An outbreak of gastroenteritis due to Salmonella Typhimurium phage type 170 associated with consumption of a dessert containing raw egg

Eggs are frequently implicated as a source of foodborne salmonellosis. In February 2009 an investigation was commenced following reports of gastrointestinal illness among diners at a Canberra restaurant. The investigation sought to confirm the existence of an outbreak, identify a source and implement public health measures to prevent more cases. Menus and booking lists were obtained from the restaurant and a case-control study was commenced. A suspected case was defined as a person who ate at the restaurant on 13 or 14 February 2009 and subsequently developed diarrhoea and/or vomiting. Twenty cases and 31 controls were enrolled in the study. Eating a tiramisu dessert containing raw egg had a highly statistically significant association with illness (crude odds ratio 130.50, 95% confidence interval 13.54-1605.28). Among the 20 cases, nine of 12 stool samples were positive for Salmonella Typhimurium phage type 170 (STm 170). No microbiological evidence of STm 170 was obtained from the restaurant or during the egg trace-back investigation. This report highlights the risk associated with consumption of foods containing raw or undercooked shell egg.     

Resection of Colorectal Liver Metastases

Introduction  

The gold-standard treatment for colorectal liver metastases (CLM) is liver resection. Advances in staging, surgical technique, perioperative care and systemic chemotherapy have contributed to steady improvement in oncologic outcomes for patients following surgery in this subset of patients with stage IV colorectal cancer. The limits of resection continue to expand to include patients with more, larger and bilateral CLM, yet outcomes continue to improve with 5-year overall survival exceeding 50% following resection. Chemotherapy is an important element of treatment for patients with CLM, and chemotherapy can be combined safely with surgery to improve outcomes further.     

Local Lymphocytes and Nitric Oxide Synthase in the Uterine Cervical Stroma of Patients with Grade III Cervical Intraepithelial Neoplasia

OBJECTIVES:

Precancerous and cancerous cells can trigger an immune response that may limit tumor development and can be used as a prognostic marker. The aims of the present study were to quantify the presence of B and T lymphocytes, macrophages and cells expressing inducible nitric oxide synthase (iNOS) in the cervical stroma of women with grade III cervical intraepithelial neoplasia (CIN III) or in the intratumoral and peritumoral tissue of women with stage I invasive carcinoma.

METHODS:

Cervical tissue specimens were obtained from 60 women (20 each from control tissues, CIN III and invasive carcinomas). The average ages in the control, CIN III and invasive groups were 43.9 (± 4.3), 35.5 (± 9.5), and 50 (± 11.2) years, respectively. The specimens were immunohistochemically labeled with antibodies to identify T lymphocytes (CD3), cytotoxic lymphocytes (CD8), B lymphocytes (CD20), macrophages (CD68) and iNOS. We evaluated the markers in the stroma above the squamocolumnar junction (control), at the intraepithelial lesion (CIN cases), and in the nfiltrating tumor. Two independent observers performed the immunohistochemical analysis.

RESULTS:

T lymphocytes, B lymphocytes, macrophages and iNOS were present more frequently (P<0.05) in the stroma of peritumoral invasive tumors compared to the controls and intratumoral invasive cancer samples. CD3+ and CD20+ lymphocytes were present more frequently in CIN III patients compared to samples from patients with intratumoral invasive cancer (P<0.05).

CONCLUSION:

High numbers of T and B lymphocytes, macrophages and iNOS-expressing cells in the peritumoral stroma of the invasive tumors were observed. Cell migration appeared to be proportional to the progression of the lesion.     

Paraplegia following intraoperative celiac plexus injection

The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.     

Neurolymphomatosis: MRI and 18FDG‐PET features

Neurolymphomatosis (NL) is a rare presentation of lymphoma or leukemic infiltration of cranial or peripheral nerves. It is distinct from subarachnoid seeding of lymphoma as well as perineural tumour seen in epidural lymphoma. This rare condition has been reported mainly in oncology literature. Imaging features of solitary nerve involvement mimics, among others, peripheral nerve sheath tumours. We present the MRI and ¹⁸fluorodeoxyglucose positron emission tomography (¹⁸FDG‐PET) features of three cases of NL. MRI demonstrated variable appearances: infiltrative mass displacing neural fascicles, diffuse thickening and enhancement, and thickening of individual neural fascicles. ¹⁸FDG‐PET demonstrated avid uptake in all cases, two of which revealed skip lesions of the same nerve. The diagnosis of NL was confirmed by uncomplicated CT‐guided biopsy of the affected sciatic nerve in one patient.     

