r = 0.90) condyles. The correlation between bone mineral content and an average of three condylar penetration tests was somewhat weaker (medical condyle: r = 0.65, lateral condyle: r = 0.62). It is concluded that dual-photon absorptiometric bone-mineral assay may be a suitable noninvasive alternative to bone-strength measurement and thus suitable for monitoring the changes in tibial condylar bone during follow-up studies.

Detection of intrinsically resistant (heteroresistant) Staphylococcus aureus with the Sceptor and AutoMicrobic systems

Modified procedures for the Sceptor Gram-Positive MIC Panel and the Vitek AutoMicrobic System GPS-M Card were evaluated for their ability to detect methicillin-resistant (heteroresistant) Staphylococcus aureus. A total of 398 clinical isolates (including 222 methicillin-resistant S. aureus) obtained from 10 hospitals were tested. Both systems had 2% NaCl in the oxacillin wells. Sceptor MIC panels were inoculated with an organism suspension prepared from an 18- to 24-h blood agar plate and were inoculated for a full 24 h at 35 degrees C before MICs were read. All methicillin-resistant S. aureus isolates were detected as resistant to oxacillin at greater than or equal to 8 micrograms/ml by the Sceptor method and at greater than 2 micrograms/ml by the Vitek method. All 176 oxacillin-susceptible, methicillin-susceptible S. aureus isolates were correctly distinguished from methicillin-resistant S. aureus isolates by Sceptor. However, with the Vitek system 29 methicillin-susceptible S. aureus isolates tested as falsely resistant to oxacillin and four isolates tested as falsely resistant to vancomycin. The modified testing procedure with the Sceptor system can be used reliably for accurate susceptibility testing of methicillin-resistant and methicillin-susceptible S. aureus. The Vitek GPS-M card does not accurately discriminate between methicillin-resistant and methicillin-susceptible S. aureus with an oxacillin breakpoint of greater than 2 micrograms/ml.

Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus

A prospective microbiological surveillance (PMS) program was developed in a comprehensive hospital-wide effort for control of nosocomial methicillin-resistant Staphylococcus aureus (MRSA). This PMS program entailed: active identification of colonized and infected patients; application of a screening microbiologic system for MRSA; isolation of colonized and infected patients; antibiotic decolonization of MRSA; and educational efforts. The PMS program was studied over three and one half years for its contribution to infection control of MRSA, early identification of nosocomial MRSA outbreaks, use of the highest yield surveillance culture sites, and cost effectiveness. Following initiation of the PMS program in December 1982, during an MRSA outbreak, the frequency of new MRSA cases declined from 14 to none by the end of a 3-month pilot study. The frequency of new MRSA cases stabilized at approximately 2 per month until October 1983, when the PMS system allowed prompt detection of a new outbreak of 11 cases. Following isolation and antibiotic decolonization, the frequency of cases again declined to 3 per month. A third outbreak in December 1985 again was promptly detected and controlled. Infection to colonization ratio decreased from a maximum of 1.5 during outbreaks to a minimum of 0.17 after outbreaks. Wounds and tracheostomy sites provided the greatest yield of detection of new cases of MRSA. During one 15-month period, 35 of the 43 new cases were detected initially at wounds and tracheostomy sites. No new MRSA cases were detected by a positive axillary or nares site alone. The estimated quarterly cost of outbreaks and infection paralleled the quarterly frequency of new MRSA cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Subchondral bone strength in arthrosis. Cadaver studies of tibial condyles

We measured the axial penetration strength of subchondral cancellous bone in a close, regular pattern at the tibial resection surface of five valgus and seven varus human, cadaveric knees. The strength patterns obtained were illustrated by pseudo-three-dimensional reconstructions of strength values as a function of the location on the resection surface. The varus knees had high strength values towards the medial margin of the medial condyle. Three qualitatively different strength patterns were distinguished in the valgus knees: two knees showed a near normal strength distribution with higher peak values medially; two knees with centrolateral bony attrition had high bone strength values at the center of the lateral condyle; and one knee with moderate posterolateral bony attrition showed a high strength area at the posterolateral aspect of the lateral condyle. In both types of malalignment, there was a decrease of bone strength with the depth from the resection surface.

