Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture

INTRODUCTION

The aim of the current study was to determine whether application of an intramedullary hip screw for definitive management of intertrochanteric fracture was associated with post-operative deformity. Specifically this study investigated whether nail insertion would cause a "wedge effect" of the intertrochanteric fracture manifesting as lateralization of the femoral shaft and varus malalignment.

MATERIALS AND METHODS

The trauma database at the University of Pittsburgh Medical Center was investigated to identify all intertrochanteric fractures (AO/OTA 31A) over the past 3 years treated with an IMHS. Fractures eligible for inclusion were performed under the supervision of a fellowship trained orthopedic trauma surgeon. All fractures were reduced in optimal alignment using percutaneous or mini-open strategies during the reaming process and nail insertion. The entry portal was over-reamed by at least 1.5 mm. Cases selected for review of the "wedge effect" had optimal post-operative imaging allowing for assessment of discrepancy between the operative and normal hip.

RESULTS

Forty six patients with an average age of 77 years were included for study. Fifty percent were classified as unstable patterns. Shaft lateralization following IMHS fixation of the fractured hip was found to be an average of 7 mm greater than the contralateral intact hip (p < 0.001) (range 0-30 mm). The neck-shaft angle of the operative hips was 129° as compared to 133° on the intact side (p = 0.009). The stability of the fracture pattern was not predictive for post-operative lateralization of the femoral shaft or varus angulation (p > 0.05) (Table 2). There was no difference in post-operative deformity among techniques used for maintenance of reduction during reaming and nail insertion (p > 0.05). Despite deformity, all cases demonstrated radiographic radiographic fracture union.

CONCLUSION

Despite attention to detail, the application of an intramedullary hip screw for intertrochanteric fracture has the tendency to lateralize the shaft relative to the head/neck segment (The "wedge effect").

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture

BACKGROUND

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture.

METHODS

Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older.

RESULTS

The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%).

CONCLUSIONS

The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations.

CLINICAL RELEVANCE

The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.

Comparison of outcomes after triceps split versus sparing surgery for extra-articular distal humerus fractures

OBJECTIVES

To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach.

DESIGN

Retrospective review.

SETTING

Two level one trauma centres.

PATIENTS

Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up.

INTERVENTION

Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients).

MAIN OUTCOME MEASUREMENTS

Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

RESULTS

Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p=0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p<0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p=0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p=0.333).

CONCLUSIONS

A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome.

LEVEL OF EVIDENCE

Level III.

Bicolumnar 90-90 plating of low-energy distal humeral fractures in the elderly patient

Fragility fractures of the distal humerus in elderly patients, especially the low transcondylar fracture pattern, can be difficult to optimally manage. Although the fractures are typically low energy resulting in either extra-articular or simple intra-articular patterns, gaining fixation into the distal fragments can be difficult with open reduction internal fixation (ORIF) using traditional 90-90 or parallel plating techniques. Anatomy preserving reconstruction with ORIF is preferred over total elbow arthroplasty (TEA) if possible. In this study, 15 patients were managed with a bicolumnar 90-90 plating construct as a novel method of enhancing distal fixation in these fractures. Fourteen patients went on to radiographic union at an average of 77 days after surgery with an average arc of motion of 105°. One patient was lost to follow-up. Bicolumnar 90-90 plating of distal humerus fractures in elderly patients may represent a viable alternative to traditional ORIF or TEA.

Open reconstruction of complex proximal metadiaphyseal fragility fractures of the humerus

PURPOSE

A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications.

METHODS

From 2008 to 2012, 21 such operations were performed; 18 were considered "fragility" fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation (ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative.

RESULTS

The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean = 21, standard deviation = 20, n = 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15).

CONCLUSION

Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.

