The Queensland cholera incident of 1977. 1. The index case

The first known case of cholera to be contracted in Australia during the seventh pandemic occurred in Queensland in 1977. There was no record of recent travel abroad by the patient, or of her having been in contact with persons suffering from gastroenteritis. Vibrio cholerae, biotype eltor, serotype Inaba, phage-type 2, was the causative microorganism. This case is unique in that the microbiological diagnosis was based on the identification of an isolate from venous blood. This indicates that the patient was bacteraemic, an observation not previously reported. The incident shows the importance of routine screening of faecal specimens for V. cholerae, as well as other enteropathogens.

Location of the stilbenedisulfonate binding site of the human erythrocyte anion-exchange system by resonance energy transfer

The stilbenedisulfonate inhibitory site of the human erythrocyte anion-exchange system has been characterized by using serveral fluorescent stilbenedisulfonates. The covalent inhibitor 4-benzamido-4'-isothiocyanostilbene-2,2'-disulfonate (BIDS) reacts specifically with the band 3 protein of the plasma membrane when added to intact erythrocytes, and the reversible inhibitors 4,4'-dibenzamidostilbene-2,2'-disulfonate (DBDS) and 4-benzamido-4'-aminostilbene-2,2'-disulfonate (BADS) show a fluorescence enhancement upon binding to the inhibitory site on erythrocyte ghosts. The fluorescence properties of all three bound probes indicate a rigid, hydrophobic site with nearby tryptophan residues. The Triton X-100 solublized and purified band 3 protein has similar affinities for DBDS, BADS, and 4,4'-dinitrostilbene-2,2'-disulfonate (DNDS) to those observed on intact erythrocytes and erythrocyte ghosts, showing that the anion binding site is not perturbed by the solubilization procedure. The distance between the stilbenedisulfonate binding site and a group of cysteine residues on the 40 000-dalton amino-terminal cytoplasmic domain of band 3 was measured by the fluorescence resonance energy transfer technique. Four different fluorescent sulfhydryl reagents were used as either energy transfer donors or energy transfer acceptors in combination with the stilbenedisulfonates (BIDS, DBDS, BADS, and DNDS). Efficiencies of transfer were measured by sensitized emisssion, donor quenching, and donor lifetime changes. Although these sites are approachable from opposite sides of the membrane by impermeant reagents, they are separated by only 34--42 A, indicating that the anion binding site is located in a protein cleft which extends some distance into the membrane.

Reactive sulfhydryl groups of the band 3 polypeptide from human erythroycte membranes. Location in the primary structure

Human erythrocyte membranes contain a major transmembrane protein, known as Band 3, that is involved in anion transport. This protein contains a total of five reactive sulfhydryl groups, which can be assigned to either of two classes on the basis of their susceptibility to release from the membrane by trypsin. Two of the groups are located in the region COOH-terminal to the extracellular chymotrypsin-sensitive site of the protein and remain with a membrane-bound 55,000-dalton fragment generated by trypsin treatment. The three sulfhydryl groups NH2-terminal to the extracellular chymotrypsin site are released from the cytoplasmic surface of the membrane by trypsin. All three groups are present in a 20,000-dalton tryptic fragment of Band 3. Two of these groups are located very close to the sites of trypsin cleavage that generate the 20,000-dalton fragment. The third reactve group is probably located about 15,000-daltons from the most NH2-terminal sulfhydryl group. Two other well defined fragments of the protein do not contain reactive sulfhydryl groups. They are a 23,000-dalton fragment derived from the NH2-terminal end that is also released by trypsin from the cytoplasmic surface of the membrane and a 19,000-dalton membrane-bound region of the protein that is produced by treatment with chymotrypsin in ghosts. The 20,000-dalton tryptic fragment may, therefore, constitute a sulfhydryl-containing domain of the Band 3 protein.

