Group Milleri Streptococci in perianal infections.

BACKGROUND: Anal abscesses are commonly associated with fistulas-in-ano and are usually polymicrobial in nature, with gram-negative rods and anaerobes being the most prevalent isolates. Group Milleri Streptococci (GMS) comprise a heterogeneous group of cocci, which are capable of causing severe purulent infection with a high recurrence rate. METHOD: All anorectal infections caused by GMS, which were identified at our centre during a 4-year period were retrospectively analysed. The 18 patients with GMS-positive anorectal abscesses were matched with 36 GMS-negative anorectal abscesses to identify outcome characteristics of this clinical entity. RESULTS: During the study period, 358 patients underwent surgical treatment for anal infections; GMS were isolated in 46 individuals (13%) including 18 perianal abscesses, 11 pilonidal sinuses, eight fistulae in and nine miscellaneous infections. Seventy-two per cent of perianal GMS infections were polymicrobial with E. coli and Bacteroides fragilis being the predominant second bacteria. Nine patients (20%) developed recurrent abscesses and fistulae-in-ano and underwent additional surgical interventions with resolution at follow-up. Additional antibiotic treatment was administered in 10 patients with complex anal infections. Matched pair analysis revealed that GMS-positive perianal abscesses were more commonly polymicrobial, and that the recurrence rate was higher (55.6% GMS-positive and 22.2% GMS-negative patients, P = 0.017). CONCLUSIONS: Our data confirm the propensity of GMS to form deep and recurrent abscesses with a higher recurrence rate than non-GMS infections. First-line treatment includes surgical drainage, and antibiotic treatment may be useful in selected patients.

Laparoscopic gastric banding in a kidney-pancreas transplant recipient with new onset type II diabetes mellitus associated with morbid obesity.

Combined kidney-pancreas transplantation is the treatment of choice for end-stage diabetic nephropathy. Post-transplant weight gain increases the risk for post-transplant complications and death owing to cardiovascular events. Gastric banding is an established treatment for moderate morbid obesity. We report on a patient who experienced significant weight gain and developed type II diabetes mellitus following successful kidney-pancreas transplantation. He underwent laparoscopic gastric banding and initially had good weight loss. However, lack of compliance with dietary guidelines led to transient failure of weight loss therapy. With further adjustment of the gastric band good weight loss was achieved.

Rotavirus enteritis in solid organ transplant recipients: an underestimated problem?

BACKGROUND: Diarrhea in solid organ transplantation can be a complication with a high morbidity and mortality. Rotavirus (RV) infection normally occurs in children up to 3 years of age and often presents with severe diarrhea; however, it can also affect adults. We investigated the prevalence and outcome of RV infections in both adult and pediatric patients after solid organ transplantation. PATIENTS AND METHODS: Retrospective analysis of RV-related enteritis in solid organ transplant recipients with a minimum of a 1-year follow-up from a single center between 2000 and 2004. RESULTS: Within our cohort of 1303 solid organ transplants, RV infection was observed in 19 patients (1.5%); 14 of these were liver recipients. Infection was most prevalent among pediatric liver recipients, with 52% (11/21) of the children affected. Five adults acquired the infection during their initial hospitalization. Two adult patients had to be readmitted following late-onset RV infection. In all cases, infection was self-limiting, but led to prolonged hospitalization because of significant loss of fluids and electrolytes. CONCLUSIONS: RV enteritis is a common infection in pediatric solid organ recipients but may also affect adult patients.

Are acetylcholine-induced acetyl groups driving fuel cells in the systems of transducin, t and G proteins?

Life is completely dependent on a support of energy which is generated by the direct absorption of light or by the reduction of oxygen. Metabolized food yields ac(et)yl groups which are utilized in the reduction of oxygen with the assistance of many other compounds. Acetylcholine appears to be an important substance for the transportation of acetyl groups. Acetylcholine activates systems regulated by transducin, t and G proteins, probably Se enzymes, reacting by similar mechanisms in triggered reactions ending in nerve or muscle signals. These activations are performed by GTP (or ATP), probably resulting from the reactions of acetylcholine-induced acetyl groups. The inactivation-activation states of these systems are regulated by changes of GTP to cGMP to GMP which form a loop.Diminished support of energy to systems, because of impaired charge transfer to oxygen, may be responsible for many diseases. For example, there is a low level of acetylcholine in the brains of patients with Alzheimer's disease.

