Molecular epidemiology of a reproductive tract-associated colibacillosis outbreak in a layer breeder flock associated with atypical avian pathogenic Escherichia coli.

The molecular epidemiology of 70 Escherichia coli isolates from an infection outbreak in a layer breeder flock was examined by pulsed-field gel electrophoresis and for a range of virulence factors by polymerase chain reaction. Pulsed-field gel electrophoresis showed 35 of 45 isolates from eight disease cases were associated with a single clonal group that was the exclusive strain associated with reproductive tract. A second unrelated group was found in environmental isolates and healthy birds. The remaining isolates were unrelated to each other or either clonal group. Polymerase chain reaction virulotyping indicated the "epidemic" clonal group contains virulence factors including iss, sfa, tsh, iucC, ibeA, and sitA associated with avian pathogenic E. coli plus several virulence factors more normally associated with human urinary tract infection. Significantly, the "epidemic" clone was also found in an environmental sample, suggesting it may have been transmitted to the flock via the environment.

Observations on salpingitis, peritonitis and salpingoperitonitis in a layer breeder flock.

A flock of 13,951 hens and 1379 cockerels was monitored from 26 to 58 weeks of age for the complex of salpingitis, peritonitis and salpingoperitonitis (sps). Two hundred and forty-three hens (78 per cent of the hens that died) were examined postmortem, and sps was recognised by gross examination for inflammatory exudate, in the body cavity or oviduct in 111 (46 per cent) of them. Salpingoperitonitis was the most common form, followed by salpingitis and then peritonitis. There were acute and chronic cases in all three conditions, but only in peritonitis were acute cases more common than chronic cases. Seventeen birds that had died of sps were cultured for aerobic bacteria within 12 hours of death. Escherichia coli was recovered from a variety of tissues from all of them, and other bacteria, including staphylococci, Mannheimia haemolytica and Streptococcus bovis, were isolated from a few carcases, either alone or together with E coli. Relatively few isolations of E coli were made from normal hens cultured 48, 72 and 96 hours after death.

Spontaneous cervical hematoma: a rare manifestation of parathyroid adenoma.

Extracapsular hemorrhage from spontaneous rupture of a hyperplastic parathyroid gland is exceedingly rare. Rupture of an intrathoracic parathyroid adenoma mimicking a dissecting thoracic aortic aneurysm has been reported in two cases. Hypercalcemic crisis associated with contained hemorrhage within a parathyroid adenoma has been well documented. We present the first reported case of spontaneous rupture and extracapsular hemorrhage of a cervical parathyroid adenoma. Serum calcium levels should be obtained when spontaneous cervical or mediastinal hemorrhage develops without obvious cause.

Microbiological monitoring of aortic aneurysm wall and contents during aneurysmectomy.

Fifty-six patients, ranging in age from 49 to 90 years, underwent abdominal aortic aneurysmectomy and had cultures taken from the aneurysm wall and atheromatous debris to identify possible microbiological sources of future graft infection. All patients received antibiotics before and after operation. Eleven (19.6%) of 56 cultures yielded bacterial growth. The most common organism isolated was Staphylococcus epidermidis (in six of 11 patients). Thirty-seven percent of the aneurysms cultured were symptomatic (expanding or ruptured); however, this group accounted for 54% (6/11) of the positive cultures. During an average follow-up period of 24.5 months (range, four to 82 months), no early or late graft infections were documented. A literature review demonstrated the same disparity between positive cultures obtained at aneurysmectomy and subsequent low graft-infection rate.

Endoscopic papillotomy for recurrent common bile duct stones and papillary stenosis. A community hospital experience.

Fifty-nine papillotomies were performed, 56 for biliary tract disease and three for papillary stenosis (secondary to carcinoma in two cases). All 56 patients with biliary tract disease had undergone previous cholecystectomies. Fifty-one of them had stones in the common duct, and in 41, all identified stones were removed. Stones were retained in ten patients, four of whom required surgical biliary tract exploration for extraction. Our results indicate that common bile duct stones with diameters 2.5 cm or greater should be approached surgically. Endoscopic papillotomy had an initial success rate of 80% for extraction of common bile duct stones and a late or actual success rate of 92%, confirmed by cholangiography. There were nine complications, including five episodes of bleeding (three requiring surgical intervention for control), giving an overall morbidity rate of 15.2%. The mortality was 3.4%. The procedure is indicated in the treatment of papillary stenosis and stones retained in the common bile duct after cholecystectomy.

