The antimicrobial activity of mupirocin--an update on resistance

Mupirocin (pseudomonic acid A) has a novel chemical structure that is unrelated to any other known class of antibiotic, and possesses a unique mode of action. As a consequence, mupirocin lacks cross-resistance with other antibacterial agents and exhibits activity against strains of bacteria that are multiresistant. The selection in vitro of resistant variants of Staphylococcus aureus is slow, which is reflected in the low incidence of mupirocin resistance encountered in clinical practice. Pulse field gel electrophoresis studies on S. aureus highly resistant to mupirocin, have confirmed the presence of a large plasmid in the majority, but not all, of the isolates. Restriction endonuclease digests of the large plasmid DNA, and DNA hybridization studies with a non-radiolabelled probe constructed from total plasmid DNA, have shown that there were marked differences in plasmid types between isolates from different locations, but general similarities between plasmid types isolated from the same location.

Treatment of acutely infected arthroplasty with local antibiotics

The authors have identified 22 patients with acutely infected total joint arthroplasties, 9 hips, and 13 knees. Following organism identification and assessment of the patients' general medical condition, the patients were treated with an implantable antibiotic pump. This allowed the delivery of a high concentration of antibiotic solution to a localized area. Systemic levels of antibiotic were kept to a minimum, thereby eliminating potential serious side effects of antibiotic treatment. Local concentrations were extremely high, exceeding the minimal inhibitory concentration (MIC) in all cases by 8-10-fold. Twenty patients have been followed for 30 months, and of these, 17 patients are considered to be infection free. There were three failures. The organisms that have been treated have been gram negatives, gram positives, and some mixed infections. Results are encouraging with this form of treatment, and additional patients are continually being added to the study.

A novel dipyridodiazepinone inhibitor of HIV-1 reverse transcriptase acts through a nonsubstrate binding site

A novel dipyridodiazepinone, 6,11-dihydro-11-cyclopropyl-4-methyldipyrido[2,3-b:2',3'-e]- [1,4]diazepin-6-one (BI-RG-587), is a selective noncompetitive inhibitor of HIV-1 reverse transcriptase (RT-1). An azido photoaffinity analogue of BI-RG-587 was synthesized and found to irreversibly inhibit the enzyme upon UV irradiation. BI-RG-587 and close structural analogues competitively protected RT-1 from inactivation by the photoaffinity label. A thiobenzimidazolone (TIBO) derivative, a nonnucleoside inhibitor of RT-1, also protected the enzyme from photoinactivation, which suggests a common binding site for these compounds. Substrates dGTP, template-primer, and tRNA afforded no protection from enzyme inactivation. A tritiated photoaffinity probe was found to stoichiometrically and selectively label p66 such that 1 mol of probe inactivates 1 mol of RT-1.

An integrated, hospital information system based obstetrical medical record and database

Described in this paper is the implementation and integration of an obstetrical medical record and database into an existing hospital information system. A unique feature of this system was the integration of existing data captured by the established hospital information systems with the newly implemented obstetrical database to form a complete patient data profile. This complete database integrated data from hospital functions such as demographic data obtained at patient registration, outpatient visits and tests, inpatient admission historical data, tests and procedures, newborn data and miscellaneous data required for birth registration. An important second feature was the utilization of physicians and nurses to enter the obstetrical data. This permitted immediate access to patient data from any hospital information system terminal, immediate retrieval for generating reports, and subsequently, ad hoc queries, statistical analysis and the electronic transfer of birth registration data to the State Vital Statistics Registry.

Hypnosis with a criminal defendant and a crime witness: two recent related cases

2 legal cases involving hypnosis have recently been adjudicated by American courts. In Rock v. Arkansas (1987), the United States Supreme Court ruled that the hypnotically elicited testimony of a criminal defendant was admissible in court. This decision was grounded upon the constitutional right of a defendant both to testify, and to call witnesses, on his or her own behalf. Shortly afterwards, citing Rock as a precedent, a Texas Court of Appeals admitted the hypnotically elicited testimony of an eyewitness in Zani v. State (1988), on the grounds that it would be unfair to admit the hypnotically elicited testimony of defendants, and proscribe it for victims and witnesses. It is not clear what effect this doctrine of equity will have upon other North American court cases that involve hypnosis.

