Serratia plymuthica sepsis associated with infection of central venous catheter.

Serratia plymuthica was isolated from the blood and from a central venous catheter tip in a 54-year-old man with alcoholic cirrhosis and clinical signs of sepsis. This was the seventh reported isolate of S. plymuthica from a clinical specimen and the first in which the organism was clearly a significant pathogen.     

Functional expression and properties of the human skeletal muscle sodium channel

Full-length deoxyribonucleic acid, complementary (cDNA) constructs encoding the-subunit of the adult human skeletal muscle Na⁺ channel, hSkM1, were prepared. Functional expression was studied by electrophysiological recordings from cRNA-injectedXenopus oocytes and from transiently transfected tsA201 cells. The Na⁺ currents of hSkM1 had abnormally slow inactivation kinetics in oocytes, but relatively normal kinetics when expressed in the mammalian cell line. The inactivation kinetics of Na⁺ currents in oocytes, during a depolarization, were fitted by a weighted sum of two decaying exponentials. The time constant of the fast component was comparable to that of the single component observed in mammalian cells. The block of hSkM1 Na⁺ currents by the extracellular toxins tetrodotoxin (TTX) and -conotoxin (CTX) was measured. The IC₅₀ values were 25 nM (TTX) and 1.2 M (CTX) in oocytes. The potency of TTX is similar to that observed for the rat homolog rSkM1, but the potency of CTX is 22-fold lower in hSkM1, primarily due to a higher rate of toxin dissociation in hSkM1. Single-channel recordings were obtained from outside-out patches of oocytes expressing hSkM1. The single-channel conductance, 24.9 pS, is similar to that observed for rSkM1 expressed in oocytes.     

Reliability of the acetabular teardrop as a landmark

Summary This study investigated the effect of tilt and observer reliability on radiographic measurements of the position of a prosthetic acetabular cup in seven dry bone pelves using the teardrop as a landmark. Coronal or sagittal tilt of more than five degrees was easily recognisable and there was effectively no observer variation in the measurements up to this limit. In addition, 90 out of 100 randomly selected antero-posterior pelvic radiographs from an outpatient department were not significantly rotated and 93 demonstrated a clearly defined teardrop. Measurements about the teardrop on routine radiographs are therefore sufficiently accurate to allow assessment of prosthetic position.

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La valeur du sourcil cotyloidien comme repère d'analyse radiologique

Résumé Cette étude, conduite sur 7 bassins secs, apprécie l'effet de l'inclinaison du bassin sur la qualité de l'analyse radiographique de la position d'une cupule prothétique de hanche en utilisant le sourcil cotyloïdien comme repère. Une inclinaison du bassin dans les plans coronal et sagittal est aisément détectable et il n'existe pas de variation d'analyse entre les différents observateurs en dessous de 5° d'inclinaison. De plus, sur 100 radiographies antéro-postérieures de bassin choisies au hasard dans les dossiers de consultation, 90 avaient été réalisées sans incidence particulièrement adaptée et l'on pouvait repérer facilement le sourcil sur 93% d'entre elles. Les mesures faites sur des radios de routine sont donc suffisamment précises pour permettre l'évaluation de la position d'une prothèse à partir du sourcil cotyloïdien.

     

Untersuchungen über die elektrophoretische Wanderungsgeschwindigkeit kompletter und inkompletter A-, B- und Rh (D)-Antikörper

Medical Microbiology and Immunology - In der Säulen-Elektrophorese-Apparatur nachSvensson mit äthanolisierter Cellulose nachFlodin u.Kupke als Trägerstoff wurden sechs Seren von...     

Use of the PATH Alliance database to measure adherence to IDSA guidelines for the therapy of candidemia

Candidemia is an increasing complication of the care of complex patients. Adherence to Infectious Diseases Society of America (IDSA) guidelines for the treatment of candidemia was investigated to assess the impact of compliance on outcomes of therapy. Data on the epidemiology, diagnosis, and treatment of patients with invasive fungal infections (IFIs) was extracted from the PATH Alliance registry, a prospective, multicenter, observational database of invasive fungal infections. Patients with proven candidemia were evaluated for adherence to the IDSA guidelines in terms of choice, dosage, and duration of antifungal therapy. Removal of central venous catheters and time to treatment initiation were assessed. Four-week survival data were compared. Of the 418 patients with candidemia who were included in the study, 361 patients with the necessary data sets were identified, of whom 262 (72.6%) were treated within the IDSA guidelines for the treatment of candidemia (IDSA group); the remaining 99 (27.4%) patients received treatment different from the guidelines (non-IDSA group). Kaplan-Meier (KM) survival analysis for patients in the IDSA and non-IDSA group showed mortality rates of 21.9 and 13.6%, respectively; the difference between the two groups was not statistically significant (P = 0.093). Following the exclusion of patients requiring mechanical ventilation or acute cardiac support, the modified survival KM curves were similar between the two groups. Significantly more patients in the IDSA group required mechanical ventilation and tunneled central catheters, had a concomitant IFI, and received caspofungin. The duration of treatment and inappropriate dosing did not appear to have had a significant impact on survival. Most of the deviations from IDSA guidelines were due to the inappropriate duration and dosing of therapy. No significant difference in mortality was noted between the IDSA and non-IDSA groups. The basis of these differences merit further study. Presented in part at the 44th Annual Meeting of Infectious Disease Society of America, Toronto, Canada, 2006.     