Novobiocin and rifampicin in combination against methicillin-resistant Staphylococcus aureus: an in-vitro comparison with vancomycin plus rifampicin

Novobiocin and rifampicin were evaluated in vitro as a possible new antibiotic combination against methicillin-resistant Staphylococcus aureus. An evaluation of 20 strains of methicillin-resistant Staph. aureus using microdilution checkerboard techniques at 10(5) cfu/ml showed neither synergy nor antagonism between novobiocin and rifampicin or between vancomycin and rifampicin. Agar surface inoculation of six strains of methicillin-resistant Staph. aureus showed increased synergy with increased inocula (10(6)-10(9) cfu) for novobiocin plus rifampicin compared to vancomycin plus rifampicin. Time-kill curves showed indifference at 6h for all combinations, whereas, at 24 and 48 h, they generally showed indifference, occasionally synergy, but never antagonism. The 'synergy' between novobiocin and rifampicin at higher inocula of methicillin-resistant Staph. aureus appears to be due to prevention of emergence of resistant organisms and may have clinical relevance. The combination of novobiocin-rifampicin merits further investigation.

Wound infection after lower extremity amputation because of ischemia

The importance of postoperative wound infection in major amputations was elucidated by recording the organisms isolated in preoperatively infected gangrene and in postoperatively infected wounds of patients undergoing lower-limb amputations for ischemia. Sixty-four amputations were performed on 61 patients. The frequency of coexisting diabetes mellitus was 34%. Postoperative infections occurred in nearly two-thirds of the 19 cases of infected gangrene, as compared with less than one-third of cases of noninfected gangrene. The presence of diabetes mellitus did not significantly influence the infection rate. Preoperatively as well as postoperatively, the most frequently isolated bacterium was Staphylococcus aureus. Clostridium perfringens was cultured in four cases. Postoperative wound infection following lower-limb amputation for ischemia is the main reason for reamputation, especially in patients with infected gangrene.

Screening method for rapid detection of methicillin-resistant (heteroresistant) Staphylococcus aureus

A broth screening method was developed to detect methicillin-resistant (heteroresistant) strains of Staphylococcus aureus from primary plates. Lyophilized vials containing cation-supplemented Mueller-Hinton broth, 2% NaCl, and 10 micrograms of methicillin and 6 micrograms of oxacillin per ml were hydrated and tested with 129 methicillin-resistant and 35 methicillin-susceptible strains of S. aureus. With the addition of a tetrazolium indicator after 5 h of incubation, 96.9% of resistant strains were detected. No false-positive results occurred.

Activity of novobiocin against methicillin-resistant Staphylococcus aureus

As infections due to methicillin-resistant Staphylococcus aureus become increasingly prevalent, newer alternative antibiotics, especially those which are orally administered, will be required. In order to provide an in-vitro basis for selecting alternative antibiotics, we studied the susceptibility of 103 strains of methicillin-resistant Staph. aureus from seven institutions to oral antimicrobial agents. Novobiocin, rifampicin, and trimethoprim-sulphamethoxazole had excellent in-vitro activity against virtually all strains of methicillin-resistant Staph. aureus. The MIC90 and MBC90 of novobiocin against methicillin-resistant Staph. aureus were 0.25 mg/l. Since previously reported achievable serum levels with oral novobiocin are 100 to 200 times its MIC90 against methicillin-resistant Staph. aureus, novobiocin should be evaluated further for combination therapy with rifampicin or trimethoprim-sulphamethoxazole.

