Genotypes of Staphylococcus aureus: On-farm epidemiology and the consequences for prevention of intramammary infections.

Staphylococcus aureus is a highly contagious mastitis-causing pathogen infecting dairy cattle worldwide. Previous studies have shown the presence of different genotypes (GT) on farms. In Switzerland, Staph. aureus genotype B (GTB) is contagious, whereas GTC and other genotypes cause sporadic, noncontagious mastitis. In this study, we evaluated the epidemiological properties of Staph. aureus, together with its genotypes and spa types, on Swiss dairy farms. A total of 21 dairy farms were sampled throughout Switzerland; 10 farms were positive for the contagious Staph. aureus GTB and 11 farms were negative for GTB. Samples were taken from milk, body surfaces of dairy cattle and other animals, milkers, milking equipment, and environmental sites (e.g., parlor, washing room, stall floor, manger, and bedding). The epidemiology of Staph. aureus depended markedly on the genotype. Staphylococcus aureus GTB was associated with mammary gland, intramammary infections (IMI), and milking clusters, whereas GTC and other genotypes were related to cow and other animal surfaces and occasionally to environment. Genotype C was by far the most common subtype in cattle and was found on GTB-negative and GTB-positive farms. Each farm had a predominant genotype, such as GTB, GTC, GTA, or GTF, but a few farms were almost free from Staph. aureus. The genotypes and spa types of Staph. aureus detected in the noses of milkers clearly differed from those found in dairy cattle, other animals, milking equipment, and the environment. Exceptions were GTS (spa type t034) and GTF (t899), which crossed the species barrier. In most cases, however, the species barrier was maintained because Staph. aureus is adapted to a particular host and even to particular body sites. As biological properties differ among the genotypes, new guidelines to prevent IMI caused by different genotypes were established: classical measures to prevent IMI caused by contagious pathogens still hold for GTB but not for Staph. aureus genotypes that are opportunistic colonizers of bovine skin (e.g., GTC and GTA). For those genotypes, protection of the skin from minor lesions and wounds, particularly on the hocks, is essential.

Sanitation of Staphylococcus aureus genotype B-positive dairy herds: A field study.

Staphylococcus aureus is one of the most widespread mastitis pathogens infecting dairy cattle worldwide. In Switzerland, different bovine genotypes of Staph. aureus have been identified, and genotype B (GTB) was demonstrated to be a highly contagious subtype, causing herd problems in cattle. As the efficacy of antibiotic therapy against Staph. aureus is not satisfactory, the most promising strategy for controlling this udder pathogen is the implementation of specific sanitation programs for affected farms. The aim of the present longitudinal study was the field evaluation of 2 analytical approaches for the sanitation of Staph. aureus GTB-positive dairy herds. We compared a new real-time quantitative PCR (qPCR) assay based on the detection of the unique target gene adlb with classical bacteriology. Sanitation was successfully achieved using both analytical methods, but the qPCR approach showed some main advantages, namely the use of clean (instead of aseptically collected) milk samples facilitates sample collection in terms of time and costs, enabling the sampling of entire herds during a regular milking procedure and by the farm staff. The high inclusivity and exclusivity of the new target gene adlb enable very specific detection of only the genotype of interest. Because of the very high diagnostic sensitivity of qPCR, each GTB-positive cow can be correctly identified at any time point during lactation, allowing farmers to continuously update milking groups to prevent transmission during milking. Milk sample analysis becomes more objective, faster, less expensive, and more suitable for routine application, enabling the sanitation of even big herds in short time.

Radiographic evaluation of anterior dislocation of the shoulder.

PURPOSE: To establish radiographic criteria to choose the most appropriate technique of reduction for each type of anterior glenohumeral dislocation, and to determine the type of dislocation which requires general anesthesia. MATERIAL AND METHODS: Radiography in two different projections was performed in 67 patients with antero-inferior shoulder dislocations before a reduction attempt. The method proposed by BOss-HOLZACH-MATTER was used as the primary technique for all shoulder dislocations. RESULTS: Most subcoracoid dislocations (84.4%) could be reduced by the BOss-HOLZACH-MATTER method while only a few subglenoid dislocations (15.8%) were reducible by this technique. Displaced associated fractures significantly reduced the success rate of the reduction attempts. CONCLUSION: Anterior dislocations of the shoulder require different methods of reduction depending upon the type (sub-group) of dislocation. Reduction of subglenoid dislocations with associated greater tuberosity fracture should be performed under general anesthesia to avoid head-splitting fracture.

Anteroinferior shoulder dislocation: an auto-reduction method without analgesia.

