PCR-ELISAs for the detection of Campylobacter jejuni and Campylobacter coli in poultry samples

Campylobacter species, primarily Campylobacter jejuni and Campylobacter coli, are regarded as a major cause of human gastrointestinal disease, commonly acquired by eating undercooked chicken. We describe a PCR-ELISA for the detection of Campylobacter species and the discrimination of C. jejuni and C. coli in poultry samples. The PCR assay targets the 16S/23S ribosomal RNA intergenic spacer region of Campylobacter species with DNA oligonucleotide probes designed for the specific detection of C. jejuni, C. coli, and Campylobacter species immobilized on Nucleo-Link wells and hybridized to PCR products modified with a 5' biotin moiety. The limit of detection of the PCR-ELISA was 100-300 fg (40-120 bacterial cells) for C. jejuni and C. coli with their respective species-specific oligonucleotide probes and 10 fg (4 bacterial cells) with the Campylobacter genus-specific probe. Testing of poultry samples, which were presumptive positive for Campylobacter following culture on the Malthus V analyzer, with the PCR-ELISA determined Campylobacter to be present in 100% of samples (n = 40) with mixed cultures of C. jejuni/C. coli in 55%. The PCR-ELISA when combined with culture pre-enrichment is able to detect the presence of Campylobacter and definitively identify C. jejuni and C. coli in culture-enriched poultry meat samples.

Attitudes on organ donation among Hawaii physicians

A survey of physicians attending the recent Hawaii Medical Association meeting was conducted in order to assess physician attitudes on organ donation. Physicians were asked 6 questions and demographics were collected. Results indicate that Hawaii physicians generally support organ donation and are aware of some of the current federal legislation regarding donation.

Postirradiation morphea of the breast presentation of two cases and review of the literature

The advent of radiation therapy as a common modality in the treatment and palliation of breast cancer has led to the observation of morphea developing months to years after supervoltage radiation therapy, in and around the site of treatment. We report 2 new cases of morphea at the site of previous supervoltage radiation therapy for breast cancer. The time period between irradiation and onset of morphea in our 2 patients were an atypically long 6.5 years and 32 years, the latter being the longest reported such interval. With conservative treatment, the inflammatory component of the lesions resolved over an approximately 1-year period, leaving residual sclerosis. These patients are compared to those previously reported in the medical literature so as to summarize the range of clinical presentation and course. Recognition of postirradiation morphea is important in distinguishing it from infectious cellulitis, recurrent carcinoma, metastatic carcinoma or development of a second primary carcinoma.

Detection and differentiation of Campylobacter jejuni and Campylobacter coli in broiler chicken samples using a PCR/DNA probe membrane based colorimetric detection assay

Campylobacter enteritis in humans has been linked to consumption of poultry meat. Surveys show that 30-100% of poultry harbour Campylobacter as normal flora of the digestive tract which indicates a need to identify prevalent organism types in flocks and trace their epidemiology. In this study we describe a Campylobacter genus specific polymerase chain reaction (PCR) assay, amplifying the 16 S-23 S rRNA intergenic spacer region with an internal Campylobacter genus specific DNA probe and species specific probes for Campylobacter jejuni and Campylobacter coli designed for confirmation of the amplified PCR products by Southern blot and colorimetric reverse hybridization assays. The specificity of this assay was established by testing a range of food pathogens. Broiler chicken samples were tested following presumptive positive identification by the Malthus System V analyser (Malthus Instruments, UK). The combined PCR and colorimetric reverse hybridization assay is easy to perform and faster than conventional methods for confirmation and identification of Campylobacter species.

Characteristics of hepatitis C-positive blood donors in Victoria, Australia

Data from 3156 voluntary blood donors in Victoria, Australia, who were repeatedly reactive on anti-HCV screening test were analysed. It showed that between 1990 and 1997, 0.97% of routine blood donors were anti-HCV repeat reactive. Sixty-four (64) donors tested positive for HCV RNA. They were more likely to be male, had a mean age of 32.7 +/- 10.9 years and a mean serum ALT level of 70.9 +/- 46.5 i.u.L-1: the latter value being significantly different from donors with biological false reactivity (P < 0.0001). Among HCV antibody-positive donors there was a significantly increased rate of prior injecting drug use (34 vs. 1%), transfusion (25 vs. 10%) and tattooing (31 vs. 7%) than among donors with biological false reactivity (all P < 0.0001). The association of these risk factors is stronger with positivity for both immunoblot and HCV RNA than immunoblot alone. The data suggest that efforts should be made to increase the efficacy of donor questioning about prior drug use.

