The Styrian Salmonella Monitoring Programme for pork production.

The Styrian Salmonella Monitoring Programme for pork production is based on a representative analysis of the current status, serological meat juice monitoring and bacteriological tests of carcass halves and parts and has been in operation since 1999. A total of 34 170 meat juice samples from 3417 finisher herds were tested using the meat juice SALMOTYPE-ELISA (Labor Diagnostik, Leipzig, Germany) in the period from 1999 to 2003. More than 95% of the samples investigated were below the negative cut-off of <20% based on the 5-year average. The mean extinction values for meat juice samples showed regional differences, which were visualized for epidemiological purposes using the VETGIS geographical information system (Department of Veterinary Administration, Graz, Austria). Salmonella spp. were detected in only 15 cases (0.13%) of a total of 11 330 bacteriologically tested wipe samples from meat-processing plants. The Salmonella isolates detected included four S. Typhimurium, two S. Enteritidis PT 4, five S. Infantis, one S. Bredeny, one S. Saintpaul, one S. Brenderup and one S. Livingstone isolates. The proportion of Salmonella-contaminated pork in the total population estimated from the annual sample showed a falling tendency. It decreased from 0.48% (CI: 0.23 < or = P < or = 0.85) in 1999 to 0.14% (CI: 0.07 < or = P < or = 0.24) in 2003. The contamination of Styrian pork with Salmonella is extremely low and thus poses a negligible risk of infection to consumers.

Salmonella Enteritidis phage type 21 outbreak in Austria, 2005.

We report an outbreak of gastroenteritis due to Salmonella Enteritidis PT 21 associated with attending an annual traditional fair in a small Austrian village on 4 May 2005. The outbreak lasted from 4 to 8 May. Descriptive and analytical epidemiological investigations were conducted in order to determine the extent of the outbreak and to identify outbreak risk factors. Of the 115 persons who visited the fair, 85 persons fulfilled the criteria of an outbreak case (attack rate = 73.9%). Stool specimens from 52 patients, including two kitchen staff, were tested for salmonella, and 20 specimens were positive for Salmonella Enteritidis PT 21. The cohort study revealed mixed salad (which included potatoes) as the likely cause of the outbreak (RR: 10.4, 95%CI 2.8 - 39.1; P = < 0.001). The causative agent of the outbreak was cultured from the stock of eggs used at the fair and from all three drag swabs and one barn dust sample collected from the responsible egg laying flock. Molecular subtyping by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion showed that isolates from eggs, from the flock and from humans were indistinguishable. We hypothesise that cross contamination from eggs to boiled potatoes occurred in the kitchen area, where raw eggs were handled by village residents preparing a traditional Viennese egg dressing. Unrefrigerated storage of peeled potatoes may have favoured bacterial growth. Eggs from small rural flocks of laying hens kept in a traditional 'natural' way should not be assumed to be salmonella-free.

Salmonella Enteritidis phage type 21 outbreak in Austria, 2005.

We report an outbreak of gastroenteritis due to Salmonella Enteritidis PT 21 associated with attending an annual traditional fair in a small Austrian village on 4 May 2005. The outbreak lasted from 4 to 8 May. Descriptive and analytical epidemiological investigations were conducted in order to determine the extent of the outbreak and to identify outbreak risk factors. Of the 115 persons who visited the fair, 85 persons fulfilled the criteria of an outbreak case (attack rate=73.9%). Stool specimens from 52 patients, including two kitchen staff, were tested for salmonella, and 20 specimens were positive for Salmonella Enteritidis PT 21. The cohort study revealed mixed salad (which included potatoes) as the likely cause of the outbreak (RR: 10.4, 95%CI 2.8 - 39.1; P=<0.001). The causative agent of the outbreak was cultured from the stock of eggs used at the fair and from all three drag swabs and one barn dust sample collected from the responsible egg laying flock. Molecular subtyping by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion showed that isolates from eggs, from the flock and from humans were indistinguishable. We hypothesise that cross contamination from eggs to boiled potatoes occurred in the kitchen area, where raw eggs were handled by village residents preparing a traditional Viennese egg dressing. Unrefrigerated storage of peeled potatoes may have favoured bacterial growth. Eggs from small rural flocks of laying hens kept in a traditional 'natural' way should not be assumed to be salmonella-free.