OBJECTIVES: To describe a new reduction method for anteroinferior shoulder dislocations. DESIGN: Retrospective for the first thirty patients; prospective for the remaining seventy patients. SETTING: University hospital. PATIENTS: One hundred patients with anteroinferior shoulder dislocations. INTERVENTIONS: X-rays in two different projections were taken. The patient then was asked to sit on a relatively hard surface. The wrists were protected. The patients's forearms were placed around the homolateral knee, which is flexed at 90 degrees. The head of the examination table was lowered, and the patient was asked to lean backward with his or her neck in hyperextension. The patient had to push his or her shoulders (shrug) anteriorly, thus creating a rational movement of the scapula around a vertical axis. MAIN OUTCOME MEASURES: The authors analyzed initial prereduction x-rays and established a classification system based on the position of the humeral head, then assessed the success rate of the new technique with respect to the radiologic study. RESULTS: When using the reduction method described by Boss-Holzach-Matter, the authors attained an overall success rate of 60 percent, with a mean reduction time of three minutes and a time interval varying from fifteen seconds to nine minutes. CONCLUSION: The Boss-Holzach-Matter method is a reduction technique for anteroinferior shoulder dislocations that can be used without premedication or anesthesia. The authors recommend it for those patients who are not going to be sedated and for whom "quick" reduction and early discharge is desirable.

[Invasive Streptococcus pyogenes infection (beta-hemolytic Streptococcus of group A)]. / Infections invasives à Streptococcus pyogenes (streptocoque beta-hémolytique du groupe A).

Group A streptococcal infections are frequent and most often benign. Severe invasive infections due to this microorganism have nevertheless been reported with increasing frequency in various countries for several years. Moreover, a toxic shock-like syndrome has recently been recognized and characterized in such infections. Two cases of invasive group A streptococcal infections (one primary peritonitis and one toxic shock syndrome) are reported to increase a better understanding of this disease in the light of a review of the pertinent literature. This is hoped to contribute to better management of what is a growing problem for many physicians who are nowadays no longer familiar with the broad spectrum of group A streptococcal infections.

[Coronary revascularizations using multiple mammary anastomoses compared to classical vein grafts]. / Revascularisations coronariennes par anastomoses mammaires multiples en comparaison avec les greffons veineux classiques.

In a series of 100 consecutive patients the internal mammary arteries have been used whenever possible for revascularization of the coronary arteries. At least one internal mammary artery was used in 89% of cases; both internal mammary arteries were used in 30% and in 17% sequential internal mammary-coronary artery anastomoses were performed. The results in this group of patients were compared to another group of 250 consecutive patients in whom the coronary arteries were revascularized by classical saphenous vein grafts. In-hospital mortality was 3% for the internal mammary artery group and 2.5% for the saphenous vein group (NS). The follow-up was complete for 89% of the patients after a mean duration of 6 months. At control the mean NYHA functional class was assessed as 1.0 +/- 0.2 for the internal mammary artery group and 1.2 +/- 0.2 for the saphenous vein group (p less than 0.01). Stress test was electrically positive in 7.1% of the internal mammary artery group and in 15.3% of the saphenous vein group (p less than 0.05). Although the method is technically more demanding, the results after internal mammary-coronary artery anastomoses appear to be superior.

[Femoral artery thrombosis associated with heparin-induced thrombopenia]. / Thrombose artérielle fémorale associée à une thrombopénie induite par l'héparine.

We report a case of acute thrombosis of the common femoral artery which occurred on the tenth day of postoperative prophylactic heparin therapy. Platelet count was 14,000/mm3 at the time of the acute event. Cessation of heparin administration resulted in progressive normalization of the platelet count. Iliofemoral thrombectomy, followed by popliteal thromboembolectomy, allowed successful recanalization of the occluded arteries, after failure of local thrombolysis with low-dose streptokinase. The pathogenesis, diagnosis and treatment of heparin-induced thrombocytopenia associated with thromboembolic complications are discussed.

[Long-term study following photocoagulation in diabetic retinopathy]. / Langzeitbeobachtungen nach Photokoagulation bei diabetischer Retinopathie.

Diabetic Retinopathy can be stabilized for years by ophthalmological measures. Proliferation in slowed down by photocoagulation and laser coagulation, but they do not prevent other vascular complications. Angiopathy of the arteries and arterioles of the retina and optic nerve can lead to additional, unexpected complications.

Implantation of antibiotic-releasing carriers for treatment of recurrent prosthetic endocarditis.