The effect of wind speed and direction on the distribution of sewage-associated bacteria

A study of the relationship between wind and the distribution of sewage-associated bacteria was undertaken at a location where the sewage was discharged into the sea adjacent to the mouth of a river. The numbers of presumptive Escherichia coli were determined in 149 sea-water samples taken from three locations at distances of 1.9, 2.4 and 4.3 km from the outfall. On each sampling occasion, data on the wind speed and direction in the 3 h prior to collection of the samples were also collected. Analysis of these data demonstrated a significant role for wind speed and direction. With respect to wind direction, the numbers of presumptive E. coli present in a sample were significantly higher when the sample site lay downwind of the outfall. Wind speed was shown to have an influence on the numbers of presumptive E. coli only when the sample site was downwind of the outfall. In an analysis of 61 samples, an inverse correlation (r2 = 0.73) between salinity and log presumptive E. coli numbers was demonstrated. These data demonstrate that wind speed and direction at the time of sampling significantly influence the numbers of presumptive E. coli detected in any sea-water sample. It is argued that failure to pay sufficient attention to these parameters in the design of monitoring programmes may result in the generation of data that could provide a seriously distorted picture of the microbiological status of a water body.

Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson's disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures

Intellectual, psychological and functional outcomes were evaluated in a consecutive series of 20 Parkinsonian patients who had unilateral (UPVP) or simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion and Stereoplan (Radionics Inc., Boston, Mass., USA) with stimulation for lesion localization. Comprehensive baseline and 3-month postoperative neuropsychological and neurological assessment protocols were administered together with questionnaire measures of functional disability, quality of life and psychological symptomatology. Changes in patients' clinical presentation and scores on psychometric tests, questionnaires and observational rating scales were then examined. We observed no new neuropsychiatric sequelae directly related to pallidotomy. Cognitive sequelae were restricted to selective reductions in categorical verbal fluency following UPVP (P < 0.001) and BPVP (P < 0.01) and a reduction in phonemic verbal fluency following BPVP (P < 0.01); these changes were not reported subjectively. A fall in diadochokinetic rates (P < 0.01) and some subjective reports of a worsening in pre-existing dysarthria, hypophonia and hypersalivation/drooling following BPVP also suggested changes in speech motor apparatus; however, these changes did not have significant functional consequences. There was one case of more generalized cognitive impairment following BPVP. We also observed significant symptomatic improvement on neurological rating scales; following UPVP, Total Unified Parkinson's Disease Rating Scale (UPDRS) scores improved by 27% (P < 0.01) and following BPVP the improvement was 53% (P < 0.05). Patients' perceptions of reduced postoperative functional disability and improvements in 'quality of life' also achieved statistical significance on a number of both physical and psychosocial questionnaire subscales.

Visual fields in patients with posterior GPi pallidotomy

The objective of this study was to describe the incidence and types of visual field defects after posterior globus pallidus internus (GPi) pallidotomy for Parkinson's disease. The creation of the pallidotomy lesion carries a risk of damaging neighboring structures such as the optic tract. The reported frequency of visual field defects in patients after pallidotomy varies from 0 to 40%. Goldmann visual field testing was performed on 40 patients who underwent microelectrode-guided posterior GPi pallidotomy. The optic tract was identified during the procedure by listening during microelectrode recording for the evoked responses to light flashes and by assessing stimulation-induced subjective responses. After the first 18 patients, lesioning thresholds were increased from 0.5 to > or =1.0 mA so that the lesion was placed more distant from the optic tract. The location of individual lesions was determined on postsurgical MRI. Three patients (7.5%) had visual field defects likely related to the pallidotomy. These were contralateral homonymous superior quadrantanopias, associated in two patients with small paracentral scotomas. The incidence of visual field defects with the early technique was 11% (2/18) and decreased to 4.5% (1/22) after thresholds for lesioning were increased. Except for the location of the lesion relative to the optic tract (more ventral, adjacent to or extending into the optic tract), no other variable correlated with a post-pallidotomy visual field defect. Microelectrode-guided GPi pallidotomy is a relatively safe procedure as regards visual function even when the optic tract is used as a guide for lesion placement.

