Haemophilus paraphrophilus frontal lobe abscess: case report

We report a case of cerebral abscess due to Haemophilus paraphrophilus in a 51-year-old man who was otherwise healthy and had no cardiac abnormality. A source for the infection was not definitively identified; however, the patient had had dental manipulations 2 weeks before the onset of symptoms, and an oral source is probable. The patient was treated successfully with antibiotics after removal of the abscess. Bacteriological studies are discussed.     

Campylobacter bacteremia: Clinical experience with three different blood culture systems at Mayo Clinic 1984–1990

Summary The efficiency of three commercially available blood culture systems for isolatingCampylobacter sp. was investigated. Thirteen of 189,688 blood cultures from patients seen at the Mayo Clinic from 1984 through 1990 were positive forCampylobacter sp. Eleven out of 13 blood cultures positive forCampylobacter sp. were part of a complete three bottle set of cultures (Isolator from Du Pont, Roche Septi-Chek from Hoffman-La Roche, and non-vented Tryptic Soy Broth from Difco), none of them providing a specific microaerophilic mileu. The aerobic Roche Septi-Chek seems to be more efficient for the detection ofCampylobacter sp. in blood cultures than either the anaerobic Tryptic Soy Broth (Difco) or the Isolator (Du Pont) using the incubator condition of 5% CO₂.

---

Campylobacter Bakteriämie: Erfahrungen mit drei verschiedenen Blutkultursystemen an der Mayo Clinic 1984–1990

Zusammenfassung Drei kommerzielle Blutkultursysteme wurden auf ihre Eignung für den Nachweis vonCampylobacter sp. untersucht. In den Jahren 1984 bis 1990 waren 13 von 189.688 Blutkulturen von Patienten der Mayo Clinic positiv fürCampylobacter sp. Elf dieser 13 Blutkulturen bestanden aus einem Set von drei gleichzeitig beimpften Systemen (Isolator von Du Pont, Roche Septi-Chek von Hoffman-La Roche und unbelüftete Tryptic Soy Broth von Difco); keines dieser Systeme bietet dezidiert ein mikroaerophiles Milieu. Das aerobe System von Hoffman-La Roche (Roche Septi-Chek) erwies sich im Hinblick auf den Nachweis vonCampylobacter-Bakteriämien sowohl der anaeroben Tryptic Soy Broth von Difco als auch dem Isolatorsystem von Du Pont mit Bebrütung der Platten in 5% CO₂ als überlegen.

     

Identification of Clinical Isolates of Mycobacteria with Gas-Liquid Chromatography Alone

Identification of 18 mycobacterial species was performed by analysis of profiles obtained by using gas-liquid chromatography. Organisms were saponified in methanolic NaOH, and the reaction mixture was treated with BF(3) in methanol and extracted with a hexane-chloroform mixture. An identification scheme was developed from 128 stock strains and tested against a collection of 79 clinical isolates. By using gas-liquid chromatographic profiles alone, 58% of specimens were correctly identified to species level, and an additional 41% were correctly identified to a group of two or three organisms. Use in a clinical laboratory over a 2-month period proved chromatography to be as accurate as and more rapid than concurrent biochemical testing. Of 81 isolates tested, 64% were identified to species level by chromatography alone. An additional 35% were differentiated to the same groups of two or three organisms as found in our analysis of stock strains. These groups consisted of: Mycobacterium tuberculosis, M. bovis, and M. xenopi; M. avium complex, M. gastri, and M. scrofulaceum; or M. fortuitum and M. chelonei. Identification to species level from these groups could usually be done by colonial morphology alone and could always be done by the addition of one selected biochemical test. This study demonstrated the practical application of gas-liquid chromatography in the identification of mycobacteria in a clinical laboratory. In particular, all strains of M. gordonae and M. kansasii were identified to species level. M. tuberculosis was definitively identified in 85% of cases. When it could not be definitely identified, the only alternatives were M. bovis and M. xenopi, both of which are rare causes of infection.     

Esophageal lichen planus: case report and review of the literature

Involvement of the esophagus by lichen planus is a rarely reported condition. The histologic features of esophageal lichen planus, which may differ from those of cutaneous disease, have only rarely been illustrated. We describe a 58-year-old woman with skin and oral lichen planus who presented with dysphagia and an esophageal stricture that were ultimately diagnosed as esophageal lichen planus. Multiple esophageal biopsies demonstrated a lichenoid, T cell-rich lymphocytic infiltrate, along with degeneration of the basal epithelium and Civatte bodies. Correct diagnosis of esophageal lichen planus is critical because of its prognostic and therapeutic distinction from other more common causes of esophagitis and stricture formation.     

“Turn It Off!”: Diabetes Device Alarm Fatigue Considerations for the Present and the Future

Safe and widespread use of diabetes technology is constrained by alarm fatigue: when someone receives so many alarms that he or she becomes less likely to respond appropriately. Alarm fatigue and related usability issues deserve consideration at every stage of alarm system design, especially as new technologies expand the potential number and complexity of alarms. The guiding principle should be patient wellbeing, while taking into consideration the regulatory and liability issues that sometimes contribute to building excessive alarms. With examples from diabetes devices, we illustrate two complementary frameworks for alarm design: a “patient safety first” perspective and a focus on human factors. We also describe opportunities and challenges that will come with new technologies such as remote monitoring, adaptive alarms, and ever-closer integration of glucose sensing with insulin delivery.     

Novel spinal dysplasia in two generations

We report on a father and son with a previously undescribed skeletal abnormality and severe short stature. Antenatal sonographic evaluation of the propositus (son), obtained due to maternal pre-eclampsia, suggested an abnormal spine. At birth, no congenital anomalies were noted and transition to extra-uterine life was smooth. Radiographs performed five days after birth showed spina bifida, hemivertebrae in the mid-thoracic region, and widened lumbar in-terpedicular distances. MRI of the lower thoracic and lumbar vertebrae documented crescent-shaped appearance of the affected vertebrae and abnormally narrow A-P diameter of the vertebral bodies. Intervertebral discs were small, and the posterior elements, as well as the spinous processes of the affected vertebrae, were markedly hypoplas-tic. However, there was no narrowness of the spinal canal, and the limbs were unaffected. CT scan with three-dimensional reformatting of the thoracic and lumbar vertebrae documented unusual sagittal clefting of all of the vertebral bodies, which has previously been undescribed. The father had severe kyphoscoliosis and a height of 131.6 cm (?7.5 S.D.). Radiograph-ically, he was found to have multiple segmentation anomalies and diminished A-P diameter of his affected vertebral bodies. The multiple vertebral anomalies are the probable cause for the father's severe kyphoscoliosis. The pattern of inheritance suggests that an autosomal dominant gene is responsible for this condition and that father represennts a de novo mutationn. These radiographic abnormalities have not been described previously and represent a new form o vertebral spinal dysplasia. © 1995 Wiley-Liss, Inc.