A 26-year-old man had early recurrence of aortic prosthetic endocarditis with recurrent prosthetic valve dysfunction. Tertiary valve replacement with implantation of antibiotic-releasing carriers for local treatment of aortic root abscesses was performed successfully in this highly lethal condition.

[The corneoscleral suture with resorbent suture material]. / Die Korneoskleralnaht mit resorbierbarem Nahtmaterial.

Modern resorbent materials are perhaps still not ideal in every respect. Resorbent fibers are an alternative to the non-resorbent synthetic materials and to Barraquer silk, as the author points out with reference to results of operations carried out during the last three years at the ophthalmological clinic in Aarau.

[Symptomatology of a primary intraorbital meningioma of the optic nerve]. / Zur Symptomatologie eines primär intraorbitalen Meningiomes des Nervus opticus.

Report on an 18-year-old man with a histologically confirmed intraorbital meningioma (transitional type) of the right optic nerve. The symptoms were slowly progressive loss of vision with central scotoma and pallor of the disk, without proptosis or disturbance of eye motility. Computer tomography performed preoperatively did not permit the differential diagnosis of glioma.

[Burns in childhood - epidemiology and prevention]. / Thermische Verletzungen im Kindesalter - Epidemiologie und Prävention.

An analysis of 230 children treated for burns at the Department oif pediatric Surgery in Berne, Switzerland, shows, that approximately three quarter of the cases were caused by hot liquids. Children below the age of seven are at the highest risk (80% of the patients). Most burns occur either during cooking, during meals or while the children are playing. The vast majority of parents applies no or only inadequate first-aid measures. The resulting prolonged time of exposure to the heat increases the damage to the skin. The most effective way of preventing burns in children consists in eliminating hazards or at least protecting the children from known specific dangers. Because in childhood most burns are self-inflicted all the preventive measures should be independent from an active cooperation or comprehension by the patient.

[Surgery in the treatment of retinopathies (author's transl)]. / Chirurgische Massnahmen bei Retinopathien.

Conservative measures for the treatment of affections of retina and choroid are being complemented and expanded upon increasingly by the use of xenon or lasercoagulation. Retinopathies are one of the indications for these microsurgical procedures. The etiology varies, whereas the clinical picture is usually similar. Basic criteria for photocoagulation can be established, but these will be modified considerably by the various coagulation techniques of different surgeons. Personal experiences are compared with accounts featuring in the wide range of available literature.

[Trabeculectomy or Goniotrepanation -- a comparison of the postoperative course (author's transl)]. / Trabekulektomie oder Goniotrepanation -- ein Vergleich des postoperativen Verlaufes.

No significant differences could be determined postoperatively between trabeculectomy and goniotrepanation. However, cases of flattened anterior chambers and choroidal detachments were less frequent after goniotrepanation than after trabeculectomy.

[Effect of timolol and acetazolamide on intraocular hypertension after intracapsular lens extraction with alpha-chymotrypsin (author's transl)]. / Die Wirkung von Timolol und Acetazolamid auf die intraokulare Druckerhöhung nach Extractio lentis mit Alpha-Chymotrypsin.

After intracapsular lens extraction with alpha-chymotrypsin three groups of 14 patients were formed. The first group was given Timolol 0.25% 2 x 1 drops, the second acetazolamide in sustained release form 1 x 500 mg and the third served as control. In all three groups the postoperatively elevated pressure diminished significantly in the first five postoperative days. The pressure diminution on the fourth and fifth postoperative day was accelerated by Timolol but not by acetazolamide.

[Clinical and therapeutic aspects of Candida endophthalmitis]. / Zum klinischen Bild und zur Therapie der metastatischen Candida-Endophthalmitis.

Case report on a 59-year-old woman who was affected by a Candida septicaemia after several abdominal interventions. After therapy with amphotericin B and 5-flurocytosine the disappearance of a central retinal metastasis is documented. Beside these drugs, clotrimazole, miconazole, econazole, and some combinations with amphotericin B are more recent possibilities.

[On the technic of dacryocystorhinostomy (author's transl)]. / Zur Technik der Dacryocystorhinostomie.

A new simplified operative technique for dacryocystorhinostomy is presented. The modifications are compared with the methods of Toti, Ohm, Dupuy-Dutemps, Kaleff and Hollwich.

[Computed tomography findings in bilateral blindness (author's transl)]. / Computertomographiebefunde bei doppelseitiger amaurose.

The use of computed tomography (CT) simplifies neuroradiological investigations. A CT helped to confirm the diagnosis of an occipital vascular leasion in two cases of bilateral blindness.