Clinical and molecular epidemiology of enterococcal bacteremia in a pediatric teaching hospital

An apparent increase in the incidence of enterococcal bacteremias from 7 to 48/1000 bacteremias during 1986 to 1991 (p < 0.01) prompted this descriptive clinical and molecular epidemiologic study of 83 episodes occurring in 80 children between 1986 and 1992. Most community-acquired cases were in infants, in comparison with nosocomial episodes (24/26 and 34/57; p < 0.01); many of them were neonates (10/26 and 6/57; p < 0.01). Nosocomial cases were associated with underlying conditions including major surgery 56%, immunosuppression 49%, organ and tissue transplants 30%, and cardiac 32%, pulmonary 25%, renal 21%, and hepatic 21% disorders. Nosocomial episodes developed after a median of 32 days. There were 58 primary and 25 secondary bacteremias. Thirty-two episodes were polymicrobial and 44 organisms were involved. Twenty-six percent of the patients died. In 15%, death was preceded by septic shock, disseminated intravascular coagulation, and polymicrobial bacteremia (p < 0.01). Of 75 isolates, 82% were Enterococcus faecalis and 14% were Enterococcus faecium. Fourteen E. faecalis strains produced hemolysin; none produced beta-lactamase. Three had high-level resistance to gentamicin and 13 to streptomycin; two E. faecium and none of the E. faecalis strains were vancomycin resistant at a low level (p < 0.01) and one was ampicillin resistant. Pulsed-field gel electrophoresis of whole-cell DNA digested with restriction enzymes Sma I and Eag I showed five isolates with a homogeneous pattern, two with another homogeneous pattern, and 68 with distinct heterogeneous patterns. The increase in enterococcal bacteremias was not due to a clonal strain dissemination but to an increase in cases of heterogeneous enterococcal strains. We conclude that enterococcal septicemia is now an important cause of serious morbidity and death in critically ill children.

Response to venepuncture for monitoring in primary schools

The feasibility and acceptability of collecting blood from children by venepuncture was assessed in a sample of 593 children from seven primary schools in Canterbury. Venepuncture is necessary to obtain blood for the measurement of haemoglobin, ferritin, and cholesterol in line with Department of Health surveys in England. Return of consent forms was 87%; 75% of parents in the total sample allowed their child to be tested. Response rates differed between schools. Only 4% of eligible children refused to participate at the time of testing. In 22 (3.7%) children a blood sample could not be obtained or the volume was insufficient for analysis. There was a significant difference in the failure rate between phlebotomists. Venepuncture in the school setting was technically feasible and acceptable. The reluctance of some groups in the community to participate may bias the sample.

Morbidity and mortality in medium chain acyl coenzyme A dehydrogenase deficiency

Medium chain acyl coenzyme A dehydrogenase (MCAD) deficiency presents with episodic fasting, hypoketotic hypoglycaemia, and coma. It is known to be potentially lethal, but the outlook for survivors is thought to be good. We reassessed all patients with MCAD deficiency diagnosed in New South Wales (population six million) to explore long term morbidity and mortality. There were 16 probands and two siblings were confirmed and two presumed to be affected. Assuming an incidence of 1:20,000 births, these represented about 22% of the total number of expected cases. Five (25%) of the 20 patients died aged 3 days-30 months, all during the first episode of illness. Seven others had only one episode and one affected sibling was asymptomatic. Eight had had significant neonatal symptoms. Only two had a significant, serious life threatening episode after diagnosis. Of 15 survivors, one has severe handicap after a single severe episode, and four, aged 9-17 years, have mild intellectual handicap. Eight (including six aged less than 7 years), have apparently normal development. Two are lost to follow up. Our study of unselected patients with MCAD deficiency from a defined population shows not only a substantial risk of death, but also of long term morbidity.

