The central nervous system pressure histogram in hydrocephalus and hydromyelia.

This work makes proposals on the relationship between intracranial pressure (ICP) and hydrocephalus that changes over time with the evolution of the disease. This includes the cerebrospinal fluid (CSF) filling mechanism that leads to an increase in mode pressure if excess fluid volume exacerbates the obstructive process. Elevation in mode occurs because pressure in the central nervous system (CNS) represents a state of reduced flow, rather than an abnormality of volume. Diseases that cause elevated mode pressure by means of a primary edema can lead to hydrocephalus if there is sufficient time and obstruction to flow for the filling mechanism to act. Hydrocephalus is driven primarily by labile pressure due to restricted compliance, it can expand skeletal compartments and deplete parenchyma volume as it advances. This hypothesis applies existing principles of water balance. It is part of a series of works that propose a spectrum of hydrocephalic disorders including developmental forms such as achondroplasia with other conditions such as functional trapped fourth ventricle, arachnoid cyst, syringomyelia and normal pressure hydrocephalus (NPH). Links between the conditions can be made by understanding the continuously variable pressure profile local to the cavity that is subject to filling. Fluid lesions of the brain or spine that arise from developmental malformations of the skull have a physiological component. Changes form part of the mechanisms that may compensate the disease process.

Patients' perceived health status following primary surgery for oral and oropharyngeal cancer.

How oral and oropharyngeal cancer patients view their 'quality of life' is of fundamental importance. Any differences seen in their health state compared with normative data and with other disease conditions allows a wider perspective on their outcome after surgery. A cross-sectional postal survey was undertaken of patients treated for oral/oropharyngeal squamous cell carcinoma by primary surgery using the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL v4) and the EuroQol EQ-5D. Of 348 patients surveyed, 224 returned analysable forms, (response rate 64%). In the EQ-5D items, 40% of the group reported a problem in walking, 23% with self-care, 44% in performing usual activities, 50% with pain or discomfort and 33% with anxiety or depression. The mean overall health visual analogue scale (VAS) score was 74 (SE 1) minimum 30 and maximum 100. The mean utility (health index) score was 0.75 (SE 0.02) minimum -0.18 and maximum 1.0. Compared to national reference data, patients in our cohort of under 60 years of age fared significantly worse than expected for their age but this was not so for older patients. There were strong correlations between appropriate domains of the EQ-5D and UW-QOLv4 and between UW-QOL global measures and EQ-5D VAS.

Characterization of a spirochaete isolated from a case of bovine digital dermatitis.

AIMS: The aim of the study was to characterize a spirochaete isolated from the lesions of a cow with digital dermatitis (DD). METHODS AND RESULTS: The characterization was on the basis of its light and electron microscopic appearance, enzymic profile and DNA sequence analysis of its flagellin and 16S rRNA genes. The spirochaete was 6-8-microm long and 0.2-0.3 microm in diameter, and possessed seven to eight periplasmic flagella, with three to five helical turns. The enzymic profile of the bacterium resembles, but is not identical to that of Treponema brennaborense. Its flagellin gene sequence was identical to that of Treponema phagedenis but distinct from that of an ovine spirochaete. Analysis of a 1477-bp region of the 16S rRNA genes indicated that this is a Treponema species and that it is indistinguishable from some isolates made from cases of bovine DD in the United States. Finally, electron microscopy revealed the presence of myovirus-like bacteriophage particles in all cultures of the treponeme examined. CONCLUSIONS: The spirochaete isolate was identified as a Treponema species closely related to some isolates from the United States (by 16S rDNA) and to T. phagedenis (by flagellin gene sequence) and is associated with bacteriophage particles. SIGNIFICANCE AND IMPACT OF THE STUDY: The fact that the isolates with the same or very similar 16S rDNA sequences have been obtained from cases of bovine DD in cattle in different countries at different times, lends further support to the hypothesis that treponemes play a role in the pathogenesis of this disease.

Integrating the Occupational Safety & Health Administration mandates on bloodborne pathogens in the practice setting.

The Occupational Safety & Health Administration Bloodborne Pathogen Standard was developed to reduce the risk of exposure of healthcare workers to hepatitis B and C, human immunodeficiency virus, and other bloodborne pathogens. This can only be achieved if all healthcare workers continue to work to understand, adhere to, and enforce this mandate. The requirements of the Occupational Safety & Health Administration Standard will be discussed, including an exposure control plan, engineering and work practice controls, training, and hepatitis B vaccination. The risk to healthcare workers will be discussed in terms of the relevant pathogens, the extent of contamination, the risks associated with different occupations, and transmissibility. Finally, assessment and management of actual exposure incidents, as mandated by the Occupational Safety & Health Administration Standard, will be described.