Hand eczema and steroid-refractory chronic hand eczema in general practice: prevalence and initial treatment.

BACKGROUND: The self-reported annual prevalence of hand eczema (HE) in adults is about 10%. Incidence and prevalence data for HE, chronic HE (CHE) and steroid-refractory CHE (SR-CHE) in physician-attended populations are lacking. OBJECTIVES: To estimate the prevalences of HE, CHE and SR-CHE in a primary-care population using a cross-sectional design; and to estimate the incidence of each and describe initial therapy using a cohort approach. METHODS: The population was all patients in the Clinical Practice Research Datalink for 2000-10, 2005-10 and 2010-11. HE was defined as any of 12 diagnoses (six specific to the hand, six for contact dermatitis). HE became CHE if any of these 12, or three additional diagnoses, occurred 90-365 days after the first HE, and if the patient was prescribed at least one course of potent topical steroids. A patient with CHE was classified as having SR-CHE if they were (i) referred to a dermatologist and/or (ii) prescribed phototherapy, systemic immunomodulators, oral corticosteroids, alitretinoin or acitretin. RESULTS: The 1-year adult prevalence of HE was 0·4%. The period prevalences of SR-CHE for 1, 5 and 10 years in adults were 0·008%, 0·036% and 0·072%, respectively; lifetime estimates were 0·071%, 0·080%, 0·098%. About one-half of cases of CHE were steroid refractory. All conditions were more common in female than in male patients. One-third of HE diagnoses were specific for the hand, the remainder were for contact dermatitis. The majority (62%) of newly diagnosed patients with HE were not prescribed treatment in the 12 months after diagnosis. CONCLUSIONS: Although the prevalence of HE could be 2-3 times higher than reported herein, the proportion of adults seeking medical care for HE is a fraction of those who self-report HE. SR-CHE is rare.

Sustaining eHealth engagement in a multi-year weight gain prevention intervention.

INTRODUCTION: Digital tools are widely used and effective in weight management interventions; however, usage declines over time. Strategies to promote continued engagement should be explored. We examined the effects of offering additional modes of weight reporting as well as periodic online campaigns to promote engagement, assessed by frequency of weight reporting, in a weight gain prevention study for young adults. METHODS: Using an observational design, self-reported weights obtained through digital tools were pooled across participants assigned to two interventions (n = 312). Analysis examined the effects before during and after introduction of an additional reporting modality (email) and for three time-limited refresher campaigns over 2 years. RESULTS: Adding a new modality to the three existing modes (SMS, web, and mobile web) increased weight reporting as well as the number of modalities participants used to report weights. The use of several modes of reporting was associated with more weights submitted (p < 0.01). Refresher campaigns did not increase the proportion of participants reporting; however, the number of weights submitted during the 4-week campaigns increased compared with the 4 weeks before the campaign (p's ≥ 0.45, <0.001, respectively). CONCLUSION: Using multiple digital modalities and periodic campaigns shows promise for sustaining engagement with weight reporting in a young adult population, and incorporating such strategies may mitigate typical declines in eHealth and mHealth interventions.

Measurement of a monoclonal antibody-defined, melanoma-associated antigen in human sera: correlation of circulating antigen levels with tumor burden.

Quantities of a 100,000-mol wt human melanoma-associated antigen (MAA), defined by both monoclonal and polyclonal xenoantibodies, were measured in sera of 32 patients with malignant melanoma and 15 carefully documented healthy volunteers by use of an amplified sandwich enzyme-linked immunoabsorbent assay. Detectable levels of MAA were found in all normal adult sera. Five of 10 patients with stage III and 9 of 16 patients with stage IV disease had antigen levels that exceeded. the 95th percentile of serum levels in the normal donors (P less than .001). Elevated levels of the 100K MAA were associated with evidence of residual tumor (P less than .008): Only 3 of 13 patients with no evidence of tumor had abnormal values, whereas 9 of 16 patients with evident tumor had increased serum levels. Levels of the 100K MAA were unrelated to the levels of soluble immune complexes as detected by the fluid-phase C1q binding test. Molecular evaluation of the 100K MAA in serum indicated that the molecule associated with albumin in a strong, noncovalent manner. When the complex was dissociated by treatment with sodium dodecyl sulfate, the 100K MAA in serum comigrated with the molecule from spent culture medium of human melanoma cells. Antigen levels in sera were measured under these dissociating conditions. These studies suggest that measurement of the 100K MAA may be useful in monitoring tumor burden in patients with malignant melanoma.

