Grouping of some clinically relevant gram-positive rods by automated fatty acid analysis. Diagnostic implications

One hundred and ninety-four strains of aerobically growing Gram-positive rods of the genera Corynebacterium, Actinomyces, Arcanobacterium, Erysipelothrix, Listeria, Oerskovia, Nocardia, Rhodococcus, and of unnamed Center for Disease Control (CDC) groups were checked for cellular fatty acid profiles with the microbial Identification System (Microbial ID, Newark, Del., USA). In order to obtain unified data usable for the clinical laboratory, 24 or 48 h sheep blood agar cultures were used. It was thought that grouping and perhaps identification could be aided by this approach. With the aid of numerical analysis, four groups (two consisting of two subgroups each) were established. The discriminatory ability of the scheme, however, was only 77.2%, indicating that grouping of an unknown isolate could be done with some accuracy, but that speciation would still require biochemical testing.

Acute renal allograft rejection: the role of monoclonal antibodies in treatment: experience with orthoclonal anti-T3 cell antibody

We have reviewed the literature relating to the use of monoclonal antibodies in acute renal allograft rejection. More emphasis has been placed on Orthoclone OKT3 which has been more commonly used and summarise our experience with its use as rescue therapy in renal allograft rejection.

A comparison of cyclosporin versus azathioprine treatment in renal transplants in Edinburgh

Three year graft survival rates were calculated for 66 patients on cyclosporin and prednisolone immuno-suppression and compared to survival rates for 73 patients on azathioprine and prednisolone. There was a temporary early advantage for the cyclosporin treatment group up to four months post transplant. There was no further significant difference between the two treatment groups with graft survival rate of 81.4% in cyclosporin and 76.7% in azathioprine group at three years post transplant. Fewer of the patients on cyclosporin had acute episodes of rejection. There was no significant difference in serum creatinine or urea at one year, but the haemoglobin level was higher in cyclosporin treated patients. Cyclosporin does not appear to have increased the survival rate significantly in our centre where there is already a high graft survival with azathioprine.

1500 cases of renal and ureteric calculi treated in an integrated stone centre

Fifteen hundred consecutive cases of renal and ureteric calculi were treated in an integrated stone centre; 1464 of these were treated by extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, ureterorenoscopy and ureteroscopic lasertripsy. Only 36 (2.4%) required open surgery.

"Patient focused charting"

A study of charting in the Nursing Division at St. Boniface General Hospital identified problems with the narrative style of charting. This project was designed to develop and evaluate a practical, easy to use documentation system, with a structure for recording care as decisions were made. Integration of the care plan and nurse's notes was achieved, making documentation individualized to the patient and reflective of nursing practice. The charting system was tested on a 30-bed surgical unit with 25 nursing staff and evaluated through a chart audit, charting opinionnaire and time survey. Four evaluations were done, one prior to change and at 3, 8 and 12 months after implementation. Chart audit scores increased significantly from a mean of 9.05 to 12.75. Mean scores on the charting opinionnaire increased significantly from 47.59 to 55.62. Mean time spent charting per patient in 24 hours decreased from 22.73 to 18.27 minutes. These results indicate that integration of the careplan and nurse's notes is possible with improvement in charting quality.

Biosynthesis, import and processing of precursor polypeptides of mammalian mitochondrial pyruvate dehydrogenase complex

An immunological analysis has been conducted of early events in the biosynthesis, import and assembly of the mammalian pyruvate dehydrogenase complex (PDC). For this purpose, monospecific polyclonal antisera were produced against the intact assembly from ox heart, Mr 8.5 x 10(6), and each of its component polypeptides, E1 alpha, E1 beta, E2, E3 and protein X. Optimal detergent-based incubation mixtures were developed for obtaining clean immunoprecipitation of PDC polypeptides and their precursors from [35S]methionine-labelled extracts of PK-15 (pig kidney), NBL-1 (bovine kidney) and BRL (Buffalo Rat liver) cells. In PK-15 cells, independent higher Mr species, corresponding to precursors of the E2, E1 alpha and E1 beta subunits of PDC, could be detected by immune precipitation and fluorography after incubation of intact cells for 4 h with [35S]methionine and 1-2 mM-2,4-dinitrophenol or 10-15 microM-carbonyl cyanide p-trifluoromethoxyphenylhydrazone. Similar precursor states could be observed in uncoupler-treated BRL or NBL-1 cells. Pre-E1 alpha, pre-E1 beta and also pre-E3, have signal sequences in the Mr range 1500-3000 while pre-E2 contains a long additional segment of Mr 7000-9000. All of these forms exhibit similar kinetics of processing to the mature subunits with a transit time of 10-12 min. In NBL-1 cells, E3 is present in the immune complexes formed with anti-PDC serum whereas this is not the case in PK-15 cells. Thus, there are significant variations in the affinity of lipoamide dehydrogenase (E3) for the E2 core structure in different species. Pre-E1 alpha accumulates only poorly in PK-15 cells and is aberrantly processed on removal of uncoupler. This precursor is markedly more stable in NBL-1 and BRL cells. The lack of detection of a precursor form of component X is also discussed.

