An evaluation of simple cleaning methods that may be used in red meat abattoir lairages.

Concrete tiles artificially contaminated with field strains of Escherichia coli and Salmonella kedougou, with and without the presence of bovine faecal matter, to simulate visually clean and visually dirty surfaces respectively, were cleaned using a specially designed mechanical rig. Cleaning was carried out using (1) water under mains pressure, (2) water under pressure, (3) water under pressure with a proprietary sanitising agent, (4) steam under pressure and combinations of (5) mains water followed by steam under pressure or (6) water under pressure followed by steam under pressure. Thirty replicates of each of visually clean and visually dirty concrete surfaces were cleaned using each method. Where there was no faecal matter, the use of a proprietary sanitiser at maximum recommended concentration, or the application of steam under pressure gave greater reductions in microbial contamination than the use of mains or a pressure wash. Where the surface was visually contaminated with the faecal material, the use of a pressure wash followed by immediate steam application gave reductions in microbial contamination comparable with the use of a proprietary sanitiser at maximum recommended concentration. The use of steam alone on a visually dirty surface was not an effective means of reducing microbial contamination. A small pilot trial under commercial conditions ranked the efficacy of cleaning treatments as follows: pressure washing followed immediately by steam application was the best method of cleaning a holding pen floor, followed by use of a sanitising agent at the greatest concentration recommended by the manufacturer, and then by pressure washing alone. Pressure washing followed by a delayed steam application appeared to give a poor final result on the surface.

18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes.

PURPOSE: Correctly identifying infection in cancer patients can be challenging. Limited data suggest that positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) may be useful for diagnosing infection. To determine the role of FDG-PET in the diagnosis of infection in patients with multiple myeloma (MM). PATIENTS AND METHODS: The medical records of 248 patients who had FDG-PET performed for MM staging or infection work-up revealing increased uptake at extramedullary sites and/or bones and joints that would be atypical for MM between October 2001 and May 2004 were reviewed to identify infections and evaluate FDG-PET contribution to patient outcome. RESULTS: One hundred sixty-five infections were identified in 143 adults with MM. Infections involved the respiratory tract [99; pneumonia (93), sinusitis (six)], bone, joint and soft tissues [26; discitis (10), osteomyelitis (nine), septic arthritis (one), cellulitis (six)], vascular system [18; septic thrombophlebitis (nine), infection of implantable catheter (eight), septic emboli (one)], gastrointestinal tract [12; colitis (seven), abdominal abscess (three), and diverticulitis and esophagitis (one each)], and dentition [periodontal abscess (10)]. Infections were caused by bacteria, mycobacteria, fungi, and viruses. FDG-PET detected infection even in patients with severe neutropenia and lymphopenia (30 episodes). The FDG-PET findings identified infections not detectable by other methods (46 episodes), determined extent of infection (32 episodes), and led to modification of work-up and therapy (55 episodes). Twenty silent, but clinically relevant, infections were detected among patients undergoing staging FDG-PET. CONCLUSION: In patients with MM, FDG-PET is a useful tool for diagnosing and managing infections even in the setting of severe immunosuppression.

Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial.

PURPOSE: To evaluate the effectiveness and safety of samarium-153 (153Sm) lexidronam (EDTMP) in a double-blind, placebo-controlled study. PATIENTS AND METHODS: Patients with painful bone metastases secondary to a variety of primary malignancies were randomized to receive 153Sm-EDTMP 0.5 or 1.0 mCi/kg, or placebo. Treatment was unblinded for patients who did not respond by week 4, with those who had received placebo eligible to receive 1.0 mCi/kg of active drug in an open-label manner. Patient and physician evaluations were used to assess pain relief, as was concurrent change in opioid analgesia. RESULTS: One hundred eighteen patients were enrolled onto the study. Patients who received 1.0 mCi/kg of active drug had significant reductions in pain during each of the first 4 weeks in both patient-rated and physician-rated evaluations. Pain relief was observed in 62% to 72% of those who received the 1.O-mCi/kg dose during the first 4 weeks, with marked or complete relief noted in 31% by week 4. Persistence of pain relief was seen through week 16 in 43% of patients who received 1.0 mCi/kg, of active drug. A significant correlation (P = .01) was observed between reductions in opioid analgesic use and pain scores only for those patients who received 1.0 mCi/kg 153Sm-EDTMP. Bone marrow suppression was mild, reversible, and not associated with grade 4 toxicity. CONCLUSION: A single dose of 1.0 mCi/kg of 153Sm-EDTMP provided relief from pain associated with bone metastases. Pain relief was observed within 1 week of administration and persisted until at least week 16 in the majority of patients who responded.

