Comparative study of aerobic pathogenic bacteria isolates from patients with recurrent tonsillitis.

BACKGROUND: To find out if isolated aerobic bacteria pathogens from surface tonsillar swab can correctly predict the infective pathogens within the core tonsillar tissues in recurrent tonsillitis. METHODS: This was a prospective, hospital based study of 60 patients with recurrent tonsillitis at University College Hospital, Ibadan, Nigeria. Surface swabs of the infected-tonsils-biopsies-of the core tonsillar tissues were obtained. Microscopy, Culture and Sensitivity studies were performed on the specimens. The aerobic pathogens were isolated by standard microbiological methods. Data analysis was done by SPSS version 20.0. RESULTS: Only 54 (90%) surface swab specimens yielded aerobic pathogens while 47 (78.3%) core tissue specimens yielded aerobic pathogens. The tonsil surface swab for identification of aerobic pathogenic bacteria has a sensitivity of 97.7%, specificity of 31.3%, positive predictive value or precision of 79.6%, negative predictive value of 83.3% and accuracy of 80%. Overall, there was no statistical significant difference in the aerobic pathogenic organisms isolated from surface tonsillar swab and core tonsillar tissue specimens (p=0.103). CONCLUSION: Aerobic bacteria pathogens grown on tonsillar surface were not significantly different from those from core tonsillar specimenshence, the tonsillar surface swab can reliably be used to identify the pathogenic organisms in recurrent tonsillitis.

Revision hip arthroplasty using a modular revision hip system in cases of severe bone loss.

We sought to identify outcomes of the Restoration Modular Hip System in cases of severe femoral bone stock deficiency. We performed a retrospective review of 55 revTHAs with a mean follow-up of 32 months (24-60 months). Outcomes included the WOMAC and HHS. Preoperative bone loss was categorized as Paprosky 3A (n = 13), 3B (n = 14), and 4 (n = 17). Periprosthetic fractures were classified as Vancouver B2 (n = 6) and B3 (n = 5). 53 of 55 stems were in situ at time of final review. WOMAC improved from 46 ± 18 to 70 ± 22 and HHS improved from 47 ± 15 to 78 ± 15. Complications were identified in 9 patients, which included dislocation (3), subsidence (2), infection (2), and periprosthetic fracture (2). In cases of significant proximal femoral bone deficiency, this stem demonstrated improvement in clinical outcomes with good results at short-term follow up.

Results of inspection and cleaning of two radionuclide air-sampling systems based on the requirements of ANSI/HPS N13.1-1999.

The Pacific Northwest National Laboratory inspected and cleaned two radionuclide air-sampling systems that continuously monitor radioactive air emissions from research and development facilities. The inspection and cleaning was performed to evaluate effective methods and potential cost impacts of maintenance requirements in the revised American National Standard Institute standard Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stacks and Ducts of Nuclear Facilities. The standard requires at least annual inspections of sampling systems followed by cleaning if deposits are visible. During 2001 and 2002, inspections were performed leaving the sampling systems in place and inserting videoscope cables into different access points to allow viewing of the inside and outside of sampling manifolds and transport lines. Cleaning was performed on one of the systems by disconnecting and extracting the sampling manifold, then washing it with de-ionized water and scrub brushes. The wash water was analyzed for radioactivity and solids. Results of the inspection showed greater deposition in one of the systems than would be expected by a High Efficiency Particulate Air (HEPA) filtered exhaust stream, possibly due to accumulation of dust from a short period when unfiltered air was exhausted from construction areas. The second system was also downstream of HEPA filters and appeared much cleaner. The videoscope was a useful and cost-effective tool and provided a better view than could be obtained with the naked eye. However, because even small amounts of deposition were made visible with the videoscope, clarification is needed in defining when probe washing is merited, particularly in existing sampling systems whose design is not conducive to easy removal and cleaning.

Early results of targeted prophylaxis for coccidioidomycosis in patients undergoing orthotopic liver transplantation within an endemic area.

