Seroepidemiology of HTLV-III (LAV) in the Federal Republic of Germany

Summary In 1984 10,281 sera were collected in the FRG and examined for antibodies to HTLV-III (LAV) with an enzyme-linked immunosorbent assay and confirmative tests. Of the German AIDS patients 81% have antibodies. Individuals belonging to AIDS risk groups, homosexuals, haemophiliacs and i.v. drug abusers, have antibody frequencies between 25%–72%. The detection of HTLV-III antibodies in blood donours indicates that the virus is being transmitted by blood transfusions.Abbreviations AIDS acquired immunodeficiency syndrome - LAS lymphadenopathy syndrome - ARC AIDS related complex - LAV lymphadenopathy associated virus - HTLV-III human T-lymphotropic virus type III - HBV hepatitis B virus     

Oxygen-dependent up-regulation of mucoid exopolysaccharide (alginate) production in Pseudomonas aeruginosa.

We previously showed substantial differences in Pseudomonas aeruginosa exopolysaccharide production in vitro at oxygen tensions reflective of the right versus left cardiac circuits in vivo (40 versus 80 mm Hg, respectively; A. S. Bayer, T. O'Brien, D. C. Norman, and C. C. Nast, J. Antimicrob. Chemother. 23:21-35, 1989). However, those studies did not specifically confirm this exopolysaccharide to be the characteristic P. aeruginosa mucoid alginate seen in patients with cystic fibrosis. With a murine monoclonal antibody prepared against P. aeruginosa alginate, strongly positive immunofluorescence (IF) staining of a nonmucoid P. aeruginosa strain (PA-96) was seen after its exposure in vitro to oxygen tensions (pO2) of approximately 80 mm Hg; the intensity of the IF staining under these conditions was similar to that observed with a phenotypically mucoid P. aeruginosa strain (C1712M) from a cystic fibrosis patient. In contrast, the same nonmucoid strain (PA-96), after exposure to pO2 of approximately 40 mm Hg, showed little IF staining for alginate. Following enzyme treatment with alginase, PA-96 cells previously exposed to the higher pO2 and exhibiting enhanced alginate production, as determined by IF staining, now showed no IF staining. Moreover, treatment of the oxygen-up-regulated PA-96 cells with alginase released amounts of unsaturated alginate breakdown products (uronic acids) quantitatively similar to those released by typically mucoid strains treated with the same enzyme. These data indicated that the P. aeruginosa exopolysaccharide in our studies was, indeed, mucoid alginate and that variations in oxygen tensions represent one of the trigger mechanisms for the up-regulation of mucoid exopolysaccharide production.     

Sensitization of nociceptive cutaneous nerve fibers from the rat's tail by noxious mechanical stimulation

Summary This single fiber study on rat tail nerve afferents attempts to establish a peripheral neural correlate for the hyperalgesia to mechanical stimulation which follows injury to the skin. Mechano-heat sensitive C fibers (MH-C or polymodal nociceptors) and high-threshold mechanoreceptive A delta fibers (HTM-A delta) were examined with a series of constant noxious pressure stimulations (4-6-8-4 N on 25 mm², 120 s each, 5 min intervals). These injurious stimuli were either directed to the most sensitive spot of the receptive fields (central stimulation) or closely outside their borders (1–5 mm). With this protocol no clear sensitization was seen in MH-C fibers apart from a stronger dynamic response to central stimulation in some of them. In contrast, most HTM-A delta units, irrespective of the site of noxious stimulation, developed spontaneous activity, lowering of their von Frey thresholds and expansion of their receptive fields. All HTM-A delta units responded to outside stimulation: upon the first stimulus (4 N) there was a delayed discharge of continuously increasing frequency (recruited response), but the onset of the last stimulation (4 N repeated) evoked vigorous dynamic responses in many fibers. The recruitment of HTM-A delta nociceptor activity may contribute to post-injury hyperalgesia to mechanical stimulation and it may counteract adaptation of the single afferent fiber during prolonged noxious influence.On leave from the Laboratoire de Physiologie, Faculté de Médecine Lyon-Sud, Chemin du Petit Revoyet, F-69600 Ouillins, France     

Recreational gasoline sniffing: acute gasoline intoxication and latent organolead poisoning. Case reports and literature review

Gasoline is a readily obtainable intoxicant that unfortunately lends itself to habitual abuse by sniffing, a practice found particularly among children and adolescents. The concerted effects of the multiple hydrocarbon and other constituents of gasoline result in a predictable acute toxic syndrome. Organoleads, primarily tetraethyl lead (TEL), cause a separate toxicologic symptom-sign complex that overlaps with the initial acute toxic syndrome. The different clinical symptomatology, effects on hemoglobin synthesis, and response to chelation therapy are all in keeping with the view that organolead poisoning is a separate and distinct toxicologic entity from that of classical elemental lead poisoning or "plumbism".     

