The high-pathogenicity island is absent in human pathogens of Salmonella enterica subspecies I but present in isolates of subspecies III and VI

In this study we tested 74 Salmonella strains of all eight Salmonella groups and were able to demonstrate the presence of two high-pathogenicity island types in strains of Salmonella groups IIIa, IIIb, and VI. Most high-pathogenicity island-positive isolates produced yersiniabactin under iron-limited conditions and were positive for the high-molecular-weight proteins HMWP1 and HMWP2.

[Intramedullary stabilisation of metastatic fractures of long bones]

Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept.

PATIENTS AND METHODS

From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery.

RESULTS

No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1).

CONCLUSION

Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.

[Treatment of emergencies in the hospital--problems and management]

Due to the growing number of high-risk patients, the increasing proportion of geriatric patients and the expansion of surgical and invasive-diagnostic procedures, medical stuff in hospitals are confronted with a rising number of emergency situations. Nearly 50% are of cardio-circulatory origin and occur during surgical interventions or immediately afterwards. Another cause of life-threatening complications are side-effects of orally or intravenously administered agents, especially after treatment with antibiotics, anaesthetics, analgetics and sedatives. Due to a lack of emergency training and management in most hospitals, the survival rate after cardiopulmonary resuscitation in general wards lies between just two and 35%. Thus it seems necessary to perform special training in CPR procedures and emergency management at regular intervals for the entire medical stuff. In addition, a special infrastructure for giving sufficient treatment in emergencies has to be established (emergency team, emergency telephone number, intra-hospital emergency car). The second part of this review presents current diagnostic and therapeutic strategies for the most common emergency situations, e.g. anaphylaxis, myocardial infarction, pulmonary embolism, gastrointestinal bleeding, and heparin-induced thrombocytopenia (HIT).

[Evaluation of radiological teaching programs in the Internet]

PURPOSE

Evaluation of web based training programs, which can be contacted from the homepages of radiological departments of German universities.

MATERIAL AND METHOD

From June 2000 to January 2002 the 75 web based training programs of 57 providers,which can be contacted from the web pages of the radiological departments of German universities were evaluated in a prospective study. A medical student experienced in using the world wide web examined each training program three times in an interval of six months using the following criteria: availability of the web sites, target group, kind of training program, contents and structure and the technical solution.

RESULTS

51 of the 57 the homepages were fully available at each visit. 64 of the 75 web based training programs which could be connected from these sites were available at all three visits.One program was only partially available at one spot check. 8 of the 75 programs were designed for physicians and medically trained personal, 23 were made for medical students and 44 addressed both target groups (partially more than once mentioned). The number of the presented cases ranged between one single and 3700. In 31 of 75 training programs links to other teaching files were found. A complete presentation of cases was presented by 48 of the 75 web sites.5 of the 75 web sites offered physiological images for comparison. In 20 training programs the pathological changes were optically marked in the x-ray images. A logical and didactical structure was found in 24 teaching files, 14 gave the possibility to check the learning results. No provider made use of the possibility to pass credits to the students or physicians account with regard to official training programs. Multimedia techniques were used in 15 training programs.43 sites used data reduced preview images (thumbnails). The latest update of the site is mentioned in 55 of the 75 web sites. 19 of 57 providers had either no possibility of contact or did not answer to an e-mail.

CONCLUSION

From the homepages of the departments of diagnostic radiology of German universities 75 teaching files can be contacted. There is a great variety in quantity and quality. Most sites offer collections of cases. A web based training program which is comparable in quality to a CD-ROM teaching program could not be found. No program used the possibility to give credits to the users with regard to official training programs.

[Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures]

AIM

The purpose of the study was to verify test criteria of the upper-limb DASH questionnaire in patients with Colles' fractures.

METHODS

107 of 139 patients with Colles' fractures treated operatively were examined and asked to complete the questionnaire. To establish reliability, the item answers of all questionnaires were analysed by using Cronbach's Alpha correlation coefficient and corrected item total correlation. Construct validity was evaluated by comparing the DASH points with clinical measures according to Gartland/Werley and Castaing (Spearman correlation coefficient). Discriminant validity was assessed by comparing the DASH points of patients with AO-type A/B fractures and AO-type C fractures (Mann-Whitney U-Test).

