Percutaneous drainage of a tuberculous liver abscess

The authors describe the management by percutaneous drainage of a rare solitary tuberculous liver abscess in a 37-year-old woman. Open surgical drainage of such abscesses can be avoided using percutaneous drainage combined with transcatheter infusions of antituberculous agents. For the safe and successful use of this method three criteria must be met: the abscess should be unilocular, there must be a safe access route and a previously sterile compartment must not be contaminated. In addition a small (22 or 23 gauge) needle should be used for the initial puncture.     

Progesterone inhibition in mid-trimester termination of pregnancy: physiological and clinical effects

A double-blind, placebo controlled clinical trial was conducted to assess the clinical and physiological effects of 'epostane', a progesterone synthesis inhibitor, in mid-trimester prostaglandin termination of pregnancy. Mean peripheral progesterone levels had fallen by 74% after 72 h in the patients treated wtih epostane. The mean induction-abortion interval in the treatment group was 490 (SD 271) min, compared with 1432 (SD 640) min in the control group. Intrauterine pressure recording demonstrated increased sensitivity to prostaglandin E2 after epostane treatment but no change in oxytocin sensitivity. The clinical implications of facilitated induction of abortion are discussed.     

Convergence of occipital nerve and superior sagittal sinus input in the cervical spinal cord of the cat

Co-existence of facial and occipital pain may occur in occipital neuralgia, migraine and cluster headache; suggesting convergence of trigeminal and cervical afferents. Such convergence has been shown in humans and other animals, but the site and extent of this are uncertain. In anaesthetized adult cats, the superior sagittal sinus and occipital nerve were stimulated electrically, and extracellular recordings made in the dorsolateral area of the upper cervical cord using glass-coated tungsten electrodes. Of 49 units in 10 cats, 33 (67%) had input from the superior sagittal sinus and the occipital nerve. Thirteen (27%) had superior sagittal sinus input and 3 (6%) had occipital nerve input. Convergent receptive fields were identified mechanically in 7 units. These experiments in cats show convergent input from occipital nerve and superior sagittal sinus on dorsolateral area units in two-thirds of cases studied. This experimental site of trigeminocervical convergence may relate to referral of pain in occipital neuralgia and other headaches.     

Nonsteroidal anti-inflammatory drugs (NSAIDs) and the kidney

In patients with PG-dependent renal function, NSAID administration constantly reduces GFR and RBF in a dose-dependent fashion. In this situation, the risk of overt acute renal failure is high and should be taken into proper account. In contrast, the incidence of NSAID-related renal structural alterations appears to be very low, yet the absolute number of patients may be significant considering the wide use of such drugs. Concerning the antiproteinuric effect of NSAIDs, the unfavourable ratio risk/benefit does not seem to support their indication in proteinuric nephropathies. The development of PGHS-2 selective inhibitors is promising, and may open new therapeutical strategies in the treatment of the progression of renal disease.      

The bactericidal activity of pulsed Nd-YAG laser radiation in vitro

Pulsed Nd-YAG laser irradiation of bacteria has been suggested as a possible means of treating contaminated intra-oral sites although relatively few studies have been conducted. In this investigation, the antimicrobial activity of a pulsed Nd-YAG laser was assessed in vitro for a range of oral bacteria using several pulse energies and exposure durations. Pure cultures of each organism were lased in saline suspensions followed by standard colony counting techniques for test and control samples. Microbial inhibition was found to be organism-dependent and varied with energy dose and pulse energy. For all nine test species 120-mJ laser pulses proved more efficient than 80-mJ pulses, with 99.9% kills compared with around 90% kills after exposure to 1800 pulses. These killing activity levels compare favourably with those achieved with other lasers in vitro.     

Experimental dermatophytosis in mice: correlation between light and electron microscopic changes in primary, secondary and chronic infections

The histopathological and electron microscopic features of experimental dermatophytosis due to Trichophyton quinckeanum in Balb/c mice have been studied in animals with primary, secondary and chronic infections. Infected animals all showed pathological changes with adherence of microconidia to keratinocytes within 4 h of infection. Other features were the early infiltration of neutrophils, the formation of a mycelial mass (scutulum) in the epidermis, and epidermal oedema. Increased thickness of the epidermis was measured within 3 days of infection, although this was mainly due to oedema. The main differences seen in secondary infections were the paucity of fungal elements, even after 24 h, a sustained increase in epidermal thickness, and the dense dermal infiltrate of mononuclear cells. Chronically infected animals showed similar changes to those at the peak of a primary infection, but in addition there were large numbers of mast cells in the dermis. Cells carrying Ia markers were identified in the epidermis (Langerhans cells) and the dermis (macrophages) in all infections and their distribution did not appear to change. Although recovery from infection has been correlated previously with T lymphocyte mediated responses an increase in the number of cell layers of the epidermis and a dense infiltrate of neutrophils at the zone of infection were both seen within 2 days of infection. It is suggested that neutrophil killing of fungi and increased epidermal proliferation, not dependent on T cell activation, may also be implicated in host defence against dermatophytes.     

Some Practical Considerations in the Control of Louse-borne Typhus Fever in Great Britain in the Light of Experience in Russia,Poland, Rumania and China: (Section of Epidemiology and State Medicine)

This paper deals with some aspects of the control of louse-borne typhus fever. The epidemic form is associated with famine and overcrowding. In producing an epidemic in a hitherto endemic area malnutrition is of greater importance than over-crowding; another factor which brings this about is widespread movement of civil or military population thus bringing non-immunes into a district where typhus is endemic.Endemic typhus usually occurs in the early months of the year, whilst the epidemic form may appear at any time. Conditions under which epidemic typhus occurs favour the outbreak of other diseases so that an uncomplicated case is rarely seen.Louse-borne typhus fever lasts from twelve to sixteen days. The incubation period is usually twelve to fourteen days, though it may be from five to twenty-one days. The onset is sudden, but is often preceded by malaise and a rise of temperature. Two common initial symptoms are acute frontal or occipital headache and bronchitis. The first sign may be mental confusion or delirium. Acute delirium is usually present after the first week.