Campylobacter jejuni isolated from poultry and humans in Styria, Austria: epidemiology and ciprofloxacin resistance.

Sixty-six broiler flocks were sampled to determine the presence of Campylobacter spp. at slaughter in 1998. Thirty flocks (45%) tested positive and C. jejuni was identified in all isolates. Combined pulsed-field gel electrophoresis/amplified fragment length polymorphism (PFGE/AFLP) subtyping of 177 isolates from 24 positive flocks revealed 62 subtypes; 16 flocks harboured more than one subtype. When subtyping 101 clinical C. jejuni isolates collected in the same time period and area, 60 PFGE/AFLP types were identified. Comparison of subtypes from poultry and human isolates revealed three shared PFGE/AFLP types, which were present in 11 human isolates. Fifty per cent of all poultry isolates and 39% of all human isolates were resistant to ciprofloxacin. The present study confirms the increase in ciprofloxacin resistance in both human and poultry C. jejuni isolates in Austria, as observed in several countries worldwide. A small number of human isolates shared PFGE/AFLP types with poultry isolates, however, further studies should also focus on the identification of other sources of C. jejuni infection in humans.

Anatomy and kinematics of the lateral collateral ligament of the knee.

The anatomy and kinematics of the lateral collateral ligament were studied in 10 unembalmed limbs and 20 isolated femurs and fibulas. The ligament's average overall length was 66 mm (range, 59 to 74) and the average greatest dimension of its thin middle portion was the anteroposterior dimension of 3.4 mm (range, 3 to 4). The center of the femoral attachment site was 3.7 mm posterior to the ridge of the lateral epicondyle, not at it apex. A potential radiographic technique for operatively locating the femoral attachment site to within 3 mm is described. During knee flexion in neutral rotation the distance between the femoral and fibular attachment sites of the lateral collateral ligament decreased to 88% of its value in full extension. With 6.5 N x m of applied external rotation force, beyond 30 degrees of flexion the attachment sites rapidly approximated. With the same internal rotation force, beyond 15 degrees of flexion the attachment sites separated. From 60 degrees to 105 degrees they were greater than 100% of the value in full extension, suggesting significant distraction between the attachment sites. These changes correlated well with the ligament's change from an 11 degrees posterior slope in extension to a 19 degrees anterior slope in flexion with no applied rotation.

Obsessive-Compulsive Disorder and Tourette's Syndrome.

Obsessive-compulsive behavior (OCB) or full-blown obsessive-compulsive disorder (OCD) afflict more than 50% of patients with Tourette's syndrome (TS) and often are more debilitating than the tic disorder itself. Medications for OCD, including selective serotonin reuptake inhibitors (SSRIs), help patients with TS and OCD, particularly in combination with low-dose antipsychotic drugs, but seldom eliminate OCD entirely. Behavioral therapies are more effective as medications for the treatment of OCD. A combination of cognitive behavioral therapy and medication is the treatment of choice for most patients with TS and OCD.

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.

[Teaching development and professional identity in nursing: the system of concepts as a mediator in learning]. / Desenvolvimento discente e identidade profissional de enfermagem: os sistemas de conceitos como mediadores do aprendizado.

The focus of this study is characterisation of the representations socially constituted about the concepts "Nursing" and "Nursing and context". The interpretative mental schemes were sequentially configured during the Graduation course starting from the written answers supplied by students to the following questions: "How do you judge Nursing?" and "What is the relation between the profession and social context? "We have used interpretation schemes based on the contain analysis. As a result, we have identified a peculiar development of schemes formed by means of structures that were involved with forming system and used system of human resources as reference which promote distinct perspectives of professional performance. The components nucleuses of each stage of conception expressed the logical structure which were incorporated to subsequent construction, that configures a evolution determined by selective adhesion of students to the graduation or to the practice field. There has been a movement alongside to those systems resulting from discrepancy between the experience and personal schemes.

Carpal tunnel syndrome. MR imaging diagnosis.

Carpal tunnel syndrome is a common condition that is often diagnosed by careful history and physical examination. Symptoms from cervical disc disease, thoracic outlet syndrome, and more proximal entrapment syndromes of the median nerve may be confused clinically with carpal tunnel syndrome. Incision of the flexor retinaculum in these patients will not relieve the symptoms, because the locus of the entrapment is not in the carpal tunnel. Electrophysiologic studies are invasive, painful, and may be equivocal on occasion. Furthermore, they provide little information into the cause of carpal tunnel syndrome. MR imaging is the best modality to image the carpal tunnel. It can define the locus of entrapment to the carpal tunnel. Findings includes swelling of the median nerve just proximal to the carpal tunnel, flattening of the nerve within the carpal tunnel, bowing of the flexor retinaculum, and increased signal intensity of the median nerve. Etiologic findings can differentiate space occupying lesions from diffuse inflammatory causes, and this may aid in management. Also, the signal characteristics of soft-tissue masses may be diagnostic. Knowledge of the course of the median nerve may be helpful when planning corticosteroid injection or surgery, especially with the endoscopic technique. MR imaging also may serve a role in postoperative evaluation of patients with recurrent symptoms by demonstrating an incomplete release of the flexor retinaculum or healing of an incised retinaculum. These unique abilities of MR imaging makes it a useful diagnostic tool not only for the initial evaluation and management but also in the postoperative evaluation of patients with carpal tunnel syndrome.

