Gallium citrate Ga 67 imaging in noninfectious interstitial nephritis.

Gallium citrate Ga 67 has been reported to be of value in the diagnosis of both malignant and infectious intra-abdominal diseases. The drug may also be taken up by mononuclear phagocytes in noninfectious tubulo-interstitial disease of the kidney. Positive renal scans from patients with these diseases either become negative or show decreased uptake following treatment. With further support of these findings, gallium citrate Ga 67 may become a valuable tool in both diagnosis and follow-up of noninfectious interstitial nephritis.

Community-acquired pneumonia. A prospective outpatient study.

We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season.

Aerosolized immunoglobulin treatment of respiratory syncytial virus infection in infants.

BACKGROUND: Recent studies in animals with experimental respiratory syncytial virus (RSV) infection indicate that passive immunization by intranasal or intratracheal application of gamma-globulins (immunoglobulins) may be beneficial for treatment of infants with lower respiratory tract infection caused by RSV. METHODS: We conducted a placebo-controlled, randomized multicenter study involving 68 infants with proven RSV infection admitted to 5 pediatric centers in Switzerland from November 1, 1992, through April 30, 1993. Treatment was carried out with aerosolized human IgG (Sandoglobulin) by assisted ventilation. On the day of hospital admission a single dose of 0.1 g of IgG per kg of body weight in a 5% solution or an identical amount of placebo, each delivered in 2 parts, was given. RESULTS: The two groups did not differ substantially in their response to the aerosol received. The rate of improvement for symptoms of respiratory tract infection, oxygen requirement and length of hospital stay were comparable for both groups. There was a significant reduction (P < 0.05) in the frequency of apneic spells observed in the treatment group by Day 3 posttreatment. Aerosol therapy was generally well-tolerated in nonintubated infants, but some severe side effects (increased oxygen requirements in two patients, pneumothorax in one patient) were observed in two of three intubated and ventilated infants treated with IgG. CONCLUSIONS: Aerosolized immunoglobulin in the dosage used had no substantial beneficial effect on RSV bronchiolitis. Despite these findings passive immunotherapy for treatment of RSV-induced lower respiratory tract infection deserves further evaluation before being discarded as ineffective.

Evaluation of 2-SP transport medium for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by two automated amplification systems and culture for chlamydia.

AIMS: To assess the performance of 2-sucrose-phosphate based transport medium (2-SP) for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae by an automated commercial polymerase chain reaction (PCR) and ligase chain reaction (LCR) compared to centrifugation culture on McCoy cells for C trachomatis. Second, to compare both amplification systems for initial diagnostic testing of a low prevalence population for sexually transmitted diseases. METHODS: Four hundred and eighty one consecutive urogenital and conjunctival specimens were examined. All tests were performed on the same specimen collected with a dacron swab and transported in 2-SP medium. Samples that were positive by culture or by both PCR and LCR were considered to be true positives. RESULTS: The prevalences of C trachomatis and of N gonorrhoeae were 2.7% and 0.4%, respectively. PCR had a resolved sensitivity and specificity of 100% and 99.8%, respectively, for C trachomatis, and 100% and 98.9%, respectively, for N gonorrhoeae. LCR was 100% sensitive and specific for both pathogens. The resolved sensitivity of the shell vial assay was 85%. No culture positive sample would have been missed by PCR or LCR. The inhibition rate for PCR was 4.8%. CONCLUSIONS: 2-SP medium proved to be suitable for both PCR and LCR. It is not limited to any one test manufacturer and allows the performance of amplification techniques and viral and chlamydia culture from the same specimen. The LCR was more reliable than PCR on initial testing. However, hands on time is longer, and no amplification control is available for LCR.

Competitive polymerase chain reaction using an internal standard: application to the quantitation of viral DNA.

