Rubella outbreak, Fort Bragg, North Carolina, 1995: a clash of two preventive strategies.

An outbreak of rubella occurred among visiting German troops involved in a combined military exercise at Fort Bragg, North Carolina, in April 1995. Public health and military operational concerns centered on the significant contact the German soldiers had had with host battalion dependents and the impact of the outbreak on the exercise. Ten of the 120 German soldiers were found to be nonimmune; six of these soldiers developed clinical rubella. The four nonimmune soldiers who did not develop skin rashes had received serum immune globulin within 12 hours of identification of the index case. The impact of this outbreak on the Fort Bragg community and its military operations, and the methods used to control the outbreak and salvage the military mission, are described.

Picture archiving communication system does not decrease the number of radiographs needed to evaluate the trauma patient.

BACKGROUND: Picture Archiving Communication System (PACS) is a sophisticated software and hardware package that enables clinicians to retrieve, review, and digitally manipulate radiographs from computer workstations throughout the hospital. PACS was instituted at Brooke Army Medical Center in July 1993. METHODS: Fifty consecutive trauma and 50 consecutive motor vehicle crash (MVC) trauma admissions to an urban trauma center were reviewed before PACS (January 1993) and 18 months after PACS was instituted (January 1995). Patients were compared by the number of radiographs needed during the initial evaluation by type and total. The trauma groups were subdivided by mechanism and also compared. Demographic and physiologic data were collected for each patient. RESULTS: There are no differences in the demographic and physiologic data between groups. For the 50 consecutive trauma admissions, only two areas of statistical difference were found: more chest films were obtained in the MVC PACS group and more pelvis films were obtained in the gunshot wound pre-PACS group. For the 50 consecutive MVC trauma admissions, the PACS group had more chest and total radiographs per patient than the pre-PACS group. More computed tomographic scans of the neck were obtained in the PACS group. CONCLUSION: PACS did not decrease the number of radiographs needed to adequately and fully evaluate the trauma patient.

Management of the brown recluse spider bite to the glans penis.

A significant number of people are bitten by the brown recluse spider (BRS) each year. Medical treatment regimens are sometimes unsatisfactory and surgical intervention is often necessary to debride the necrotic wound. This case study reports the treatment given to a 19-year-old active duty United States Army soldier who suffered a BRS bite to the glans penis. This patient received immediate medical attention and was started on intravenously administered diphenhydramine, methylprednisolone, calcium gluconate, and famotidine. Oral dapsone treatment was begun in the emergency room. Within 24 hours after his injury, the patient received his first hyperbaric oxygen treatment, which was continued twice daily for 5 days. Skin necrosis was avoided, the patient did not require any surgical intervention, and he was discharged after 8 days without sequelae.

IV chenodeoxycholate prevents calcium bilirubinate gallstones during total parenteral nutrition in the prairie dog.

BACKGROUND: The purpose of this study was to determine whether IV chenodeoxycholate (CDC) could prevent total parenteral nutrition (TPN)-associated pigmented gallstones in the prairie dog. METHODS: Twelve prairie dogs were divided into two equal groups, each receiving an identical TPN regimen. Each animal received 92 kcal/d with 61% of the calories from carbohydrate. The total volume of infusate delivered to each animal was 59 mL/d. Animals in one group, termed the TPN + CDC group, received a daily bolus injection of CDC at a dose of 15 mg/kg. Prairie dogs in the second group, termed the TPN group, received water (vehicle carrier) 1 mL/kg/d. The TPN and TPN + CDC groups received TPN for 40.3 +/- 1.3 and 42.5 +/- 0.6 days, respectively. RESULTS: There was no statistical difference in the initial and final weights between the two groups. None of the TPN + CDC-treated animals had gallstones or calcium bilirubinate crystals. In contrast, all of the TPN-treated animals had calcium bilirubinate crystals (p = .002), and five of six had macroscopic black pigmented gallstones (p = .015). Cholesterol crystals were not observed in either group of animals. The amount of biliary bilirubin and ionized calcium was significantly greater in the TPN group (both p < .001); however, both groups had a similar total biliary calcium concentration. CONCLUSION: IV CDC is effective in preventing TPN-associated gallstones in the prairie dog.

Chenodeoxycholate: the bile acid. The drug. a review.

