Multicenter evaluation of the MicroScan Rapid Gram-Negative Identification Type 3 Panel.

The accuracy and performance of the revised MicroScan Rapid Gram-Negative Identification Type 3 Panel (Dade MicroScan Inc., West Sacramento, Calif.) were examined in a multicenter evaluation. The revised panel database includes data for 119 taxa covering a total of 150 species, with data for 12 new species added. Testing was performed in three phases: the efficacy, challenge, and reproducibility testing phases. A total of 405 fresh and stock gram-negative isolates comprising 54 species were tested in the efficacy phase; 96.8% of these species were identified correctly in comparison to the identification obtained either with the API 20E system (bioMérieux Vitek, Hazelwood, Mo.) or by the conventional tube method. The number of correctly identified isolates in the challenge phase, including new species added to the database, was 221 of 247, or 89.5%, in comparison to the number correctly identified by the conventional tube method. A total of 465 isolates were examined for intra- and interlaboratory identification reproducibility and gave an agreement of 464 of 465, or 99.8%. The overall reproducibility of each individual identification test or substrate was 14,373 of 14,384, or 99.9%. The new Rapid Gram-Negative Identification Type 3 Panel gave accurate and highly reproducible results in this multiple-laboratory evaluation.

Escherichia coli dihydrodipicolinate synthase: characterization of the imine intermediate and the product of bromopyruvate treatment by electrospray mass spectrometry.

Simplified procedures for assaying and purifying dihydrodipicolinate synthase (EC 4.2.1.52), the first enzyme of the lysine biosynthetic pathway, have been developed and electrospray ionization m.s. has been used to observe the imine intermediate with pyruvate and to investigate the reaction of the enzyme with bromopyruvate and fluoropyruvate.

Gender and the clinical usefulness of the albumin: creatinine ratio.

One hundred and eighty-seven diabetic and 105 control subjects collected timed overnight urine samples to measure the inter-individual variation in creatinine excretion rate and its determinants, and to test the relationship between albumin excretion rate (AER) and two 'surrogate measures', the albumin concentration and albumin:creatinine ratio. Creatinine excretion was 55% higher in men than women (geometric mean 8.9 mumol min-1 (95% confidence limits 4.7-17.0) compared with 5.7 (3.0-10.9); p < 0.001). Gender accounted for 31% of the variation in creatinine excretion and body mass index 1.4%; neither age nor the diabetic state had a significant effect. The relationships between AER and the two surrogate measures differed between diabetic subjects and controls such that relationships constructed from non-diabetic data would not hold true for diabetes. Likewise, the relationship between AER and albumin:creatinine ratio differed between men and women such that a ratio of 4.0 mg mmol-1 corresponded to a predicted AER of 35 micrograms min-1 in men and 23 micrograms min-1 in women. The albumin:creatinine ratio outperformed albumin concentration in terms of sensitivity and specificity and its performance was better in women than men. We conclude that the albumin:creatinine ratio is a better surrogate for AER than albumin concentration. If 'action levels' are to be defined for screening programmes, they should be derived from diabetic and not non-diabetic data and should be different in men and women. We propose a direct rather than screening role for the albumin:creatinine ratio in the management of diabetic nephropathy.

Results of zone I and zone II flexor tendon repairs in children.

In a combined study of three hand surgery practices, 78 patients younger than 16 years who had sustained flexor tendon lacerations in zone I or zone II of 95 digits were available for critical evaluation. The average postrepair follow-up period was 24 months (range, 3-144 months). Patient age was divided into three groups: 0-5 years, 6-10 years, and 11-15 years. Performance of all digits was assessed to determine the percentage return of normal digital function following repair. Data were analyzed to determine the effect of age, the effect of varying periods of postrepair immobilization, and the long-term changes in digital performance resulting from growth. All profundus repairs in zone I returned excellent function. Isolated profundus and combined profundus and superficialis repairs in zone II achieved comparable results when managed with an early passive motion program or following immobilization for 3 or 4 weeks. Immobilization for longer than 4 weeks resulted in an appreciable deterioration of function. Digital motion following zone II flexor digitorum profundus and superficialis injuries treated with less than 4 weeks of immobilization or early motion was not significantly different in the three age groups studied. Digits with associated digital nerve and/or palmar plate lacerations fared less favorably when compared with isolated tendon lacerations. In many digits, a modest improvement in digital motion was found when patients returned after several years of growth.

Effects of the fasciocutaneous radial forearm flap on vascularity of the hand.

Twelve randomly selected fasciocutaneous radial forearm flaps underwent bilateral vascular analysis an average of 26 months following surgery. Digital temperature comparisons revealed an average 2.5% (0.8 degree C) decrease following use of the radial forearm flap. Doppler flow studies performed to determine the digital/brachial pressure indices revealed no significant difference between the donor (1.06) and control (1.08) extremities; however, Doppler pulse-volume recordings performed after cold stress testing revealed an 18% delay in reconstitution of normothermia in the radial forearm flap group compared to controls. Only two patients reported transient mild symptoms of cold intolerance, which resolved over time.

Proximal metatarsal segmental resection: a treatment for intractable plantar keratoses.

For the past 15 years, a procedure the authors have termed proximal metatarsal segmental resection has been used for the treatment of intractable, painful, submetatarsal plantar keratoses which have failed nonoperative treatments. This simple procedure basically is the resection of a cylindrical segment of proximal metatarsal bone approximately 0.5 cm long. Fifty-four patients (70 metatarsals) underwent the procedure and were followed a mean of 6 years. Good to excellent results were reported in 89% of these patients. Transfer lesions occurred in 18% of feet and were responsible for all fair and poor results. When the procedure was carried out in association with a bunion correction, transfer lesions occurred in 23%; whereas when performed as an isolated metatarsal procedure, transfer lesions followed in 12%. Recurrent keratoses developed in 7%. This technically simple procedure is associated with minimal patient morbidity and should be considered an option in the surgical management of metatarsalgia.