Merkel cell carcinoma masquerading as cellulitis: a case report and review of the literature.

Merkel cell carcinoma (mcc) is an uncommon malignancy of the skin arising from cells located in the deeper layers of the epidermis called Merkel cells. This malignancy rarely presents as a metastatic disease, and the field is therefore deficient in regards to management. We report the case of a 49-year-old woman who presented with a presumptive diagnosis of osteomyelitis of the left fifth digit that was resistant to treatment with antibiotics; she underwent debridement of the digit that revealed mcc and was later to have metastatic disease to her lungs, liver, and musculoskeletal system. The management of mcc, although simple in the early stage of the disease, can become challenging when it is more advanced. Multiple new modalities for its treatment have emerged over the last few years, and more recently, clinical trials are being conducted for the use of immunotherapy agents in the treatment of this malignancy.

Musculoskeletal infections associated with Citrobacter koseri.

Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase(®) and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery.

Challenges in the management of extremity vascular injuries: A wartime experience from a tertiary centre in Sri Lanka.

BACKGROUND: Management of peripheral vascular injuries often present critical challenges in resource limited settings of developing countries. The additional burden from a military conflict poses further challenges. Delays in presentation often result in the loss of limb and even life, in what is usually a young active population. The objective of this report is to analyse the early outcome of vascular intervention at a tertiary referral centre in Sri Lanka. METHODS: A retrospective descriptive review of eighty one consecutive extremity vascular injuries in seventy patients during a seven month period was performed with regards to the cause of injury, types of presentations, ischaemia time, interventional procedures, complications and early outcome. RESULTS: Mean age was 31.2 years (9-72 years) and 96% were males. Injuries were caused by blasts in 41%, cuts in 26%, gunshots in 17% and road traffic injuries in 9%. Indications for revascularization were acute ischaemia in 44%, active bleeding in 43% and pseudo-aneurysms in 13%. Six patients underwent primary amputations due to non-viable limbs. 64 patients underwent vascular intervention. Fifty one percent needed vein grafts while 46% had direct repairs. Bleeding was often (73%) from upper extremity injuries. Median time to revascularization was 5.5 (2-16) hours with all limbs salvaged. Acute ischaemia (40%) was often from popliteal injuries. Median time to revascularization was 10 (5-18) hours and viability was prejudged at fasciotomy. 92% of revascularized limbs were salvaged. There was no perioperative mortality. CONCLUSIONS: Results from vascular repairs are encouraging despite significant delays.

Blunt carotid injury from a penetrating stick: an unexpected injury.

Unattended blunt carotid injury (BCI) has stroke high risk of stroke and screening based on injury probability is recommended. Penetrating forces are not considered high risk and concomitant BCI would go unattended. The authors report a case of a 48-year-old man who fell out of a tree on to an upright stick that penetrated his lateral neck. He presented with impalement, which was removed after surgically laying open the entire wound. The carotid sheath had been breached and the internal jugular vein was bleeding. The adjacent common carotid artery was intact and pulsating with no external evidence of injury. However, injury proximity led to vascular imaging that demonstrated intimal disruption without thrombus or stenosis. Although he remained asymptomatic on heparin, the injury progressed to cause significant lumen stenosis. Endovascular stenting re-established the vessel lumen and he remains well on aspirin 9 months later. Awareness that penetrating neck trauma may cause BCIs is important.

Pertussis: a cluster of linked cases in the United Kingdom, 2006.

Pertussis is a vaccine-preventable disease with a high rate of complications, especially in young children. It often presents in an atypical fashion in adults and adolescents, making diagnosis difficult. This report describes a cluster of linked cases of three adults and one infant in a family, spread across the United Kingdom (UK). The initial follow-up was of a 20-year-old student with clinical symptoms of pertussis. This diagnosis led to the discovery of two other unvaccinated adult family members with symptoms that fit the case definition for pertussis and a laboratory-confirmed tertiary case in an unvaccinated infant who had to be hospitalised. This report aims to act as a reminder for including pertussis as a differential diagnosis in patients with a long duration of respiratory symptoms and highlights the importance of rapidly identifying and managing close contacts of cases. This is key in protecting the most vulnerable - namely, infants - from infection.

Equine herpesvirus 1 glycoprotein D expressed in E. coli provides partial protection against equine herpesvirus infection in mice and elicits virus-neutralizing antibodies in the horse.

The envelope glycoprotein D of EHV-1 (EHV-1 gD) is essential for virus infectivity and entry of virus into cells and is a potent inducer of virus-neutralizing antibody. In this study, truncated EHV-1 gD (gDt) was expressed with a C-terminal hexahistidine tag in E. coli using a pET vector. Western blot analysis using an anti-gD monoclonal antibody demonstrated the presence of gDt bands at 37.5, 36, 29.5 and 28 kDa. The immunogenicity and protective efficacy of partially purified gDt was compared with gD expressed in insect cells by a recombinant baculovirus (Bac gD) using a BALB/c mouse model of EHV-1 respiratory infection. The proteins were also compared in a prime-boost protocol following an initial inoculation with gD DNA. gDt elicited similar levels of gD-specific antibody and neutralizing antibody compared with Bac gD and also provided a similar level of protection against EHV-1 challenge in mice. Inoculation of horses with gDt elicited EHV-1 gD-specific antibodies including virus-neutralizing antibody, suggesting that despite the lack of glycosylation, E. coli may be a useful vehicle for large scale production of EHV-1 gD for vaccine studies.

