Different utilization of alginate and other algal polysaccharides by marine Alteromonas macleodii ecotypes

The marine bacterium Alteromonas macleodii is a copiotrophic r-strategist, but little is known about its potential to degrade polysaccharides. Here, we studied the degradation of alginate and other algal polysaccharides by A. macleodii strain 83-1 in comparison to other A. macleodii strains. Cell densities of strain 83-1 with alginate as sole carbon source were comparable to those with glucose, but the exponential phase was delayed. The genome of 83-1 was found to harbour an alginolytic system comprising five alginate lyases, whose expression was induced by alginate. The alginolytic system contains additional CAZymes, including two TonB-dependent receptors, and is part of a 24 kb genomic island unique to the A. macleodii 'surface clade' ecotype. In contrast, strains of the 'deep clade' ecotype contain only a single alginate lyase in a separate 7 kb island. This difference was reflected in an eightfold greater efficiency of surface clade strains to grow on alginate. Strain 83-1 furthermore hydrolysed laminarin, pullulan and xylan, and corresponding polysaccharide utilization loci were detected in the genome. Alteromonas macleodii alginate lyases were predominantly detected in Atlantic Ocean metagenomes. The demonstrated hydrolytic capacities are likely of ecological relevance and represent another level of adaptation among A. macleodii ecotypes.

Severe epiglottic prolapse and the obscured larynx at intubation

Laryngomalacia is the most common congenital anomaly of the larynx and usually involves prolapse of the arytenoids, so-called 'posterior laryngomalacia'. Most cases resolve with growth of the child and maturation of the larynx, although, rarely, significant airway obstruction can be present. Severe laryngomalacia preventing intubation is rarely encountered. We report a case of a difficult emergency intubation secondary to 'anterior laryngomalacia' in a 4-month-old boy in whom the epiglottis prolapsed posteriorly and became trapped in the laryngeal introitus. The child was referred with a diagnosis of laryngeal atresia on the basis of the intubating laryngoscopic view of no apparent epiglottis or laryngeal inlet. The child was transferred with a tube in the oesophagus that kept the child oxygenated. At the time, oxygenation was felt to be due to a coexisting tracheo-oesophageal fistula, although this was eventually found not to be the case.

Occipital meningocele and Mondini deformity of the cochlea

We present two cases of a previously unreported association between occipital meningocele and Mondini deformity of the cochlea. The probability of the association is supported by the intimate relationship between the development of these structures; the existence of dysembryoplastic factors that can cause both abnormalities; and the universal existence of cochlear abnormalities in anencephalic foetuses. The importance of considering the association is emphasized, in terms of early identification and referral of children with hearing loss, and avoidance of duplication of investigations.

Image-guided transnasal endoscopic surgery of the paranasal sinuses and anterior skull base

Image-guided surgery represents a new technology with applicability to patients undergoing functional endoscopic sinus surgery for medically refractory rhinosinusitis. It also shows promise in helping to safely expand minimally invasive transnasal endoscopic techniques for nonrhinosinusitis diagnoses of the paranasal sinuses, orbits, and anterior skull base. This report discusses the application of the InstaTrak, a commercially available image-guided surgical navigation system, in 109 consecutive operations. The device was useful for localization to within less than 3 mm in 106 (98%) cases. In the remaining three (2%) surgeries where the perceived accuracy was not within 3 mm, the device was not used. The acquisition of radiographic data, operating room set-up, intraoperative localization and complications, and indications for surgical navigation will be discussed.

Risk factors for hearing loss from meningitis in children: the Children's Hospital experience

OBJECTIVES

To identify statistically significant risk factors for hearing loss in children with meningitis, determine the overall incidence of hearing loss in a large group of children with confirmed meningitis, and quantify the percentage of children with progressive or fluctuating hearing loss after meningitis.

DESIGN

Retrospective analysis.

PATIENTS AND OTHER PARTICIPANTS

Four hundred thirty-two children admitted to the Children's Hospital, Birmingham, Ala, from January 1, 1985, to December 31, 1995, with the diagnosis of meningitis.

RESULTS

Of 432 children with meningitis, 59 (13.7%) had the development of hearing loss. Of these 59 children, 46 (78.0%) had stable sensorineural hearing loss and 13 (22.0%) had either progressive or fluctuating hearing loss. Of the variables examined using multiple logistic regression backward-elimination modeling, only 5 appeared to be significantly associated with the development of hearing loss: computed tomographic scan evidence of increased intracranial pressure (estimated odds ratio [OR] = 2.3), male sex (OR= 1.9), the common logarithm of glucose levels in the cerebrospinal fluid (OR = 0.58), Streptococcus pneumoniae as the causative organism (OR= 2.1), and the presence of nuchal rigidity (OR = 1.9). In the children with progressive hearing loss, the time for progression varied from 3 months to 4 years before hearing stabilized.

CONCLUSIONS

In this study of children diagnosed as having meningitis, hearing loss developed in 59 (13.7%). Forty-six (78.0%) of these children with hearing loss had stable auditory thresholds over time, and 13 (22.0%) exhibited deterioration or fluctuation of acuity over time. Evidence of increased intracranial pressure by computed tomographic scan, male sex, low glucose levels in the patients' cerebrospinal fluid, S pneumoniae as the causative organism, and the presence of nuchal rigidity appear to be significant predictors for future hearing loss.

Erbe constant voltage electrocautery versus conventional variable voltage electrocautery for tonsillectomy in children

This prospective, randomized study was performed to compare postoperative pain, blood loss, and procedure time using the Erbe electrocautery device and conventional electrocautery. The Erbe device differs from conventional cautery devices in that it produces constant voltage and variable wattage whereas conventional devices produce variable voltage and constant wattage. This means that the conventional devices allow voltage surges and constant wattage no matter what type of tissue is encountered. The Erbe device has the inherent capability to maintain constant voltage, i.e. no surging as well as varying wattage according to tissue resistance. This, in theory, allows the Erbe device to impose less tissue damage and, theoretically, less postoperative pain. Fifty-seven patients 5-21 years of age who were scheduled for adenotonsillectomy were enrolled in the study. Results indicated less postoperative pain, although blood loss appeared to be increased compared to conventional electrocautery. The Erbe electrocautery device appears to be a viable device to perform tonsillectomy in children.

A rapid slide test for penicillinase

The authors developed a rapid slide test modification of the iodometric method for detection of penicillinase produced by organisms growing on routine plating media. A loopful of colonies is scraped from the agar surface and emulsified in one drop of an iodine-penicillin solution on a glass slide. Addition of a drop of 0.4% starch solution results in a purple color when penicillinase is not present; a colorless reaction denotes a positive test. The slide test yielded positive results identical to those of a starch agar-plate method with 26 Staphylococcus aureus isolates; a further seven showed comparable negative tests. Penicillinase production was associated with a S. aureus penicillin MIC of greater than or equal to 0.5 micron/ml. All 15 Staphylococcus epidermidis isolates gave negative test results, as did 22 Bacteroides fragilis (MIC greater than or equal to 3.1). Twenty ampicillin-susceptible Haemophilus influenzae were negative by both the slide test and a Levinthal broth method; an additional five resistant (MIC greater than or equal to 10) isolates were positive by both methods. Twenty-eight (penicillin MIC greater than or equal to 0.8) of 50 Bacteroides melaninogenicus were slide test-positive for penicillinase. Two penicillinase-producing strains of Neisseria gonorrhoeae gave positive slide tests, while eight other non-penicillinase-producers were negative.