Comment on ‘Predicting recurrence in axillary node negative breast cancer patients’, by Rosner and Lane

on behalf of the Nottingham Breast Unit     

Aerators as a reservoir of Acinetobacter junii: an outbreak of bacteraemia in paediatric oncology patients

Tap water can play a role as a source of nosocomial pathogens, and faucet aerators have occasionally been mentioned in the literature associated with colonization or infection in hospitalized patients. In this study, we report on outbreak of bacteraemia in paediatric oncology patients caused by Acinetobacter junii. Environmental sampling showed the water system to be contaminated with A. junii. Molecular typing using automatic laser fluorescence analysis of randomly amplified polymorphic DNA (RAPD-ALFA) revealed two distinct strains. The outbreak strain, isolated from blood cultures of the affected children, was only found in the water taps of staff rooms. Aerators were commonly found to be contaminated, and more so than water obtained after removal of these devices. We believe that conventional aerators consisting of several wire meshes can serve as a reservoir for low levels of bacteria present in the water system. We recommend, especially for high-risk areas, either that aerators should not be used, or the use of aerators consisting of radially and vertically arranged lamellae, which do not lead to the collection of sediment or water stagnation, and to clean them regularly.     

Prevalence of behaviour disorders in low birthweight infants

OBJECTIVE--To determine the prevalence of behaviour disorders in low birthweight infants. DESIGN--Children of birth weight < or = 2000 g born to mothers resident in Merseyside in 1980-1 assessed using the Rutter parent and teacher behaviour questionnaires and the Conner modification of the Rutter teacher questionnaire. Children attending normal schools were assessed with controls matched for age, sex, and class in school. Children attending special schools were assessed unmatched. SUBJECTS--233 matched case-control pairs attending normal primary schools and 46 unmatched children attending special schools. SETTING--Primary and special schools. MAIN OUTCOME MEASURES--Emotional, conduct, and undifferentiated behaviour disorders and hyperactivity. RESULTS--On the parental questionnaire screen, 36% of the cases and 22% of the controls had a behaviour disorder and on the teacher questionnaire the proportions were 27% and 12% respectively. Hyperactivity was significantly more common among male cases than their controls (21% v 5.0%) but differed little among female cases and controls (9% v 7%). CONCLUSIONS--Improving neonatal survival of low birthweight infants is accompanied by a higher prevalence of behaviour disorders. The long term implications for psychiatric morbidity and other adult disease must be monitored.     

Granulocyte function in premature infants before the 34th week of pregnancy and in mature newborn infants]

BACKGROUND: Preterm and term neonates have an increased risk to develop severe bacterial infections. Impairment of neutrophil function may be responsible for this increased risk. Other diseases related to prematurity like retinopathia of prematurity (ROP) or broncho-pulmonary dysplasia (BPD) on the other hand may be due to poorly controlled O2-radical production. PATIENTS AND METHODS: Blood samples of 112 premature (34 weeks of gestation and older) and term neonates were analysed. Blood samples of 23 healthy adults (18 to 50 years old) served as controls. O2-radical production and phagocytosis of neutrophils were determined by flow cytometry, using a commercial test system. RESULTS: Under the experimental conditions applied, the capacity to produce O2-radicals following vigorous stimulation (E. coli) is comparable between neutrophils of preterm/term neonates and healthy adults. However, unstimulated or weakly stimulated (fMLP) neutrophils of preterm and term neonates show a statistically higher O2-radical production as neutrophils of the control group. The production of oxygen radicals increases during the first 10 days of the life. The capability of neutrophils to phagocytose E. coli is significantly lower in newborns (preterm and term) compared to the adult controls. CONCLUSIONS: The values reported here for phagocytosis and O2-radical production utilizing a commercially available test system may serve as "preliminary normal values" for neonates. No differences were found between the groups of neonates with and without infection. Impaired neutrophil-phagocytosis possibly contributes to the increased risk of preterm and term neonates to acquire bacterial infections. The increased spontaneous O2-radical production, on the other hand, may play a role for the development of so called "free radical diseases" such as ROP or BPD. However, our results cannot add further proof to this hypothesis.     

BENIGN GASTROCOLIC FISTULA ASSOCIATED WITH PERITONITIS

SUMMARY Gastrocolic fistula is most often related to malignancy or previous gastric surgery. It is an uncommon complication of benign gastric ulceration in patients who have not had a previous operation. Benign gastrocolic fistula associated with peritonitis is extremely rare — this case is only the fourth ever reported. The patient presented with an acute abdomen, and subsequent investigations demonstrated a gastrocolic fistula of benign aetiology.     

Schwere Armaturenbrett-(Dashboard)Verletzungen der unteren Extremität und des Hüftgelenkes

Zusammenfassung Die durch einen charakteristischen Unfallmechanismus entstehenden und nach Art und Lokalisation typischen Armaturenbrett-Traumen der unteren Extremität und des Hüftgelenkes stellen häufige und oft zu bleibender Invalidität führende Verletzungen dar. Physikalische Berechnungen machen deutlich, daß selbst bei Unfallgeschwindigkeiten um 20 km/Std erhebliche Schäden zu beobachten sind. Einige der wichtigsten Maßnahmen zur Vermeidung dieser folgenschweren Verletzungen bei Autounfällen besteht in der Fixierung der Insassen durch Sicherheitsgurte.

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Heavy dashboard-injuries of the lower extremity and the hip-joint

Summary In mode and localisation typical dashboard-injuries of the lower extremity and the hip-joint following a characteristic accident mechanism, are frequent and often cause permanent invalidity. Physical calculations demonstrate, that even speeds about 20 km/hr cause considerable injuries. One of the most important provision to avoide those injuries of great consequence, consists in fixing the inmates on safety-belts.

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Herrn Prof. Dr. R. Zenker zum 70. Geburtstag gewidmet.     

Anatomische und mathematische Untersuchungen zur Genese der traumatischen Achillessehnenruptur

Zusammenfassung Nachdem an Hand anatomischer Messungen der Nachweis erbracht werden konnte, daß sich die Achillessehne bei Dorsalflexion im oberen Sprunggelenk der Tibia nähert, wird ein eigenes Rechenmodell zur Beurteilung der auf die Achillessehne einwirkenden dynamischen Zugkräfte aufgestellt. Die Berechnungen ergeben, daß bei einem Winkel von 34° (Dorsalflexion) die Belastungsgrenze der Sehne von 700 kp überschritten wird. Das bedeutet, daß beispielsweise für einen Skifahrer bei einer Geschwindigkeit von 30 bzw. 50 km eine Bremsstrecke unter 4 bzw. 11 m zur Ruptur führen kann.

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Anatomical and mathematical investigations concerning to the genesis of the traumatic Achilles tendon-rupture

Summary Basing on anatomical measurements, it was demonstrated, that the Achilles tendon approximates the Tibia, when dorsal flexion in the ankle joint is present. Thus it was developed a particular mathematical model in order to evaluate the dynamic tension — efficacy acting on the Achilles tendon. Our investigations show, that the tendon's limit of charge (700 kp) is overload at an angular position of 34° (dorsal flexion). Concerning to skiing, that means, that at a speed of 30 resp. 50 km/hr a brake — straight line less than 4 resp. 11 m may cause rupture of the tendon.