Production of leucinostatins and nematicidal activity of Australian isolates of Paecilomyces lilacinus (Thom) Samson.

AIMS: To evaluate the relationship between leucinostatin production by Paecilomyces lilacinus isolates and their biological activities. METHODS AND RESULTS: The nematicidal, parasitic and enzymatic activity of Australian P. lilacinus isolates were investigated. Nematicidal activities of culture filtrates were measured by mortality and inhibition of reproduction of Caenorhabditis elegans, whereas egg-parasitic activity was measured by colonization on Meloidogyne javanica. Enzymatic activities (protease and chitinase) were assayed on solid media. The results suggest that leucinostatins in P. lilacinus are indicators of nematicidal activity, whereas chitinase activity might be related to parasitism. CONCLUSIONS: Nematicidal activity of culture filtrates of Paecilomyces lilacinus strains related to their ability to produce leucinostatins. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study describing the leucinostatins as nematicides.

Lung volume reduction surgery in emphysema: a systematic review.

The aim of this study was to systematically review the literature regarding the safety and efficacy of lung volume reduction surgery (LVRS) in patients with emphysema. Studies on LVRS to August 2000 were identified using MEDLINE, Embase, Current Contents, and the Cochrane Library. Human studies of patients with upper, lower or diffuse distributions of emphysema were included. All types of bullous emphysema were excluded. A surgeon and researcher independently assessed the retrieved articles for their inclusion in the review. When LVRS was compared with medical management, at 2 years LVRS was associated with a higher FEV1 and at least equivalent survival. The use of staple excision of selected areas of lung appeared to be more efficacious than laser ablation. There is insufficient evidence to show preference for median sternotomy or videoscopically assisted thoracotomy, as the more safe and efficacious procedure. In highly selected patients with emphysema LVRS is deemed an acceptable treatment. To fully evaluate the safety and efficacy of LVRS, outcomes beyond 2 years must be included. The results of prospective randomized trials between medical management and LVRS, now in progress, are essential before a final assessment can be made.

Clinicopathological correlates of cardiac myxomas: a 30-year experience.

Between 1961 and 1991, 23 patients (eight men and 15 women, with a mean age of 50 (range 25-72) years) with cardiac myxomas were managed at the Alfred Hospital, Prahran, Victoria, Australia. Symptoms of mitral valve obstruction were present in 13 patients and of systemic embolism in nine. In the patients, 21 myxomas were confined to the left atrium. In the other two patients, one myxoma was confined to the right atrium and the other was a dumb-bell-shaped biatrial myxoma. Most tumours were diagnosed with echocardiography. Removal was achieved via a median sternotomy and by entering the involved chamber. Those myxomas presenting with systemic embolism were always soft and friable, whereas those with obstructive symptoms were large and of variable consistency. There was one operative death early in the series. The 22 surviving patients have been assessed as functional class I of the New York Heart Association at follow-up, ranging from 2 months to 23 years (mean 9 years). There were no episodes of tumour recurrence. Excellent short, intermediate and long-term results can be achieved by excision of cardiac myxomas.

Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome.

The histological features of the flexor tendon sheath in the spontaneous carpal tunnel syndrome were studied. The main differences between our findings and previous studies were twofold. Firstly a striking absence of inflammation in our material and secondly the diversity of the pathological changes encountered--alterations in the connective tissue especially the collagen; proliferation with thickening of the tissues of the tendon sheath; fibrosis; amyloid deposition; oedema; vascular lesions including thickening of vessels walls, intimal hyperplasia, and thrombosis; and a foreign body giant cell reaction. Although the lesions described here may not be significant in every case in which they are encountered, they do appear to support the view that pressure in the carpal tunnel and ischaemia are the important factors in a majority of cases of the spontaneous carpal tunnel syndrome.

Stress inoculation for acute pain: a clinical trial.

The study attempted a clinical evaluation of the efficacy of stress inoculation training for postoperative pain control using patients undergoing coronary artery graft surgery. A treatment group receiving stress inoculation training was compared to attention-education and no-treatment control groups. No differences were found between the groups on two pain rating measures, analgesic intake, or measures of state anxiety and depression. The ineffectiveness of stress inoculation in this study may be due to the difference between experimental and clinical pain, the multiple demands of the preoperative period, possible memory difficulties which some patients may have experienced, or the possibility that the procedure is not sufficiently potent for the intensity of this type of pain.

Antibiotic prophylaxis for coronary bypass grafting. Comparison of a five-day and a two-day course.

