Mass mortality of harbor seals: pneumonia associated with influenza A virus.

More than 400 harbor seals, most of them immature, died along the New England coast between December 1979 and October 1980 of acute pneumonia associated with influenza virus, A/Seal/Mass/1/180 (H7N7). The virus has avian characteristics, replicates principally in mammals, and causes mild respiratory disease in experimentally infected seals. Concurrent infection with a previously undescribed mycoplasma or adverse environmental conditions may have triggered the epizootic. The similarities between this epizootic and other seal mortalities in the past suggest that these events may be linked by common biological and environmental factors.

Open lung biopsy. Its effects on therapy in the pediatric patient.

The records of 35 pediatric patients who had open lung biopsies at Columbus Children's Hospital, Columbus, Ohio, were analyzed to determine the results and the effects on therapy. Twenty-two (63 percent) of these patients were immunocompromised, and they are compared to the non-compromised group. A diagnosis was obtained in all cases. An infectious agent was identified in 13 (37 percent) of the patients. Ten of these were immunocompromised. In 43 percent (15 patients) of the total group and 55 percent (12 patients) of the immunocompromised group, the results of the biopsy effected a change in therapy. Five patients died, all of whom were immunosuppressed. None died as a direct result of the open lung biopsy. The total morbidity rate was 23 percent (eight patients). We concluded that open lung biopsy can be accomplished safely in the pediatric patient and that the results affect the therapeutic decision-making process a significant portion of the time.

A technique for postembolectomy streptokinase infusion.

Despite successful arterial thromboembolectomy, some extremities may have progressive ischemic necrosis due to persistent arterial occlusion. Streptokinase infusion can be valuable in this situation. We have developed a clinically applicable technique that is of value in lysing residual thrombi.

Excellence and low case volume: an example of the inapplicability of volume-based credentialing.

BACKGROUND: Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing. METHODS: Using The Society of Thoracic Surgeons Cardiac Database, we examined the data for all coronary artery bypass graft-only patients (n = 615) operated on by us from July 1991 to June 1997. RESULTS: The observed mortality was 0.33% and the observed-to-expected ratio was 0.12 (p<0.005). Morbidity was low as well. CONCLUSIONS: Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.

Simplified method of left ventricular thrombectomy.

Postinfarction left ventricular thrombi are at risk for embolization with resultant injury. Surgical removal is recommended especially if they are pedunculated or mobile. We describe an easily applied transatrial method that can allow avoidance of a ventriculotomy.

Use of the spiral Salmonella assay to detect the mutagenicity of complex environmental mixtures.

The success demonstrated by the spiral Salmonella assay in a recent study of 20 pure prompted us to examine the effectiveness of this automated bacterial mutagenicity assay for testing complex environmental mixtures. Three sets of combustion emissions were selected for evaluation: automotive diesel exhaust, woodsmoke, and a coal combustion emission. Each sample was tested in the Salmonella mutagenicity assay according to standard protocol (plate incorporation) and spiral assay techniques. In the spiral assay, a specialized plating instrument dispenses the bacteria, test agent, and S9 mix in a spiral pattern onto a minimal agar plate supplemented with histidine and biotin. The components of the assay are administered in such a way that a uniform density of bacteria is exposed to a concentration gradient of the test agent on a single plate. When results are analyzed, a dose-response curve comprised of 13 data points is generated. A comparison of results from the two assays demonstrated the following: 1) Diesel exhaust was generally the most mutagenically potent sample in both assays, followed closely by the coal combustion emission. The woodsmoke sample was only weakly mutagenic in the standard assay but demonstrated higher mutagenic activity in the spiral assay. 2) Samples were more mutagenic on rev/microgram basis in the spiral assay, especially when metabolic activation was added. This disparity presumably was due to differences in the relative amounts of S9 administered across the dose range. 3) The spiral assay required 1/20 the sample mass of the standard assay to test equivalent doses; in addition, for some samples, 50 times more sample mass was required by the standard assay to generate a comparable dose response. 4) Dichloromethane extracts of the complex mixtures could be tested for mutagenicity in the spiral assay, thereby precluding solvent exchange (to dimethylsulfoxide) required by the standard assay for sample/bioassay compatibility.

Autotransfusion of unwashed mediastinal shed blood fails to decrease banked blood requirements in patients undergoing aortocoronary bypass surgery.

Infusion of unwashed mediastinal shed blood (MSB) is one technique advocated for decreasing use of donor blood in cardiac surgery patients. A commercially available system was prospectively evaluated in 96 consecutive patients. The control group was comprised of 78 consecutive patients. All underwent elective aortocoronary bypass surgery. Student's t-test, chi-square analysis, multivariate analysis, and Fisher's exact test were used where appropriate. There was no decrease in the amount of banked blood required or percentage of patients who received transfusions in the MSB autotransfusion group.

Morbillivirus infection in cetaceans of the western Atlantic.