Hypnotizability, preference for an imagic cognitive style, and memory creation in hypnosis

We sought to extend the finding (Laurence & Perry, 1983) that it is possible through hypnosis to create a pseudomemory of a specific event. Subjects were compared on their responses to a hypnotic suggestion. We also examined the relation between nonhypnotic measures (Preference for an Imagic Cognitive Style [PICS] test and the Tellegen Absorption Scale [TAS]) and response to the suggestion. Highly (45.45%) and moderately-highly (46.15%) susceptible subjects believed that the pseudomemory was veridical, but none of the low susceptible subjects did so. Together, hypnotic susceptibility, the PICS, and their interaction more strongly predicted pseudomemory creation than any of these main effects alone. Performance on the TAS was also related to the occurrence of pseudomemory, but this relation was redundant with performance on the other measures. These results point to the complexity of the variables involved in pseudomemory creation during hypnosis.

Hypnotizability, preference for an imagic cognitive style, and memory creation in hypnosis

We sought to extend the finding (Laurence & Perry, 1983) that it is possible through hypnosis to create a pseudomemory of a specific event. Subjects were compared on their responses to a hypnotic suggestion. We also examined the relation between nonhypnotic measures (Preference for an Imagic Cognitive Style [PICS] test and the Tellegen Absorption Scale [TAS]) and response to the suggestion. Highly (45.45%) and moderately-highly (46.15%) susceptible subjects believed that the pseudomemory was veridical, but none of the low susceptible subjects did so. Together, hypnotic susceptibility, the PICS, and their interaction more strongly predicted pseudomemory creation than any of these main effects alone. Performance on the TAS was also related to the occurrence of pseudomemory, but this relation was redundant with performance on the other measures. These results point to the complexity of the variables involved in pseudomemory creation during hypnosis.

Interactions of Escherichia coli SO-187 tRNA(IVal) with Bacillus stearothermophilus valine-tRNA synthetase studied by 13C-NMR

Uracil isotopically labelled with 13C at C4 and C5 has been incorporated into nucleic acids of the Escherichia coli uracil auxotroph, SO-187. [4,5-13C]uracil-labeled tRNA(IVal) was isolated and purified. 13C longitudinal relaxation times measured at 67.8 MHz demonstrated that the C5 dipole caused a 20-50% increase in the C4 relaxation. Interactions of this tRNA with valine-tRNA synthetase (VTS) purified from Bacillus stearothermophilus were established by 13C-NMR. Specific spectral changes were seen at 4-thiouridine, ribothymidine and pseudouridine of the 'bend' in the three-dimensional structure, and particularly at the uridine-5-oxyacetic acid in the wobble position of the anticodon. Thus, the protein seems to be in contact along the entire tRNA molecule, including the anticodon loop.

In vivo [31P]NMR studies on the influence of age on rat brain hypoxia

In this paper the response of cerebral phosphate metabolism to mild hypoxia in young, medium and old rats has been studied via in-vivo [31P]nuclear magnetic resonance (NMR). It was found that the young adults (5-6 months) were more sensitive to this mild stress than either the mature adult (11-12 months) or senescent (23-24 months) rats even though the depth of hypoxia (paO2 = 45-55 mm Hg) was equal for all age groups. They displayed an earlier onset of acidosis, a greater fall in PCr and larger rise in Pi. This response is presumably an attempt to maintain adequate adenosine triphosphate (ATP) levels via anaerobic glycolysis. In contrast, mature adults and senescent adults appear to be able to maintain ATP levels by increasing mitochondrial rates. Acidosis is less severe as are drops in PCr and rises in Pi. Recovery is less complete for the young rats: Pi levels remain high while PCr and pHi levels stay low after normoxia has been reinstigated. All metabolite levels in the mature and senescent adults return to within 10% of control levels. All the data were analyzed and differences were found to be statistically significant. This study reveals that, contrary to popular belief, mature and old rats respond more favorably to reduced O2 than younger individuals. This is due to a more severe anaerobic acidosis in the latter age group. Speculations to explain this disparity are based on the fact that previous in-vitro studies involve systems that are totally or partially disconnected from the organism will not account for important feedback control present in an in-vivo system as studied here.