Is molecular oxygen, O(2), the reactive radical behind oxidations of (aut)oxidable agents to which the bases of DNA belong?

The transfer of charges to reducible oxygen plays a basic role in the supply of energy to living organisms. These electron transfer (ET) reactions may be performed by selenium (Se) enzymes and autoxidable agents. Among the molecules which have satisfactory structures for this purpose are (hypo)xanthine, dopamine (DA), serotonin, arginine, creatine, thyroid hormones T(2)/T(3)/T(4) and the bases of DNA. Single-strand DNA breaks may be initiated by these reactions to yield the bases for the transfer of charges. But a high rate of DNA single-strand breaks may be caused by destructive oxidations. If the activity of the O(2) protective enzymes (Se enzymes such as gluthatione peroxidase (Gpx), superoxide dismutase (SOD) and catalase) is limited, the oxygen species H(2)O(2), O(2)(-) and OH generate free O(2). I believe that randomized oxidations are performed by the radical O(2) (two unshared orbitals) when it is not enzyme protected. Among the substances exposed to oxidation are the autoxidable agents. Are the bases of DNA and RNA to be included in these, taking part in ET reactions?

Oral induction of anesthesia with droperidol and transmucosal carfentanil citrate in chimpanzees (Pan troglodytes).

Five chimpanzees (Pan troglodytes) initially received oral droperidol sedation (1.25 mg for a juvenile chimpanzee, body wt = 18.5 kg, and 2.5 mg for adults, body wt >20 kg, range: 18.5-71 kg) followed by transmucosal carfentanil administration at 2.0 microg/kg. This preinduction regimen was developed to produce heavy sedation or even light anesthesia in order to eliminate the need for or at least minimize the stress of darting with tiletamine/zolazepam at 3 mg/kg i.m. This study was designed to assess the safety and efficacy of transmucosal carfentanil. Once each animal was unresponsive to external stimuli, or at approximately 25 min (range 24-34 min) after carfentanil administration, naltrexone and tiletamine/zolazepam (N/T/Z) were combined into one intramuscular injection for anesthetic induction. Naltrexone was administered at 100 times the carfentanil dose in milligrams. For comparison, two chimpanzees received only droperidol, 2.5 mg p.o., followed by tiletamine/zolazepam, 3 mg/kg i.m. The preinduction period for all animals receiving carfentanil was characterized as smooth, with chimpanzees becoming gradually less active and less responsive to external stimuli. Two animals became very heavily sedated at 24 and 35 min, respectively, and were hand injected with N/T/Z. The other three chimpanzees became sternally recumbent but retained some response to stimuli, and N/T/Z was administered by remote injection with minimal response. Rectal body temperatures, pulse and respiratory rates, arterial oxygen hemoglobin saturation, and arterial blood gases were measured at initial contact (t = 0 min) and at 10-min intervals thereafter. Respiratory depression was present in all chimpanzees, regardless of protocol. Mean hemoglobin saturation was 91% for both groups. Mean partial pressure of oxygen, arterial values for carfentanil-treated and control animals were 64.4 +/- 7.6 and 63.5 +/- 6.0 at t = 0, respectively. Only the partial pressure of carbon dioxide, arterial (Paco2) and pH showed significant differences between treated and control animals. Mean Paco2 was greater and mean pH lower for the carfentanil-treated group compared with the controls at t = 0 (58.9 +/- 3.7 and 50.3 +/- 3.1 for Paco2 and 7.33 +/- 0.02 and 7.40 +/- 0.30 for pH, respectively). The results of this study suggest that oral droperidol followed by transmucosal carfentanil can be used effectively as a premedication regimen to produce profound sedation, which limits the stress of darting during parenteral anesthetic induction with tiletamine/zolazepam in chimpanzees. The main side effect of respiratory depression appears to be adequately managed by reversing the carfentanil at the time of induction.

