Susceptibility testing of fluconazole by the NCCLS broth macrodilution method, E-test, and disk diffusion for application in the routine laboratory

Antifungal susceptibility testing may be an important aid in the treatment of patients with life-threatening yeast infections. In order to establish the suitability of different susceptibility test methods for fluconazole with yeasts, the Rosco tablet and the E-test were compared with the gold standard NCCLS broth macrodilution method for 106 yeast strains. These included 102 clinical isolates of Candida spp., including Candida glabrata (n = 30), Candida albicans (n = 20), Candida tropicalis (n = 13), Candida parapsilosis (n = 10), Candida krusei (n = 8), plus Cryptococcus neoformans (n = 3), Saccharomyces cerevisiae (n = 2), and 16 strains belonging to other Candida spp. Four American Type Culture Collection strains of Candida were included as quality controls. The NCCLS method was found to be too complex and labor-intensive for routine testing. The E-test is an accurate alternative, but experience in determining MICs and careful attention to procedural details are critically important. The Rosco tablet showed the best agreement with the NCCLS reference method, especially when newly established breakpoints of R < or = 10 mm and S > or = 21 mm were used.     

High Pressure Compression-Molding of α-Cellulose and Effects of Operating Conditions

Commercial α-cellulose was compression-molded to produce 1A dog-bone specimens under various operating conditions without any additive. The resulting agromaterials exhibited a smooth, plastic-like surface, and constituted a suitable target as replacement for plastic materials. Tensile and three-points bending tests were conducted according to ISO standards related to the evaluation of plastic materials. The specimens had strengths comparable to classical petroleum-based thermoplastics. They also exhibited high moduli, which is characteristic of brittle materials. A higher temperature and higher pressure rate produced specimens with higher mechanical properties while low moisture content produced weaker specimens. Generally, the strong specimen had higher specific gravity and lower moisture content. However, some parameters did not follow the general trend e.g., thinner specimen showed much higher Young’s Modulus, although their specific gravity and moisture content remained similar to control, revealing a marked skin-effect which was confirmed by SEM observations.     

Relation of left ventricular shape to volume and mass in patients with minimally symptomatic chronic aortic regurgitation

In 19 male patients with significant but minimally symptomatic or asymptomatic chronic aortic regurgitation, measurements of left ventricular shape, volume, and mass were assessed by cross-sectional echocardiography. End-diastolic volume and mass were significantly larger than normal values. There was a significant negative correlation between the volume-to-mass ratio (V/M) and both the end-diastolic (r = -0.70, p less than 0.01) and end-systolic (r = -0.73, p less than 0.001) long axis-to-minor diameter ratios (L/D), suggesting that maintenance of the normal geometry of the left ventricle is in part dependent on the adequacy of hypertrophy, as expressed by a normal V/M. Since preoperative volume-to-mass indices have been shown to be important predictors of postoperative course, the L/D ratio should be a useful and simple parameter to follow in asymptomatic patients.     

Head‐pelvis coupling is increased during turning in patients with Parkinson's disease and freezing of gait

Turning is the most important trigger for freezing of gait (FOG). The aim of this study was to investigate the relationship between impaired head‐pelvis rotation during turning and FOG. Head, trunk, and pelvic rotation were measured at onset and throughout a 180‐degree turn in 13 freezers and 14 nonfreezers (OFF medication). We also studied 14 controls at preferred and slow speed to investigate the influence of turn velocity on axial rotation. Location and duration of FOG episodes were defined during the turn. At turning onset, head rotation preceded thorax and pelvic rotation in all groups, but this craniocaudal sequence disappeared when FOG occurred. Maximum head‐pelvis separation was significantly greater in controls, compared to freezers and nonfreezers (35.4 versus 25.7 and 27.3 degrees; P < 0.01), but this finding was speed dependent. Timing of maximum head‐pelvis separation was delayed in freezers, compared to nonfreezers and controls, irrespective of turn velocity. This delay was correlated with increased neck rigidity (R = 0.62; P = 0.02) and worsened during FOG trials. FOG occurred more often at the end of the turn, when difference in rotation velocity between head and pelvis was greatest. Even after controlling for speed and disease severity, turning in freezers was characterized by delayed head rotation and a closer coupling between head and pelvis, especially in turns where FOG occurred. These changes may be attributed to delayed preparation for the change in walking direction and, as such, contribute to FOG. © 2013 Movement Disorder Society     

Intracardiac thrombi associated with antiphospholipid antibodies

Two cases of intracardiac thrombi associated with antiphospholipid antibodies are presented, one in the right atrium and the other in the left ventricle, the latter occurring in the presence of normal left ventricular function. In each, the diagnosis was made by transthoracic echocardiography. Both patients had contraindications to thrombolytic therapy and underwent successful surgical thrombectomy. We suggest that serial transthoracic echocardiography may be warranted in the follow-up of patients with primary hypercoagulable states.     

