Esophageal perforation. An unusual presentation with a benign clinical course

A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation.     

Relationship of somatic cell count and cell volume analysis of goat's milk to intramammary infection with coagulase-negative staphylococci

The prevalence of intramammary infection in 4 commercial goat herds was studied in conjunction with electronic somatic cell count and volume analysis determined using a Coutler Counter and volume analyser. Neither streptococci nor mycoplasma were isolated from any half and the prevalence of intramammary infection with Staphylococcus aureus ranged from 0 to 3% between herds. For coagulase-negative staphylococci the range from infected halves was 36-71%. There was no significant difference between the mean total microscopic somatic cell count for halves infected with coagulase-negative staphylococci and those free from infection. A similar trend was observed for electronic somatic cell counts although the mean electronic cell count was greater than the mean total microscopic count on the 2 occasions that they were compared. The correlation coefficients between the 2 cell counting methods were 0.86 and 0.94. Between herds there were significant differences in mean electronic somatic cell count, with herd means ranging from 438 x 103 to 1684 x 103 cells/ml. In 2 of the 4 herds studied, milk samples from halves infected with coagulase-negative staphylococci had a significantly higher prevalence of cell volume distributions with a modal cell volume between 65 mu 3 and 100 mu 3. This was attributed to a higher proportion of polymorphonuclear neutrophils. Use of electronic somatic cell count and cell volume analysis were considered of little value in predicting infection caused by coagulase-negative staphylococci as there was a high proportion of false negative and false positive predictions.     

Accessory cardiac bronchus: 3D CT demonstration in nine cases

OBJECTIVES: To monitor the documentation of blood pressure measurements and other cardiovascular risk factors in general practice patients with hypertension. METHOD: Twenty-five case notes of patients diagnosed as hypertensive were randomly selected from each of 58 participating general practitioners in suburban general practice in Adelaide, South Australia and were monitored by two registered nurses. Main outcome measures: to assess whether blood pressure readings, weight, smoking history, alcohol intake and family history were documented, and whether electrocardiogram, plasma lipids, urinalysis and biochemical screen (which includes blood urea nitrogen, creatinine, glucose, electrolytes and uric acid) had been undertaken. RESULTS: Data from 1446 hypertensive patients showed that for the last three blood pressure values recorded, 483 (33%) had an average level of 140/90 mm Hg or less and 1100 (76%) had an average of 160/95 mm Hg or less. The other cardiovascular risk factors selected were variably recorded, with biochemical screen being most commonly recorded [1198 (83%)] and family history [423 (29%)] the least. CONCLUSIONS: Inadequacies in the control of hypertension and in the documentation of other cardiovascular risk factors suggest that further educational initiatives are required in this common chronic illness.     

Axonal damage revealed by accumulation of beta-APP in HIV-positive individuals without AIDS

The presence of neuropsychological disturbances in HIV-positive, pre-symptomatic individuals is a controversial issue. Neuroimaging studies have not shown brain atrophy or hyperintensity in the white matter, whereas proton magnetic resonance spectroscopy has revealed some abnormality of cerebral biochemistry. Using an antibody to beta-amyloid precursor protein (beta-APP), we previously demonstrated frequent and widespread axonal changes in the brains of AIDS patients. In this study, we extended the use of beta-APP to asymptomatic patients in order to establish a possible morphological correlation with neuropsychological disorders. Brain samples from 29 patients were examined. Results showed bundles of beta-APP-positive axons in 8/29 cases (27%). The changes, seen in both superficial and deep white matter, were either focal or diffuse, could not be visualized by silver or ubiquitin stains, and did not coexist with any change in distribution or morphology of astrocytes and microglial cells. We conclude that in HIV-positive asymptomatic individuals, axonal changes: (a) may be related to the state of immune activation with consequent presence of toxic substances, including cytokines, observed in these patients; (b) may represent mild changes that could undergo repair, unless other pathological events, such as the supervening of the AIDS stage and the specific encephalitis, make them permanent.