Is It Worth Considering Colonic Evaluation After Appendicectomy?

Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by mass at the base of the appendix. There have been no national recommendations or guidelines for follow-up with patients aged 40 and older after an emergency appendicectomy. The purpose of this study was to evaluate the prevalence of caecal and colonic cancer or polyps in patients over the age of 40 who have undergone an appendicectomy. This shall enable us to develop the necessary strategies to investigate and diagnose associated caecal and colonic pathology in acute appendicitis to prevent delayed diagnosis of colon cancer. Methods All patients who underwent appendicectomy between October 2011 and October 31, 2021, and who were 40 years of age or older were included in this retrospective cohort study. Patients aged 40 to 54 years old and patients 55 years or older underwent subgroup analyses. We looked at any investigations of the colon (CT pneumocolon or colonoscopy) within three years before the appendicectomy or three years after an appendicectomy. All colorectal cancers diagnosed within five years of the index episode of appendicitis were included in the analysis. Results A total of 1076 appendicectomies were performed on patients aged 40 and older during the study period of 10 years. A total of 769 patients were confirmed to have appendicitis on histology. One hundred and fifty-seven patients had colonic investigations within three years of the diagnosis of acute appendicitis. In our study, 51 of the 769 patients (6.63%) were found to have colorectal neoplasms. Eight patients (8/769, 1.04%) were diagnosed with colorectal cancers, and the occurrence of caecal cancer was 0.26% (2/769). The mortality rate was 75% (6/8) in these patients diagnosed with colorectal cancer. Four out of six died due to advanced metastatic colonic cancer. In comparison to patients aged 40 to 54, patients over the age of 55 had a statistically significant increased risk of caecal pathology (polyp and cancer) (p = 0.07). Conclusion There seems to be an increased risk of significant colorectal neoplasm in patients over the age of 55 who are admitted with acute appendicitis, and there appears to be an increased severity with a poor prognosis of cancer in these individuals. We recommend the use of routine colonoscopy or CT pneumocolon, particularly for those over the age of 55 who present with acute appendicitis or the histology of appendicular neoplasms.

Effects of a large wildfire on vegetation structure in a variable fire mosaic

Management guidelines for many fire-prone ecosystems highlight the importance of maintaining a variable mosaic of fire histories for biodiversity conservation. Managers are encouraged to aim for fire mosaics that are temporally and spatially dynamic, include all successional states of vegetation, and also include variation in the underlying "invisible mosaic" of past fire frequencies, severities, and fire return intervals. However, establishing and maintaining variable mosaics in contemporary landscapes is subject to many challenges, one of which is deciding how the fire mosaic should be managed following the occurrence of large, unplanned wildfires. A key consideration for this decision is the extent to which the effects of previous fire history on vegetation and habitats persist after major wildfires, but this topic has rarely been investigated empirically. In this study, we tested to what extent a large wildfire interacted with previous fire history to affect the structure of forest, woodland, and heath vegetation in Booderee National Park in southeastern Australia. In 2003, a summer wildfire burned 49.5% of the park, increasing the extent of recently burned vegetation (<10 yr post-fire) to more than 72% of the park area. We tracked the recovery of vegetation structure for nine years following the wildfire and found that the strength and persistence of fire effects differed substantially between vegetation types. Vegetation structure was modified by wildfire in forest, woodland, and heath vegetation, but among-site variability in vegetation structure was reduced only by severe fire in woodland vegetation. There also were persistent legacy effects of the previous fire regime on some attributes of vegetation structure including forest ground and understorey cover, and woodland midstorey and overstorey cover. For example, woodland midstorey cover was greater on sites with higher fire frequency, irrespective of the severity of the 2003 wildfire. Our results show that even after a large, severe wildfire, underlying fire histories can contribute substantially to variation in vegetation structure. This highlights the importance of ensuring that efforts to reinstate variation in vegetation fire age after large wildfires do not inadvertently reduce variation in vegetation structure generated by the underlying invisible mosaic.