Screening for lower genital tract infections in women presenting for termination of pregnancy

Over a four-month study period, 87 patients requesting termination of pregnancy at a gynaecology clinic were offered screening for sexually transmitted diseases, of whom 63 accepted. A total of 41 infections were found in 34 women, the commonest being vaginal candidiasis and bacterial vaginosis. Chlamydia was found in six patients. Although HIV antibody testing was offered to every patient, all declined this test.

Serum total cholesterol and ferritin and blood haemoglobin concentrations in primary schoolchildren

Serum total cholesterol and ferritin and haemoglobin concentrations were measured in blood samples obtained by venepuncture in 378 of 593 children aged 5-6 or 8-9 years from seven primary schools in Canterbury. This study formed part of an investigation to assess the feasibility of including a venepuncture procedure for monitoring purposes in primary schoolchildren. Although only one child had a very low haemoglobin concentration of 61 g/l, a large percentage, 25% in the rising 6 years and 7% in the rising 9 years, had concentrations between 100 and 115 g/l--that is, less than the reference fifth centile. Eight per cent had a serum ferritin concentration less than 8 micrograms/l. Cholesterol concentrations higher than 5.2 mmol/l were found in 20% of the 5-6 year olds and 23% of the 8-9 year olds, and in 19% of boys and 25% of girls. About 5% of children had cholesterol concentrations above 6 mmol/l. The number of children with anaemia, iron deficiency, and high cholesterol raises serious concerns about the nutritional and coronary heart disease risk of British children.

Estimation in community surveys of total body fat of children using bioelectrical impedance or skinfold thickness measurements

OBJECTIVE

To compare skinfold thickness measurements with bioelectrical impedance analysis (BIA) as a measure of body fat for use in a survey of children (the National Study of Health and Growth).

DESIGN

Part cross-sectional, part repeated measurement study.

SETTING

A junior school in Bath.

SUBJECTS

42 boys and 33 girls aged from 9 to 11 years.

INTERVENTIONS

Measurements of BIA, height, weight, and triceps, biceps, subscapular and suprailiac skinfolds.

RESULTS

All measurements were highly repeatable with intraclass correlation coefficients > 0.90. The level of agreement between estimates of percentage of body fat derived from prediction equations based on impedance or skinfold measurements respectively was poor: the mean difference (impedance estimate minus skinfold estimate) was 4.67% (95% range -3.47 to 12.82) for boys and 7.81% (95% range 1.27 to 14.34) for girls. The two estimates were found to correlate highly (r = 0.83 for boys and r = 0.81 for girls) because weight, used to convert estimates of fat-free mass derived from impedance to fat mass, was highly correlated with impedance and moderately highly correlated with skinfold thicknesses. The correlations of resistance (R) and (H)2/R with skinfold thicknesses were very low. There was a moderate correlation of R and H2/R with log(weight-for-height index), but lower than that of log(weight-for-height index) with each of the skinfolds.

CONCLUSIONS

As currently available equations for converting impedance-based estimates of total body water to fat mass are not fully developed for use in children of varying ages, estimates of body fat calculated from skinfold thickness measurements remain preferable in epidemiological studies of children's health and growth.

Neonatal symptoms in medium chain acyl coenzyme A dehydrogenase deficiency

Medium chain acyl coenzyme A dehydrogenase (MCAD) deficiency has not been thought to be associated with significant neonatal symptoms. To determine the validity of this, all known MCAD cases from New South Wales were reassessed. A total of 16 confirmed and three presumed cases has been identified in New South Wales, from 15 families. The casenotes of patients were reviewed, and where possible the mothers interviewed, either directly or by telephone, to obtain information about neonatal events. Six of the 16 confirmed cases had significant neonatal symptoms, with onset from 17 hours to 3 days of age. All required intravenous dextrose and four of the six needed other interventions, including hospital transfer. One baby died. All six were breast fed, but so were five of the eight asymptomatic neonates for whom information was available. Four of the six symptomatic neonates were homozygous for the common MCAD mutation, an A to G transition at position 985, and one was heterozygous. It is concluded that serious neonatal symptoms are common in MCAD. Newborn siblings of MCAD cases must have careful monitoring and support during the first few days of life.

