First UK trial of Xenex PX-UV, an automated ultraviolet room decontamination device in a clinical haematology and bone marrow transplantation unit.

BACKGROUND: There is growing interest in the use of no-touch automated room decontamination devices within healthcare settings. Xenex PX-UV is an automated room disinfection device using pulsed ultraviolet (UV) C radiation with a short cycle time. AIM: To investigate the microbiological efficacy of this device when deployed for terminal decontamination of isolation rooms within a clinical haematology unit. METHODS: The device was deployed in isolation rooms in a clinical haematology unit. Contact plates were applied to common touch points to determine aerobic total colony counts (TCCs) and samples collected using Polywipe™ sponges for detection of vancomycin-resistant enterococci (VRE). FINDINGS: The device was easy to transport, easy to use, and it disinfected rooms rapidly. There was a 76% reduction in the TCCs following manual cleaning, with an additional 14% reduction following UV disinfection, resulting in an overall reduction of 90% in TCCs. There was a 38% reduction in the number of sites where VRE was detected, from 26 of 80 sites following manual cleaning to 16 of 80 sites with additional UV disinfection. CONCLUSIONS: The Xenex PX-UV device can offer a simple and rapid additional decontamination step for terminal disinfection of patient rooms. However, the microbiological efficacy against VRE was somewhat limited.

Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward.

BACKGROUND: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings and have been documented in surgical, obstetrics and gynaecology, and burns units. The environment may serve as a reservoir and facilitate transmission via contaminated equipment. AIM: To describe the investigation and control of an outbreak of healthcare-associated GAS infection on an ear, nose and throat (ENT) ward in a tertiary referral centre. METHODS: Two patients with laryngeal cancer developed invasive GAS infection (bacteraemia) with associated tracheostomy wound cellulitis within a 48 h period. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, healthcare worker screening and sampling of patient curtains. Immediate control measures included source isolation, a thorough rolling clean with a chlorine-based disinfectant and hydrogen peroxide decontamination of patient equipment. FINDINGS: Prospective patient screening identified one additional patient with carriage of GAS from a tracheostomy wound swab. Staff screening identified one healthcare worker who acquired GAS during the outbreak and who subsequently developed pharyngitis. Environmental sampling demonstrated that 10 out of 34 patient curtains on the ward were contaminated with GAS and all isolates were typed as emm-1. CONCLUSION: This is the first outbreak report to demonstrate patient curtains as potential source for GAS cross-transmission, with implications in relation to hand hygiene and frequency of laundering. Based on this report we recommend that during an outbreak of GAS infection all patient curtains should be changed as part of the enhanced decontamination procedures.

Social influences on health-risk behaviors among minority middle school students.

PURPOSE: To determine whether parent social influences are associated with health-risk behaviors more than peer social influences among young minority adolescents. METHODS: We conducted a cross-sectional survey of seventh-grade students in a public urban magnet middle school using a survey instrument adapted from the Centers for Disease Control and Prevention Youth Risk Behavior Survey. The sample consisted of all seventh-grade students in the school, and the survey was part of a needs assessment for a school-based health education program. We measured four health-risk behaviors: use of (a) tobacco, (b) alcohol, (c) onset of sexual activity, and (d) marijuana use; and five social influences: (a) parent disapproval of health-risk behaviors, (b) parent modeling of health-risk behaviors, (c) parent monitoring of health-risks, (d) peer disapproval of health risks, and (e) peer modeling of health-risk behaviors. The analyses included measures of the prevalence of health-risk behaviors, bivariate analyses to evaluate relationships between health-risk behaviors and social influences, and regressions analyses to determine the independent associations of the social influences with the four health-risk behaviors. RESULTS: Twenty percent of respondents reported using tobacco, over 50% used alcohol in the past year, 13.3% were sexually active, and 12% reported marijuana use. Parent influences were associated with differences in alcohol use, whereas peer influences were associated with differences in all measured health-risk behaviors: tobacco and alcohol use, sexual activity, and marijuana use. Regression analyses demonstrated that peer social influences were the only measures independently associated with abstinence from tobacco (p < .05), alcohol (p < .01), sexual activity (p < .05), and marijuana use (p < .05). In all analyses, peers emerged as the most consistent social influence on health-risk behavior. CONCLUSION: This study suggests peers and peer group behavior may be better predictors of adolescent health-risk behaviors than parental social influences among young adolescents.

Traumatic hemorrhage of occult pheochromocytoma: a case report and review of the literature.

Pheochromocytoma usually presents with gradual onset and mild to moderate symptoms, but may present acutely with severe symptoms. Hemorrhage into pheochromocytoma is a rare cause of acute presentation that is often devastating to patients. We describe the case of a 34-year-old woman with hemorrhage into a previously undiscovered pheochromocytoma following a fall on a patch of ice. This is the first reported case of hemorrhagic pheochromocytoma associated with traumatic injury. Despite removal of the tumor within 18 hours of presentation, the patient suffered severe complications of massive catecholamine excess, including shock, cardiomyopathy, and adult respiratory distress syndrome. Animal studies have shown that early treatment with alpha blockers can prevent some, if not all of these complications. Proper management of hemorrhagic pheochromocytoma should include a high index of suspicion with early diagnosis and treatment with alpha blockers and surgical resection of the tumor when the patient is stable enough to tolerate the procedure.

