Distribution and diversity of New Zealand isolates of ryegrass mosaic virus

Summary.  Sequences from the coat protein cistron of five ryegrass mosaic virus (RgMV) isolates indicated the presence of two distinct strains in New Zealand. The nucleotide differences between the strains, and their distribution, suggested that both strains were introduced recently, either as a mixed infection or as two independent introductions. The relationship between these New Zealand strains and other strains and isolates of RgMV, and their potential severity is discussed. Accepted April 21, 1999 Received October 5, 1998     

Utilization of the extended rectus abdominis myofasciocutaneous free flap in upper extremity reconstruction

Degloving injuries of the upper extremity may require extensive soft tissue coverage. Free tissue transfer is often useful in the management of these injuries. We describe the use of an extended rectus abdominis myofasciocutaneous vascularized free flap in the management of a massive longitudinal upper extremity traumatic soft tissue defect.     

Effect of Haloperidol Dacanoate on the Cardiovascular System

Abstract: Rapid speed electrocardiograms were recorded in 13 chronic schizophrenic patients before, and at regular intervals during a six-month trial of haloperidol decanoate. Measurements of conduction intervals in the EEG were carried out blind to patient and to assessment interval. No significant changes in heart rate; PR, QRS on QTc intervals; or T-wave height were found. Neither was there a significant change in the blood pressure. The findings confirm that haloperidol does not have clinically relevant cardiac effects when given in therapeutic doses to physically healthy individuals.     

Quantitative analysis of labelled inner retinal proteins in experimental optic neuritis

In order to determine if axonal transport changes in chronic experimental allergic encephalomyelitis (EAE) were due to blockade or increased discharge of fast transported proteins from the inner retina, we examined the presence of pulse labeled proteins in autoradiograms of the optic nerve head, retinal ganglion cell and nerve fiber layers of juvenile strain-13 guinea pigs with chronic EAE and normal controls. Quantitative analysis of silver grains, performed six and twenty-four hours following the intravitreal injection of tritiated leucine, showed a decrease in inner retinal radioactivity in those with EAE, whereas no difference was detected between the two groups after three days. Grain counts within the optic nerve heads of guinea pigs with EAE were reduced at all time intervals studied. These results are consistent with an increase in discharge of fast transported proteins from retinal ganglion cells into optic nerve axons and support our previous observations of increased radioactivity at the foci of optic nerve demyelination.     

Pigmentary retinopathy of neonates and infants. Their examination using electroretinography and visual evoked potentials

A method of neurophysiological investigation (electroretinography and visual evoked potentials) is described as a non invasive exploration used in awake children. E.R.G. and V.E.P. normal patterns are described in relation to age. The data obtained in pigmentary retinopathies are referred to the physiopathology of these diseases. Usefulness of both neurophysiological tests is showed in the early diagnosis. Significative abnormalities are seen even before any detectable ophthalmoscopic symptom. In pigmentary retinopathies, V.E.P. are normal while E.R.G. is slightly then severely altered. E.R.G. and V.E.P. are also helpful in the differential diagnosis: in macular diseases, E.R.G. is usually normal while V.E.P. are altered. Repeated examinations have a prognostical value: when a disease is progressing, E.R.G. becomes more and more altered and V.E.P.'s abnormalities appear.     

Prevention of acquired infections in intubated patients with the combination of two decontamination regimens