A trial was conducted to compare the effectiveness of a 2 day and a 5 day course of antibiotic prophylaxis after coronary bypass grafting. One hundred sixty patients were randomized to one of the two courses. The 2 day course comprised 48 hours of intramuscular kanamycin and intravenous cephalothin. The 5 day course comprised 48 hours of intramuscular kanamycin and intravenous cephalothin followed by 3 days of oral cephalexin. After the 2 day course, there were two wound infections and two respiratory tract infections in 79 patients (5.1%), and after the 5 day course, one wound infection and two respiratory tract infections in 81 patients (3.7%). Subsequently, in 171 patients undergoing coronary bypass grafting and given the 2 day course, the infection rate was 3.5%. There was no significant difference in infection rates among the three groups (p greater than 0.05). We conclude that no more than 2 days of antibiotic prophylaxis are necessary for patients undergoing coronary bypass grafting.

Hospital costs and return to work after coronary bypass surgery.

A study to assess the cost and some of the benefits of coronary bypass surgery was carried out at the Alfred Hospital, Melbourne. The minimum cost to the hospital of a typical coronary bypass graft procedure in 1980 was estimated to be $4700. The benefit of the procedure in terms of symptomatic relief and return to work was assessed by means of questionnaires. In the working-age group (55 years and under) of 591 patients, assessed from two to nine years after surgery, 68% of patients were working. In a group of 100 patients, aged 55 years and under, and interviewed from one to two years after surgery, 56 patients were working before surgery, but only 16 of these at full capacity. After surgery, 78 patients were working; 64 of these at full capacity. The cost of a coronary bypass graft operation is considerable, but this is offset in the majority of patients in the working-age group by a return to gainful employment.

Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery.

Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

A report on the use of five bubble oxygenators for cardiopulmonary bypass surgery.

Bubble oxygenators available for cardiopulmonary bypass vary in design and in price. Choice of oxygenator is often made on the basis of price, or an empirical assessment of performance. This paper reports our clinical experience with five "hard shell" bubble oxygenators--Harvey H 1500, Harvey H 1000, Shiley S100A, Cobe Optiflo II and Bentley BOS 10. Data relating to gas transfer, heat exchanger performance, haematological changes and oxygenator design is presented and some comparisons made.

A recirculating cooling system for improved topical cardiac hypothermia.

A simple system is described that recirculates cooling fluid for topical cardiac hypothermia. This disposable system can produce a flow of 1,500 ml/min at 2 degrees to 4 degrees C. The recirculating cooler produced significantly lower myocardial temperatures than a conventional fluid-discard system in 22 patients having coronary operation. This system has been used as part of the technique of hypothermic cardioplegia in more than 600 patients. During various cardiac procedures, septal temperatures were maintained well below 20 degrees C for 60 minutes or more without the need to reinfuse the cardioplegic solution.

Malignant childhood neoplasms in the western region of Saudi Arabia.

In a sample of 8 cases of solid malignant neoplasms occurring in children resident in the Western Region of Saudi Arabia the most important finding was a remarkable preponderance of lymphomas when compared with Western series. Other notable differences were the prevalence of Hodgkin's disease in the first decade of life, the different proportions of its subtype, and the occurrence of well-differentiated lymphocytic lymphoma. Included is a case of lympho-epithelioid cellular lymphoma (Lennert's lymphoma) which, as far as we can ascertain, is the youngest reported case. There was a relatively large number of embryonal rhabdomyosarcomas and a paucity of neuroblastomas. Our study, which is concerned with proportional rates (population studies are not yet completed), contributes to the interesting ethnic and geographical differences which exist in the prevalence of childhood lymphomas and other solid malignant neoplasms. The biases that affect studies such as ours are stressed.

Maximal conservation and minimal usage of blood products in open heart surgery.

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.

Preoperative mediastinoscopy in lung carcinoma.

One hundred and sixty cases of pulmonary neoplasm were seen in one year at the Alfred Hospital, Victoria, Australia. Only 41 patients were considered suitable for operative resection. Preoperative mediastinoscopy showed that 19 of these 41 patients had inoperable tumours, and thus prevented 19 unnecessary operations. Potentially curative resections were performed in 15 patients (10%).

Malignant neoplasms in Saudi Arabia.

In a sample of 1000 consecutive malignant neoplasms in Saudis resident in the Western Region of Saudi Arabia, malignant lymphoma was the commonest of the life-threatening malignancies. The differences between malignant lymphoma in this sample and Western series include the greater frequency of lymphoma; the tendency for reticulum cell and poorly differentiated lymphomas to present as abdominal lesions; the earlier peak of prevalence of Hodgkin's disease, and the dissimilar proportions of its subtypes. The distribution of cancers in the gastrointestinal tract in our sample is almost the reverse of that encountered in the West in that cancer of the mouth and esophagus were more common than cancer of the lower intestinal tract. Lung cancer was relatively uncommon. The smoking habit is not so prevalent in Saudi Arabia as in the West and there is a need to maintain this situation by discouraging smoking. Cancer of the breast was by far the commonest major malignancy in the female, although most Saudi women have their first child early in their reproductive life. Skin cancers proved to be the most prevalent malignancy, and of these squamous cell carcinoma was the most common. The biases that affect studies such as ours in Saudi Arabia are stressed.