The semimembranosus-tibial collateral ligament bursa. Anatomical study and magnetic resonance imaging.

A bursa that was deep to the tibial collateral ligament and adjacent to the semimembranosus tendon was studied in fifty cadaveric knees; a vinyl solution was injected into four of the specimens in order to facilitate a study of the relationship between the bursa and its surrounding structures. The bursa had the shape of an inverted U: the superficial arm was an elliptical pocket that was located between the semimembranosus tendon and the tibial collateral ligament, and the deep arm was a triangular pocket that was located between the semimembranosus tendon and the medial tibial condyle. The bursa measured, on the average, twenty-one millimeters in its greatest anteroposterior dimension and ten millimeters in its greatest superoinferior dimension. Magnetic resonance images were made of two patients, and they showed fluid in the bursa.

Developmental differences in praxis in learning-disabled and normal children and adults.

Gestures made on tasks in response to verbal command or to imitation and on tasks involving axial and distal movements were compared for groups of learning-disabled and normal children and adults. The 15 learning-disabled children and 15 adults scored lower than the 15 normal children and 15 adults on all tasks. All groups scored higher on imitation than on verbal command and scored similarly on the axial and distal tasks. The findings from this study suggest that it would be worthwhile to test the hypothesis that dyspraxic behaviors may persist into adulthood.

Magnetic resonance imaging of ankle ligaments. Emphasis on anatomy and injuries to lateral collateral ligaments.

Ankle ligament sprains are the most frequent sports injury, and radiographic evaluation of the ankle accounts for 10% or all radiographic examinations requested from an emergency department. This article reviews the diagnosis of the ankle sprain and the anatomy and injuries of the ankle ligaments.

The efficacy of upper extremity inhibitive casting: a single-subject pilot study.

This pilot study was designed to examine the effects of short-term (48-hr) upper extremity inhibitive casting, with an encased thermoplastic splint, on problems related to upper motor neuron damage. The subject was an 8 1/2-year-old girl with left upper extremity spasticity. Three different measures were used: (a) rating of videotaped active movements of the child; (b) the Modified Ashworth Scale, a clinical measure of spasticity; and (c) The Biodex System, a measure of torque during passive elbow flexion and extension. After cast removal, subjective improvements were noted in the quality of active movement (through videotapes) and increased awareness and use of the casted hand by the child (through parents' reports). A trend toward decreased spasticity was demonstrated by the Modified Ashworth Scale and a statistically significant decrease in resistance to passive movement was shown by the Biodex recordings. However, this reduction in symptoms was temporary, lasting less than 3 days. The results of this study suggest that short-term inhibitory casting may prove efficacious in the treatment of the child with cerebral palsy, although further research is needed.

MR imaging of the most commonly injured ankle ligaments. Part I. Normal anatomy.

To determine the optimum foot position and imaging plane at magnetic resonance (MR) imaging of each ankle ligament, 10 cadaver ankles were dissected to visualize the orientation, precise attachment sites, and relationships of each ligament. Then eight cadaver ankles were studied with MR imaging and were cryosectioned in the optimum imaging planes. The ankles of 12 healthy volunteers were imaged to ensure consistency in identifying the normal ligaments. With the foot taped into full dorsiflexion of 10 degrees-20 degrees, axial imaging provided optimum views of the anterior, posterior, and inferior tibiofibular ligaments and of the anterior and posterior fibulotalar ligaments and provided an overview of the deltoid ligament. Coronal images provided full-length views of the tibiospring, tibiocalcaneal, and posterior tibiotalar parts of the deltoid ligament. With the foot taped into full plantar flexion of 40 degrees-50 degrees, axial imaging optimized visualization of the fibulocalcaneal ligament and of the tibionavicular and anterior tibiotalar parts of the deltoid ligament. Sagittal images provided the best full-length views of the spring ligament.

MR imaging of the most commonly injured ankle ligaments. Part II. Ligament injuries.

