Maintenance of body temperature in elderly patients who have joint replacement surgery A comparison between the heat and moisture exchanger and heated humidifier

The effect of a heat and moisture exchanger on intra-operative aural canal (core) and mean skin temperatures was investigated in elderly patients who had elective total hip arthroplasty under general anaesthesia with artificial ventilation of the lungs. Group 1 (n = 20) did not receive any form of artificial humidification while in group 2 (n = 20) a heat and moisture exchanger was inserted in the breathing system and in group 3 (n = 20) the inspired gases were humidified and warmed at 40 degrees C by means of a heated humidifier. Time of surgery, intravenous fluid administration and operating theatre temperature were standardised. Mean (SD) aural canal (core) temperature decreased significantly in groups 1 and 2 (p less than 0.001), while there was a fall of 0.3 degrees C (0.6) in group 3, which was not significant. Mean skin temperature decreased during anaesthesia and surgery in both groups 1 and 2 (p less than 0.05), while it increased in group 3. There was a significantly greater loss of body heat in groups 1 and 2 compared with group 3 intra-operatively (p less than 0.001). We conclude tha a heat and moisture exchanger did not prevent the decrease in intra-operative body temperature in elderly patients.     

Elbow ganglion arising from medial epicondyle pseudarthrosis.

We present a patient with an asymptomatic painless medial elbow swelling of one year's duration, which was diagnosed as a ganglion originating from a non-united avulsion fracture of the medial epicondyle with a pseudarthrosis. Medial elbow ganglia are unusual lesions typically arising from the medial aspect of the ulnohumeral joint capsule, often in combination with symptoms of cubital tunnel syndrome. To our knowledge, a ganglion arising from a pseudarthrosis has not been reported in the literature, and should be considered in the differential diagnoses of lesions encountered over the site of fracture non-union in proximity to a joint.     

Engineered BGMK cells for sensitive and rapid detection of enteroviruses

Decay-accelerating factor (DAF) has been reported to be a cellular receptor for several enteroviruses. Buffalo green monkey kidney (BGMK) cells expressing human DAF (BGMK-hDAF cells) showed increased susceptibility and sensitivity to several types of enteroviruses compared to wild-type BGMK cells. When 17 frozen positive clinical samples were tested, BGMK cells detected 8 and BGMK-hDAF cells detected 16. Since the CaCo-2 cell line has been documented to support the replication of most enteroviruses, CaCo-2 cells were mixed with BGMK-hDAF cells in order to increase the number of viruses detected. Thirty-four frozen clinical samples that previously had tested positive for enteroviruses were tested, and the following numbers were detected: 33 of 34 by CaCo-2/BGMK-hDAF cells, 29 of 34 by CaCo-2/BGMK cells, 28 of 34 by H292/RD (E-mix A) and A-549/BGMK (E-mix B) cells, and 26 of 34 by MRC-5 and pRhMK cells.     

New-onset seizures in patients with immunodeficiency virus infection in Bobo-Dioulasso Hospital (Burkina Faso)

Seizures are common in advanced stages of immunodeficiency virus (HIV) infection. HIV-infected outpatients and inpatients in the national hospital in Bobo-Dioulasso among whom seizures occurred had been recruited over four years. There were mainly male (30/13) with an average age of 35 years with extremes ranging from 22 to 60 years. New-onset generalised seizures occurred in all cases of cryptococcal meningitis or partial motor secondary generalised in 64% among patients with suspected cerebral toxoplasmosis due to the efficiency of the treatment of the antitoxoplasmic proof. Identified causes such as suspected cerebral toxoplasmosis (65%), suspected tuberculous meningitis (7%) as CSF culture is not available, cryptococcal meningitis (16%) were found in this study. In four cases among 43 patients, no identified causes could be determined. CD4 lymphocytes count which was available in 24 patients was under 200/41 in 74% of the cases. This study indicates clearly that seizures in young adults are strongly associated with focal brain lesions and cerebral toxoplasmosis is becoming an important cause of seizure in tropical area. This should imply a screening of toxoplasmosis with new-onset seizure in young people.     

Comparison of two automated DNA amplification systems with a manual one-tube nested PCR assay for diagnosis of pulmonary tuberculosis.

Eighty-four specimens of respiratory secretions culture positive for mycobacteria (70 positive for Mycobacterium tuberculosis and 14 positive for nontuberculous mycobacteria) and 120 culture-negative specimens were evaluated by three DNA amplification techniques: a manual in-house single-tube nested PCR (nPCR) and two commercial automated assays (the Cobas Amplicor System [aPCR-h] from Roche Diagnostic Systems and the Abbott LCx Probe System [aLCx-p] from Abbott Laboratories). The overall diagnostic sensitivities of the nPCR, aPCR-h, and aLCx-p were 77.1, 84.3, and 77.1%, respectively, and the sensitivities were 57.9, 57.9, and 36.8%, respectively, for smear-negative specimens. Specimens culture positive for nontuberculous mycobacteria were negative by all three assays. Eight culture-negative specimens which were positive by one or more assays had previously been documented by culture to be positive for M. tuberculosis and were taken from patients who were treated with antituberculosis agents. Retesting of specimens negative by one assay by the other two assays revealed that each test had its unique group of negative specimens. When considering the DNA extraction and amplification steps of these assays separately, it was found that extracts from aPCR-h and aLCx-p were compatible with nPCR amplication, while the two automated assays could only amplify extracts processed with their own reagents. Limiting dilution analysis revealed that the order of analytical sensitivity was nPCR, followed by aLCx-p and then aPCR-h. Comparison of the work flow of each assay revealed that although the aPCR-h demands the least specimen handling, the turnaround time of aLCx-p is the most favorable.