Heterotopic gastric mucosa of the rectum. A rare cause of rectal bleeding.

We studied a patient with rectal gastric heterotopia and found nine reported cases of this rare disease in the literature. Symptoms include proctitis and rectal bleeding. Heterotopic gastric epithelium may be developmental or acquired, depending on the type of mucosal epithelium involved. Since this type of lesion can occur anywhere in the alimentary tract and even in multiple sites, long-term follow-up is recommended. The diagnosis is made by biopsy and pathologic examination. The treatment consists of total local excision. Sigmoidoscopy, colonoscopy, and technetium scanning can be used as adjunctive aids in diagnosing secondary sites of gastric heterotopia.

Endoscopic papillotomy: impact on community hospital treatment of common duct stones.

High mortality rates reported with common bile duct exploration (CBDE), 3.4 per cent to as high as 30 per cent in re-exploration of those over 70 years of age, prompted review of endoscopic papillotomy (EP) for stone extraction in a community hospital as well as an attempt to assess its impact on the treatment of common duct stones. Endoscopic papillotomy in 237 patients had a 1.3 per cent mortality. Successful extraction of the stone occurred in 91.6 per cent of 108 patients followed for at least 2 years with no further treatment required. Morbidity and mortality was uneffected by previous biliary surgery, repeat attempts at stone extraction or EP performed prior to cholecystectomy (P greater than 0.1). The results of treatment for choledocholithiasis in 111 consecutive patients was then retrospectively reviewed to assess the impact of endoscopic papillotomy. CBDE was used initially in 79 and EP in 32 patients. Previous cholecystectomy and age biased the selection for endoscopic papillotomy (P less than 0.01). The mean ages were 57.8 years and 70.6 years (P less than 0.01), for CBDE and EP pts respectively. Age adjusted hospital stay was significantly longer for common bile duct exploration (P = 0.002). Overall, morbidity was not different between the treatment modalities (P = 0.50) and each group had one death (P = 0.23). In this community hospital, endoscopic papillotomy is safe, effective, and was reserved mainly for older patients or those with prior cholecystectomy and choledocholithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary adenocarcinoma of the appendix. Can preoperative or intraoperative diagnosis be made?

Adenocarcinoma of the appendix is a rare entity with a reported incidence of .03 to .08 per cent. A review of all appendectomies performed at St. Joseph Mercy Hospital (a private community hospital) between 1963 and 1979 was undertaken to assess the efficacy of preoperative diagnosis. Six adenocarcinomas were found, consisting of five male patients and one female patient with a mean age of 65 years. Symptoms were present for 24 hours or greater in all cases. A preoperative diagnosis was not made in any patient. Three patients later required a definitive therapeutic procedure, and two patients died from metastatic disease during their initial hospitalization. The literature was reviewed to evaluate methods of preoperative and intraoperative diagnosis of appendical adenocarcinoma. A suspicion of carcinoma of the appendix should be entertained for patients over the age of 50 years who present with signs and symptoms of appendicitis for greater than 24 hours. A barium enema performed preoperatively and especially a frozen section at the time of surgery of any suspicious appendiceal lesions may improve the diagnostic accuracy and survival of patients with this disease entity. If preoperative or intraoperative diagnosis is made, the patient can be better prepared and definitive surgical therapy carried out. This avoids delay in treatment and a second operative procedure.

Internal hernia and gangrenous intestine. A rare complication of a femoral--femoral bypass graft.

An unusual case of an internal hernia related to a retropubic femoral-femoral bypass graft is presented. An orifice between the left and right inguinal ligaments and a protruding intraperitoneal portion of the prosthetic graft material resulted in herniation and strangulation of a portion of the small intestine. Technical factors (graft redundancy or misplacement) and natural factors (pulsatile erosion or age elongation) may be implicated. The potential for this complication exists in all grafts currently placed. The subcutaneous location appears to be a better technique.