Evaluating the impact of hemp food consumption on workplace drug tests.

Foods containing seeds or oil of the hemp plant (Cannabis sativa L.) are increasingly found in retail stores in the U.S. The presence of delta9-tetrahydrocannabinol (THC) in these foods has raised concern over their impact on the results of workplace drug tests for marijuana. Previous studies have shown that eating hemp foods can cause screening and confirmed positive results in urine specimens. This study evaluated the impact of extended daily ingestion of THC via hemp oil on urine levels of its metabolite 11-nor-9-carboxy-delta9-tetrahydrocannabinol (THC-COOH) for four distinct daily THC doses. Doses were representative of THC levels now commonly found in hemp seed products and a range of conceivable daily consumption rates. Fifteen THC-naïve adults ingested, over four successive 10-day periods, single daily THC doses ranging from 0.09 to 0.6 mg. Subjects self-administered THC in 15-mL aliquots (20 mL for the 0.6-mg dose) of four different blends of hemp and canola oils. Urine specimens were collected prior to the first ingestion of oil, on days 9 and 10 of each of the four study periods, and 1 and 3 days after the last ingestion. All specimens were screened for cannabinoids by radioimmunoassay (Immunalysis Direct RIA Kit), confirmed for THC-COOH by gas chromatography-mass spectrometry (GC-MS), and analyzed for creatinine to identify dilute specimens. None of the subjects who ingested daily doses of 0.45 mg of THC screened positive at the 50-ng/mL cutoff. At a daily THC dose of 0.6 mg, one specimen screened positive. The highest THC-COOH level found by GC-MS in any of the specimens was 5.2 ng/mL, well below the 15-ng/mL confirmation cutoff used in federal drug testing programs. A THC intake of 0.6 mg/day is equivalent to the consumption of approximately 125 mL of hemp oil containing 5 microg/g of THC or 300 g of hulled seeds at 2 microg/g. These THC concentrations are now typical in Canadian hemp seed products. Based on our findings, these concentrations appear to be sufficiently low to prevent confirmed positives from the extended and extensive consumption of hemp foods.

Epidemiologic application of pulsed-field gel electrophoresis to an outbreak of Campylobacter jejuni in an Austrian youth centre.

We report the first documented Campylobacter jejuni outbreak in an Austrian youth centre. Sixty-four children were involved of which 38 showed classical signs of campylobacter gastroenteritis. Since unpasteurized milk distributed by a local dairy was suspected to be the source of infection, stool samples were collected from 20 cows providing the milk. Five of the cows tested positive for C. jejuni. These isolates together with 37 clinical samples were compared by pulsed-field-gel electrophoresis (PFGE). The PFGE patterns, using the restriction endonucleases SmaI and SalI, were identical for the human and bovine isolates. This finding confirmed that the outbreak was caused by the consumption of unpasteurized milk contaminated with C. jejuni.

Improvement of Salmonella detection on motility enrichment media by ferrioxamine E-supplementation of pre-enrichment culture.

Supplementation of buffered peptone water with ferrioxamine E in concentrations ranging from 0.001 to 1.0 microgram/ml significantly increased the motility of Salmonella on MSRV and DIASSALM semi-solid enrichment media. Zone diameters of swarming S. enteritidis and S. typhimurium increased more than twofold following use of pre-enrichment cultures supplemented with 0.01 microgram ferrioxamine E/ml. The activity of ferrioxamine E is similar at 37 degrees C and 42 degrees C. Pre-enrichment of Salmonella in a variety of foods in supplemented buffered peptone water, with shaking at 37 degrees C for 6 h and motility enrichment at 42 degrees C for 16 h, enabled motile Salmonella to be detected in 1 day.

