[Cysts and cystoid formations]

Cystic and cyst-like lesions of bone are very common. They can be of primary origin or secondarily caused by several diseases. For exact diagnosis or at least narrow differential diagnosis the assessment of radiological findings is important. However, patient data, clinical symptoms, laboratory parameters, and site of the lesion have to be included for a reasonable final diagnosis or differential diagnosis.

Fracture repair of the distal portion of the radius by use of a condylar screw implant in an adult horse

An 8-year-old American Quarter Horse gelding was evaluated because of an open fracture involving the left radius. The horse had fallen during training and became immediately non-weight-bearing in the left forelimb. On initial evaluation, the horse was unable to bear weight on that limb; radiography revealed a long oblique fracture of the distal metaphysis of the radius with minimal displacement of the fracture fragments. Because of the configuration of the fracture, we recommended surgical intervention with internal fixation. A condylar screw implant and 4.5-mm broad dynamic compression plate were applied to the medial and dorsolateral aspects of the radius, respectively. The horse recovered in a sling and full-limb bandage. Six months after discharge, the horse was reevaluated because of a grade 4/5 lameness in the same limb. Palpation revealed signs of severe pain over the distomedial aspect of the radius. Radiography of the left radius revealed severe osteolysis beneath the distal aspect of the condylar screw implant. Surgical removal of the medial plate was performed. Sixteen months after the initial fracture repair, the horse had returned to light training without signs of lameness. Removal of the dorsal plate may be indicated if this horse is to return to aggressive training or becomes lame in the left forelimb.

Characterization of the innate and adaptive immunity to Salmonella enteritidis PT1 infection in four broiler lines

Four broiler lines were inoculated orally with Salmonella enteritidis phage type 1 at the age of 7 days (experiment A: lines 1 and 2) and at the age of 1 day (experiment B: lines 3 and 4). At various days post-infection chickens were sacrificed and the number of Salmonella in the caeca, liver, and spleen were determined. Furthermore, phagocytic activity, cellular immune responses, and humoral responses were determined using, respectively, single-cell suspensions of spleen or intestine and serum. In both experiments, similar trends were seen. Increased numbers of S. enteritidis were found in the caeca of lines 1 and 3, whereas at the same time a decreased colonization was found in the spleen and in the liver, as compared to lines 2 and 4. In the latter two lines, the phagocytic activity of the phagocytes was higher and the humoral responses were lower. Observations from this study suggest that lower activity of phagocytes and higher humoral activity prevent systemic S. enteritidis infection.

People with AIDS as residents: preparedness and acceptance by Connecticut long-term care facilities

The management of AIDS has become an issue of chronic care as well as acute treatment. As the number of people with AIDS increases, the demand for ongoing care and support, both informal and formal, is expected to increase. The present study is based on a survey of all licensed nursing homes in the state of Connecticut with respect to prevailing attitudes toward the admission of residents with AIDS, and the level of staff, resident and procedural preparedness that exists. Both positive attitudes among the various LTC constituent groups as well as the level of preparation in a number of areas are correlated with the admission of residents with AIDS. Implications are discussed and recommendations are offered for policy development.

Introduction of the new Centers for Disease Control and Prevention group B streptococcal prevention guideline at a large West Coast health maintenance organization

OBJECTIVE

Our purpose was to assess the impact of new consensus guidelines issued by the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics to prevent perinatal group B streptococcal disease.

STUDY DESIGN

We performed a descriptive analysis and a before-and-after analysis of implementation of the group B streptococcal disease prevention guidelines among singleton-birth pregnancies in 2 Group Health Cooperative hospitals from October 1, 1995, through December 31, 1997. We studied the speed and completeness of implementation and the effect on pregnancy care practices including intrapartum antibiotic use, test ordering, and maternal and neonatal health.

RESULTS

Guideline implementation occurred rapidly. The proportion of term pregnancies screened according to the guideline increased markedly, and overall intrapartum antibiotic use more than doubled. Among group B streptococci-positive women, intrapartum antibiotic prophylaxis increased from 24% before to 74% after guideline implementation. Median duration of treatment before delivery increased from 1.8 to 4.3 hours. The rate of rash did not increase, and there were no cases of anaphylaxis or pseudomembranous colitis. The proportion of infants undergoing evaluation decreased after implementation of the neonatal guidelines; among infants of group B streptococci-negative women, test ordering dropped by almost 40%.

