Gossypiboma of the abdomen

Intra-abdominal cysts may rise from a variety of organs. However, foreign-body reaction and cyst formation should be considered in the differential diagnosis. In this report, we describe the finding of a preoperatively undetected gossypiboma. A gossypiboma is a mass within the body that is composed of a cotton matrix; in this case, an unmarked laparotomy sponge. The evaluation, findings, and prevention of gossypiboma are discussed.     

Features of autoimmune hepatitis in primary sclerosing cholangitis: an evaluation of 114 primary sclerosing cholangitis patients according to a scoring system for the diagnosis of autoimmune hepatitis

Overlapping features between primary sclerosing cholangitis (PSC and autoimmune hepatitis (AIH) have previously been noted. To assess systematically similarities between these disorders, we have evaluated 114 PSC patients (36 women; 78 men), all confirmed by endoscopic retrograde cholangiography (ERC), according to a scoring system proposed by The International Autoimmune Hepatitis Group for the diagnosis of AIH. The scoring system attributes positive or negative scores to the parameters sex, ratio of elevation of serum levels of alkaline phosphatase (ALP) vs. aminotransferase, serum levels of immunoglobulins and autoantibodies, viral markers, history of drug and alcohol intake, genetic factors, liver histology, and response to therapy. Two of the PSC patients (2%) obtained scores above 15 before treatment, satisfying the diagnostic criterion of "definite" AIH. Thirty-eight patients (33%) scored between 10 and 15 points and could be classified as "probable" AIH. The serum level of immunoglobulin G (IgG) was elevated in 68 patients (61% of 111 cases tested), and positive titers of antinuclear antibodies (ANA) or smooth muscle antibodies (SMA) were detected in 24 patients (22% of 111 cases tested). Thirty-five of the PSC patients (33% of 105 evaluable biopsy specimens) obtained positive scores for histological features similar to those of AIH, but the total score for histology was in the negative range in 72 patients (69%) because of the presence of biliary changes. The frequent finding of high scores in PSC patients underlines the similarities PSC may have with AIH. A modification of the scoring system, in particular by increasing the negative score for histological biliary changes, would improve its potential to discriminate between AIH and PSC.     

Acanthamoeba keratitis: multicentre survey in England 1992-6. National Acanthamoeba Keratitis Study Group

AIM: To investigate the frequency, outcomes, and risk factors for acanthamoeba keratitis (AK) in England during the past 4 years. METHODS: An ophthalmologist in 12 of the 14 regional health authorities (RHAs) coordinated identification of patients in their region presenting with AK between 1 October 1992 and 30 September 1996. Clinical and postal patient questionnaire data were analysed. RESULTS: 243 patients (259 eyes) with an AK diagnosis were identified, equating to an annualised incidence of 0.14 per 100,000 individuals. UK resident patients for each year numbered 50, 71, 73, and 32 respectively. Among patients with sufficient data 170/237 (72%) were diagnosed early (within 30 days of presentation), 197/218 (90%) were treated with polyhexamethyl biguanide and/or chlorhexidine, and 40/243 (16%) underwent surgery. Visual acuities of 6/12 or better were achieved by 222/259 (86%) eyes, including 84 eyes of patients under review or lost to follow up. Non-contact lens (CL) wearers were associated with delayed diagnosis, increased need for surgery and a poorer visual outcome (only 10/18 eyes, 56%, achieved 6/12 acuity). 225/243 (93%) patients were CL wearers, and 205/243 (84%) were soft CL (SCL) users. Among SCL user respondents, previously identified risk factors--swimming with CL (47/138, 34%), non-sterile CL rinsing (11/138, 8%), omitted disinfection (85/138, 62%), and chlorine release disinfection (65/138, 47%)--were identified for 125/138 (91%) patients. CONCLUSIONS: Earlier diagnosis and more effective medical therapy have improved the prognosis for most AK patients. The study demonstrates the highly preventable nature of the disease: 91% of the SCL wearers could have avoided the disease by refraining from inadvisable practices, and a marked fall in frequency was seen after intensive media attention to AK, possibly in conjunction with increasing penetrance of new CL products. Since the frequency of AK appears to be largely determined by the ever changing trends in CL use, continued monitoring is indicated.     

A case-based emergency medicine curriculum for senior medical students

OBJECTIVE: To determine the effects of a case-based, core content-oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students. METHODS: All senior medical students rotating through the Milwaukee County EM elective during the 1992-1993 academic year were assigned specific chapter readings from a case-oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. All students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five-point Likert scale. RESULTS: Seventy-five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 +/- 7.1%; final examination score 76.2 +/- 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of -1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale. CONCLUSIONS: A case-based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

Tumour size measured by transrectal ultrasonography in the staging of prostate cancer before radical prostatectomy

Fluoroquinolone-resistant mutants of Mycoplasma hominis were selected in vitro from the PG21 susceptible reference strain either by multistep selection on increasing concentrations of various fluoroquinolones or by one-step selection on agar medium with ofloxacin. The quinolone resistance-determining regions (QRDR) of the structural genes encoding the A and b subunits of DNA gyrase were amplified by PCR, and the nucleotide sequences of eight multistep-selected resistant strains were compared to those of susceptible strain PG21. Four high-level resistant mutants that were selected on norfloxacin or ofloxacin contained a C-to-T transition in the gyrA QRDR, leading to substitution of Ser-83 by Leu in the GyrA protein. Analysis of the sequence of the gyrB QRDR of the eight multistep-selected mutants did not reveal any difference compared to that of the gyrB QRDR of the reference strain M. hominis PG21. Similar analyses of eight one-step-selected mutants did not reveal any base change in the gyrA and gyrB QRDRs. These results suggest that in M. hominis, like in other bacterial species, a gyrA mutation at Ser-83 is associated with fluoroquinolone resistance.     

Oral Neospora caninum inoculation of neonatal calves

The bcl-2 protein plays an essential role in preventing cell death. Its activity is regulated through association with bcl-2 homologous and nonhomologous proteins and also by serine phosphorylation. We now report that bcl-2 can be proteolytically cleaved towards its N-terminus by a cysteine proteinase present in RL-7 lymphoma cell lysates, yielding a major product of apparent MW 20 kDa, different from the products of bcl-2 cleavage by HIV protease. Moreover, bcl-2 proteins mutated for Asp residues at positions 31 and 34 were efficiently cleaved by RL-7 cell lysates, indicating that this proteolytic activity is distinct from the caspase-3 that cleaves bcl-2 at Asp 34. This bcl-2 cleaving activity is inhibited by E-64 and is therefore distinct from the proteinases of the ICE/Ced-3 family (caspases), whereas reciprocally, ICE (caspase-1) is unable to cleave bcl-2. It is optimally active at pH 5, a feature distinguishing it from calpain, another non-ICE cysteine proteinase which has been associated with apoptosis. This novel bcl-2 cleaving protease, although constitutively present in RL-7 cells and resting peripheral blood lymphocytes (PBL) was upregulated following induction of apoptosis in RL-7 cells or mitogen activation in PBL. The N-terminus of bcl-2 which contains the BH4 domain that binds the kinase Raf-1 and the phosphatase calcineurin is essential for anti-apoptotic activity. Its cleavage might provide a novel post-translational mechanism for regulating bcl-2 function and could amplify ongoing programmed cell death.