Enzymatic profile of clinical isolates ofAcinetobacter calcoaceticus

The enzymatic profiles of 109 clinical isolates ofAcinetobacter calcoaceticus subsp.anitratus andlwoffi were determined with conventional plate tests and the rapid API ZYM system (Analytab Products, Plainview, N.Y.). The majority of strains tested lacked DNase, hemolysin, protease, elastase and gelatinase. Strong enzymatic activities of butyrate esterase (C4), caprylate esterase (C8) and leucine arylamidase were detected in all isolates. No trypsin, chymotrypsin, alkaline phosphatase or glucosidase activities were present. This profile was characteristic of all isolates examined by the API ZYM system and could serve as a useful diagnostic feature ofAcinetobacter calcoaceticus subsp.anitratus and subsp.lwoffi.     

High prevalence of SV40 infection in patients with nodal non-Hodgkin's lymphoma but not acute leukemia independent of contaminated polio vaccines in Taiwan

Recent studies have linked simian virus 40 (SV40) to non-Hodgkin's lymphoma (NHL), especially in countries in which people were exposed to contaminated polio vaccines prior to 1963. In Taiwan, nearly all children were not exposed to contaminated polio vaccine during this period; the relationship between SV40 infection and hematological malignancies is unclear and deserves to be studied. Using PCR amplification of SV40 large T antigen DNA, confirmed by Southern blot hybridization and sequence analysis, 91 frozen lymph nodes from NHL patients were examined. Thirteen (14.3 percent) showed positive for SV40. All other test samples, including diagnostic bone marrow from patients with acute leukemia, peripheral blood from 10 relatives of SV40 positive-patients and 91 age-matched normal volunteers, and 5 reactive hyperplastic lymphoid tissues, showed negative. These results may reflect that human-to-human transmission of SV40 is independent of contaminated polio vaccines; and SV40 is possibly associated with the development of NHL in Taiwan (p = 0.0001). Prospective studies are needed to determine the prevalence of SV40 infections in our and other human populations and to explore the means of transmission of the virus.     

A report of 6 children with small bowel intussusception that required surgical intervention

Background/Purpose

We aim to justify the need for surgical intervention in our patients with childhood small bowel intussusceptions (SBIs) and review the current concepts in childhood SBI.

Materials and Methods

We retrospectively reviewed the clinical charts of all patients with surgically confirmed SBI between July 1999 and October 2002. Demographic data, clinical presentation and investigations, operative and pathologic findings, and outcome were analyzed.

Results

Of 173 patients with intussusception, 6 (3.5%) were diagnosed with SBI. Median age was 11 months. Ultrasonography revealed intussusceptions in all patients, but only 1 was diagnosed with SBI. Air enema reductions were attempted in 4 of 6 patients with all ending up in failure and surgery. Surgery revealed ileoileal intussusceptions in 4 patients and jejunojejunal intussusceptions in 2 patients. Two patients had long intussusceptions measuring between 30 and 50 cm in length. Five patients had pathologic lead points, and bowel complications occurred in 2 patients. All underwent bowel resection and primary anastomosis.

Conclusion

Despite reports on spontaneous reduction of SBI, surgery was unavoidable in all our patients with SBI because of the presence of pathologic lead points and/or bowel complications. Air enema reduction was ineffective in SBI. Due caution should be exercised when selecting patients for expectant management.     

Embryologische Untersuchung des intraepidermalen Anteils des Ausführganges der ekkrinen Schweißdrüsen

Zusammenfassung Nach einem Überblick über die Literatur bezüglich des intraepidermalen Teiles des Ductus geben die Verfasser ihre embryologischen Beobachtungen bekannt. Laut ihren Feststellungen beginnt der intraepidermale Teil des Ausführganges 2 Wochen nach Einsetzen der Entwicklung der Drüse zu wachsen. Zwischen der 14. und 22. Woche des embryonalen Lebens gelangen der intraepidermale Ductus und sein Feinbau zur Entwicklung.

