Validation of an antimicrobial susceptibility testing protocol for Brachyspira hyodysenteriae and Brachyspira pilosicoli in an international ring trial.

Brachyspira hyodysenteriae and Brachyspira pilosicoli cause economically important enteric disease in pigs. Treatment of these infections often includes antimicrobial administration, which can be most effective when therapeutic options are informed by antimicrobial susceptibility testing data. Here we describe a method for broth dilution antimicrobial susceptibility testing of these bacteria, both of which are difficult to culture in vitro. The protocol was evaluated for its fitness for use in an inter-laboratory ring trial involving eight laboratories from seven countries, and employing eleven test strains (5 Brachyspira hyodysenteriae including the type strain B78T and 6 Brachyspira pilosicoli) and six antibiotics. Overall intra- and inter-laboratory reproducibility of this method was very good (>90 % MICs at mode +/- 1 log2). Whole genome sequencing revealed good correspondence between reduced susceptibility and the presence of previously defined antimicrobial resistance determinants. Interestingly, lnu(C) was identified in B. pilosicoli isolates with elevated MICs of lincomycin, whilst tva(B) was associated with elevated MICs of pleuromutilins in this species. We designated two new control strains with MICs lying within currently tested ranges, including for the pleuromutilins, in contrast to the control strain B. hyodysenteriae B78T. These were deposited at the DSMZ-German Collection of Microorganisms and Cell Cultures GmbH. The validation of a standard protocol and identification of new control strains facilitates comparisons between studies, establishment of robust interpretative criteria, and ultimately contributes to rational antimicrobial use when treating infected livestock.

[Did the distribution of trauma treatment by general practitioners and emergency departments in the county of Ringkøbing change after the introduction of the on-call coverage for general practitioners?]. / Aendres fordelingen af skadebehandlingen i Ringkøbing Amt mellem almen praksis og skadestue ved etablering af storvagtkredse for alment praktiserende laeger?

The aim of the study was to investigate the changes in minor trauma treatment structure after a reduction in the number of general practitioners on call in a county, where minor trauma treatment is supposed to be carried out by general practitioners and only major trauma is supposed to be treated at the hospital Accident and Emergency Department. The design was a cross-sectional analysis of trauma treatment in Ringkøbing County before and after the reduction in the number of general practitioners on call. Over a four week period before and after the reduction in the number of general practitioners on call all trauma treatment at the Accident and Emergency Departments was registered together with trauma treatment by general practitioners. Furthermore a questionnaire was given before and after the reduction to a sample of the population regarding the population's behaviour and attitude towards minor trauma. Analysis showed that there was a minor reduction in the total number of trauma treatments after the reduction in the number of general practitioners on call was made. The percentage of patients that were treated at the Accident and Emergency Departments at hospital directly without being referred from general practitioners was reduced from 30% to 21%. The population's behaviour and attitude towards minor trauma was unchanged.

[Treatment of injuries in the county of Ringkøbing. 1. Incidence of injuries during a period of 4 weeks]. / Skadebehandlingen i Ringkøbing Amt. 1. Tilskadekomst i en fireugers periode.

During a period of four weeks (17 September-14 October 1990) all treatments of injured persons in the five hospitals in the County of Ringkøbing were registered. In addition, the refund accounts for all additional services connected with injuries submitted by the 166 general practitioners to the Danish National Health Insurance were also registered. A total incidence rate (calculated on an annual basis) of injuries requiring treatment was found to be 229/1000 og the population per annum. As compared with a similar investigation carried out in 1969, increases in incidence rates of 2.1 for admissions, 3.8 for outpatient hospital treatments and 4.4 for treatment of injuries in general practice were found. An increase in the number of minor injuries is thus concerned, probably partly conditioned by an altered threshold for seeking treatment and partly a slighter increase in the number of more serious injuries. In addition, a significant difference in the frequency of injuries requiring treatment with more numerous treatments was found in the regions of Lemvig and Ringkøbing as compared with the remainder of the county. It is recommended that registration from casualty departments with collection of data for analysis of accidents be undertaken with the object of elucidating the background for the increase in the injuries and the differences between the individual regions in the county.

