Use of leeches in plastic and reconstructive surgery: a review.

Leeches possess properties that make them uniquely able to assist with venous compromised tissue. Their saliva contains an anticoagulant and a histamine-like vasodilator that promote local bleeding, a local anesthetic, and hyaluronidase that promotes the local spread of the other leech salivary secretions into the wound/bite. In addition, active pharyngeal peristalsis further promotes the egress of venous blood. Resurgence in the use of leeches has been stimulated by Upton in the United States and Mahaffey in Europe. Currently, leeches are used at many microsurgical centers to provide critical venous outflow for compromised tissue replantations and transfers that might otherwise be unsalvageable. As the use of leeches becomes more widespread, knowledge of leech biology and physiology is important. This review reports on Hirudo medicinalis, the species used most often medically in Europe and the United States.

Evaluation of three commercially available rotavirus detection methods for neonatal specimens.

Commercially available assay kits have now made detection of rotavirus in stool specimens possible as a routine laboratory test. One such kit, Rotazyme II (Abbott Laboratories, North Chicago, IL) has been reported to give a higher incidence of false positive results with neonatal stool than with stool from older patients. One hundred stool specimens from asymptomatic neonates (age range, two to five days) were tested by two ELISA methods and one latex agglutination method in order to evaluate the rate of false positivity in this group of patients. Negative staining electron microscopy was used as the reference method. The two ELISA methods were Rotazyme II and Rotavirus EIA (International Diagnostic Laboratories, St. Louis, MO), and the latex agglutination method was Meritec-Rotavirus (Meridian Diagnostics, Inc., Cincinnati, OH). The Rotavirus EIA and Meritec-Rotavirus tests gave 0% and 1% false positive results, respectively, while the Rotazyme II test gave a 4% false positive rate with an additional 19% equivocal results. This extensive comparative analysis of commercially available assays for detection of rotavirus in neonatal stool specimens suggests a false positive or equivocal rate with the Rotazyme II test that impairs clinical utility.

Chorioamnionitis: a comparative histologic, bacteriologic, and clinical study.

Using morphologic and bacteriologic techniques, we examined placentas from 224 deliveries considered potentially complicated by infection. The severity of the chorioamnionitis was graded histologically according to the intensity of the inflammatory infiltrate. Chorioamnionitis or funisitis occurred in 111 placentas. Neonatal morbidity in this group was 48 (43%) as compared with 14 (12%) in those without chorioamnionitis. Pathogens were cultured from 49 of the 111 placentas with chorioamnionitis. Neonatal morbidity or mortality occurred in 28 (58%) of the group with positive cultures but occurred also in 20 (32%) of the 63 with chorioamnionitis from which no pathogens were cultured. Perinatal mortality was especially high (64%) among premature infants (less than 30 weeks) with infection. A comparison of culture techniques (surface swab versus swab of subchorionic fibrin after searing amnionic surface) showed similar rates of recovery but less contamination using the deep culture technique. Neonatal morbidity and mortality with severe chorioamnionitis (grades II and III; 62% and 82%) were significantly greater than with little or no chorioamnionitis (grades I and 0; 43% and 36%). Higher grades of histologically demonstrable chorioamnionitis are associated significantly with the highest rates of neonatal morbidity or mortality. In many instances, pathogens are not recovered by conventional aerobic and anaerobic bacteriologic study. A search for other infectious agents (viruses, mycoplasmas, chlamydiae) deserves attention.

Subchorionic fibrin cultures for bacteriologic study of the placenta.

Previous bacteriologic studies of the placenta have been hampered by a high rate of contamination of vaginal flora. In the present study, cultures of the subchorionic fibrin layer of the placenta were compared to conventional swab-cultures of the surface of the fetal membranes for recovery of aerobic and anaerobic bacteria. Parallel cultures of membrane surface and subchorionic fibrin (SCF) were done in the placentas of 33 deliveries suspected clinically of being complicated by infection (CD). Placentas from 46 uncomplicated deliveries were similarly cultured to serve as controls. SCF cultures were positive in 11 of 33 CD placentas and in only 1 of 46 controls (P less than 0.001). SCF cultures showed contaminating vaginal flora in 2 of 79 while surface cultures showed vaginal contamination in 16 of 79 (P less than 0.01). Recovery of pathogens was similar by the two methods: 10 of 33 and 14 of 33 respectively. One hundred ninety-one additional CD placentas were cultured by the SCF technique. Forty-nine of the 224 SCF cultures yielded pathogens with a predominance of group B hemolytic streptococci, anaerobic gram positive cocci and anaerobic gram negative rods (81 total isolates). Escherichia coli was isolated in 5 cases. Cultures showing exclusively contaminating vaginal flora were obtained from only 3 of the 224 placentas. Subchorionic fibrin cultures combine technical simplicity, low rate of contamination and excellent recovery of pathogens. The bacterial types found by this method are the predominant species that cause endometritis, pelvic infections, and neonatal septicemia. Subchorionic fibrin culture is a useful technique for the bacteriologic diagnosis of infection in the placenta.

Isolation of Clostridium difficile from hospitalized patients without antibiotic-associated diarrhea or colitis.

Stool samples from 100 hospitalized patients and 21 healthy adults, obtained between March and June 1980, were cultured on a special selective medium containing cefoxitin and cycloserine to detect Clostridium difficile. This organism was isolated from 13 of the hospitalized patients and from 1 healthy subject. None of the patients with positive cultures had received antimicrobial therapy in the 3 preceding months. The observed rate of C. difficile isolation from adults not suffering from antibiotic-associated diarrhea or colitis is higher than previously reported. C. difficile culture is not recommended as a substitute for toxin assay in the evaluation of patients with intestinal disorders after antimicrobial chemotherapy.