Coccidioidomycosis (CM) is an endemic fungal infection of the desert southwestern United States. In immunocompromised hosts, such as transplant recipients, this infection is often a severe, disseminated disease with high mortality. A history of coccidioidal infection or positive serologic results increases the risk of CM after transplantation. At our institution, all liver transplant candidates with either positive history or serologic results for coccidioidal infection receive fluconazole in order to prevent recurrent infection after transplantation. Patients with neither a history of coccidioidal infection nor positive serologic results do not receive prophylaxis but are followed serologically every 3 months. From June 1999 to October 2001, 81 liver transplantations were performed at our institution in 76 patients with end-stage liver disease. Four of these 76 patients received prophylactic fluconazole in order to prevent CM. None of these 4 patients had reactivation of CM. A new coccidioidal infection developed after orthotopic liver transplantation in 1 of 72 patients (1.4%). Close surveillance and targeted prophylaxis are safe and effective alternatives to universal prophylaxis for CM in patients undergoing liver transplantation in an endemic area.

Isolated visceral angioedema: an underdiagnosed complication of ACE inhibitors?

Angiotensin-converting enzyme (ACE) inhibitors are known to cause potentially fatal peripheral angioedema in some patients. ACE inhibitors may also cause isolated visceral angioedema, a rarely reported complication. This article describes 2 patients who experienced this complication. Both patients came to medical attention with episodes of recurrent abdominal symptoms that had occurred while taking ACE inhibitors for hypertension. Each patient had undergone surgical procedures for symptoms that persisted after surgery and were ultimately relieved with cessation of their ACE inhibitors. These cases call attention to what may be an underappreciated cause of abdominal pain in patients presenting to emergency departments.

Hepatitis-associated aplastic anemia and acute parvovirus B19 infection: a report of two cases and a review of the literature.

Hepatitis-associated aplastic anemia is rare in general, but occurs in up to 28% of patients receiving liver transplantation for fulminant non-A, non-B hepatitis. Cases are commonly young men with mild hepatitis but severe aplastic anemia. Although cases have been reported in association with hepatitis A, B, and C, most appear to be due to a non-A-B-C virus. We report two cases of acute hepatitis subsequently complicated by marrow hypoplasia in patients with acute parvovirus B19 infection. Hepatic manifestations of parvovirus B19 infection range from liver chemistry abnormalities to fulminant hepatic failure and aplastic anemia. Our cases demonstrate a less severe form of hepatitis-associated aplastic anemia, and together with other data, suggest that parvovirus B19 is at least one cause of hepatitis-associated aplastic anemia, and may be a heretofore underrecognized hepatotrophic virus.

The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient.

Transmission of hepatitis B infection from hepatitis B surface antigen (HBsAg)-negative antibody to hepatitis B core (anti-HBc)-positive liver donors has been previously described. The long-term outcome of these transplant-associated de novo hepatitis B patients has not been well described and may affect future use of donor organs that are anti-HBc-positive. We describe the experience in our first 332 transplants, performed before exclusion of anti-HBc-positive liver donors. Nine of these 332 (3%) donors were anti-HBc positive. Three of these 9 (33%) recipients developed transplant-associated de novo hepatitis B infections compared with only 2 of 323 (0.5%) recipients who received anti-HBc-negative donor livers (P = .00014). Of our 9 recipients of anti-HBc-positive livers, 6 (67%) are alive, and no deaths or allograft failures have been related to complications of hepatitis B. Only 1 of 5 patients (20%) with de novo hepatitis B has developed significant graft dysfunction with an average follow-up of more than 7 years (range 63-124 months). The 1 recipient with allograft dysfunction related to de novo hepatitis B has significantly elevated viremia levels (average HBV DNA 460 pg/mL) compared with the other de novo hepatitis B recipients (average HBV DNA 23-58 pg/mL). In summary, anti-HBc-positive donors are more likely to transmit hepatitis B infections to recipients, but these de novo infections usually have a mild clinical course and do not seem to adversely affect long-term patient survival. Hepatitis B-related allograft dysfunction, when it occurs, is associated with higher levels of viral replication. With our current donor shortage, perhaps anti-HBc-positive donors could be used in very selected recipient populations.

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Randomized controlled trial of recombinant alpha-2a-interferon for chronic hepatitis C. Comparison of alanine aminotransferase normalization versus loss of HCV RNA and anti-HCV IgM.