Atlantoaxial instability in a patient with neck pain and rheumatoid arthritis

Context: The purpose of this report is to describe the clinical decision-making process for a patient with rheumatoid arthritis with neck pain with underlying atlantoaxial instability.Findings: The patient was evaluated for worsening upper neck pain that began insidiously 1 year prior. The patient denied numbness or tingling in her upper or lower extremities, dizziness or lightheadedness, difficulty maintaining balance with walking, or muscle weakness. Cervical spine range of motion was limited in all planes due to pain and apprehension. The patient’s neurological examination was unremarkable. Prior flexion and extension radiographs of the cervical spine were interpreted as unremarkable with alignment preserved in flexion and extension. However, upon further inspection, the cervical spine flexion radiograph was concerning for inadequate cervical motion, which may have limited the diagnostic utility of these radiographs. Additionally, a Sharp-Purser test was performed, which was positive for excessive motion. Flexion and extension radiographs of the cervical spine were then repeated ensuring the patient adequately flexed and extended during the imaging. Severe anterior subluxation of C1 relative to C2 with cervical flexion was noted, as C1 moved as much as 8–9 mm anterior to C2 with cervical flexion. Given the degree of atlantoaxial instability, the patient subsequently underwent successful posterior fusion from the occiput to C2.Conclusion/Clinical Relevance: This case report demonstrates the importance of properly screening for upper cervical spine instability in patients with rheumatoid arthritis and neck pain and understanding the importance of obtaining adequate and appropriate diagnostic imaging.     

Effect of age and care organization on sources of variation in kidney transplant waiting list registration

Despite national guidelines, medical practices and kidney transplant waiting list registration policies may differ from one dialysis/transplant unit to another. Benefit risk assessment variations, especially for elderly patients, have also been described. The aim of this study was to identify sources of variation in early kidney transplant waiting list registration in France. Among 16 842 incident patients during the period 2016–2017, 4386 were registered on the kidney transplant waiting list at the start of, or during the first year after starting, dialysis (26%). We developed various log-linear mixed effect regression models on three levels: patients, dialysis networks, and transplant centers. Variability was expressed as variance from the random intercepts (± standard error). Although patient characteristics have an important impact on the likelihood of registration, the overall magnitude of variability in registration was low and shared by dialysis networks and transplant centers. Between-transplant center variability (0.23 ± 0.08) was 1.8 higher than between-dialysis network variability (0.13 ± 0.004). Older age was associated with a lower probability of registration and greater variability between networks (0.04, 0.20, & 0.93 in the 18–64, 65–74, and 75–84 age groups). Targeted interventions should focus on elderly patients and/or certain regions with greater variability in waiting list access.     

Whose Line Is It Anyway?: Dismantling the Foundations of Rape Culture

Archives of Sexual Behavior -     

Atypische bakterielle Endokarditis und Klappenringabsceß

Zusammenfassung Anhand von 14 eigenen Fällen wird das Krankheitsbild der atypischen bakteriellen Endokarditis mit Klappenringabsceß beschrieben. Das Krankheitsbild kommt in höherem Alter vor, es besteht ein starkes Überwiegen des weiblichen Geschlechts. Größere Absceßbildungen im verkalkten Faserring der Mitralklappe, konstante Endokarditis im subvalvulären Winkel und inkonstante thrombulceröse Endokarditis an der Klappenoberfläche kennzeichnen das anatomische Bild bei den 12 akuten Fällen. Bei 2 chronischen Fällen mit abgekapseltem Klappenringabsceß fehlt die Endokarditis. Die Klappenringabscesse und die sie begleitende basale atypische Endokarditis sind regelmäßig im marginalen Segel der Mitralklappe lokalisiert. Wichtige pathogenetische Faktoren sind die senile Klappenringsklerose mit Bewegungseinschränkung des marginalen Segels, Stase im subvalvulären Winkel und verkalkende höckerige Thrombenabscheidungen subvalvulär mit Nischenbildungen, in denen die Bakterienansiedelung auf frischen Thromben erfolgt. Von der akuten subvalvulären Endokarditis geht die Infektion des Faserringes und die Absceßbildung aus. Sie kann — in dieser Untersuchungsreihe in der Hälfte der Fälle — auch zu thrombulceröser Endokarditis an der atrialen Seite der Mitralklappe führen. In 5 von 10 bakteriologisch untersuchten Fällen wurde Staphylococcus aureus, in 2 Fällen Streptococcus pyogenes, in 2 weiteren Fällen Escherichia coli und bei einem Fall Salmonella cholerae suis als Erreger nachgewiesen. Die unicale Beobachtung eines Klappenringabscesses durch S. cholerae suis wird ausführlicher besprochen.

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Atypical bacterial endocarditis and valve ring abscess

Summary Fourteen cases of valve ring abscesses of the heart associated with atypical bacterial endocarditis are presented. This entity occurs in the older age groups and predominately in women. Large abscesses in the calcific mitral annulus, constant endocarditis in the subvalve angle, and inconstant thrombo-ulcerous endocarditis on the atrial surface characterize the pathoanatomical pattern in our twelve acute cases. Endocarditic lesions could not be found in two chronic cases with encapsulated valve-ring abcesses. Usually, the valve ring abscesses and the concomitant basic atypical endocarditis are localized on the posterior mitral cusp. Important pathogenetic factors are senile mitral annulus sclerosis, a decreased movement of the posterior cusp, stasis in the subvalve angle, and calcifying humpy subvalvular thrombotic deposits that form pockets for fresh thrombi which become invaded by bacteria. The infection of the valve rings and the following ring abscesses originate from the acute subvalvular endocarditis. However, this mode of infection can cause the inconstant thromboulcerous endocarditis on the atrial surface, which developed in only the half of our cases. In five of ten cases examined bacteriologically Staphylococcus aureus was grown, in two other cases Streptococcus pyogenes, in two cases Escherichia coli, and in one instance Salmonella cholerae suis. To our knowledge, this is the first case reported of a valve ring abscess due to S. cholerae suis. It has been particularly discussed.

     

HIV prevention and the two faces of partner notification.

In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.