RESULTS

2.7 percent of all questionnaires were unusuable. The time to fill out the questionnaire was on average 12 minutes. Cronbach's alpha values were high in all scales (alpha > 0.8). No items were found unsuitable (corrected item total correlation > 0.5 in 28 of 30 questions). DASH scores were correlated with ROM deficits and clinical measures of wrist function (r = 0.53; r = 0.59; r = 0.52, p < 0.01). The questionnaire could discriminate patients with different fracture types (p < 0.05).

CONCLUSIONS

DASH is a workable, reliable and valid instrument for patients with Colles' fractures.

[3-dimensional image acquisition for analysis of primary, cleft-induced facial deformity with an optoelectronic surface scanner]

BACKGROUND

Anthropometric analysis of the face has been performed with direct facial measurement and photogrammetry. Both methods have disadvantages. The aim of our investigation was to create a three-dimensional image of the primary cleft nasal deformity with a video scanner and to carry out linear measurements.

MATERIAL AND METHODS

Facial plaster casts of 19 patients with uni- and bilateral cleft lip and palate before primary lip repair were scanned with digital surface photogrammetry DSP 400. The width of the nose and of the nostril floor, the distance of the alar bases, the length of the ala, and the nasal tip protrusion were measured.

RESULTS

Imaging was possible without problems in all models. Direct measurements of the model correlated well with the results of the three-dimensional image. Significant dimensional differences of the nasal parameters examined were noted, depending on the cleft type.

DISCUSSION

A video-supported surface scanner allowed immediate three-dimensional imaging of the face. The computer software analyzed the generated surface exactly. The data measured with the presented system resembled other previously published results.

[Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis]

PURPOSE OF THE STUDY

Comminuted fractures of the radial head represent a particular therapeutic problem. Due to characteristic complications the resection as well as the implantation of the Swanson-prothesis could not convince.

MATERIAL AND METHODS

We applied the radial head prothesis of Judet in 16 cases (14 type IV and 4 type III by Mason).

RESULTS

At the moment we survey the follow up of 15 patients after 12 to 45 months (average 18.2), the evaluation was performed using the score of Radin and Riseborough and the score of Morrey. With the score of Radin and Riseborough we found in 7 cases good, in 6 case fair and in 2 case poor results. With the score of Morrey we found 2 excellent, 11 good and 1 fair and poor results. The radiological examination did not show an increase of the carrying angle of the elbow, an osteoporosis, a proximal migration of the radius and a distal radio-ulnar dissociation.

CONCLUSION

Compared with resection or Swanson-prothesis the bipolar prothesis of Judet has definite advantages.

Cerebral oxygen monitoring during neonatal cardiopulmonary bypass and deep hypothermic circulatory arrest

BACKGROUND

This study was undertaken to investigate the physiological effects of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) on cerebral oxygen metabolism estimated by near-infrared spectroscopy (NIRS).

METHODS

Ten newborn piglets (2.1 to 2.6 kg) were monitored with right frontal NIRS; the right jugular bulb was cannulated for intermittent sampling of jugular venous blood. All animals underwent CPB, cooling to a core temperature below 15 degrees C, 60 minutes of DHCA followed by subsequent reperfusion and rewarming. Continuously recorded NIRS data and intermittent jugular venous blood values were compared.

RESULTS

NIRS performance was examined over the jugular venous oxygen saturation (SjvO2) range of 40 to 98 %, a linear correlation was found between SjvO2 and NIRS-derived regional cerebral oxygen saturation (rSO2) (r = 0.91, p < 0.001). A correlation was observed between the cellular oxidation NIRS-parameter cytochrome oxidase aa3 (CytOx) slope during the DHCA period in relation to rectal and nasopharyngeal temperature immediately before the onset of DHCA (r = 0.75 and 0.85, p < 0.001).

CONCLUSIONS

This study suggests that NIRS-measured hemoglobin oxygenation parameters may reflect functional changes in cerebral hemodynamics and brain tissue oxygenation, while CytOx values represent related effects on intracellular oxidative metabolism.

