[Manual medicine in Germany. A descriptive analysis]. / Manuelle Medizin in Deutschland. Eine deskriptive Analyse.

BACKGROUND: In Germany manual medicine (MM) is widely used by physicians. The purpose of this study was to give a first description of relevant health service research aspects of MM. METHODS: A structured questionnaire was placed online between April 2009 and March 2010 after pilot testing. Cooperating MM schools invited their members to take part in the study through different media. RESULTS: A total of 60 female and 241 male physicians participated in this survey. The most common indication for MM is the ileosacral joint syndrome, 73% stated that from their experience a single therapy does change symptoms and 47% stated that there are average to severe unspecific effects involved in MM therapy. Factors most influencing current MM treatment are time pressure and own wellbeing. There were no differences between the schools or specialties with respect to experienced effects of MM and frequency of therapy. CONCLUSION: Future study research can be planned to cover all schools of MM.

Validation of food-grade salts of organic acids as ingredients to control Listeria monocytogenes on pork scrapple during extended refrigerated storage.

This study was conducted to investigate control of Listeria monocytogenes on pork scrapple during storage at 4°C. In phase I, scrapple was formulated, with or without citrate-diacetate (0.64%), by a commercial processor to contain various solutions or blends of the following antimicrobials: (i) lactate-diacetate (3.0 or 4.0%), (ii) lactate-diacetate-propionate (2.0 or 2.5%), and (iii) levulinate (2.0 or 2.5%). Regardless of whether citrate-diacetate was included in the formulation, without the subsequent addition of the targeted antimicrobials pathogen levels increased ca. 6.4 log CFU/g within the 50-day storage period. In the absence of citrate-diacetate but when the targeted antimicrobials were included in the formulation, pathogen numbers increased by ca. 1.3 to 5.2 log CFU/g, whereas when citrate-diacetate was included with these antimicrobials, pathogen numbers increased only by ca. 0.7 to 2.3 log CFU/g. In phase II, in the absence of citrate-diacetate, when the pH of the lactate-diacetate-propionate blend (2.5%) was adjusted to pH 5.0 or 5.5 pathogen numbers remained unchanged (≤0.5 log CFU/g increase) over 50 days, whereas when citrate-diacetate was included with the lactate-diacetate-propionate blend adjusted to pH 5.0 or 5.5, pathogen numbers decreased by 0.3 to 0.8 log CFU/g. In phase III, when lower concentrations of the lactate-diacetate-propionate blend (1.5 or 1.94%) were adjusted to pH 5.5, pathogen numbers increased by ca. 6.0 and 4.7 log CFU/g, respectively, whereas when the mixture was adjusted to pH 5.0, pathogen numbers increased by ≤0.62 log CFU/g. Thus, scrapple formulated with lactate-diacetate-propionate (1.5 and 1.94% at pH 5.0) is an unfavorable environment for outgrowth of L. monocytogenes.

Control of Listeria monocytogenes on commercially-produced frankfurters prepared with and without potassium lactate and sodium diacetate and surface treated with lauric arginate using the Sprayed Lethality in Container (SLIC(R)) delivery method.

Viability of Listeriamonocytogenes was monitored on frankfurters formulated with or without potassium lactate and sodium diacetate at a ratio of ca. 7:1 and treated with lauric arginate (LAE; 22 or 44ppm) using the Sprayed Lethality in Container (SLIC(R)) delivery method. Without antimicrobials, pathogen numbers remained relatively constant at ca. 3.3logCFU/package for ca. 30d, but then increased to ca. 8.4logCFU/package over 120d. Regardless of whether or not lactate and diacetate were included, when treated with LAE, pathogen numbers decreased from ca. 3.3logCFU/package to ca. 1.5logCFU/package within 2h, but then increased to 7.3 and 6.7logCFU/package, respectively, after 120d. When frankfurters were formulated with lactate and diacetate and treated with LAE, pathogen numbers decreased by ca. 2.0logCFU/package within 2h and remained relatively unchanged over the 120d. These data confirm that LAE provides an initial lethality towards L. monocytogenes and when used in combination with reduced levels/ratio of lactate and diacetate as an ingredient for frankfurters provides inhibition throughout shelf life.

Viability of Listeria monocytogenes on commercially-prepared hams surface treated with acidic calcium sulfate and lauric arginate and stored at 4°C.