The status of statewide burn prevention legislation

Successful programs in injury prevention can focus on changing an individual's attitude and behavior or on creating and amending the environment to reduce the likelihood of injury. To investigate the latter approach as it pertains to burn prevention, the American Burn Association Burn Prevention Committee catalogued statewide legislation (as opposted to county or municipal ordinances) in major areas of burn and fire prevention. Burn reporting was generally viewed by state fire marshals as a means to apprehend arsonists or investigate child abuse, as opposed to collect demographic data for injury prevention. Smoke detectors are mandated in new residential construction by the majority of states; however, one in six still leave this to local initiatives. Sprinkler systems have generally not been addressed by state legislation. The committee concludes that pursuing statewide legislative agendas as an area of burn and injury prevention is open to further initiatives.

Validation of a food frequency questionnaire for assessing dietary intake in a study of coronary heart disease risk factors in children

A food frequency questionnaire (FFQ) was designed and validated for use in an epidemiological survey measuring coronary heart disease risk factors in British children. The questionnaire asked about the frequency of children's consumption of 35 food items over the previous month and was completed by parents/guardians. Food items represented a range of food groups from which children may eat, with emphasis on foods with a high fat and fibre content. The questionnaire was validated against 14 daily recalls of consumption, using the same food list as the FFQ. The sample consisted of 272 children, aged 5-11 years, The response rate for the FFQ was 92% and for the recall, 82% in the first week and 66% in the second week. The level of agreement between the FFQ and the recall was measured by calculating (McGinnis JM & Nestle M, 1989, Am. J. Clin. Nutr. 49, 23-28) the median difference between results from the two methods and (Willett WC (ed.), 1990, Nutritional epidemiology, ch. 15; Oxford University Press) the percentage of children classified by FFQ to within +/- 1 day per week of the recall. Median differences between individual items on the questionnaire and the recall were < or = 0.5 days for 91% of items and equal to 1 day for the remainder. The percentage agreement to within +/- 1 day per week between frequencies reported in the two methods ranged from 99.8% for lamb to 46.8% for low-fibre cereal. Better agreement was found for food items representative of fat intake than those of fibre intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Pregnancy and fetal long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency

We report on eleven pregnancies in 5 mothers. 6 of the babies had long-chain 3-hydroxyacyl coenzyme A dehydrogenase (LCHAD) deficiency, and each of the pregnancies was complicated by features such as fatty liver and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. By contrast, 3 of the mothers also gave birth to unaffected babies, and these pregnancies were largely uncomplicated. We conclude that there may be adverse effects on maternal liver function from a fetus with LCHAD deficiency. Heterozygosity in the mother cannot alone account for the adverse effects because of the segregation of these effects with fetal LCHAD status.

The non-use of 9-1-1. Private transport of trauma patients to a trauma center

HYPOTHESIS

Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use.

METHODS

Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry.

RESULTS

In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult.

CONCLUSION

Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for non-emergencies, the causes of underutilization should not be ignored.

A feather-trap system for the removal of chicken feathers from laboratory sewage

A simple feather-trap system is described for use on the drain lines of buildings housing poultry for research or other purposes where floors are frequently washed. The trap uses disposable plastic-mesh bags that can efficiently remove almost all feathers from the water, preventing sewer lines from being blocked by compacted feathers. Critical measurements and operational procedures are described.

Improved compliance with quality assurance markers during trauma room resuscitation using trauma nurse specialists

Trauma nurse specialists (TNS) have been shown to reduce the burden on house staff and to facilitate patient care on trauma wards. In the authors' facility, this expertise has been extended to the emergency department where TNS contribute to an improved standard of care by (1) nursing assessment and injury recognition and (2) continuity of care. As specially trained individuals, TNS expand upon the role of the emergency department staff nurse. The TNS could be shown to improve compliance with trauma resuscitation room protocol and quality assurance markers of direct patient management at a statistically significant level.

