Diagnosis of bovine-associated parapoxvirus infections in humans: molecular and epidemiological evidence.

Orf virus, pseudocowpox virus and bovine papular stomatitis virus, are parapoxviruses, associated with domestic ruminants, which are capable of causing cutaneous infections in humans. Owing to virtually identical appearances in humans, clinical differentiation of these viruses is difficult. We discuss three recent occurrences of parapoxvirus infection, involving contact with domestic bovine and use a combination of molecular and epidemiological data in the diagnosis. These cases underscore the utility of modern diagnostic tools, along with species-specific contact information in acquiring a definitive diagnosis, in the case of suspected parapoxvirus infection.

Diverticulitis and polycystic kidney disease.

Patients with adult polycystic kidney disease (PKD) have previously been shown to have an increased incidence of complicated diverticulitis after renal transplantation. The purpose of this study was to assess the risk of diverticulitis in the PKD population. We retrospectively reviewed patients with advanced PKD, defined as end-stage renal failure requiring dialysis. Patients were obtained from a single nephrology group practice between January 1985 and January 1997, or from all patients being evaluated or actively considered for renal transplantation at our institution as of May 1997. The incidence and severity of diverticulitis in these patients was compared with that observed in a similar cohort of patients with end-stage renal disease due to other etiologies. The study population consisted of 184 renal failure patients, 59 with PKD and 125 with other causes of end-stage renal disease. Twelve (20%) patients with PKD had a history of active diverticulitis, whereas only 4 (3%) of the non-PKD controls had diverticulitis (P = 0.0003, Fisher's exact test). Six of the 12 PKD patients required surgical intervention. Patients with renal failure due to PKD experience a significantly higher rate of diverticulitis than do other patients with end-stage renal disease. Furthermore, diverticulitis is frequently severe in PKD patients, with 50 per cent requiring surgical intervention. These data suggest that diverticular disease may be an extrarenal manifestation of polycystic kidney disease.

Comparing contrast-enhanced breath-hold MR angiography and conventional angiography in the evaluation of mesenteric circulation.

OBJECTIVE: Our aim was to compare the results of gadolinium-enhanced breath-hold MR angiography with those of conventional angiography for the study of mesenteric circulation. SUBJECTS AND METHODS: MR angiography and digital subtraction angiography were prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimensional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference. RESULTS: A pure arterial angiogram (one on which veins could not be visualized) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourth acquisition) we obtained a pure venous angiogram (one on which arteries could not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), the superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0.75). Agreement was poor, and vessels were better shown by conventional angiography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventional angiography revealed 29 and 27 portosystemic collaterals, respectively. CONCLUSION: Dynamic breath-hold contrast-enhanced MR angiography compared favorably with conventional angiography in preoperative assessment of the proximal mesenteric arteries and in the evaluation of portal hypertension; however, conventional angiography is still necessary to evaluate distal arteries.

[Cholesterol embolism: unusual cause of small intestine occlusion]. / Embolie de cholestérol: une cause rare d'occlusion de l'intestin grêle.

We describe a case of small bowel obstruction secondary to cholesterol crystal embolism in a 83-year-old man. Clinical symptoms were dominated by weight loss and vomiting. Small bowel barrium X-ray displayed a short and unique stricture of the jejunum. Atheromatous embolism was suspected in the presence of an aortic aneurysm. At laparotomy, a 2 cm stricture of jejunum was identified and a 6 cm length segment of small bowel was resected. Pathological features were consistent with cholesterol crystal embolism. The patient did well 3 months after surgery. This observation points out the nonspecific clinical presentation of gastrointestinal cholesterol embolism.

Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn's disease.

