Weekend diagnosis of Escherichia coli urinary tract infection does not predict poor outcome.

It has been suggested that mortality is higher in patients admitted to hospitals during the weekend. The objective of this study was to compare outcomes in patients with E. coli urinary tract infection (UTI) depending on the hospital admission day. For this purpose, a secondary analysis of data from a prospective cohort of patients with E. coli UTI was conducted. Weekend diagnosis of UTI was not associated with higher mortality. However, mortality was associated with sepsis, sepsis-induced hypotension and intensive care unit (ICU) admission. Sepsis-induced hypotension and ICU admission were independent determinants of mortality. The results indicate that indicators of severity of illness are associated with higher mortality in patients with UTI rather than the time of diagnosis.

Suicide - a statistical analysis by age, sex and method.

A total of 115 suicide cases dealt with by St. Pancras Coroner's Court, London, UK were studied in order to determine what patterns exist regarding the age and gender of the victims and chosen method of suicide. The results were compared with those of a 1998 study of suicides in England and Wales commissioned by the UK Home Office. It was found that suicides in the male population are approximately twice as common as female victims of suicide. In terms of gross number of cases, the peak age group for both males and females resorting to suicide was found to be the 15-44 age group. When the results were standardised according to 2001 census data, however, the most vulnerable age group per head of population for both sexes was 75 and over. Good agreement was found between the results of this study and those of the Home Office Study.

Patterns of non-firearm homicide.

Sixty-two recent non-firearm homicides dealt with by an inner London public mortuary were studied. The majority of homicides involved stabbing--usually multiple wounds to the trunk. These were followed by blunt instrument homicides--nearly all involved multiple blows to the head, and asphyxiation--usually consisting of strangulation with a ligature being employed in the majority of cases. Homicides tended to occur during the evening and night in spring and early summer. Most victims were found to be in the 20-39 age group, with male victims outnumbering females in a 2:1 ratio. A marked difference in homicide pattern existed between the male and female victims. Males tended to fall victim to strangers encountered while socialising in and around bars and clubs. Females were most often killed by close acquaintances in domestic disputes at home.

Intramedullary ganglioneuroma of spinal cord: a clinicopathologic study.

A case of intramedullary ganglioneuroma, a rare tumor occurring in the cervical spinal cord, is presented, and its histologic and ultrastructural features are discussed. In view of the benign course of ganglioneuroma, as represented in this case, it is important to distinguish this tumor histologically from ganglioglioma, a tumor that is histologically similar but has greater malignant potential. The inherent problems in this distinction are discussed. The embryogenesis of ganglioneuroma of the nervous system is also reviewed.

Antecedent use of fluoroquinolones is associated with resistance to moxifloxacin in Clostridium difficile.

OBJECTIVE: Moxifloxacin is characterized by high activity against Gram-positive cocci and some Gram-positive and -negative anaerobes, including Clostridium difficile. This study investigates the role of prior quinolone use in relation to patterns of susceptibility of C. difficile to moxifloxacin. METHODS: Sixty-three clinical isolates of C. difficile were investigated for toxigenicity, susceptibility to moxifloxacin, and mutations in the DNA gyrase gene. The medical histories for 50 of these patients were available and used to identify previous fluoroquinolone use. RESULTS: Thirty-three (52.4%) strains showed resistance to moxifloxacin (MICs > or = 16 mg/L). All moxifloxacin-resistant strains harbored a mutation at amino acid codon Ser-83 of gyrA. Forty-five isolates (71.4%) were toxigenic; all moxifloxacin-resistant strains were in this group. Resistance to moxifloxacin was associated with prior use of fluoroquinolones (P-value 0.009, chi-square). CONCLUSIONS: Although the use of moxifloxacin to treat C. difficile-associated diarrhea is not likely to be common, these data show a relationship between antecedent fluoroquinolone use and resistance to moxifloxacin in C. difficile isolates, and raise questions regarding selection pressure for resistance placed on colonizing bacteria exposed to fluoroquinolones. Mutations in gyrA are involved in moxifloxacin resistance.

Surgical results in obese patients with sciatica.

A prospective study was done to determine the effect of obesity on the surgical results in patients with intractable sciatica. One hundred ten patients entered the study over an 8-month period. Five patients (1 obese) were excluded. Seventeen patients were included in the obese group. The two populations did not differ in age, sex, occupation, level of disc herniation, involvement of compensation, length of hospitalization, duration of disability, or incidence of surgical complications. At the 6-month follow-up assessment, 14 obese patients vs. 80 nonobese patients rated their surgical results good or excellent. Patients with postoperative weight loss were equally distributed between the groups. The data demonstrate that obesity should not be considered a prognostic factor when patients are eligible for surgical therapy.

