A partial atomic structure for the flagellar hook of Salmonella typhimurium

The axial proteins of the bacterial flagellum function as a drive shaft, universal joint, and propeller driven by the flagellar rotary motor; they also form the putative protein export channel. The N- and C-terminal sequences of the eight axial proteins were predicted to form interlocking alpha-domains generating an axial tube. We report on an approximately 1-nm resolution map of the hook from Salmonella typhimurium, which reveals such a tube made from interdigitated, 1-nm rod-like densities similar to those seen in maps of the filament. Atomic models for the two outer domains of the hook subunit were docked into the corresponding outermost features of the map. The N and C termini of the hook subunit fragment are positioned next to each other and face toward the axis of the hook. The placement of these termini would permit the residues missing in the fragment to form the rod-like features that form the core domain of the hook. We also fit the hook atomic model to an approximately 2-nm resolution map of the hook from Caulobacter crescentus. The hook protein sequence from C. crescentus is largely homologous to that of S. typhimurium except for a large insertion (20 kDa). According to difference maps and our fitting, this insertion is found on the outer surface of the hook, consistent with our modeling of the hook.     

Immune responses to Campylobacter and serum autoantibodies in patients with complex regional pain syndrome

We hypothesised that some complex regional pain syndromes (CRPS) may have a postinfectious and/or autoimmune basis. Sera from 92 patients with CRPS and 92 controls were investigated for immunoreactivity to Campylobacter strains and to rodent tissues. Both IgA-antibodies to Campylobacter and tissue-specific reactivity were often present in patients with short disease duration (< or = 1.5 years). Patients with minimal preceding trauma had stronger nervous tissue-specific reactivity than other patients, regardless of disease duration. These results provide preliminary evidence for immune activation early in CRPS and, additionally, that patients with minimal trauma may comprise an autoimmune subgroup.     

Suppressive effect of zinc on antibody response to cholera toxin in children given the killed, B subunit-whole cell, oral cholera vaccine

In a previous study, children aged 2-5 years old in Bangladesh were supplemented orally with a single dose of Vitamin A (200,000 IU) and a placebo for zinc (zinc equivalent to 20 mg of elemental zinc) everyday for 42 days (group A), zinc and a placebo for Vitamin A (group Z), zinc and Vitamin A (group AZ) or both placebos (group P). All children were orally immunised with two doses of the killed cholera vaccine containing whole cells and a recombinant B subunit of cholera toxin (CT). The number of children who responded with > or = 4-fold vibriocidal antibody (a proxy indicator of protection against cholera) was significantly greater among the zinc-supplemented groups than among the non-zinc-supplemented groups, while Vitamin A supplementation did not appear to have any effect. The sera from these children were assayed for antibody to CT. Antibody to CT is known to exert a synergistic protective effect against cholera in animal studies, and offer significantly higher short-term protection against cholera and significant short-term protection against enterotoxigenic Escherichia coli diarrhoea in humans on oral immunisation with the cholera vaccine. Children who received zinc had significantly reduced levels of serum antibodies to CT than children who received placebos only. Factorial analysis showed a trend for zinc showing a reduction in the number of children responding with CT-antibody, while Vitamin A did not appear to have any effect. Thus, zinc enhanced vibriocidal antibody response, but suppressed CT-antibody response, suggesting that zinc supplementation has different modulating effects on vibriocidal antibody response and CT-antibody response.     

Severe acne as a side effect of propranolol and nadolol in a migraineur

Beta-blockers have proven effective in the treatment of migraine. Dermatologic side effects are extremely rare. We report a patient with migraine who developed an acnelike dermatitis with two different beta-blockers with complete resolution of the acne upon discontinuation of each drug.     

A 19–year–old man with severe obstructive lung disease

A 19-year-old boy presented to ambulatory clinic with shortness of breath after walking two blocks. He denied any cough, orthopnea, chest pain or hemoptysis. Ten months prior to admission he was admitted to the medical intensive care unit with respiratory failure and was diagnosed with Goodpasture syndrome. He was treated with cyclophosphamide and steroids. He was discharged home after recovering. Patient subsequently developed dyspnea on minimal exertion. Spirometry showed severe obstructive lung disease and HRCT of chest showed diffuse micronodular disease with patchy ground-glass opacities, mild bronchiectasis and bronchiolectasis. Serologies for goodpasture syndrome were normal. A diagnosis of post-Goodpasture syndrome constrictive bronchiolitis was made. Due to severity of symptoms he was treated with azithromycin. His FEV1 doubled in 3 months and in addition to significant clinical improvement the HRCT findings also improved. This is the first described case of constrictive bronciolitis developing as an aftermath of Goodpasture syndrome.     