We enrolled 32 patients with chronic hepatitis C into a randomized, controlled trial to evaluate the efficacy of recombinant alpha-2a-interferon treatment. Sixteen patients were randomized to receive 1.5 million units of recombinant alpha-2a-interferon subcutaneously, thrice weekly, for six months while the remaining 16 patients were randomized to a control group that received no treatment. The mean serum alanine aminotransferase (ALT) level during the six-month study period, expressed as a percentage of the prestudy baseline value, was 82% for the control group compared to 56% for the treatment group (P = 0.014). One fourth of the treatment group normalized their serum ALT level compared to only 6% of the controls (P = 0.05). During posttherapy follow-up, 86% of responders clinically relapsed. Loss of anti-HCV IgM and HCV RNA occurred exclusively in interferon-treated responders. Anti-interferon antibodies developed in 32% of all treated patients. Forty percent of nonresponders developed anti-interferon antibodies compared to only 14% of responders (P = NS). We conclude that recombinant alpha-2a-interferon is clinically effective in patients with chronic hepatitis C. However, most responders in this trial of low-dose interferon relapsed upon cessation of treatment.

Absence of hepatitis B virus DNA detected by polymerase chain reaction in blood donors who are hepatitis B surface antigen negative and antibody to hepatitis B core antigen positive from a United States population with a low prevalence of hepatitis B serologic markers.

A recent study in hepatitis B surface antigen (HBsAg)-negative, antibody to hepatitis B core antigen (anti-HBc)-positive blood donors from a population with a high prevalence of hepatitis B serologic markers showed the presence of hepatitis B virus DNA (HBV DNA) as detected by polymerase chain reaction (PCR) in 4 percent of these donors. A sensitive, nested PCR assay was used to assess the prevalence of HBV DNA in a population of HBsAg-negative, anti-HBc-positive blood donors from a United States population with a low prevalence of hepatitis B serologic markers. The lower limit for detection by the PCR assay was 10(-5) pg per mL of HBV DNA. There was a review of 26,492 consecutive blood donations in a 12-month period. During this time, only 1 unit (0.004%) was HBsAg positive. An additional 158 units (0.6%) were repeatably reactive for anti-HBc. These 158 HBsAg-negative, anti-HBc-positive units were given by 119 donors of blood for allogeneic and autologous use. HBV DNA was not detected by PCR in blood from 83 allogeneic blood donors (93 samples) or 36 autologous blood donors (65 samples). Anti-HBc testing is an inefficient means of screening for potential hepatitis B infectivity and is associated with low test specificity in populations with a low prevalence of hepatitis B serologic markers.

The necessity of mandatory exploration of penetrating zone II neck injuries.

To reevaluate the validity of our policy of mandatory surgical exploration of penetrating zone II neck injuries, the charts of 110 patients who underwent surgical exploration for such injuries were reviewed. Fifty-three percent of the patients had normal findings at exploration, whereas 33% had injuries involving vascular structures of the neck and 14% had nonvascular injuries. Injuries were not suspected on clinical grounds preoperatively in 23% of the patients in whom surgical exploration revealed injury. The injuries most likely to escape preoperative diagnosis were isolated venous injuries and isolated pharyngoesophageal injuries. Arteriography yielded false-negative results in two arterial injuries. No deaths and only a 5% incidence of minor complications occurred in the group with no injuries detected at exploration. We conclude that surgical exploration of penetrating zone II neck injuries is safe and appropriate.

Bone marrow biopsy technic. Artifact induced by aspiration.

Bone marrow aspiration and trephine biopsy specimens are of additive value when assessing various marrow disorders. Many physicians obtain both an aspirate and a trephine core when taking a biopsy of bone marrow, but opinions differ about which biopsy specimen should be obtained first. Some authors mention the possibility of artifactual hypocellularity and hemorrhage in the trephine biopsy specimen when trephine biopsy follows aspiration at the same site. This report describes the occurrence and significance of bone marrow aspiration artifact. The artifact usually occupies a relatively small area of the biopsy specimen and satisfactory evaluation of the marrow is still possible. However, the artifact occasionally hinders marrow evaluation, particularly when the trephine biopsy specimen is relatively short. Because the artifact is not observed in specimens obtained away from the aspiration site, it is best to perform the trephine biopsy before aspiration, or away from the aspiration site, especially when technical problems prevent obtaining a large amount of trephine material.

A new technique for rapid endoscope-assisted intubation of the small intestine.

We describe a simple method for rapid intubation of the small intestine. The method was successful in 13 out of 14 attempts. A forward-viewing fiberscope, two endoscopic biopsy forceps, five rubber bands, and the tube to be positioned are required for the method. It should have broad application for the passage of tubes for small intestinal decompression, jejunal feeding, jejunal biopsy, and biliary and pancreatic drainage studies.