Comparative Activity of Telithromycin Against Macrolide-Resistant Isolates ofStreptococcus pneumoniae:Results of Two Years of the PROTEKT Surveillance Study

The increase in resistance to macrolides has been linked with increasing use of these agents as empirical therapy for community-acquired respiratory tract infections (CARTIs). As part of the ongoing PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) surveillance program, over 7600 Streptococcus pneumoniae isolates were collected worldwide from 1999-2001 and evaluated for macrolide resistance. Globally, macrolide resistance was 31-33%, with considerable inter-country variation (<10-88%) and particularly high prevalence in the Far East (>71%). In Europe, France had the most resistant isolates (>53%). The highest rates of macrolide resistance were seen in 0-2 year olds. Co-resistance to clindamycin (64%) and all beta-lactams (14-79%) was seen among macrolide-resistant isolates, but >99% of these isolates were susceptible to telithromycin, vancomycin and linezolid. There was considerable variation in the prevalence of erm(B) (56-64%) and mef(A) (30-35%): erm(B) was prevalent in Europe and mef(A) in North America. Globally, 5-7% isolates carried both mechanisms (erm(B)+mef(A)); of these, 47-65% were from South Korea. These double resistance isolates were >90% resistant to the beta-lactams, except amoxicillin-clavulanate. Clindamycin was active against >98% mef(A) but poorly active against erm(B) and erm(B)+mef(A) isolates. Telithromycin, vancomycin and linezolid were highly active (>99.5%) across all three genotypes.

CONCLUSIONS

In vitro, telithromycin, vancomycin and linezolid are highly active against antibiotic-resistant strains of S. pneumoniae. Telithromycin may be a useful therapeutic alternative to macrolides for the treatment of CARTIs.

Eight-year (2002-2009) summary of the linezolid (Zyvox® Annual Appraisal of Potency and Spectrum; ZAAPS) program in European countries

The linezolid surveillance network (ZAAPS program) has been monitoring linezolid activity and susceptibility rates for eight years (2002-2009) in european medical centers. Samples from 12-24 sites annually in 11 countries were monitored by a central laboratory design using reference MIC methods with international and regional interpretations (EUCAST). A total of 13,404 gram-positive pathogens were tested from 6 pathogen groups. Linezolid remained without documented resistance from 2002 through 2005, but beginning in 2006 resistant strains emerged at very low rates among Staphylococcus aureus (G2576T mutant in ireland, 2007), coagulase-negative staphylococci (CoNS; usually Staphylococcus epidermidis, France and Italy in 2006-2009) and enterococci (Enterococcus faecium in Germany [2006, 2008, 2009] and E. faecalis in Sweden [2008], United Kingdom [2008] and Germany [2009]); all but one strain having a target mutation. A mobile cfr was detected in an italian CoNS strain (2008 and 2009), and clonal spread was noted for linezolid-resistant strains (PFGE results). Overall the linezolid susceptibility rates were >99.9, 99.7 and 99.6% for S. aureus, CoNS and enterococci, respectively; and all streptococcal strains were susceptible (MIC(90), 1 mg/l). In conclusion, the ZAAPS program surveillance confirmed high, sustained levels of linezolid activity from 2002-2009 and without evidence of MIC creep or escalating resistance in gram-positive pathogens across monitored european nations.

Sustained antimicrobial activity of tigecycline against methicillin-resistant Staphylococcus aureus (MRSA) from United States Medical Centers from 2004 through 2008

Tigecycline, a glycylcycline, has been approved by the United States Food and Drug Administration (USA-FDA) for the treatment of complicated skin and skin structure infections, intra-abdominal infections and community-acquired bacterial pneumonia. based on broth microdilution minimum inhibitory concentration (MIC) testing, tigecycline demonstrated sustained high activity (MIC(50/90), 0.12/0.25 mg/L) against a contemporary collection (10,242) of methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) collected from 32 USA hospitals over a 5-year period (2004-2008). Tigecycline MIC distribution did not vary significantly during the study period and only three isolates (0.03%) were non-susceptible at USA-FDA breakpoints. Vancomycin (MIC(90), 1 mg/L), trimethoprim/sulfamethoxazole (MIC( 90), <0.5 mg/L) and linezolid (MIC(90), 2 mg/L) were also very active. The results of this study indicate that tigecycline potency and spectrum against MRSA have not changed since its initial regulatory approval by the USA-FDA.