CONCLUSIONS

Implementation of the new guidelines is feasible and can be accomplished rapidly. The guidelines were associated with increased maternal intrapartum antibiotic use, particularly among women at highest risk, and with a decrease in laboratory use for infants.

Evaluation of a new method for assessing symptoms

BACKGROUND

Many studies in rhinology are based on results from symptom scoring. Numerous methods are used to estimate symptoms. With some of them the patients choose between various alternatives for estimating the severity of their symptoms, but the commonest method is the visual analogue scale (VAS), which is regarded as reliable.

METHODS

In this study, we evaluate a new method for assessing symptoms, with which the patient uses the telephone to call a computer. We compare the results using the new method with those using symptoms estimation with VAS.

RESULTS

The results are based on 487 observations in patients with birch pollen allergic rhinitis in the pollen season. A high correlation was found between the results using the new method and those using the VAS. In a questionnaire, the patients answered questions concerning the two methods. Most patients preferred the new telephone method. They found it easier to estimate their symptoms properly and easier to perform.

CONCLUSION

We conclude that telephone scoring of symptoms is a reliable and adequate method when symptom scoring is used as hard data in a study.

Centrosomes and the Scrambled protein coordinate microtubule-independent actin reorganization

In Drosophila syncytial blastoderm embryos, centrosomes specify the position of actin-based interphase caps and mitotic furrows. Mutations in the scrambled locus prevent assembly of mitotic furrows, but do not block actin cap formation. The scrambled gene encodes a protein that localizes to the mitotic furrows and centrosomes. Sced localization, actin reorganization from caps into mitotic furrows, and centrosome-coordinated assembly of actin caps are not blocked by microtubule disruption. Our results indicate that centrosomes may coordinate assembly of cortical actin caps through a microtubule-independent mechanism, and that Scrambled mediates a second microtubule-independent process that drives mitotic furrow assembly.

Interleukin 21 and its receptor are involved in NK cell expansion and regulation of lymphocyte function

Cytokines are important in the regulation of haematopoiesis and immune responses, and can influence lymphocyte development. Here we have identified a class I cytokine receptor that is selectively expressed in lymphoid tissues and is capable of signal transduction. The full-length receptor was expressed in BaF3 cells, which created a functional assay for ligand detection and cloning. Conditioned media from activated human CD3+ T cells supported proliferation of the assay cell line. We constructed a complementary DNA expression library from activated human CD3+ T cells, and identified a cytokine with a four-helix-bundle structure using functional cloning. This cytokine is most closely related to IL2 and IL15, and has been designated IL21 with the receptor designated IL21 R. In vitro assays suggest that IL21 has a role in the proliferation and maturation of natural killer (NK) cell populations from bone marrow, in the proliferation of mature B-cell populations co-stimulated with anti-CD40, and in the proliferation of T cells co-stimulated with anti-CD3.

Frequencies of certain complement protein alleles and serum levels of anti-heat-shock protein antibodies in cerebrovascular diseases

BACKGROUND AND PURPOSE

A strong correlation exists between the intensity of atherosclerotic alterations in different arteries. Marked differences exist, however, in the age and sex distribution and risk factors for coronary heart disease (CHD) and cerebrovascular disease (CVD). We therefore performed genetic and immunologic studies in patients with CVD.

METHODS

We studied 292 patients with CVD (stroke or transient ischemic attack) and as control either 198 healthy blood donors and 485 healthy elderly (aged >60 years) people (genetic study) or 94 blood donors aged 45 to 60 years and 49 healthy elderly (aged >60 years) people (anti-heat-shock protein [hsp] measurements). Allele frequencies of 3 genes (C4A, C4B, and C3) encoding proteins of the complement system were determined by electrophoresis and immunofixation. Serum concentration of autoantibodies against 60-kDa heat-shock protein (anti-hsp60) was measured by the enzyme-linked immunosorbent assay method.

RESULTS

Marked differences were observed between CVD patients and controls in the genetic studies. In the CVD patients aged >60 years, the frequency (11.3%) of the deficient allele of the C4B gene (C4B*Q0) was significantly (P:=0.0003) higher than that of the healthy controls (5.4%). By contrast, in the group aged 45 to 60 years, the frequency of the C4B*Q0 allele was lower in patients than in controls. Serum concentration of anti-hsp60 in the CVD patients did not differ from control values.