The mutational specificity of 1-nitroso-6-nitropyrene in the lacI gene of Escherichia coli strains deficient in nucleotide excision repair

We have examined the mutational specificity of 1-nitroso-6-nitropyrene (1,6-NONP), an activated metabolite of the carcinogen 1,6-dinitropyrene, in the lacI gene of Escherichia coli strains which are deficient in nucleotide excision repair (strain NR6113, delta uvrB; strain CM6114, delta uvrB, plasmid pKM101). Separate collections of lacI- mutations and dominant lacI-d mutations, which contain DNA sequence alterations in the region of the lacI gene that encodes the DNA binding domain of the lacI repressor, were made following 1,6-NONP treatment. The DNA sequence of 418 mutations was determined, of which 228 were lacI- mutations and 190 were lacI-d mutations. Ninety three percent of the induced point mutations occurred at G:C residues.0 -(G:C) frameshifts were the dominant mutational class in the lacI- collections of both NR6113 and CM6114, and in the lacI-d collection of NR6113. The frameshift mutations occurred preferentially in runs of guanine residues and their frequency increased markedly with the length of the reiterated sequence. In strain CM6114, which contained the plasmid pKM101, there was a marked stimulation in the frequency of G:C-->T:A transversions that was particularly apparent in the lacI-d collection. We discuss models which might account for the apparent differences in mutational specificity resulting from the presence of the UmuD/C and MucA/B proteins. The results suggest that major classes of mutation are recovered in both the lacI- and lacI-d collections. However, the proportions of the major classes of mutations within the two collections can differ significantly. Depending on the genetic background of the host strain, the relative ratios of base substitutions to frameshift mutations in the lacI-d target can differ by almost an order of magnitude as compared with the lacI- target. This is primarily a function of the relative mutational target size of the different classes of mutation.

Nonadherent cultures of human monocytes kill Mycobacterium smegmatis, but adherent cultures do not

Human peripheral blood monocytes are permissive for the growth of Mycobacterium tuberculosis, but the fate of nonpathogenic Mycobacterium smegmatis in these cells is not known. Since M. smegmatis may be used as a host with which to express and screen for M. tuberculosis genes needed for survival in monocytes, we determined whether human peripheral blood monocytes could restrict the growth of Mycobacterium smegmatis. Adherent human peripheral blood monocytes were permissive for the growth of M. smegmatis, as measured by ex vivo [3H]uracil uptake. However, human peripheral blood monocytes which were cultured nonadherently in Teflon wells were able to restrict the growth of M. smegmatis while remaining permissive for the growth of M. tuberculosis H37Ra. The loss of viability of M. smegmatis in nonadherent cells was correlated with an increase in nonspacious phagocytic vacuoles. The killing of M. smegmatis was not blocked by NG-monomethyl-L-arginine, suggesting that it was not due to the production of reactive nitrogen intermediates. Incubation of the monocytes for 1 to 7 days before infection had no effect on the fate of M. smegmatis, suggesting that adherence versus nonadherence, and not differentiation, was the key determinant for the difference in functional ability. Nonadherent human peripheral blood monocytes may be a more appropriate model than adherent cells for the study of factors employed by bacterial to survive within monocytes and for selection screening of bacterial genes needed for intracellular survival.

A biomechanical comparison of techniques of flexor tendon repair

Achieving satisfactory digital motion after suturing severed flexor tendons remains a challenge. Although a suture technique proposed by Savage is stronger in vitro than a true Kessler repair, the Savage technique has not been previously tested in vivo. We repaired 96 severed canine tendons using either of two modifications of the Kessler technique or the Savage technique. The tensile strength of these repairs were compared at 0, 1, 3, and 6 weeks after suturing. The Savage technique provided a significantly stronger repair than the "suture locking" method in vitro and at 1 and 3 weeks after repair. We found no significant differences between the tensile strengths of the Kessler-Tajima and suture-locking methods at any time.

