Occurrence of bacteria and polymorphonuclear leukocytes in fetal compartments at parturition; relationships with foal and mare health in the peripartum period.

This study investigated the relationship of the health of the newborn foal and (1) number of polymorphonuclear leukocytes (PMNLs) in the amniotic fluid, (2) bacteria present in the amniotic fluid and the venous umbilical blood, and (3) bacteria present in the uterus of the newly foaled mare. A further aim was to investigate relationships between the bacteriologic findings in the amniotic fluid, umbilical blood, and uterus postpartum. Samples were taken from 50 Standardbred trotter foaling mares from a well-managed stud in Sweden. Parturition was spontaneous in all cases. Length of pregnancy, parturition and postpartum complications, health status of the foal, the time between foaling and the expulsion of the placenta, and the number of postfoaling mares becoming pregnant after insemination were recorded. Amniotic fluid was collected when the amniotic vesicle was clearly visible; it was analyzed for bacteriology and occurrence of PMNLs. Umbilical blood was analyzed for the presence of bacteria and the concentration of serum amyloid A. The uterus of the mare was swabbed for bacteriology 6 to 17 hours postpartum. A blood sample was taken from the foal before administering plasma. The foals were divided into two groups: group 1 required up to 2 hours to rise after birth (≤2 hours; 31 foals) and group 2 required more than two hours (>2 hours; 19 foals). The length of gestation varied between 332 and 356 days; there was no significant difference in gestation length between the two foal groups. Partus and postpartum complications occurred in a significantly higher proportion of mares giving birth to group 2 foals than group 1 foals (P = 0.02), although uterine culture postpartum and the subsequent pregnancy rate per season were not different between the groups. Compromised health status was significantly higher among foals belonging to group 2 than group 1 (P = 0.001). Most of the amniotic samples contained 5% or less PMNLs. Only three samples contained more than 30% PMNLs; group 2 foals had the highest percentage of PMNLs. Bacterial growth was found in both amniotic fluid (57%) and umbilical blood (35%) in mares irrespective of whether their foals were healthy or compromised. Coagulase-negative staphylococci were the most frequent bacteria. There were no differences in bacterial occurrence in amniotic fluid or in umbilical blood between the two foal groups.

Diversity of spore-forming bacteria in cattle manure, slaughterhouse waste and samples from biogas plants.

AIMS: As biowaste intended for biogas production can contain pathogenic micro-organisms, the recommended treatment is pasteurization at 70°C for 60min. This reduces pathogens such as Salmonella spp., whereas spore-forming bacteria (Bacillus spp. and Clostridium spp.) survive. Most spore-forming bacteria are harmless, but some can cause diseases such as blackleg, botulism and anthrax. In this study, the effect of the biogas process on Bacillus spp. and Clostridium spp. was investigated. METHODS AND RESULTS: We analysed 97 faecal samples, 20 slaughterhouse waste samples and 60 samples collected at different stages in the biogas process. Bacillus spp. and Clostridium spp. were quantified and subcultured. The isolates were identified by biochemical methods and by 16S rRNA gene sequencing. Phylogenetic trees were constructed from the sequences obtained from isolates from the samples. Clostridium botulinum/Clostridium spp. and Clostridium sordellii were found both before and after pasteurization, but not after digestion (AD). Some of the isolated strains probably represented new members of the genera Clostridium and Bacillus. CONCLUSION: After digestion, the numbers of clostridia decreased, but none of the pathogenic bacteria did, whereas Bacillus spp. remained constant during the process. SIGNIFICANCE AND IMPACT OF THE STUDY: Biogas is gaining in importance as an energy source and because the residues are used as fertilizers, we needed to study the prevalence of pathogenic bacteria in such material.

Detection and identification by PCR of Clostridium chauvoei in clinical isolates, bovine faeces and substrates from biogas plant.