CONCLUSIONS

In previous studies C4B*Q0 frequency was reported to be higher in CHD patients aged 45 to 60 years than in aged-matched controls. Moreover, high anti-hsp60 levels were found in CHD patients. These findings contrast with our present report of lower frequency of C4B*Q0 in CVD patients. Therefore, genetic and immunologic factors may at least partly explain the differences between the natural history and risk factors of CHD and CVD.

Cognitive consequences and central nervous system injury following treatment for childhood leukemia

OBJECTIVES

To determine the relationship between membrane damage and intellectual and academic abilities in children with acute lymphoblastic leukemia (ALL) and pilot test a math intervention for children with ALL who were affected.

DATA SOURCES

Research studies and review articles.

CONCLUSIONS

Despite the prophylactic central nervous system (CNS) treatment for long-term disease-free survival, many children with ALL subsequently experience declines in intellectual and academic skills.

IMPLICATIONS FOR NURSING PRACTICE

Improving academic abilities in children who have received CNS treatment is of high priority and may have longlasting implications on quality of life.

Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty

The authors report the results of a prospective randomized clinical trial using continuous passive motion after total knee arthroplasty. One hundred twenty patients were assigned randomly to one treatment group: No continuous passive motion (Group I), continuous passive motion from 0 degrees to 50 degrees and increased as tolerated (Group II), and continuous passive motion from 70 degrees to 110 degrees (Group III). The continuous passive motion was initiated in the recovery room and was maintained for a maximum of 24 hours at which point all patients began identical postoperative physiotherapy regimens. Patients were assessed preoperatively, during their hospital stay, at 6 weeks, 12 weeks, 26 weeks, and 52 weeks after their surgery. There were no statistical differences between any of the treatment groups regarding cumulative analgesic requirements, range of motion at any measured interval, length of stay (Group I, 5.1 days; Group II, 5.2 days; Group III, 5 days) or Knee Society scores. The current study does not support the use of short-term continuous passive motion after total knee replacement. A standard and a high flexion continuous passive motion protocol failed to show any advantage over physiotherapy alone in the parameters evaluated.

Dynamic magnetic resonance imaging of the levator palpebrae superioris muscle

The relationship between upper lid elevation (h) and shortening (s) of the levator palpebrae superioris muscle (LPS) has an influence on the dose-response relationship in ptosis surgery. In order to investigate the relationship between upper lid elevation and shortening of the LPS, parasagittal T1-weighted MR images of the orbit were obtained in healthy subjects with the eye in down- and upgaze. The position of the upper lid margin and the length of the LPS were measured in the images in down- and upgaze and the amount of h and s was determined. For a mean (+/- SD) vertical upper lid elevation of 15 +/- 1 mm, the mean (+/- SD) shortening of the LPS muscle was 21 +/- 3 mm (n = 4). The mean ratio of his was calculated to be 1:1.4, which means that the levator muscle must contract by 1.4 cm in order to achieve a lid elevation of 1 cm. Therefore, the force of the LPS which is necessary to lift the upper eyelid can be smaller than the lid-closing force. This strongly suggests a physiological mechanism which reduces the muscle force necessary for lifting the upper eyelid.

IgA content of washed red blood cell concentrates

Saline-washed red blood cell (RBC) concentrates are largely depleted of leukocytes, microaggregates, and nearly of all plasma originally contained in the blood unit. Our aim was to determine the concentration of the eliminated IgA and total protein in the buffy coat and plasma removed RBC concentrate before and after a sequential dilution-centrifugation washing procedure, 75.3% protein, and 99% IgA were eliminated by the washing process used. The recovery of red blood cells was 87.2%. Our results have led to the conclusion that two sequential washings seem to guarantee an IgA level of less than 0.2 mg/unit to meet the recommendations of the Council of Europe. Additional advantages of washing include low levels of extracellular hemoglobin, metabolic waste products and debris in the supernatant.