The minimum inhibitory concentration of tilmicosin and tylosin for mycoplasma gallisepticum and Mycoplasma synoviae and a comparison of their efficacy in the control of Mycoplasma gallisepticum infection in broiler chicks.

The minimum inhibitory concentrations of tylosin tartrate and a new macrolid antimicrobial agent, tilmicosin, were assessed for six strains of Mycoplasma gallisepticum (MG) and three strains of Mycoplasma synoviae (MS) in vitro by the microbroth method. For four of the strains of MG, tilmicosin showed a slightly lower minimum inhibitory concentration (MIC) than did tylosin at both the initial reading (when pH 7.0 is first seen in the dilutions under test) and the final reading at 14 days of incubation. For one of the remaining strains, the MIC for tilmicosin was equal to or less than that for tylosin at the initial reading but greater at the final reading. For the other strain, the MIC for tilmicosin was greater than for tylosin, and for both of them the MICs were very much higher than for other strains. For the three strains of MS, there was little difference between the two drugs for one strain whereas the MIC for tilmicosin was slightly less for the other two groups. Groups of 30 chicks were infected with a virulent strain of MG and treated with either tylosin (0.5 g/liter) or tilmicosin (at concentrations of 0.125, 0.25 or 0.5 g/liter). One infected group was untreated and another group was uninfected and untreated. Clinical signs, mainly depression and nervous signs, were seen in two to five birds in the infected treated groups. In contrast, in the infected untreated group, 16 of 30 birds showed clinical signs. Mortality was significantly less in the infected treated groups compared with the infected untreated group (P < 0.001), and following infection there were significantly (P < 0.05) greater weight gains in the infected medicated groups. At necropsy the prevalence of gross lesions of the airsac walls was similar in all the infected medicated groups and was less than that for the infected unmedicated group. For the group on tylosin, MG was recovered from five chicks during life and from six dead chicks. The corresponding figures for the group receiving the lowest dose of tilmicosin were four for each; however, the organism was not recovered from the groups on the higher doses of tilmicosin either during life or from dead chicks. Serological results were negative for all groups except the infected untreated group, in which all three birds that were tested were positive.

A model for testing the efficacy of enrofloxacin (Baytril) administered to turkey hens in the control of Mycoplasma iowae infection in eggs and embryos.

In a preliminary experiment, a field infection with Mycoplasma iowae was simulated by inoculating turkey eggs with various doses of two strains of M. iowae immediately before incubation. The strain and dose chosen for further study were those that best multiplied and resulted in infection of embryos from which the organism could be isolated after 25 days of incubation. Ten turkey hens free from infection with mycoplasmae were housed in isolation. The hens were given enrofloxacin in the drinking water at a concentration of 50 ppm on 3 successive days, on two occasions at intervals of 14 days. Within 48 hours of lay, their eggs were each inoculated with 0.1 ml of the selected strain and dose (10(5) colony-forming units/ml) of M. iowae. M. iowae was recovered from almost all eggs laid by hens before the initial medication but not from any of the eggs laid for several days after each period of medication. Thereafter, the organism could be recovered from a high proportion of inoculated eggs. The treatment of infected turkey laying flocks with enrofloxacin at strategic periods might be helpful in the control of this Mycoplasma by limiting both vertical and horizontal transmission.

The comparison of an aqueous preparation of tilmicosin with tylosin in the treatment of Mycoplasma gallisepticum infection of turkey poults.