BACKGROUND: Clostridium chauvoei causes blackleg, an acute disease associated with high mortality in ruminants. The apparent primary port of entry is oral, during grazing on pasture contaminated by spores. Cases of blackleg can occur year after year on contaminated pastures. A method to determine the prevalence of C. chauvoei spores on pasture would be useful.The standard method for C. chauvoei detection is culture and biochemical identification, which requires a pure culture. In most muscle samples from cattle dead from blackleg the amount of C. chauvoei in samples is high and the bacterium can easily be cultured, although some samples may be contaminated. Detection by PCR would be faster and independent of contaminating flora.Digested residues from biogas plants provide an excellent fertiliser, but it is known that spore-forming baeria such as Clostridium spp. are not reduced by pasteurisation. The use of digested residues as fertiliser may contribute to the spread of C. chauvoei. Soil, manure and substrate from biogas plants are contaminated with other anaerobic bacteria which outgrow C. chauvoei. Therefore, detection by PCR is would be useful. This study applied a PCR-based method to detect of C. chauvoei in 25 muscle and blood samples, 114 manure samples, 84 soil samples and 33 samples from the biogas process. METHODS: Muscle tissues from suspected cases of blackleg were analysed both by the standard culture method followed by biochemical identification and by PCR, with and without preculture. To investigate whether muscle tissue samples are necessary, samples taken by swabs were also investigated. Samples from a biogas plant and manure and soil from farms were analysed by culture followed by PCR. The farms had proven cases of blackleg. For detection of C. chauvoei in the samples, a specific PCR primer pair complementary to the spacer region of the 16S-23S rRNA gene was used. RESULTS: Clostridium chauvoei was detected in 32% of muscle samples analysed by culture with identification by biochemical methods and in 56% of cases by culture in combination with PCR. Clostridium chauvoei was detected in 3 (out of 11) samples from the biogas plants collected before pasteurisation, but samples taken after pasteurisation and after digestion all tested negative. Clostridium chauvoei was not detected in any soil or silage samples and only one manure samples tested positive. CONCLUSION: The diagnostic method used for C. chauvoei was not applicable in estimating the risk of blackleg on particular pastures from manure or soil samples, but found to be highly useful for clinical samples.

The potential for disinfection of separated faecal matter by urea and by peracetic acid for hygienic nutrient recycling.

No efficient, reliable, and scale independent disinfection methods for toilet waste are available today for safe recycling of plant nutrients. Therefore, two chemical treatment methods, addition of urea or of PAA (a quaternary mixture of 15% peracetic acid, 15% hydrogen peroxide and 30% acetic acid), were evaluated for disinfection of faecal matter.Degradation of the added urea resulted in 30 g of ammonia nitrogen per kilogram of treated matter and a pH increase to approximately 9.3. This produced an efficient disinfection of E. coli, Enterococcus spp., and Salmonella spp. within 3 weeks (>6log(10) reduction) and a reduction of the chemical resistant Salmonella typhimurium 28b phage, corresponding to a decimal reduction within 7.5 days. No viable Ascaris suum eggs were found after 50 days of treatment. No reduction of spore forming Clostridia spp. was observed. Urea treatment proved to be efficient for disinfection of source separated faecal matter in a scale independent method used for safe recycling of nutrients found in the faecal matter.PAA reduced all of the above indicator organisms within 12 h after application. For this faecal material, with a dry matter content of approximately 10%, an addition of 0.5-1% of PAA (active substance, corresponding to 3.3-6.7% of the Proxitane 15 used) was required before no viable organisms were found in the material. However, this was not tested for the A. suum. No viable spore-forming bacteria or phages were detected. A high rate of bacteria regrowth occurred at 0.15% dosage and 5 days of treatment. PAA is an efficient alternative for disinfection of separated faeces if a rapid treatment is needed.

Holotranscobalamin - a sensitive marker of cobalamin malabsorption.