Weight-for-height in children aged 4-12 years. A new index compared to the normalized body mass index

Data from the 1990 survey of the National Study of Health and Growth, comprising 3357 white English boys and 3050 white English girls, were used to construct and evaluate a new index of weight-for-height. Prediction of triceps + subscapular skinfold thickness, using half of the data, led to the index (weight -9)/height3.7, where weight was in kilograms, height in metres. Using the second half of the data the index was shown to have almost as good a correlation with normalized (triceps + subscapular skinfold) as the body mass index (BMI) in children aged 4-12 years. The new weight-for-height index had stable variance from age 4 to 12 years after simple log transformation, unlike the BMI which required transformation via three age-related parameters prior to analysis or centile calculation. Neither index was a good proxy for skinfold measurements for comparison of ethnic groups. From data from inner city areas surveyed in 1989 children of Indian subcontinent origin had substantially lower weight-for-height, but only Gujarati children were thinner than white children, whereas Afro-Caribbean children were slightly heavier for their height, but thinner. Centiles of weight-for-height, and of BMI by age, for ages 4-12 years, were calculated for white English boys and white English girls.

Balanced translocation (14;20) in a mentally handicapped child with cystinuria

A mentally handicapped 3 year old child with cystinuria is presented. Routine chromosomal analysis showed an apparently balanced de novo translocation in the child with breakpoints 14q22 and 20p13. Family studies suggested that the child is a type I/type II compound heterozygote for cystinuria. This translocation may indicate a possible locus for the gene for cystinuria.

Potyvirus serology, sequences and biology

Amino acid sequences of the cytoplasmic cylindrical inclusion protein (CIP), large nuclear inclusion protein (NIb), and coat protein (CP) of potyviruses were re-examined in light of reported serological relationships, and correlated with known and deduced biological functions. No obvious correlations were observed between either amino acid sequences or epitopes recognized by monoclonal antibodies and the natural host ranges of the potyviruses examined. Whereas the identified sequence motifs of the RNA helicase (CIP) and replicase (NIb) are predicted to be antigenic, most of the conserved sequences and epitopes in the CIP, NIb and CP were presumed to be maintained for structural rather than functional reasons. Three possible potyvirus clusters are proposed on the basis of the length and composition of the virion surface-exposed amino terminal extension of the CP; these clusters do not correlate with overall CP sequence homology, host range, or vectors, but are of potential evolutionary significance and hence of possible taxonomic value.

Burns in octogenarians

Trauma is the fifth leading cause of death for the elderly. Approximately 7.4 million (3% of the population) are more than 80 years old (the so-called "old" old). More than 40% of Americans will reach the age of 80 years, and those who do can expect to live an average of 8 years more. The advanced elderly burn victim creates special demands because of a greater morbidity and mortality associated with a smaller body surface area burn. From September 1982 through August 1990, there were 29 patients 80 years old or older treated at our burn center. The mean age was 83 years, and 72% of the patients were women. The most common preexisting medical problems were hypertension and diabetes. Seventeen (59%) survived. The mean percentage of body surface area (BSA) burned was 6% among the survivors, with a mean length of hospital stay of 24 days. The mean BSA burned was 32% among those who died, with a mean stay of 17 days. Five of the 12 deaths were due to burns of less than 20% BSA, below the standard commonly used to define a "major" burn. The abbreviated burn severity index (ABSI) was a good indicator of survival. Eleven of 12 with an ABSI of 7 or less survived, and nine of 11 with an ABSI of 9 or more died. Twelve patients had operation; seven survived. Of the 15 survivors living independently before the injury, 11 were discharged home and four were transferred to nursing facilities. In this age group, even small burns can be problems, and indications for hospital admission should be broadened. The advanced elderly also cause financial burdens to burn centers because of inadequate diagnosis-related group (DRG) reimbursement. For those surviving, there is a good chance for maintaining independent function and for being discharged home.