[Thrombolysis and acute myocardial infarction. Reduced residual ischemia in first acute myocardial infarction]. / Trombolyse og akut myokardieinfarkt. Mindre restiskoemi ved førstegangs akut myokardieinfarkt.

In order to assess the effect of thrombolysis on residual myocardial ischaemia, we prospectively performed maximal exercise testing and ambulatory ST-segment monitoring in a consecutive series of 123 men recovering from a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only 35 patients received thrombolytic agents, whereas 39 were conservatively treated (controls). In 49 patients thrombolytic therapy was not indicated. Thrombolysis resulted in a non-significant reduction in the prevalence of exercise-induced ST-segment depression: 43% in reperfused patients versus 62% in controls. During 36-hour ambulatory ST-segment monitoring, however, the duration of myocardial ischaemia was significantly reduced in thrombolyzed patients: 322 minutes versus 1144 minutes in controls (p < 0.05). Exercise testing revealed a higher maximal work capacity in thrombolyzed patients compared with controls: 160 +/- 41 versus 139 +/- 34 W (p < 0.02). No difference was found in left ventricular ejection fraction between the two subgroups. We conclude, that thrombolysis given for a first AMI reduces residual myocardial ischaemia. The reduced ischaemic burden is assumed to be the pathophysiologic mechanism underlying the also observed improvement in exercise tolerance.

Rapid Detection of Salmonellae by Means of a New Impedance-Splitting Method.

An Impedance-Splitting method is proposed for the rapid detection of salmonellae in foods. The measuring System, BacTrac™ 4100, permits the registration of changes, caused by bacterial metabolism, not only of the impedance of the culture medium but also of changes in the ionic layers at the measuring electrodes, which has advantages in case of high salt concentrations. These changes are expressed as percentage decreases of the initial values, M-value and E-value, respectively. Food samples were pre-enriched 14 to 16 h at 37°C in peptone water by addition of mannitol, which facilitated the detection of salmonellae on selective culture media. Following this, 0.1 mi of the preenrichment culture was transferred to 9.9 ml of Impedance-Splitting Salmonellae (ISS) medium which consisted of magnesium chloride (hydrated), malachite green oxalate, novobiocin, phosphate buffer, mannitol, peptone and yeast extract. Despite the high magnesium chloride concentration in this medium, salmonellae produced changes of the E-value up to 100%, while the changes in M-values were limited to a few percent. The impedance changes were automatically recorded during incubation in the measuring system for up to 22 h at 40°C, and the time required to exceed a threshold value of 15% (E reaction time) was evaluated. Comparative testing of the ISS method with standard cultural analysis of 250 unknown food samples showed high sensitivity and selectivity in detecting salmonellae. From all of the 122 Salmonella -positive samples, the largest number (119) was obtained by the ISS method, as compared to that obtained by conventional testing with the selenite-cystine (106), Rappaport Vassiliadis soya (95), Rappaport Vassiliadis (92) and tetrathionate brilliant green medium (64). Six samples were false positive by Enterobacter cloaceae . One strain each of Salmonella enteritidis PT8 and Salmonella panama were not recorded. The ISS method is very suitable as a screening test, all the more since a negative investigation result will be obtained within 38 h. In view of the practicability, this method is superior to the enzyme-immunological and molecular-biological procedures.

Transient myocardial ischemia after a first acute myocardial infarction and its relation to clinical characteristics, predischarge exercise testing and cardiac events at one-year follow-up.