Nonlinear mirror modelocking of a bounce geometry laser

We present the investigation of nonlinear mirror modelocking (NLM) of a bounce amplifier laser. This technique, a potential rival to SESAM modelocking, uses a nonlinear crystal and a dichroic mirror to passively modelock a Nd:GdVO(4) slab bounce amplifier operating at 1063nm. At 11.3W, we present the highest power achieved using the NLM technique, using type-II phase-matched KTP, with a pulse duration of 57ps. Using type-I phase-matched BiBO, modelocking was achieved with a shorter pulse duration of 5.7ps at an average power of 7.1W.

High power scaling of a passively modelocked laser oscillator in a bounce geometry

In this paper we present the first operation and power scaling of a modelocked Nd:YVO4 bounce laser oscillator at 1064 nm. We obtain up to 16.7 W of average output power from 38 W of pump power, in a continuous-wave modelocked pulse train with 30 ps pulses at a repetition rate of 78 MHz. We then use a Master Oscillator Power Amplifier (MOPA) configuration utilising another bounce amplifier, to achieve 60 W of modelocked output power.

Activity of telithromycin and comparators against isolates of Legionella pneumophila collected from patients with community-acquired respiratory tract infections: PROTEKT Years 1-5

The in-vitro activity of telithromycin and comparator antibacterial agents was determined against clinical isolates of Legionella pneumophila collected in the PROTEKT surveillance study. In total, 133 isolates were collected between 1999 and 2004 from 13 countries (Australia, Belgium, Czech Republic, France, Germany, Hungary, Ireland, Italy, Japan, Portugal, Spain, Sweden and the USA). MICs were determined by broth microdilution. Telithromycin maintained activity between Year 1 (MIC(90) 0.015 mg/L) and Year 5 (MIC(90) 0.03 mg/L), as did the comparator antibacterial agents. Telithromycin appears to be a candidate for coverage of legionellosis in the empirical treatment of community-acquired respiratory tract infection.

Global distribution of TEM-1 and ROB-1 beta-lactamases in Haemophilus influenzae

OBJECTIVES

To determine the global distribution of TEM-1 and ROB-1 beta-lactamases in Haemophilus influenzae isolated from patients with community-acquired respiratory tract infection during the first 4 years of the PROTEKT study (1999-2003). To investigate the activities of commonly used antibiotics against these isolates.

METHODS

For 14 870 H. influenzae, MIC testing was performed using NCCLS broth microdilution methodology. For 2225 beta-lactamase-positive (BLP) H. influenzae, TEM-1 and ROB-1 genes were detected using a Taqman PCR method.

RESULTS

beta-Lactamase positivity was 15.0% overall but varied greatly by country (<5% in several countries to 67.9% in Taiwan). Prevalences of TEM-1 and ROB-1 BLP H. influenzae were 93.7% and 4.6%, respectively, however almost all ROB-1 isolates were found in Canada, the USA and Mexico. ROB-1 isolates (n = 102) were less susceptible against cefaclor (29.4% versus 87.6%) and cefprozil (42.2% versus 91.9%) than TEM-1 (n = 2085) isolates. Differences in susceptibility rates for chloramphenicol, co-trimoxazole and tetracycline were also found between the two groups.

CONCLUSIONS

The ROB-1 beta-lactamase was found almost exclusively in North America and was more active against cefaclor and cefprozil than the TEM-1 beta-lactamase.

In vitro activity of telithromycin against Gram-negative bacterial pathogens

OBJECTIVES

To investigate the in vitro activity of the ketolide anti-bacterial telithromycin against a range of commensal bacteria and common aerobic Gram-negative respiratory and non-respiratory pathogens.

METHODS

Isolates were derived from both clinical material supplied by centres in various European countries and patients with community-acquired respiratory tract infections (RTIs) from centres worldwide as part of a longitudinal surveillance study. Telithromycin susceptibility testing was conducted using methods in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines and interpreted using CLSI breakpoints.

RESULTS

Telithromycin displayed the highest activity against clinical isolates of Haemophilus spp., Neisseria spp., Bordetella pertussis, Legionella pneumophila and Moraxella catarrhalis, with low activity against a number of other bacterial species, including Acinetobacter spp., Enterobacteriaceae spp., Vibrio spp., Campylobacter jejuni, Aeromonas hydrophila, Plesiomonas shigelloides and Pseudomonas aeruginosa.

