Staphylococcus pseudintermedius can be misdiagnosed as Staphylococcus aureus in humans with dog bite wounds.

The purpose of this study was to investigate whether S. pseudintermedius is misdiagnosed as S. aureus by clinical laboratories when isolated from humans with dog bite wounds. In addition, we attempted to determine whether S. pseudintermedius isolates related to dog bite wounds share phenotypic and genotypic traits. S. pseudintermedius was identified by PCR targeting the nuc gene. Isolates were tested for antibiotic susceptibility using VetMIC GP-mo microdilution panels. The occurrence of genes encoding leukocidins, exfoliatins, pyrogenic toxin superantigens and enterotoxins was determined by PCR. The relatedness of S. pseudintermedius isolates was investigated using Multi Locus Sequence Typing (MLST). Out of 101 isolates defined as S. aureus by human clinical microbiology laboratories, 13 isolates were re-identified as S. pseudintermedius and one isolate was confirmed to carry the mecA gene, i.e. methicillin-resistant (MRSP). The MRSP isolate was also defined as multi-resistant. Two methicillin-susceptible S. pseudintermedius isolates were also multi-resistant and five were susceptible to all antibiotics tested. With the exception of three S. pseudintermedius isolates belonging to multi locus sequence type (MLST) 158, all the isolates belonged to unique STs. All isolates contained lukS/F-I, siet and se-int, and expA were identified in two isolates and expB and sec canine-sel in one isolate respectively. S. pseudintermedius is frequently misdiagnosed as S. aureus from humans with dog bite wounds showing that it can act as an opportunistic pathogen in humans. No common phenotypic and genotypic traits shared by the S. pseudintermedius isolates could be identified.

Single-dose etoposide in advanced pancreatic and biliary cancer, a phase II study.

Palliative chemotherapy can add to the duration and quality of life in patients with advanced pancreatic and biliary cancer, albeit in a limited way. Between March 1995 and October 1997, 31 symptomatic patients were treated with etoposide in a phase II trial. Measurements of objective and subjective responses were performed, the latter by the treating physician and with the method of clinical benefit response (CBR). Quality of life was evaluated with the EORTC QLQ-C30 questionnaire. A partial response was seen in 2 (6%) patients. Subjective responses/quality of life gains were seen in 6 (19%), 7 (23%) and 9 (29%) patients, respectively, with the different methods. Median survival was 4.5 months. WHO grade 3 and 4 toxicity, alopecia excluded, was seen in 20% of the patients. The clinical activity of etoposide is limited, and in the same low range as other drugs in these diseases.

Effect of dietary and injectable vitamin E and selenium in weanling swine antigenically challenged with sheep red blood cells.

Two experiments were conducted to evaluate the effect of supplemental vitamin E and (or) Se, provided either in the diet or by injection, on humoral antibody production in weanling swine after an antigenic challenge with sheep red blood cells (SRBC). In the first experiment, a 2 x 2 factorial design was used, with pigs fed either 0 or .5 ppm Se and 0 or 220 IU vitamin E/kg diet. The basal diet contained a natural Se and alpha-tocopherol content of .02 ppm and 7 mg/kg, respectively. In a second 2 x 2 factorial trial, 0 or 6 mg Se and 0 or 220 mg alpha-tocopherol were injected intramuscularly into weaning pigs fed the basal diet without supplemental Se or vitamin E. A fifth treatment group was fed a positive control diet containing both nutrients (.5 ppm Se and 220 IU vitamin E/kg). In both experiments, intraperitoneal injections of SRBS (1 x 10(8)) were administered weekly, with hemagglutination titers determined at these intervals. Hemagglutination assays indicated that vitamin E and Se independently enhanced the immune response, particularly during the latter weeks of the experiment. The combination of both nutrients, provided either in the diet or via injection, resulted in a further increase in hemagglutination titers, suggesting an additive response. Pigs receiving either Se or vitamin E had higher serum concentrations of the nutrient provided. Dietary sources of these nutrients resulted in greater serum and tissue levels than did injections.

