Importation and Circulation of Vaccine-Derived Poliovirus Serotype 2, Senegal, 2020–2021

Environmental surveillance for poliovirus is increasingly used in poliovirus eradication efforts as a supplement to acute flaccid paralysis (AFP) surveillance. Environmental surveillance was officially established in 2017 in Senegal, where no poliovirus had been detected since 2010. We tested sewage samples from 2 sites in Dakar monthly for polioviruses. We identified a vaccine-derived poliovirus serotype 2 on January 19, 2021, from a sample collected on December 24, 2020; by December 31, 2021, we had detected 70 vaccine-derived poliovirus serotype 2 isolates circulating in 7 of 14 regions in Senegal. Sources included 18 AFP cases, 20 direct contacts, 17 contacts in the community, and 15 sewage samples. Phylogenetic analysis revealed the circulation of 2 clusters and provided evidence on the virus introduction from Guinea. Because novel oral polio vaccine serotype 2 was used for response activities throughout Senegal, we recommend expanding environmental surveillance into other regions.     

The role of the anesthesiologist in the care of the parturient with cardiac disease

Women with cardiac disease constitute a growing percentage of parturients, and in many series cardiac disease is the leading cause of maternal mortality. Involvement of anesthesiologists in the planning for and management of delivery in these women can improve the experience and potentially the outcome of these patients. Communication with the anesthesiology team about particularly complex cases is essential to avoid both medical complications and inter-disciplinary disagreements. The specific role and contributions of the anesthesiology team will depend significantly on the nature of the institution and the organization of the (obstetric) anesthesiology service.     

The azygos lobe: an unusual anatomical observation with pathological and surgical implications

The azygos lobe is a rare anomaly in broncho-pulmonary segmentation due to an unusual course of the azygos vein. Its radiological aspects are well known but there are few anatomical reports about its bronchial and vascular components. The authors describe the characteristic features in a particular case of the azygos lobe observed in the right lung after studying a fresh specimen and doing a casting of said specimen. This azygos lobe was in a position medial to the right upper lobe and above the hilum. It had the shape of an egg and was 5 cm high, 4 cm wide and 2 cm thick. The azygos fissure was of a vertical form. The lobe was ventilated by the posterior branch of the apical segmental bronchus (B1a). This latter was accompanied by two apical sub-segmental arteries (A1ai, A1aii) and the apical intersubsegmental vein (V1a). The new findings were that: first, the azygos lobe bronchus supplied a part of the right upper lobe; second, the passage of the azygos vein deformed the bronchus of the right upper lobe, and not that of the azygos lobe. This means that it was the right upper lobe, rather than the azygos lobe that was predisposed to the pathology. So, in excising this type of azygos lobe, particular precautions have to be taken to spare the bronchus of the azygos lobe that supplies the right upper lobe.     

Aggressive approach to the extremity damaged by electric current

Electrical current injuries involving the extremities occurred in 41 of 75 patients with electrical burns admitted to the Oregon Burn Center over an 11 year period. Based solely on physical findings, the muscle compartments of 27 limbs in 14 patients were promptly explored, decompressed, and debrided of necrotic tissue on admission. This resulted in the salvage of 10 useful extremities. Major amputation of 11 extremities was carried out during initial surgery. No extremity needing exploration was overlooked. After exploration and fasciotomy, exposed tissues were protected with biologic dressings until repeated explorations and debridements demonstrated the absence of necrotic tissues and closure could be accomplished. The use of both local and free flaps was helpful in closing the wounds. No evidence or renal failure and no deaths attributable to retained necrotic tissue occurred.     

Binding of apomorphine to neural membranes

The intrinsic fluorescence of apomorphine has been used to measure its binding to neural membranes. A large number of relatively weak binding sites are concentrated in myelin and synaptic membrane fractions. Butyrophenones have the highest affinities for these sites--KD = 43 micrometer for haloperidol--while dopamine and dopamine releasers and reuptake blockers, as well as a variety of other alkaloids, have much lower affinities. The sites are hydrophobic and undergo a phase transition to a highly fluid state near 26 degrees C. Calcium is a noncompetitive inhibitor of apomorphine binding. Some of the actions of neuroleptic drugs may result from binding to these hydrophobic membrane sites in vivo, blocking conduction in small catecholamine axons.     

Die Dynamik der experimentellen tuberkulösen Entzündung des Meerschweinchens unter Einwirkung der Ethambutol-Therapie

A comparative study of the dynamics of experimental tuberculous lesions in guinea pigs, under the monotherapic effect of ethambutol, was performed. The results of these investigations showed that ethambutol influences the morphologic dynamics of experimental tuberculous lesions by favoring the cellular resorption of exsudative and necrotic lesions, by regression and reorganisation of the epitheloidcell-nodules, by stimulation of the lymphoid follicles. The alteration occurs slowly but progressively by lymphoreticular cell proliferation and cellular differentiation. Ethambutol tends to reduce the fibrous delimination of the tuberculous lesions. The statistical evaluation (White-test) showed significant differences between control and treated animals. In monotherapy, ethambutol appears especially effective in treating recent tuberculous lesions.