The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading

Between 1950 and 1965, 365 patients were treated for transitional cancer of the bladder at our hospitals. A retrospective study was done, using clinical records and a histopathologic review to determine the long-term natural history of this population when treated conservatively. The natural history of 3 separate patient populations was discovered, based solely on the grading of the transurethrally resected fragments. Based on the grade on initial presentation these patients were divided into grades I, II and III. Of the patients 5 per cent in grade I, 16 per cent in grade II, 28 to 35 per cent in grade III not involving muscle and 83 per cent in grade III involving muscle died of bladder cancer. Ninety-seven patients (26 per cent) died of bladder cancer, 110 (31 per cent) died of other causes and 158 (43 per cent) have been alive more than 5 years (104 more than 10 years). Grade I tumors that progressed to a higher grade did so within 2 years of the initial diagnosis. Of the bladder cancer deaths 83 per cent occurred within 2 years of the initial diagnosis. Of 64 patients dying more than 5 years after presentation only 7 died of bladder cancer.

Bacteraemia following oesophageal dilatation and oesophago-gastroscopy

Significant, but asymptomatic, bacteraemia after oesophageal dilatation with Hurst's bougies for oesophageal stricture or spasm was detected in six of 11 patients. No bacteraemia was identified in ten volunteers without oesophageal pathology, who underwent passage of the same dilators. After oesophago-gastroscopy significant bacteraemia was identified in one of ten patients examined. The predominant bacterial isolates were streptococci ("Streptococcus viridans" and non-haemolytic Streptococcus sp.). All the strains were sensitive in vitro to penicillin, amplicillin and cephalosporins. Any of these antibiotics are considered suitable for prophylactic use prior to performing oesophageal dilatation and upper gastrointestinal endoscopy in "at risk" patients. The risk of bacteraemia is much lower after endoscopy than oesophageal dilatation for stricture or oesophageal spasm. Mucosal trauma is concluded as the site of entry of pharyngeal commensals leading to bacteraemia; and the incidence of bacteraemia appears related to the degree of trauma to the oesophagus.

Hodgkin's disease in children

From 1921 to 1973, 106 children with Hodgkin's disease under the age of 17 years were seen at Roswell Park Memorial Institute and were analyzed retrospectively. Evaluation was separated into three eras: 1921-1949 (early era), 1950-1964 (middle era), and 1965-1973 (recent era). In the early era, suboptimal radiation therapy was employed. In the middle era, radiation therapy techniques were improved, and single-agent chemotherapy was introduced. In the recent era, multiagent chemotherapy routines were frequently used; aggressive external megavoltage radiation therapy became routine in conjunction with improvement in staging procedures. The best survival was observed in the recent era where five-year survival of 96% was noted in early stage disease. Favorable prognostic features included: younger age group (5-9 years), female sex, lymphocytic predominant histology, early stage disease, and complete response to therapy. Nodular sclerosing and mixed cell types had an equal prognosis. The concept of involved area radiotherapy along with combination chemotherapy appears a reasonable approach in children and should be tested in a randomized study against more extensive radiotherapy techniques in early stage disease.

Intestinal amoebiasis and amoebic liver abscess in Brisbane, 1956 to 1973. Clinical syndromes and the results of medical and surgical management

Nineteen patients presented to teaching hospitals in Brisbane with symptomatic amoebiasis from 1965 to 1973. The majority of patients gave a history of overseas travel or residence. Intestinal amoebiasis most frequently occurred in its non-dysenteric form, so that there were some problems in differentiating it from more commonly occurring forms of colitis. The potential for amoeboma to be mistaken for a neoplasm was evident. Amoebic liver abscess was confirmed in 10 cases and, in nine of these, the abscess was localized to the right lobe of the liver. A total colectomy had been performed in one case and an abdominoperineal resection of the rectum in another before hospital admission in Brisbane and confirmation of the diagnosis of amoebiasis. Five of the patients with amoebic liver abscess underwent laparotomy soon after admission because of upper abdominal symptoms and signs which resembled those of other surgical conditions. Although the indirect haemagglutination test was of considerable assistance in diagnosing amoebiasis, it was apparent that attention to detail in the collection and examination of faecal specimens remained of major importance. A trial of metronidazole, which is both effective and relatively safe, is advocated in cases of diagnostic difficulty, when amoebiasis is suspected but unproven, and when the adoption of an alternative diagnosis would lead to the initiation of less satisfactory drug therapy or involve otherwise unnecessary surgery.