Course and management of renal subcapsular abscess in a 63-year-old diabetic woman

Renal subcapsular abscess is a very rare disease that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. The course and management of subcapsular abscesses have received less attention than those of renal and perirenal abscesses. We describe a 63-year-old diabetic woman who presented with intermittent fever of 1 month's duration. She was initially treated for suspected acute pyelonephritis then referred to our hospital because of poor clinical response to cefazolin plus gentamicin. Computed tomography of the abdomen revealed a huge subcapsular abscess with displacement and compression of the left renal parenchyma. A percutaneous catheter was inserted and left in place for 8 days; a total of approximately 850 mL of pus was drained. Culture of the pus yielded Klebsiella pneumoniae and Enterobacter cloacae. A 2-week course of moxalactam was administered on the basis of the results of in vitro antibiotic susceptibility testing. The distorted renal parenchyma appeared normal at sonographic follow-up examination 3 weeks after hospitalization. The course and management of this rare entity are presented as a reminder to physicians that renal subcapsular abscess could manifest as fever of unknown origin in a diabetic patient. A high degree of clinical suspicion is required for early diagnosis and treatment in order to achieve a satisfactory outcome.

Characterization of an ADP-ribosylation factor-like 1 protein in Saccharomyces cerevisiae

ADP-ribosylation factors (ARFs) are highly conserved approximately 20-kDa guanine nucleotide-binding proteins that enhance the ADP-ribosyltransferase activity of cholera toxin and are believed to participate in vesicular transport in both exocytic and endocytic pathways. Several ARF-like proteins (ARLs) have been cloned from Drosophila, rat, and human; however, the biological functions of ARLs are unknown. We have identified a yeast gene (ARL1) encoding a protein that is structurally related (>60% identical) to human, rat, and Drosophila ARL1. Biochemical analyses of purified recombinant yeast ARL1 (yARL1) protein revealed properties similar to those ARF and ARL1 proteins, including the ability to bind and hydrolyze GTP. Like other ARLs, recombinant yARL1 protein did not stimulate cholera toxin-catalyzed auto-ADP-ribosylation. yARL1 was not recognized by antibodies against mammalian ARLs or yeast ARFs. Anti-yARL1 antibodies did not cross-react with yeast ARFs, but did react with human ARLs. On subcellular fractionation, yARL1, similar to yARF1, was localized to the soluble fraction. The amino terminus of yARL1, like that of ARF, was myristoylated. Unlike Drosophila Arl1, yeast ARL1 was not essential for cell viability. Like rat ARL1, yARL1 might be associated in part with the Golgi complex. However, yARL1 was not required for endoplasmic reticulum-to-Golgi protein transport, and it may offer an opportunity to define an ARL function in another kind of vesicular trafficking, such as the regulated secretory pathway.

Agrobacterium radiobacter bacteremia in a patient with chronic obstructive pulmonary disease

Agrobacterium radiobacter is a gram-negative bacillus, which is recognized as an emerging opportunistic human pathogen. To our knowledge, there have been only 25 cases of A. radiobacter bacteremia reported. In most of these, A. radiobacter was associated with long-term indwelling plastic central venous catheters. We describe a 78-year-old man who had a history of chronic obstructive pulmonary disease with long-term use of a corticosteroid. He was admitted to the China Medical College Hospital with pneumonia caused by Serratia marcescens. His general condition gradually improved after initiation of appropriate treatment. Unfortunately, he developed A. radiobacter bacteremia while hospitalized in the medical intensive care unit. With the onset of this infection, the patient had a high fever, leukocytosis, raised C-reactive protein level, and positive blood cultures for A. radiobacter. A central venous catheter-related infection was suspected because of redness and localized tenderness at the catheter site. The patient gradually recovered after removal of the catheter and appropriate antimicrobial treatment with latamoxef 1.5 g intravenously every 8 hours for 10 days.