Preservation of the eye in paranasal sinus cancer surgery

Forty-one patients undergoing surgery between 1977 and 1985 for malignant tumors of the paranasal sinuses abutting or eroding the orbital walls were studied for the need to remove the orbital contents. All patients had preliminary computed tomographic scans to delineate the extent of orbital invasion. All were treated with preoperative radiotherapy. If the tumor mass could be peeled from the periorbita, the eye was saved. Preservation of eyes in the patients without periosteal invasion did not alter survival. Frozen-section control may be used to determine periorbital involvement. If the periorbita was minimally involved, it was locally resected. If invasion of the periorbita was extensive, an orbital exenteration was done. Only five of 41 patients required exenteration. Local recurrence of disease in the orbit has not occurred in these patients.

Multiple predictors of hypnotic susceptibility

In this article, we report two experiments in which various measures thought to be related to hypnotizability were analyzed by stepwise discriminant analysis techniques. Absorption (Tellegen, 1981, 1982; Tellegen & Atkinson, 1974) and preference for an imagic style of thinking (Isaacs, 1982) were robust predictors of hypnotizability; each variable accounted for significant variance in hypnotizability at their respective steps in two samples and correctly classified a significant proportion of low- and high-hypnotizable subjects in the discriminant analyses. The addition of two other variables in Experiment 2--a Sleep-Dream score derived from Evans's (1977) Cognitive Control of Sleep Mentation subscale and Gibson's (1985) Dream Questionnaire, and the Belief in the Supernatural subscale of the Taft (1969) Experience Questionnaire--increased the correct classification of the medium-hypnotizable subjects from chance levels to 74%. It is argued that a confirmatory and hierarchical approach is needed in future studies to explore correlates of hypnotizability more fully.

Total glossectomy

Total glossectomy is a procedure based on sound oncologic principles, and its usefulness may not be fully appreciated. Given the dimensions of the tongue and the need to obtain a wide margin of resection, this procedure may be indicated in selected T3 lesions and recurrences after irradiation. The procedure offers excellent palliation of pain, and form and function may be preserved by rim mandibulectomy when indicated. New reconstructive techniques allow for speedier recovery. Aspiration need not be a complication of total glossectomy if care is taken to preserve the superior laryngeal nerve. Speech rehabilitation plays an important role in returning these patients to their normal environment. Overall 1 and 3 year disease-free survival rates have been encouraging.

Multiple predictors of hypnotic susceptibility

In this article, we report two experiments in which various measures thought to be related to hypnotizability were analyzed by stepwise discriminant analysis techniques. Absorption (Tellegen, 1981, 1982; Tellegen & Atkinson, 1974) and preference for an imagic style of thinking (Isaacs, 1982) were robust predictors of hypnotizability; each variable accounted for significant variance in hypnotizability at their respective steps in two samples and correctly classified a significant proportion of low- and high-hypnotizable subjects in the discriminant analyses. The addition of two other variables in Experiment 2--a Sleep-Dream score derived from Evans's (1977) Cognitive Control of Sleep Mentation subscale and Gibson's (1985) Dream Questionnaire, and the Belief in the Supernatural subscale of the Taft (1969) Experience Questionnaire--increased the correct classification of the medium-hypnotizable subjects from chance levels to 74%. It is argued that a confirmatory and hierarchical approach is needed in future studies to explore correlates of hypnotizability more fully.