We demonstrated the effectiveness of delivering an antimicrobial purge/fluid into shrink-wrap bags immediately prior to introducing the product and vacuum sealing, namely the "Sprayed Lethality In Container" (SLIC™) intervention delivery method. The pathogen was Listeria monocytogenes, the antimicrobials were acidic calcium sulfate (ACS; calcium sulfate plus lactic acid; 1:1 or 1:2 in dH(2)O) and lauric arginate (LAE; Ethyl-N-dodecanoyl-l-arginate hydrochloride; 5% or 10% in dH(2)O), and the product was commercially prepared "table brown" ham (ca. 3 pounds each). Hams were surface inoculated with a five-strain cocktail of L. monocytogenes (ca. 7.0 log(10) CFU per ham), added to shrink-wrap bags that already contained ACS or LAE, vacuum-sealed, and stored at 4°C for 24h. Pathogen levels decreased by 1.2, 1.6, 2.4, and 3.1 log(10) CFU/ham and 0.7, 1.6, 2.2, and 2.6 log(10) CFU/ham in samples treated with 2, 4, 6, and 8mL of a 1:1 and 1:2 solution of ACS, respectively. In samples treated with 2, 4, 6, and 8mL of a 5% solution of LAE, pathogen levels decreased by 3.3, 6.5, 5.6, and 6.5 log(10) CFU/ham, whereas when treated with a 10% solution of LAE pathogen levels decreased ca. 6.5 log(10) CFU/ham for all application volumes tested. The efficacy of ACS and LAE were further evaluated in shelf-life studies wherein hams were surface inoculated with either ca. 3.0 or 7.0 log(10) CFU of L. monocytogenes, added to shrink-wrap bags that contained 0, 4, 6, or 8mL of either a 1:2 solution of ACS or a 5% solution of LAE, vacuum-sealed, and stored at 4°C for 60 days. For hams inoculated with 7.0 log(10) CFU, L. monocytogenes levels decreased by ca.1.2, 1.5, and 2.0 log(10) CFU/ham and 5.1, 5.4, and 5.5 log(10) CFU/ham within 24h at 4°C in samples treated with 4, 6, and 8mL of a 1:2 solution of ACS and a 5% solution of LAE, respectively, compared to control hams that were not treated with either antimicrobial. Thereafter, pathogen levels remained relatively unchanged (±1.0 log(10) CFU/ham ) after 60 days at 4°C in hams treated with 4, 6, and 8mL of a 1:2 solution of ACS and increased by ca. 2.0-5.0 log(10) CFU/ham in samples treated with 4, 6, and 8mL of a 5% solution of LAE. For hams inoculated with 3.0 log(10) CFU, L. monocytogenes levels decreased by 1.3, 1.9, and 1.8 log(10) CFU/ham within 24h at 4°C in samples treated with 4, 6, and 8mL of a 1:2 solution of ACS, respectively, compared to control hams that were not treated. Likewise, levels of the pathogen were reduced to below the limit of detection (i.e., 1.48 log(10) CFU/ham) in the presence of 4, 6, and 8mL of a 5% solution of LAE within 24h at 4°C. After 60 days at 4°C, pathogen levels remained relatively unchanged (±0.3 log(10) CFU/ham) in hams treated with 4, 6, and 8mL of a 1:2 solution of ACS. However, levels of L. monocytogenes increased by ca. 2.0 log(10) CFU/ham in samples treated with 4 and 6mL of a 5% LAE solution within 60 days but remained below the detection limit on samples treated with 8mL of this antimicrobial. These data confirmed that application via SLIC™ of both ACS and LAE, at the concentrations and volumes used in this study, appreciably reduced levels of L. monocytogenes on the surface of hams within 24h at 4°C and showed potential for controlling outgrowth of the pathogen over 60 days of refrigerated storage.

Prevalence of Campylobacter within a swine slaughter and processing facility.

