Spread of Cryptococcus gattii into Pacific Northwest Region of the United States

Cryptococcus gattii has emerged as a human and animal pathogen in the Pacific Northwest. First recognized on Vancouver Island, British Columbia, Canada, it now involves mainland British Columbia, and Washington and Oregon in the United States. In Canada, the incidence of disease has been one of the highest worldwide. In the United States, lack of cryptococcal species identification and case surveillance limit our knowledge of C. gattii epidemiology. Infections in the Pacific Northwest are caused by multiple genotypes, but the major strain is genetically novel and may have emerged recently in association with unique mating or environmental changes. C. gattii disease affects immunocompromised and immunocompetent persons, causing substantial illness and death. Successful management requires an aggressive medical and surgical approach and consideration of potentially variable antifungal drug susceptibilities. We summarize the study results of a group of investigators and review current knowledge with the goal of increasing awareness and highlighting areas where further knowledge is required.     

A complicated incomplete syndactylism

Surgical desyndactylism is reviewed. A case report of an incomplete, complicated syndactylism and its surgical treatment is presented. The operative method consists of a commissure created by a dorsal V-flap with removal of abnormal bone and closure without grafting.     

Lysozyme-mediated de-chaining of Streptococcus mutans and its antibacterial significance in an acidic environment

The ability of physiological amounts of lysozyme to de-chain two serotype c strains of Streptococcus mutans was determined. Both human and hen lysozymes were equally effective in chain breakage of S. mutans DPR and S. mutans DJR. De-chaining did not affect growth of cultures, but resulted in finely dispersed suspensions, at stationary phase, which were visibly different from untreated cultures. Less than 50 micrograms lysozyme per ml culture medium reduced chain length to virtually all diplococci and single cells, and this chain disruption increased total viable cell count. De-chaining required an active enzyme indicating that a degree of hydrolysis of the peptidoglycan occurred at the septae of the streptococci. De-chained S. mutans did not survive as well as streptococci of normal chain length when incubated under acidic conditions (pH 5.5), but gross cellular lysis was not apparent. The reduced aciduric property of the disrupted chains may have been due to a participation of autolysins or to a lethal triggered by the lysozyme-damaged peptidoglycan. De-chaining may be a mechanism by which lysozyme could regulate the levels of S. mutans in acidogenic plaque samples.     

Is reduced release of gastrin the mechanism of ulcer healing after gastroenterostomy?

Until recently in this unit gastroenterostomy was the operation of choice for patients with duodenal ulcer whose maximal acid output (MAO) is less than 30 mmol/hr. Ulceration (jejunal) has recurred in only 2.1%. Unlike partial gastrectomy, which has a peak incidence of ulcer recurrence in the first two years, the incidence of ulcer recurrence remains constant throughout the years after gastroenterostomy. In looking for the explanation of this low recurrence rate we have studied the effect of the operation upon serum gastrin responses to standardized test meals 3 weeks and 26 weeks after operation in 9 patients. Nine normal subjects acted as controls. Six months after operation the responses were significantly lowered, a fall in the serum levels of gastrin at 30, 45, 60, and 90 min after meals suggesting that gastroenterostomy reduces both the gastric and intestinal phases of acid secretion. The mean integrated gastrin response (IGR) throughout the postprandial 90 min is also significantly lower 6 months after surgery. The overall mean reduction was 31.1%.     

The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse.

Doubt remains as to the safest surgical approach to the prolapsed thoracic intervertebral disc. Laminectomy, lateral rhachotomy and the transthoracic approach all have their protagonists. Twenty-two patients from the National Hospital for Nervous Diseases, Queen Square, and Atkinson Morley's Hospital have been reviewed. Their clinical presentation is discussed and the ancillary aids to diagnosis assessed. The diagnostic value of disc space calcification is stressed, and the use of air myelography as an adjunct to positive contrast myelography is noted. Fifteen patients were subjected to laminectomy, and seven to lateral rhachotomy. Each group contained patients with a wide range of neurological deficit. Six of the patients who underwent laminectomy were improved, two were unchanged, six deteriorated and one died. Of the patients who had lateral rhachotomy, six were improved, one was unchanged and none deteriorated. The conclusion is drawn that lateral rhachotomy is a safer procedure.     

Noninvasive cardiovascular studies in patients with inflammatory myopathy

The authors prospectively performed echocardiographic and Doppler studies on 13 patients with inflammatory myopathy to evaluate ventricular function, to assess valve morphology and function, and to obtain hemodynamic data. No patient had a reduction in left ventricular function or evidence of significant valvular disease. Hemodynamic assessment suggested evidence of pulmonary hypertension in 9 patients. They conclude that cardiomyopathy in association with inflammatory myopathy is unusual and that the suggestion of pulmonary hypertension is unexplained and merits further evaluation.     

Transcription in aging: The response of rat liver nuclear RNA polymerases to cycloheximide in vivo

Experiments were performed to address the known relationship between diet and longevity. The acute response of rat liver nuclear RNA polymerases to inhibition of protein synthesis by cycloheximide (10 mg/kg) was quantitated in rats of varying ages. Thirty minutes after cycloheximide adminstration, there was a “compensatory” 1.5–2-fold increase in RNA polymerase II activity at all ages. Nucleolar RNA polymerase I activity was significantly diminished only up to 4 months, indicating a loss in tight control coupling of protein synthesis to rRNA synthesis with age.     

The injury potential of Fogarty balloon catheters.

The problem of arterial injury following embolectomy using a balloon catheter is reviewed. Three illustrative clinical cases are presented. The cause of the arterial injury in these cases was due to rupture of the vessel. The hypotheses were that either the vessel was ruptured by direct penetration or bursting by overdistension of the balloon. The linear appearances of the arterial tear in two patients and a false aneurysm in the third suggested that bursting was the correct explanation. Laboratory investigation was carried out on animals and human cadavers and these confirmed that arterial injury and bursting can be caused by over-distension of the balloon catheter. If the maker's recommendations are strictly adhered to; that is, the balloon should not be over-inflated and the correct volume of fluid used then rupture of the artery is unlikely by occur.