Erfolgreiche Behandlung einer thyreotoxischen Krise durch kontinuierliche Plasmapherese am Blutzellseparator

Zusammenfassung Bei einem 26jährigen Patienten im thyreotoxischen Koma erwies sich die kontinuierliche Plasmapherese am IBM-Blutzellseparator klinisch als akut wirksame Krisentherapie. Schon während der Plasmapherese mit Austausch von 51 Plasma in 3 1/2 h wurde der Patient aus einem tiefen Koma heraus ansprechbar. Mit den 51 Plasma wurden 633 µg Thyroxin (T₄) und 13,6 µg Trijodthyronin (T₃) entzogen. Dies führte erstaunlicherweise nicht zu einem Abfall der Gesamtspiegel von T₄ und T₃ im Serum, ein Befund, der als Hinweis auf einen raschen Rückstrom aus dem Gewebe in die Blutbahn zu interpretieren ist. Die freien Schilddrüsenhormonspiegel nahmen dagegen signifikant ab, erkennbar am Abfall der Werte des T₃-in vitro-Tests und der T₄- und T₃-Ausscheidung im Urin. Diese Befunde zeigen auf, daß neben dem Entzug von Schilddrüsenhormon vor allem die Zufuhr freier Bindungsstellen für Schilddrüsenhormon mit dem Spenderplasma bei der Behandlung der thyreotoxischen Krise von Bedeutung ist.Mit Unterstützung der Sonderforschungsbereiche SFB 51¹ und SFB 37²     

Case report: glomus tumor of the colon

Glomus tumors are tumors of pericytic origin and are usually found in the distal extremities. Glomus tumors have rarely been reported in viscera. The authors report a glomus tumor of the colon that caused rectal bleeding in a 40-yr-old man and was biopsied and excised endoscopically. The histology and immunohistochemical profile of the tumor are described and the literature on visceral glomus tumors is reviewed.     

Amnesic effects of bilateral lesions placed in the hyperstriatum ventrale of the chick after imprinting

Summary The purpose of this study was to investigate whether bilateral lesions to a part of the hyperstriatum ventrale (IMHV) impair retention if they are placed after chicks have been imprinted. Domestic chicks were hatched and reared in darkness and exposed to an imprinting (training) stimulus for 2 h commencing 22 h post hatch. The chicks were then anaesthetised and bilateral lesions placed in IMHV (N = 16) birds, hyperstriatum accessorium (HA; N = 16) or the lateral part of the cerebral hemispheres (LCA; N = 16). Forty-eight sham-operated chicks served as controls. Chicks were returned to the dark incubator, and, 15–20 h after the operation, their approach towards the training stimulus and to a second novel stimulus was measured. The controls and the chicks with lesions in HA and LCA showed a strong preference for the training stimulus and hence a high level of retention. The preferences of these three experimental groups did not differ significantly from one another. The mean preference of chicks with lesions in IMHV was significantly less than that of the sham-operated controls (P<0.01) and of chicks lesioned in HA (P<0.05). Bilateral lesions to IMHV therefore selectively impair retention of a preference acquired through imprinting. This impairment is unlikely to be a non-specific consequence of defective sensory processing or motor performance because the four groups did not differ from each other in (i) the time taken accurately to peck a rocking bead, (ii) the accuracy of pecking millet seeds and (iii) the performance of a simultaneous visual discrimination task involving heat reinforcement.Supported by grants from the Science Research Council, the Leverhulme Trust, the Wellcome Trust and FAPESP (Brazil)     

Monocyte-mediated growth control and the induction of tumor cell death

In the present article a hypothesis is put forward and supporting data are referred that explain the elimination of tumorigenic cells as a consequence of their failure to comply with the rules of ubiquitous negative growth control mechanisms involving among others also mononuclear phagocytes as effector cells. This hypothesis does not invoke the recognition of altered cell surface structures on tumorigenic cells as the basis for discriminating them from normal cells and thus avoids one of the most irritating problems of hypothetical tumor defense mechanisms involving the recognition of spontaneously arising tumor cells as 'non-self' by immunologic effector cells.