Thirteen patients with clinically diagnosed sprained ankles underwent magnetic resonance (MR) imaging. Five of these cases are presented to illustrate the potential of MR imaging to enable identification of both primary and associated ligament injury sites, grading of the severity of the injuries, and visualization of the associated findings of tendon sheath and joint effusion. The appropriate combination of foot position and imaging plane is essential to achieve full-length visualization of each ligament. Two patients demonstrated findings compatible with total gross disruption of the anterior fibulotalar ligament; two, with injury to the fibulocalcaneal ligament with effusion of the overlying peroneus tendon sheath; and one, with thinning, lengthening, and fibrotic changes involving the anterior fibulotalar ligament. MR imaging can provide a noninvasive means to evaluate the site and severity of ankle ligament injuries (a) in acute ankle injuries that demonstrate significant instability, (b) in stable acute injuries involving athletes or litigation, or (c) in patients with repeated injuries or instability in whom surgery is contemplated.

Comparison of pencil-grip patterns in first graders with good and poor writing skills.

The purpose of this study was to compare nondysfunctional children with and without handwriting difficulties for an examination of grip and hand preference. Additionally, in the group of children with handwriting difficulties, the children with decreased proprioceptive-kinesthetic finger awareness were compared with the children without such a decrease. The results suggest that children with handwriting difficulties may demonstrate a lower grip score than children without handwriting problems. In addition, among children with poor handwriting, those with decreased proprioceptive-kinesthetic finger awareness may demonstrate a lower grip score than those with good proprioceptive-kinesthetic awareness. Children with poor hand-writing also show less hand preference than those with good handwriting.

Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children.

This study was designed to investigate the developmental progression in pencil and crayon grip. The subjects were 320 nondysfunctional children aged 3.0 to 6.11 years, with 20 boys and 20 girls at each 6-month age interval. On the basis of a review of the literature, developmental pencil and crayon grips were defined for the study, and the type of grips each child used to perform a drawing task and a coloring task were recorded. Many children at each age level used mature pencil grips. A developmental progression, however, was shown by the percentage change of children at each age level who used mature grips. Forty-eight percent of the youngest group used mature grips, compared with 90% of the oldest children. Two pencil grips-dynamic and lateral tripod-appear to be common in older children. Differences in the developmental progression of pencil grip were noted between boys and girls and between a drawing task and a coloring task.

The effect of damage to the lateral collateral ligaments on the mechanical characteristics of the ankle joint--an in-vitro study.

Injuries to the lateral collateral ligaments of the ankle joint are among the most frequently occurring injuries at the lower limb. The present study was conducted for the purpose of establishing the basis for the development of a quantitative diagnostic procedure for such injuries. To achieve this goal, the effect of four types of ligament injuries on the three-dimensional mechanical characteristics of the ankle were investigated. These types of injuries consisted of: 1) isolated tear of the anterior talofibular ligament; 2) isolated tear of the calcaneofibular ligament; 3) isolated tear of the posterior talofibular ligament; and 4) combined tear of both the anterior talofibular ligament and the calcaneofibular ligament. The experiments were conducted on 31 amputated lower limbs and consisted of comparing the three-dimensional load-displacement and flexibility characteristics of the ankle joint prior to and following sectioning of selected ligaments. The experimental and analytical procedures used to derive these characteristics was developed previously by the authors. From the results of this study it was concluded that the three-dimensional flexibility characteristics of the ankle joint are strongly influenced by damage to the lateral collateral ligaments. Furthermore, it was found that each type of ligament injury produced unique and identifiably changes in the flexibility characteristics of the ankle. These unique changes, which are described in detail in this paper, can be used to discriminate between the different types of ligament injuries. Consequently, it was concluded that it is feasible to develop a quantitative diagnostic procedure for ankle ligament injuries based on the effect of the injury on the flexibility characteristics of the ankle.

Anterior protrusion of retroperitoneal processes. A mimic of lesser sac or gastrohepatic masses.

The space between the left lobe of the liver and the lesser curvature of the stomach normally contains intraperitoneal structures. These include the gastrohepatic recess of the greater peritoneal cavity, the medial recess of the lesser sac and the interposed gastrohepatic ligament. An anterior protrusion of retroperitoneum can project into this space, dorsal to the posterior reflection of the medial compartment of the lesser sac. Tumors that extend into this fossa are anterior and medial to the fundic and upper body region of the stomach. These tumors may cause confusion regarding their origin if the radiologist is not aware of the existence of this retroperitoneal protrusion. Between 1982, and 1986, 183 patients with pancreatic cancer were hospitalized at our institution, 63 of whom had computed tomography (CT) scans of the abdomen. Four of these patients (6.3%) demonstrated direct tumor extension anterior to the stomach. During this same period, four large benign retroperitoneal tumors also exhibited this finding. Masses in the gastrohepatic interval between the liver and stomach can be extensions of retroperitoneal processes and should not be assumed to represent intraperitoneal involvement.