A prospective investigation of the long-term auditory-neurological sequelae associated with bacterial meningitis: a study from Vanuatu

During the period August 1988-July 1991 all cases of bacterial meningitis admitted to Lenakel Hospital on the island of Tanna in Vanuatu were followed. During this period there were 83 cases of purulent meningitis giving an annual incidence of 134 per 100,000 population. There were 13 deaths during the acute illness phase (CFR = 15.7%). Of the 70 survivors 65 (93%) were successfully followed for a mean duration of 17.5 months. When grouped by severity of illness there was no significant difference in the mean age, duration of symptoms or sex of the patients. At the time of discharge 31.5% had auditory-neurological abnormalities. During follow-up 35% of the survivors were found to have one or more auditory-neurological sequelae. Hearing loss was the most frequent abnormality occurring in 32.2% of the study group. Of those with auditory-neurological sequelae 39% were judged to have severe disabilities likely to impair their ability to live independently. A statistically significant association was found between the severity of the illness at presentation and the risk of auditory-neurological sequelae. Meningitis caused by Streptococcus pneumoniae was associated with the highest incidence of sequelae and that caused by Hemophilus influenzae type b with the lowest. There was no association with sex or age group. Strategies to reduce the mortality and morbidity from bacterial meningitis in developing countries are briefly discussed.

The epidemiology of bacterial meningitis occurring in a Pacific Island population

During a 36-month period 83 cases of bacterial meningitis were seen, giving an overall annual incidence rate of 134 per 10(5) population. The highest incidence was seen in infants (930 per 10(5) infants) and 59% of the patients were 0-5 years of age (incidence rate 207 per 10(5) children). Pathogens were successfully identified in 80% of the cases, by employing a combination of microscopy and antigen detection using a commercially available latex agglutination kit. Neisseria meningitidis was identified in 58%, Streptococcus pneumoniae in 29%, Haemophilus influenzae type b in 11% and dual infection with H. influenzae type b and S. pneumoniae in 3% of the cases. Serogrouping was successfully performed on cerebrospinal fluid (CSF) deposits from 8 cases of meningococcal meningitis; 7 belonged to serogroup C and 1 to serogroup Y. There was a significant difference in the geometric mean age of meningitis caused by the three organisms. There was no seasonal or geographical clustering of cases caused by N. meningitidis. Although admissions for severe pneumonia in children less than 5 years of age peaked during the cold dry season (July-October), this was not associated with a similar peak in meningitis admissions caused by H. influenzae or S. pneumoniae. The overall case fatality rate was 15.7%, and the highest case fatality rate was found in infants (28%). Meningitis caused by H. influenzae was associated with the highest case fatality rate (29%) and N. meningitidis with the lowest (8%), but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical decompression for peroneal nerve palsy after total knee arthroplasty

Five patients were treated by operative exploration and decompression of the peroneal nerve for peroneal nerve palsy complicating total knee arthroplasty (TKA). All patients had failed to demonstrate improvement in the peroneal nerve function despite extended conservative care. The procedure was performed five to 45 months after the index TKA. Patients were evaluated and graded preoperatively and postoperatively using the Modified Nerve Palsy Scale of Weber, Daube, and Coventry. All patients demonstrated improved nerve function. Four of five patients had full peroneal nerve recovery. All patients were able to discontinue their ankle-foot orthoses. This is a rare complication of TKA, and when conservative nonoperative measures do not lead to sufficient improvement in nerve function, consideration may be given to operative decompression of the peroneal nerve.

Skin infections in Tanna, Vanuatu in 1989

Skin infections are an important health problem in Vanuatu and other Pacific island countries. In this study, 18,223 people, representing 90% of the population of the southern island of Tanna in Vanuatu, were examined. Scabies was found in 16% of those screened, with 24% of children under 10 years affected. Other skin infections were predominantly furuncles, abscesses, impetigo and cellulitis and were found in 12% overall and in 16% of children under 10 years of age. These infections were found to be more common in larger households and in the vicinity of the volcano Yasur. Strategies for prevention and management of skin infections in Vanuatu are discussed.

