European molecular epidemiology and strain diversity of feline calicivirus.

Feline calicivirus (FCV) causes a variable syndrome of upper respiratory tract disease, mouth ulcers and lameness. A convenience-based prospective sample of oropharyngeal swabs (n=426) was obtained from five countries (France, Germany, Greece, Portugal and the UK). The prevalence of FCV by virus isolation was 22.2 per cent. Multivariable analysis found that animals presenting with lymphoplasmacytic gingivitis stomatitis complex were more likely to test positive for FCV infection. Furthermore, vaccinated cats up to 48 months of age were significantly less likely to be infected with FCV than unvaccinated animals of similar ages. Phylogenetic analysis based on consensus sequences for the immunodominant region of the capsid gene from 72 FCV isolates identified 46 strains. Thirteen of the 14 strains with more than one sequence were restricted to individual regions or sites in individual countries; the exception was a strain present in two sites close to each other in France. Four strains were present in more than one household. Five colonies, four of which were rescue shelters, had multiple strains within them. Polymerase sequence suggested possible rare recombination events. These locally, nationally and internationally diverse FCV populations maintain a continuous challenge to the control of FCV infection and disease.

Experience with plerixafor for hematopoietic cell mobilization in nine patients with germ cell tumors.

STUDY OBJECTIVE: To evaluate the efficacy of plerixafor as a just-in-time therapy for patients with germ cell tumors who were identified as poor hematopoietic cell mobilizers after the initiation of apheresis. DESIGN: Case series. SETTING: National Cancer Institute-designated cancer center. PATIENTS: Nine patients with germ cell tumors who received plerixafor as an adjunct to granulocyte colony-stimulating factor (G-CSF) for hematopoietic cell mobilization in an attempt to prevent mobilization failure between January 2009 and December 2012. MEASUREMENTS AND MAIN RESULTS: Patients were heavily pretreated, having received at least four prior treatment cycles. A median of three total apheresis days (range 1-4 days) was required for all patients, but a median of two apheresis days (range 1-2 days) was needed after the initiation of plerixafor. A median of 0.9 × 106 CD34⁺ cells/kg (range 0.3-1.5 × 106 CD34⁺ cells/kg) was harvested with G-CSF mobilization alone; in addition, a median of 2.6 × 106 CD34⁺ cells/kg (range 0.6-32 × 106 CD34⁺ cells/kg) was harvested using plerixafor. All nine patients received high-dose carboplatin and etoposide followed by hematopoietic cell transplantation. The median time to neutrophil engraftment was 11 days (range 8-12 days). The median time to platelet engraftment was 16 days (range 10-22 days). CONCLUSIONS: The use of plerixafor in addition to G-CSF as just-in-time therapy permits patients with germ cell tumors to pursue potentially curative therapy with high-dose chemotherapy followed by autologous stem cell rescue.

Incidence of venous thromboembolism in the setting of hematopoietic cell transplantation.

The underlying risk of venous thromboembolism (VTE) is unclear in patients undergoing hematopoietic cell transplantation (HCT). As such, these patients should still be considered at risk for development of VTE due to factors such as their underlying malignancy and the marked inflammatory state that develops from treatment. The purpose of this study was to characterize the incidence of VTE in patients undergoing HCT. Retrospective chart review of patients from the Indiana University Stem Cell Transplant Unit treated between January 1, 2008, and May 24, 2011. Patients were older than 18 years and had undergone HCT. The primary objective was to analyze the incidence of VTE in patients undergoing autologous HCT versus allogeneic HCT. Secondary objectives included documentation of VTE treatment strategies and time to occurrence of VTE. Of the 567 patients who underwent autologous HCT, 14 developed VTE (2.5%), whereas 5 of the 180 patients who underwent allogeneic HCT developed VTE (2.8%; P = 1.000). The median time to development of VTE from admission for HCT was 12 days in the autologous HCT arm versus 19 days in the allogeneic HCT arm (P = 0.610). The most commonly used VTE treatment strategy was enoxaparin (12 out of 19 VTEs). This study illustrates that VTE does occur rarely in patients who have undergone HCT. The optimal treatment regimen in this population requires further evaluation. Until a reliable protocol for treatment and evidence for risk factors are established, providers should be vigilant for occurrence of VTE in these patients.

A study of forty-nine consecutive Whipple resections for periampullary adenocarcinoma.

