Transmission of Pneumocystis carinii from patients to hospital staff.

BACKGROUND: An extrahuman reservoir of human pathogenic Pneumocystis carinii remains unknown. Host to host transmission has been described in animal studies and in cluster cases among immunodeficient patients. P carinii DNA has recently been detected in air filters from inpatient and outpatient rooms in departments of infectious diseases managing patients with P carinii pneumonia (PCP), suggesting the airborne route of transmission. Exposure of staff to P carinii may occur in hospital departments treating patients with PCP. METHODS: Exposure to P carinii was detected by serological responses to human P carinii by ELISA, Western blotting, and indirect immunofluorescence in 64 hospital staff with and 79 staff without exposure to patients with PCP from Denmark and Sweden. DNA amplification of oropharyngeal washings was performed on 20 Danish staff with and 20 staff without exposure to patients with PCP. RESULTS: There was no significant difference in the frequency or level of antibodies to P carinii between staff exposed and those unexposed to patients with PCP. None of the hospital staff had detectable P carinii DNA in oropharyngeal washings. CONCLUSIONS: There is no difference in antibodies and no detectable P carinii DNA in oropharyngeal washings, which suggests that immunocompetent staff treating patients with PCP are not a potentially infectious source of P carinii for immunocompromised patients.

Impalpable breast lesions diagnosed by mammography: incidence of histologically confirmed malignancy.

OBJECTIVE: To evaluate the suitability of currently applied mammographic criteria for the early diagnosis of subclinical tumours by comparing radiological findings with the final histological diagnosis. DESIGN: Open study. SETTING: District hospital, Denmark. SUBJECTS: 151 Women who underwent needle biopsy of 161 occult breast lesions that had been diagnosed by mammography during the period 1986-90. INTERVENTIONS: Definitive operation if frozen section at the time of needle biopsy indicated malignancy. Radiographic examination of the specimen ensured that the abnormal area had been excised. MAIN OUTCOME MEASURES: Correlation of mammographic and histological findings. RESULTS: Eight foci showed carcinoma in situ and 33 invasive carcinoma; 10 of the 33 had lymph node metastases. Foci with mammographic masses had a significantly higher risk of malignancy than those without (25/70, 37%, compared with 8/91, 17%, p = 0.005). Spiculated foci with clustered calcifications had the highest risk of malignancy (6/11, 54%). 16/87 foci in women less than 50 years old contained malignant disease compared with 25/74 in women aged 50 or more (p = 0.04). A fifth of the frozen sections contributed nothing to the diagnosis. The incidence of malignant disease in impalpable lesions of a quarter is similar to the reported incidence in palpable mammary tumours, but metastases at the time of diagnosis are appreciably less common (30% compared with 50%). CONCLUSION: The currently applied mammographic criteria are particularly helpful to patients under the age of 50.

Iatrogenic radiant heat burns in severely asphyxic newborns.

We report two cases of newborns who developed second-degree burns following resuscitation under infra-red heating lamps. Both infants were asphyxic and suffered from insufficient peripheral circulation which, combined with the long duration of the exposure to the light, contributed to the development of the lesions. Both infants died shortly after birth for reasons other than the burns.