Two tails of the normal curve. Similarities and differences in the study of mental retardation and giftedness

Professionals in the fields of mental retardation and giftedness have much to teach each other as well as the field of human development in general. Examining the commonalities and differences between the fields in social issues, definitions, developmental differences from the norm, values and policy issues, and educational and long-term implications deepens insights about both normal and deviant development. The authors stress the importance of individual differences in the differential design of educational strategies and the application of approaches developed with specialized populations to normally developing children. Current social inequalities affect both of these fields in particular ways. Finally, numerous research agendas can be enhanced by including representatives of both ends of the normal curve.

Transvenous pacing lead-induced thrombosis: a series of cases with a review of the literature

Although transvenous pacing is a safe treatment modality for bradyarrhythmias, serious thrombotic and embolic complications are reported to occur in 0.6-3.5% of cases. We describe 5 cases of pacemaker-associated thrombosis, 3 with a superior vena cava syndrome (SVC), 1 with an axillary vein thrombosis and 1 with a thrombus attached to the pacing lead in the right atrium. All of the patients were initially treated with intravenous heparin which proved successful as the sole treatment in only the least severe case (axillary vein thrombosis). One of the patients with SVC obstruction was successfully treated with intravenous heparin followed by thrombolytic therapy. The remaining 3 cases (2 SVC syndromes and 1 right atrial thrombus) required surgical removal of thrombus and pacing leads. Both of the patients with evidence of infection were in the group for whom failure of medical therapy necessitated surgery.

Angiographic and clinical restenosis following the use of long coronary Wallstents

This study assessed clinical and angiographic restenosis following the deployment of the long coronary Wallstent. Between May 1995 and June 1997, 182 Wallstents were deployed in 162 vessels in this unit. Forty-eight percent had an unstable coronary syndrome and 94% had AHA grade B or C lesions. The mean lesion length was 37 +/- 20 mm and the mean stent length was 48 +/- 20 mm. The procedural success rate was 99% and the primary success rate was 93%. Six in-patients suffered subacute stent thrombosis, the majority being in the era of anticoagulation rather than antiplatelet regimes. Seventy-three percent remained free of major adverse clinical events in the follow-up period, but 41% had angiographic restenosis. The Wallstent can be deployed in complex lesions with a high primary success rate and an acceptably low restenosis rate. The optimal management of in-stent restenosis remains to be defined.

Induction of myocardial nitric oxide synthase by Coxsackie B3 virus in mice

BACKGROUND

Inducible nitric oxide synthase (iNOS) expression is regulated by cytokines. This study investigated whether Coxsackie group B virus (CVB) myocarditis resulted in an environment suitable for induction of NOS in the murine heart.

MATERIALS AND METHODS

Myocardium was removed from mice infected with CVB3 and from controls. Histology, reverse transcriptase polymerase reaction (RT-PCR) for murine iNOS, NOS enzyme activity and immunohistochemistry were assessed.

RESULTS

Histology revealed severe myocarditis 7 days after infection with CVB3 but not in controls. RT-PCR using primers for murine iNOS detected iNOS mRNA in infected mice but not in controls. Calcium-independent NOS activity increased by day 5 after infection with a peak at day 7. Calcium-dependent NOS activity was present throughout, with a trend to lower levels during peak calcium-independent activity. Immunohistochemistry revealed iNOS to be localized to inflammatory cells rather than to myocytes.

CONCLUSION

This study demonstrates the development of calcium-independent NOS activity and de novo gene transcription for iNOS in the murine myocardium in response to CVB3 infection. The nitric oxide produced at such high output may act at times as part of the immune defence as an antiviral agent and may be toxic to host tissue.

Long-term follow-up of a true contractile left ventricular diverticulum

The natural history of contractile left ventricular diverticulum in the adult is not known. Serial left ventricular angiography in an adult revealed that a left ventricular diverticulum did not increase in size over a 13-year period, suggesting that the clinical course may be benign.

