Epidemiology of Enterotoxigenic Escherichia coli infection in Minnesota, 2016-2017.

Enterotoxigenic Escherichia coli (ETEC) is a well-established cause of traveller's diarrhoea and occasional domestic foodborne illness outbreaks in the USA. Although ETEC are not detected by conventional stool culture methods used in clinical laboratories, syndromic culture-independent diagnostic tests (CIDTs) capable of detecting ETEC have become increasingly prevalent in the last decade. This study describes the epidemiology of ETEC infections reported to the Minnesota Department of Health (MDH) during 2016-2017. ETEC-positive stool specimens were submitted to MDH to confirm the presence of ETEC DNA by polymerase chain reaction (PCR). Cases were interviewed to ascertain illness and exposures. Contemporaneous Salmonella cases were used as a comparison group in a case-case comparison analysis of risk factors. Of 222 ETEC-positive specimens received by MDH, 108 (49%) were concordant by PCR. ETEC was the sixth most frequently reported bacterial enteric pathogen among a subset of CIDT-positive specimens. Sixty-nine (64%) laboratory-confirmed cases had an additional pathogen codetected with ETEC, including enteroaggregative E. coli (n = 40) and enteropathogenic E. coli (n = 39). Although travel is a risk factor for ETEC infection, only 43% of cases travelled internationally, providing evidence for ETEC as an underestimated source of domestically acquired enteric illness in the USA.

Evaluation of the BioFire FilmArray® GastrointestinalPanel in a Midwestern Academic Hospital.

The BioFire FilmArray® Gastrointestinal Panel (GIP) was implemented to replace traditional stool culture and enzyme immunoassay (EIA) testing for stool pathogens. The purpose of this study was to evaluate the detection rate, incidence of coinfection, and culture recovery rate of gastrointestinal (GI) pathogens detected by the GIP over a 1-year period. A total of 2257 stools collected from January to December 2015 were tested using the GIP. Clostridium difficile colonization was also evaluated by an antigen/toxin EIA and confirmatory polymerase chain reaction (PCR). The GIP detected one pathogen in 911 (40.4%) specimens. Coinfections were detected in 176 (7.8%) of these specimens. The most frequently detected pathogens were C. difficile (15.2%), norovirus (8.9%), enteropathogenic Escherichia coli (7.1%), enteroaggregative E. coli (3.4%), Campylobacter spp. (2.3%), and sapovirus (2.0%). Each of the remaining GIP targets had a detection rate of ≤1.6%. The recovery of bacteria for public health investigations varied, with rates as high as 77% for Salmonella to as low as 30% for Yersinia enterocolitica. Of stools positive for C. difficile on the GIP that were tested by EIA, only 42.7% (88/206) were found to be producing detectable toxin. Overall, the implementation of the GIP resulted in high detection rates of GI pathogens, including the frequent detection of coinfections. This is a promising test to streamline the testing of agents causing infectious gastroenteritis from multiple tests down to a single order with limited hands-on time. Ongoing studies will need to assess the impact that the GIP has on downstream patient care and public health practices.

Renal metastases from a squamous cell carcinoma of the larynx.

Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.

Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism.

BACKGROUND: Tertiary hyperparathyroidism continues to cause significant morbidity in patients with chronic renal failure. This is frequently resistant to medical management and may ultimately require a surgical parathyroidectomy. Recent studies have reported upon the technique of percutaneous ethanol ablation for both primary and tertiary hyperparathyroidism. In this study we report on a 5 year experience using ethanol injection and compare the results with surgical parathyroidectomy. METHODS: A prospective study in 39 patients with tertiary hyperparathyroidism, 25 were dialysis dependent and 14 had a functioning renal allograft. Twenty-two patients underwent percutaneous fine needle ethanol injection (PFNEI) and 17 underwent surgical parathyroidectomy. RESULTS: A > 30% reduction in intact parathyroid hormone (iPTH) was achieved in 11 of 22 patients undergoing PFNEI after a mean of 1.8 +/- 1.4 injections per gland. In four patients, symptomatic hyperparathyroidism recurred and they required further PFNEI or surgical parathyroidectomy at 17, 28, 46, and 48 months later. There was no significant reduction in iPTH in 11 patients following PFNEI after a mean of 2.5 +/- 1.3 injections per gland. They all required a subsequent surgical parathyroidectomy for symptomatic hyperparathyroidism. Four patients developed a laryngeal nerve palsy following PFNEI, two of which were permanent. Seventeen patients underwent successful surgical parathyroidectomy as a primary procedure. CONCLUSION: Whilst PFNEI is successful in primary hyperparathyroidism, when typically only one adenoma is present, the effectiveness of PFNEI is unpredictable and the long term results are poor compared with those of surgical parathyroidectomy in tertiary hyperparathyroidism. The procedure is not without complications and makes subsequent surgery more difficult. Therefore it can only be recommended for patients with a known single parathyroid gland such as patients in whom hyperparathyroidism has recurred following a previous surgical subtotal parathyroidectomy and who are unsuitable for further surgery.

