Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection.

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser treatment of eye disorders in children.

The increasing range of indications for laser treatment and the development of new modalities of lasering have led to a growing tendency to extend this type of treatment to the pediatric population. Problems of compliance in this age group often necessitate the use of general anesthesia. This report describes the operative technique used in 11 children (13 eyes) under the age of 13 years, all of whom underwent laser treatment under general anesthesia for a variety of ocular conditions. Argon or krypton laser photocoagulation was performed in eight children (10 eyes), seven of whom were treated for various retinal pathologies and one for an iris cyst. The other three children underwent Nd:YAG posterior capsulotomy for secondary cataract.     

C1 esterase inhibitor deficiency in X-linked hypogammaglobulinaemia: an anomaly fostering anaphylactoid reactions following intramuscular gammaglobulin administration

A patient with apparent X-linked agammaglobulinaemia was found to be inordinately susceptible to anaphylactoid reactions to intramuscular injections of gammaglobulin. The patient was found also to have low levels of C1 esterase inhibitor (C1 INH). The possibility that the C1 INH deficiency and in this patient, whether genetic or acquired, fostered the susceptibility to the production of anaphylactoid reactions after gammaglobulin injections urges further studies of the association of C1 INH deficiency and anaphylactoid reactions to gammaglobulin injections. The possibility that C1 INH levels like C1q levels may be low in hypogammaglobulinaemic patients as a consequence of increased catabolism of this regulator of the complement system when IgG levels are low is considered.     

Compression syndromes of the radial nerve in the area of the elbow and lateral elbow pain

Preoperative, intraoperative, and postoperative findings are described and discussed with reference to 93 operations for entrapment syndromes of the radial nerve in the cubital region. Reference is also made to the importance of this pathological pattern in the context of the whole complex of "lateral elbow pain".     

Pulsing electromagnetic field stimulation of the in vitro growth plate

Specific pulsing electromagnetic fields (PEMFs) have been used to stimulate growth and repair of osteogenic tissues; however, the basis for this specificity is unknown. Previously, we determined the relevant electromagnetic field parameters of the clinically used PEMF and independently verified the beneficial effects of PEMFs on the rabbit fibula fracture healing model. The goal of the present study was to develop an in vitro model that would permit the effectiveness of various electric and magnetic field components of the PEMF to be determined. The costochondral junction (CCJ) of the 21-day-old rat was exposed in vitro to PEMFs with various electric and magnetic field component amplitudes. Response of this model to PEMFs was determined by nondestructive macrophotographic measurement of CCJ growth. Preliminary data indicated that temperature effects were present in this in vitro system. Subsequent experiments designed to separate the effects of temperature and PEMFs on the growth of CCJs in tissue culture were performed. Results indicate that accurate and frequent temperature measurements must be made for in vitro models being used to study effects of PEMFs. Small temperature differences induced by the coils used to produce PEMFs in the CCJ experimental system can have significant stimulatory effects, and the combined effects of temperature and PEMFs are not linearly additive in this model. Furthermore, our results suggest that thermal and PEMF stimuli could affect macrophotographically measured growth of the CCJ by separate mechanisms or could have a synergistic effect. Therefore, PEMF stimulation experiments should be performed under strictly "athermal" conditions.     

Intraosseous infusion of resuscitative fluids and drugs: long-term effect on linear bone growth in pigs.

We studied the effects of intraosseous (IO) infusion of a standard fluid bolus and resuscitative drugs on long-term bone growth and epiphyseal closure in the "pediatric" swine model. Eighteen weanling pigs were randomly assigned to six groups as follows: three animals received two normal saline boluses, 20 mL/kg IO over 20 minutes; three received sodium bicarbonate, 1 mEq/kg IO; three received a 10% sodium bicarbonate infusion IO at maintenance rate over 1 hour; three received epinephrine 1:10,000, 0.1 mL/kg IO; three received an epinephrine infusion IO at 1 microgram/kg/min for 1 hour; and three received a dopamine infusion IO at 10 micrograms/kg/min for 1 hour. All infusions were given in the left hindleg; the right hindleg was used as a control. Lateral radiographs of the hind extremities were obtained at the beginning of the study and at 1 and 3 months after infusion. Linear radiographic measurements of the infused and control tibias were compared. At 6 months after infusion, the tibias were harvested, measured directly, and radiographed to determine the degree of epiphyseal closure. Analysis of variance for the first 3 months' data yielded a nonsignificant time-by-treatment interaction (P = .84) and a nonsignificant main effect for time (P = .22). Separate analysis of the direct measurements taken at 6 months revealed no difference in growth between experimental and control tibias. In addition, no radiographic difference in epiphyseal closure was noted between the two groups at the conclusion of the study, nor were any structural defects discovered. Intraosseous infusion of fluids and resuscitative drugs does not adversely affect subsequent bone growth and development in the swine model.     

Critical evaluation of the short "Z" bunionectomy

The authors reviewed 120 "short Z" bunionectomy operations and, on the basis of available clinical and radiographic data, selected 50 osteotomies in 36 patients for review. Follow-up averaged 21 months and ranged from 13 to 26 months. Excellent and good results were found in 92%, while fair and poor results were obtained in 8% of patients. Although seven fractures occurred in the 50 osteotomy sites, most of these resolved without sequellae after appropriate treatment.