BACKGROUND: No simple and reliable method of identifying patients with cobalamin malabsorption is available at present. The measurement of plasma holotranscobalamin, i.e. the metabolically active cobalamins bound to the transport protein transcobalamin, has been suggested as a means of fulfilling such criteria. DESIGN: We describe a method that directly quantifies cobalamins attached to transcobalamin. The method is evaluated in patients referred for gastrointestinal examination because of suspected cobalamin malabsorption. RESULTS: Of the 101 patients referred, all 48 with gastrointestinal conditions compatible with cobalamin malabsorption had plasma holotranscobalamin below 35 pmol L-1 (interval of 35-160pmol L-1). None of the patients with plasma holotranscobalamin above the lower reference limit had conditions compatible with cobalamin malabsorption. CONCLUSION: The values obtained for plasma holotranscobalamin showed a better correlation with possible malabsorption than the values obtained for plasma cobalamins. The specificity of the test, however, needs to be elucidated further.

Clinical validation of self-reported osteoarthritis.

OBJECTIVE: To evaluate the use of a postal survey to detect subjects in the community with osteoarthritis (OA) and the ability of metrologists to detect clinical OA. METHODS: Questionnaires were posted to a random sample of residents of the Northern Sydney Health Area, aged 45-64 years old, asking for details of musculoskeletal complaints and diagnoses. A questionnaire definition of OA was made if 'osteoarthritis' was reported or 'degenerative arthritis', 'joints wearing' out together with pain in joints during the previous 6 months. Hands, hips, and knees of 106 subjects were examined by one of two trained metrologists according to ACR clinical criteria for OA. A second subsample was examined by two metrologists and two rheumatologists independently to test for inter-observer variation. Data were analyzed for percentage agreement and concordance using the kappa statistic. RESULTS: After two mailouts, 59% responded (526 males and 796 females). Definite OA (excluding spine alone) was reported by 52 males (10%), 155 females (19.5%) and possible OA by 62 males (11.8%), 164 females (20.6%). Following examination, 81% of self-reported 'definite' OA was confirmed, while 57% of 'possibles' and one self-reported 'negative' were determined to have clinical OA. Reporting of specific joint OA was less reliable than the highly reliable self-reporting of general OA. Good agreement was demonstrated between rheumatologists and metrologists in the clinical diagnosis. CONCLUSION: Postal questionnaires have the potential to detect OA in the community. The clinical diagnosis can be confirmed by a trained metrologist. Further evaluation of this instrument is warranted in other populations.

Low growth hormone secretion in patients with fibromyalgia--a preliminary report on 10 patients and 10 controls.

OBJECTIVE: To evaluate the secretion of growth hormone in patients with fibromyalgia (FM). METHODS: Serum concentrations of growth hormone (24 h profiles), insulin-like growth factor I (IGF), and IGF binding protein-3 were determined in 10 women with FM and in 10 healthy controls. Quality of sleep was assessed by means of a visual analog scale. RESULTS: Sleep was significantly more disturbed in the patients than in controls. A significantly lower secretion of growth hormone was found in the patients in comparison with healthy controls. CONCLUSION: These results suggest that growth hormone secretion is decreased in patients with FM. Substitution therapy with low doses of growth hormone may be worth evaluating in the treatment of FM.

Schilling and protein-bound cobalamin absorption tests are poor instruments for diagnosing cobalamin malabsorption.

OBJECTIVES: To assess the advantage of a protein-bound cobalamin absorption test (PBAT) over the Schilling test in patients with suspected cobalamin (vitamin B12) malabsorption. DESIGN: Clinical study of consecutive patients referred from primary care units, medical and neurological clinics. SETTING: The catchment area of Sahlgrenska University Hospital, Göteborg. SUBJECTS: Referred patients (n = 155) with suspected cobalamin deficiency and at least one serum cobalamin value < 200 pmol L-1. INTERVENTIONS: All patients were investigated with upper gastrointestinal endoscopy with biopsies taken from the gastric body and duodenal mucosa. Serum methylmalonic acid (MMA) and homocysteine (Hcy) were determined in all 109 patients not on cobalamin substitution. A dual isotope cobalamin absorption test was then performed with the concomitant administration of crystalline (Schilling) and protein-bound cobalamin (PBAT). MAIN OUTCOME MEASURES: Number of patients with gastric body atrophy diagnosed with each absorption test and the relation between these results and functional cobalamin deficiency defined as elevated MMA and Hcy, that normalized after cobalamin substitution treatment. RESULTS: The majority of patients with abnormal absorption tests had already developed elevated MMA and/or Hcy. PBAT was more sensitive than the Schilling test in identifying patients with gastric body atrophy but the sensitivity was too low for clinical use. About 1/3 of the patients with gastric body atrophy and normal absorption tests had elevated MMA and/or Hcy, indicating cobalamin deficiency. CONCLUSION: PBAT may be somewhat more sensitive than the Schilling test but neither test is sensitive enough for diagnosing cobalamin malabsorption at an early stage.