The selenium link: the missing link in our understanding of biochemical trigger reactions?

'Inorganic' selenium (Se), e.g. selenite and selenate, is assumed to be transformed into selenide and to be incorporated into selenoproteins, but this has never been proved. There is evidence, however, that vitamin C reduces selenite to elemental Se. Elemental sulphur (S) and Se bind easily to sulphides and selenides, forming links containing two or more S or Se atoms. Such links exist in natural minerals and have been found in proteins in living organisms. There are many indications that selenocysteine in special proteins combines with elemental Se to form Se links that transfer electrons from redoxable agents to oxygen (O2). This implies a reduction to hydrogen peroxide (H2O2) or H2O, while gaining energy and achieving trigger effects. H2O2 supplies anaerobic reactions with energy eventually via adenosine 5'-triphosphate (ATP) or guanosine 5'-triphosphate (GTP). Without Se links, redoxable agents can be oxidized by oxygen, which leads to the formation of oxygen products and inhibition of further electron transference. Nitrous oxide (NO) is one product of oxidation that, firmly binding to heme structures, may result in a system of protection. NO can prevent O2 from binding to them and thereby stop destroying oxidations.

Survival and development of larval Onchocerca volvulus in diffusion chambers implanted in primate and rodent hosts.

Third-stage larvae (L3) of Onchocerca volvulus were implanted in diffusion chambers in chimpanzees, mangabey monkeys, rhesus monkeys, squirrel monkeys, and inbred strains of mice, jirds, and rats for 3-63 days. At different times during the experimental period, larvae were recovered and assessed for their viability and development. Survival and growth rates were equal regardless of whether the implanted larvae were fresh or cryopreserved. Survival and growth rates of the larvae did not differ among the primate and rodent hosts tested, with the exception of squirrel monkeys and rats, which were resistant to infection. Molting from L3 to fourth-stage larvae began on day 3 and continued through day 14 in the primates and rodents. The primate and rodent models developed in the present study will be useful for the study of the immunology and chemotherapy of onchocerciasis.

Cytologic assessment of tumor cell kinetics: applications of monoclonal antibody Ki-67 to fine-needle aspiration smears.

Rates of tumor-cell proliferation often provide prognostic information about a given neoplasm. Previously available methods for accessing cell kinetics are time consuming and expensive, and often require special equipment or radioactive reagents. Monoclonal antibody Ki-67 binds a nuclear antigen expressed in proliferating but not in resting cells. We studied Ki-67 immunostaining of fine-needle aspiration smears from 40 benign and malignant masses. Labeling indices ranged from 0 (thyroid follicular adenoma) to 75 percent (pulmonary oat-cell carcinoma). Frozen section immunostaining (11 cases) and flow cytometric assessment of cell proliferation (8 cases) were in good agreement with Ki-67 labeling indices on smear material. We suggest that this method provides a rapid, inexpensive, and dependable means of assessing tumor-cell kinetics in cytologic preparations.

Clear PMMA versus yellow intraocular lens material. An electrophysiologic study on pigmented rabbits regarding "the blue light hazard".

Pigmented rabbits were exposed for 3.5 h to light (retinal irradiance 60-70 mW/cm2, i.e. below the level of thermal damage) from a Xenon lamp, passing IR filters and a fiber optic system as well as a Perspex CQ (clear PMMA) IOL material in front of one of the eyes (the "PER" eye) and a yellow (blue light absorbing) filter (potential IOL material) in front of the other eye (the "YEL" eye). The difference in spectral distribution of light transmitted by the two filters may be important. Does the yellow filter offer significant protection against "the blue light hazard"? DC ERG recordings were performed before, 1 day after and 4-6 days after exposure. The c- (mainly pigment epithelium (PE)) and b-wave (neuroretina) amplitudes were measured and the cPER/cYEL as well as the bPER/bYEL ratios calculated. Both ratios were found to be reduced after exposure, for the c-wave 30-33% (p less than 0.05 - 0.001), and for the b-wave 12-20% (p less than 0.01 - 0.02). This means that both the PE and the neuroretina were injured in the PER eye, the PE more than the neuroretina. At day 4-6 the c- and b-wave ratios were found to have returned to initial levels, indicating that the damage was reversible to a large extent. Thus, the yellow filter offered a better protection than the Perspex material. There were no ophthalmoscopic fundal changes 1-2 h after exposure. After 1 day minimal changes were seen in 3/16 YEL eyes and somewhat more pronounced changes in 8/16 PER eyes, all in the central fundus. The conclusion is that in acute experiments and under the conditions applied the yellow filter protected the PE and the retina against photochemical light injury (mainly "the blue light hazard") significantly better than the Perspex material. Furthermore, the yellow filter was found to protect significantly better than a UV absorbing IOL material.