Transient visual anomalies associated with drug treatment for spastic colon

A case report revealing two previously unreported adverse side effects of meprobamate and tridihexethyl chloride (Milpath) drug therapy for a spastic colon is presented. The two previously unreported adverse effects are a diffuse loss of color discrimination and an increased time course to complete dark adaptation.

Flicker electroretinogram in retinitis pigmentosa

Electroretinograms (ERGs) were recorded as a function of flicker frequency from 5 to 50 Hz for 14 retinitis pigmentosa (RP) patients, 12 normal subjects and 1 rod monochromat. Data were analyzed by measuring the angular position of the response maximum, i.e. the phase, as a function of pulse-train frequency. Flicker ERGs obtained from the RP patients showed non-linear, frequency-dependent phase shifts when compared to the normal data. These phase shifts were simulated in a normal observer by attenuating the stimulus luminance by 1 log unit. However, the shape of the waveforms recorded from the normal differed markedly from those recorded from the RP patients. The differences, but not the ratios of the times-to-peak of the positive and negative ERG wavelets were longer in the RP patients than in the normal. These data suggest that the temporal anomalies in the RP flicker ERG are most likely due to changes in the amplitudes and time constants of the ERG components, and not simply to a reduced quantum catch or photoreceptor loss.

Pressure-time product, flow, and oxygen cost of resistive breathing in humans

We examined the relationship between the pressure-time product (Pdt) of the inspiratory muscles and the O2 cost of breathing (VO2 resp) in five normal subjects breathing through an external inspiratory resistance with a tidal volume of 800 ml at a constant end-expiratory lung volume [functional residual capacity, (FRC)]. Each subject performed 30-40 runs, each of approximately 30 breaths, with inspiratory flow rates ranging from 0.26 +/- 0.01 to 0.89 +/- 0.04 l/s (means +/- SE) and inspiratory mouth pressures ranging from 10 +/- 1 to 68 +/- 4% of the maximum inspiratory pressure at FRC. In all subjects VO2 resp was linearly related to Pdt when mean inspiratory flow (VI) was constant, but the slope of this relationship increased with increasing VI. Therefore, Pdt is an accurate index of VO2 resp only when VI is constant. There was a linear relationship between the VO2 resp and the work rate across the external resistance (W) for all runs in each subject over the range of W 10 +/- 1 to 137 +/- 21 J/min. Thus, at a constant tidal volume the VO2 resp was related to the mean inspiratory pressure, independent of flow or inspiratory duration. If the VO2 resp were determined mainly during inspiration, then for a given rate of external work or O2 consumption, VI would be inversely related to mean inspiratory pressure. Efficiency (E) was 2.1 +/- 0.2% and constant over a large range of VI, pressure, work rate, or resistance and was not altered by the presence of a potentially fatiguing load. The constant E over such a wide range of conditions implies a complex integration of the recruitment, mechanical function, and energy consumption of the muscles utilized in breathing.

A problem with refusing certain forms of psychiatric treatment

Certain affective disorders are associated with compromised cognitive and emotional capacities and thus, with one's ability to act as a fully autonomous individual. Some of these personality problems have been treated very successfully with specified drug regimes. Continued treatment with lithium has rendered previously incompetent manic patients fully capable of competent self-governance. If the competent have the right to refuse medical attention (even when the refusal is not in the patient's best interest) does the drug-induced competent psychiatric patient have the right to refuse that medical treatment necessary for his continued competency? This paper investigates this issue.

New lessons favoring physicians' support of clinical trials

The publications of the Hypertension Detection and Follow-up Program and the Multiple Risk Factor Intervention Trial have produced different opinions concerning the therapeutic implications of their results. However, they provide new lessons concerning the design of clinical trials and the ethical implications of this research. Their experiences clearly illustrate the scientific requirements for controlled clinical trials and clarify the ethical validity of future investigations for medical researchers and the medical profession.