Clinical evaluation of a computer-based patient monitoring and data management system

Clinical information systems can extend the scope of computerization beyond laboratory data collection and storage. An automated and computerized intensive care unit flowsheet and patient chart can reduce nonnursing work and improve the quality, quantity, and recall of clinical information.

A qualitative comparison of paper flowsheets vs a computer-based clinical information system

Demonstrating the value of computerized clinical information systems (CIS) relative to its cost has been difficult. Decreased mortality in the intensive care unit or a reduction in nursing staff have not been apparent, but CIS does lead to a significant improvement in documentation over handwritten flowsheets, both in volume and accuracy. This may have a medicolegal and quality assurance impact, as well as enhancing patient care.

Comparison and differentiation of potyvirus isolates and identification of strain-, virus-, subgroup-specific and potyvirus group-common epitopes using monoclonal antibodies

A panel of monoclonal antibodies (MAbs) generated against an admixture of 12 potyvirus isolates was used to compare and differentiate diverse potyviruses. Both native and denatured virions of strains of bean yellow mosaic (BYMV), potato virus Y, tobacco etch, pea seed-borne mosaic, iris severe mosaic, iris mild mosaic and asparagus virus-1 potyviruses were used as immunogen and as antigen for screening of the hybridoma cell lines. Thirty cell lines secreting potyvirus-specific antibodies reactive in indirect antigen-coated plate (ACP-) ELISA were selected for detailed analysis. All 30 MAbs reacted with at least one strain of BYMV; 11 MAbs reacted with between one and eight of the nine BYMV strains and an additional three MAbs reacted only with isolates within the BYMV subgroup (BYMV, pea mosaic virus and clover yellow vein virus). The remaining 16 MAbs reacted with a BYMV isolate and with at least one of the other 43 potyvirus isolates tested. MAb PTY 1 reacted with all 55 potyvirus isolates tested (representing at least 33 different and distinct aphid-transmissible potyviruses). The potyvirus cross-reactive MAbs generally gave higher reactivity values in ACP-ELISA with dissociated virus than with polyclonal antibody-trapped intact virions in triple antibody sandwich ELISA (i.e. were cryptotope-specific). The BYMV strain- and virus-specific MAbs reacted strongly with both types of antigens (i.e. were metatope-specific). At least 25 distinct epitopes (12 cryptotopes and 13 metatopes) could be identified from the MAb-antigen reactivity patterns. The distribution of these epitopes between virus isolates can be used to detect and differentiate potyviruses in infected plant extracts and to examine virus architectures. Some of these epitopes are shared by potyvirus isolates not previously shown to be serologically related. The broad spectrum-reacting MAb PTY 1 recognizes a cryptotope conserved on all of the aphid-transmissible potyviruses examined and should be a valuable tool for the detection and assay of these potyviruses.

Perceptions of the FRACGP examination. A study of Victorian candidates

It is proposed that by 1995 Fellowship of the Royal Australian College of General Practitioners will be the only recognised endpoint of vocational training in general practice in Australia. Currently however only one in six eligible general practitioners and one in three college members holds the FRACGP in Victoria. This case-controlled study carried out by survey questionnaire was designed to compare and contrast perceptions of the FRACGP examination of a group of candidates with a group of demographically matched non candidates. The study suggested that those who sat the examination did so to improve their self esteem, and wished their knowledge, competence and skills to be 'peer reviewed'.

Trauma systems. Economic and political considerations

Mounting morbidity and mortality from trauma should be viewed as a societal problem. Preventable trauma deaths can be reduced to less than 10% with a regionalized trauma system. Trauma systems, however, incorporating categorization, regionalization, registry data, and prevention efforts, are difficult to design and maintain. As of 1988, only two states had full coverage of all components deemed essential to such a system. Burdens such as uncompensated care, increased malpractice liability, and the need for uniform standards must be overcome to insure survival of trauma systems.

