The use of trypsin and lysozyme immobilized on a cellulose carrier in treating otitis externa

In December 1991, an outbreak of Streptococcus bovis septicaemia occurred in a Belgian pigeon loft where 25 male and 25 female racing pigeons were housed. The main clinical signs included inability to fly and poor breeding results. None of the female pigeons and only one male pigeon was able to fly. Nine affected pigeons were necropsied. Histologically a tenosynovitis of the tendon of the deep pectoral muscle was observed in most of them and S bovis was isolated from the canalis triosseus or the shoulder joints of five of the nine pigeons. The pigeons were successfully treated with ampicillin administered in the drinking water for seven days.     

Surgical prophylaxis for pulmonary embolism

The trauma patient population is at special risk for fatal pulmonary embolism. We experienced 11 fatalities in one 12-month period. Specific risk factors for both deep venous thrombosis and pulmonary embolism can be identified among trauma patients. The latter usually cannot be offered prophylactic anticoagulation, and the nature of their injuries (e.g., long bone fractures) makes not only bedside surveillance difficult but also precludes use of pneumatic compression, etc. We have developed a protocol for prophylactic inferior vena caval filtration for our trauma patients deemed at particular risk for pulmonary embolism. Since 1986 we have inserted 205 Greenfield filters in 201 patients. Two hundred were inserted prophylactically. There was no mortality, and morbidity was minimal. No patient with a Greenfield filter sustained a fatal pulmonary embolism during this period. Four patients died from pulmonary embolism before vena caval filters could be inserted. We believe that the trauma patient, at risk for pulmonary embolism, should be offered a Greenfield filter prophylactically as soon after hospitalization as logistically possible.     

Mycobacterial growth and bacterial contamination in the mycobacteria growth indicator tube and BACTEC 460 culture systems

The BACTEC 460 system currently provides the most rapid detection of mycobacterial growth, but the system is radiometric and requires needles to inoculate specimens through the bottle's septum. The Mycobacteria Growth Indicator Tube (MGIT) system has a liquid medium, like the BACTEC system, and does not require needles when inoculating specimens. We compared mycobacterial growth from 510 specimens in the two systems. Average time to acid-fast bacillus (AFB) detection and identification to the species level was less with the BACTEC system, but this result was statistically significant only for AFB detection in specimens containing Mycobacterium avium-M. intracellulare complex. The contamination rate with MGIT was 29%; the BACTEC rate was 5%. To investigate MGIT contamination, we initiated a second study with changes in specimen processing. The MGIT contamination rate was reduced to 12%; the BACTEC rate was not significantly affected (5.5%). The most likely explanation for the contamination in MGIT is the richness of its medium compared to the BACTEC medium. Cost analysis for the two systems in a laboratory that processes 4,500 specimens a year is presented. The data suggest that the BACTEC 460 and the MGIT systems are approximately equivalent in cost and ability to support the growth of AFB. The MGIT system appears safer and easier to use and was preferred by laboratory personnel, but it cannot currently be used for blood specimens or antituberculosis susceptibility testing.     

Topical carbonic anhydrase inhibition increases ocular pulse amplitude in high tension primary open angle glaucoma

We report herein an unusual case of a composite glandular-neuroendocrine carcinoma of the hilar bile duct. A 71-year-old Japanese woman was admitted to our hospital suffering from general fatigue, progressive jaundice, and a high fever. Computed tomography and angiography findings revealed a solid hypervascular mass in the hepatic hilus. Thus, a subsegmentectomy of the liver (S4, S5) and bile duct resection with lymph node dissection were performed. A tumor measuring 6.0 x 3.0 cm was found to be located in the bile duct of the hepatic hilus. Histologically, the tumor was composed of well-differentiated adenocarcinoma and small cell neuroendocrine carcinoma cells, with a histological transition between the two components. Grimelius' method revealed the presence of diffuse positive tumor cells in neuroendocrine carcinoma. The neuroendocrine tumor cells were also diffusely immunoreactive to chromogranin A. To the best of our knowledge, only 22 previous cases of composite glandular-neuroendocrine carcinoma in the biliary tract have been reported; however, this is the first case report of a clearly composite tumor of the hilar bile duct.     

