Swine influenza-like viruses in turkeys: potential source of virus for humans?

Influenza A viruses (subtype H1N1), recently isolated from turkeys in different areas of the United States, were determined to be closely related to strains typically associated with pigs. This conclusion was based on comparisons of H1N1 isolates from pigs, humans, ducks, and turkeys with polyclonal and monoclonal antibodies, RNA-RNA competitive hybridization, and replication studies. One of the H1N1 isolates from turkeys caused influenza in a laboratory technician, who displayed fever, respiratory illness, virus shedding, and seroconversion. These results suggest that turkeys as well as pigs are involved in the maintenance of these viruses and their transmission to humans.

Mass mortality of harbor seals: pneumonia associated with influenza A virus.

More than 400 harbor seals, most of them immature, died along the New England coast between December 1979 and October 1980 of acute pneumonia associated with influenza virus, A/Seal/Mass/1/180 (H7N7). The virus has avian characteristics, replicates principally in mammals, and causes mild respiratory disease in experimentally infected seals. Concurrent infection with a previously undescribed mycoplasma or adverse environmental conditions may have triggered the epizootic. The similarities between this epizootic and other seal mortalities in the past suggest that these events may be linked by common biological and environmental factors.

Changes in H3 influenza A virus receptor specificity during replication in humans.

Influenza A viruses of the H3 subtype caused the 1968 Hong Kong pandemic, the hemagglutinin (HA) gene being introduced into humans following a reassortment event with an avian virus. Receptor specificity and serum inhibitor sensitivity of the HA of influenza A viruses are linked to the host species. Human H3 viruses preferentially recognize N-acetyl sialic acid linked to galactose by alpha2,6 linkages (Neu5Acalpha2,6Gal) and are sensitive to serum inhibitors, whereas avian and equine viruses preferentially recognize Neu5Acalpha2,3Gal linkages and are resistant to serum inhibitors. We have examined the receptor specificity and serum inhibitor sensitivity of H3 human influenza A viruses from the time they were introduced into the human population to gain insight into the mechanism of viral molecular evolution and host tropism. All of the viruses were sensitive to neutralization and hemagglutination inhibition by horse serum. Early H3 viruses were resistant to pig and rabbit serum inhibitors. Viruses isolated after 1977 were uniformly sensitive to inhibition by pig and rabbit sera. The recognition of Neu5Acalpha2,3Gal or Neu5Acalpha2,6Gal linkages was not correlated with the serum sensitivity. These data showed that the receptor specificity of HA, measured as inhibitor sensitivity, has changed during replication in humans since its introduction from an avian virus.

Balloon dilation of prostatic urethra.

Retrograde balloon catheter dilation of the prostatic urethra was performed for the management of bladder outlet obstruction secondary to prostatic hyperplasia. Of the 55 patients in our series, 43 were treated entirely as outpatients and 12 were inpatients for unrelated conditions. The patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Twenty-two of these patients had Foley catheters for relief of their outflow obstructions. The procedures were performed under local anesthesia or intravenous sedation. Successful results were noted in 46 of 55 patients with relief of symptoms for up to twenty-six months. In 9 cases the procedures were unsuccessful and transurethral resection of the prostate was required.

Balloon dilatation of urethral strictures.

Balloon dilatation of the urethra in 9 male patients with either post-inflammatory or post-traumatic strictures was successfully performed. This procedure is primarily indicated in those patients with unsatisfactory results using conventional dilatation with metal sounds. A flexible endoscope was used for guide wire passage and fluoroscopic guidance for positioning the balloon and assuring complete dilatation of the urethral strictures or vesical neck contracture. In this manner, dilatation to 36 F can be performed in a relatively atraumatic manner with minimal discomfort.

Pneumocalyx following percutaneous nephrostolithotomy.

We present an interesting and unusual case of persistent gas within the renal collecting system occurring two days after percutaneous nephrostolithotomy.

Forceps extraction of ureteral stones.

Ureteroscopy and pyeloscopy in association with ultrasonic lithotripsy for extraction of ureteral stones has, in most instances, eliminated the need for open surgical intervention. Four ureteral stones were successfully extracted by the technique described using flexible cup biopsy forceps introduced through a Teflon sheath. This method was used when basket extraction, ureteroscopy, and other forms of endoscopic stone manipulation were unsuccessful. Two ureteral stones were removed by the transurethral route, and two were removed through a percutaneous nephrostomy tract. There has been little morbidity with this procedure, and patients have returned to normal activity within several days of hospital discharge.

Fibrous mass complicating epidural morphine infusion.

The benefits of continuous epidural morphine infusion using an implanted pump delivery system to control intractable cancer pain have recently been described. Most articles on this subject relate to dosage, technique, degree of pain relief, and tolerance. There are some anticipated complications of the treatment related to the surgical implantation of the system and drug toxicity. We present a complication presumably related to the epidural catheter. A fibrous reaction that developed around the catheter tip progressed into a mass. This caused a significant displacement of the spinal cord with the development of long tract symptoms. Identification of this abnormality using myelography and computed tomography led to prompt surgical decompression resulting in improvement of the patient's condition.