Odontoid fractures in elderly patients.

This retrospective analysis describes the clinical characteristics, treatment, and outcome of 19 patients aged 80 years or older with odontoid fractures. The fractures were due to falls in 15 patients (78.9%) and were associated with motor-vehicle accidents in four. Type III fractures were seen in three patients and type II fractures in 16. No patient suffered a neurological injury associated with the fracture. Five patients (26.3%) died during hospitalization; factors contributing to their death included prolonged bed rest, associated injuries, and concomitant medical illnesses. The mean follow-up period in the remaining 14 patients was 28.8 months (range 5 to 72 months). Eight patients with a posterior displacement of 5 mm or less were treated with cervical immobilization, three of whom showed a stable non-union of the fracture site at follow-up review. One patient with 10-mm displacement refused operative treatment. Three of the patients without surgical treatment subsequently died from unrelated causes; all remaining patients resumed their routine activity. Five patients with displacement of 5 mm or greater and instability at the fracture site were treated with posterior cervical fusion of C1-2 using wire and autologous iliac bone grafts. In this group, no operative morbidity or mortality occurred and stable constructs developed in all patients; one patient died from an unrelated cause during the follow-up period and the other patients resumed their normal activity. Prolonged bed rest caused respiratory complications in two of six patients who survived initial hospitalization; two of three patients treated with rigid immobilization developed complications that required alternative treatments.

Vertebral artery rupture associated with closed head injury. Report of two cases.

The authors report two patients with closed head injury who suffered laceration with rupture of the third portion of the vertebral artery. One patient died suddenly, with angiographic evidence of bilateral vertebral artery rupture. The mechanism of injury to the C1-2 segment of the vertebral artery relating to head and neck injury is discussed.

Traumatic peroneal tendon instability.

To investigate the causes of, pathologic changes associated with, and treatment results after traumatic peroneal tendon subluxation or dislocation, we reviewed 11 cases in 10 patients at a mean followup of 29 months. We also describe a technique of superior peroneal retinacular repair combined with fibular rotational osteotomy. Excellent clinical and functional results were achieved in 9 of the 11 cases, enabling the patients to return to previous competitive sports by 3 months. There was one persisting subluxation that required further surgery. Another ankle, with chronic sepsis from previous surgery and documented degeneration of the ankle joint, had a recurrence of the infection and sequestration of the osteotomized fragment. The personal tendons, however, remained stabilized by the resultant scar tissue. We conclude that superior peroneal retinacular repair, with or without fibular rotational osteotomy, is a successful technique in treating both acute and recurrent instability of the peroneal tendons. It can be combined with a Bröstrom repair when there is concurrent peroneal tendon and anterolateral ankle instability. Peroneal tenosynovitis and tendon splitting were commonly found at operation, especially in cases of recurrent instability. The degree of pathologic change in the tendon did not affect the clinical result.

Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy.

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.

The use of DNA statistics in criminal trials.

In a number of recent cases in the UK, convictions have been quashed by the Court of Appeal on the grounds that the jury had been misdirected as to the factual significance of random occurrence statistics. The mathematical basis on which those statistics are calculated was reviewed and recent appeal cases involving DNA evidence in the UK and the US were examined. It was found that a widespread misconception exists regarding the random occurrence ratio and its relationship with probability of guilt. It is in fact impossible to relate the two with any degree of accuracy without consideration of social and demographic factors particular to a case as well as any non-DNA evidence obtained.

Myelopathy associated with fibrocartilaginous emboli (FE): review and two suspected cases.

BACKGROUND: Myelopathy secondary to fibrocartilaginous emboli is rarely reported and has been documented antemortem only once. The pathophysiology of fibrocartilaginous emboli lacks consensus, although the role of trauma has been previously entertained. METHODS: We reviewed the reported cases of myelopathy secondary to fibrocartilaginous emboli. We extensively evaluated two cases of myelopathy in otherwise healthy individuals using myelography and serial magnetic resonance imaging (MRI). Evaluation for underlying systemic disease was conducted in both cases. RESULTS: No evidence of infectious, autoimmune, inflammatory, or neoplastic disease was found in either patient. Furthermore, no other lesions were found in the neuroaxis. Findings on serial MRIs were consistent with vascular lesions thought to be venous strokes. CONCLUSIONS: We report two cases of acute myelopathies associated with heavy lifting, in otherwise healthy young men. Serial MRI studies in each case demonstrated lesions consistent with venous infarcts. We postulate that migration of disc material into the perivertebral venous system was the result of increased intervertebral disc pressure and simultaneous excessive Valsalva associated with heavy lifting. We further postulate that this may be a more prevalent cause of acute myelopathy than previously recognized.