Chenodeoxycholate (3 alpha, 7 alpha-dihydroxy-5 beta-cholanic acid) is a primary bile acid directly synthesized from cholesterol. It is an amphipathic molecule, possessing both a hydrophobic side and a polar hydrophilic side, giving it the ability to solubilize lipids in a water environment. Bile acids are necessary for the absorption of fats and fat soluble vitamins. Chenodeoxycholate inhibits the rate-limiting step of cholesterol synthesis, the formation of hydroxymethyl-glutaryl-coenzyme A. It was first reported to be useful in the dissolution of cholesterol gallstones in 1972. Today, chenodeoxycholate has other medicinal uses and is used for the management of cerebrotendinous xanthomatosis, hypertriglyceremia, congenital liver diseases, rheumatoid arthritis, and constipation. This article details some finer points of chenodeoxycholate biochemistry and physiology and discusses in some detail the current and past clinical uses of chenodeoxycholate. This is not an exhaustive discussion on gallstone dissolution therapies, but an overview of some of the lesser-known uses for this drug.

Hematologic and blood chemistry data for the prairie dog (Cynomys ludovicianus).

1. The prairie dog has been used extensively for the study of gallstone genesis and gallstone dissolution therapies, and has recently been implicated in an effort to prevent total parenteral nutrition-associated cholelithiasis with intravenous chenodeoxycholate. 2. Towards this effort, it is important that a range of normal blood chemistry values be reported for the prairie dog. This paper reports the mean values for a complete blood cell count, electrolytes, blood urea nitrogen, creatinine, calcium, phosphorus, liver enzymes, total bilirubin, protein, albumin, cholesterol, triglycerides and lipids for 45 adult prairie dogs. 3. The prairie dog has normochromic, microcytic blood with an increased number of red blood cells. The prairie dog also has a high concentration of small platelets. 4. The prairie dog has a higher CO2 concentration with a slightly increased potassium concentration than is found in man. The anion gap is 12 with a calculated serum osmolality of 316. The BUN concentration is elevated with a 3-fold increase in the AST concentration. 5. The prairie dog has lower serum values for cholesterol, VLDL and LDL cholesterol than man. In the prairie dog, HDL cholesterol consists of 67% of the total cholesterol concentration and the LDL and HDL ratio is 0.3.

The prevention of cholelithiasis with infused sodium chenodeoxycholate in the prairie dog (Cynomys ludovicianus).

1. This study examines the efficacy of infused sodium chenodeoxycholate to prevent cholesterol gallstone formation in the prairie dog when fed a high cholesterol diet. 2. Three experimental groups were designed to examine this. The first group (N = 5) was fed a normal rat chow diet, the second group (N = 5) was fed a high cholesterol diet (0.4% cholesterol by weight), and the third group (N = 5) was fed a high cholesterol diet plus given a daily injection of intravenous sodium chenodeoxycholate (15 mg/kg). 3. All of the animals in the second group had cholesterol crystals and cholesterol gallstones. In the third group, none of the animals had gallstones, and all but one lacked cholesterol crystals. 4. Statistical analysis showed that the first and third groups were statistically identical in their lithogenic indices and biliary lipid composition. 5. We concluded that infused sodium chenodeoxycholate is effective in preventing cholesterol gallstone formation in the prairie dog when fed a high cholesterol diet.

The quantitative and qualitative analysis for biliary lipids in the prairie dog Cynomys ludovicianus.

1. The quantitative analysis of biliary lipids has been well characterized, however, there is little data related to the qualitative and quantitative analysis of phospholipids and conjugated bile salts for the prairie dog. 2. Gallbladder and hepatic bile were collected and the bile salts in each sample were analyzed by first fractionating them into unconjugated, glycoconjugated, and tauroconjugated bile salts. These fractions were further resolved by using HPLC techniques. 3. The data has shown that cholate exists predominately as the tauroconjugate and is the major bile salt, whereas chenodeoxycholate is rarely conjugated. 4. The qualitative analysis of biliary phospholipids by thin layer chromatography has shown a remarkable similarity to that of humans. Phosphatidylcholine was found to be the major phospholipid followed by phosphatidylethanolamine with trace amounts of lysophosphatidylcholine and phosphatidylserine.

Safety precautions to be observed with cooled premixed gases.

The gas delivered from a cylinder of Entonox (50% nitrous oxide and 50% oxygen) may not contain adequate quantities of oxygen if the cylinder has been cooled and then allowed to warm up in a vertical position.The composition of gas delivered from cylinders cooled to not lower than -40 degrees C. remains unaltered if the cylinders are rewarmed for 24 hours in a horizontal position at a temperature of not less than 5 degrees C.Cylinders of Entonox delivered in cold weather should be stored in a horizontal position at 5 degrees C. or more for at least 24 hours before use.