Sexual life following 'minimal' and 'total' transurethral prostatic resection

81 otherwise healthy men with an average age of 67 years and verified prostatic hypertrophy were randomized into two groups for either 'minimal' or 'total' transurethral prostatic resection (TUR-P). Interviews on sexual life were made preoperatively and 6 and 12 months postoperatively. 58 men (72%) were prior to the operation sexually active. 18 (31%), mainly men of advanced age, discontinued sexual activity following TUR-P. 40 (69%) remained active. 19 had retrograde ejaculation. No significant difference was found between 'minimal' and 'total' TUR-P concerning the effect on sexual activity and the occurrence of retrograde ejaculation.

Trabecular bone strength patterns at the proximal tibial epiphysis

The longitudinal compressive strength of trabecular bone from the human proximal tibial epiphysis was investigated in 12 autopsy specimens using multiple penetration tests with a small diameter indentor. Strength profiles were visualized by three-dimensional computerized reconstruction as a function of location on the resection surfaces. There were large variations of the maximal values between individuals, but the patterns obtained were remarkably uniform. The medial condyle showed the highest peak value in all but one knee with a mean medial-to-lateral peak value-ratio of 1.7. At the medial condyle the high strength area was relatively large with peak values being obtained centrally and anteriorly; the lateral condyle showed a more restricted, posteriorly localized area of high strength. Beneath the menisci, bone strength gradually decreased toward the margins of the condyles; likewise, bone strength decreased to reach very low values at the intercondylar region. There was a significant reduction of bone strength with the distance from the subchondral resection surface. This reduction was most pronounced at the high strength areas.

Variation in the abilities of automated, commercial, and reference methods to detect methicillin-resistant (heteroresistant) Staphylococcus aureus

The abilities of commercial MIC, automated, and reference methods for in vitro detection of methicillin-resistant Staphylococcus aureus were determined on 49 strains from eight hospitals. Micro-Media, MicroScan, Sensititre, Sceptor, API Uniscept KB, Abbott MS-2, Vitek AMS, Autobac MTS, NCCLS disk diffusion, and broth microdilution antimicrobial susceptibility testing procedures were evaluated. All testing was performed by using manufacturers' or reference procedures, and results were determined at no later than 24 h of incubation at 35 degrees C. With NCCLS disk diffusion, all strains were resistant to oxacillin (1 microgram), 47 (96%) were resistant to methicillin (4 micrograms), and 48 (98%) were resistant to nafcillin (1 microgram). The percentages of strains resistant to methicillin (greater than 8 micrograms/ml) were 98% with API Uniscept KB, 86% with Sceptor, MicroScan, and Autobac MTS, 84% with Sensititre, 71% with Micro-Media, and 70% with NCCLS MIC. Abbott MS-2 detected 86% of strains resistant to methicillin (greater than 5 micrograms/ml). With oxacillin (greater than 2 micrograms/ml), 90% were detected with Vitek AMS and 70% were detected with NCCLS MIC. With nafcillin (greater than 2 micrograms), 82% were resistant with Micro-Media, 57% were resistant by NCCLS MIC, and 50% (three of six) were resistant by MicroScan. Two strains from one hospital and one strain from another gave susceptible results with all automated and commercial methods. All strains from three centers were detected by all methods. Variability also occurred among the systems with cephalothin, clindamycin, gentamicin, chloramphenicol, and trimethoprim sulfamethoxazole.

Resin-process methods for improved isolation of organisms from blood and other body fluids

Two resin-based processes and conventional culturing methods were compared in isolating organisms from blood specimens of patients given antimicrobial agents. Of 20 patients whose specimens were found to contain clinically relevant organisms, one or both of the resin-process methods isolated organisms in eight after conventional culturing was unsuccessful. Conventional cultures were successful in five cases in which the resin-process methods did not work, and both resin-process and conventional culturing were successful in seven cases. In eight cases in which other body fluids were cultured, only a resin-process method was successful in four, although they are intended for use only with blood specimens. Data indicate that resin-process methods should be used along with conventional culturing methods when patients have already been given an antimicrobial. A review of the literature shows that the devices improve the recovery of organisms but does not establish that detection time is decreased.