OBJECTIVE: The use of topical polymyxin and tobramycin to prevent intensive care infections is controversial. Moreover, these antibiotics are ineffective against methicillin-resistant Staphylococcus aureus. A decontamination regimen using mupirocin and chlorhexidine could prevent acquired infections, including those involving S. aureus. Because these two regimens could have a complementary role, we evaluated their effects when given both alone and combined. DESIGN: The authors conducted a multiple-center, placebo-controlled, randomized, double-blind study performed according to a 2 x 2 factorial design. SETTING: The study was conducted at three polyvalent medical intensive care units at university-affiliated hospitals in France. PATIENTS: Adult patients (age, > or =18 yrs) intubated for <48 hrs who were likely to be ventilated for >48 hrs. INTERVENTION: Two regimens were used: topical administration of polymyxin/tobramycin (or placebo) and nasal mupirocin with chlorhexidine body washing (or nasal placebo with liquid soap). The patients (n = 515) received polymyxin/tobramycin alone (n = 130), mupirocin/chlorhexidine alone (n = 130), both regimens (n = 129), or all placebos (n = 126) for the period of mechanical ventilation plus 24 hrs. MEASUREMENTS AND MAIN RESULTS: The incidence of total infections acquired from the date of randomization until the termination date of study treatments plus 48 hrs was assessed. There were fewer acquired infections with both regimens than with polymyxin/tobramycin alone (odds ratio, 0.44; 95% confidence interval, 0.26-0.75; p = .003), mupirocin/chlorhexidine alone (0.43; 0.25-0.73; p = .002), or all placebos (0.42; 0.25-0.72; p = .001). There were no differences between polymyxin/tobramycin alone (0.95; 0.59-1.54; p = .84) and mupirocin/chlorhexidine alone (0.98; 0.60-1.58; p = .92) vs. all placebos. The probability of freedom from infection was higher with both regimens than with polymyxin/tobramycin alone (p = .002), mupirocin/chlorhexidine alone (p < .001), or all placebos (p < .001). Infection rates were also significantly lower with both regimens than with polymyxin/tobramycin alone (p = .017), mupirocin/chlorhexidine alone (p < .001), or all placebos (p < .001). CONCLUSION: Acquired infections were substantially reduced by mupirocin/chlorhexidine plus polymyxin/tobramycin, whereas each regimen given alone was ineffective. Whether both regimens could increase Candida infections deserves further investigation.     

Intracardiac echocardiographic guidance during transcatheter device closure of atrial septal defect and patent foramen ovale

OBJECTIVES: To describe our experience with intracardiac echocardiographic (ICE) guidance during transcatheter device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) and to describe a detailed stepwise approach for performing ICE examinations. PATIENTS AND METHODS: We reviewed the ICE results of all patients who underwent transcatheter device closure of ASD/PFO at the Mayo Clinic in Rochester, Minn, between October 2000 and November 2002. Conscious sedation was used, and all ICE studies were performed using a diagnostic ultrasound catheter. RESULTS: Ninety-four patients (47 male; median age, 51 years [range, 17-81 years]) underwent ICE during transcatheter device closure of ASD/PFO. Total procedure time was 128 minutes (range, 27-320 minutes). ICE identified a previously unrecognized anatomical diagnosis in 32 of 94 patients. An additional ASD or PFO was found in 16 patients; a redundant atrial septum or an atrial septal aneurysm was found in 12 patients. There were few ICE complications (4%): 3 patients developed atrial fibrillation, and 1 developed supraventricular tachycardia; of these 4, 2 resolved spontaneously, and 2 required cardioversion with no recurrence. CONCLUSION: ICE provides anatomical detail of ASD/PFO and cardiac structures facilitating congenital cardiac interventional procedures. ICE eliminates major drawbacks related to the use of transesophageal echocardiographic guidance for transcatheter device closure of ASD/PFO, specifically problems related to airway management. Finally, ICE gives the interventional cardiologist the ability to control all aspects of imaging without relying on additional echocardiographic support. We believe that ICE should be considered the preferred imaging technique for guidance of transcatheter device closure of ASD/PFO in adults and larger pediatric patients.     

Pancuronium blood level monitoring in patients with tetanus

Overdosage of muscle relaxant has been given as a possible explanation for the hypotensive episodes occurring during the management of tetanus. The aim of the present work was to study the pharmacokinetics of pancuronium during long term infusion. Pancuronium was administered to eight patients with severe tetanus for a period varying from 8 to 24 days. The concentration of pancuronium was measured daily in plasma and urine using a fluorimetric method. The plasma concentration varied from 0.27 to 0.48 g/ml. No tendency to accumulation was observed. The plasma concentration fell rapidly below the level associated with muscle relaxation when pancuronium was discontinued. This absence of accumulation can be explained by a rapid elimination of pancuronium through the kidney according to a process of ultrafiltration.This work was supported by grants from Faculté de Médecine Xavier-Bichat (Université Paris VII). This work was presented in part at the Second World Congress on Intensive Care, September 1977, Paris, France