Characterization of Coxsackie B virus RNA in myocardium from patients with dilated cardiomyopathy by nucleotide sequencing of reverse transcription-nested polymerase chain reaction products

This study was performed to detect and characterize the enterovirus present in myocardium of some patients with heart muscle disease by nucleotide sequencing of polymerase chain reaction (PCR) products after amplification with enterovirus group-specific primers. Enterovirus sequences have been detected previously in myocardium of patients with myocarditis or dilated cardiomyopathy and seem causal, although the particular virus serotypes involved have not been identified. In a prospective study of endomyocardial biopsy specimens from 35 consecutive patients with suspected heart muscle disease, enterovirus sequences from the 5' nontranslated region were amplified by reverse transcription-nested PCR using group-specific primers. This region contains both conserved and variable sequence motifs, characteristic of particular enterovirus serotypes. The nucleotide sequences of individual PCR products were determined by cycle sequencing and compared with all known sequences (GenBank/EMBOL), using the GCG software package. Endomyocardial biopsy specimens from 9 of 21 (42.9%) patients with a histologically confirmed diagnosis of dilated cardiomyopathy were positive for enterovirus by PCR, compared with only 1 of 14 (7.1%) patients with other myocardial pathological conditions (Fisher's exact probability=0.0275: odds ratio=9.75; 95% confidence interval=1.31-72.78). The nucleotide sequence of the PCR products differed, indicating no cross-contamination. However, computerized comparison showed that each had greatest homology with the 5' nontranslated region of Coxsackie B virus but contained up to 11% sequence variations compared with the prototype Coxsackie B3 strain Nancy. Parallel investigation of tissue from our mouse model of Coxsackievirus B3-induced myocarditis showed that nucleotide sequence changes are not introduced by reverse transcription or PCR. These data support the link between enteroviral infection and dilated heart muscle disease and suggest that Coxsackie B serotypes are the enteroviruses most frequently involved.

Instantaneous lead entrapment: successful percutaneous removal using the cook workstation

An unusual complication of transvenous endocardial lead placement is reported in which an electrode became entrapped within the vicinity of the tricuspid valve apparatus, resisting all initial attempts at removal. The lead was subsequently successfully removed percutaneously via the right femoral vein.

Induction and role of NO synthase in hypotensive hepatic failure

Nitric oxide (NO) plays an important role in the physiological and pathophysiological control of the vascular system. NO is synthesized by isoforms of the enzyme NO synthase (NOS). Hepatic failure is complicated by hypotension, low systemic vascular resistance, and resistance to vasoconstrictor drugs. The potential role of NO in these abnormalities was investigated by using in vitro pharmacological interventions on hepatic arteries obtained from both donor and recipient patients at the time of liver transplantation. The presence of NOS mRNA was investigated by reverse transcription polymerase chain reaction (RT-PCR) with primers designed from human endothelial NOS (eNOS) and inducible NOS (iNOS) cDNA sequences. Arteries from patients with hepatic failure had an impaired constrictor response to phenylephrine compared with those of donor arteries. The constrictor effect of phenylephrine was potentiated by NG-monomethyl-L-arginine, an inhibitor of NOS, which had no effect in donor control arteries. RT-PCR identified human eNOS mRNA in donor and recipient arteries and human iNOS mRNA in recipient arteries only. Induction of NOS in the vasculature with subsequent NO-induced vasodilatation may therefore contribute to the hemodynamic abnormalities observed in hepatic failure and potentially in other pathologies associated with endotoxemia. Whether selective inhibitors of iNOS will improve hemodynamic control or clinical outcome in these conditions requires further study.

Inducible nitric oxide synthase gene transcription and protein activity in the rat heart during endotoxaemia

Septicaemia leads to an impairment of myocardial contractility in animals and humans. Cytokines released during endotoxaemia are capable of increasing inducible nitric oxide synthase (iNOS) expression in vitro in myocytes, endothelial cells and macrophages. The aim of this study was to assess whether iNOS gene transcription occurs in the myocyte in vivo. Rats were injected with intraperitoneal endotoxin. Myocardial sections obtained 4, 6 and 8 hours after infection were hybridised with oligonucleotides complementary to iNOS cDNA. Myocardial homogenates were used to measure NOS enzyme activity and to detect iNOS mRNA. Uninfected control animals did not demonstrate myocardial iNOS expression. Myocardium from endotoxaemic animals contained iNOS mRNA and high calcium-independent NOS enzyme activity. In situ hybridisation did not localise iNOS to myocytes but to cells located between myocytes. Endotoxaemia leads to iNOS gene transcription and calcium-independent NOS enzyme activity in the rat myocardium. In situ hybridisation demonstrates that iNOS is not transcribed by the myocyte in vivo.