The relation between early out-of-hospital ambulatory ST-segment monitoring, clinical characteristics, predischarge maximal exercise testing and cardiac events was determined in 123 consecutive men (age 55 +/- 8 years) with a first acute myocardial infarction (AMI). During 36 hours of ambulatory recording 11 +/- 5 days after AMI 23 patients (19%) had 123 ischemic episodes (group 1), whereas 100 patients demonstrated no ischemia (group 2). Exercise-induced ST-segment depression was more prevalent in group 1 (83%) than in group 2 (47%) (p < 0.005). Group 1 patients also had more severe ischemia as judged from a shorter exercise duration before significant ST-segment depression (5.5 +/- 2.4 vs 7.7 +/- 4.1 minutes; p < 0.03) and more pronounced ST-segment depression on exercise testing (4.1 +/- 2.6 vs 2.6 +/- 1.6 mm; p < 0.03). Furthermore, exercise test results revealed an impaired hemodynamic response in group 1 compared with group 2: systolic blood pressure at maximal work load 160 +/- 31 vs 176 +/- 28 mm Hg (p < 0.025) and systolic blood pressure increase during exercise 41 +/- 24 vs 56 +/- 22 mm Hg (p < 0.01). With-in 368 +/- 8 days of follow-up the frequency of cardiac events (cardiac death, nonfatal reinfarction, and severe angina including the need of revascularization) was 52% in group 1 compared with 22% in group 2 (p < 0.01). Exercise-induced ischemia did not predict an adverse outcome: event rate 30 vs 25% in patients without residual ischemia (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring.

In a prospective study of 123 consecutive survivors of a first myocardial infarction (43 non-Q wave, 80 Q wave), we determined the total residual ischaemic burden by use of pre-discharge maximal exercise testing and post-discharge 36 h ambulatory ST-segment monitoring initiated 11 +/- 5 days after the infarction. The prevalence of exercise-induced ischaemic manifestations in the infarct types was similar: chest pain 14% vs 16% and ST-segment depression 54% vs 54%. The ischaemic threshold did not differ either (heart rate at 1 mm of ST-segment depression 120 +/- 27 vs 119 +/- 25 beats.min-1). During early post-discharge daily activities, more patients with non-Q wave infarction demonstrated transient episodes of ST-segment depression: 28% vs 14% (ns). Furthermore, ischaemic episodes were significantly longer (42.5 +/- 50.1 vs 22.0 +/- 20.6 min; P < 0.001), and the ischaemic threshold was significantly lower in non-Q wave infarction (heart rate at onset of ST-segment depression 84 +/- 11 vs 88 +/- 9 beats.min-1; P < 0.05). During 3.5 +/- 0.9 years of follow-up the proportion of patients with > or = 1 ischaemic event (non-fatal reinfarction, angina pectoris, revascularization) was significantly higher in non-Q wave infarction (51%) as compared to Q wave infarction (31%) (P < 0.05). In both infarct types the presence of ST-segment depression on ambulatory recording and exercise testing significantly predicted the development of future angina pectoris, whereas patients at increased risk for subsequent non-fatal reinfarction or cardiac death were not identified.

Changing circadian variation of transient myocardial ischemia during the first year after a first acute myocardial infarction.

In a consecutive series of 123 men (aged 55 +/- 8 years) with a recent first acute myocardial infarction (AMI), 24-hour ambulatory ST-segment monitoring was performed early after discharge (day 11 +/- 5), 6 months (day 185 +/- 6) and 1 year (day 368 +/- 8) after AMI. No difference in the prevalence of transient myocardial ischemia was found between the 3 recordings (17, 17 and 20%), and most ischemic episodes were silent (98, 100 and 97%). In the early postinfarction period, a peak of ischemic activity was demonstrated between 6 P.M. and midnight (40 of 93 episodes [43%]). Over time, the maximal occurrence of ischemia gradually advanced toward the morning hours with a peak activity between 6 A.M. and noon at 1-year follow-up (32 of 73 episodes [44%]). Significantly more patients (16 of 21 [76%]) had ischemia from 6 P.M. to midnight at discharge compared with the findings 1 year later (9 of 23 patients [39%]) (p < 0.03). An opposite trend was found regarding patients who exhibited ischemic episodes in the hours from 6 A.M. to noon: 10 of 21 patients (48%) early after discharge versus 17 of 23 patients (74%) at 1-year follow-up (p = not significant). Results from the 6-month recording displayed characteristics between the findings from discharge and 1-year ambulatory monitoring. The pathophysiologic processes underlying the observations from this study are unknown. The change in circadian periodicity could not be explained from differences in heart rate variation patterns or medical antianginal treatment among the 3 recordings.(ABSTRACT TRUNCATED AT 250 WORDS)

Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction.

In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only the last 35 patients included received thrombolytic therapy. As thrombolysis was not available in our Department at the start of the study, the first 39 patients included were conservatively treated (controls). No significant differences in baseline clinical characteristics were found between the two groups. In-hospital atrial fibrillation and digoxin therapy was more prevalent in controls (P less than 0.05). During exercise, thrombolysed patients reached a higher maximal work capacity compared with controls: 160 +/- 41 vs 139 +/- 34 W (P less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144 min in controls (P less than 0.05). Thrombolysed patients reached a higher heart rate during transient ischaemic episodes: 114 +/- 17 vs 93 +/- 11 b.min-1 in controls (P less than 0.001). In conclusion, thrombolytic therapy administered for a first AMI significantly reduces the burden of transient myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study.

Circadian variation of transient myocardial ischemia in the early out-of-hospital period after first acute myocardial infarction.

Circadian rhythms have been demonstrated in acute myocardial infarction (AMI) and in other clinical cardiac dysfunctions. The purpose of this study was to elucidate whether a circadian pattern of transient myocardial ischemia exists after first AMI. Prospectively, 24-hour ambulatory ST-segment monitoring was initiated at discharge on day 11 +/- 5 in 123 consecutive survivors of first AMI. A total of 93 ischemic episodes (91 asymptomatic) occurred in 21 of the 123 patients (17%) (mean duration of 30 minutes, range 4 to 292). A significant circadian rhythm of transient myocardial ischemia was found with a peak activity occurring in the evening hours (p less than 0.01). Thus, 43% of ischemic episodes and 42% of ischemic time occurred between 6 P.M. and 12 midnight. The characteristics of morning and evening episodes were similar, except for the heart rate at maximal ST-segment depression, which was significantly higher during morning episodes (p less than 0.02). Patients with transient myocardial ischemia had a diurnal distribution similar to the circadian variation displayed during ischemic activity. Thus, 16 of the 21 patients had ischemic episodes from 6 P.M. to 12 midnight versus 10 patients from 6 A.M. to 12 noon (p less than 0.01). The 24-hour mean minimal heart rate was significantly higher in patients with than without ischemic episodes (p less than 0.02). In conclusion, this study has established a significant circadian peak of transient myocardial ischemia in the evening hours in survivors of first AMI. Whether the pattern displayed is due to endogenous biologic functions or cyclic variations, or both, in the external environment needs to be clarified.

[Temporary pacemaker treatment in Denmark]. / Temporaer pacemakerbehandling i Danmark.

The employment of temporary pacing (TP) in Denmark in 1986 is illustrated by means of a questionnaire investigation. Seventy-four out of 77 Danish hospitals with a medical-cardiological specialist returned usable replies. Facilities for temporary pacing were available in 39 (53%) of the hospitals. The method of pacing most extensively employed was the transvenous method which was used in 33 hospitals while external transcutaneous pacing by Zoll's method was available in 13 hospitals. In transvenous pacing, the subclavian vein was employed routinely in 24 hospitals while a cubital vein was used primarily in eight hospitals. More than 85% of the pacing catheters employed were of disposable type. Only one hospital always employed a permanent pacing lead which could be utilised if permanent pacing should be required. A total of 486 patients with or without acute myocardial infarction (AMI) were submitted to temporary pacing. Employment of temporary pacing in patients with AMI was 0-8.3% (average 3.7%). In general, it was found that hospitals with cardiac laboratory facilities showed the greatest temporary pacing activity. The indications for temporary pacing are assessed on the basis of two case reports. The greatest employment of temporary pacing was found in patients with AMI with third degree atrioventricular block and ventricular escape rhythm (anterior wall 74%, posterior wall 56%). Employment of temporary pacing was least in symptomfree patients with anterior wall AMI and bifascicular block (9%).

Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients.

The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage was 200 (100-400) mg. Follow-up period 3 mths (15 days-15 mths). Based on the history and ECG flecainide had been effective in 51 pts. The improvement was most pronounced in pts suffering from supraventricular tachycardia involving an accessory bypass tract (84-92%). Flecainide had been discontinued in 50 pts due to: insufficient effect in 28, side effects in 17 and for other reasons in 5. The side effects indicating flecainide withdrawal (pts) were: cerebral symptoms (4), gastrointestinal complaints (2), bradyarrhythmias (2), heart failure (3) and suspected pro-arrhythmia (4). (Ventricular tachycardia in 3, 1:1 AV-conducting during atrial flutter in 1).

[Exercise-induced ST segment depression following acute myocardial infarction. Occurrence and prognostic significance]. / Anstrengelsesinduceret ST-segmentdepression efter akut myokardieinfarkt. Forekomst og prognostisk betydning.

On the basis of a review of 20 investigations (3,587 patients), the prevalence of significant ST-segment-depression (ST-depr) in patients performing an exercise test 9-30 days after acute myocardial infarction (AMI) was found to be 33% (3-70%). The reason for the considerable variation is due to a combination of several factors: 1) different and frequently incomplete definition of significant ST-depr; 2) heterogenically composed patient groups (first vs subsequent AMI, different prevalence of infarct types and localization, consecutive vs selected patients, +/- cardioactive drugs during the exercise test); 3) different procedures for the exercise tests (submaximal vs maximal; few vs several ECG leads). The great variation in the prevalence of ST-depr, is also reflected in the prognostic significance. In about half of the investigations ST-depr has been prognostic for future death and/or cardiac events while ECG changes as an isolated variable did not prove to be of prognostic significance in the remainder. In general, it may be stated that a maximal exercise test with several ECG leads is more sensitive while ST-depr at a submaximal work capacity appears to be more specific for subsequent cardiac events.

Superiority of multiprogrammable to nonprogrammable VVI pacing: a comparative study with special reference to management of pacing system malfunctions.

Analysis of pacing system malfunctions was performed in 374 patients at initial implantation or at pulse generator and lead replacement during a period of 55 months. A total of 150 nonprogrammable pacemakers were implanted in 148 patients, while 236 multiprogrammable pacemakers were implanted in 226 patients. The purpose of the analysis was to investigate the occurrence and management of malfunction unrelated to pacemaker/lead failure or lead dislodgement. The nonprogrammable group was followed for 3-53 months (median, 36). Malfunction occurred in 18 patients (12.0%): muscle stimulation in 14; exit block in three; sensing problem in one. Surgical correction was necessary in 14 of 18 cases. The multiprogrammable group was followed for 3-52 months (median, 12). Malfunction occurred in 30 cases (12.7%): muscle stimulation in 22; threshold increase in seven; sensing problem in one. Only seven of these patients required surgical correction as 23 cases were successfully managed by reprogramming alone. Malfunctions occurred during a period of several days to 36 months (median, 2.3 months). The difference in rate of secondary surgical intervention was significant (p less than 0.01). Measurements during reoperation in the nonprogrammable group showed that at least 40% of late malfunctions would have been correctable by reprogramming alone. Thus, multiprogrammability is of significant value for noninvasive correction of malfunctions unrelated to pacemaker and lead failures, predominantly muscle stimulation and threshold elevation.