Association of circulating immune complexes with cytogenetic abnormalities but not with prognosis in acute nonlymphocytic leukemia.

Sera from 91 adult acute nonlymphocytic leukemia patients were tested for circulating immune complexes by the C1q binding test. In 42 patients tested prior to the initiation of therapy, C1q binding activity was inversely correlated with leukemic infiltrate of the bone marrow (rs = -0.34, p less than 0.02), but it was not related to peripheral white blood cell count or presence of infection. Patients with abnormal C1q binding activities (greater than 6%) were more likely to have cytogenetic abnormalities in their bone marrow (p = 0.02); the most frequent abnormality was an extra No. 8 chromosome. The median survival of 8 patients with abnormal values was 1.5 months as compared to 7.8 months in 34 patients with normal values. However, the C1q binding test did not identify patients likely to achieve remission; and after remission was achieved, it did not identify those likely to relapse. Differences between these findings and those recently published by other investigators are discussed.

Circulating immune complexes and tumor cell cytotoxins as prognostic indicators in malignant melanoma: a prospective study of 53 patients.

To evaluate the relationship between tumor burden and circulating immune complexes (IC) in malignant melanoma, we tested sera collected serially from 15 normal donors and 53 patients. Forty-eight of these had Stage III or IV disease at the outset of the study. The median survival time (MST) of ten patients with Stage IV disease whose sera contained C1q-binding IC at the outset of the study was 4.7 months; the MST of the 25 Stage IV patients whose sera were initially free of IC by this test was 8.65 months (p less than 0.02). C1q-binding IC were not found in the initial serum samples from 13 patients with Stage III or 5 patients with Stage I disease. Abnormal C1q binding tests were measured in 4 of 67 sera (6%) from 13 patients who remained free of evident tumor for up to 41 months. IC were detected in 13 of 39 sera (33%) from 19 patients with progressively growing tumors and in 21 of 68 sera (31%) from 21 patients who were initially free of disease but developed recurrences later, or who had significant remissions of variable duration during follow-up. The MST of 31 patients whose serial serum samples remained free of C1q-binding IC was 15.8 months. Twelve patients whose sera were initially free of circulating IC later developed abnormal serum C1q-binding levels. Their MST was 10.3 months. The MST of ten patients with persistently abnormal serum IC levels was 4.7 months. C1q-binding IC were reciprocally related to the presence of complement-dependent antibodies, cytotoxic for cultured allogeneic malignant melanoma cells in sera from 29 of these patients (r = -0.491;p = 0.003). These results suggest that the appearance of circulating C1q-binding IC is pathophysiologically important in malignant melanoma. Measurement of C1q-binding IC may be useful in assigning prognosis in this disease.

Prolonged action of regular insulin in diabetic patients: lack of relationship to circulating insulin antibodies.

We previously reported that in insulin-treated diabetic subjects the time course of action of regular insulin injected sc is different from that reported in standard textbooks. The present studies evaluated the role of insulin antibodies (Abs) in the altered pharmacokinetics of regular insulin by comparing the time course of insulin action in 10 patients receiving chronic insulin therapy and having insulin Abs with that in 15 previously untreated patients without detectable Abs. After an overnight fast, the patients were given an infusion of 5% dextrose in water at 100 ml/h. Regular insulin (15 U) was then injected sc in the deltoid region of the arm. The onset of action of sc insulin, as indicated by a 10% fall in serum glucose, was similar in both patient groups [1.9 +/- 0.1 (+/- SEM) hour in Ab-negative and 1.8 +/- 0.1 h in Ab-positive patients]. The peak effect of insulin action, as determined by the nadir of serum glucose, was 4.6 +/- 0.2 h in the previously untreated patients, not significantly different from the value in the diabetic patients with insulin Abs (5.2 +/- 0.4 h). The duration of action of insulin was also similar in both groups (14.7 +/- 0.7 vs. 14.4 +/- 1.0 h). No significant correlations were found between insulin Ab levels and any of these 3 parameters of insulin action. However, the peak effect and total duration of insulin action were significantly correlated with the baseline serum glucose levels. A possible role of insulin Abs was evaluated in these patients by repeating the studies over a 2-year period. During this time, the previously untreated patients were treated with highly purified pork insulin, to which they developed low titers of insulin Abs. The diabetic patients who had been chronically treated with insulin were changed from less purified insulin to highly purified pork insulin, and all had a significant reduction in their Ab titers. No changes in insulin pharmacokinetics were found in either group. These studies demonstrate that the prolonged action of sc injected regular insulin in diabetic patients is not related to the effect of circulating insulin Abs.