An outbreak of Aujeszky's disease in sheep in Northern Ireland.

An outbreak of Aujeszky's disease occurred in a flock of 160 ewes which had been shorn and housed adjacent to pigs which were excreting Aujeszky's disease virus. The 29 affected sheep developed either the classical 'mad itch' signs associated with Aujeszky's disease in ruminants or signs of encephalitis. Aujeszky's disease virus was isolated from the central nervous system of the affected ewes. Five farm cats also became ill and died. Histological lesions of viral encephalitis were observed in one of the cats and Aujeszky's disease virus was isolated from its brain.

Anaemia and low viability in piglets infected with Eperythrozoon suis.

Eperythrozoon suis infection was identified in a pig herd during an investigation into anaemia and low viability in newborn piglets and severe regenerative macrocytic anaemia in older piglets. The organisms were identified in the erythrocytes of piglets a few days old. Extensive investigations failed to detect other causes of the anaemia and low viability. There was no response to parenteral iron administration alone but the piglets' viability and anaemia responded to the administration of tetracyclines. This is the first report of E suis infection in Northern Ireland.

Clinical signs and radiographic diagnosis of a portosystemic shunt in a foal.

A three-month-old native pony foal had a history of recurrent episodes of bizarre neurological behaviour. The results of clinical examinations were non-specific but clinicopathological investigations indicated hepatic encephalopathy. A percutaneous, needle liver biopsy revealed histopathological changes consistent with a portosystemic shunt, which was later identified by operative mesenteric portovenography, and confirmed at post mortem.

Nasal polyps in a cat.

Ethmoturbinate polyps are described in a one-year-old cat with a four month history of stertorous respiration and frequent sneezing. Remission of clinical signs occurred after rhinotomy and polypectomy. This appears to be the first known case of nasal polyps reported from outside Italy and the USA.

Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria.

BACKGROUND: Infections with vancomycin-resistant enterococci (VRE) are a growing concern in hospitals. The impact of vancomycin resistance in enterococcal urinary tract infection is not well-defined. AIM: To describe the epidemiology of enterococcal bacteriuria in a hospital and compare the clinical picture and patient outcomes depending on vancomycin resistance. METHODS: This was a 6-month prospective cohort study of hospital patients who were admitted with or who developed enterococcal bacteriuria in a 1250-bed tertiary care hospital. We examined clinical presentation, diagnostic work-up, management, and outcomes. FINDINGS: We included 254 patients with enterococcal bacteriuria; 160 (63%) were female and median age was 65 years (range: 17-96). A total of 116 (46%) bacteriurias were hospital-acquired and 145 (57%) catheter-associated. Most patients presented with asymptomatic bacteriuria (ASB) (119; 47%) or pyelonephritis (64; 25%); 51 (20%) had unclassifiable bacteriuria and 20 (8%) had cystitis. Secondary bloodstream infection was detected in 8 (3%) patients. Seventy of 119 (59%) with ASB received antibiotics (mostly vancomycin). There were 74 (29%) VRE bacteriurias. VRE and vancomycin-susceptible enterococci (VSE) produced similar rates of pyelonephritis [19 (25%) vs 45 (25%); P = 0.2], cystitis, and ASB. Outcomes such as ICU transfer [10 (14%) VRE vs 17 (9%) VSE; P = 0.3], hospital length of stay (6.8 vs 5.0 days; P = 0.08), and mortality [10 (14%) vs 13 (7%); P = 0.1] did not vary with vancomycin susceptibility. CONCLUSIONS: Vancomycin resistance did not affect the clinical presentation nor did it impact patient outcomes in this cohort of inpatients with enterococcal bacteriuria. Almost half of our cohort had enterococcal ASB; more than 50% of these asymptomatic patients received unnecessary antibiotics. Antimicrobial stewardship efforts should address overtreatment of enterococcal bacteriurias.