Staphylococcus aureus food-poisoning outbreak associated with the consumption of ice-cream.

In April 2013, a food poisoning outbreak caused by staphylococcal enterotoxins (SEs) in ice-cream occurred in Freiburg, Germany, among the 31 participants of a christening party. Of the 13 cases, seven were hospitalized or obtained ambulatory treatment. Different types of ice-cream, which was freshly produced at the hotel where the party took place, were found to contain SE and high amounts of coagulase positive staphylococci. Enterotoxigenic Staphylococcus aureus strains isolated from ice-cream and human cases were of the same spa-type (t127), harboured the sea gene and displayed identical phenotypic resistance-, Fourier transform infrared spectroscopy- (FT-IR) and microarray-profiles. Despite the strong microbiological and epidemiological evidence of ice-cream being the incriminated food vehicle of the outbreak, a common source of S. aureus from the ice-cream could not be deduced. As none of the employees carried the outbreak strain, either the equipment used for the production of the ice-cream or a contaminated ingredient is the most likely introduction source.

Methicillin-resistant Staphylococcus aureus in cattle food chains - prevalence, diversity, and antimicrobial resistance in Germany.

Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) have been found in various farm animal species throughout the world. It was the objective of this study to estimate the prevalence of MRSA in different cattle food chains (milk, beef, and veal) in Germany, to analyze the MRSA diversity along each food chain and to compare the characteristics of the different subtypes. Samples were collected between 2009 and 2012 from dairy herds (bulk tank milk), veal herds (dust from the stables), veal calves, and beef cattle at slaughter (nasal swabs) and carcasses of veal calves (surface cuts) and beef as well as veal at retail. Sampling was proportionally distributed over the country according to the cattle population (on-farm sampling), slaughterhouse capacity (abattoir samples), and the human population (meat at retail). Methicillin-resistant S. aureus were isolated using harmonized methods from all sample types and populations investigated. The highest proportion of positive samples was found in nasal swabs from veal calves at slaughter in 2012 (144/320; 45.0%) and the lowest rate in bulk tank milk in 2009 (14/388; 4.1%). Most isolates, irrespective of the origin, were from spa types t011 and t034. Both have been assigned to the clonal complex (CC) 398. Few isolates (15/632; 2.4%) were from spa types not associated with the CC398. Spa-type patterns were similar along individual food chains but differed between food chains. Antimicrobial resistance patterns differed between isolates from the different food chains and spa types. Isolates from the veal chain displayed the highest resistance rates. We conclude that there is substantial diversity in the MRSA prevalence across different cattle production sectors.

Prevalence, antimicrobial resistance, and molecular characterization of methicillin-resistant Staphylococcus aureus from bulk tank milk of dairy herds.

It was the objective of the study to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in bulk tank milk from German dairy herds and to characterize isolates from bulk tank milk with respect to their Staph. aureus protein A (spa) and staphylococcal cassette chromosome mec (SCCmec) type, their phenotypic antimicrobial resistance and resistance- resp. virulence-associated genes using broth microdilution and a microarray for Staph. aureus. Bulk tank milk samples (25 mL) were tested for MRSA using a 2-step selective enrichment protocol. Presumptive MRSA were confirmed by PCR. Thirty-six isolates collected from bulk tank milk of dairy herds in 2009 and 2010 were included in the characterization. All isolates displayed spa-types assigned to the clonal complex CC398. Based on the epidemiological cut-off values for the interpretation of minimum inhibitory concentrations isolates were resistant to tetracycline (100%), clindamycin (58%), erythromycin (52%), quinupristin/dalfopristin (36%), and kanamycin (27%). Isolates did not carry genes associated with typical virulence factors for Staph. aureus such as the Panton-Valentine leukocidin. However, they did carry hemolysin genes. Livestock-associated MRSA of CC398 does occur in German dairy herds and the strains have similar properties as described for strains from pigs.

Characterization of a Yersinia enterocolitica biotype 1A strain harbouring an ail gene.

AIMS: The chromosomal ail gene (attachment and invasion locus) is commonly used as target gene for the detection of pathogenic Y. enterocolitica strains in food testing. The ail PCR does not detect strains of biotype 1A (BT1A), which are regarded as non-pathogenic because BT1A strains lack the virulence plasmid and chromosomally encoded virulence genes. In some recent reports, however, BT1A strains were discovered that harboured the ail gene. We isolated an ail-positive strain and characterized this strain with phenotypic and genotypic methods to study its possible relation to pathogenic Y. enterocolitica strains. METHODS AND RESULTS: The ail region of the BT1A strain was sequenced and compared with the corresponding region of nonpathogenic BT1A strains and pathogenic strains. Pulsed field gel electrophoresis (PFGE) analysis was applied revealing no similarity of the PFGE pattern of this strain to the patterns of pathogenic strains. Virulence-gene-based PCR analyses showed the strain to be positive for ystB, but negative for virulence genes ystA, virF and yadA. Whole-cell MALDI-TOF MS combined with a shrinkage discriminant analysis approach was applied and clearly classified the ail-positive biotype 1A strain within the cluster of BT1A strains. CONCLUSIONS: PCR detection of ail sequences in food matrices should be followed by the isolation of the responsible strain and its characterization using phenotypic or genotypic methods. SIGNIFICANCE AND IMPACT OF THE STUDY: The ail gene may be present in Y. enterocolitica BT1A strains, which are commonly considered as nonpathogenic. Efficient methods such as PCR typing of other virulence genes or rapid MALDI-TOF MS-based bacterial profiling allow a more comprehensive assessment of the pathogenicity potential of Yersinia strains.