Is histological subtype a marker for environmental exposures in acute myelogenous leukemia?

The association between occupational and other environmental exposures was evaluated in 60 acute myelogenous leukemia cases and controls. Odds ratios and 95% confidence intervals for prior cytotoxic therapy and benzene exposure, adjusted for age, sex, and race by logistic regression, were 3.7 (0.7, 19.9) and 2.6 (0.4, 15.2), respectively. No other work-related associations, including employment in electrical occupations, were present. Other associations were suggestive but may have been due to biases in control selection or small numbers of subjects. The risks for prior cytotoxic therapy (odds ratio = 10.2) and benzene exposure (odds ratio = 11.4) were concentrated in 13 patients with French-American-British M4 leukemia; no environmental exposures were associated with French-American-British subtypes M1 and M2. These findings support the concept that French-American-British histological subtypes of AML may have different etiologies.

Correlation between selected environmental exposures and karyotype in acute myelocytic leukemia.

Many bone marrow cytogenetic abnormalities in acute myelogenous leukemia (AML) are tumor specific, clonal, nonrandom, and related to prognosis; it has been hypothesized that they may be markers of exposure to etiological agents. A previous report from our institution revealed several such associations; the purpose of the current study was to determine whether previous findings were present in a new group of patients. Subjects included 84 newly diagnosed AML patients (French-American-British M1 and M2); exposure data were gathered using self-report questionnaires at the time of registration. Two sets of comparisons were made: (a) patients with all (AA) or some (AN) cytogenetically abnormal cells versus those with normal karyotypes (NN) and (b) patients with specific abnormalities [-5/5q-, -7/7q-, +8, t(8;21)] versus all others. Odds ratios (ORs) were 4.64 for the association between prior cytotoxic therapy and -5/5q- and 6.38 for the association with -7/7q-, but were <1.00 for +8 and t(8;21). There were no ORs > 2.0 for specific abnormalities in any of the other exposures evaluated (cigarette smoking, alcohol use, occupational exposure to organic chemicals, paints, or pesticides/herbicides), with the exception of exposure to paints and -7/7q- (OR, 7.50). The ORs for AA/AN versus NN patients were 1.43 and 3.81 for smoking and alcohol use, and weak dose-response trends were present. The most consistent positive associations between the two series were for prior cytotoxic therapy (-5/5q-; -7/7q-), cigarette smoking (AA/AN versus NN) and alcohol use (AA/AN versus NN). Reasoning from the known association between prior cytotoxic therapy and -7/7q-, we would have predicted relatively high ORs (> 4.0) if specific abnormalities acted as markers for the exposures assessed, but none were present. However, in both series, AA/AN patients were more likely to smoke and use alcohol than were NN patients, and weak dose-response patterns were present for both. This finding suggests that both smoking and alcohol use may play a role in the pathogenesis of cytogenetic abnormalities in AML-M1/M2; however, the mechanism by which they work and whether they are involved in the etiology of these diseases remain unclear.

Cocaine use in women from a defined population: prevalence at delivery and effects on growth in infants.