In this work, the occurrence of Campylobacter in a swine slaughter and processing facility was studied. Thirty composite carcass samples, representing 360 swine carcasses, were taken immediately after exsanguination, immediately after polishing, after the final wash, and after overnight chilling at 2 degrees C. Thirty matching composite rectal samples were also taken immediately after exsanguination, and 60 nonmatching individual colon samples were collected from the same lot of swine during evisceration. Also, 72 environmental samples were collected from equipment used in the slaughter operation (42 samples) and the processing operation (30 samples). Campylobacter was isolated by direct plating on Campy-Line agar (CLA) or Campy-Cefex agar (CCA), as well as by Bolton broth enrichment and subsequent inoculation onto CLA or CCA. For all four recovery methods combined, Campylobacter was detected on 33% (10 of 30) of the composite carcasses immediately after exsanguination, 0% (0 of 30) after polishing, 7% (2 of 30) immediately before chilling, and 0% (0 of 30) after overnight chilling. The pathogen was recovered from 100% (30 of 30) of the composite rectal samples and 80% (48 of 60) of the individual colon samples. Campylobacter was detected in 4.8% (2 of 42) and 3.3% (1 of 30) of the slaughter and processing equipment samples, respectively. The recovery rate achieved with direct plating on CLA was significantly higher (P < 0.05) than those achieved with the other three recovery methods. For the 202 isolates recovered from all of the various samples tested, Campylobacter coli was the predominant species (75%) and was followed by Campylobacter spp. (24%) and Campylobacter jejuni (1%). These results indicate that although Campylobacter is highly prevalent in the intestinal tracts of swine arriving at the slaughter facility, this microorganism does not progress through the slaughtering operation and is not detectable on carcasses after overnight chilling.

Salmonella spp. and Escherichia coli biotype I on swine carcasses processed under the hazard analysis and critical control point-based inspection models project.

The present study examined the prevalence of Salmonella spp. and the prevalence and quantity of generic (biotype I) Escherichia coli on carcasses or in pig feces at a pork processing plant operating under the hazard analysis and critical control point-based inspection models project (HIMP) program. The surfaces of carcasses were sponged on 10 separate days over a 30-day period at two processing steps: (i) immediately following exsanguination (100 carcasses), and (ii) after the carcasses were washed, eviscerated, and chilled overnight (122 carcasses). Feces were also collected from 60 of the 100 sponged, postexsanguinated pigs. Salmonella spp. were detected on 73.0% of the 100 postexsanguinated pigs, in 33.3% of the 60 fecal samples, and on 0.7% of the 122 chilled carcasses. E. coli was found on 100.0% of the postexsanguinated pigs and on 30.1% of chilled carcasses tested. The mean concentration of E. coli on carcasses was 1,700 CFU/cm2 immediately after the exsanguination step and 1.1 CFU/cm2 at the chilled carcass stage. Previous studies at this processing plant showed that the pre-HIMP baseline level of Salmonella spp. on the chilled carcasses was 0.8%, indicating that the present HIMP inspection system produced an equivalent level of bacteriological performance.

Endothelial function of human vena saphena magna prepared with different minimally invasive harvesting techniques.

OBJECTIVES: Minimally invasive saphenous harvesting techniques have been shown to reduce post-operative morbidity. However, when applying new techniques of vein harvesting, endothelial integrity should be preserved in order to guarantee graft quality. We investigated the impact of two different minimally invasive saphenous vein harvesting techniques on endothelial function compared with the traditional 'open' technique by inducing endothelium-dependent in vitro relaxation. METHODS: Two different minimally invasive techniques for harvesting the greater saphenous vein were used in 66 patients, either using a video-assisted dissector (ETHI, n=33) or a light coupled retractor (AUTS, n=33); other patients were treated conventionally (CONV, n=30). The physiological response was tested in vitro using an organ chamber on vein segments exposed to acetylcholine after precontraction with potassium. RESULTS: In both minimally invasive groups, two patients each had to be converted to the traditional open technique and dropped out of the study. The endothelial function of the other veins harvested by either of the minimally invasive techniques showed no significant difference compared with veins harvested conventionally. Reactivity was measured as the percentage relaxation of pharmacological contraction and was significant in all groups (P<0.05); ETHI, 49.1+/-4.2%; AUTS, 48.8+/-5.1%; and CONV, 51.7+/-6. 0%. The responder/non-responder ratio was similar in all groups: ETHI (two drop-outs), 28/3 (90.3%); AUTS (two drop-outs), 28/3 (90. 3%); and CONV, 27/3 (90.0%). CONCLUSION: Veins harvested by minimally invasive techniques have not shown an impaired reactivity of the endothelium compared with the conventional technique.

Effect of dehairing operations on microbiological quality of swine carcasses.