[Treatment of injuries in the county of Ringkøbing. 2. Function of the closed casualty department]. / Skadebehandlingen i Ringkøbing Amt. 2. Den lukkede skadestuefunktion.

The closed casualty department function in the County of Ringkøbing was investigated during a period of four weeks. It was demonstrated that this functioned according to plan as the distribution general practice/casualty department was 3.4:1 and 70% of the patients in the casualty department were referred via general practice. The result of this was that the majority of minor injuries (removal of foreign bodies and treatment of wounds) were treated in general practice. In the casualty departments, there were fewer minor injuries and injuries which did not require specific treatment than are the case in open casualty departments. However, a definite diurnal variation was observed in the function of the closed casualty department as patients showed a greater tendency to seek treatment in the casualty department after working hours than during working hours and the general practitioners referred twice as many patients after working hours for continued treatment in the casualty departments. It is concluded that the closed casualty department system in the County of Ringkøbing functions well but that problems may be anticipated with the function if the duty-rosters for the general practitioners are altered so that the distances between general practitioners on duty increase and these have an increased work-load.

[Rectal ameboma]. / Amoeboma recti.

After a stay in the far east, a man aged 20 years developed difficulty in defaecation and slight difficulty in micturition. Rectoscopy revealed a stenosing tumour resembling a carcinoma. The tumour disappeared completely following treatment with amoebicides. Surgical treatment of amoebomata is associated with complications and is warned against.

Cystic mesothelioma of peritoneum: occurrence in a man.

We report a case of cystic mesothelioma of the peritoneum in a 54-year-old man in whom cystic masses were removed twice by surgery at an interval of 2 years. The patient died of cardiac arrest shortly after the second operation for a concurrent unresectable colonic cancer. The pathogenesis of the disease is uncertain, but we consider it neoplastic of low grade malignancy.

[Patient information might reduce the use of benzodiazepines in general practice]. / Patientinformation kan reducere forbruget af benzodiazepiner i almen praksis.

Information about benzodiazepines was given during a period of three months in a general practice with two doctors and 2,500 patients in group 1 of the Danish Health Insurance (low income group). The number of requests for repeated prescriptions and the number of defined daily doses of benzodiazepines were registered during periods of one month before and three months after the three month period of information with the object of assessing the patients own wishes for repeated prescription. The investigation revealed an average decrease of 35.4% of requests for repeated prescriptions and a decrease of 55.8% in the defined daily doses prescribed as compared with the month before the information period. The social consequences are discussed.

Skeletal scintigraphy. The use of technetium 99M-labeled complexes in the detection of early osseous involvement by metastatic tumors.

Skeletal scintigraphy using Technetium-99m ((99m)Tc) complexes was carried out in a series of 332 cancer patients. The results of scintigraphy were compared with the results of roentgenography and with the diagnostic usefulness of serum alkaline and acid phosphatase levels and the presence or absence of bone pain. In 25 percent of cases, lesions were first identified with scintigraphs. When metastastic lesions were present on both scintigraphs and roentgenograms, the number was greater on scintigraphs in 72 percent of cases. Six false negative studies were recorded (1 percent). Sixty percent of patients with early metastasis-that is, those with abnormal scintigraphs and negative roentgenograms-were asymptomatic. Serum alkaline and acid phosphatase levels were normal in 40 percent and 42 percent respectively of those with early skeletal involvement. Skeletal scintigraphy with (99m)Tc complexes is superior to other commonly employed techniques used to assess bone metastasis.

Whole body skeletal scintiphotography in the detection of occult metastatic breast carcinomas.

Whole body skeletal scintiphotography was carried out in a series of 111 breast cancer patients. The results of scintiphotography were compared with the results of roentgenography and with the diagnostic usefulness of serum alkaline phosphatase levels and the presence or absence of bone pain. In 27 percent of cases, lesions were first identified with the scintiphotos. When lesions were present on both scintiphotos and roentgenograms, involvement generally appeared greater on the scintiphotos. Two false negative studies were recorded. Sixty-seven percent of patients with early metastasis-that is, those with positive scintiphotos and negative roentgenograms-were asymptomatic. Serum alkaline phosphatase levels were normal in 38 percent of those with early skeletal involvement. Skeletal scintiphotography is superior to other commonly employed techniques used to assess bone metastasis in breast carcinoma.