Adverse health effects associated with intrauterine cocaine exposure (prematurity and its associated morbidity, intrauterine growth retardation, possible risk of sudden infant death syndrome) are based on studies from large urban hospitals, but few data exist from other sources. The current study, set in a community hospital, was designed to (1) estimate the prevalence of maternal cocaine use at delivery, (2) describe neonatal outcomes, and (3) evaluate physiological growth in exposed children. The study was conducted over 30 months (total births were 14,074) at The Children's Hospital of Greenville Memorial Hospital, the major source of neonatal care for Greenville County, South Carolina (1990 population: 320,000). A child was considered exposed to cocaine if there was documented evidence of use in the mother's medical record or if one member of the pair had a positive urine drug screen. Growth data were abstracted from clinical records. Overall prevalence of exposure was 1.0%. Of the 137 subjects (89, positive urine drug screen; 48 self-reported exposure), 21 (15%, 95% confidence interval, 9% to 21%) were premature (gestational age < 37 weeks) and 2 died of sudden infant death syndrome. Mean age- and sex-adjusted percentiles for weight, length, and head circumference increased from 23%, 29%, and 18%, respectively, at birth to 43%, 49%, and 54% in children followed for 12 months; however, 50% of the cohort were lost to follow-up, and these children were smaller at birth than those under active follow-up. Rates of prematurity and infant death were similar to those reported in urban hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of implantation and pregnancy rates in African American and white women in an assisted reproductive technology practice.

OBJECTIVE: To compare IVF outcomes between infertile African American and white women. DESIGN: Retrospective cohort study. SETTING: Hospital-based IVF practice. PATIENT(S): Women undergoing IVF procedures between November 1996 and June 2000. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates. RESULT(S): There were 24 African American and 273 white women < or =40 years of age who underwent 25 and 333 IVF cycles, respectively. African American women were more likely to have had tubal factor as a primary diagnosis, to have had a child, and to have undergone fewer previous assisted reproductive technology (ART) cycles as compared to white women. No differences between the two groups for clinical variables were noted with the exception of body mass index (BMI [kg/m(2)], 27.1 in African Americans vs. 24.8 in whites). Implantation rates were higher in African American than in white women (35% vs. 23%, respectively). Pregnancy rates were 71% in African Americans and 48% in whites. After adjustment for tubal factor, BMI, and parity, the odds ratio for pregnancy in African American women versus white women increased from 2.6 to 3.3. CONCLUSION(S): This is the first study to demonstrate a significantly higher clinical pregnancy rate in African American women as compared to white women undergoing ART. These data strongly contradict a recent study comparing the same two groups of women undergoing ART. We urge other ART centers to report their data pertaining to race.

Control of air quality in an assisted reproductive technology laboratory.

OBJECTIVE: To investigate the effect of improved air quality on IVF and subsequent embryo development. DESIGN: Retrospective cohort study. SETTING: Hospital-based IVF facility composed of an anteroom, a cleanroom, and an adjacent operating room. PATIENT(S): Two-hundred seventy-five couples requesting IVF between 1993 and 1997. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Particle counts (sizes 0.3, 0.5, 1.0, and 5.0 microm); IVF rates; and embryo quality (stage and grade). RESULT(S): Clinical pregnancy rates decreased from 35% in 1993 to 16% in 1994 (numerous construction odors were detected during 1994) and increased steadily after the cleanroom was built (rates for 1995-1997 were 20%, 32%, and 59%, respectively). Fertilization rates decreased between 1993 (74%) and 1994 (60%) and then steadily increased after cleanroom installation (62% in 1995, 71% in 1996, and 69% in 1997). The proportion of embryos past the four-cell stage decreased from 66% in 1993 to 61% in 1994 but then increased steadily in the years after the cleanroom was built (78%, 77%, and 83% in 1995, 1996, and 1997, respectively). During the same 5-year period, there were no differences in embryo quality or number of embryos transferred. CONCLUSION(S): Construction of a Class 100 cleanroom improved air quality and IVF rate and increased the number of embryos past the four-cell stage available for transfer.

Validity and cost-effectiveness of antisperm antibody testing before in vitro fertilization.