Bacterial contamination of bone marrow grafts intended for autologous and allogeneic bone marrow transplantation. Incidence and clinical significance

In a series of 100 bone marrow harvests, the incidence of bacterial contamination of the bone marrow graft was 17 percent. Ex vivo manipulation of some of the grafts prior to infusion may have caused additional bacterial contamination. All isolated bacteria were common skin flora, and no serious sequelae were observed in the patients receiving the culture-positive bone marrow grafts. Samples of harvested bone marrows purposely contaminated with an isolate of Staphylococcus epidermidis demonstrated a bactericidal property that was maximal early after bone marrow collection. Bone marrow collection and ex vivo manipulation may result in considerable bacterial contamination. Procedures must be developed to assure that marrow collection and processing do not result in clinically significant contamination.

An unusual interpodocyte cell junction and its appearance in a transplant graft kidney

In a case of focal and segmental glomerulonephritis unusual cell junctions were discovered between podocytes. These most closely resembled lesions described in aminonucleoside induced nephrosis in rats and were unlike anything previously seen in our experience. Shortly after renal transplantation nephrotic syndrome recurred and biopsy specimens showed recurrent focal and segmental glomerulonephritis, with the appearance of these unusual interpodocyte junctions in the graft kidney. This may be related to circulating factors in the blood of the patient.

Unaltered platelet [3H]-imipramine binding in dementia of the Alzheimer type

High-affinity [3H]-imipramine binding to platelets was evaluated in 11 patients suffering from dementia of Alzheimer type (DAT) in comparison to 12 normal controls. The [3H]-imipramine binding values (Bmax and Kd) did not differ between the DAT patients and the controls. Previous studies have demonstrated hypofunction of central serotonergic system in this disease, including reduced imipramine binding to brain. Thus, it seems that the low imipramine binding in DAT is confined to the brain tissue and not reflected in the platelets.

Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic

One thousand patients underwent extracorporeal shockwave lithotripsy for renal and ureteric calculi at this clinic. An overall success rate of 91.8% was achieved (stone free or less than 2 mm fragments at three months) and for stones measuring 1 cm 96.3%. Lithotripsy produced extremely low morbidity, and no deaths have occurred at the clinic. Patients who had lithotripsy alone had a mean hospital stay of three days and in most instances were able to perform their full range of activities on discharge. Planned combination of lithotripsy with minimally invasive endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy has allowed us to extend the range of treatable cases to include large stones. Prophylactic use of Double-J ureteric stents in selected cases has reduced the incidence of obstruction by stone fragments after lithotripsy, thereby decreasing morbidity and hospital stay.

Effects of acute and chronic methylphenidate administration on beta-endorphin, growth hormone, prolactin and cortisol in children with attention deficit disorder and hyperactivity

The effect of 5 mg/p.o. methylphenidate (MPH) challenge on beta-endorphin (beta-EP), growth hormone (GH), prolactin (Prl) and cortisol was investigated in 16 children suffering from attention deficit disorder with hyperactivity (ADDH) before and after 4 weeks MPH treatment. The study population consisted of 13 males and 3 females aged 6-11 years. All patients were drug free for at least 3 months prior to investigation. The severity of ADDH symptomatology and response to MPH chronic treatment was assessed using parent/teacher abbreviated Conners rating scale. Blood samples for beta-EP, cortisol, Prl and GH were drawn before initiation of treatment (basal pre-treatment level), 2 hours after MPH challenge, 4 weeks after MPH treatment (basal post-treatment level) and 2 hours after re-challenge with MPH. Chronic MPH treatment resulted in a decrease in basal Prl levels (5.5 +/- 2.8 vs 3.7 +/- 1.9 ng/ml; p less than 0.05). Pre-treatment challenge stimulates significantly both beta-EP (15.0 +/- 7.5 vs 12.5 +/- 5.3 pmol/l; p less than 0.05) and cortisol secretion (20.6 +/- 6.6 vs 12.6 +/- 5.8 micrograms/dl; p less than 0.05), and suppressed Prl secretion (4.0 +/- 1.5 vs 5.5 +/- 2.8 ng/ml; p less than 0.05). Re-challenge with MPH enhanced beta-EP levels (14.9 +/- 8.6 vs 10.6 +/- 5.0 pmol/l; p less than 0.05) but failed to affect cortisol, Prl and GH secretion. The acute and chronic neuroendocrine effects of MPH administration might be related to its dopaminergic and adrenergic agonistic activity. It might be that the stimulatory effect of single and repeated acute MPH administration on beta-EP release contributes to the beneficial effect of MPH treatment in ADDH children.