An improved algorithm for rotational motion artifact suppression in MRI.

An improved algorithm for planar rotational motion artifact suppression in standard two-dimensional Fourier transform magnetic resonance images is presented. It is shown that interpolation of acquired view data on the uncorrupted k-space create data overlap and void regions. We present a method of managing overlap data regions, using weighted averaging of redundant data. The weights are assigned according to a priority ranking based on the minimum distance between the data set and the k-space grid points. An iterative estimation technique for filling the data void regions, using projections onto convex sets (POCS), is also described. The method has been successfully tested using computer simulations.

Determination of albendazole-2-aminosulfone in bovine milk using high-performance liquid chromatography with fluorometric detection.

An analytical method for the determination of albendazole (ABZ) residues in bovine milk was developed using one of its major metabolites, albendazole-2-aminosulfone (ABZ2NH2) as the marker. The method involved acid hydrolysis of milk followed by liquid-liquid extraction and solid-liquid phase clean-up of the extract. A reversed-phase HPLC with fluorometric detection was used to quantitate the marker residue. The method exhibited a high degree of precision and good accuracy as demonstrated by a relative standard deviation (R.S.D.) < 5% for the replicate analyses and 91.8 to 104.1% recovery of the fortification level (25-200 ng/ml), respectively. The ratio of the concentrations of the marker and total residues in milk over a 36-120 h withdrawal period was found to be steady at 43.1 indicating a definite relationship between the marker and the total residues of ABZ. The analytical method was used successfully to determine total residues in milk of cattle treated with ABZ.

Comparison between Sri Lankan and Australian strains of Babesia bovis in the vaccination of imported cattle in Sri Lanka.

A Sri Lankan strain of Babesia bovis (designated A strain) was isolated from larval ticks and prepared for use as vaccine by syringe-passage in 20 splenectomised calves followed by irradiation. The A strain and a vaccine strain of Babesia bovis (designated K strain) brought in frozen form from Australia were used to vaccinate 37 susceptible bulls imported from southern Australia. Rectal temperatures, packed cell volumes, parasitaemias and overt clinical signs were monitored for three weeks following vaccination. The results indicated that the A strain was slightly more virulent than the K strain but suitable for the vaccination of well-supervised cattle.

A double-blind comparative study: amineptine (Survector 100) versus imipramine.

The aim of the study was to compare the antidepressant effects of amineptine with imipramine in depressive illness. According to the DSM-III criteria, 33 patients diagnosed as having depressive illnesses were given either imipramine or amineptine, 50-100 mg and 100-200 mg, respectively, per day on a double-blind basis over a period of 2 months. Both groups presented steady improvement of the symptoms of depression during treatment, as scored on the Hamilton and Montgomery and Asberg Depression Rating Scales and Clinical Global Impression Scale. Amineptine produced fewer anticholinergic effects than imipramine. The results show that amineptine, as well as imipramine, is well suited for treating depressed patients.

Effect of synthetic C-terminal fragments of hGH on glucose oxidation by isolated islets.

The effect of polypeptides containing the human growth hormone sequence 177--191 on the glucose metabolism of isolated islets of Langerhans has been investigated. It has been found that such peptides accelerate the incorporation of hydrogen at carbon atom 5 into water while accelerating the flux (1-14C oxidation) through the pentose phosphate shunt and inhibiting the oxidation of [6-14C]glucose. The latter inhibition was found not to be due to inhibition of the pyruvate dehydrogenase complex, and it was further found that the previously demonstrated potentiation of glucose-induced insulin release by the peptides was independent of energy provision because none of the glyceraldehyde, pyruvate, or leucine could substitute for glucose. In view of the fact that the insulinogogue effect of this peptide is to potentiate the glucose stimulatory effect on islets, these phenomena may well be unrelated.

Effect of synthetic C-terminal fragments of hGH on insulin release by isolated islets.

Synthetic fragments representing the C-terminal end of the growth hormone molecule have been tested for their direct in vitro effects on insulin release by isolated rat islets of Langerhans. hGH 177-191 caused a dose-related potentiation of glucose-induced insulin release, whereas the peptide by itself caused no stimulation of insulin release from the islets. The rate curves constructed for insulin secretion as a function of extracellular glucose concentration showed that the Km for glucose is not altered in the presence of the peptide, but that the Vmax of secretion is increased. Significant potentiation of insulin release by the peptide was seen only at high extracellular concentrations of glucose. Measurement of cAMP levels in islets showed that the peptide caused no significant alteration of cAMP levels while still potentiating insulin release. It was therefore concluded that the mechanism of potentiation of insulin release by the peptide may be independent of the changes in cAMP levels in islets. hGH 172-191, too, caused potentiation of glucose-stimulated insulin release from islets, whereas hGH 179-191 was not active in this report.