Tubo-ovarian abscess caused by multidrug resistant Bacteroides gracilis

Bacteroides gracilis infections are very rare and have always been reported to have a polymicrobial etiology. The majority of these infections occur in the head and neck areas, the pleuropulmonary system, and the abdominal cavity. We report a case of tubo-ovarian abscess caused by B. gracilis. A literature search revealed no previous reports. Our patient, a 29-year-old woman, experienced fever and lower abdominal pain caused by a tubo-ovarian abscess. Her treatment consisted of surgical drainage and prolonged intravenous antibiotic therapy. Initial therapy with cefotaxime and metronidazole failed and she remained febrile after the laparotomy. Her clinical condition improved slowly after initiation of imipenem therapy. Culture of a pus specimen obtained during surgery yielded B. gracilis, which was resistant to imipenem but susceptible to clindamycin. Combination therapy with imipenem and clindamycin was then administered and she recovered completely. Clindamycin was subsequently prescribed for long-term bacterial suppression. The potential difficulties in treating B. gracilis infections were a major clinical concern in the treatment of this patient.

A cytogenetic study of 514 Chinese couples with recurrent spontaneous abortion

OBJECTIVE

To study the role of chromosomal aberration in the causation of recurrent spontaneous abortion (RSA) in Chinese population.

METHODS

A total of 514 Chinese couples with 2 or more spontaneous abortions at less than 24 weeks of gestation were included. For each proband, a minimum of 13 metaphases were analyzed by G-banding. Additional cells (usually 50-100 cells) were screened when mosaicism was suspected. Chi 2 test was used to compare the number and frequency of couples with and without balanced translocation with respect to whether liveborn was present or absent. Chi 2 test for trend was used to show whether a correlation existed between the occurrence of balanced translocation and the number of spontaneous abortions at ascertainment.

RESULTS

The overall incidence of chromosome anomaly was 51 out of 514 (9.92%). Chi 2 test for trend analysis showed that the chance of one member of a couple being a balanced carrier increased with the number of spontaneous abortions. The chance of finding translocation in couples with liveborn was higher than that in couples without liveborn, but the difference was not statistically significant. We also found that pericentric inversion 9 did not play an important role in the causation of recurrent abortion.

CONCLUSIONS

Cytogenetic analysis is indicated in couples with 2 or more spontaneous abortions and the chance of finding chromosomal aberration increases with the number of abortions at the time of ascertainment.

[Chemical constituents of Artemisia dalailamae Kraschen]

Five compounds were isolated from Artemisia dalailamae. They were identified as taraxeryl acetate, isofraxidin, scopoletin, scopolin and kumatakenin.

Preparative slab electrofocusing of methane monooxygenase from a type I methanotroph Methylomonas GYJ3

The isolation and purification of methane monooxygenase from a type I methanotroph Methylomonas GYJ3 to near homogeneity is reported. The isoelectric focusing in flat-bed granulated gels has resolved the methane monooxygenase into three protein components. The specific activity of the enzyme is 198.4 n mol per min per mg protein, degree of purification 4.13-fold. Recovery of the focused proteins is high and elution simple. Several purification steps may be omitted from the previously published scheme by other techniques.

[Household survey of diarrhoeal disease control in P.R. china]

126,965 population, including 10,987 children less than 5 years in 20 provinces were visited, and 7,681 cases due to diarrhoea, including 1 800 cases less than 5 years were found during the survey in Aug 1988. According to the calculating methods recommended by WHO, the morbidity is 0.70 episodes/person/per year in China, 1.90 episodes/per child/per year in children less than 5 years. The highest morbidity, 2.44 episodes/per child/per year, is in the age group from 6 months to 2 years. 37.86% of all cases went to health facilities, among them 62.24% were treated in village health facilities. 63.36% of all cases received treatment. The use rate of ORT was 14.24%, including 1.98% of using ORS and 12.26% of using home fluids. The use rate of antibiotics was 55.16%. The use rate of traditional medicine was 8.07%. From Sep 1987 to Aug 1988, there were 605 deaths in 102,470 population. The death rate was 5.9 per 1,000 population. With 15 deaths due to diarrhoea, the mortality of diarrhoea was 0.002% 76.18% of 1,247 children under 7 months were breast-fed, and 19.49% of them were partially breast-fed, and 4.33% of them were bottle-fed. The result of the survey indicates that diarrhoeal disease is a major constraints to people's health and social development, and the character of high morbidity and low mortality determines that the strategy of diarrhoeal diseases Control will be prevention, and the situation of low ORT use rate and abuse of antibiotics should be improved, and it should be emphasized to train health workers of village facilities.