Hepatic Doppler perfusion index: measurement in nine healthy volunteers.

Nine healthy volunteers were studied to validate the reproducibility of the Doppler perfusion index--the ratio of hepatic arterial to total liver blood flow--and to evaluate the method of its derivation and the influence of the variable parameters necessary for its calculation. Wide intraobserver variability was observed, and Doppler perfusion index values were consistently outside the previously reported normal range.

Reporting requirements for skeletal digital radiography: comparison of soft-copy and hard-copy presentation.

PURPOSE: To assess diagnostic performance and reader preference when reporting results from digital hard-copy and two soft-copy formats of skeletal digital radiography. MATERIALS AND METHODS: The data comprised hand radiographs of patients undergoing renal dialysis. Normal hand radiographs obtained in trauma patients were assessed as control images. One hundred fifteen images acquired with a photostimulable-phosphor computed radiography system were analyzed. Image selection and initial assessment were by consensus of two experienced radiologists, who graded the radiographic changes of hyperparathyroidism with the Ritz scoring system. The images were then presented to four readers in three formats: hard-copy output and soft-copy presentations at 2K2 and 1K2 resolutions. These readers scored pathologic change and image preference. The results were analyzed with the receiver operating characteristic technique. RESULTS: There was a significant improvement in diagnostic performance for both soft-copy formats relative to the hard-copy format (P < .001). No significant difference in diagnostic performance was found between the two soft-copy formats. There was a significant preference for both soft-copy formats relative to the hard-copy format (P < .01), with the 2K2 soft-copy images preferred to the 1K2 images (P < .01). CONCLUSION: Soft-copy reporting can provide superior diagnostic performance even for images viewed at a modest (1K2) resolution. The lack of difference between the two soft-copy formats has important economic implications with respect to departmental hardware requirements.

Possible aluminum content of canned drinks.

Preliminary analyses by a commercial laboratory demonstrated varying amounts of aluminium in a small sampling of canned drinks, which had been stored at 15-20 degrees C., ranging from < 0.1 to 74 ppm depending on the product and storage time. Aluminum foil wrap immersed in several drinks demonstrated varying raters of dissolution from nearly zero to 100% over a 7 months periods when stored at an incubator temperature of 32-34 degrees C. Should aluminum prove to be of significant pathophysiologic consequence, some consideration should be given to all possible sources, including canned drinks which are consumed in copious quantities. When internal protective coatings are complete and remain intact, the cans stored properly and the contents consumed within a reasonable period of time, there appears to be little basis for concern about the ingestion of aluminum from the consumption of the canned drinks tested, as things now stand.

Testicular infarction mimicking tumour on scrotal ultrasound--a potential pitfall.

We present two cases of spontaneous testicular infarction. Although the clinical presentation indicated an acute pathology, the ultrasound examination demonstrated focal, hyporeflective intra-testicular lesions that could not be discriminated from tumour. As a result of the ultrasound examinations, radical orchidectomies were performed and diagnoses of spontaneous testicular infarction proven histologically.

Classification of alcoholism with reference to comorbidity.