Combined endoscopic intragastral resection of a posterior stromal gastric tumor using an original technique

Gastric stromal tumors are solitary, usually asymptomatic, lesions that can bleed, become obstructive, or even degenerate into malignant neoplasms. Therefore, their surgical excision is recommended. We report a technique for the successful resection of a stromal tumor of the posterior gastric wall using a transgastric approach. After the creation of a 12 mmHg pneumoperitoneum using a three-trocar technique, a 2-cm gastrostomy was performed; an 18-mm trocar was then positioned in the gastric lumen and secured with a pursestring suture. Next, an intragastric wedge resection of the posterior gastric wall was carried out under endoscopic guidance. Finally, the anterior gastric wall was closed using a linear stapler. Histopathological analysis showed a benign spindle cell tumor, which was excised in toto. Patient recovery was uneventful. This report supports previous data showing the feasibility of a laparoscopic transgastric approach for the resection of stromal tumors of the posterior gastric wall. It also underscores the synergy of laparoscopic and endoscopic procedures in minimally invasive gastric surgery.

[Quality of life after foot injuries]

OBJECTIVE

Assessment of quality of life after foot injuries.

METHODS

All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05).

RESULTS

110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries.

CONCLUSIONS

Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.

Evaluation of BACTEC MGIT 960 and BACTEC 460TB systems for recovery of mycobacteria from clinical specimens of a university hospital with low incidence of tuberculosis

Clinical samples obtained over a period of 8 months (n = 2,624) were processed in parallel with the BACTEC 460TB system, with the MGIT 960 system, and in Löwenstein-Jensen (LJ) medium, resulting in the recovery of 127 mycobacteria. Recovery rates in combinations of the BACTEC 460TB or MGIT 960 system with LJ were, respectively, 94.7 and 94.7% for Mycobacterium tuberculosis complex (n = 57) and 91.4 and 70.0% for nontuberculous mycobacteria (n = 70). Contamination rates, elevated in the MGIT 960 system, were associated with patients (cystic fibrosis) and type of material but not with transport time. Detection time was reduced in the MGIT 960 system.

Changes in the expression and binding properties of the estrogen receptor in MCF-7 breast cancer cells during growth inhibition by tamoxifen and cisplatin

Most mammary carcinomas contain estrogen receptors (ER), which are an important factor in diagnosis and prognosis, and in deciding on the type of therapy. ER-positive tumors are most commonly treated with the antiestrogen tamoxifen or with a combination of chemotherapeutic drugs. An important aspect for further treatment and anticipating possible side effects is the fate of the ER during the course of therapy. To study the effect of drug-induced growth inhibition on ER expression and binding properties. human breast cancer MCF-7 cells were treated with tamoxifen and cisplatin. and also estradiol (E2) for 5 days. Following this incubation, intact cells were incubated with [3H]E2 to determine the dissociation constant (KD) and maximal number of binding sites (Bmax) of the ER. The amount of ER protein per cell was quantified using anti-ER antibodies. For analysis of ER mRNA, total cellular RNA was subjected to Northern blotting. The 5-day treatment with E2 reduced Bmax and the amount of ER protein by about 70%, while the cellular level of ER mRNA was reduced by 40%. Treatment with E2 did not affect the subsequent growth inhibitory response to tamoxifen or cisplatin. In contrast, tamoxifen reduced the capacity for E2 binding; it caused about a 30-fold increase in the KD value. At the same time, Bmax and ER protein content were increased (about 3.5- and 2-fold, respectively), but the cellular level of ER mRNA was again reduced by 40%. The growth of tamoxifen-treated cells remained sensitive to subsequent treatment with estradiol, tamoxifen or cisplatin. Treatment of MCF-7 cells with cisplatin likewise reduced E2 binding due to a 20-fold increase in KD value. In this case, both Bmax and the amount of ER protein were decreased when calculated per milligram of protein, but were increased on a cellular basis due to an increase in cell size. The ER mRNA content was not altered in cisplatin-treated cells. Growth of these cells also remained sensitive to tamoxifen and cisplatin. In conclusion, drug-induced changes in ER expression and binding capacity do not necessarily indicate a loss of sensitivity of breast cancer cells to a subsequent chemotherapeutic treatment.