To develop a hazard analysis and critical control point plan for food processing operations, critical control points must be determined. Swine slaughtering and dressing operations were investigated to establish their critical control points. We monitored the microbiology of swine carcasses by surface swabbing carcass bellies at various steps during the process and by quantitating total aerobic plate count (APC) and coliforms. Starting with a dehaired carcass, the sequential steps monitored included presingeing, postsingeing, polishing, and chilling. Initial results indicate that singeing and chilling substantially reduced the levels of APC and coliforms, whereas polishing increased their levels. The hygienic characteristics of individual operations involved in dressing swine carcasses were then evaluated in the second experiment. A set of 40 randomly selected carcasses leaving singeer, polisher, shaver, and washer were sampled. Carcasses were heavily contaminated during the final polishing procedure, and the APC increased threefold compared with prepolishing levels. Washing reduced the bacterial numbers by 69%. To reduce the microbial load on swine carcasses, final polishing and manual shaving steps were not used during the dressing operation on a set of 90 carcasses. APCs on singed carcasses were reduced from 1.34 to -0.15 log10 CFU/cm2 when the final polisher and manual shavers were not used. However, carcasses were subsequently recontaminated with bacteria after evisceration, and the APCs were similar (P > 0.05) regardless of whether the final polishing and manual shaving steps were used, averaging 1.30 and 1.46 log10 CFU/cm2. These results indicated that individual operations can be identified as critical control points, appropriate limits can be set and monitored in a hazard analysis and critical control point system, and steps where further changes to reduce bacterial levels may be needed for swine slaughtering plants.

Spinal cord hamartoma: case report.

OBJECTIVE AND IMPORTANCE: Spinal cord hamartomas are infrequently mentioned in the literature. The authors present a unique report detailing the clinical presentation of a spinal cord hamartoma, with supporting radiographic and pathological data. CLINICAL PRESENTATION: A 26-year-old man presented with progressive right upper extremity weakness. Imaging studies revealed an exophytic cervical spinal cord mass. INTERVENTION: Open biopsy was undertaken and revealed tethering of the lesion to the dura. A pathological examination revealed a spinal cord hamartoma. CONCLUSION: The patient's symptoms improved postoperatively, suggesting that tethering of the spinal cord was responsible for the symptoms. Although unusual, hamartoma should be included in the differential diagnosis of an exophytic spinal cord lesion.

Application and evaluation of male-specific bacteriophage as a process integrity or faecal contamination indicator in a pork slaughterhouse environment.

A male-specific bacteriophage plaque assay was evaluated as a faecal contamination or process integrity indicator for aspects of the pork slaughter process. Over 400 samples were tested including: sponge swabs from animal hauling trailer floors and dressed carcass surfaces; faecal material; water from slaughter sites; and water from each stage of wastewater treatment. Bacteriophage were observed in wastewater, trailers, slaughter process water and swine faeces. No bacteriophage were observed on dressed carcasses. Numbers of phage plaque-forming units per gram or millilitre showed greater variation and were usually lower than standard indicators, including total coliform or Escherichia coli counts. Among the applications studied, male-specific bacteriophage appear to be best suited for process control verification for wastewater treatment.

Microbiology of the swine head meat deboning process.

The microbiology of swine head meat was evaluated by comparing the levels of aerobic plate count (APC), coliforms, and Escherichia coli as well as the incidence and levels of Salmonella spp. in swine head meat harvested by either the old or a new improved procedure. Based on 144 samples (72 by each procedure), the levels of APC, coliforms, and E. coli were 4.52 +/- 0.26, 2.37 +/ 0.42, and 2.25 +/ 0.42, and log(10) CFU/g respectively, regardless of the procedure used for harvesting the meat. The incidence (27/22) versus 28/72) and MPN levels (4 to 93 versus 4 to 1100) of Salmonella spp. determined by the Bacteriological Analytical Manual (BAM) methods also were the same for meat obtained using either the old or the new procedure. The BAM method detected a higher incidence of Salmonella spp. (55/144) than other methods, PCR(38/144; BAX, Du Pont) or DNA hybridization (41/144; Gene-Trak). Time of harvesting during the processing day or site of origin of the head meat (check versus tongue versus back of head) had no effect on the incidence of Salmonella spp. The data in this study indicate that the levels of bacteria encountered in swine head meat are a reflection of the harvesting procedures themselves, as well as levels in and around the head and oral cavity of swine.

Intracranial tumor in children: MR imaging findings within 24 hours of craniotomy.