Are rheumatoid arthritis patients more willing to accept non-steroidal anti-inflammatory drug treatment risks than osteoarthritis patients?

One hundred and thirty-four patients with either osteoarthritis or rheumatoid arthritis, and with a history of current or past non-steroidal anti-inflammatory drug (NSAID) treatment, were interviewed regarding the benefits, expectations and side-effects of NSAID therapy. Their willingness to accept risks in medical treatment was also evaluated. Both groups experienced positive effects of the NSAID treatment corresponding to their expectations. However, rheumatoid arthritis patients were significantly more willing to accept gastrointestinal side-effects when given an effective NSAID than the osteoarthritis patients, and they were also more willing to take risks in trying a hypothetical new NSAID that had been shown to be effective in clinical trials.

Cost of open versus laparoscopically assisted right hemicolectomy for cancer.

The aim of this study was to estimate and compare the costs of open right hemicolectomy (ORHC) versus laparoscopically assisted right hemicolectomy (LARHC) performed for cancer. A retrospective cost analysis of 61 consecutive patients operated on between January 1992 and August 1994 for right-sided colonic cancer by either LARHC (n = 28) or ORHC (n = 33) was performed. The analysis focused on the cost (in Australian dollars) incurred from the date of operation to the date of discharge. LARHC was significantly more expensive than ORHC (total cost LARHC $9064, ORHC $7881; p < 0.001). LARHC was associated with a significantly longer operating room utilization time (LARHC 261 minutes, ORHC 203 minutes; p < 0.001) and a greater cost of disposables (LARHC $854, ORHC $189; p < 0.001). This study demonstrates no cost benefit for LARHC compared to ORHC when performed for cancer.

Intra-articular administration of polyclonal immunoglobulin G in rheumatoid arthritis. A double-blind, placebo-controlled pilot study.

The aim of our study was to assess local anti-inflammatory effects of high dose immunoglobulin G (IgG) in rheumatoid arthritis (RA). Eleven patients with definite RA, having flare-up of knee joint synovitis, were included in the study. Six received an intra-articular injection of 1 g of IgG in 10 ml saline and five received an intra-articular injection of 10 ml physiological saline alone. The effect of the treatment was evaluated clinically and by magnetic resonance imaging using gadolinium contrast enhancement. In one of the six patients that received intra-articular IgG and one of the five patients that received physiologic saline a modest decrease of synovial hypertrophy was noted. None of the patients experienced clinical signs of increased joint inflammation as a consequence of the treatment procedures. The results of this pilot, double-blind, placebo-controlled study do not support local administration of IgG as an anti-inflammatory treatment in patients with RA.

Osteoarthritis in older patients. Optimum treatment.

A number of therapeutic options to control pain, maintain function and decrease disability are available for older patients with osteoarthritis. The indication for pharmacological therapy should be restricted to periods with pain. Great attention should be given to nonpharmacological interventions such as education, exercise, lifestyle modification and emotional support. If medication is necessary, most patients require only pure analgesics such as paracetamol (acetaminophen); nonsteroidal anti-inflammatory drugs (NSAIDs) should be used if patients do not respond to simpler measures. All medication should be carefully monitored considering the frequency of adverse drug reactions in older patients.

The prevalence of radiographic osteoarthritis is low in elderly patients with growth hormone deficiency.