BACKGROUND & AIMS: Infectious agents are suspected of being involved in the pathogenesis of Crohn's disease. This study was designed to look for the presence of virulent Escherichia coli strains associated with the ileal mucosa of patients with Crohn's disease. METHODS: E. coli strains were recovered from resected chronic ileal lesions (n = 20), neoterminal ileum after surgery from patients with (n = 19) and without (n = 11) endoscopic recurrence, and controls (n = 13). Bacterial adhesion was determined in vitro using intestinal cell lines; other associated virulence factors were assessed by DNA hybridization and polymerase chain reaction experiments. RESULTS: None of the strains harbored any of the virulence factor-encoding genes of E. coli involved in acute enteric diseases. However, mannose-resistant adhesion to differentiated Caco-2 cells was found for 84.6% and 78.9% of the E. coli strains isolated from chronic and early recurrent lesions, respectively, compared with 33% of controls (P < 0.02). In addition, 21.8% of the strains induced a cytolytic effect by synthesis of an alpha-hemolysin. CONCLUSIONS: E. coli strains isolated from the ileal mucosa of patients with Crohn's disease adhere to differentiated intestinal cells and may disrupt the intestinal barrier by synthesizing an alpha-hemolysin.

Complicated diverticulitis following renal transplantation.

PURPOSE: Colonic perforations in renal transplant recipients have historically been associated with mortality rates as high as 50 to 100 percent. However, these previous series generally predate the use of cyclosporine-based immunosuppressive protocols. METHODS: We retrospectively reviewed all patients who had undergone renal transplant from our institution and who developed complicated diverticulitis. Complicated diverticulitis was defined as diverticulitis involving free perforation, abscess, phlegmon, or fistula. Factors analyzed included the time interval since transplantation, use of cyclosporine, living-related vs. cadaveric donor, cause of renal failure, and presenting signs and symptoms. RESULTS: Between August 1969 and September 1996, 1,211 kidney transplants were performed in 1,137 patients. The first 388 patients (1969-1984) received prednisone and azathioprine, with cyclosporine added to the immunosuppressive regimen for the subsequent 823 recipients (1984-1996). Thirteen (1.1 percent) patients had episodes of complicated diverticulitis, occurring from 25 days to 14 years after transplant; all required surgical therapy. Clinical presentation was highly variable, ranging from asymptomatic pneumoperitoneum (2 patients) to generalized peritonitis. There was one perioperative mortality (7.7 percent). Patients with polycystic kidney disease as the cause of renal failure had a significantly higher rate of complicated diverticulitis. Specifically, patients with polycystic kidney disease (9 percent of the total transplant population) accounted for 46 percent of the cases of diverticulitis (P < 0.001, Fisher's exact probability test). Neither treatment with cyclosporine nor donor source had a significant effect on the rate of diverticular complications (P = 0.36 and P = 0.99, respectively, Fisher's exact probability test). CONCLUSION: Complicated diverticulitis following renal transplantation is rare, and the clinical presentation may be atypical in the immunosuppressed transplant recipient. Patients with polycystic kidney disease experience a significantly higher rate of complicated diverticulitis than do other transplant patients and, therefore, warrant aggressive diagnostic evaluation of even vague abdominal symptoms. In addition, pretransplant screening and prophylactic sigmoid resection in this high-risk population deserve consideration and further study.

Effect of manual therapy techniques on the stretch reflex in normal human quadriceps.

The effect of four manual therapy techniques on the quadriceps stretch reflex amplitude (elicited by mechanical vibration) was studied in a randomized, controlled trial in 120 (20 in each of six groups) healthy human subjects aged 18-64 years. Passive and active techniques were studied; each under static and dynamic conditions. The passive procedures were massage (static) and knee oscillation (dynamic) for 5 min. Active techniques involved eight repetitions of isometric quadriceps contractions (static) and leg extension (dynamic). The two static techniques had no effect on the stretch reflex amplitude. Both dynamic techniques caused a reduction (active by 25%, p < 0.00001 and passive 12%, p < 0.05). Only the active, dynamic technique caused a greater change than in the control group (p < 0.005). The effect lasted for less than 1 min. These data question the ability of such techniques to make clinically valid changes in motoneuron excitability. Further studies are required on those with neuromuscular pathology, who may respond differently to normal subjects.