A general strategy for the construction of an internal standard for the polymerase chain reaction (PCR) is described together with its application in the evaluation of clinical samples. This internal standard is a plasmid containing a modified target sequence that is co-amplified with the native target using the same set of primers. The co-amplification reaction will generate two fragments of different size that are readily separated without the need for restriction enzyme digestion. Thereafter, they are detected and quantitated by hybridization to the same probe. Detection of HIV proviral DNA was chosen as a model for this competitive PCR. The assay proved to be a sensitive tool for the detection of PCR inhibitors and allowed quantitation of HIV with a 20-30% variation coefficient. Despite limitations that appear inherent to the amplification process, internal standards appear to be useful tools for quantitative analysis by PCR.

Detection of mumps virus in clinical specimens by rapid centrifugation culture and conventional tube cell culture.

Conventional tube cell culture was compared with a 2 day and 5 day spin-amplified shell vial indirect immunofluorescence assay for the detection of mumps virus in swabs from the area of Stensen's duct. The sensitivity and specificity of the shell vial assay were 95.9 and 100%, respectively. The shell vial detected 66.3% of the positive cultures within 2 days of inoculation while the first positive results were available by conventional tube cell culture after 3 days (1.6%) reaching 72.4% of all culture positive specimens after 7 days. These data suggest that a centrifugation shell vial indirect immunofluorescence assay may be useful for rapid detection of mumps virus in clinical specimens.

Three-step isolation method for sensitive detection of enterovirus, rotavirus, hepatitis A virus, and small round structured viruses in water samples.

Control of drinking or bathing water quality in respect to viral contamination remains an unsolved problem. A highly sensitive isolation protocol was developed for concentration and detection of different enteric viruses from water samples. The three-step isolation procedure combines filtration with a positively charged nylon membrane, ultrafiltration and clean-up of the viral RNA with a silica based membrane. Detection of the viral RNA is accomplished by reverse-transcription polymerase chain reaction (RT-PCR). Detection limits were determined to be one 50% tissue culture infective dose (TCID50) of seeded coxsackievirus B2 or hepatitis A Virus per litre of tap water by RT-PCR compared to two orders of magnitude lower sensitivity for culture in the case of coxsackievirus B2. The isolation procedure is highly sensitive, easy to perform and allows the detection of different human pathogenic virus groups in one water sample. The application of the isolation procedure to six river water samples and subsequent detection with nested or semi-nested PCR revealed enterovirus in 6/6 (100%), rotavirus in 6/6 (100%), hepatitis A virus in 0/6 (0%), small round structured virus genotype I in 6/6 (100%) and small round structured virus genotype II in 2/6 (33%) of the samples. These findings suggest that first, we have developed a very sensitive detection procedure and second, that river water in Switzerland-where most of the wastewater is handled by sewage treatment plants-shows a high contamination rate with enteric viruses.

Coincidence of Behçet's disease and SAPHO syndrome.

A young woman presented with deteriorated visual acuity due to acute retinal vasculitis. The diagnosis of Behçet's disease was made on the basis of the ophthalmologic findings and recurrent oral and genital aphthous ulcerations. In the past, this young woman had been operated on several times because of progressive aseptic osteitis of the right clavicle. The actual examination revealed chronic osteitis, osteosclerosis and hyperostosis of the anterior chest wall, as well as severe acne papulopustulosa et conglobata. These findings resulted in an additional diagnosis of SAPHO syndrome. This report is the first description of Behçet's disease occurring in association with SAPHO syndrome, both fulfilling the diagnostic criteria.

[Estimation of the efficacy of three strains of mumps vaccines during an epidemic of mumps in the Geneva canton (Switzerland)]. / Estimation de l'efficacité de trois souches vaccinales ourliennes au cours d'une épidémie d'oreillons dans le canton de Genève (Suisse).