Atrial and pulmonary mass: intracardiac thrombus mimicking myxoma on multiplane transesophageal echocardiography

Transesophageal echocardiography is the method of choice for investigating suspected intracardiac masses. It also plays a valuable role in the detection of central pulmonary artery embolism. We present a case that highlights the use of transesophageal echocardiography for imaging of a mass in the right atrium and the right pulmonary artery.

Electrical injury to the heart may cause long-term damage to conducting tissue: a hypothesis and review of the literature

Electrical injury, particularly alternating current, may lead to disease of conducting tissue, myocardial damage or may cause sudden cardiac death. Subtle abnormalities, particularly of sinus node function, may pose diagnostic difficulties and may not present for many years. The long-term follow-up of patients, perhaps as part of a registry, will help to define the clinical spectrum of cardiac presentations of electrical injury.

Spontaneous haemothorax as a complication of anti-coagulation following coronary angioplasty

Haemorrhagic complications are well recognized when heparin is used during percutaneous transluminal coronary angioplasty (PTCA). We present a 74-year-old female who developed a large acute spontaneous haemothorax 20 h after coronary angioplasty. Spontaneous haemothorax has rarely been described and is predominantly associated with pulmonary embolism. In the absence of a pulmonary embolus, a spontaneous haemothorax during anti-coagulation has only been described twice in the world literature since 1862 (1). This is the first description of this complication following the use of heparin during PTCA.

Comparison of clinical outcome after elective and "bail out" coronary stent insertion

BACKGROUND

Coronary stents may be used electively during percutaneous transluminal coronary angioplasty (PTCA) or as a "bail-out" device to treat abrupt or threatened vessel closure following PTCA.

OBJECTIVE

To compare the clinical outcome of elective and "bail-out" coronary stent insertion.

DESIGN

A retrospective analysis of all patients receiving coronary stents.

SETTING

Tertiary referral center performing over 400 PTCA procedures a year.

PATIENTS

Fifty-six patients (42 male), mean age 57 (range = 32 to 78) years received 67 Palmaz-Schatz coronary stents. Forty-nine stents were deployed as "bail-out" in 41 patients (abrupt vessel closure in 15 and threatened vessel closure in 26) and 18 stents were deployed electively in 15 patients.

MAIN OUTCOME MEASURES

Myocardial infarction, repeat angiography, coronary artery bypass graft surgery and death.

RESULTS

Stents were successfully deployed in 56/62 (90.3%) patients. In-hospital events were significantly more common in the "bail-out" group compared to the elective group. The in-hospital events, comparing the "bail-out" group versus the elective group, were as follows: Death 2/41 (4.9%) vs 0/15 (0%), coronary artery bypass graft surgery (CABG) 8/41 (19.5%) vs 0/15 (0%), stent thrombosis 3/41 (7.3%) vs 0/15 (0%), and myocardial infarction 6/41 (14.6%) vs 1/15 (6.7%) respectively. After discharge no patient died or had CABG. One patient in the "bail-out" group had a myocardial infarct (late stent thrombosis). Two patients from each group had repeat angiography because of recurrent angina in the 6 month follow up period.

CONCLUSION

"Bail-out" stenting has an increased incidence of in-hospital complications compared to elective procedures. If these short-term problems can be overcome however, the clinical events in the first 6 months after leaving hospital are low and similar to patients under-going elective procedures.