Robotic equipment in the meat industry.

Robotic technology is beginning to find uses in the meat processing industry. This paper attempts to describe the potential benefits and some of the problems in implementing robots for meat processing. An overview of some of the robotic equipment available and in development for beef, pork, lamb, poultry, fish and seafood processing is given. Standard industrial robots already perform meat industry tasks involving regular and uniform products and processes. Robotic automation is emerging for more skilled tasks but is not yet fully accepted or implemented in the meat industry.

Enhancement of tumorigenicity of human breast adenocarcinoma cells in nude mice by matrigel and fibroblasts.

The failure of MCF7 cells to induce the formation of tumours after sub-cutaneous inoculation into athymic nude mice can be obviated by the simultaneous injection of an extract of basement membrane proteins (matrigel). Tumour growth is promoted and the latency period is low (2 to 4 weeks). In the absence of matrigel, the simultaneous inoculation of fibroblasts and MCF7 cells also resulted in the development of tumours, but with a longer latency period (about 2 months). The tumorigenic synergy between matrigel and fibroblasts was evidenced by co-inoculating MCF7 cells MDA-MB 231 cells with fibroblasts and matrigel. This co-inoculation decreased the delay of appearance of the tumours and/or accelerated the tumour growth, depending upon the number of fibroblasts injected. Repeated injections of fibroblasts conditioned medium, at the site of inoculum of tumour cells also enhanced tumour growth, suggesting the involvement of soluble factors secreted by fibroblasts. Histologically, tumours induced by co-inoculation of tumour cells and fibroblasts contained more stromal structures including vimentin-positive cells, fibronectin and interstitial collagens. These data suggest that human tumours may be reconstituted and grown in athymic nude mice using basement membrane components and fibroblasts as inductors.

The application of a rapid D-dimer test in suspected pulmonary embolus.

A prospective, consecutive series of plasma D-dimer (D-D) using a rapid, sensitive, and semiquantitative latex agglutination test from 169 patients clinically suspected of having acute pulmonary embolus (PE) was performed to determine its clinical utility in acute PE. All patients had ventilation/perfusion (V/Q) scans and 20 patients (12%) subsequently had pulmonary arteriography (PAG). The 20 patients who subsequently had PAG were used to establish the predictive value(s). In 10 patients with normal D-D results, none had PE according to PAG. In 10 patients with abnormal D-D results, seven showed PE by PAG and three did not show PE by PAG. The sensitivity, specificity, positive predictive values, and negative predictive values of the plasma D-D tests for acute PE based on PAG were 1.00, 0.77, 0.70, and 1.00, respectively. In nine patients with indeterminate V/Q scans who had PAG, four had PE and the D-D result was abnormal. Five of these patients did not have PE and the D-D result was abnormal in three and normal in two. Seventeen patients had high-probability V/Q scans, all of whom had abnormal D-D results. Only one had PAG that showed PE in this group. A normal D-D result using a rapid latex agglutination method can effectively exclude the diagnosis of acute PE. The negative predictive value of the rapid latex agglutination method is as good as the more cumbersome enzyme-linked immunosorbent assay methods. An abnormal result is nonspecific and is not useful in the diagnosis of acute PE. While some "false positives" did occur, there were no false-negative results. The best use of the D-D test is in the examination of the patient with indeterminate V/Q studies. We conclude that the D-D test can rapidly provide information in determining whether a patient needs further angiographic studies.

Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus.

Although ventilation-perfusion lung scanning is widely used in evaluating patients with suspected pulmonary embolus, additional rapid screening tests are needed to supplement scintigraphy in patients in whom the scan is indeterminate or the scan results are discordant with clinical suspicion. D-dimer is a fibrin degradation product which should be elevated in the presence of intravascular coagulation. We prospectively studied patients referred for lung scanning by obtaining a plasma D-dimer latex agglutination assay at the time of the scan. Of 64 patients who had pulmonary angiography to confirm the diagnosis, 16 were positive for pulmonary embolus and only one had a normal D-dimer. The D-dimer was normal in 27 of 48 patients without embolus and elevated in 21. Although an elevated D-dimer level is a nonspecific finding, we conclude that a normal D-dimer is a good negative predictor for pulmonary embolus, with a negative predictive value of 0.97.

