M antigens among group A streptococci isolated from skin lesions.

Three new provisional types of Group A streptococci have been identified among strains isolated from skin infections of American Indian children. A previously established type, Type 41, was also recognized among the pyoderma strains. Most of the skin streptococci with T-agglutination pattern 3/13/B3264 could be identified as Type 41 or as one of two new provisional types, Schoenborn (Type 52) and Hanson (proposed Type 53). Strains of the third new provisional type, Kingbird (proposed Type 54), agglutinated as 15/17/19/23/47, a T pattern not associated with skin infections in studies of other populations. Approximately half of the pyoderma strains examined were found to produce an M antigen; the proportion of M-typable strains from skin infections was found to be similar to that currently found in throat cultures of children with pharyngitis. The demonstration of M antigens in streptococci from skin lesions provides evidence of their potential virulence and should facilitate their classification in subsequent epidemiological studies.

Location of stents in the left anterior descending coronary artery using three dimensionally acquired, two dimensionally displayed transthoracic echocardiography.

The location of left anterior descending arterial stents was documented in 10 of 13 patients using 3-dimensionally acquired, 2-dimensionally displayed transthoracic echocardiography. The echocardiographic appearance of stents was characterized, and the location of the proximal and mid-left anterior descending artery was objectively documented.

Comparison of multiplane and biplane transesophageal echocardiography in the assessment of aortic stenosis.

The aim of the study was to compare the accuracy of multiplane transesophageal echocardiography (TEE) with the more conventional biplane technique in the direct assessment of aortic valve area in patients with aortic stenosis. Short-axis images of the aortic valve adequate for measuring aortic valve area were obtained in all 81 patients studied by multiplane TEE but in only 56 of 64 patients (88%) using the biplane approach. The correlation coefficient for aortic valve area determined by multiplane TEE (r = 0.89; SEE = 0.04 cm2) was higher (p < 0.01) than biplane TEE (r = 0.74; SEE = 0.06 cm2). Correlations were higher for bicuspid valves (multiplane, r = 0.93; biplane, r = 0.75) than tricuspid valves (multiplane, r = 0.87; biplane, r = 0.75). Our study has demonstrated the superiority of multiplane TEE to both biplane TEE and transthoracic echocardiography (TTE) in the direct evaluation of aortic valve area in patients with aortic stenosis.

Serological grouping of streptococci by slide agglutination.

Streptococcal grouping sera for groups A, B, C, and G prepared for conventional testing by precipitation were made specific by absorption and used to identify streptococci by slide agglutination with and without staphyloccocal coagglutination. Trypsinised suspensions of 1055 strains, identified by precipitation as belonging to group A, B, C, or G, were tested by slide agglutination. Of these, 998 were correctly identified using a streptococcal suspension and antisera alone and a further 65 were identified when a loopful of protein A-positive staphylococci was added. Suspensions of 88 strains not of groups A, B, C, or G gave no reaction in the agglutination test with or without the addition of staphylococci. Group polysaccharide extracted by conventional methods also caused agglutination of staphylococci on a slide when specific antiserum was added. Growth from primary or secondary cultures digested in streptomyces enzyme for only 15-30 minutes provided an excellent antigen for a quick and simple method of streptococcal grouping using non-sensitised staphylococcal suspension and specific antisera for coagglutination.

Immunological heterogeneity among the M-associated protein antigens of group-A streptococci.

Different serotypes of group-A streptococci share common antigens that are closely associated with the type-specific determinant of M protein. By the use of selected human sera containing antibody to these M-associated antigens, we have shown that group-A streptococci can be divided into three categories. The majority of the opacity-factor-negative respiratory serotypes possess a shared M-associated antigen or antigens, to which high titres of antibody are common in patients with rheumatic fever, or patients recovering from upper respiratory infections with certain opacity-factor-negative serotypes. The antibody in these sera has a demonstrable but limited affinity for the M-associated antigens of strains belonging to a second category of M types, the majority of which are opacity-factor-positive serotypes of "throat" or "skin" origin. A third group, consisting mainly of opacity-factor-negative pyoderma serotypes, gave variable results and seemed to be intermediate between the other two categories. Complement-fixation-inhibition tests and absorption studies showed a marked degree of cross-reactivity between the M-associated antigens of the three categories.

Major complications of silicone penile prosthesis: predisposing clinical situations.

Necrosis of the corpora cavernosa of the penis developed in 2 patients with diabetes mellitus complicated by significant vascular disease following insertion of a silicone penile prosthesis necessitating its removal. The surgical maneuvers thought to predispose to these complications will be considered.

Pyeloduodenal fistula.

Twenty-eight cases of pyeloduodenal fistula are reviewed from the standpoint of pathogenesis, clinical presentation, diagnosis, and management. Our review suggests the majority of these fistulas involved the right kidney and occurred as a result of chronic renal inflammatory disease. The fistulas are most effectively diagnosed with retrograde pyelography. The review suggests the best management of pyeloduodenal fistula is nephrectomy and primary closure of the duodenum.

Peliosis hepatis after long-term androgen therapy.

Peliosis hepatis is a recognized, but rare, complication of androgen replacement therapy. We herein report such a complication with necropsy study of the liver so involved.

Misconceptions about posterior approach for renoureteral surgery.

Misconceptions about the posterior approach for renal and ureteral surgery are dispelled. A review of the pertinent lumbar anatomy and a few fine points of technique are emphasized. The advantages of easy access to the kidney, minimal postoperative pain, and absence of the occurrence of postoperative hernia warrant more frequent use of this procedure.

Neurogenic fibrosarcoma following radiation therapy for seminoma.

We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.

Transthoracic echocardiographic power motion tissue imaging of an intracardiac tumor that could not be seen with conventional transthoracic echocardiographic recordings.

Power motion imaging allows interrogation of low-velocity tissue. By means of power motion imaging with 2 different late-model echographs we identified an intra-atrial tumor that was undetectable on conventional transthoracic echocardiograms.

Establishment of a clinically correlated human pericardial fluid bank: evaluation of intrapericardial diagnostic potential.

The development of a clinically correlated human pericardial fluid bank and database is described. A unique feature of this registry is the availability of a large number of pericardial fluid samples for testing with respect to multiple factors and for correlation with angiographic findings and clinical syndromes expressed by the patients. The collection of data at the present time comprises frozen pericardial fluid samples obtained from patients who have undergone cardiac surgery; and historical, clinical, and laboratory data obtained from the patient records. Nearly 400 samples have been stored and analyzed thus far, with sample entry continuing. This registry is designed to evaluate the local factors that play a role in mediating or reflecting myocardial or coronary responses. Pathophysiologic processes of particular interest include restenosis, plaque ruptures, and angiogenesis. Study of the pericardial fluid bank should lead to enhanced understanding of molecular mechanisms, as well as to the explanation for the reasons underlying interpatient variability in these processes. It is further anticipated that this information might provide a foundation for the diagnostic use of pericardial fluid to individualize therapies targeting angiogenesis or plaque physiology.