The value of transthoracic echocardiography during percutaneous balloon mitral valvuloplasty

Percutaneous balloon mitral valvuloplasty is a standard alternative to surgery in a selected group of patients with symptomatic dominant rheumatic mitral stenosis. With careful transthoracic and transesophageal echocardiographic selection of patients, there is a low complication and high success rate. Echocardiography has also been established as extremely useful in the long-term follow-up of patients. We present four cases that highlight our view that transthoracic echocardiography should be performed during the procedure, after each balloon inflation, and before and after the intervention. In our experience transthoracic echocardiography during balloon mitral valvuloplasty is invaluable in assessing commissural separation, increasing mitral valve area, new mitral regurgitation, and occasional unexpected anatomic sequelae of balloon inflation.

Long-term developmental follow-up of infants of diabetic mothers

The neurodevelopmental consequences of maternal insulin-dependent diabetes were studied in 109 infants of diabetic mothers and 90 control infants. The infants born to diabetic mothers included 70 "early entry" subjects and 39 "late entry" subjects. Maternal diabetes control during pregnancy was significantly better in "early entry" mothers than in late-entry mothers, as determined by glycosylated hemoglobin levels. Infants were examined by a psychologist and a developmental pediatrician unaware of group status at 6, 12, 24, and 36 months of age; 71% of the subjects completed the 3-year-study. Neurodevelopment of early-entry subjects was similar to that of control subjects, whereas late-entry subjects scored less well on language measures. Mean head size in late-entry subjects was significantly less (p = 0.03) than in either control subjects or early-entry subjects at age 3 years, and correlated negatively with glycosylated hemoglobin levels during all three trimesters. Less optimal intellectual development was associated with reduced head circumference. In addition, the presence of major congenital malformations was associated with reduced developmental performance through age 2 years. Our results indicate that mothers with insulin-dependent diabetes who maintain good control during pregnancy can expect to have infants who are neurodevelopmentally normal; mothers whose diabetes is less well controlled may have infants with less optimal neurodevelopment.

Combination drug testing of Mycobacterium chelonae

PURPOSE

Medical therapy of Mycobacterium chelonae keratitis is difficult because there are so few effective antimicrobial agents and single agent therapy frequently fails clinically. To identify more effective medical treatment regimens, the in vitro antimicrobial efficacy of amikacin, the most frequently used single agent, was investigated in combination with four antibiotics previously reported to have activity against M. chelonae: erythromycin, imipenem, ciprofloxacin, and vancomycin.

METHODS

The drug combinations were tested by the checkerboard method against seven corneal isolates of M. chelonae.

RESULTS

The combination of amikacin with erythromycin or vancomycin consistently led to synergistic or additive effect, however the minimum inhibitory concentrations for vancomycin were very high. The combination of amikacin with imipenem or ciprofloxacin led to results ranging from antagonism to additive effects.

CONCLUSIONS

Of the antibiotics tested, erythromycin showed the most activity against M. chelonae in combination with amikacin. In vitro combination drug testing of M. chelonae by the checkerboard method should be further evaluated for clinical relevance in microbial keratitis.

The solubility of antibiotic and corticosteroid combinations

The use of collagen shields soaked in various combinations of medications has been advocated to enhance drug delivery to the cornea. Recently, severe corneal toxicity associated with aggregate formation in mixtures of gentamicin and methylprednisolone prompted our study of the effect of drug concentration, pH, and temperature on the solubility of several antibiotic and corticosteroid formulations commonly used to treat ocular disease. Selected combinations of cefazolin, vancomycin, tobramycin, gentamicin, methylprednisolone, and dexamethasone were evaluated. Mixtures of tobramycin and vancomycin produced no precipitates, but many spheroid aggregates were seen when methylprednisolone and gentamicin were combined. Although the effects of precipitate formation on drug bioavailability and toxicity have not been fully determined, until such information is available, the use of combinations of drugs that remain in solution during administration is recommended.

Infectious crystalline keratopathy caused by Candida albicans

Two patients developed corneal opacities resembling infectious crystalline keratopathy. Predisposing factors included a recent corneal transplant with suture replacement in one patient and postradiation keratoconjunctivitis with disposable therapeutic contact-lens wear in the other patient. Both patients were using a topically applied corticosteroid and an aminoglycoside antimicrobial. Smears of corneal scrapings showed numerous yeasts without inflammatory cells. Culturing yielded Candida albicans and Staphylococcus haemolyticus in the first case and C. albicans and S. epidermidis in the second case. Combined antifungal and antimicrobial therapy, with initial withdrawal of corticosteroid use, was effective. The microbial cause of pauci-inflammatory keratitis includes not only viridans streptococci and other bacteria but fungi as well.