Antibiotic-resistant bacteria in surveillance stool cultures of patients with prolonged neutropenia

The value of stool surveillance for antibiotic-resistant gram-negative bacteria was analyzed in 86 neutropenic bone marrow transplant patients. Twice-weekly specimens were inoculated onto culture medium containing gentamicin plus carbenicillin. The recovered organisms were identified to the species level and tested for antibiotic susceptibility. Forty-eight resistant organisms were recovered from 35 patients. Thirteen isolates persistently colonized patients. Escherichia coli (29%) and Pseudomonas aeruginosa (19%) were the most frequently recovered organisms. Although most organisms were recovered while patients were on antibiotics, 15 isolates, including eight of nine resistant P. aeruginosa, were detected before antibiotics were initiated. The duration of antibiotic use was longer for patients persistently colonized than for those not colonized (P = 0.03). Of the 15 resistant organisms which caused infection, 12 were detected in the surveillance cultures. Infections by antibiotic-resistant organisms occurred more frequently in patients colonized than in those not colonized (P = 0.006) and more frequently in patients persistently colonized than in those colonized only once (P = 0.01). The absence of colonization or persistent colonization correlated well with the absence of infection (negative predictive values of 94 and 91%, respectively).

Effects of monensin-feeding regimens on flock immunity to coccidiosis

Feed medication with monensin caused delays in development of immunity in two floor-pen experiments which simulated commercial broiler production. Development of immunity was retarded with the higher level of monensin (120 p.p.m.) but was progressively less delayed as the monensin level was decreased (100, 60 or 0 p.p.m.). Delay was greatest with Eimeria tenella, but also occured with intestinal species including E. acervulina, E. brunetti, E. maxima, E. mivati, and E. necatrix. Drug withdrawal permitted earlier development of immunity. Plans involving use of monensin on layer replacements which later will be maintained on the floor without medication should consider: 1) prevalence of infective oocyst exposure in the area, 2) the lowest possible level of drug required for protection, and 3) its use for the shortest possible period of time.

[Dietary modification of a specific hormonal system of the duodenal mucosa controlling the endocrine and exocrine pancreatic secretions]

The effect of different food substrates on production by the duodenal mucosa of factors acting on the endocrine and exocrine functions of the pancreas was studied in the rat in vivo. Intragastric loads of glucose, maltose, arginine, lysine, peanut oil or a protein hydrolysate (Nesmida) were given to a first group of rats. The duodenum was removed at various times after food and extracts of duodenal mucosa were injected into the pancreatic-duodenal artery of other rats. The effect of these extracts was determined by measuring immunoreactive insulin levels in the portal vein and amylase, trypsin and lipase activities in the pancreatic juice of this second series of rats. Glucose and arginine, but not lysine, increased the activity of duodenal extracts on insulin secretion, whereas oil ingestion modified the activity of the duodenal extracts by inhibiting insulin secretion. Duodenal mucosa extracts taken 30 min after glucose and maltose ingestion stimulated amylase but not trypsin in the pancreatic juice, whereas extracts taken 45 min after ingestion of a protein hydrolysate stimulated trypsin but not amylase production. The extracts taken after oil ingestion specifically stimulated lipase secretion. These observations suggest the possibility of a hormonal system which is modulated by various food substrates and influences both endocrine and exocrine pancreas functions.

Anticoccidial activity of Lasalocid in control of moderate and severe coccidiosis

The fermentation product lasalocid ("Antibiotic X-537A," Hoffmann-LaRoche) showed good anticoccidial activity when administered via feed at 50 or 75 ppm in a replicated floor-pen experiment. Lasalocid was compared with monensin (121 ppm) ("positive control") and also with unmedicated ("negative") controls in pens heavily seeded or indirectly seeded with eight species of coccidia (Eimeria acervulina, E. brunetti, E. hagani, E. maxima, E. mitati, E. necatrix, E. praecox, and E. tenella). Under severe coccidiosis exposure (litter seeded by infected birds) both anticoccidials permitted significantly increased weights, improved feed conversions, and reduced lesion scores. Shank depigmentation was numerically less in anticoccidial-treated birds than in unmedicated controls, though not significantly. Coccidiosis mortality (lesions or parasites demonstrated) was 10% in unmedicated controls. Lasaloic reduced this mortality significantly to 0.8% at 50 ppm and 0.4% at 75 ppm. No coccidiosis mortality occurred with monensin-fed birds. With moderate exposure (indirect seeding) both anticoccidials permitted significantly greater weight gains and less shank depigmentation than in unmedicated controls. In unmedicated pens severity of coccidiosis was significantly greater in the intentionally seeded pens than in indirectly seeded pens with all parameters except depigmentation. This design provided a practical procedure for testing anticoccidials in a single experiment against severe and moderate exposures to coccidiosis as are normal in broiler production.