Enhanced detection of polymicrobic bacteremia by repeat subculture of previously positive blood cultures

Blood subcultures repeated 3 days after the cultures were first identified as positives increased our detection of polymicrobic bacteremia in 9.1 to 27% of clinically significant patient episodes. Reincubation and repeated subculture of previously positive blood cultures had a direct impact on the therapeutic management of patients with polymicrobic bacteremia.

Concurrent comparability of automated systems and commercially prepared microdilution trays for susceptibility testing

Susceptibility test results from 100 clinical isolates, using the AMS, MS-2, Autobac MTS, Micro-Media system, and Sensititre, were compared with results from the proposed National Committee for Clinical Laboratory Standards reference microdilution method for minimum inhibitory concentrations and with Bauer-Kirby results. Isolates were tested concurrently by each method on consecutive days to obtain duplicate results. The data were computer analyzed, using National Committee for Clinical Laboratory Standards guidelines for break point interpretation. Analysis was centered on drug-organism combinations and not on overall percent correlation. Data were analyzed for comparability to the reference methods and for reproducibility within each system. Commercial system results were very reproducible. Results from 4- to 8-h tests (AMS, MS-2, MTS) gave more very major discrepancies when compared with either reference method than did results from 15- to 18-h systems (Micro-Media, Sensititre).

Functionally deficient differentiation of HL-60 promyelocytic leukemia cells induced by phorbol myristate acetate

The human promyelocytic leukemia cell line HL-60 undergoes terminal myeloid differentiation in vitro in response to a wide variety of chemicals. The tumor promoter phorbol myristate acetate induces these cells to develop macrophage-like morphology, adherence, and enzymatic characteristics. The present study confirms those observations and further documents the induction, by 16 nM phorbol myristate acetate, of 5'-nucleotidase activity, another human macrophage marker enzyme. However, more importantly, functional studies show that phorbol myristate acetate-induced HL-60 cells fail to increase above base line uninduced levels of hexose monophosphate shunt activity, superoxide generation, nitroblue tetrazolium reduction, bacterial ingestion, or complement secretion. These cells therefore possess some macrophage-like properties but do not meet several important functional criteria of macrophage identity.

Effect of carbon dioxide and pH on susceptibility of Bacteroides fragilis group to erythromycin

We examined the effects of pH and incubation in a CO(2)-containing atmosphere on the activity of erythromycin against 81 strains of the Bacteroides fragilis group. A striking reduction in erythromycin activity was noted when the pH decreased below 7.0 and when the organisms were incubated with CO(2).

Variation in susceptibility patterns of species within the Bacteroides fragilis group

Minimal inhibitory concentrations of eight antibiotics were determined for 159 clinical isolates of members of the Bacteroides fragilis group using the National Committee for Clinical Laboratory Standards proposed agar dilution reference method. Isolates were identified by standard techniques with deoxyribonucleic acid homolog confirmation. These closely related species demonstrated differences in susceptibility to commonly used drugs.

A clinical evaluation of a card agglutination test for rheumatoid factor

The Macro-Vue Card Test for Rheumatoid Factor (Hynson, Westcott, and Dunning) is a new commercially available card agglutination test designed for qualitative and quantitative procedures. Coded sera from 195 patients, six known positive sera, and two positive serum pools were tested using four commercial kits. The commercial kits evaluated included latex (Hyland RA Test, Behring-Rapi/tex RF Test), sheep erythrocytes (Wampole, Rheumaton), and charcoal (HWD-Macro-Vue RF Card Test) as carrier particles. Using the prescribed quantitative procedures, the percentages of positive and negative results for rheumatoid factor detected by each product were determined after the (serum) code was broken. The Macro-Vue test compares well with the Behring and Hyland latex dilution systems, and appears to detect more positive sera than the Wampole test. Titers obtained using the Macro-Vue test were more reproducible day to day with known positive sera than were titers obtained using any of the other kits.