Properties of electroretinographic intensity-response functions in retinitis pigmentosa

Dark-adapted electroretinogram (ERG) b-wave amplitudes and implicit times were recorded as a function of stimulus luminance for 15 retinitis pigmentosa (RP) patients and 15 normal subjects. B-wave amplitude as a function of log stimulus luminance was fit by non-linear regression with the Naka-Rushton equation, which has 3 independent parameters: The maximum response (Rmax), slope (n) and half-saturation constant (K). B-wave implicit-time as a function of log stimulus luminance was fit by linear regression. Compared to normal, the RP Rmax values were markedly reduced, suggesting response compression; the RP K values were elevated by an average of 0.76 log unit, suggesting relatively small losses in retinal sensitivity. There was no correspondence between Rmax and visual field area for the RP patients (coefficient of correlation = -0.02). All but 2 of the 15 RP patients had normal or shallower-than-normal implicit-time intensity-response functions, indicating that over most of the dynamic range of the ERG, the implicit-times were either normal or faster-than-normal. These results are discussed in terms of possible RP disease mechanisms.

Patient diagnostic, behavioral and demographic variables associated with changes in civil commitment procedures

Examined diagnostic and demographic characteristics of six groups of voluntary and committed patients (N = 300) over a 3-year period in order to assess the impact of a change in civil commitment procedures in the state of Missouri. Committed and voluntary patients differed on the basis of several demographic and behavioral variables, including diagnosis, employment status, and instances of serious physical harm recorded on admission. No differences were found between patients committed under the old law (which stipulated that the presence of "mental illness" was a sufficient criterion) and patients committed under the new law (which requires the presence of serious physical harm as an essential criterion). These findings were interpreted to suggest that, in at least some settings, clinicians were restricting commitment to cases that gave evidence of physical harm prior to the enactment of new legislation.

Hypnotically created memory among highly hypnotizable subjects

A pseudomemory of having been awakened by some loud noises during a night of the previous week was suggested to 27 highly hypnotizable subjects during hypnosis. Posthypnotically, 13 of them stated that the suggested event had actually occurred. This finding has implications for the investigative use of hypnosis in a legal context.

Can claims for 'wrongful life' be justified?

The authors reject arguments by Professor Joseph Fletcher (author of Situation Ethics) that in some circumstances parents may be held responsible for producing genetically defective offspring, but offer arguments of their own for the same conclusion. Their arguments could, they suggest, justify `wrongful life' claims by the genetically defective infant against the mother.

While researching this paper both authors were postdoctoral fellows in medical ethics in the Program on Human Values and Ethics at the University of Tennessee Center for the Health Sciences.

Physicochemical characterization of large unilamellar phospholipid vesicles prepared by reverse-phase evaporation

Properties of large unilamellar vesicles (LUV), composed of phosphatidylcholine and prepared by reverse-phase evaporation and subsequent extrusion through Unipore polycarbonate membranes, have been investigated and compared with those of small unilamellar vesicles (SUV) and of multilamellar vesicles (MLV). The unilamellar nature of the LUV is shown by 1H-NMR using Pr3+ as a shift reagent. The gel to liquid-crystalline phase transition of LUV composed of dipalmitoylphosphatidylcholine (DPPC) monitored by differential scanning calorimetry, fluorescence polarization of diphenylhexatriene and 90 degrees light scattering, occurs at a slight lower temperature (40.8 degrees C) than that of MLV (42 degrees C) and is broadened by about 50%. The phase transition of SUV is shifted to considerably lower temperatures (mid-point, 38 degrees C) and extends over a wide temperature range. In LUV a well-defined pretransition is not observed. The permeability of LUV (DPPC) monitored by leakage of carboxyfluorescein, increases sharply at the phase transition temperature, and the extent of release is greater than that from MLV. Leakage from SUV occurs in a wide temperature range. Freeze-fracture electron microscopy of LUV (DPPC) reveals vesicles of 0.1-0.2 micron diameter with mostly smooth fracture faces. At temperatures below the phase transition, the larger vesicles in the population have angled faces, as do extruded MLV. A banded pattern, seen in MLV at temperatures between the pretransition and the main transition, is not observed in the smaller LUV, although the larger vesicles reveal a dimpled appearance.