Evaluation of chimpanzee antiserum to human carcinoembryonic antigen.

An adult chimpanzee (Pan troglodyte) with an endogenous circulating carcinoembryonic antigen (CEA) level of 60 ng/ml was immunized s.c. with human CEA. After 1 year of immunizations, the anti-human CEA antibody titer had plateaued. This chimpanzee antiserum demonstrated high avidity specific recognition of human CEA and showed ionic strength effects for CEA recognition similar to those previously described for goat and baboon anti-CEA antisera. Radioimmunoassay of 93 human plasma samples for CEA content using chimpanzee anti-CEA versus Roche goat anti-CEA antisera gave essentially identical results (R = 0.985). Endogenous CEA in chimpanzee blood was very poorly identified by chimpanzee anti-human CEA antisera compared to Roche goat antisera. Column chromatography of human and chimpanzee CEA in the presence of chimpanzee anti-CEA antibody showed only reactivity for the human CEA. In addition, chimpanzee antiserum had only minimal blocking effect on the binding of either goat or baboon antiserum to human CEA. We conclude from these studies that chimpanzee anti-human CEA antiserum recognized a determinant(s) on human CEA which was different from these recognized by goat or baboon antiserum to human CEA and this determinant(s) was poorly represented on chimpanzee CEA. In contrast, the human CEA determinant(s) recognized by baboon and goat anti-CEA antiserums were readily detected on chimpanzee (CEA).

A proposed Comet Nucleus Penetrator for the Comet Rendezvous Asteroid Flyby mission.

Among the major objectives of NASA's program of space exploration is a better understanding of the origin and evolution of the solar system. Crucial to this objective is the study of comets, which are thought to be the most primitive, pristine bodies remaining in the solar system. The importance of the study of comets has led NASA to plan a mission to rendezvous with comet Tempel 2 in 1997. Critical to the understanding of comets will be measurements of the nucleus material to determine its elemental and isotopic composition, its mechanical properties, and its thermal state and properties. This paper describes a proposal for a Comet Nucleus Penetrator to accomplish these measurement goals. The Comet Nucleus Penetrator will implant instruments into the comet's nucleus beneath a probable volatile-depleted surface mantle into material more representative of the bulk composition of the nucleus.

Lack of transmission of human immunodeficiency virus from infected to uninfected chimpanzees.

Four uninfected chimpanzees were each housed in separate cages with an HIV-infected chimpanzee for six to twenty-nine months. Despite close daily contact, all uninoculated chimpanzees remained seronegative for HIV, and virus was never isolated from peripheral blood mononuclear cells of the uninfected chimpanzees. These data indicate that the probability of transmission from infected animals to humans is extremely low and also provide supportive evidence for lack of transmission of HIV by casual contact.

Carcinoembryonic antigen in nonhuman primates.

Blood levels of carcinoembryonic antigen (CEA) have been measured in several nonhuman primate species. Only gorillas and chimpanzees were found to have significant elevations of CEA-like activity in their blood compared to the normal values of less than 2.5 ng/ml in humans. The average CEA level in 134 chimpanzees was 25.2 ng/ml (range, 4.2--95 ng/ml) and in 13 gorillas it was 32 ng/ml (range, 12.4--61.9 ng/ml). These levels were not related to sex. Blood levels repeatedly taken over a 1 1/2-year period remained relatively stable in both species. Analysis of parallelism of immunologic reactivity showed chimpanzee CEA to be similar to but not identical with human CEA. The molecular size of chimpanzee CEA was also similar to that of human CEA.