Streptokinase does not activate the complement system

Streptokinase is an extensively used thrombolytic agent. However, different preparations cause severe hypotension during therapy, partially related to the complement cascade activation. In four ischaemic stroke patients treated with Streptase, an increased level of soluble terminal complement complex (SC5b-9) was measured. In the sera of normal subjects, the increase in SC5b-9 induced by Streptase, Kabikinase and Calbiochem streptokinases was highly significant (P < 0.005). Sigma streptokinase did not activate the complement system. Sigma streptokinase analyzed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis showed a homogeneous band. The other three preparations were contaminated with albumin and other proteins. Based on our in vivo and in vitro data, we conclude that complement activation is related to contamination of different streptokinase products rather than the streptokinase itself.

Kinematics of the hind limb in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and intra-articular administration of anesthetic

OBJECTIVE

To identify hind limb and pelvic kinematic variables that change in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and after subsequent intra-articular administration of anesthetic.

ANIMALS

8 clinically normal adult horses.

PROCEDURE

Kinematic measurements were made before and after transient endotoxin-induced lameness of the distal intertarsal and tarsometatarsal joints and after intra-articular administration of anesthetic. Fourteen displacement and joint angle (metatarsophalangeal [fetlock] and tarsal joints) measurements were made on the right hind limb, sacrum, and the right and left tubera coxae. Kinematic measurements were compared by general linear models, using a repeated measures ANOVA. Post hoc multiple comparisons between treatments were evaluated with a Fisher least squared difference test at alpha = 0.05.

RESULTS

After lameness induction, fetlock and tarsal joint extension during stance decreased, fetlock joint flexion and hoof height during swing increased, limb protraction decreased, and vertical excursion of the tubera coxae became more asymmetric. After intra-articular administration of anesthetic, limb protraction returned to the degree seen before lameness, and vertical excursion of the tubera coxae became more symmetric.

CONCLUSIONS AND CLINICAL RELEVANCE

Increased length of hind limb protraction and symmetry of tubera coxae vertical excursion are sensitive indicators of improvement in tarsal joint lameness. When evaluating changes in tarsal joint lameness, evaluating the horse from the side (to assess limb protraction) is as important as evaluating from the rear (to assess pelvic symmetry).

Cognitive decline in women in relation to non-protein-bound oestradiol concentrations

BACKGROUND

Previous studies have found no association between serum concentrations of total oestradiol and cognitive function, but these measurements may not reflect concentrations of hormone available to the brain. We tested the hypothesis that concentrations of non-protein-bound (free) and loosely bound (bioavailable) sex hormones are associated with cognitive function in older women.

METHODS

We measured cognitive performance with a modified mini mental status examination (mMMSE) at baseline (1986-88) and 6 years later in 425 women (65 years or older). Concentrations of non-protein-bound and bioavailable oestradiol and total and non-protein-bound testosterone were measured by RIA in serum samples taken at baseline.

FINDINGS

Initial cognitive scores did not differ by tertile of non-protein-bound oestradiol, bioavailable oestradiol, or testosterone. Cognitive impairment (a decrease of 3 points or more in mMMSE score) occurred in five (5%) of 94 women in the high tertile for non-protein-bound oestradiol and in 17 (16%) of 106 in the low tertile (odds ratio 0.3 [95% CI 0.1-0.8]). After adjustment for age, years of education, body-mass index, current oestrogen use, history of surgical menopause, and baseline mMMSE score, the odds ratio was 0.3 (0.1-0.9). The results were similar for bioavailable oestradiol (five [5%] vs 15 [15%]; adjusted odds ratio 0.3 [0.1-1.0]). There was no association between risk of cognitive impairment and serum testosterone.

INTERPRETATION

Women with high serum concentrations of non-protein-bound and bioavailable oestradiol, but not testosterone, were less likely to develop cognitive impairment than women with low concentrations. This finding supports the hypothesis that higher concentrations of endogenous oestrogens prevent cognitive decline.

Monitoring steam sterilization practices in primary care settings

Steam sterilization is a common method for processing reusable instruments in ambulatory care settings. Ensuring that sterilization practices are consistent with accepted standards is a quality-of-care parameter as well as an infection control issue. Factors that must be considered in improving performance in this important area are: operator training and continued competency, selection of chemical and biological media and methods, work flow controls, documentation methods and standards, written policies and procedures to support practices, and ongoing monitoring of the system and practices with feedback to responsible persons.