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Embryological study of the intraepidermal portion of the eccrine sweat duct

Summary After review of the literature about the intraepidermal portion of the eccrine sweat duct the authors describe own embryological observations. It is found, that 2 weeks after beginning of the development of the gland the intraepidermal portion of duct begins to grow. Between the 14th and 22nd week of pregnancy the intraepidermal duct and its fine structure develops.

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Herrn Professor Dr. N. Melczer zum 80. Geburtstage gewidment.     

Direct identification of Pseudomonas aeruginosa from blood culture bottles by PCR-enzyme linked immunosorbent assay using oprI gene specific primers

A PCR-enzyme-linked immunosorbent assay (PCR-ELISA) was developed for direct identification of Pseudomonas aeruginosa from positive BACTEC blood culture bottles. PCR primers were designed to target a 249 bp sequence of the oprI gene in P. aeruginosa. Biotin-labeled probe (PA3) targeted to the species-specific motif were hybridized to the digoxigenin-labeled amplified products from P. aeruginosa and captured on streptavidin-coated microtiter plates. The specificity of the assay using the PA3 probe was investigated with a range of microorganisms, which are commonly isolated from blood culture bottles serving as negative controls. The PCR-ELISA assay was shown to be highly specific for the identification of P. aeruginosa and was 10-fold more sensitive than an agarose gel-based detection method using the same pair of primers, with a detection limit at 10 fg of template. The PCR-ELISA assay developed in this study is 100% sensitive and 100% specific as it correctly identified all 73 positive and 42 negative controls as well as 25 double blind clinical samples. It significantly reduces the time needed for the identification of P. aeruginosa from positive BACTEC blood cultures bottles from 2-3 days to 6-8h.     

Role of the anterior intermeniscal ligament in tibiofemoral contact mechanics during axial joint loading

The anterior intermeniscal ligament (AIML) is an anatomically distinct structure that connects the anterior horns of the medial and lateral menisci. We hypothesized that both menisci work together as a unit in converting axial joint loading into circumferential hoop stresses, due to intermeniscal attachments. Therefore, loss of the AIML could lead to increased tibiofemoral contact stress and predispose to arthritic change. In this cadaveric study, we compared tibiofemoral contact pressures on axial loading, before and after sectioning of the AIML. Five fresh frozen human cadaveric knees were mounted on a linear x-y motion table and loaded in extension under axial compression of 1800N (about 2.5 times body weight for a 70kg individual), using a materials testing machine. Tibiofemoral contact pressures before and after sectioning of the AIML were measured using resistive pressure sensors. Contrary to our hypothesis, sectioning of the AIML produced no statistically significant increase in mean contact pressure, peak contact pressure or change in contact area, in either the medial or lateral compartment of the knees. This implies that the menisci work independently in converting axial loads into circumferential hoop stresses, and is probably due to their individual root attachments to the tibia. Based on this study, inadvertent sectioning of the AIML during knee surgery, e.g., arthroscopy, anterograde tibia nailing, anterior cruciate ligament reconstruction, meniscus transplantation and unicondylar knee replacement, is functionally insignificant.     

Ministry of Health clinical practice guidelines: schizophrenia

The Ministry of Health (MOH) has updated the clinical practice guidelines on Schizophrenia to provide doctors and patients in Singapore with evidence-based treatment for schizophrenia. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Schizophrenia, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov. sg/mohcorp/publications.aspx?id=26138. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.     

ECG delta waves in patients with palpitation

It is important to recognise Wolff-Parkinson-White (WPW) syndrome in electrocardiograms (ECG), as it may mimic ischaemic heart disease, ventricular hypertrophy and bundle branch block. In addition, ECG can aid in the localisation of the accessory pathway. Recognising WPW syndrome allows for risk stratification, the identification of associated conditions and the institution of appropriate management.