Surgical area contamination--comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow

The effect of different head coverings on air-borne transmission of bacteria and particles in the surgical area was studied during 30 strictly standardized sham operations performed in a horizontal laminar air flow (LAF) unit. The operating team members wore disposable gowns plus either a non-sterile head covering consisting of a squire type disposable hood and triple laminar face mask, a sterilized helmet aspirator system or no head cover at all.In the wound area both types of head cover resulted in low and comparable air (means of 8 and 4cfu/m(3)) and surface contamination (means of 69 and 126cfu/m(2)/h) rates. Omission of head-gear resulted in a three- to five-fold increase (P > or = 0.01- 0.001), depending on site sampled air contamination rate (mean of 22cfu/m(3)) whereas the bacterial sedimentation rate in the wound area increased about 60-fold ( P > or = 0.0001). A proper head cover minimized the emission of apparently heavy particles that were not removed by the horizontal LAF and contained mainly streptococci, presumably of respiratory tract origin. Dust particle counts revealed no differences between the three experimental situations. No correlation between air and surface contamination rates or between air contamination and air particle counts was found.We conclude that, from a bacteriological point of view, disposable hoods of squire type and face masks are equally as efficient as a helmet aspirator system and both will efficiently contain the substantial emission of bacteria-carrying droplets from the respiratory tract occurring when head cover is omitted. Finally, the use of bacterial air counts to assess surgical site surface contamination in horizontal LAF units must be seriously questioned.     

TracheobronchiaI Clearance in Twins

Tracheobronchial clearance was studied with a lest aerosol of 6μ-7μ monodisperse fluorinated ethylene propylene (Teflon 120) particles tagged with technetium 99m (half-life, 6.0 hours) and external measurements of the radioactivity in the lungs. Nine pairs of monozygotic and nine pairs of dizygotic twins were studied. The clearance patterns in the monozygotic pairs were highly similar. In the dizygotic pairs there was a tendency to similarity. Among the pairs there was a remarkable difference in the clearance patterns, Consequently the result indicates that tracheobronchial clearance to a great extent is constitutionally determined. The medical implications of this are discussed.     

Differential regulation of muscarinic M1 receptors by orthosteric and allosteric ligands

Allosteric modulation of membrane receptors is a widespread mechanism by which endogenous and exogenous agents regulate receptor function. For example, several members of the nicotinic receptor family are modulated by physiological concentrations of extracellular calcium ions. In this paper, we examined conformational changes underlying this modulation and compare these with changes evoked by ACh. Two sets of residues in the α7 acetylcholine receptor extracellular domain were mutated to cysteine and analyzed by measuring the rates of modification by the thiol-specific reagent 2-aminoethylmethane thiosulfonate. Using Ba²⁺ as a surrogate for Ca²⁺, we found a divalent-dependent decrease the modification rates of cysteine substitutions at M³⁷ and M⁴⁰, residues at which rates were also slowed by ACh. In contrast, Ba²⁺ had no significant effect at N⁵²C, a residue where ACh increased the rate of modification. Thus divalent modulators cause some but not all of the conformational effects elicited by agonist. Cysteine substitution of either of two glutamates (E⁴⁴ or E¹⁷²), thought to participate in the divalent cation binding site, caused a loss of allosteric modulation, yet Ba²⁺ still had a significant effect on modification rates of these residues. In addition, the effect of Ba²⁺ at these residues did not appear to be due to direct occlusion. Our data demonstrate that modulation by divalent cations involves substantial conformational changes in the receptor extracellular domain. Our evidence also suggests the modulation occurs via a binding site distinct from one which includes either (or both) of the conserved glutamates at E⁴⁴ or E¹⁷².     

