Comparison of four commercially available rapid enzyme immunoassays with cytotoxin assay for detection of Clostridium difficile toxin(s) from stool specimens.

Rapid (2.5- to 3.5-h) enzyme immunoassays (EIAs) for the detection of Clostridium difficile toxins have been developed. We report the results of simultaneous testing of 700 fresh stool specimens by the tissue culture cytotoxin assay and four EIAs (Bartels Prima System C. difficile Toxin A EIA, Cambridge Biotech Cytoclone A+B EIA, Meridian Diagnostics Premier C. difficile Toxin A EIA, and TechLab C. difficile Tox-A Test EIA). In cases of disagreement, culturing for toxigenic C. difficile was performed. A total of 61 (8.7%) specimens from 46 patients were positive for C. difficile toxin. The sensitivity of the cytotoxin assay was 87%, and that of culture was 93%. In comparison with the cytotoxin assay results, the sensitivity and specificity of the EIAs were as follows: Bartels, 87 and 96%; Cambridge, 89 and 99%; Meridian, 87 and 98%; and TechLab, 87 and 95%, respectively. In comparison with the cytotoxin assay plus toxigenic culture results, the sensitivity and specificity of the EIAs were as follows: Bartels, 84 and 97%; Cambridge, 85 and 99%; Meridian, 79 and 98%; and TechLab, 80 and 96%, respectively. The EIAs varied in positive predictive values (PPVs). A high PPV was seen with the Cambridge EIA (96%); lower PPVs were seen with the TechLab (64%), Bartels (72%), and Meridian (80%) EIAs because of high false-positive rates. The negative predictive values (98 to 99%) were excellent with all EIAs. Results were indeterminant with 0.3% of the samples by the Meridian EIA and 3% by all the other EIAs. Although the EIAs were less sensitive than the cytotoxin assay, they provide same-day results and may be useful in laboratories without tissue culture facilities.

Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.

OBJECTIVE: The prevalence and nature of findings of cervicogenic dysfunction is explored in subjects with muscle contraction/tension-type (MCH) headache and common migraine without aura (CM). DESIGN: Descriptive survey. SETTING: Chiropractic outpatient research clinic. PATIENTS: Forty-seven (47) subjects, aged 18-55 with two categories of benign headache, were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an intervention trial and, thus, form a consecutive sample of patients. The present findings were elicited as part of the initial assessment. INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURES: Standardized headache history; plain film and dynamic spinal X rays; motion palpation; and pressure algometry. RESULTS: For CM, the most prevalent headache locations were frontal (81%) and occipital (78%). Neck pain and upper back pain accompanied headache in 90% and 41% of subjects, respectively. For MCH, the most prevalent headache locations were occipital (87%) and frontal (81%). Neck and upper back pain accompanied headache in 100% and 27%, respectively, of all subjects. For the total group, 77% of all subjects and 89% of females exhibited a marked reduction, absence or reversal of the normal cervical lordosis. Ninety-seven percent of all subjects exhibited, on dynamic X-ray studies, at least one significant abnormality of segmental mobility from C1 to C7, while 43% exhibited abnormalities at four or more segments. Segmental motion at C0-C1 was reduced in 90% of subjects in flexion and 70% of subjects in extension. On motion palpation, 84% of CM and MCH subjects were found to have at least two major fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had at least one verifiable tender point (TP) in the upper cervical region. The most common locations for TPs were mid-cervical (C2-C3), lateral occipital and suboccipital. CONCLUSIONS: Both MCH and CM subjects demonstrate high occurrences of: a) occipital and neck pain during headaches; b) tender points in the upper cervical region; c) greatly reduced or absent cervical curve; and d) X-ray evidence of joint dysfunction in the upper and lower cervical spine. These findings support the premise that the neck plays an important, but largely ignored role in the manifestation of adult benign headaches. A case-control study should be conducted to confirm the greater prevalence of cervicogenic dysfunction in headache as compared to nonheadache subjects.

Painless infraspinatus atrophy due to suprascapular nerve entrapment.

A case of painless suprascapular nerve entrapment, resulting in isolated atrophy and weakness of the infraspinatus, is described. Electromyography was used to confirm the clinical diagnosis. The etiology of this neuropathy ranges from trauma to overexertion of the upper extremity. Consequent entrapment most often occurs at the suprascapular or spinoglenoid notch. Local ganglionic cysts have been found compressing the suprascapular nerve. Conservative management, including "benign neglect," physical therapy, and local injections, is often effective. Surgical decompression may be indicated in refractory or posttraumatic cases.