Acute interleukin-6 infusion increases IGFBP-1 but has no short-term effect on IGFBP-3 proteolysis in healthy men.

Human conditions of elevated interleukin-6 (IL-6) and transgenic mice overexpressing IL-6 have increased proteolytic degradation of insulin-like growth factor binding protein (IGFBP)-3. In addition, IL-6 alters the hepatic expression of insulin-like growth factor-I (IGF-I) and the IGFBPs in vitro. The aim of the present study was to investigate whether moderately elevated IL-6 levels have short-term effects on circulating IGF-I, IGFBP-1 and IGFBP-3 proteolysis in vivo. Healthy men received a 3-h IL-6 (n = 6) or saline (n = 6) infusion and blood samples were collected prior to and up to 8 h after the start of infusion. Free IGF-I, total IGF-I, IGFBP-1, insulin and cortisol were measured using immunoassays. Serum IGFBP-3 proteolysis was analyzed by Western immunoblot and by in vitro degradation of (125)I-IGFBP-3. We found that IL-6 concentrations reaching approximately 100 pg/ml significantly increased IGFBP-1 after the end of infusion in the absence of changes in insulin. In addition, plasma levels of cortisol were increased in response to IL-6 during and after infusion compared to saline. There was no effect of IL-6 on IGFBP-3 proteolysis, total IGF-I or free dissociable IGF-I. These data suggest that moderately elevated levels of IL-6 such as in the post-operative state or after exercise may contribute to increased levels of IGFBP-1. Although this study does not exclude that high levels and/or prolonged exposure to IL-6 may induce IGFBP-3 proteolysis in sepsis or chronic inflammatory disease, it suggests that IL-6 released from exercising skeletal muscle is not directly involved in proteolysis of circulating IGFBP-3.

Genetic and molecular analysis of a set of unstable white mutants in Drosophila melanogaster.

Two related unstable mutants at the white locus of Drosophila melanogaster show different interactions with the zeste1 mutant: one mutated white gene becomes repressed in males, whereas the other is unaffected by z1. By use of Southern blot techniques and by constructing genomic lambda-libraries, molecular analyses of the white regions of these two strains were performed. The results showed a single difference at a site 2.5 kb (kilobases) downstream of the white transcription unit. In both strains, FB (foldback) elements were integrated at this site, but the repressed strain also harboured a 4 kb NOF (Nofretete) element. No other restriction site polymorphisms between the two strains were observed within a 120 kb region surrounding the white gene. The extent of twelve white deletions and twelve white transpositions deriving from these unstable strains was analysed by in situ hybridisation and Southern blot techniques. The results revealed that the distal breakpoint of all aberrations coincided with the insertion site of the mobile elements, but that the centromere proximal breakpoints varied. The mechanisms for the instability and the interaction with the zeste1 mutant are discussed.

Changes in the intestinal lactase activity in the small intestine of two breeds of swine from birth to 6 weeks of age.

Total and specific lactase activities in the small intestine of Chester White and Hampshire pigs were measured at 1, 8, 15, 22, 29, and 43 days of age. The small intestine was divided into 10 segments of equal length, the proximal 10 cm of each segment was scraped, and the scrapings were homogenized for use in the lactase determinations. Significant breed, age, and segment differences were observed for both specific and total activities. In both breeds, the total lactase activity at 1 day of age was lower than that at any other age. After reaching maximal levels at 15 days of age, the total activity declined with the loss of activity occurring primarily in the ileum. At 1 and 8 days of age, the total lactase activities for the two breeds were similar, but the Chester White pigs had higher activities at all other ages. The pattern of changes in specific activity with age was similar for both breeds. The mean specific activity was highest at 1 and 8 days of age and then fell progressively to minimal levels at 43 days of age. Chester Whites had higher specific activities than Hampshires during the first 4 weeks of life, but at 6 weeks of age there was little difference between the breeds. The peak lactase activity, expressed as total or specific activity, occurred in the proximal one-third of the small intestine of both breeds, and the distal one-third of the gut had relatively low activities as the animals matured.