Glucose and amino acid metabolism in chronic renal failure: effect of insulin and amino acids

The effects of hyperinsulinemia and hyperaminoacidemia on glucose and amino acid metabolism were examined in 16 control and 13 chronic renal failure (CRF) patients under two conditions: 1) euglycemic hyperinsulinemia and 2) amino acid infusion. All studies were performed with continuous indirect calorimetry and [1-14C]leucine infusion. In CRF patients insulin-mediated whole body glucose metabolism was reduced by 35% (4.41 +/- 0.50 vs. 6.76 +/- 0.73 mg.kg-1.min-1, P less than 0.01), primarily due to a decrease in nonoxidative glucose disposal (1.70 +/- 0.70 vs. 4.32 +/- 0.60 mg.kg-1.min-1, P less than 0.01); glucose oxidation was similar in both groups. In the postabsorptive state total leucine turnover (1.56 +/- 0.06 vs. 1.75 +/- 0.06), leucine oxidation (0.25 +/- 0.01 vs. 0.30 +/- 0.01), and nonoxidative leucine disposal (1.29 +/- 0.06 vs. 1.40 +/- 0.07 mumol.kg-1.min-1) were reduced in CRF vs. control subjects (all P less than 0.05). In response to hyperinsulinemia, endogenous leucine flux (index of proteolysis), leucine oxidation, nonoxidative leucine disposal (NOLD) (index of protein synthesis), and net leucine flux into protein were similar in CRF and control subjects. In contrast, the ability of hyperaminoacidemia to enhance NOLD (1.54 +/- 0.11 vs. 2.10 +/- 0.10 mumol.kg-1.min-1, P less than 0.01) and net leucine balance (0.27 +/- 0.05 vs. 0.41 +/- 0.05, P less than 0.05) was reduced in CRF patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Yaws infection in Tanna, Vanuatu 1989

Yaws has been resurgent in the island of Tanna in southern Vanatu in the 1980's. Screening, conducted in 1988 and in 1989 during a mass treatment program identified a total of 464 clinical cases from the population of 20,200, a rate of 23 per thousand. Most of these (82%) were under 15 years of age. Serology was performed on 286 of which 23% were VDRL positive. Primary care services had been hampered in controlling yaws by difficulties with transport, isolation, community resistance and the lack of skilled personel to diagnose yaws and arrange prophylactic treatment. A mass screening and treatment program was implemented in 1989 with 91.8% coverage. This program was designed to work in the context of primary health care and thus has enhanced the relationship between the health services and local villagers. The program was successfully integrated with other health activities including health education, treatment of other diseases and vector control.

Scapho-trapezio-trapezoid arthrodesis for treatment of chronic static and dynamic scapho-lunate instability: a 10-year perspective on pitfalls and complications

Goals of reducing wrist pain, allowing a stable active wrist range of motion, and retarding degenerative changes make arthrodesis of the scapho-trapezio-trapezoid joint a popular treatment for chronic static and dynamic scapho-lunate instability; however, pitfalls and complications have not been well studied. Forty-seven wrists in 46 patients over a 10-year period revealed a complication rate of 52%. Failure to attain perfect scaphoid reduction consistently resulted in persistent incapacitating pain. Radial styloid-scaphoid impingement, observed after "successful" limited wrist fusion, was effectively treated by simple styloidectomy. Carpal osteomyelitis, lunate avascular necrosis, pin-tract infection, progressive medial carpal translation, and intractable pain without arthrosis complete the spectrum of complications managed in this series. Careful preoperative patient screening and attention to detailed recommendations will assist surgeons in avoiding the many potential problems associated with this procedure.

Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints

One hundred thirty-four closed articular fractures of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were reviewed to identify common fracture patterns, assess results, and define the most successful methods of treatment. Articular involvement greater than 20 per cent and displacement more than 1 to 2 mm usually requires open reduction and internal fixation. Fracture involvement and displacement were better tolerated by the MCP than PIP joint. Problem fractures and treatment recommendations are discussed.