Anterolisthesis in the cervical spine--spondylolysis.

Two cases of cervical spondylolisthesis are reported, and the relevant English language literature is reviewed. Analysis of data derived from all of the cases reported revealed no statistically significant etiological or prognostic factors. The roentgenological evaluation, including associated anomalous findings, is presented. Etiological and clinical aspects of cervical spondylolisthesis are discussed. It is concluded that cervical spondylolysis is a relatively rare congenital defect. The role of manipulative therapy in the treatment of associated symptoms is discussed.

Quantitative analysis of abnormal hemoglobins by agar gel electrophoresis.

Measurement of the proportion of abnormal hemoglobin in a hemolysate is essential for differentiation of simple and compound heterozygotes (e.g., sickle cell trait vs. sickle thalassemia), for differential of alpha- and beta-thalassemia in compound heterozygotes, and for differentiation of various types of beta-thalassemia in such persons. Utilization of such measurements is hampered by the imprecision and inconvenience of current methods. We have adapted a readily available agar electrophoresis method for this purpose, scanning unstained gels at 420 nm. The new method is particularly valuable for rapid estimation of percent of HbS after partial exchange transfusion in patients with sickle cell anemia. It cannot be used for quantitation of HbF or for quantitation of hemoglobins that comigrate with HbA; contrariwise, it can be used for hemoglobins that only separate from HbA on agar (e.g., HbBethesda).

Combined glucose phosphate isomerase and glucose-6-phosphate dehydrogenase deficiency of erythrocytes.

A patient with combined deficiency of erythrocyte glucose phosphate isomerase (GPI) and glucose-6-phosphate dehydrogenase (G6PD) is presented. The propositus has persistent unconjugated hyperbilirubinemia. One of his two brothers exhibits the same rare enzymatic defect, but without any clinical symptoms. The electrophoretic pattern of GPI showed GPI type 1. There seems to be a correlation between the unconjugated hyperbilirubinemia and the combined enzymopathy in our patient.

Distribution of newly formed fatty acids among glycerolipids of isolated perfused rat liver.

Livers of chow fed rats were perfused 1-3 h with buffer, glucose, albumin, and red blood cells, made up in 100 percent D(2)O. Glycerolipids were isolated and the deuterated fatty acids determined by gas chromatography with mass spectrometry on Silar 5 CP. Percentage of replacement by deuterated acids ranged from 1 to 14, of which palmitate was 87 percent. Differences were found in total lipid class and in subcellular distribution of the newly synthesized acids. Microsomes had 37 percent more deuterated acids than the total or floating fat. At 3 h the highest replacement was found in diacylglycerols (17 percent) and free fatty acids (11 percent). Of the palmitate in hepatic choline and ethanolamine phosphatides, 6.9 percent and 4.7 percent, respectively, contained dueterium. The serine and inositol phosphatides had a higher proportion of deuterated palmitate (7.7 percent) than other phosphatides. The data support the hypothesis that palmitate is incorporated into glycerolipids largely via de novo synthesis while stearate enters them by deacylation-acyl transfer replacement.

Distribution of newly formed palmitate and stearate among molecular species of choline and ethanolamine phosphatides.

The choline and ethanolamine phosphatides derived from isolated rat livers during perfusion with 75 percent deuterated water (Kuksis, A., Myher, J.J., Marai L., Yeung, S.K.F., Steiman, I. & Mookerjea, S. (1975) Can. J. Biochem. 53, 509-518) were resolved into molecular species by argentation thin-layer chromatography. The time course of percentage replacement of the newly synthesized fatty acids in each molecular species was determined by gas chromatography with mass spectrometry. The results confirmed the earlier postulated differential utilization of palmitic and stearic acids in glycerolipid biosynthesis as well as supported the hypothesis of a precursor-product relationship between the oligoenoic and tetranoic species of both phosphatides. Calculations of half-lives gave values of 14-19 h for palmitoyl oligoenes, 40-50 h for palmitoyl tetraenes, and 22-28 h for palmitoyl hexaenes of both choline and ethanolamine phosphatides. The corresponding stearoyl species had half-lives which ranged from 89 to 200 h. Evidence was obtained for a metabolic heterogeneity among subsets of molecular species recognized on the basis of combinations of new and old glycerol and fatty acids in the same glycerolipid molecule.