A virulent strain of Mycoplasma gallisepticum (MG) was used to infect groups of 40 2-day-old poults kept in separate pens of 10 each. Of the six groups, three were treated with separate concentrations of tilmicosin, one was treated with tylosin, one remained untreated, and a final group was not infected and not treated. Mortality, clinical signs, and gross lesions were significantly less (P < 0.001) in the uninfected and infected medicated groups than in the infected unmedicated group. Also, the mean body weight gain of poults surviving to the end of the experiment was greater (P < 0.005) in the uninfected and infected medicated groups. MG was not recovered from the uninfected birds, and, among the infected poults, it was recovered from significantly fewer (P < 0.05) poults in the medicated groups. Serologic results were negative for the uninfected group, and there were fewer positive reactors for the infected medicated than the infected unmedicated group. In consideration of these results, tilmicosin should prove to be a useful addition to the antimicrobials in the treatment of MG infection in poults.

In vitro and in vivo comparisons of valnemulin, tiamulin, tylosin, enrofloxacin, and lincomycin/spectinomycin against Mycoplasma gallisepticum.

The minimum inhibitory concentrations (MICs) for valnemulin, tiamulin, enrofloxacin, tylosin, and lincomycin/spectinomycin were determined for a virulent strain of Mycoplasma gallispeticum (MG). At the initial reading, the lowest MICs were seen with valnemulin and tiamulin, followed by tylosin, enrofloxacin, and a relatively high MIC for lincomycin/spectinomycin. At the final reading, at 14 days, a similar pattern was obtained, with valnemulin giving the lowest MIC (< 0.008 mg/ml). The same strain of MG was used to infect groups of 20 2-day-old chicks in two separate experiments. In both, several concentrations of valnemulin and tiamulin and one each of tylosin and enrofloxacin were administered to separate groups in the drinking water. In the second experiment, one group of chicks was given lincomycin/spectinomycin. Each experiment had one infected unmedicated group and an uninfected unmedicated group. Mortality, clinical signs, and gross lesions, in both experiments, were significantly less (P < 0.001) in the uninfected and infected medicated groups (except for the two lowest dosages of valnemulin, lincomycin, and spectinomycin) than in the infected unmedicated groups. Also, the mean body weight gain was greater in the uninfected and infected medicated groups. Among the infected birds, MG was recovered from fewer chicks in the infected medicated groups except for the lowest two dosages of valnemulin. Serologic results were negative for the uninfected groups, and there were fewer positive reactors for the infected medicated groups except for the group treated with lincomycin/spectinomycin. Valnemulin should prove to be a useful addition to the antimicrobials in the control of MG infection in chickens.

An evaluation of the modified endorectal procedure for Hirschsprung's disease.

During the past 4 yr, 60 patients with Hirschsprung's disease have been treated at our institution. Twenty-eight patients within this group have undergone a modified endorectal pull-through procedure. There are 18 males and 10 females in the series. There are 5 children with total colonic involvement, 3 patients with aganglionosis to the mid-transverse colon, and one child with Hirschsprung's disease extending to the distal jejunum. The associated anomalies have consisted of four cases of Down's syndrome, one of whom also has transposition of the great vessels. There has been no operative-related mortality or late mortality in our series. Two major complications (anastomotic leak following a colostomy closure and incorrect pathological diagnosis of aganglionic level) and five minor complications have occurred. The average follow-up period is 31.3 mo. The functional results postoperatively have been excellent. The 18 patients over the age of 3 yr are completely toilet-trained. The remaining patients are too young to be toilet-trained, but are continent in the sense that they do not soil between bowel movements. Because of the satisfying functional results in this series, we have now expanded our indications for this procedure to patients requiring total colectomy for ulcerative colitis and familial polyposis. During the past 2 yr, 8 patients with ulcerative colitis have undergone the endorectal pull-through together with a total colectomy.

A survey of Mycoplasma infections in domestic poultry.

A survey of mycoplasma infections of chickens, turkeys and ducks was made on tissues from a variety of sources and birds of various ages, and from pipped and dead-in-shell turkey embryos. The tissues examined consisted mainly of respiratory tissue and the cloaca and contents and also a small number of joint lesions and other tissues. From chickens, mycoplasmas were isolated from a total of 138 tissues with Mycoplasma gallisepticum in preponderance. This was followed by M gallinarum, untyped organisms, M synoviae and a number of other mycoplasmas and Acholeplasma laidlawii. From turkeys, poults and embryos, mycoplasmas were recovered from 164 tissues with M meleagridis in preponderance. This was followed by M gallisepticum, serovar I, M synoviae and a number of other species including untyped isolates. From ducks, M gallisepticum and M anatis were recovered in equal numbers. Mycoplasma infections with more than one species occurred in the same tissue in all species of stock but especially in turkeys.