OBJECTIVE: To determine the usefulness of and cost-effectiveness of antisperm antibody testing in the prediction of poor fertilization rates in couples undergoing IVF. DESIGN: Retrospective cohort study. SETTING: A hospital-based reproductive endocrinology and infertility practice. PATIENT(S): Male partners of 251 couples undergoing IVF between 1992 and 1997. MAIN OUTCOME MEASURE(S): Fertilization rates in couples undergoing conventional IVF. RESULT(S): One hundred nineteen couples were evaluated for antisperm antibodies; fertilization rates were similar in those couples whose husbands were and were not tested (64% versus 68%). Antisperm antibodies were detected in 16 men. Four (25%) of the 16 couples whose husbands had antisperm antibodies fertilized < or = 50% of oocytes, compared with 31 (30%) of the 103 couples whose husbands did not have these antibodies. Overall, 21 couples (8.4%) experienced complete fertilization failure. In a program that included antisperm antibody testing for selected couples and intracytoplasmic sperm injection (ICSI) for those who tested positive, it would cost $11,735 to prevent a fertilization failure (assuming ICSI were 100% effective), whereas it would cost $9,250 to perform ICSI in a second IVF cycle for those who initially failed. CONCLUSION(S): In this practice setting, antisperm antibody testing has low sensitivity in predicting low or no fertilization and does not appear to be cost-effective when selectively ordered as part of an IVF workup.

Zidovudine improves psoriasis in human immunodeficiency virus-positive males.

BACKGROUND AND DESIGN: Patients with human immunodeficiency virus (HIV) infection can develop severe psoriasis, which is difficult to treat using conventional therapy. Anecdotal case reports have suggested that administration of zidovudine can improve psoriasis in the HIV-infected patient. An open-label study was conducted to determine the safety and effectiveness of zidovudine therapy in 24 patients with HIV-associated psoriasis and to correlate response with laboratory and clinical variables. RESULTS: Of 19 evaluable patients, 90% had either partial (58%) or complete (32%) improvement of their HIV-associated psoriasis during zidovudine therapy. Greater than 75% reduction in the body surface area involved was positively associated with antigenemia and an age younger than 30 years. CONCLUSIONS: Zidovudine therapy, at a dosage of 1200 mg/d, appears to be beneficial in the treatment of HIV-associated psoriasis, although long-term relapses occurred and the associated arthritis did not improve.

Factors associated with limb loss despite a patent infrainguinal bypass graft.

Lower-extremity limb salvage should parallel infrainguinal bypass graft patency. To determine factors associated with limb loss despite a patent bypass, we reviewed 191 consecutive infrainguinal bypasses in 158 patients followed prospectively over 42 months. In this series of 176 (92%) vein grafts, 15 (8%) expanded polytetrafluoroethylene grafts, 122 (64%) tibial artery bypasses, and 170 (89%) bypasses placed for limb salvage, 29 major lower-extremity (above-knee or below-knee) amputations were performed in 29 patients, 12 because of ischemia after graft thrombosis and 17 (9% of series) due to progression of soft tissue infection/necrosis despite a functioning bypass. Primary and secondary 36-month vein graft patencies by life-table analysis were 61 per cent and 81 per cent, respectively. When the 17 cases of limb loss were compared to the rest of the series, nonstatistically significant variables included male sex [11 (65%) vs 79 (56%); P = 0.608] and diabetes [12 (71%) vs 80 (57%); P = 0.310]. Statistically significant variables included black race [9 (53%) vs 39 (28%); P = 0.048]; chronic renal failure [6 (35%) vs 12 (9%); P = 0.005], placement to a tibial/pedal artery [15 (88%) vs 107 (62%); P = 0.034], distal anastomosis to the anterior tibial/dorsalis pedis (AT/DP) artery [8 (47%) vs 27 (16%); P = 0.004], and grafts requiring late revision [7 (41%) vs 22 (13%); P = 0.006]. Thirteen (76%) extremities had an intact pedal arch. Nine amputations were performed within 30 days (early group), and eight were performed from 45 days to 20 months (median, 8 months) after bypass placement (late group). The most common primary causes of limb loss in the early group were overwhelming progression of soft-tissue infection despite patent bypass (n = 4; 44%) and insufficient runoff in the foot (n = 3; 33%). In the late group, amputation most often followed long treatment of a chronic proximal diabetic neuropathic foot ulcer with osteomyelitis. Five (63%) grafts in this group were anastomosed to the AT/DP arteries. These data suggest that patients with chronic renal failure, chronic neuropathic heel ulcers, and an AT/DP bypass are at greater risk for amputation despite a working bypass, especially if the graft develops a hemodynamically significant stenosis. Careful judgment and patient selection under these circumstances are thus justified.