Effects of various dietary levels of dried whey on the performance of growing pigs.

Because dried whey contains approximately 70% lactose, it could be harmful if incorporated into the diet of animals with low tolerance for lactose. Three experiments were conducted to determine the effects of various levels of dried whey in the diet of growing pigs. In the first two experiments diets containing up to 40% dried whey were fed from weaning to approximately 5 months of age. With respect to rate of gain or feed efficiency, there were no significant differences among dietary treatment groups. In a third experiment pigs that had consumed a diet containing no lactose from 6 to 12 weeks of age performed normally when fed a diet containing 40% dried whey from 12 to 21 weeks of age. The results of the three experiments suggest that the growing pig can tolerate up to 30% lactose in the diet without any symptoms of lactose intolerance, and that continuous exposure to lactose in the diet is not necessary to maintain tolerance to this level of lactose.

Effects of diets containing dried whey on the lactase activity of the small intestinal mucosa and the contents of the small intestine and cecum of the pig.

Two studies were conducted to establish the effects of dietary lactose supplied from dried whey on the lactase activity in the contents of the small intestine and cecum as well as the mucosa of the small intestine. In the first study, feeding 0, 10, 25, or 40% dried whey for 120 days did not alter the mucosal lactase specific activity (mumoles galactose released/mg protein) in the duodenum, upper jejunum, or lower ileum. In the second study, total lactase activity in the small intestine was estimated from the total activity found in 10-cm segments of each meter of small intestine. Feeding a diet containing 40% whey continuously from weaning at 5 weeks of age or from 12 weeks of age did not alter the total lactase activity of pigs killed at 21 weeks of age. Dietary lactose tended to increase the lactase activity in the contents of the cecum and small intestine, but the increases were not always statistically significant. In the second study, Chester White pigs had approximately threefold greater mucosal lactase activities than that of Hampshires. These two breeds may be suitable models for detailed studies into the relationships between lactase deficiency and lactose intolerance.

A pilot study of factors influencing bowel function after colorectal anastomosis.

PURPOSE: This study was undertaken to assess subjective bowel function after anterior resection and to search for clinical characteristics that might affect the functional results. METHODS: A total of 70 patients answered a questionnaire concerning bowel function a median of 65 months after anterior resection, and 40 patients responded to the same questionnaire a median of 60 months after colonic resection. RESULTS: Median frequency of bowel movement per 24 hours was two (range, 0.2-9) after rectal resection and one (range, 0.4-6) after colonic resection (P < 0.001). Incontinence for loose stools (P < 0.01), need to wear a pad (P < 0.05), and need to return to the toilet after defecation (P < 0.05) was more common in the rectal resection group. In the latter group, advanced age, use of descending or transverse colon for anastomosis, and large amount of intraoperative bleeding was associated with fecal incontinence (P < 0.05). Preoperative radiotherapy was correlated with a high bowel frequency (P = 0.003). CONCLUSIONS: These data indicate that alterations of subjective bowel function frequently observed after colorectal anastomosis may be affected by both surgical technique and adjuvant radiotherapy.

Vernal keratoconjunctivitis in a Stockholm ophthalmic centre--epidemiological, functional, and immunologic investigations.

PURPOSE: To classify a cohort of 62 patients with vernal keratoconjunctivitis (VKC) in immunologic, functional, and epidemiological terms. METHODS: A retrospective chart review was conducted to establish the patients' ethnic origin and to ascertain the results of standard in vitro and in vivo testing for atopic allergy. The latter data were compared with tear Phadiatop, an allergy screening test, in 31 subjects. Further subgroup analyses included methacholine bronchial provocations, serum screening for chlamydial antibodies and epidemiological calculations of the observed prevalence of VKC in the Stockholm area in 1994. RESULTS: Thirty-seven subjects (59.7%) were sensitised to common allergens. No additional allergic subjects were diagnosed with the tear Phadiatop test. The serology for ocular chlamydial disease was negative. Only 6 out of 17 subjects displayed bronchial reactivity to methacholine of whom 4 had a history of asthma. VKC was clearly more common in individuals with an Asian and African origin. CONCLUSIONS: Sensitivity to allergens is a strong determinant for the disease but in a large proportion of the subjects this immunologic abnormality is absent. The varying prevalence of the condition in different ethnic groups indicates a genetic predisposing factor.

Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer.

BACKGROUND: The extent to which chemotherapy may relieve tumour-related symptoms, improve quality of life and prolong survival in patients with gastric cancer is not known in spite of the extensive use of this treatment modality. The aim of this study was to estimate any gain in the quantity and quality of life produced by chemotherapy in these patients. PATIENTS AND METHODS: Between January 1991 and February 1995, 61 patients with gastric cancer were randomized to either chemotherapy in addition to best supportive care or to best supportive care. Chemotherapy was allowed in the latter group if the supportive measures did not lead to palliation. Chemotherapy was the ELF-regimen consisting of 5-fluorouracil, leucovorin and etoposide, or, in elderly patients with poor performance, a 5-fluorouracil/leucovorin regimen (FLv). Quality of life was evaluated with the EORTC-QLQ-C30 instrument. RESULTS: More patients in the chemotherapy group (45%, 14/31) had an improved or prolonged high quality of life for a minimum period of 4 months compared to those in the best supportive care group (20%, 6/30, P < 0.05). A similar difference was seen in the treating physician's evaluation of whether the patient was subjectively improved or continued to do well for at least 4 months (17/31, 55% versus 6/30, 20%, P < 0.01). Overall survival was longer in the chemotherapy group (median 8 vs. 5 months) although the difference was not statistically significant (P = 0.12). After corrections for imbalances in pretreatment characteristics, chemotherapy treatment was, however, associated with a survival benefit (P = 0.003). Also, the quality-adjusted survival time and time to disease progression were longer for patients randomized to chemotherapy (median 5 vs. 2 months, P = 0.03). CONCLUSIONS: The results show that chemotherapy can add to both quantity and quality of life in advanced gastric cancer. The number of patients who benefit from treatment is, however, still rather limited.

Cancer risk following organ transplantation: a nationwide cohort study in Sweden.

A substantial excess risk of lymphomas and nonmelanoma skin cancer has been demonstrated following organ transplantation. Large sample size and long follow-up time may, however, allow more accurate risk estimates and detailed understanding of long-term cancer risk. The objective of the study was to assess the risk of cancer following organ transplantation. A nationwide cohort study comprising 5931 patients who underwent transplantation of kidney, liver or other organs during 1970-1997 in Sweden was conducted. Complete follow-up was accomplished through linkage to nationwide databases. We used comparisons with the entire Swedish population to calculate standardised incidence ratios (SIRs), and Poisson regression for multivariate internal analyses of relative risks (RRs) with 95% confidence intervals (CI). Overall, we observed 692 incident first cancers vs 171 expected (SIR 4.0; 95% CI 3.7-4.4). We confirmed marked excesses of nonmelanoma skin cancer (SIR 56.2; 95% CI 49.8-63.2), lip cancer (SIR 53.3; 95% CI 38.0-72.5) and of non-Hodgkin's lymphoma (NHL) (SIR 6.0; 95% CI 4.4-8.0). Compared with patients who underwent kidney transplantation, those who received other organs were at substantially higher risk of NHL (RR 8.4; 95% CI 4.3-16). Besides, we found, significantly, about 20-fold excess risk of cancer of the vulva and vagina, 10-fold of anal cancer, and five-fold of oral cavity and kidney cancer, as well as two- to four-fold excesses of cancer in the oesophagus, stomach, large bowel, urinary bladder, lung and thyroid gland. In conclusion, organ transplantation entails a persistent, about four-fold increased overall cancer risk. The complex pattern of excess risk at many sites challenges current understanding of oncogenic infections that might become activated by immunologic alterations.