A comparison of the virulence of three strains of Mycoplasma gallisepticum and one strain of Mycoplasma gallinarum in chicks, turkey poults, tracheal organ cultures and embryonated fowl eggs.

The virulence of three strains of Mycoplasma gallisepticum (S6 of low broth passage, S6 of high broth passage and A514) and of one strain of M gallinarum was investigated in specific pathogen free chicks, turkey poults, chick embryo tracheal organ cultures and embryonated fowl eggs. One strain of M gallisepticum, S6, of low passage, caused high mortality in newly hatched chicks, and turkey poults, high embryo mortality, and rapid suppression of ciliary activity in tracheal organ cultures. The other strains of M gallisepticum and M gallinarum had relatively less effect. In view of its greater sensitivity, chick embryo mortality is preferable to tracheal organ culture for assessing the virulence of experimental strains of M gallisepticum.

Culturing anomalies associated with Mycoplasma recovered from the tissues of chicks and turkey poults experimentally infected with Mycoplasma gallisepticum or Mycoplasma gallinarum.

Tissues of mycoplasma infected chicks and turkey poults were cultured and subcultured on mycoplasma agar. Usually, colonies which grew on the agar initially inoculated could be subcultured, but sometimes they could not. At other times, colonies were not seen on the agar initially inoculated but appeared on the subcultured plate.

Experimental infection of ducklings with Mycoplasma gallisepticum and Mycoplasma anatis.

Two groups of day-old ducklings were infected with Mycoplasma gallisepticum and M anatis respectively by air sac inoculation. Clinical disease was not produced but air sacculitis was produced by both infections. M gallisepticum could be recovered readily from respiratory tissue 10 and 30 days after infections but RSA tests were negative. M anatis was not reisolated from these tissues or from the cloaca but a positive RSA test was observed on the serum of a few ducklings.

Demonstration in live chickens of the carrier state in infectious laryngotracheitis.

Two separate groups of nine-week-old specific pathogen free cockerels maintained in isolation were infected with a field strain of infectious laryngotracheitis (ILT) virus, either by intratracheal or combined intranasal and supraconjunctival inoculation. Birds were monitored for virus shedding from five sites on alternate days during the acute phase and three times weekly until week 17. They were then treated with cyclophosphamide on three consecutive days and thereafter swabbed daily. During the acute phase clinical signs were observed and virus was recovered from ocular and nasal sites for up to six to eight days. Initially after the acute phase no virus could be detected. However, from the seventh week after infection intermittent, apparently spontaneous shedding was detected in four of five birds in each group. There was no clear effect of cyclophosphamide treatment on re-excretion patterns, possibly because of the high levels of virus shedding already occurring. Thus, a carrier state for ILT virus has been demonstrated experimentally in live clinically recovered birds.

Effects of certain stress factors on the re-excretion of infectious laryngotracheitis virus from latently infected carrier birds.

Experiments were set up to assess the effects of 'natural' and 'artificial' stresses on the re-excretion of infectious laryngotracheitis (ILT) virus in latently infected chickens recovered from the acute phase of the disease. The stresses were rehousing with the addition of ILT-free contact birds, corticosteroid treatment and the onset of lay. The contact birds were also monitored for transmission of the virus from the carrier birds. Rehousing with unfamiliar birds induced ILT virus shedding in one of five birds and there was evidence of transmission from this bird to its mate. The onset of lay had a significant effect on the overall shedding rates of the carrier birds. Nine of 10 birds shed virus after onset of lay compared with only two in the three-and-a-half weeks before, and there was a highly significant increase (P less than 0.001) in the overall number of virus isolations during this period. Corticosteroid treatment did not affect virus shedding. These results may explain some of the apparently spontaneous outbreaks of ILT which occur in the field.