Discitis associated with pregnancy and spinal anesthesia.

Discitis (inflammation of the intervertebral disk) most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery (1) with a postoperative incidence of 1%-2.8% (2). It is also a complication of discography-the intradiscal injection of saline or contrast material (3). The incidence of postdiscography discitis is 1%-4% (3); no cases have been reported when prophylactic antibiotics have been used, supporting the theory of bacterial contamination (3). Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial (4). Honan et al. (5) reported 16 cases of spontaneous discitis and reviewed another 52 patients from the literature. In their series, patients tended to have one or more comorbid conditions, such as diabetes, vertebral fracture, or a preexisting spine injury. Spontaneous discitis has also been associated with advanced age, IV drug abuse, IV access contamination, urinary tract infection, and immunocompromised states (5,6). No cases of infectious discitis associated with pregnancy and spinal anesthesia have been reported in the English literature. Discitis presents as spasmodic pain in the back that may be referred to the hips or groin (7). The pain may radiate to the lower extremities. The erythrocyte sedimentation rate is usually increased. Radiological changes in discitis include narrowing of the intervertebral disk space, vertebral sclerosis, and erosion of the end plates. The best diagnostic measure may be magnetic resonance imaging (MRI) or a combination of bone and gallium scanning (2). The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess, and paralysis. IMPLICATIONS: This is a case report of a disk infection (discitis) caused by the bacteria, Streptococcus bovis after spinal anesthesia for cesarean delivery. S. bovis rarely causes discitis, and spinal anesthesia for labor and delivery has not been reported as a cause of discitis.     

The Keratinophilic Fungi in Soils from the Detroit Metropolitan Area/Die keratinophilen Pilze in Bodenproben vom Hauptstadtgebiet Detroit

Summary: The keratinophilic fungi in soils from the Detroit metropolitan area were surveyed by the hair-bait technique. One-hundred soil samples were studied and 92 yielded 172 isolates. Trichophyton ajelloi and its teleomorph, Arthroderma uncinatum, were the preponderant organism, appearing in 58 % of the soils (21% minus, 13% plus, and 24% teleomorphic). Microsporum gypseum and its teleomorph, Nannizzia gypsea, occurred in 33% of the soils (8% teleomorphic). Other isolates were M. cookei (8%) and its teleomorph, N. cajetani (6%); Chrysosporium spp. (46%); Aphanoascus sp. (7%); Ctenomyces serratus (2%); T. terrestre (5%); and 5% were unidentified.
Zusammenfassung: Die keratinophilen Pilze in Bodenproben vom Hauptstadtgebiet Detroit wurden durch die Haar-Köder-Methode überprüft. Hundert Bodenproben wurden analysiert und 92 ergaben 172 Isolierungen. Trichophyton ajelloi und dessen Teleomorphe, Arthroderma uncinatum, waren die überwiegenden Organismen, die in 58% der Bodenprobe (21% minus, 13% plus und 24% teleomorph) gefunden wurden. Microsporum gypseum und dessen Teleomorphe, Nannizzia gypsea, kamen in 33% der Bodenproben vor (8% davon waren teleomorph). Andere Isolate waren: M. cookei (8%) und dessen Teleomorph, N. cajetani (6%); Chrysosporium spp. (46%); Aphanoascus sp. (7%); Ctenomyces serratus (2%); T. terrestre (5%); und 5% blieben unidentifiziert.     

Arthroskopische Eingriffe nach Oberflächenersatz des Hüftgelenks

Hip arthroscopy has evolved into a safe and effective procedure. The role of arthroscopy has widened and it has now entered the realms of resolving the mystery of the pain of unknown origin following arthroplasty. The technique of arthroscopy following resurfacing hip arthroplasty and its usefulness in diagnosing unexplained pain is described in this study. Hip arthroscopy can help diagnose occult infections, metal ion allergy, impingement lesions, iliopsoas tendinopathy, capsular thickening and non-specific synovitis. Dynamic assessment with arthroscopy especially aids in detecting macro-movement in early cases of aseptic loosening and post-arthroplasty femoroacetabular impingement. Hip arthroscopy also plays a therapeutic role in debridement and rinsing of infected arthroplasties, excision of impingement lesions, severance of the iliopsoas ligament, capsular release, removal of loose bodies and synovectomies. The arthroscopic procedure in resurfacing hip arthroplasty can be technically demanding but it is a safe and useful tool in the armamentarium of a properly trained hip surgeon.