In vitro evaluation of antimicrobial compounds for cysticidal activity against Acanthamoeba

Amebic keratitis presents a therapeutic dilemma because Acanthamoeba, unlike Naegleria, encysts in infected tissues. To date, the results of medical therapy have been disappointing, and the optimal medical regimen for acanthamoeba keratitis is yet to be defined. Clinical cure necessitates eradication of the encysted amebae with medications known to have ocular toxic effects in combination with surgical maneuvers. Antiinfective agents possessing in vitro cysticidal activity include paromomycin, neomycin, ketoconazole, natamycin, and ciclopirox olamine, but no agent has been shown to be uniformly effective against all isolates of Acanthamoeba. Treatment of amebic cysts with propamidine isethionate plus either paromomycin or neomycin has produced slightly additive cysticidal effects. Multiple factors, including the varied clinical presentation and the lack of standardized in vitro techniques for the assay of cysticidal activity, account for the lack of correlation between in vitro activity and in vivo efficacy.

Comparison of acridine orange and Gram stains in bacterial keratitis

We assessed the comparative sensitivities of acridine orange and Gram stains in the examination of corneal scrapings using an experimental model of Pseudomonas aeruginosa keratitis. Acridine orange was more sensitive than Gram stain, requiring concentrations of about 10(4) colony-forming units/mg of corneal tissue compared to approximately 10(5) colony-forming units/mg. Our clinical experience with 21 consecutive cases of suspected microbial keratitis showed a similar diagnostic accuracy of acridine orange and Gram stain. Acridine orange accurately predicted culture results in 15 of 21 specimens (71%) compared to a diagnostic accuracy of 62% (13 of 21 specimens) for Gram stain.

Fungal keratitis in contact lens wearers

In a retrospective review from 1972 through 1987 of patients with microbial keratitis, fungal infection occurred in four (4%) of 90 cosmetic or aphakic contact lens wearers and in four (27%) of 15 patients using a therapeutic soft contact lens. Predisposing factors included improper lens care by the refractive lens wearers and a chronic epithelial defect with topical corticosteroid use among the therapeutic lens wearers. The responsible organisms in the refractive lens group were Fusarium solani (two patients) and Cephalosporium and Paecilomyces (one patient each), and in the therapeutic lens group Candida (three patients) and Aspergillus (one patient). Filamentous fungi were more likely to be associated with cosmetic or aphakic lens wear, whereas yeasts were more frequently found with therapeutic lens use.

Rapid diagnosis of Acanthamoeba keratitis using calcofluor white

Calcofluor white (CFW) is a chemofluorescent dye with an affinity for the polysaccharide polymers of amebic cysts. Using CFW staining with fluorescent microscopy, we demonstrated amebic cysts in corneal scrapings and keratectomy specimens from four patients with culture-proved Acanthamoeba keratitis and from one in whom CFW was the only positive laboratory test. Calcofluor white staining is simple, rapid, and highly reliable in the diagnosis of Acanthamoeba keratitis.

Conjunctival cytology of adult chlamydial conjunctivitis

We assessed the diagnostic value of ocular cytologic examination by reviewing Giemsa-stained smears of conjunctival scrapings. Of 387 patients with a clinical diagnosis of adult chlamydial conjunctivitis, intracytoplasmic inclusions were found in 30 (8%). Both polymorphonuclear leukocytes and lymphocytes were common; the predominant cell type was not useful to differentiate chlamydial from adenoviral conjunctivitis. More sensitive cytologic features included the presence of plasma cells, Leber cells, blastoid cells, and multinucleated cells. Giemsa-stained conjunctival cytologic examination can provide a useful method to support the clinical diagnosis and to direct further laboratory testing.