"Hidden observer" phenomena in hypnosis: an experimental creation?

Spanos and Hewitt (1980) have recently argued, on the basis of an experiment they report, that Hilgard's "hidden observer" phenomenon is pure laboratory artifact. This report reviews their claim and concludes on the following grounds that their experiment does not warrant so sweeping a conclusion: (a) Spanos and Hewitt have posed the issue as fact versus fiction and do not appear to be aware of a third alternative, namely, that the hidden observer effect is a phenomenon encountered in hypnosis that may be influenced both by demand characteristics and by the social-psychological context. (b) They appear to obtain the effect 100% of the time, unlike Hilgard, who has emphasized the phenomenon's differential incidence. (c) In contrast to Hilgard, who furnishes abundant verbal reports of his subjects' phenomenal experience as buttressing evidence for the "genuineness" of the effect in subjects who report having it, Spanos and Hewitt do not. (d) Two major procedural aspects of their experiment are discussed. Either or both may have inadvertently influenced the outcome of their experiment in the direction of their hypothesis that the responses of subjects are entirely the product of experimenter-induced expectations.

"Hidden observer" phenomena in hypnosis: an experimental creation?

Spanos and Hewitt (1980) have recently argued, on the basis of an experiment they report, that Hilgard's "hidden observer" phenomenon is pure laboratory artifact. This report reviews their claim and concludes on the following grounds that their experiment does not warrant so sweeping a conclusion: (a) Spanos and Hewitt have posed the issue as fact versus fiction and do not appear to be aware of a third alternative, namely, that the hidden observer effect is a phenomenon encountered in hypnosis that may be influenced both by demand characteristics and by the social-psychological context. (b) They appear to obtain the effect 100% of the time, unlike Hilgard, who has emphasized the phenomenon's differential incidence. (c) In contrast to Hilgard, who furnishes abundant verbal reports of his subjects' phenomenal experience as buttressing evidence for the "genuineness" of the effect in subjects who report having it, Spanos and Hewitt do not. (d) Two major procedural aspects of their experiment are discussed. Either or both may have inadvertently influenced the outcome of their experiment in the direction of their hypothesis that the responses of subjects are entirely the product of experimenter-induced expectations.

An NMR study of 13C-enriched galactose attached to the single carbohydrate chain of hen ovalbumin. Motions of the carbohydrates of glycoproteins

In order to facilitate the study of motions of the carbohydrate moiety of glycoproteins, a method of enzymatically attaching uniformly 13C-enriched galactopyranose ([U-13C]galactose) onto the nonreducing end of the carbohydrate chain has been developed. Specifically, [U-13C]glucose (20% 13C) was converted through a sequence of four enzymatic steps to [U-13C]UDP-galactose which was then attached, via a beta-1,4 glycosidic bond, to a nonreducing terminal N-acetylglucosamine of hen ovalbumin using the enzyme bovine galactosyltransferase. The overall reaction was followed using 31P and 13C NMR. 13C NMR spectra of the modified ovalbumin show six well resolved resonances arising from the six carbons of the attached [U-13C]galactose. Values of the spin-lattice relaxation time, the line width, the 13C (1H) nuclear Overhauser effect, and the intensity ratio, a measure of the off-resonance rotating frame spin-lattice relaxation time, were obtained for the individual carbons of the [U13-C]galactose as well as other carbon resonances of the protein. Relaxation data for the protein alpha-carbon and aromatic methine carbon resonances could be fit to theoretical values by assuming a correlation time of 25 ns for overall isotropic motion of the glycoprotein. Relaxation data for the anomeric carbon of the attached [U-13C]galactose could only be fit by assuming an additional correlation time between 40 and 80 ps for free internal motion, subject to the constraint that its carbon-proton bond vector makes an angle of about 30 degrees with an effective axis of rotation.