BACKGROUND: We designed a program to evaluate the morbidity, mortality, survival rates, and patient's quality of life after Whipple resection for pancreatic and other periampullary adneocarcinoma. PATIENTS AND METHODS: After studying 11 fresh and unembalmed cadavers to learn the regional anatomy and to practice the surgical techniques for traditional Whipple procedure by the senior author (JS), 49 patients aged 56 to 84 years old were treated with Whipple's pancreatoduocenectomy. RESULTS: There was no postoperative mortality or morbidity from anastomotic leakage. All 49 patients were discharged in an improved condition following surgery, including 5 patients with emergency resection. Eight patients are alive at the time of this writing, including 2 patients who had their pancreatic cancer resected 168 and 139 months ago. CONCLUSIONS: In the opinion of these authors, treatment of all resectable cancers with Whipple's pancreatoduodenectomy offers not only a superior palliation but also the hope of cure.

Iatrogenic pneumothorax: etiology and morbidity. Results of a Department of Veterans Affairs Cooperative Study.

The purpose of this study was to delineate the etiological factors for iatrogenic pneumothorax in the era of increased use of invasive procedures and to determine its impact on morbidity. Between 1983 and 1987 the Department of Veterans Affairs conducted a cooperative study at 13 medical centers to assess the utility of the intrapleural instillation of tetracycline for the prevention of recurrent pneumothorax. Since all patients with any type of pneumothorax were screened at each medical center, it was decided to collect data on all the iatrogenic pneumothoraces during that period. During the study period, the number of reported iatrogenic pneumothoraces were 538. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration (128), subclavicular needle stick (119), thoracentesis (106), transbronchial biopsy (54), pleural biopsy (45) and positive pressure ventilation (38). Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization. Patients with underlying chronic obstructive pulmonary disease required significantly longer duration of treatment than those without. We conclude that in our patient population, the three leading causes of iatrogenic pneumothorax are transthoracic needle aspiration, subclavicular needle stick and thoracentesis. Hospitalization is prolonged in only a small percentage of the patients who required treatment for the iatrogenic pneumothorax.

Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study.

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.

Teaching school health to undergraduate medical students.

This paper describes a teaching programme for final- (sixth-) year undergraduate medical students during their 10-week term in child health. Students attend schools on two occasions and are actively involved in the physical, educational and emotional assessment of children. The advantages of the programme include active participation by the students, contact with children in a less threatening environment, learning new skills in the assessment of children, and knowledge of common screening procedures. Student evaluation of the programme has been positive.

Changes in body size and fatness of Australian schoolchildren 1911-1976.

Data have been analysed from surveys of Queensland schoolchildren done in 1911, 1950 and 1976. Over this period there has been a marked increase in both height-for-age and weight-for-age in boys and girls. However, in boys, this increases growth has been associated with minimal increase in fatness. In girls there has probably been a real increase in body fatness, particularly since 1950. Raw data from past growth studies would make the analysis for secular changes in status more meaningful and accurate. We suggest that a central data bank for Australian growth studies be set up.

Pre-school vision screening-a pilot study.

The importance of early vision screening in children is well known, but also are the difficulties of choosing a satisfactory programme and its implementation. This paper describes the reasons for the programme being implemented and discusses the method by examination and the co-operation required to carry it out. More than 10,000 children were screened by more than 350 voluntary family doctors. The examinations were carried out throughout Queensland in pre-school centres. The family doctors were fundamental in the success of the programme, as they had the considerable task of examining the children. The scheme was made possible by the co-operation of the family doctors through the help of the Royal Australian College of General Practitioners, The Family Medicine Programme and the Australian Medical Association. These organisations, together with the Division of School Health, Queensland, and The Royal Australian College of Ophthalmologists were responsible for the organisation of the scheme. The results of the Pilot Study and the requirements for an on-going programme are discussed.

Indication for translumbar aortogram.

Percutaneous transfemoral or to a lesser degree the transaxillary catheterization for peripheral angiography is the procedure of choice by most radiologists. Under certain circumstances, however, these vessels may not be suitable or accessible for such studies. We have performed 330 translumbar aortograms and have found translumbar aortograms to be a safe and simple procedure that may be used as an alternative to the other methods for evaluating aortofemoral occlusive disease, particularly when the femoral artery becomes inaccessible.

Fatal clostridial infection following hemorrhoidal banding.

A case is described in which death followed banding of hemorrhoids. The clinical course was suggestive of overwhelming toxemia due to clostridia.

Patterns of growth in Queensland schoolchildren, 1911 to 1976.

The heights, weights and skinfold thicknesses of 4466 Queensland schoolchildren, who were aged from six to 12 years and were measured in 1976, have been analysed and compared with the results of previous surveys conducted in 1911 and 1950. The 1976 study shows that Aboriginal children are generally smaller than Caucasian children, that Caucasian children in Queensland do not differ significantly from those in New South Wales, and that social class differences in stature have disappeared. Comparisons with the previous studies suggest that the secular increases in height and weight have become much smaller in the last 26 years.