Experimental infection of turkeys and chickens with a clonal strain of Tetratrichomonas gallinarum induces a latent infection in the absence of clinical signs and lesions

The pathogenicity of a mono-eukaryotic culture of Tetratrichomonas gallinarum in specific pathogen free (SPF) chickens and turkeys was studied. Two experiments of identical design were performed: the first with SPF chickens and the second with commercial turkeys. Each experiment included three groups. Groups 1 and 2 each contained 12 infected and three in-contact birds. The birds in these groups were infected on the first day of life, either cloacally (group 1) or orally (group 2). Group 3 consisted of four control birds. Re-isolation of the parasite from cloacal swabs was performed to verify the excretion of T. gallinarum. The infected birds excreted trichomonads from the second day post-infection. Spread of the flagellate from infected to in-contact birds was detected after 5 days post-infection (dpi), based on the re-isolation of the protozoa. No clinical signs or deaths were recorded in chickens or turkeys. Three birds were killed at 4, 8, 14 and 21dpi and various tissues were collected for pathological examination. No gross lesions were noted. Protozoal DNA was demonstrated in the oesophagus, duodenum, jejunum, caecum, liver, lung, bursa of Fabricius and brain by polymerase chain reaction and in-situ hybridization. No antibodies were detected in the serum of infected birds by enzyme linked immunosorbent assay. Microscopical changes were only present in the caecum, where there was sloughing of the epithelium associated with the presence of numerous flagellates on the epithelial surface, within the crypts of Lieberkühn and in the lamina propria. These changes were found in caecal samples from infected and in-contact birds. These studies have demonstrated the rapid transmission of T. gallinarum between both turkeys and chickens and the establishment of a latent infection in both species.

Histopathology of culture-associated skin erosions and papillary hyperplasia of Atlantic halibut, Hippoglossus hippoglossus (L.)

Atlantic halibut, Hippoglossus hippoglossus (L.), that were cultured in tanks with a smooth bottom (gel-coated fibreglass) substrate developed papillary hyperplasia and skin erosions on the blind (ventral) side. No viruses, bacteria or parasites were observed in any sections of affected skin. Comparison of microscopic pathology with that of skin from normal, wild-caught halibut showed severe epidermal proliferation with foci of severe mucous cell hyperplasia. Both epidermal thickness and mucous cell density were significantly greater in fish held on a smooth substrate compared to skin of healthy fish. Spongiosis was present, especially at the base of the papillary, hyperplastic epidermis, and there was a chronic inflammatory infiltrate in the scale pockets composed of lymphocytes, histiocytes and erythrocytes. Skin erosions had various degrees of epidermal loss, in some cases to the basement membrane. A predisposing factor for the epidermal sloughing may have been related to the spongiosis, and the vacuolated, degenerated basal cells. When affected halibut were cultured for an additional 28, 62 or 97 days on a sand substrate, which is conducive to skin lesion healing, there was no apparent change in epidermal thickness over time. However, mucous cell density significantly increased from day 0 to 97 during the healing process.

VTE prophylaxis across the continuum of care in U.S. cancer patients

e17510

Background: The period of VTE risk in cancer patients extends beyond the hospital stay. This analysis evaluated VTE prophylaxis patterns for US cancer patients across the continuum of care. Methods: Premier's Perspective inpatient data were cross-matched with Ingenix LabRx outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in medical cancer patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatient anticoagulant groups were assigned based on the drug the patient received during hospital stay and were followed by their outpatient prophylaxis use. Patients were evaluated on drug utilization, diagnoses and clinical practice patterns during and after hospitalization. Results: Overall, 75.3% of 2,337 cancer patients did not receive anticoagulation during their hospital stay. Of the 577 patients receiving prophylaxis, 66% received UFH and 25% received enoxaparin ( Table ). The mean length of hospital stay was 3 days after which 97.9% of patients did not receive any prophylaxis within the following 30 days. Of the 50 patients who received outpatient prophylaxis, 60% received warfarin alone and 22% received both enoxaparin and warfarin. Conclusions: This unique analysis presents VTE prophylaxis patterns across the continuum of care. Most cancer patients did not receive anticoagulation in the inpatient or outpatient settings. Further efforts are needed to identify optimal VTE prevention in cancer patients, namely the duration of prophylaxis and how healthcare providers can increase awareness. Financial and editorial support was provided by sanofi-aventis US, Inc.

[Table: see text]

[Table: see text]

Evaluation of the effect of systemic corticosteroids for the treatment of immune-related adverse events (irAEs) on the development or maintenance of ipilimumab clinical activity

9037

Background: Ipilimumab, a fully human monoclonal antibody that inhibits cytotoxic T-lymphocyte antigen-4, has clinical activity at 10 mg/kg in patients (pts) with advanced melanoma. Most grade 3/4 immune-related adverse events (irAEs) associated with ipilimumab can be managed with systemic corticosteroids following established treatment guidelines. However, little has been reported about the effects of corticosteroids used to treat irAEs on ipilimumab antitumor responses. Methods: Across 3 phase II studies with 10 mg/kg ipilimumab monotherapy in advanced melanoma (CA184008, 022, and 007; N=283), 83 pts (29.3%) achieved disease control [complete/partial responses (CR/PR), or stable disease (SD) ≥12 weeks] and 43/83 (52%) received steroids for treatment of irAEs. The pts' ability to develop and maintain disease control in the presence and absence of steroids was analyzed. Disease control was assessed by modified World Health Organization (mWHO) criteria and novel immune-related response criteria (irRC) (Hodi FS, et al. J Clin Oncol 26: 2008 [May 20 suppl; abstr 3008]). The range of follow-up was 5.7–6.3 months. Results: Of 117 pts who received steroids prior to response assessment, 26 pts achieved CR or PR, or maintained SD without disease progression by mWHO, and the remaining 91 pts had PD. Of 166 pts who either never received steroids or received them after response assessment, 31 achieved a CR, PR, or SD (by mWHO). Further, of 26 pts with CR/PR by mWHO, 14 received subsequent steroids and 11 maintained a response, while of 12 pts who received no subsequent steroids, 9 maintained a response. Similar results were obtained if irRC were used (see table ). Conclusions: Systemic corticosteroids for treatment of irAEs do not appear to impact the development or maintenance of ipilimumab clinical activity in advanced melanoma.