Improved detection of oculomycoses using induced fluorescence with cellufluor

Cellufluor, a fluorochrome with affinity for chitin and cellulose, was retrospectively compared to gram and giemsa stains for detection of human oculomycoses. From culture-proven specimens, this chemofluorescent stain detected hyphae or yeasts on 50% of smears previously considered negative. Cellufluor is a useful adjunct in the detection and confirmation of fungal elements from ocular specimens.

Neuromotor development of graduates of the neonatal intensive care unit: patterns encountered in the first two years of life

The neurodevelopmental course of 219 Neonatal Intensive Care Unit graduates followed prospectively over 2 years was determined on retrospective chart review. Mild neuromotor abnormalities during the first year were identified in 50%, three-quarters of which proved transient with normal development at 2 years of age. Moderate abnormalities were identified in 7%, half of which proved transient. Severe neuromotor abnormalities were identified in 20%, two-thirds of whom had cerebral palsy at 2 years. Persistent noncerebral palsy neuromotor abnormalities remained in one-third of those in the severe abnormality group, one-half of those in the moderate abnormality group, and one-quarter of those in the mild abnormality group. As birthweight decreased, the incidence of always normal development and transient neuromotor abnormalities decreased while the incidence of persistent neuromotor abnormalities increased. Small for gestational age infants demonstrated a slightly higher incidence of persistent abnormalities than their appropriate for gestational age counterparts. No significant sex differences were observed.

Antifungal sensitivity testing for equine keratomycosis

We evaluated 31 fungal specimens obtained from equine corneas over a 10-year period, 1973 to 1983. More than half were received in late summer and early autumn, and the number tended to increase in frequency during the 1980s. These isolates included 13 different genera and 20 different species. The prevalent genus was Aspergillus (35%). On the basis of examinations for tube-dilution minimal inhibitory concentrations and minimal fungicidal concentrations of 16 fungal isolates, the imidazole antibiotics such as miconazole and ketoconazole consistently showed the lowest geometric mean titers for filamentous fungi. Because fungal sensitivities varied considerably among different species in vitro sensitivity testing is suggested as an aid in the determination of optimal therapy.

Predictive validity of the "Movement Assessment of Infants"

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washington's Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.

Social interaction and developmental competence of preterm and full-term infants during the first year of life

37 mother-preterm and 42 mother-full-term infant pairs were assessed at 1, 4, 8, and 12 months following hospital discharge. The psychosocial functioning of the families was assessed at 1 and 8 months by interview, infants received developmental assessments at 4 and 12 months, and mother-infant interactions were observed in unstructured and semistructured situations at 4, 8, and 12 months. Significant differences were found in both mothers' and preterm infants' interactive behavior across the first year of life, extending the findings of previous research that had noted differences during early infancy. Additionally, preterms performed significantly below full-terms on measures of cognitive and language development corrected for gestational age. Results are discussed in terms of the persistence of interactive differences in mother-preterm pairs and the possible effects on their relationship and infant developmental outcome.

Growth and development of infants weighing less than 800 grams at birth

A prospective study of infants weighing less than 800 g at birth and cared for in a single neonatal intensive care unit between 1977 and 1980 was conducted. Neonatal mortality was 80%; neurodevelopmental outcome was assessed in 16 of the 18 survivors. Mean birth weight for these 16 was 730 g; mean gestational age was 26 weeks. Perinatal asphyxia, respiratory distress, apnea, mechanical ventilation, and chronic pulmonary disease were commonplace. Symptomatic intracranial hemorrhage, seizures, sepsis, or meningitis did not occur in survivors. Of the 16 infants, 13 (81%), including all three with birth weight less than 700 g, were without major CNS handicaps and were developing appropriately at 6 months to 3 years of age. Only one of the 16 had clearly subnormal mental development. None had a major visual or hearing impairment. Apgar scores at one and five minutes were significantly related to outcome; apnea, mechanical ventilation, and chronic pulmonary disease were not. These data suggest that a remarkably hopeful outcome is possible for the few survivors of extremely low birth weight.