[Chronic pancreatitis: an extraintestinal manifestation of hemorrhagic rectocolitis?]. / La pancréatite chronique: une manifestation extra-intestinale de la rectocolite hémorragique?

We reported here a case of unexplained chronic pancreatitis diagnosed 4 years before the onset of ulcerative colitis. The diagnosis of chronic pancreatitis was confirmed by recurrent pancreatitis and irregularities of the main pancreatic duct on retrograde pancreatography. None of the classical etiologies for chronic pancreatitis was found. Chronic pancreatitis associated with ulcerative colitis has already been reported in 5 cases. Our case reinforces the hypothesis of a non fortuitous association between both diseases.

Transesophageal echocardiography for the initial evaluation of the widened mediastinum in trauma patients.

Traumatic disruption of the thoracic aorta is an injury that is rapidly fatal if not recognized and treated early. Increasingly, transesophageal echocardiography (TEE) is being used to evaluate the thoracic aorta after trauma with reported sensitivity and specificity rates of up to 100%. To confirm these results, we instituted a protocol using TEE as the initial diagnostic study for excluding a ruptured thoracic aorta in patients with widened mediastinum. All TEE studies were done by experienced cardiologists; 96% were done in the trauma receiving area. TEE studies were classified as positive, negative, or indeterminant. Indeterminant studies were those in which the diagnosis of aortic injury could not be excluded based solely on TEE findings. Because we were interested in using TEE as a "definitive" diagnostic modality, indeterminant studies were regarded as positive for our analysis. This protocol was used in 114 trauma patients over a 3-year period. TEE identified five thoracic aortic disruptions--three confirmed by aortography and two by thoracotomy. TEE was read as indeterminant in 17 patients and further investigation with aortography showed no aortic injury in these patients. TEE was negative in 89 patients who had no further evaluation and were subsequently discharged or who died from other injuries. TEE failed to reveal significant lesions in three patients who had aortograms that revealed disruptions requiring thoracotomy. The use of TEE for the definitive diagnosis of ruptured aorta in this series yields a sensitivity of 63% and a specificity of 84%.(ABSTRACT TRUNCATED AT 250 WORDS)

Index transposition after resection of the long finger ray.

Ten patients underwent index-to-long-finger ray transposition for repair after resection of the long finger ray. Care was taken to preserve the second web space and prevent painful neuromas. Rigid internal fixation was achieved with a T plate, and mobilization was started immediately. There were no nonunions. Postoperative motion was equal to preoperative motion in acute cases and equal or better in chronic cases. Mean grip strength was 0.65, and pinch strength was 0.78 compared with the uninjured hand. There were no painful neuromas, hypersensitive scars, or deterioration of monofilament or two-point sensibility. The breadth and appearance of the first and second web spaces were equal bilaterally. Digit alignment and rotation were normal. The six patients receiving worker's compensation returned to work in between 3 and 24 weeks, and the other patients returned in between 11 days and 12 weeks.

Neonatal measures of attention and early cognitive status.

Measures of infant attention may be more indicative of cognitive status than scores from standardized developmental tests. The purpose of this study of 56 full-term infants was to determine whether measures of attention taken from the Brazelton Neonatal Behavioral Assessment Scales (NBAS) at 2 days and the Bayley Infant Behavior Record (IBR) at 2 months would be internally consistent and would be related to developmental status at 2 months. Attention measures were internally consistent. The IBR measure was significantly related to 2-month developmental status; the NBAS measure was not. Results support attention as an important focus for nursing assessment of development.

Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern.

The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.

Maternal psychological and physiologic correlates of fetal-newborn health status.

Data were obtained from 32 primigravid women in pregnancy and in labor. Anxiety in labor, measured by a self-report inventory, and plasma epinephrine were significantly correlated with the fetal heart rate pattern in active-phase labor (3 to 10 cm of cervical dilatation). The fetal heart rate pattern was significantly correlated with Apgar scores at 1 and 5 minutes. Conflict in the acceptance of pregnancy, measured in prenatal interviews, predicted anxiety and epinephrine levels in labor and the 5-minute Apgar score.