Pelvic fractures: an anatomic guide to severity of injury. Review of 100 cases

A series of 100 cases of pelvic fracture secondary to violent trauma were reviewed and divided into two anatomic groups, those with pure anterior arch fractures (57 patients) and those with posterior fractures (43 patients). By this classification, mortality and associated injury are shown to be markedly increased in those patients with posterior fractures. A detailed study of the major complications has shown that a conservative approach to these injuries is probably the safest for the patient. Major blood loss is the rule rather than the exception and restoration of an adequate circulating volume by transfusion should precede operative attempts to control continuing retroperitoneal hemorrhage.     

Cloning and expression of a novel, tissue specifically expressed member of the UDP-GalNAc:polypeptide N-acetylgalactosaminyltransferase family

We report the cloning and expression of the fifth member of the mammalian UDP-GalNAc:polypeptide N-acetylgalactosaminyltransferase (ppGaNTase) family. Degenerate polymerase chain reaction amplification and hybridization screening of a rat sublingual gland (RSLG) cDNA library were used to identify a novel isoform termed ppGaNTase-T5. Conceptual translation of the cDNA reveals a uniquely long stem region not observed for other members of this enzyme family. Recombinant proteins expressed transiently in COS7 cells displayed transferase activity in vitro. Relative activity and substrate preferences of ppGaNTase-T5 were compared with previously identified isoforms (ppGaNTase-T1, -T3, and -T4); ppGaNTase-T5 and -T4 glycosylated a restricted subset of peptides whereas ppGaNTase-T1 and -T3 glycosylated a broader range of substrates. Northern blot analysis revealed that ppGaNTase-T5 is expressed in a highly tissue-specific manner; abundant expression was seen in the RSLG, with lesser amounts of message in the stomach, small intestine, and colon. Therefore, the pattern of expression of ppGaNTase-T5 is the most restricted of all isoforms examined thus far. The identification of this novel isoform underscores the diversity and complexity of the family of genes controlling O-linked glycosylation.     

Effect of umbilical artery catheters on blood flow and oxygen supply to extremities

The effect of catheter placement in the abdominal aorta on the blood flow and oxygenation of lower extremities was evaluated in 30 New Zealand rabbits, weighing 0.55-3.5 kg, by inserting 3.5 and 5.0 French polyvinyl chloride catheters, of the type commonly used for umbilical artery catheterization, through the femoral artery, advancing 15-20 cm, and leaving in place for 10-30 min. Arterial blood pressure (BP), common iliac artery blood flow (BF), gracilis muscle tissue oxygen availability (O2a), and subcutaneous temperature (T) in the foot were continuously monitored before and during catheter placement and after withdrawal. There were no changes in the physiologic variables measured in the contralateral leg when the catheter remained below the aortic bifurcation; however, when the catheter was advanced 15-20 cm into the abdominal aorta, a decrease in lower extremity BF, O2a, and T occurred. Because the length of catheter insertion was maintained constant in each animal, the decreases in BF, O2a, and T are related to the relative dimensions of the vessel and the catheter. The ratio of catheter to vessel diamter, in addition to the site of catheter placement, should be considered during the clinical application of arterial catheters. Reduction in blood flow could be detected by continuous differential monitoring of core and extremity temperature or extremity muscle oxygen availability.     

Sensitivity of Staphylococcus aureus to unsaturated fatty acids

Some unsaturated fatty acids were found to inhibit the growth of Staphylococcus aureus. Their effectiveness was related both to the degree of unsaturation and to the configuration of the molecule about the double bonds. Both linoleic acid and linolenic acid increased the proportion of plasmid-negative bacteria in a growing culture of bacteria containing a penicillinase plasmid. This was not due to a 'curing' effect of the fatty acids but was the result of greater sensitivity of the growth of bacteria containing penicillinase plasmid to inhibition by the unsaturated fatty acids. The presence of a plasmid conferring resistance to tetracycline, however, did not make the bacterium more sensitive to inhibition by linoleic or linolenic acids.