BACKGROUND: The number of mumps cases reported in Switzerland markedly increased from 1993 to 1995 although vaccination coverage against mumps had risen steadily since the national MMR immunization program was launched in 1987. In 1991, an estimated 80% of children 27 to 36 month-old were immunized against mumps. The purpose of the present study was to assess the hypothesis that the epidemic was the consequence of a low vaccine efficacy of the Rubini strain--a mumps vaccine strain that has been widely used in Switzerland. METHODS: Vaccine efficacy was assessed by measuring secondary attack rates among immunized and nonimmunized children 16 year-old or younger who wre family contacts of cases. RESULTS: From February 1993 to April 1996, Geneva pediatricians reported 283 primary cases of mumps and 63 secondary cases. Estimate of vaccine efficacy was equal to 6.3% (95% CI: -45.9; 39.8) for the Rubini strain, as compared to 73.1% (95% CI: 41.8; 87.6) for the Urabe Am 9 strain, and 61.6% (95% CI: 0.0; 85.4) for the Jeryl Lynn strain, two vaccine strains of mumps that had also been used in Geneva. CONCLUSION: Our study supports the hypothesis that the Rubini vaccine strain of mumps does not confer sufficient long-lasting protection against mumps.

[Mumps vaccines: virological basis]. / Mumpsimpfstoffe: Virologische Grundlagen.

The prevention of mumps virus infection relies on the application of live, attenuated mumps virus vaccines. The process of attenuation from a wildtype mumps isolate to a safe vaccine has been empirical. A lower degree of attenuation results in solid immunity but carries an increased risk of post-vaccination meningitis due to the vaccine strain. Currently used vaccine strains are highly attenuated and essentially free of vaccine strain induced disease. However, their immunogenicity may be lower than previously reported.

[Physiotherapy in lumbar disc herniation ]. / Physiotherapie bei lumbaler Diskushernie.

Physiotherapy is the treatment of choice in patients with symptoms caused by a lumbar disc herniation. In clinical practice a broad range of physiotherapeutic modalities has been revealed to be helpful. During the acute stage the efficacy of the McKenzie-concept, mobilisation therapies and traction has been demonstrated in randomized controlled trials with a blind assessor. In addition, pain reducing physical therapies such as cold or electrotherapy and non-steroidal anti-inflammatory drugs, analgesics and/or muscle relaxants are sensible initial accompanying treatments. The effectiveness of active physiotherapies such as training of local strength endurance of back and abdominal muscles has been proven in patients during the chronic stage. The indications for a in-patient rehabilitation programme, for surgery and the danger of developing chronic low back pain are discussed.

Burrowing behaviour of robotic bivalves with synthetic morphologies.

Several bivalve species burrow into sandy sediments to reach their living position. There are many hypotheses concerning the functional morphology of the bivalve shell for burrowing. Observational studies are limited and often qualitative and should be complemented by a synthetic approach mimicking the burrowing process using a robotic emulation. In this paper we present a simple mechatronic set-up to mimic the burrowing behaviour of bivalves. As environment we used water and quartz sand contained in a glass tank. Bivalve shells were mathematically modelled on the computer and then materialized using a 3D printer. The burrowing motion of the shells was induced by two external linear motors. Preliminary experiments did not expose any artefacts introduced to the burrowing process by the set-up. We tested effects of shell size, shape and surface sculpturing on the burrowing performance. Neither the typical bivalve shape nor surface sculpture did have a clear positive effect on burrowing depth in the performed experiments. We argue that the presented method is a valid and promising approach to investigate the functional morphology of bivalve shells and should be improved and extended in future studies. In contrast to the observation of living bivalves, our approach offers complete control over the parameters defining shell morphology and motion pattern. The technical set-up allows the systematic variation of all parameters to quantify their effects. The major drawback of the built set-up was that the reliability and significance of the results was limited by the lack of an optimal technique to standardize the sediment state before experiments.

Detection of human immunodeficiency virus (HIV) type 1 antibodies by new automated microparticle enzyme immunoassay for HIV types 1 and 2.