We report serologic evidence of morbillivirus infection in eleven of fifteen species of odontocete cetaceans from the western Atlantic since 1986. Blood samples were obtained both from free-ranging and stranded animals. Virus neutralizing titers were higher against porpoise and dolphin morbilliviruses than against peste des petits ruminants virus, phocine distemper virus or canine distemper virus (CDV). Serum from five species, tested in a heterologous immunoprecipitation assay using radiolabelled CDV, precipitated the nucleocapsid (N) protein. Clinical morbillivirus infection may potentially impact already threatened species such as the harbour porpoise and precipitate mass strandings of socially cohesive odontocetes.

Epizootiology of morbillivirus infection in North American harbor seals (Phoca vitulina) and gray seals (Halichoerus grypus).

A longitudinal study of morbillivirus infection among harbor (Phoca vitulina) and gray (Halichoerus grypus) seals on the Atlantic coast of North America was carried out between 1980 and 1994. Serology also was carried out on harbor seals from the Pacific northwest coast collected in 1992 and 1993. The prevalence of morbillivirus neutralizing antibodies was significantly (P < 0.0001) higher in gray (73%, n = 296) than in harbor seals (37%, n = 387) from the Atlantic. Titers were significantly (P < 0.0001) higher against phocine distemper (PDV) compared to any other morbillivirus. Antibodies were not detected in serum from Pacific harbor seals. During the winter of 1991 to 1992 an epizootic occurred among harbor seals on the northeast coast of the United States. The event was characterized by an increase in strandings and by a significant (P = 0.001) increase in PDV antibody prevalence to 83% (n = 36) in seals stranded that winter. Morbillivirus lesions and antigen were observed in six animals found stranded from southern Maine to Long Island, New York (USA), between November 1991 and April 1992. In addition, morbillivirus encephalitis was detected in tissues from a harbor seal that stranded in 1988. Enzootic infection appeared to be present in both seal species, although with a different prevalence of disease. We propose that enzootic infection among gray seals is facilitated by population size, high annual recruitment and innate resistance to clinical disease. Infection may be maintained in the smaller harbor seal population through casual contact with gray seals.

Epizootiology of morbillivirus infection in harp, hooded, and ringed seals from the Canadian Arctic and western Atlantic.

Using a virus neutralization technique, we found phocine distemper virus (PDV) antibody in 130 (83% of 157) harp seals (Phoca groenlandica) from the western North Atlantic sampled between 1988 and 1993 inclusive. In contrast, only 44 (24% of 185) hooded seals (Cystophora cristata) had antibodies against PDV even though they were sympatric with harp seals and were sampled over a similar period, from 1989 to 1994 inclusive. Antibodies occurred in 106 (41%) of 259 ringed seals (Phoca hispida); this prevalence was higher than expected given the solitary behavior and territoriality characteristic of this species. Seropositive ringed seals were found at each of seven locations across Arctic Canada from Baffin Bay to Amundsen Gulf at which samples were collected between 1992 and 1994. However, the prevalence of infection was highest where ringed seals are sympatric with harp seals in the eastern Canadian Arctic.

Abilities of normal and reading-disabled children to combine the visual and auditory modalities with dimensions of space and time.

The effects of various combinations of modalities with the dimensions of space and time on reproduction of stimulus patterns by 162 normal and 83 reading-disabled children aged 6 to 12 yr. was studied. Scores on three subtests with three different combinations of modalities with space and time dimensions were analyzed. They were visual temporal input, vocal temporal output; auditory temporal input, vocal temporal output; and visual spatial-temporal input, vocal temporal output. Visual spatial-temporal input was superior to the other subtests. Auditory temporal input was superior to visual temporal input. There were significant differences between normal and reading-disabled subjects on each subtest so the spatial dimension gives an advantage. The spatial and temporal dimensions need to be attended to in research.

Gas bubbles in seals, dolphins, and porpoises entangled and drowned at depth in gillnets.

Gas bubbles were found in 15 of 23 gillnet-drowned bycaught harp (Pagophilus groenlandicus), harbor (Phoca vitulina) and gray (Halichoerus grypus) seals, common (Delphinus delphis) and white-sided (Lagenorhyncus acutus) dolphins, and harbor porpoises (Phocaena phocaena) but in only 1 of 41 stranded marine mammals. Cases with minimal scavenging and bloating were chilled as practical and necropsied within 24 to 72 hours of collection. Bubbles were commonly visible grossly and histologically in bycaught cases. Affected tissues included lung, liver, heart, brain, skeletal muscle, gonad, lymph nodes, blood, intestine, pancreas, spleen, and eye. Computed tomography performed on 4 animals also identified gas bubbles in various tissues. Mean +/- SD net lead line depths (m) were 92 +/- 44 and ascent rates (ms(-1)) 0.3 +/- 0.2 for affected animals and 76 +/- 33 and 0.2 +/- 0.1, respectively, for unaffected animals. The relatively good carcass condition of these cases, comparable to 2 stranded cases that showed no gas formation on computed tomography (even after 3 days of refrigeration in one case), along with the histologic absence of bacteria and autolytic changes, indicate that peri- or postmortem phase change of supersaturated blood and tissues is most likely. Studies have suggested that under some circumstances, diving mammals are routinely supersaturated and that these mammals presumably manage gas exchange and decompression anatomically and behaviorally. This study provides a unique illustration of such supersaturated tissues. We suggest that greater attention be paid to the radiology and pathology of bycatch mortality as a possible model to better understand gas bubble disease in marine mammals.