The prevalence of radiographic osteoarthritis in hand and knee joints was studied in elderly patients with acromegaly and growth hormone deficiency, respectively, and compared with a normal population of elderly people. There were no major differences in the prevalence of osteoarthritis between the acromegalics and the normal population, but the patients with growth hormone deficiency had significantly (p < 0.001) less osteoarthritis than the normal population. The lack of differences between the acromegalics and the normal population could be an effect of the age interval studied in which the prevalence of osteoarthritis is high. The low prevalence of osteoarthritis in patients with growth hormone deficiency suggests that growth hormone is an important factor in the development of osteoarthritis.

Radiographic osteoarthritis in the elderly. A cohort comparison and a longitudinal study of the "70-year old people in Göteborg".

The prevalence of radiographic osteoarthritis in hand and knee joints was studied in representative subsamples of the 75 and 79 year old population of Göteborg, Sweden. A comparison between two cohorts of 79-year-olds, revealed no significant difference between them. A longitudinal study within one of these cohorts including those aged between 75 and 79 showed a modest but not statistically significant progression of osteoarthritis in hand and knee joints. The results suggest a reduced progression of osteoarthritis after 75 years of age.

A longitudinal study of the occurrence of joint complaints in elderly people.

Joint complaints were studied in two cohorts longitudinally followed at 4-5 year intervals between the ages of 70 and 79, representative of the elderly population of Göteborg, Sweden. Joint complaints were reported by 30-43% of the women and by 15-25% of the men. A significant increase of joint complaints was found in both sexes between the ages of 70 and 75 but not thereafter. The knee joints were the most common site of complaints in both sexes. Complaints were not consistently reported by the probands at all examinations, however, and a 'disappearance' of complaints with age was found. Complaints on all three occasions were reported by 15% of the women and 3% of the men. An association was observed between repeatedly reported complaints and radiographic osteoarthritis as well as with self-reported rheumatoid arthritis.

Prevalence of radiographic osteoarthritis in two elderly European populations.

Was compared the prevalence of radiographic osteoarthritis (ROA) in two elderly populations, one in Göteborg (Sweden) and one in Zoetermeer (The Netherlands). The comparison was preceded by an inter-observed analysis of 150 films, revealing lower percentage agreements and kappa values when analysing the films on a five-point scale compared to the analysis in a dichotomy of "abnormal" and "normal" films. An intra-observer analysis of 50 films revealed higher percentage agreement and kappa values of well over 0.75, suggesting that radiographs could be read by one observer when different populations are being compared. The prevalence of hand ROA was higher in the Göteborg population, while the prevalence of knee ROA showed no significant differences. No significant increase with age of the cohorts was found for hand ROA in either population and no increase with age for knee ROA was found in the Swedish population. In the Zoetermeer population, knee ROA increased with age in both sexes.

Factors associated with radiographic osteoarthritis: results from the population study 70-year-old people in Göteborg.

Selected factors potentially associated with radiographic osteoarthritis (OA) were studied in 2 subsamples of 79-year-olds, within the longitudinal prospective study 70-year-old People in Göteborg. A very significant (p less than 0.01 in men, p less than 0.001 in women) association was found between radiographic knee OA and body mass index (BMI), and a significant (p less than 0.05) association was also observed between radiographic hand OA and BMI in men. Smoking correlated negatively (p less than 0.01) to radiographic knee OA in both sexes, even after adjusting for BMI. Other factors, including diabetes, ischemic heart disease, hypertension, physical activity, education, vocational training, marital status, serum uric acid, triglycerides, cholesterol and blood glucose levels did not correlate to radiographic OA. Finally, no correlation was found between either decreased bone mineral content or the presence of previous fragility fractures.

Osteoarthritis in the elderly: clinical and radiological findings in 79 and 85 year olds.

The prevalence of joint complaints and clinical and radiological findings of osteoarthritis in wrist, hand, and knee joints was studied in representative population subsamples of 79 and 85 year olds. Joint complaints, clinical findings of osteoarthritis, and radiographic osteoarthritis were more common in women. Age related differences in the prevalence of osteoarthritis were not found. Although there was a correlation between clinical signs of osteoarthritis and radiographic osteoarthritis, clinical signs were often present without radiographic evidence and moderate and severe radiographic osteoarthritis was often present without clinical signs.