CONCLUSIONS

Telithromycin provides coverage of key Gram-negative respiratory tract pathogens, but has minimal activity against Gram-negative non-respiratory pathogens and commensal bacteria. These data support the use of telithromycin as an alternative empirical therapy for community-acquired RTIs.

Global distribution of Streptococcus pneumoniae serotypes isolated from paediatric patients during 1999–2000 and the in vitro efficacy of telithromycin and comparators

Few data exist on the distribution of Streptococcus pneumoniae serotypes in many countries and in non-invasive disease overall. Here, data are presented from 772 paediatric isolates from children with community-acquired respiratory tract infections isolated from the PROTEKT global surveillance study during 1999–2000. Overall, 60.0 % of isolates were covered by the 7-valent pneumococcal vaccine formulation (PCV7), with greater coverage in the USA compared with Europe (69.6 vs 55.5 %, P = 0.014). Geographically dispersed clones of serogroups 3, 11 and 15 accounted for most of the isolates outside PCV7 coverage. Overall, macrolide, penicillin and cotrimoxazole non-susceptibility rates were high; however, all isolates were susceptible to telithromycin. Although only 7.4 % of isolates were resistant to amoxycillin/clavulanate, a higher prevalence of resistance was found in isolates from the USA and South Korea. This study shows the feasibility and importance of serotyping antibiotic surveillance study isolates and the potential of telithromycin as an important option for empiric therapy.

Impact of Ketolides on Resistance Selection and Ecologic Effects during Treatment for Respiratory Tract Infections

Ketolides are a new class of antibacterials that have been specifically developed for the treatment of community-acquired respiratory tract infections in an era of increasing resistance among major etiologic pathogens. These agents possess several unique structural features, including a 3-keto function and a large aromatic side chain, that confer not only a mode of action that differentiates them from the macrolide class but also a reduced potential to induce--or select for--resistant strains. Studies also suggest that ketolides such as telithromycin have a lower ecologic impact on the body's microflora than agents such as clarithromycin and amoxicillin-clavulanate, potentially reducing the risk of emergence of resistant strains and the spread of such resistance to pathogenic species. Therefore, available evidence suggests that ketolides may not only provide important new treatment options in an era of increasing resistance but may also contribute to reducing the pressure for development of further resistance. Clearly, further studies are required to confirm this low resistance potential once the ketolide agents become more widely used in routine practice.

Streptococcus pneumoniae and Streptococcus pyogenes isolated from a paediatric population in Great Britain and Ireland: the in vitro activity of telithromycin versus comparators

OBJECTIVES

To investigate the antimicrobial susceptibility profiles of clinical isolates of Streptococcus pneumoniae and Streptococcus pyogenes, isolated from children within Great Britain and Ireland (Northern Ireland and Eire), with particular reference to the new oral ketolide telithromycin. To determine the distribution of macrolide resistance genes within the erythromycin resistant population.

METHODS

MICs were determined using NCCLS microbroth dilution methodology and macrolide resistance mechanisms were investigated using PCR.

RESULTS

Penicillin susceptibility was found to be 92.6% in S. pneumoniae isolates ( n=831; 3.7% intermediate, MIC 0.12-1 mg/l, 3.7% resistant, MIC >2.0 mg/l) and 100% in S. pyogenes isolates (n=1333) 8.8% of S. pneumoniae and 2.5% of S. pyogenes isolates demonstrated erythromycin-A resistance (EryA(R)). One hundred percent of S. pneumoniae and 99.8% of S. pyogenes isolates were susceptible to telithromycin (MIC<or=1.0 mg/l). Of the 73 EryA(R) S. pneumoniae isolates tested, 55 (75.3%) were mef (A) positive, 17 (23.3%) erm (B) positive and one isolate (1.4%) was positive for both mechanisms. Of the 34 isolates of EryA(R) S. pyogenes tested, 23 (67.6%) were erm (A) subclass erm (TR) positive, 4 (11.8%) erm (B) and 7 (20.6%) mef (A) positive.