Comparison of three transport systems for recovery of aerobes and anaerobes from wounds

A clinical evaluation of three commercially available transport systems (Anaerobic Specimen Collector, Becton-Dickenson; Anaswab, Scott Laboratories; and Trans-Cul, Wampole) was done, using as subjects 75 patients suspected of having infections. Holding times were purposely varied and ranged from 30 min to 48 hours. Totals of 22 aerobic species and 15 anaerobic species were isolated. There was essentially no difference among the three systems in the recoveries of aerobic or anaerobic organisms. Discrepancies appeared to be related to the order of collection and amount of clinical material available for culture. Time delay from collection to plating did not affect the recovery of aerobes or anaerobes. The three systems performed equally in the recovery of clinically significant pathogens from purulent clinical material.

A reliable test for differentiation and presumptive identification of certain clinically significant anaerobes

A modification of the slide catalase test was evaluated to determine its reliability for the presumptive identification of certain anaerobic gram-negative and gram-positive organisms isolated from clinical specimens. A total of 650 fresh isolates was evaluated. Growth from a trypticase blood agar plate or Schaedler's agar with laked blood was transferred to a slide and a drop of 15% H2O2 with Tween 80 added. Veillonella alcalescens, Proprionibacterium species, Peptococcus species, and Bacteroides fragilis, B. thetaiotaomicron, B. distasonis, B. ovatus, and B. vulgatus were positive by this method. Comparative slide and tube catalase tests were performed with the above-mentioned bacteroides species by growing each isolate on trypticase soy agar, Brucella agar, brain-heart infusion agar, each with and without added hemin, and on Schaedler's agar. Four solutions of H2O2 were used, 3 and 15%, and 3 and 15% with Tween 80. The addition of Tween 80 to H2O2 increased the sensitivity of the reaction with both slide and tube methods. The 15% H2O2 with Tween 80 consistently gave the most rapid and persistent positive reaction. A slide catalase test in combination with a Gram stain should be performed on each anaerobic isolate; this would significantly decrease the time required for presumptive identification of many anaerobic organisms.

Comparison of API and Minitek to Center for Disease Control methods for the biochemical characterization of anaerobes

Two commercially available micromethod multitest systems (API, Analytab Products, Inc., Minitek-Bioquest) were compared with conventional tests suggested by the Center for Disease Control for the identification of anaerobes. Anaerobiosis for the microsystems was achieved using GasPak system (BBL), A total of 175 anaerobes, including 158 clinical isolates and 17 reference strains, were used. Gram morphology, gas-liquid chromatography data, and biochemical reactions from the Center for Disease Control and Virginia Polytechnic Institute anaerobic manuals were used to identify the organisms. The Minitek system included a new anaerobe inoculum broth and two new disks, dextrose without nitrate and nitrate reductase disks. The percentage of correlation of 12 biochemicals using Minitek and 11 biochemicals using the API were compared with the Center for Disease Control reactions. The percentage of correlation of both positive and negative reactions with the API anaerobic strip ranged from 70.8 to 99.4% and with the Minitek from 97.1 to 100%. The microsystems were also evaluated as to the ease of use, adaptabilty to a clinical laboratory, time, and cost.

Evaluation of the BBL Minitek system for the identification of Enterobacteriaceae

Thirty-one different substrate disks were tested in parallel with comparable, prepared media (BBL) against a minimum of 300 cultures of Enterobacteriaceae. An overall correlation of 98% was observed with all the disks tested. In addition, the system was used to identify 461 fresh isolates of Enterobacteriaceae in parallel with conventional media using the schema used at the Veterans Administration Hospital, Baltimore. An overall correlation of 97% was observed. Minitek is a time and space saving system. It is accurate and easily adapted to the clinical laboratory. A wide variety of substrates are available, allowing most laboratories to use their own schema. The long shelf life of most disks is a definite advantage.