Nonendarterectomy procedures of the carotid artery: a five-year review.

Although the efficacy of carotid endarterectomy has been well established, nonendarterectomy procedures of the carotid bifurcation have only sporadically been reported. Of 334 consecutive nontraumatic carotid procedures performed on 321 patients from July 1992 until May 1997, 306 (91.6%) were carotid endarterectomies, 14 (4.2%) were carotid-subclavian bypasses/transpositions, and 14 (4.2%) were nonendarterectomy procedures of the carotid artery. These latter 14 cases (nine females and five males; mean age, 63 years) were all symptomatic (neurological or painful mass) and included carotid kink/coil resection (n = 3; 0.9%), endarterectomy and vertebral transposition (n = 2; 0.6%), carotid aneurysm resection (n = 2; 0.6%), carotid body tumor resection (n = 2; 0.6%), carotid stump ligation/external endarterectomy (n = 1; 0.3%), infected/bleeding carotid patch removal with vein graft replacement (n = 1; 0.3%), saphenous vein graft replacement (n = 1; 0.3%), carotid dilatation for fibromuscular dysplasia (n = 1; 0.3%), and descending aorta to carotid bypass (n = 1; 0.3%). With 30 day follow-up complete for all 334 carotid operations, 10 perioperative strokes (2.9%) and five deaths (1.5%) occurred for a combined stroke/death rate of 3.3 per cent. Of the 14 nonendarterectomy carotid artery operations, there were no strokes or deaths; with mean follow-up of 13 months, 13 patients (92.9%) are asymptomatic, patent, and disease-free. Three severe transient cranial nerve (CN) neuropraxias (21.4%), one myocardial infarction (7.1%), and one late death (mesenteric ischemia at 2 months), however, occurred. Although no statistical differences in stroke, death, and stroke/death occurred between the endarterectomy versus the nonendarterectomy group, transient CN injury was more common in the nonendarterectomy group (21.4% versus 4.1%; P = 0.027). Although nonendarterectomy procedures of the carotid bifurcation are infrequently needed, they seem safe, effective, and indicated in selected patients, despite a higher incidence of transient CN injury.

The pitfalls of establishing a statewide vascular registry: the South Carolina experience.

Concerned about the inadequacy of a centralized database and the importance of low morbidity and mortality on carotid endarterectomy efficacy, the South Carolina Vascular Surgical Society prospectively instituted a computer registry for carotid procedures performed by its members, to establish a statewide standard of practice. From January 1994 through December 1997, 23 of the 30 physician members voluntarily registered data on 1652 carotid operations at 14 hospitals into a central database. Blinded results were reviewed biannually. Complete data (1995-1997) were available for 1199 cases. The patients tended to be >64 years old (72%), male (62%), and white (93%). Carotid endarterectomy was the most frequently performed operation (90%). Perioperative complications (< or = 30 days) occurred in 173 patients (14.4%), including stroke (n = 19; 1.6%), death (n = 8; 0.7%), and stroke/death (n = 25; 2.0%). Although 23 surgeons (77% of the society) contributed some data, only 10 surgeons (33%) contributed complete data on >10 patients/year. Despite biannual efforts to boost participation, case entry remained stable (1994, 358; 1995, 347; 1996, 425; and 1997, 427), representing about one-third of the estimated carotid procedures performed in the state during that period. The cost of the registry was approximately $11,500. Audit of 8 surgeons revealed a >95 per cent match against the statewide discharge database and low error rate versus independent medical record review. This experience confirms that excellent outcomes after carotid endarterectomy are not limited to a few select centers and can be accomplished by adequately trained surgeons in a variety of institutional settings. Incomplete physician participation, however, inevitably raises questions about the utility of such efforts. Until volunteer registries induce full participation by heightening perceived physician benefit, their role will remain limited for future outcomes research.