Failure of bacteriophage typing to detect an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in Zagreb subsequently identified by random amplification of polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE)

Objective: To establish the extent of inter-hospital spread of methicillin-resistant Staphylococcus aureus (MRSA) in Zagreb and to determine the most suitable method for typing local strains.
Methods: We analyzed a collection of 33 MRSA isolates from three Zagreb hospitals together with five unrelated British MRSA isolates by antibiogram typing, bacteriophage typing, randomly amplified polymorphic DNA (RAPD) analysis and pulsed-field gel electrophoresis (PFGE) after digestion with Smal restriction endonuclease. Bacteriophage typing was done with the international set of S. aureus typing phages. RAPD and PFGE profiles were analyzed visually and by using the 'GelCompar' computer program.
Results: Antibiogram typing provided eight profiles. Thirty (91%) of the 33 Croatian strains of MRSA were non-typable by phage typing. Visual analysis of RAPD products identified six, and visual analysis of PFGE fragments nine, distinct profiles. Computer analysis of RAPD data separated British isolates from the Croatian ones, but did not cluster the visually determined RAPD types. PFGE computer analysis separated British isolates and clustered isolates in concordance with visual interpretation. Thirty-one of the 38 isolates (82%) were visually grouped in the same clusters by both molecular methods. The dominant strain was present in each of the three hospitals.
Conclusions: Bacteriophage typing was unhelpful for the analysis of Croatian MRSA, since most strains were untypable with the international set of bacteriophages. RAPD and PFGE were more successful in typing the organisms and showed evidence of inter-hospital spread of one predominant MRSA strain in all three Zagreb hospitals. Thus RAPD and PFGE proved to be a useful aid in elucidating the epidemiology of MRSA infection in Zagreb hospitals and should be established in Croatia for typing MRSA.     

Relaxin in sera during the luteal phase of in-vitro fertilization cycles.

To identify the time when relaxin can first be detected in peripheral sera after in-vitro fertilization (IVF) and embryo transfer, blood samples were collected from 20 women up to 14 days after oocyte retrieval. Sixteen women did not become pregnant and in eight of them relaxin (but not beta-human chorionic gonadotrophin, beta-hCG) was measurable for the first time at days 6 to 12. Concentrations of other hormones measured were also different in these eight women compared with the remaining eight non-pregnant women; their serum concentrations of 17 alpha-OH progesterone, progesterone and oestradiol were higher but concentrations of luteinizing hormone and follicle-stimulating hormone were lower. Three women became pregnant; relaxin and beta-hCG were first detected on the same day (10 to 12). The remaining woman had increased beta-hCG levels but did not develop a clinical pregnancy. Measurement of serum relaxin during IVF cycles may allow assessment of corpora luteal function before its identification by levels of steroid hormones.     

Risk factors associated with anal sphincter tear difference among midwife,private obstetrician,and resident deliveries

To identify risk factors that account for the difference in anal sphincter tear (AST) among midwife, private obstetrician, and resident deliveries. We performed a retrospective review of our obstetrical database and used logistic regression analysis to identify risk factors for AST. The relationship between delivery technique and AST was evaluated by comparing AST increase between vaginal deliveries without and with an episiotomy among the three categories of providers. After adjusting for risk factors, private obstetricians (OR: 1.81, 95% CI: 1.27-2.56) and residents (OR: 1.60, 95% CI: 1.20-2.15) had a higher rate of AST during vaginal delivery than midwives. Episiotomy increased the odds of AST by four-fold for midwives, two-fold for private obstetricians, and eight-fold for residents. Although midwife and resident's delivery methods were associated with more AST, neither experienced this complication more frequently than private obstetricians. This suggests that midwives and residents probably misdiagnosed some AST.