Single and double overexpression of C(4)-cycle genes had differential effects on the pattern of endogenous enzymes, attenuation of photorespiration and on contents of UV protectants in transgenic potato and tobacco plants

To improve the efficiency of CO(2) fixation in C(3) photosynthesis, C(4)-cycle genes were overexpressed in potato and tobacco plants either individually or in combination. Overexpression of the phosphoenolpyruvate carboxylase (PEPC) gene (ppc) from Corynebacterium glutamicum (cppc) or from potato (stppc, deprived of the phosphorylation site) in potato resulted in a 3-6-fold induction of endogenous cytosolic NADP malic enzyme (ME) and an increase in the activities of NAD-ME (3-fold), NADP isocitrate dehydrogenase (ICDH), pyruvate kinase (PK), NADP glycerate-3-P dehydrogenase (NADP-GAPDH), and PEP phosphatase (PEPP). In double transformants overexpressing cppc and chloroplastic NADP-ME from Flaveria pringlei (fpMe1), cytosolic NADP-ME was less induced and pleiotropic effects were diminished. There were no changes in enzyme pattern in single fpMe1 overexpressors. In cppc overexpressors of tobacco, the increase in endogenous cytosolic NADP-ME activity was small and changes in other enzymes were less pronounced. Determinations of the CO(2) compensation point (Gamma*) as well as temperature and oxygen effects on photosynthesis produced variational data suggesting that the desired decline in photorespiration occurred only under certain experimental conditions. Double transformants of potato (cppc/fpMe1) exhibited the most consistent attenuating effect on photorespiration. In contrast, photorespiration in tobacco plants appeared to be diminished most in single cppc overexpressors rather than in double transformants (cppc/fpMe1). In tobacco, introduction of the PEP carboxykinase (PEPCK) gene from the bacterium Sinorhizobium meliloti (pck) had little effect on photosynthetic parameters in single (pck) and double transformants (cppc/pck). In transgenic potato plants, increased PEPC activities resulted in a decline in UV protectants (flavonoids) in single cppc or stppc transformants, but not in double transformants (cppc/fpMe1). PEP provision to the shikimate pathway inside the plastids, from which flavonoids derive, might be restricted only in single PEPC overexpressors.

Distribution of the outer membrane haem receptor protein ChuA in environmental and human isolates of Escherichia coli

ChuA, the haem receptor of Escherichia coli, is thought to contribute to the pathogenicity of E. coli strains causing extraintestinal infections. We investigated the prevalence and distribution of chuA in E. coli analysing 304 strains from different origins. 30% of E. coli strains isolated from the environment and about 70% of E. coli strains isolated from human sources carried chuA. No difference in chuA prevalence was found between commensals isolated from the intestine of healthy volunteers and isolates from extraintestinal infections. Our results indicate that ChuA might be involved in the colonization of human hosts.

Dynamic changes in cerebral oxygenation related to deep hypothermia and circulatory arrest evaluated by near-infrared spectroscopy

BACKGROUND

Total circulatory arrest in deep hypothermia, which is used in corrective surgery of complex cardiovascular malformations, has been said to cause brain injury. Near-infrared spectroscopy (NIRS) is a new non-invasive method that potentially monitors changes in cerebral oxygenation and tissue oxygen utilisation. The aim of this experimental study in rabbits was to evaluate the change in intravascular and intracellular oxygenation patterns during cooling, deep hypothermic circulatory arrest and rewarming using a commercially available NIRS-cerebral oximeter.

METHODS

Ten New Zealand White male rabbits (weight, 3.1+/-0.25 kg BW) were included in this study. All animals underwent cardiopulmonary bypass (CPB), cooling to a rectal temperature below 15 degrees C, 60 min of deep hypothermic circulatory arrest (DHCA) followed by reperfusion and rewarming. Cerebral oxyhaemoglobin (HbO2), deoxyhaemoglobin (HHb) and cytochrome oxidase aa3 (CytOxaa3) concentrations were continuously measured during the entire procedure using the Cerebral RedOx Monitor 2020 (Criticon cerebral redox monitor 2020, Johnson & Johnson Medical). Total haemoglobin concentration (tHb) and regional cerebral oxygen saturation (rSO2) values were calculated by integrated algorithm.