[Table: see text]

[Table: see text]

Pseudoaneurysm of a branch of the profunda femoris artery following distal locking of an intramedullary hip nail: an unusual anatomical location

Vascular complications following internal fixation of trochanteric femoral fractures are extremely rare. Iatrogenic injury to the profunda femoris artery or one of its branches and resultant pseudoaneurysm formation has been documented, most commonly following sliding hip screw fixation and typically arises on the posteromedial aspect of the femur. We report an unusual variation, following proximal femoral nailing of an intertrochanteric femoral neck fracture, where the pseudoaneurysm presented four weeks following surgery on the posterolateral aspect of the femur. The mechanism of injury, clinical presentation and potential preventative measures are discussed.

Telephone clinic follow-up following carpal tunnel decompression

This paper investigates the feasibility of a telephone clinic follow-up service for patients undergoing carpal tunnel decompression. Six hundred and thirty patients were recruited over a 2-year period and we assessed their outcome and satisfaction level in the service, using a pre-determined questionnaire 6 weeks following surgery. The telephone clinic was overseen by a surgical care practitioner. We followed up 598 patients (93%) in total, and found 42 patients to be dissatisfied with the service (7%). These patients were referred for outpatient consultation and investigation. Most patients were satisfied with their surgical outcome and found the telephone clinic service to be convenient and effective. Cost analysis calculations estimated a potential saving of pound 45,958 over the 2-year period when compared to standard outpatient consultation. This model has been developed in our trust to follow up patients undergoing similar minor hand surgery.

A prospective randomised controlled trial of autologous retransfusion in total knee replacement

We undertook a prospective randomised controlled trial to investigate the efficacy of autologous retransfusion drains in reducing the need for allogenic blood requirement after unilateral total knee replacement. We also monitored the incidence of post-operative complications. There were 86 patients in the control group, receiving standard care with a vacuum drain, and 92 who received an autologous drain and were retransfused postoperatively. Following serial haemoglobin measurements at 24, 48 and 72 hours, we found no difference in the need for allogenic blood between the two groups (control group 15.1%, retransfusion group 13% (p = 0.439)). The incidence of post-operative complications, such as wound infection, deep-vein thrombosis and chest infection, was also comparable between the groups. There were no adverse reactions associated with the retransfusion of autologous blood. Based on this study, the cost-effectiveness and continued use of autologous drains in total knee replacement should be questioned.

The early radiological follow-up of a medial rotational design of total knee arthroplasty

The objective of this study was to investigate the hypothesis that the increased constraint of a medial rotational knee promotes earlier loosening of the prosthesis. All patients with a Freeman-Samuelson 1000 knee arthroplasty (medial pivot design), (group 1), or a Freeman-Samuelson Modular knee arthroplasty, (group 2), with a minimum follow-up of 2 years (mean follow-up 4 years) were identified from our unit's arthroplasty database, and matched as closely as possible for age, length of follow-up and pre-operative diagnosis. Standardised anteroposterior and lateral radiographs were analysed for component migration and radiolucent lines as recommended by the Knee Society. There were 48 knees in each group. There were no failures in group 2. There was one failure requiring revision of the tibial component in group 1. There was no significant difference in overall radiolucent line scores between the two groups (p=0.66, at 5 years). Progressive radiolucent lines were detected in similar numbers of patients in both groups (FS1000 8/48, FSM 7/48, p=0.84). Our early radiological survey suggests that the increased constraint of the medial pivot knee prosthesis does not result in an increased incidence of radiographic loosening.

Dedifferentiated chordoma

Dedifferentiated chordoma is a rare and aggressive variant of the conventional tumour in which an area undergoes transformation to a high-grade lesion, typically fibrous histiocytoma, fibrosarcoma, and rarely, osteosarcoma or rhabdomyosarcoma. The dedifferentiated component dictates overall survival, with smaller areas of dedifferentiation carrying a more favourable prognosis. Although it is more commonly diagnosed in recurrences and following radiotherapy, there have been a few reports of spontaneous development. We describe four such cases, which were diagnosed de novo following primary excision, and discuss the associated clinical and radiological features.

Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact

A case of heterosexual transmission of Moraxella catarrhalis by fellatio, which resulted in acute purulent urethritis mimicking gonorrhoea in the male partner, is described. In male patients with urethritis due to M. catarrhalis, orogenital contact with a sexual partner carrying the organism in his/her oropharynx is the probable route of transmission.

Smear cytology in the intra-operative assessment of periodontoid pseudotumour of the craniocervical junction

OBJECTIVE

Periodontoid pseudotumours are lesions of presumed degenerative aetiology which typically occur in elderly patients with cervical myelopathy. The clinical and radiological differential diagnosis includes neoplastic and inflammatory lesions, and the exclusion of such lesions may be of value in the intra-operative management of the patient. This audit aimed to examine the value of intra-operative smear cytology in the management of this condition.

METHODS

The intra-operative smear cytological features of four cases of periodontoid pseudotumour were reviewed.

RESULTS

In each case the intra-operative cytological interpretation was in keeping with a non-neoplastic and non-inflammatory process.

CONCLUSION

These results suggest that intra-operative smear cytology can provide information on the value in the intra-operative management of patients with this lesion.