We compared an automated microparticle double-antigen sandwich enzyme immunoassay (EIA) for the IMx test system recently developed by Abbott with two established assays (the automated indirect Vidas IgG EIA and the double-antigen sandwich EIA from Murex/Wellcome) devised for the detection of human immunodeficiency virus type 1 (HIV-1) and HIV-2 antibodies. A total of 1,078 consecutive serum samples were tested prospectively with the three assays. In addition, we used retrospectively selected panels of serum samples with discrepant results in two different screening tests and with indeterminate or positive Western immunoblot (WB) results, as well as five commercially available HIV-1 seroconversion panels. The new assay showed excellent discriminatory characteristics for the separation of samples from HIV-1-positive and HIV-1-negative persons according to Centers for Disease Control and Prevention WB criteria. The sensitivities were 98.1, 92.9, and 96.1% for the new test and the two other assays, respectively, and the specificities were 99.7, 97.9, and 98.1%, respectively. With the seroconversion panels this new test was positive several days earlier than the two other assays; i.e., seroconversion was evident at the peak of p24 antigenemia and often several weeks before WB became positive by the most stringent criteria.

[Increasing the immunization rate against measles, mumps, and rubella in medical students at the University of Berne]. / Die Erhöhung der Immunitätsrate von Medizinstudentinnen und -studenten gegen Masern, Mumps und Röteln an der Universität Bern.

From 1992 to 1997 the seroprevalence of antibodies against measles, mumps and rubella (MMR) in Swiss medical students was between 77.3% and 86.2%, which is clearly below the target of > 95%. To prevent MMR infections in doctors and possible transmission to their patients, in 1994 we started a project in which MMR vaccination was offered to non-immune students. During three courses in medical school, 82 of 87 (94.3%) non-immune students were vaccinated, thus increasing the immunization rate to more than 96%. We have developed a spread sheet allowing calculation of the direct costs of two different strategies: 1. Determination of immunity followed by MMR vaccination of non-immune students; 2. Universal MMR immunization. Screening before vaccination was less expensive if the immunity level was higher than 73.5% and the calculation was based on prices for mass screening and mass vaccination. Universal immunization was favoured when prices for individual antibody determinations and vaccinations were used for the calculation. A targeted programme of MMR vaccination was successful in increasing the immunization rate of medical students against MMR to > 96%.

Glucagon-aided reduction of intussusception.

Intramuscular glucagon was used in 2 patients with ileocolic intussusception when standard therapeutic barium enema reduction failed. Reduction was accomplished following administration of glucagon and a repeat barium enema. Use of the two methods together may improve the success rate of nonoperative reduction of intussusception.

[Carotid artery dissection. Case examples and review]. / Die Karotisdissektion. Fallbeispiele und Ubersicht.

"Spontaneous" dissection of the internal carotid artery is a not unusual cause of stroke, particularly in younger subjects. Initial signs are typical, whereas the spectrum of neurological deficits is wide. Three selected case records are presented which demonstrate the spectrum of symptoms and the management of this disease.

[Wxanthema and acute polyarthritis in a young patient]. / Exanthem und akute Polyarthritis bei junger Patientin.

A young woman developed acute polysynovitis and vasculitis-like changes to the skin. Her blood cultures were positive for Neisseria meningitidis, enabling us to diagnose chronic meningococcemia. This finding was a surprise; in retrospect this diagnosis would not have been expected in light of the fact that there was no meningism, the patient's general condition was only slightly diminished and the temperatures were subfebrile. Besides an episode of vasculitis, the primary differential diagnosis of acute polysynovitis in young women should include a bacterial infection, for example with Neisseria. Usually, Neisseria gonorrhoeae (gonococci) are involved and, as in the case described, only very rarely Neisseria meningitidis (meningococci). The present case report is given to illustrate new clinical aspects of known, but rare disease, to remind clinicians to consider the differential diagnosis of acute polyarthritis and to generate discussion about the clinical signs and pathogenesis of reactive arthritides, in particular, Neisseria.