Crossed renal ectopia. Correlative imaging.

Anatomic variants of the kidneys are often noted during renal scintigraphy and other imaging studies. These conditions have a variable effect on overall renal function and can cause confusion, both clinically and on initial imaging. The authors describe a case of unfused, crossed renal ectopia in an elderly woman that appeared to be an abdominal mass and was subsequently evaluated by computed tomography, ultrasound, and scintigraphy.

Immunoscintigraphy of prostatic cancer: preliminary results with 111In-labeled monoclonal antibody 7E11-C5.3 (CYT-356).

A phase 1 study was conducted with the investigational immunoscintigraphic agent, 111In-CYT-356, a radiolabeled, site-specific immunoconjugate of monoclonal antibody 7E11-C5.3, in 40 patients with prostatic carcinoma and known distant metastases. Each patient received a single intravenous infusion of CYT-356 (dose range, 0.1-5 mg) radiolabeled with approximately 5 mCi of 111In. None of the patients experienced adverse reactions. One patient who received a 5-mg dose developed antibodies to the CYT-356 immunoconjugate. 111In-CYT-356 immunoscintigraphy detected bony metastases in 21 of 38 patients (55%), including 12 of 14 (86%) receiving concomitant hormonal therapy, and soft tissue lesions in four of six patients (67%). Antibody imaging detected occult lesions in the bony pelvis and lumbar spine, which were confirmed by follow-up imaging tests, in one patient. Higher CYT-356 doses may clear the blood pool more slowly. These results suggest that 111In-CYT-356 can be safely administered to patients with prostatic carcinoma and that further clinical investigation of this agent is warranted.

A rapid method for standardization of the gated radionuclide left ventricular ejection fraction.

Radionuclide ventriculography has become the standard method for serially evaluating left ventricular ejection fraction (EF). The "gold standard" for evaluating EF is the contrast ventriculogram, which uses mathematical models to arrive at the volumes used to calculate EF. These models are subject to possible error. This paper reports the standardization of volume measurements of a digital angiographic camera system using a series of cardiac phantoms and the correlation of measurement of the EF of a series of patients whose EF was determined by digital angiography and radionuclide ventriculography.

Indium-111 leukocyte localization in infected prosthetic graft.

Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.

Suicide by captopril overdose.

We report a case of a 75 year-old male who committed suicide by taking an overdose of captopril. He took approximately ninety 12.5 mg captopril tablets. The postmortem plasma concentration of captopril was 60.4 mg/L. A review of the medical literature revealed five cases of captopril overdose all from unsuccessful suicide attempts. To our knowledge, this is the first case report of fatal captopril overdose with the measurement of plasma concentration of the drug.

Complications from extravasated retroperitoneal barium: case report and review of the literature.

Extravasation of barium into the retroperitoneum is an uncommon complication of radiologic examinations of the gastrointestinal tract. It may occur during evaluation of either the upper or lower tract. A case is presented in which the result was abscess formation, a potential delayed complication of duodenal perforation and retroperitoneal extravasation of barium. In this case, medical treatment was successful.

Pulmonary embolism: chest radiographic abnormalities.

The value of chest radiography in the diagnosis of pulmonary embolism has been investigated extensively. Although the chest radiograph seldom permits one to say whether embolism is or is not present, it is still an essential component in the evaluation of the patient with suspected pulmonary embolism. This article stresses the radiographic abnormalities that occur with pulmonary embolism and defines the role of the chest radiograph for evaluation of this disorder.

Computed tomography and magnetic resonance imaging in the diagnosis of pulmonary thromboembolic disease.

In selected cases CT and MRI may be useful for the evaluation of patients suspected of having central pulmonary emboli. In stable patients MRI appears to be superior to CT because no iodinated contrast medium is required. In evaluating critically ill patients CT is better because of its superior resolution, ability to assess changes in the lung parenchyma, and ease of patient monitoring.