A modified lateral approach for release of posttraumatic elbow flexion contracture.

A modified lateral approach for release of posttraumatic flexion contracture of the elbow is described. The approach is a modification of the procedure described by Nirschl for resection and repair of lateral elbow tendinosis (tennis elbow). The modified approach allows visualization of the entire anterior elbow joint without disturbing the common extensor origin or the collateral ligaments. If necessary, a second, posterior triceps-splitting incision is used to access the olecranon fossa. Twelve consecutive patients were treated from 1988 to 1992. Mean flexion/deformity, which measured 41 degrees before operation, measured 8 degrees immediately after operation. The mean flexion/extension arc measured 70 degrees before operation and improved to 117 degrees after operation. With an average follow-up of 36.5 months, mean flexion contracture was 11 degrees and the mean flexion/extension arc of motion was 114 degrees. In no case was a medial approach or transhumeral perforation required. All patients were treated after operation with the elbow splinted in extension for 3 days, after which they were started on an aggressive physical therapy regimen. There were no wound complications, no neurovascular injuries, and no formations of heterotopic bone.

Normal shoulder proprioception and the effect of lidocaine injection.

The purpose of this study was to investigate the effect of age, dominance, joint position, and lidocaine injection on proprioception of the normal shoulder. Position sense and the detection of passive shoulder motion were investigated in 40 young (20 to 30 years) and old (50 to 70 years) subjects. An additional 20 young subjects were tested before and after a glenohumeral (n = 10) or a subacromial (n = 10) lidocaine injection was performed. A significant decline occurred in proprioception between the young and old age groups. No difference was observed between dominant and nondominant sides. Position sense was consistently less accurate in the maximum range of motion tested when compared with the lesser ranges tested for flexion and abduction. No differences were identified in the ability to detect motion in flexion, abduction, and external rotation in the younger group, whereas in the older group a difference was observed in flexion. No learning effect was detected for any test trial. No significant changes occurred in proprioceptive ability after either glenohumeral or subacromial lidocaine injection was performed.

Salvage surgery for lateral tennis elbow.

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.

Assessment and treatment guidelines for elbow injuries.

Acute elbow injuries are often collision related; chronic elbow injuries typically stem from overuse and valgus stress. What seems a purely traumatic injury, though, may actually represent an acute-on-chronic process, so a detailed history and physical exam are essential in pinpointing the injury process and making a specific diagnosis. Important details in the history are the quality, intensity, and onset of pain and the location of symptoms and their effect on function. The exam should include visual inspection, palpation, range of motion, and key tests such as applying valgus stress. Treatment can often be conservative, with emphasis on strength-building rehabilitation.

Keeping Tennis Elbow at Arm's Length: Simple, Effective Strengthening Exercises.

Tennis elbow involves damage to the forearm muscles and tendons. Rehabilitation from this painful condition usually includes rest, icing, stretching exercises, improving tennis technique, and using an elbow strap called a counterforce brace. But perhaps the most important part of rehabilitation is strengthening exercises, which both promote recovery and help keep tennis elbow from returning. Two types of exercise will help you regain strength: exercises with weights and exercises without.

Systolic and diastolic performance in normal human subjects as measured by ultrafast computed tomography.

Ultrafast computed tomography (ultrafast-CT) is a minimally invasive imaging modality with very short acquisition time and excellent anatomic definition. It shows promise of providing precise measurement of right and left ventricular volumes, left ventricular mass, and left ventricular diastolic function with a single test. We expand on the knowledge regarding normal humans by studying ten normal volunteers in the short axis. Cardiac volumes and mass (mean +/- 1 S.D.) were as follows: 1) left ventricle: end-diastolic volume index (ml/m2) = 61 +/- 15, end-systolic volume index (ml/m2) = 19 +/- 7, stroke volume index (ml/m2) = 43 +/- 9, cardiac index (liters/min/m2) = 2.7 +/- .5, ejection fraction (%) = 70 +/- 7, end-diastolic mass (g/m2) = 95 +/- 15; 2) right ventricle: end-diastolic volume index (ml/m2) = 76 +/- 19, end-systolic volume index (ml/m2) = 35 +/- 13, stroke volume index (ml/m2) = 40 +/- 8, cardiac index (liters/min/m2) = 2.6 +/- .5, ejection fraction (%) = 55 +/- 6. Stroke volume index differed by 1.6 +/- 2.0 ml/m2 between ventricles. Measurement of global and segmental left ventricular diastolic function revealed: 1) Peak filling rate (end-diastolic volumes/second): global = 2.29 +/- .40, base = 1.78 +/- .49, midventricle = 2.49 +/- .57, apex = 3.13 +/- .39 (P less than .001, base vs. apex; P less than .01, base vs. midventricle and midventricle vs. apex); 2) time to peak filling rate (msec): global = 193 +/- 24, base = 192 +/- 20, midventricle = 194 +/- 26, apex = 190 +/- 19 (P = NS between levels).(ABSTRACT TRUNCATED AT 250 WORDS)

Prosthetic valve visualization by cine-computed tomography: a case report.

The use of cine-computed tomography scanning is described in evaluating cardiac function in a patient with a bileaflet mitral valve prosthesis (St. Jude medical valve) and in a second patient with both mitral and aortic bileaflet prostheses. Both biventricular and prosthesis function were assessed successfully.