Classification of individuals with alcoholism is currently limited. The purpose of this analysis was to determine whether antisocial personality disorder and other primary psychiatric syndromes identified subgroups of alcoholics with differing characteristics. Alcoholic probands (n = 224) with alcoholism were divided into those with primary alcoholism (n = 128), antisocial alcoholism (n = 50), and secondary alcoholism (n = 46). These groups were evaluated with regard to alcohol-related symptoms and upon a variety of psychiatric signs and symptoms. The secondary alcoholism. The antisocial alcoholic and primary alcoholic groups demonstrated many similarities, but overall, the antisocial alcoholic group appeared most severe. The antisocial alcoholic group additionally exhibited a dissociation between the subjectively reported and the observed behavior. These findings support the concept of heterogeneity within the alcoholism spectrum. Longitudinal data are needed to determine whether the observed cross-sectional differences predict outcome differences.

Suicide over 60: the San Diego study.

OBJECTIVES: To see if selected clinical factors characterize suicides over the age of 60 differently from younger suicides and to ascertain if those factors characterize female and male suicides over the age of 60 differently. DESIGN: A group of consecutive suicides aged 60-88 was compared with groups of consecutive suicides aged 31-59 and 16-30. The female suicides aged 60-88 were also compared with the male suicides in that age group. Data were gathered from a variety of informants using a structured interview format. SETTING: The sample was gathered in San Diego County, California, between November, 1981 and September 1982. PARTICIPANTS: The sample consisted of 204 consecutive suicides. These included 49 cases aged 60-88, 94 cases aged 31-59, and 61 cases aged 16-30. The older group consisted of 20 females and 29 males. MEASUREMENTS: Comparisons were made in demographic, diagnostic, and other clinical characteristics. RESULTS: There were no significant differences between female and male suicides over age 60 on any of the variables examined. Only minor differences were found among the groups in patterns of mental disorders diagnosed. Older suicides were significantly more likely to be married or, if not married, widowed than either of the two younger groups. They were also significantly more likely to be stressed by medical illness. They were significantly less likely to have financial problems as stressors. They were significantly less likely to have talked about suicide or made prior suicide attempts than either of the two younger groups. CONCLUSIONS: Patterns of certain characteristics of suicides are very similar regardless of age. However, specific age-related differences occur that need to be considered when assessing suicide risk. Older suicides may be harder for clinicians to predict and, therefore, prevent.

Ultrasound diagnosis of testicular tumours presenting as epididymal disease.

A prospective study of 1494 new referrals for scrotal ultrasound was performed over a 5 year period. In 610 patients referred with a clear clinical diagnosis of epididymal disease, and no clinical suspicion of malignancy, ultrasound diagnosed unsuspected testicular tumours (seven malignant, one benign) in eight patients. In this series one case was counted as false negative for ultrasound diagnosis of tumour, as tumour was the differential diagnosis and not the primary diagnosis. No other patients diagnosed as having benign disease by ultrasound have subsequently been shown to have malignant disease. Sensitivity and specificity of ultrasound for the diagnosis of testicular malignancy in this series is 98% and 99.8% respectively. It is concluded that all patients with scrotal symptoms should be examined by ultrasound in order to achieve the maximal clinical benefit from the early diagnosis of testicular tumours. The implications of this are discussed.

Suicide, stressors, and the life cycle.

OBJECTIVE: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility. METHOD: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case. RESULTS: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor. CONCLUSIONS: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.

Secular trends in psychiatric diagnoses of suicide victims.

Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.

A double-blind comparison of iopromide and iopamidol in intravenous urography.

A randomised double-blind comparative study was performed to assess the imaging properties and side-effects of two non-ionic contrast media, iopromide and iopamidol, in intravenous urography in high risk patients. The results showed the two contrast media to be similar in their imaging efficacy and incidence of side-effects. Using 50 or 100 ml of iopromide or iopamidol (370 mgI/ml), the quality of nephrograms was found to be dose dependent but the quality of pyelograms was not dose dependent.

Guns and suicide: possible effects of some specific legislation.

The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.

San Diego Suicide Study: the adolescents.

The San Diego Suicide Study involved psychological autopsy and toxicological examination of 283 suicides. Of the 133 consecutive cases under age 30, 14 were under age 20. In this paper, detailed data on the 14 adolescent cases are presented and the findings compared to other studies.