Nosocomial pseudobacteremia. Positive blood cultures due to contaminated benzalkonium antiseptic

Pseudomonas cepacia or Enterobacter species or both were isolated from blood cultures of 79 patients in a community hospital between April 1971 and March 1972. No common exposures other than venipuncture correlated with positive blood cultures. Pseudomonas cepacia, Enterobacter, and other Gram-negative enteric bacteria were cultured from aqueous benzalkonium chloride used for skin antisepsis prior to ordinary and blood culture venipuncture. Contamination of blood cultures by organisms from the antiseptic most likely accounted for positive cultures in 35 to 38 patients (92%) with P cepacia. The remaining three patients had repeated blood cultures positive for P cepacia and circumstantial clinical evidence of bacteremia; they may have contracted disease through exposure to the contaminated antiseptic. Substitution of an iodine-alcohol antiseptic abruptly reduced the isolation of P cepacia and Enterobacter.     

Evaluation of mental health service effectiveness: a "start up" model for established programs

The ventral pedal gland in the foot of the mature female whelk Buccinum undatum L. consists of a shallow pouch containing a layer of elongated cells which partially penetrate a basement membrane overlying layers of smooth muscle. This glandular epithelium contains acid mucopolysaccharide cells, ciliated and interstitial cells as well as the upper part of a new type of subepidermal gland cell. These gland cells consist of an elongated extracellular tubular duct formed by an invagination of the cell membrane and lined by numerous microvilli. Into this duct are discharged packets of a densely staining secretion. The secretion packets are produced in Golgi regions around the nuclei of the cells and are passed up through the cell to the base of the duct through or along an extensive assemblage of microtubules. The secretion packets show organized internal structure and may contain aromatic aldehydes and protein associated with the sclerotization of the egg capsules, which pass through the gland after leaving the genital tract.     

Purification of the reduced nicotinamide adenine dinucleotide dehydrogenase from membranes of Acholeplasma laidlawii

With the use of the unlabeled antibody enzyme technique and antiserum to luteinizing hormone-releasing hormone (LHRH), the distribution of LHRH in the adult male guinea pig was studied. Immunoreactive deposits were found in the cell bodies of hypothalamic neurons in the medial preoptic, anterior hypothalamic, suprachiasmatic, and arcuate nuclei. Ten to thirty LHRH-containing perikarya were seen per brain. Four fiber tracts positive for LHRH were described: Tract I runs on the pre-commissural side of the anterior commissure from the bed nucleus of the stria terminalis and medial preoptic area to the suprachismatic nucleus: Tract II runs on the post-commissural side to the retrochiasmatic portion of the suprachiasmatic nucleus; Tract III originates in the arcuate nucleus and the ventral portion of the ventromedial nucleus and courses medially and caudally to enter the median eminence; Tract IV travels from the mammillary bodies to the mid-brain. Three weeks after surgical isolation of the medial basal hypothalamus there was a slight decrease in the amount of LHRH in the median eminence. These data suggest that LHRH is synthesized in more than one hypothalamic nuclear group but that the majority of axons containing the hormone in the median eminence originate in the medial basal hypothalamus.     

Proestrous gonadotropin levels in thyroparathyroidectomized female rats

Intact and TPTx animals showed the expected afternoon increase in serum LH,FSH and prolactin levels. But the afternoon increase in serum LH levels in TPTx rats was less than that observed for intact animals (p less than 0.001). Neither serum prolactin nor FSH levels were altered by TPTx.     

Echocardiography in Lutembacher's syndrome

The findings in a patient with surgically proven Lutembacher's syndrome (coexisting mitral stenosis and atrial septal defect) are presented. In addition to a typical pattern of mitral stenosis, the preoperative echocardiogram revealed paradoxical septal motion, thereby providing, prior to cardiac catheterization, a basis for the suspicion of an associated lesion due to diastolic overload of the right ventricle.     

Hypernephroma in the solitary kidney: experience with 20 cases and review of the literature

Twenty patients with renal cell carcinoma in anatomically or functionally solitary kidneys were treated and followed for up to 18 years. Factors pertinent to management and survival of these patients and 66 other well documented similar patients reported in the literature are analyzed. Most of the patients were unusually young and a significant number had had nephrectomy for contralateral renal cell carcinoma. Survival was closely related to the earlier presence of malignant disease in the other kidney, the duration of the interval between detection of the 2 neoplasms and the stage of the lesion in the solitary kidney. Partial nephrectomy has been the most successful treatment. The mean survival in the Mayo Clinic series has been 6 years for patients still alive and 2.4 years for those dead at the time of this analysis. Results in this and other series emphasize the importance of thorough long-term followup after nephrectomy for hypernephroma and of aggressive therapy when the remaining kidney becomes involved. It is foolhardy to abandon hope merely because there is a malignant tumor in a solitary kidney.     

A halo visual illusion

A visual illusion consisting of transparent halos extending beyond the boundaries of rotating discs is reported. The effect can be obtained by rotating a variety of black-and-white discs at moderate speeds. It is not due solely to rods, as opposed to cones, and does not appear to be explainable in terms of intermittent stimulation of portions of visual fields of fixed visual angle.     

Psychotherapy of borderline psychotic children

This presentation of excerpts from the literature synthesizes many suggestions by various therapists concerning the treatment methods of borderline psychotic children. The importance of providing a stable, auxiliary ego for the child to introject emerges clearly and is clinically demonstrated. Comments on the author's own experiences are included.