PURPOSE: To evaluate whether very early magnetic resonance (MR) imaging enables distinction of residual tumor from benign postoperative change in children. MATERIALS AND METHODS: Forty-six postoperative MR examinations were performed in 43 children with intracranial tumors within 24 hours of the completion of surgery during a 2-year period. These examinations were categorized according to whether residual tumor could be definitely identified or excluded, or whether the diagnosis was uncertain. RESULTS: Contrast enhancement occurred in 33 of 46 MR examinations performed within 24 hours of surgery. In 18 instances, this was associated with obvious residual tumor. In 15 patients, only small amounts of linear or patchy enhancement were seen. Of these, seven patients (46%) were disease-free for an average of 4.5 years. Assessment for postoperative enhancement was hampered in seven patients because of the presence of methemoglobin in the tumor bed. Contrast enhancement was not observed in two patients before surgery. CONCLUSION: Surgically induced, MR-detectable contrast enhancement and extracellular methemoglobin formation occurs within 24 hours of the completion of intracranial surgery. This can interfere with the detection of small amounts of residual tumor.

Preoperative temporal bone computed tomography scan and its use in evaluating the pediatric cochlear implant candidate.

Preoperative computed tomography (CT) scan evaluation of the temporal bones in cochlear implant candidates plays a crucial role in determining candidacy and the side of implantation. The CT scans allow the surgeon to carefully review the anatomy of the inner ear and mastoid cavity in order to predict any potential difficulties or complications that may be encountered during the implant insertion. We retrospectively reviewed 50 preoperative CT scans of the temporal bone in children who have been successfully implanted. In these scans, we assessed the degree of mastoid pneumatization, cochlear anatomy and patency, size of the vestibular aqueduct, cochlear aqueduct, and internal auditory canal. We analyzed our findings and measurements and compared our results with the degree of difficulty noted in the insertion of the implant, the number of electrodes inserted in each case, and the overall complication rate. From this radiographic review, we have created a checklist for cochlear implant surgeons in order to highlight key features that need to be recognized in the temporal bone scan in preoperative evaluation of cochlear implant candidates.

CT and MRI of stroke.

A review of the CT and MRI features of stroke imaging is presented. The pathophysiology of stroke is discussed as a basis for understanding the neuroimaging findings. Neuroimaging is divided according to the time interval between ictus and imaging: hyperacute, acute, subacute, and chronic. Newer MR stroke imaging techniques such as perfusion imaging and diffusion-weighted imaging are presented.

Endovascular treatment of epistaxis in a patient with tuberculosis and a giant petrous carotid pseudoaneurysm.

A 31-year-old man with pulmonary tuberculosis who did not have human immunodeficiency virus had massive epistaxis from a giant petrous internal carotid artery pseudoaneurysm. Endovascular trapping of the aneurysm was performed, curing the epistaxis. MR showed multiple enhancing brain lesions that resolved with additional antituberculous drug therapy.

Results of the 1993 survey of the American Association of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: A survey of chief residents of academic radiology programs is conducted annually on behalf of the American Association of Academic Chief Residents in Radiology (A3CR2). Data are obtained to improve the training of diagnostic radiology residents and to increase the understanding of radiologists and their associates about issues of interest to radiologists in training. METHODS: Questionnaires were mailed to 133 accredited programs in the United States and Canada. A wide variety of demographic and common interest questions were asked. The analysis took into account geographic location of the responders and the size of the residency program. Comparisons were made to the data from prior years. RESULTS: Completed surveys from 93 programs (70%) were returned. The percentage of women residents is increasing. Important regional and size variations exist in several areas including salary, workload, prior clinical training, resident/fellow ratios, post residency plans, and call schedules. Although many chief residents feel knowledgeable about the health care system, opinions about the future of radiology and medical care are tentative. CONCLUSIONS: This survey provides important demographic information about academic radiology residency programs. The summary information regarding plans for fellowship training, resident call schedules, and opinions about socioeconomic issues may be useful for chief residents, program directors, and departmental chairmen.

Tubular communicating duplications of esophagus and stomach.

A child with vertebral anomalies and tubular communicating duplications of the esophagus and stomach had a post-natal ultrasound interpreted as normal. This complex anomaly was delineated by barium studies and surgically confirmed.

Multiple end labeling of oligonucleotides with terbium chelate-substituted psoralen for time-resolved fluorescence detection.

A new procedure for the photochemical functionalization and the subsequent nonradioactive labeling of synthetic oligonucleotides with psoralen derivatives was developed where a double-stranded poly(A-T) tail is attached to the 5'- or 3'-end of the oligonucleotide to be labeled. The double-stranded poly(A-T) tail is covalently crosslinked by psoralen molecules which carry reactive thiol or amino groups for the attachment of labels. A NH2-specific terbium chelate exhibiting long-lived fluorescence was attached to the functional groups of the intercalated psoralen molecules. Oligonucleotides substituted in this way hybridize readily and can be sensitively detected by time-resolved fluorescence measurements.