Use of directly acquired digital fundus and fluorescein angiographic images in the diagnosis of retinal disease

Direct on-line acquisition of digital fundus and fluorescein images is a useful alternative to conventional fundus photography. Immediately after acquisition, digital images may be electronically reassembled, manipulated, and displayed, avoiding the delays inherent in film development. Digital fundus images, conventional photographs, and fluorescein angiograms were obtained at the same sitting in 50 consecutive patients with retinal disease. Digital studies were displayed on a video monitor and diagnoses were made directly from the screen. The interpretations based on digital images alone were virtually identical to those made from photographs, although the resolution of digital images was not equal to that of the photographic images. Despite this disadvantage, the system proved extremely versatile, and for this reason, digital image acquisition was used to routinely document the retinal findings in the majority of the clinical patients.     

Analysis of expression of cholecystokinin in dopamine cells in the ventral mesencephalon of several species and in humans with schizophrenia.

The ventral mesencephalons of hamster, guinea pig, cat, monkey, and several humans with and without the diagnosis of schizophrenia were analyzed with in situ hybridization and immunohistochemistry. Extensive codistribution of cholecystokinin mRNA and tyrosine hydroxylase [L-tyrosine, tetrahydropteridine: oxygen oxidoreductase (3-hydroxylating), EC 1.14.16.2] mRNA was observed in cats and monkeys as well as in all five human subjects with the diagnosis of schizophrenia and in two out of five control brains. Double labeling revealed coexistence of the two markers in cat, monkey, and human. No cholecystokinin mRNA or cholecystokinin peptide was detected in the substantia nigra/ventral tegmental area of the hamster or guinea pig, even after acute and chronic neuroleptic treatment.     

Lower limb asymmetry and patellofemoral joint incongruence in the etiology of knee exertion injuries in athletes

The association between different knee exertion injuries and lower limb malalignments was studied in 121 male athletes with knee exertion injuries and in 20 male athletes without knee symptoms. The associations between different malalignments was also analyzed. Leg length inequality (LLI), knee valgus, and different indexes of patellofemoral joint congruence were measured using radiological methods. Male athletes with patellar apicitis (n = 59) had significantly more LLI (P less than 0.001) and patella alta (P less than 0.05) than athletes without knee symptoms. The knee valgus was of the same numerical value in the shorter and longer leg sides in subjects with LLI of at least 5 mm (n = 58). A positive correlation was found between lateral patellar displacement (LPD) and patella alta (LT/LP) (P less than 0.001). Negative correlations were found between the sulcus angle (SA) and the lateral patello-femoral angle (LPA) (P less than 0.001) as well as between the LPD and the LPA (P less than 0.001).     

Effects of phenylpropanolamine on ostial and nasal patency in patients treated for chronic maxillary sinusitis

Ostial and nasal patency were measured in different body positions and after phenylpropanolamine (Ppa) treatment in 12 patients earlier treated for chronic unilateral maxillary sinusitis of varying severity. Six of the sinuses were of normal appearance on sinoscopy. Phenylpropanolamine in a single dose of 100 mg was found to increase the equivalent ostial diameter significantly in the sitting and recumbent positions. The drug also reduced the nasal airway resistance. The Ppa effect might be of benefit in patients treated for chronic maxillary sinusitis.     

Subclavian flap angioplasty with absorbable suture polydioxanone (PDS). An experimental study in growing piglets

The fate of the subclavian flap in aortoplasty was studied and a new synthetic monofilament, absorbable vascular suture (polydioxanone, PDS) was evaluated. In 11 piglets submitted to the aortic repair, the diameter of the aortic arch and descending aorta and the length and width of the subclavian flap were measured. The aortoplasty was performed with a continuous running suture of 6/0 PDS. All the animals survived and grew normally. They were sacrificed 6-26 weeks postoperatively, when the mentioned variables were reestimated. No aortic narrowing was found and no suture material was detectable in the lumen. The subclavian flap had grown uniformly in length and width. Histologic examination showed evening of the inner surface by intimal proliferation and healing of the anastomoses. There was no sign of flap destruction and tissue reaction to PDS suture was minimal, indicating normal growth and viability in all parts of the flap. The suture material was absorbed 26 weeks postoperatively. Continuous suture with absorbable PDS seems to be a good alternative for repair of aortic coarctation in early infancy.