Effects of stress and social support on mothers and premature and full-term infants

This study examined the relationships of stress and social support to maternal attitudes and early mother-infant interactive behavior. 52 mother-premature infant pairs and 53 mother-full-term infant pairs were seen for structured home interviews at 1 month, and behavioral interactions at 4 months. Maternal life stress, social support, life satisfaction, and satisfaction with parenting were assessed at the 1-month home visit. Although no group differences were found, both stress and support significantly predicted maternal attitudes at 1 month and interactive behavior at 4 months when data were pooled. Mothers with greater stress were less positive in their attitudes and behavior, while mothers with greater support were significantly more positive. Intimate support proved to have the most general positive effects. Additionally, social support moderated the adverse effects of stress on mother's life satisfaction and on several behavioral variables. Maternal social support was further found to have several significant effects on infant interactive behavior. Results are discussed in terms of the ecological significance of social support to parenting and infants' early development.

Mortality in infants discharged from a neonatal intensive care unit

In a three-year period, 3.8% (43) of 1,123 infants discharged from one neonatal intensive care unit (NICU) subsequently died, the vast majority before 1 year of age. Sudden infant death syndrome was responsible for 28% of the deaths, congenital heart disease for 25% of the deaths, chronic lung disease for 16%, and trauma, infections, and chromosomal disorders each accounted for 5% of the deaths. Postdischarge death rates in the three-year study period remained stable, while infant mortality in the NICU decreased from 26.5% to 16.3%. This study suggests that decreasing mortality among infants treated in NICUs is not necessarily reflected in improved postdischarge death rates and that the vast majority of deaths in these infants are currently not preventable.

Hyaline membrane disease, birth weight, and gestational age. Effects on development in the first two years

Mean mental and motor developmental test scores (Bayley scales) at 4, 12, and 24 months of age were determined for 161 graduates of a neonatal intensive care unit during the period 1977 through 1979. Analysis of variance for our data showed significant effects of hyaline membrane disease (HMD) on mental and motor development at 4 months, but disappearance of these effects at 12 and 24 months of age. Conversely, birth weight was not significantly related to developmental performance at 4 months, but was strongly related to both mental and motor performance at 12 and 24 months of age. Gestational age was significantly related to mental performance at 24 months of age. No relationship was found between HMD and major CNS handicapping conditions; both birth weight and gestational age were highly related to the occurrence of neurologic handicaps. Of the three variables assessed, birth weight was the best predictor of neurodevelopmental outcome.

Azotobacter keratitis

Ten cases of Azotobacter keratitis were identified at the Baylor College of Medicine and Cullen Eye Institute, Houston, from 1972 to 1980. Azotobacter are large, pleomorphic, aerobic, Gram-negative rods of the family Azotobacteraceae. The genus comprises four species (A beijerinckii, A chroococcum, A paspali, and A vinelandii) that are found in soil and water throughout the world. To our knowledge, Azotobactger species have not previously been recognized as causing human, animal, or plant disease. On the basis of the similarity of the organisms, other cases of Azotobacter keratitis may have been identified erroneously as Moraxella species.

Spastic diplegia in premature infants. Etiologic and diagnostic considerations

To investigate the etiology of spastic diplegia (SD) of prematurity, we compared the prenatal, perinatal, and neonatal course of 18 preterm infants with SD to that of a control group of preterm infants without SD. No significant differences between the group with SD and the control group were found in most of the perinatal and neonatal factors analyzed. Significant differences were found in birth weight, birth head circumference, and the one-minute Apgar score. Controlling for gestational age, infants with SD weighed less at birth, had smaller heads, and were more often briefly neurologically depressed. Intracranial hemorrhage and neonatal seizures occurred significantly more often in infants with SD. Fifteen infants with SD were believed to be neurologically normal at the time of nursery discharge. These findings suggest the importance of prenatal factors in optimally treated preterm infants in whom SD develops.

Bacterionema matruchotii ocular infections

One case of endophthalmitis and two cases of corneal ulceration, each occurring in a structurally altered eye, were associated with Bacterionema matruchotii, a gram-positive filamentous bacillus.