The value of isokinetic exercise and testing in burn rehabilitation and determination of back-to-work status

Determination of work capability may require assessment of function at speeds consistent with the patient's workday requirements. Standard isotonic physical therapy techniques do not adequately test strength, power, and endurance. Isokinetic training and testing improve both outcome and assessment.

Securing endotracheal tubes in patients with facial burns or trauma

Securing an endotracheal tube on patients with facial burns or trauma can pose difficulties. A nasotracheal support splint, made of materials commonly used by occupational therapists, can facilitate safe anchoring of a nasotracheal tube.

The value of speech-language assessment in the diagnosis of child abuse

Language deficits and developmental delays may be helpful clues in the diagnosis of child abuse and neglect. Speech-language assessment of 27 children burned through abuse or neglect identified 22 (81%) with language delays. Other significant trends included a decreased attention span, inappropriate affect, irritability, and withdrawn behavior. We recommend speech-language assessment for all burned children suspected to be victims of abuse or neglect as part of the abuse team investigation and to identify children who may benefit from intervention.

Molecular cloning, sequencing and expression in Escherichia coli of the bean yellow mosaic virus coat protein gene

The sequence of 1015 nucleotides from the 3' poly(A) tract of the potyvirus bean yellow mosaic virus (BYMV) RNA has been determined from two cDNA clones. This sequence contained a single long open reading frame (ORF) starting upstream of the cloned region. The ORF was expressed as a fusion protein in Escherichia coli, and the product was detected by antibodies specific for the coat protein of BYMV. The predicted length of the coat protein gene was 822 nucleotides, corresponding to a 273 amino acid coat protein of Mr 30910. The deduced amino acid sequence of the BYMV coat protein was compared to the chemically determined amino acid composition of purified virion protein, and of protein prepared from trypsin-treated virions. The nucleotide and deduced amino acid sequences were compared to the sequences of the coat protein genes of other potyviruses. The BYMV coat protein gene was found to be 50 to 61% homologous to those of other potyviruses at both the nucleotide and amino acid levels; the greatest variation was between the 5'-proximal one-fifth of the genes. Amino acid sequences and hydrophilicity plots of the different potyvirus coat proteins showed similarities which indicated that the structure of the coat protein is highly conserved; a non-terminal region of variability was predicted to be exposed on the exterior of the virion. A putative cleavage site at a glutamine-serine dipeptide was identified by similarity in context to the cleavage sites of tobacco etch virus and tobacco vein mottling virus coat proteins from the viral polyproteins. The BYMV 3'-terminal non-coding region of 166 nucleotides is followed by a poly(A) tract.

The occurrence of acquired immunodeficiency syndrome and unsuspected human immunodeficiency virus in burn patients

Although the risk of nosocomial transmission of human immunodeficiency virus remains low, burn center personnel may be at greater risk. Approximately 10% of burn patients admitted to an urban center were found to be positive to the human immunodeficiency virus, consistent with other findings of increased prevalence in trauma patients. "Universal" precautions adequate for other health care settings may not be sufficient in the burn center. Knowledge of a patient's human immunodeficiency virus status has important treatment implications.

Burn nurse retention. Elements of success

With the national nursing shortage most acute in the critical care area, greater emphasis on effective recruitment and nurse retention is vital. Despite the high-stress environment of a busy burn center, nursing turnover can be reduced to acceptable levels. The greatest "satisfiers" are centered around nursing issues such as schedule flexibility, nurse/patient ratio, and the center's reputation and standards. Salary and the physical plant environment were of little importance in comparison.

Decision not to treat: "do not resuscitate" order for the burn patient in the acute setting

For some burn victims who are recognized early to be nonsurvivors, the decision to "make comfortable" is a treatment option. The guidelines for a "do not resuscitate" order must be based on an individual center's experience, but general principles can be formulated.