Diffuse cystic endometrial hyperplasia and metastatic endometrial adenocarcinoma in a vietnamese pot-bellied pig (Sus scrofa).

A 16-year-old female Vietnamese pot-bellied pig was euthanized after a period of inappetence and weight loss. Diffuse cystic endometrial hyperplasia and endometrial adenocarcinoma with metastasis to lymph nodes, liver, and lung were diagnosed. This report follows the recent description of cystic endometrial hyperplasia and uterine leiomyomas in 3 aged female Vietnamese pot-bellied pigs. The findings in this report and previous reports suggest that pigs may develop some similar age-related uterine lesions as do women.

Acute appendicitis in children: the importance of family history.

BACKGROUND/PURPOSE: Acute appendicitis is common, frequently atypical, challenging, and still associated with significant morbidity. Despite major technologic advances, appendicitis remains a primarily clinical diagnosis. Therefore, no relevant anamnestic information should be overlooked. Surprisingly, the relationship between heredity and appendicitis is seldom considered. Because of the potential clinical importance of the family history, the authors addressed this question prospectively over a 52-month period in a practice that includes the majority of pediatric patients with appendicitis in the region. METHODS: Family histories were obtained in a standardized manner, focusing on first-degree relatives. Children with incomplete family information were excluded. Patients (ages 2(1/2) to 19 years) were divided into 3 groups: group A, children who underwent an appendectomy (n = 166); group B (first control), children who presented with an acute abdomen and suspected appendicitis but did not undergo an appendectomy (n = 117); group C (second control), children who were seen in the practice for unrelated conditions (n = 141). RESULTS: A positive parental history was obtained from 59 patients (36%) in group A, 24 patients (21%) in group B, and 20 patients (14%) in group C, and the odds ratios (ORs) were 2.0 (P =.035) and 2.9 (P <.001) for groups A versus B and A versus C, respectively. Of the 13 patients whose sibling had had acute appendicitis, 9 were in group A versus 2 each in groups B and C, and the OR for any family history (siblings, parents) in groups A versus B was 1.9 (P =.028) and for groups A versus C was 2.9 (P < 0.001). Appendicitis was histologically confirmed in 93% of children in group A. CONCLUSIONS: Heredity is a significant factor in pediatric patients who have appendicitis. Children who have appendicitis are twice as likely to have a positive family history than are those with right lower quadrant pain (but no appendicitis) and almost 3 times as likely to have a positive family history than are surgical controls (without abdominal pain). Because of its potential value in changing the threshold for intervention, a careful family history should be obtained for every child in whom acute appendicitis is suspected.

In vitro inhibition of Salmonella organisms isolated from reptiles by an inactivated culture of microcin-producing Escherichia coli.

OBJECTIVE: To determine whether an inactivated culture of a microcin-producing avian Escherichia coli was capable of killing Salmonella isolates from reptiles in an in vitro test system. SAMPLE POPULATION: 57 Salmonella isolate from reptiles. PROCEDURE: A wild-type avian E. coli electrotransformed with a plasmid coding for the production of microcin 24 was tested in an in vitro microassay system for its ability to kill 57 Salmonella spp isolated from reptiles. The reptile population included snakes, iguana, frilled lizards, turtles, other lizards, and unspecified reptiles. RESULTS: 44 of the Salmonella isolates were inhibited strongly, compared with the in vitro assay controls; 12 had weak inhibition, and 1 was not inhibited by the microcin-producing E. coli. Thirteen of the 57 isolates had resistance to at least 1 antibiotic, primarily streptomycin. There were 9 O serogroups identified in the 57 isolates, with serogroup H being the most prevalent (18 to 57). CONCLUSION AND CLINICAL RELEVANCE: Antibiotics are not recommended to eliminate Salmonella organisms from reptiles because of the development of antibiotic resistance. Further studies are necessary to determine whether the use of microcin-producing bacteria will be effective in controlling Salmonella infections in companion reptiles.