RESULTS

In all animals an initial increase of oxygenated haemoglobin (HbO2, rSO2) and a fall in deoxygenated haemoglobin (HHb) were found during cooling on bypass. A slight decrease in CytOxaa3 signal was observed in response to initial cooling. Variation in intravascular haemoglobin oxygenation parameters (HbO2, HHb) were related to haemodynamic changes associated with fluid loading, initiation and termination of CPB, bypass flow rate and cooling and rewarming. When the pump flow was stopped all NIRS parameters, except the HHb value, decreased precipitously during the DHCA-period (P<0.01). After reperfusion and rewarming, all haemoglobin oxygen saturation readings returned nearly to pre-CPB levels (P=0.09), but the CytOxaa3 was still significantly lower than the pre-CPB levels (P<0.05).

CONCLUSION

The change in the NIRS-derived haemoglobin oxygenation parameters may reflect physiological changes in systemic and cerebral haemodynamics. CytOxaa3 values may represent related effects on cellular oxygenation. Thus, continuous, real-time NIRS-monitoring may identify critical periods with inadequate brain tissue oxygenation, particularly during DHCA. The neurological implications of the observed changes in NIRS oxygenation parameters, however, require further quantitative morphological evaluation of the brain in animals surviving a longer reperfusion and observation period.

Secretory IgA, free secretory component and IgD in saliva of newborn infants

AIM

To determine levels of secretory IgA (sIgA), free secretory component (FSC) and IgD in saliva of newborn infants at the age of 1 day and to evaluate the detection patterns, the influence of saliva flow and the relation to serum derived proteins.

METHODS

Seventy-three healthy newborn infants were studied. Saliva was obtained from the bottom of the mouth and buccal sulci using a sterile polyethylene tube connected to a syringe. SIgA, FSC, IgD and albumin were measured by radial immunodiffusion.

RESULTS

SIgA was detected in 74.0% of all saliva samples, whereas detection rates for FSC and IgD were 94.5% and 75.3%, respectively. Investigation of detection patterns and their relation to saliva flow indicated that secretion of sIgA and FSC into the oral cavity is under similar regulation. Levels of IgD were found to be independent from saliva flow, as well as from concentrations of serum-derived proteins suggesting different regulative mechanisms compared to sIgA and FSC. The flow rate of unstimulated whole saliva in newborn infants was found to be 15 times lower compared to adolescents, emphasizing the role of saliva flow as a limiting factor for secretion of sIgA and FSC.

CONCLUSION

SIgA, FSC and IgD can be determined in saliva of newborn infants even in the first day of life. The saliva flow rate has to be considered when evaluating the function and biological relevance of the oral mucosal immune system of newborn infants shortly after birth.

TSPY variants in six loci on the human Y chromosome

We have studied the structure, organization, and evolution of the human TSPY gene family by mapping three sequence variants identified through RT-PCR analysis onto genomic clones derived from two different YAC contigs. TSPY gene family members occur in at least six locations on the human Y chromosome, and each cluster contains a unique combination of variants. Our data further suggest that an 18-bp tandem duplication found in TSPY exon 1 originated from an unequal sister chromatid exchange between two tandemly arranged TSPY clusters.

Molecular evolution of the murine tspy genes

Molecular aspects of murine evolution were studied by sequencing, and subsequently comparing, introns of the Y-chromosomal tspy genes from Apodemus agrarius, A. sylvaticus, A. flavicollis, Mus platythrix (subgenus Pyromys), M. booduga (subgenus Leggada), and from species of the subgenus Mus, including M. cervicolor, M. macedonicus and M. spretus. Estimates of nucleotide substitution rates in these lineages were in perfect agreement with phylogenetic data previously published by She et al. (1990), Catzeflis et al. (1992; 1993), and Lyon et al. (1996). The only exception was provided by a comparatively late divergence of M. spretus and M. macedonicus. Our data also suggest that M. booduga diverged from the subgenus Mus about 3 Myr ago.