Verrucous carcinoma of the penis: importance of human papillomavirus typing for diagnosis and therapeutic decision.

One case of penile verrucous carcinoma (Buschke-L?wenstein tumor) undergoing anaplastic transformation and containing human papillomavirus type 6 is presented. The viral genome is detected by in situ hybridization using biotin-labeled cDNA probes. The clinical, histological and virologic criteria of verrucous carcinoma are discussed in comparison to giant condyloma and highly differentiated squamous cell carcinoma. The importance of viral typing determination for further diagnostic and therapeutic procedures is emphasized.     

Near-Infrared (NIR) Monitoring of H2O2 Vapor Concentration During Vapor Hydrogen Peroxide (VHP) Sterilisation

Purpose. There is an increasing use in the pharmaceutical industry of barrier systems such as transfer isolators, sterilisation tunnels and work station isolators. As Vapor Hydrogen Peroxide (VHP) sterilisation of isolators and lyophilizers becomes an important sterilisation method, there is an acute need for a VHP monitoring system to be used for in-process control and validation. In this study, near infrared (NIR) spectrofotometry was evaluated as a potential technique to monitor hydrogen peroxide. Additionally the H₂O₂ vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation, was evaluated. Methods. NIR spectrofotometry, using a gas cell connected with optic fibres, was evaluated as a potential technique to monitor hydrogen peroxide vapor and water vapor during VHP sterilisation of an isolator. A NIR spectrum was taken every 30 s during VHP sterilisation of an isolator. The influence of injection rate, air flow rate, working temperature and gas distribution was investigated. The H₂O₂ vapor permeability of different packaging materials was determined by placing the gas cell in the sterilisation bags and sealing the bags hermetically. The sterilisation bag was then subjected to VHP sterilisation. Results. The NIR spectra taken at steady state sterilization conditions showed 4 absorption peaks: at 1364,1378 and 1400 nm attributed to water and at 1420 nm attributed to H₂O₂ vapor. By measuring the absorbance level at these wavelengths, the actual concentration of H₂O and H₂O₂ vapor in the isolator was calculated. The water vapor permeation of the sterilisation bags, measured with NIR, appeared to be equal for all materials tested. Whereas Tyvek^® was the most permeable material for hydrogen peroxide vapor (82.7% of the reference concentration outside the bag), only 30% was found in bags made of medical paper. Sterilisation bags consisting of laminate films and PVC sealed to medical paper showed intermediate permeability. Conclusions. Near-infrared (NIR) spectroscopy using a gascell with optic fibres is a useful technique to monitor VHP sterilisation cycles. There was a difference in H₂O₂ vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation.     

Micro-encapsulation of MDCK-ras-e cells prevents loss of E-cadherin invasion-suppressor function in vivo

The invasion-suppressor molecule E-cadherin mediates Cal²⁺-dependent cell aggregation and prevents invasion. E-cadherin-positive Madin-Darby canine kidney (MDCK) cells that were non-invasive in vitro formed, upon i.p. injection, tumors that were invasive. Differentiated tubular tumor areas showed an intense immuno-signal for E-cadherin at intercellular contacts, whereas undefferentiated structures did not. Cell lines derived from such tumors turned out to be invasive in vitro and showed decreased Ca²⁺-dependent cell aggregation but no change in E-cadherin immunopositivitv. This combination of phenotypes indicated a loss of the E-cadherin invasion-suppressor function-Mi cro-en capsulation of i.p.-injected cells prevented the loss of the E-cadherin invasion-suppressor function. We concluded that this loss in vivo was dependent upon immediate contacts between tumor cells and host cells or upon host factors that could not cross the capsule membrane. © Wiley-Liss, Inc.     

Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation

Background  

Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors’ experience using laparoscopic LLS for different indications including living liver donation.