Microbial adherence to and disinfection of laryngoscopes used in office practice

This study reports the appropriate disinfection methods for flexible and rigid laryngoscopes when used in an outpatient setting. This investigation presents evidence that an appreciable number of laryngoscopes are contaminated during use. A brief tap water rinse serves to eliminate gross soil of host origin known to interfere with disinfectant efficacy. Disinfection with 3.2% glutaraldehyde (Cidexplus) for 10 minutes effectively eliminated microbial contaminants. Since potentially harmful microorganisms were included among the more than 100 isolates during our baseline experiments, the need to eliminate bacteria, viruses, fungi, and protozoa from laryngoscopes is obvious and can be attained readily.     

A Comparison of Mydriatic Eyedrops in Low-Weight Infants

The pupils of neonates often need to be dilated to examine the retina for retinopathy of prematurity and other disorders. It is known that low-weight infants (<1600 grams) are susceptible to systemic hypertension when 10% or 2.5% phenylephrine eye drops are used. To find the safest and best commercially available mydriatic agent in neonates, 30 low-weight infants were divided evenly into three groups. The drops tested were cyclopentolate 0.5% alone, cyclopentolate 0.5% plus mydriacyl 0.5%, and a combination drop of phenylephrine 1% and cyclopentolate 0.2%. There was no clinically significant effect of any of the drops on systolic blood pressure or pulse rate. The cyclopentolate and phenylephrine combination dilated the pupils by a mean of 2.8 mm which was statistically greater than the other groups (P < 0.01) and had a longer duration of maximal dilation than the other drops (P < 0.05).     

The adult presenting idiopathic Fanconi syndrome

The adult presenting Fanconi syndrome is a rare familial disorder. A 30-year follow-up of one of the original families in the literature is reported here. Two important points have emerged. Firstly, the inheritance in this family is dominant, not recessive as originally suggested, and there remains no good example in the literature of a recessive inheritance of this disorder. Second, in this family lactic aciduria and tubular proteinuria are probably the earliest manifestations of the disorder in childhood, with glycosuria and aminoaciduria developing in the second decade and osteomalacia from the start of the fourth decade. Glomerular function deteriorates slowly but is compatible with a normal lifespan.     

How to monitor SLE in routine clinical practice

A century ago syphilis was regarded as the great masquerader. Its modern equivalent is lupus. It may present to a wide range of specialists and its outcome, while much improved, remains uncertain in a significant number of patients.     

Clinical laboratory studies of disinfection with Sporicidin.

The clinical microbiology laboratory evaluation of disinfectants can serve as a guide for their application to reduce hospital-acquired infections. The use of Sporicidin, a glutaraldehyde-phenol formulation, was evaluated by the application of modified MIC and MBC determinations for standard organisms. In addition, the effect of this formulation on bacteria that may proliferate in water at ambient temperatures was studied. This investigation indicated that such studies can help the clinical microbiologist to guide the use of disinfectants and sterilants for the maintenance of a safe hospital environment.     

Pathogenicity and virulence: another view.

The concepts of pathogenicity and virulence have governed our perception of microbial harmfulness since the time of Pasteur and Koch. These concepts resulted in the recognition and identification of numerous etiological agents and provided natural and synthetic agents effective in therapy and prevention of diseases. However, Koch's postulates--the premier product of this view--place the onus of harmfulness solely on the microbial world. Our recent experiences with polymicrobic and nosocomial infections, legionellosis, and acquired immunodeficiency syndrome point to the host as the major determinant of disease. The principles of parasitism, enunciated by Theobold Smith, approximate more accurately the disturbances of the host-parasite equilibrium we designate as infection. Many complex attributes of microbial anatomy and physiology have been obscured by our dependency on the pure-culture technique. For example, bacterial attachment organelles and the production of exopolysaccharides enable microorganisms to interact with mammalian glycocalyces and specific receptors. In addition, selection, through the use of therapeutic agents, aids in the progression of environmental organisms to members of the intimate human biosphere, with the potential to complicate the recovery of patients. These factors emphasize further the pivotal significance of host reactions in infections. Parasitism, in its negative aspects, explains the emergence of "new" infections that involve harm to more than host organs and cells: we may encounter subtler infections that reveal parasitic and host cell nucleic acid interactions in a form of genomic parasitism.