High-performance liquid chromatographic determination of paclitaxel in rat serum: application to a toxicokinetic study.

A simple and sensitive high-performance liquid chromatographic method is described for the determination of paclitaxel (Taxol) at 230 nm using a Nucleosil C18 (5 microm) column and a methanol-water (70:30, v/v) mobile phase following a single-step extraction from serum with dichloromethane. The assay was validated against the classical criteria and was applied to a toxicokinetic study in rats after one or five, one per week) intraperitoneal administrations of 16 mg/kg Taxol.

Chylous ascites: a manifestation of blunt abdominal trauma in an infant.

This report presents an infant in whom a unique case of chylous ascites developed after blunt abdominal trauma. Unfortunately, this case was complicated by Pseudomonas peritonitis, likely from a distant source. Our patient was treated medically and had a good overall outcome.

Food restriction and binge eating: a study of former prisoners of war.

Food restriction is correlated with binge eating, but evidence that restriction leads to binge eating is scanty. In this study we investigated postwar binge eating in 67 World War II combat veterans and 198 former prisoners of war. As predicted, binge eating was relatively rare in combat veterans but was significantly more prevalent in veterans who, as prisoners in German prisoner of war camps, lost significant amounts of weight during their captivity. Our data thus support the contention that starvation or dieting seems to precede binge eating.

Effects of flow rate, duration of stimulation and mineralocorticoids on the electrolyte concentrations of mandibular saliva from the red kangaroo (Macropus rufus).

Mandibular saliva was collected at eight flow rates ranging between 0.052 +/- 0.0059 (S.E. of mean) and 4.294 +/- 0.0717 ml min-1 from anaesthetized red kangaroos receiving ipsilateral intracarotid infusions of acetylcholine. The concentrations of sodium (4.04 +/- 0.759 to 75.9 +/- 4.64 mmol l-1) and chloride (51.2 +/- 2.46 to 85.0 +/- 6.90 mmol l-1) and the osmolality (99.7 +/- 4.88 to 178.9 +/- 13.50 mosmol kg-1) were positively correlated with salivary flow rate over most or all of the flow range, whereas the concentrations of potassium (50.3 +/- 2.03 to 19.7 +/- 3.16 mmol l-1), calcium (5.43 +/- 1.696 to 1.26 +/- 0.055 mmol l-1), magnesium (259.8 +/- 49.3 to 19.0 +/- 1.88 mumol l-1), hydrogen ions (457.7 +/- 107.3 to 69.3 +/- 5.64 nmol l-1) and phosphate (2.22 +/- 0.171 to 0.27 +/- 0.040 mmol l-1) were negatively correlated with flow rate. Salivary bicarbonate concentration (15.6 +/- 1.76 to 21.9 +/- 1.83 mmol l-1) showed little flow dependency except possibly at high levels of stimulation. Spontaneous secretion was not observed during anaesthesia. During continuous stimulation of flow at two rates (0.5 and 2.0 ml min-1) for periods of 90 min, rest transients were observed for sodium, potassium, calcium, chloride and phosphate in the initial sample and the sodium concentration rose by 17-56% during the first 60 min of steady-state flow and stimulation. Indications that the gland was capable of responding rapidly to changes in endogenous mineralocorticoid levels were confirmed by intracarotid infusion of aldosterone at 80 micrograms h-1. With the mean salivary flow rate lying between 1.3 and 1.4 ml min-1, the salivary Na+/K+ ratio began to fall at 45-60 min of aldosterone infusion and after 4 h of infusion had fallen to 0.62 +/- 0.116. Administration of deoxycorticosterone acetate (DOCA) for 21 days at 0.25 or 0.3 mg kg-1 12 h-1 caused a further lowering of the Na+/K+ ratio to 0.09 +/- 0.013 at similar flow rates. Biopsy showed this increase to be associated with a moderate level of hypertrophy of the intralobular ducts of the gland. Two types of intralobular duct were identified on the basis of glycogen granulation after DOCA administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of fast neutrons on the eye.

The study of 93 eyes receiving neutron irradiation establishes the character of the ophthalmic complications of neutron. Significant changes are produced in the eyelids, conjunctiva, and cornea, but the production of cataract is relatively unimportant. No reaction was seen after neutron treatment that had not already been seen after chi or gamma radiation. That the unavoidable damage is similar to that reported with other forms of radiation, and not worse, is an important finding in view of the statistically significant benefit of neutron treatment to patients in a controlled clinical trial of advanced tumours of the head and neck (Catterall and others, 1975). The observations indicate that the improved cure rates with neutrons are not obtained at the expense of inflicting greater damage to normal structures. This investigation has also shown that the neutron effects of treating these very extensive tumours are acceptable and that, with carefully measured doses, they are predictable. The dose-response relationship in categories of clinical effect for a smaller series of patients, reported in Table 1 of our preliminary communication (Brown and other, 1976), is confirmed.