Anxiety in ambulatory emergency patients.

The anxiety level of ambulatory emergency department patients without a diagnosis of a physical illness was studied. These patients were compared to a group with a diagnosis of nontraumatic surgical disease. Both the study group and the comparison group were found to have elevated anxiety levels. In addition, those with nonphysical illness had elevated levels of covert anxiety when compared to their overt levels (p less than .03) and when contrasted with the comparison group's covert levels ( p less than .03). In the treatment of all a patient's problems the psychosomatic illnesses evidenced by raised covert anxiety levels may require intensive treatment both within and without the emergency department.

Internet developments and their significance for healthcare.

This paper reviews some recent developments in the technology of the Internet, and shows how they may affect the way in which healthcare is provided. Starting with a brief technical history of the Internet, the paper discusses some of the technical developments that have taken place or been proposed in recent years, and speculates on the realities of their adoption within the next five years. The paper also discusses trends in public accessibility to the Internet and the development of Internet services. Finally, the impact of the technological developments on the way in which new healthcare services may be provided is discussed. Our conclusions are that the growth rate in Internet access and the improvements in performance resulting from the new technologies will make the Internet the focus of many new healthcare developments, in particular in the areas of telemedicine and in communication between patient and healthcare professionals. Increasingly, the Internet will be used to convey more 'real-time' information.

Anti-CD40 ligand antibody treatment prevents the development of lupus-like nephritis in a subset of New Zealand black x New Zealand white mice. Response correlates with the absence of an anti-antibody response.

Systemic lupus erythematosus is characterized by B cell production of pathogenic autoantibodies dependent upon cooperation from CD4+ Th cells. The interaction between CD40 on B cells and CD40 ligand (CD40L) on Th cells is necessary for normal thymus-dependent Ab production. An anti-murine CD40L mAb blocks binding of CD40L to CD40 and prevents primary and secondary immune responses to thymus-dependent Ags. In this study, New Zealand Black x New Zealand White lupus-prone mice treated with this anti-CD40L Ab from ages 4 to 10 mo had reduced anti-DNA autoantibody production and renal disease and significantly prolonged survival compared with control mice. Pathologic examination verified the absence of significant renal damage or immune deposition in responding mice. Mice that responded to treatment did not develop an Ab response to the administered Ab. Long-term survivors mounted a substantial Ab response to keyhole limpet hemocyanin after completion of anti-CD40L Ab treatment, suggesting that some of the immunosuppressive effects of the Ab may be reversible. These results suggest a human form of this Ab may have therapeutic utility in human systemic lupus erythematosus.

Anxiety levels and cancer fear in patients admitted for elective operations.

Patients who are to have elective operations project varying degrees of anxiety, and many spontaneously express fear (without basis) that their operation involves a diagnosis of malignancy. To measure total, covert, and overt anxiety objectively, we gave the Institute for Personality and Ability Testing anxiety test to 125 consecutive patients admitted for elective general surgical procedures. A simple survey of cancer fear was also completed. Chi-square and Fisher's exact test were used to compare categoric data, and linear regression and analysis of variance were used where appropriate. Total anxiety scores were in the upper quartile compared to the general population. Scores indicating fear of cancer were elevated in 75% of patients who had no history of or reason to suspect malignancy. Covert anxiety scores correlated with cancer fear scores, and both significantly decreased as age increased (P less than .05). Also, as age increased, the cancer fear scores decreased (P less than .002). Obese patients had higher scores of cancer fear than all other patients (P less than .0001).

Genetic impact of an unusual group mortality among humpback whales.

Mass mortalities, due to infectious disease or toxic algal blooms, are known to have severe demographic impacts on marine mammal populations. The genetic impacts of these events, however, have received little attention. To investigate the genetic consequences of an unusual group mortality among humpback whales, we compared the mitochondrial DNA haplotypes of 10 whales poisoned by mackerel contaminated with a dinoflagellate neurotoxin to those of 32 live whales from the same regional population. Two haplotypes that were rare in the reference sample of live whales accounted for eight of the 10 poisoned whales. A randomized test of independence, based on 500 permutations of the data matrix, showed significant differences in the frequencies of haplotypes in the two samples (P < .002). This is the first demonstration that group mortality events in marine mammals can have unpredictable genetic consequences and points to a need to evaluate ecological disasters within the context of the genetic mosaic of natural populations.