A modified method for human bone marrow filtration prior to bone marrow transplantation

A technique is described for filtering harvested bone marrow using disposable materials, namely a 4 x 4 inch piece of sterile gauze that is gently packed into the barrel of a 60-ml plastic disposable syringe, which is connected directly to a blood collection bag. The filtration of marrow directly into the collection bag eliminates additional filtration steps and therefore may potentially reduce the incidence of inadvertent microbial contamination. In this study we describe this filtering technique and compare it to the method described by Thomas and Storb. Numbers of granulopoietic progenitors (CFU-GM) and erythropoietic progenitors (BFU-E), total white cell counts, percentage of cells positive for the CD3 (OKT3) lymphocyte surface membrane marker, and volume changes were studied following filtration by each method. The two techniques were shown to be comparable in terms of these parameters. Furthermore, when compared with historical controls, this method resulted in a reduced incidence of microbial contamination compared to filtration using successive stainless steel screens.

An improved purification procedure for preparing potyviruses and cytoplasmic inclusions from the same tissue

Twelve different potyviruses and cytoplasmic inclusion proteins were purified from a range of plant species utilizing a single purification protocol. Highly purified preparations have been obtained with yields that reflect the relative concentrations in the starting material; virus yields of up to 15 mg per 100 g of tissue were obtained. In some cases aggregation resulted in losses of significant amounts of virus to the inclusion fraction; this varied among preparations of the same virus. Preparations obtained from cesium gradients were typically unaggregated and essentially free of host materials. Purified virus was suitable for the production of antisera with high specific titers and low titers against healthy plant antigens. Both purified virus and RNA prepared from the virus retained infectivity. Purified RNA was free of detectable host plant nucleic acids, as complementary DNA preparations synthesized using virion RNA as template were highly virus-specific.

Diagnostic peritoneal lavage for blunt abdominal trauma: an unusual result

We have reported the unusual finding of a grossly bile-stained peritoneal lavage 24 hours after blunt abdominal trauma, associated with neither enteric, hepatic, nor biliary tract injury at laparotomy. Intraoperative transcholecystic cholangiography is recommended in such a situation to rule out biliary tract injury.

Family studies in ornithine transcarbamylase deficiency

Six families with at least one infant each with confirmed ornithine transcarbamylase deficiency were investigated by DNA analysis. All the affected sons had died, and no DNA had been stored. Using the restriction endonucleases MspI and Bam HI three restriction fragment length polymorphisms were detected which led to eight distinct haplotypes. Using these results and those of protein loading tests that diagnosed heterozygote (carrier) status in some family members, some carriers were detected, and prenatal diagnosis was offered to two families. In two further families no polymorphisms were found and no prenatal diagnosis was possible. In the remaining two families prenatal diagnosis was impossible because of the lack of DNA from an affected or unaffected son, or in one case from the father, of an obligate carrier. These studies emphasise the importance of preserving tissue for DNA extraction from infants dying of inborn errors of metabolism, and also show the way in which information from conventional biochemical studies can complement diagnostic tests using DNA.

Burn patient registries in the United States: a survey

The Committee on Organization and Delivery of Burn Care of the American Burn Association conducted a survey among burn care facilities to determine the extent of interest in development and maintenance of computerized patient registries. Initial questionnaires were mailed to 178 burn care facilities. Responses were obtained from 112 (62.9%). Eighty-seven (77%) of the responders indicated that they have some form of registry. Thirty-five of these registries were in the form of handwritten logbooks, while 43 were personal computers with a wide variety of hardware and software. Uses of these registries include patient census and reports (64% of responders), clinical research (62%), patient care (61%), and, less common, quality assurance and education. Twenty-five facilities stated that they do not maintain a registry, but 22 (88%) of them indicated interest in developing one. It seems unlikely that a single system could be designed to fill the needs of all facilities, nor is it likely that existing registries can be "networked" successfully. This is due not only to the diversity of data in the existing registries, but also to the important differences in the way basic terminology is used in different facilities. For burn care facilities interested in developing their own registry, a selected list of successful representative registries is provided.