CONCLUSIONS

This paper presents baseline data on penicillin and macrolide resistance in S. pneumoniae and S. pyogenes isolates in the paediatric population of Great Britain and Ireland. Telithromycin, recently approved for the treatment of community acquired respiratory tract infections (CARTI) in patients over 12 years of age throughout the European community, demonstrated high in vitro activity against these pathogens, including EryA(R) strains.

Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999-2000)

OBJECTIVE

To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin.

METHODS

Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR.

RESULTS

Of 779 Streptococcus pneumoniae isolates worldwide, 43% were non-susceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (<or=1 and <or=4 mg/L, respectively). All M. catarrhalis and 97% of S. pyogenes and isolates were susceptible to <or=1 mg/L telithromycin.

CONCLUSIONS

Antibacterial resistance complicates the empirical treatment of respiratory tract infections in children and requires continued monitoring. Telithromycin may be a useful therapeutic alternative as it is highly active against strains exhibiting various resistance phenotypes.

Macrolide resistance by ribosomal mutation in clinical isolates of Streptococcus pneumoniae from the PROTEKT 1999-2000 study

Sixteen (1.5%) of the 1,043 clinical macrolide-resistant Streptococcus pneumoniae isolates collected and analyzed in the 1999-2000 PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) study have resistance mechanisms other than rRNA methylation or efflux. We have determined the macrolide resistance mechanisms in all 16 isolates by sequencing the L4 and L22 riboprotein genes, plus relevant segments of the four genes for 23S rRNA, and the expression of mutant rRNAs was analyzed by primer extension. Isolates from Canada (n = 4), Japan (n = 3), and Australia (n = 1) were found to have an A2059G mutation in all four 23S rRNA alleles. The Japanese isolates additionally had a G95D mutation in riboprotein L22; all of these originated from the same collection center and were clonal. Three of the Canadian isolates were also clonal; the rest were not genetically related. Four German isolates had A2059G in one, two, and three 23S rRNA alleles and A2058G in two 23S rRNA alleles, respectively. An isolate from the United States had C2611G in three 23S rRNA alleles, one isolate from Poland had A2058G in three 23S rRNA alleles, one isolate from Turkey had A2058G in four 23S rRNA alleles, and one isolate from Canada had A2059G in two 23S rRNA alleles. Erythromycin and clindamycin resistance gradually increased with the number of A2059G alleles, whereas going from one to two mutant alleles caused sharp rises in the azithromycin, roxithromycin, and rokitamycin MICs. Comparisons of mutation dosage with rRNA expression indicates that not all alleles are equally expressed. Despite their high levels of macrolide resistance, all 16 isolates remained susceptible to the ketolide telithromycin (MICs, 0.015 to 0.25 microg/ml).

Effects of heat treatment on the nutritional value of raw soybean selected for low trypsin inhibitor activity

1. Two broiler experimentss and a layer experiments were conducted on Kunitz trypsin inhibitor (Kti) soybeans (SB) of low trypsin inhibitor (TI) activity to determine their nutritive value when included as mash in least-cost poultry diets. 2. Experiment 1 compared chick performance on the Kti or raw SB using a commercial full-fat SB meal (FFSBM) and a solvent extracted SB meal (SBM) as controls during a 20 d experimental period. Broiler experiment 2 compared Kti and raw SB, non-steamed, or steam-pelleted with and without DL-methionine supplementation added to every treatment containing 170 g SB/kg. For each broiler experiment the levels of each SB were 70, 120 and 170 g/kg with the control birds fed only 170 g SB/kg. 3. The layer experiment, compared steam-pelleted Kti and raw SB against a non-steamed Kti and raw SB each fed at two levels (70 and 110 g/kg) x 30 replicates from 29 weeks of age for 19 weeks in a completely randomised design. Production parameters were measured when diets were formulated to contain minimum required specifications and calculated apparent metabolisable energy (AME). At the completion of each trial, 2 broiler birds from each cage and 5 layer birds per treatment were killed, weighed, and their liver and pancreas weighed. 4. Both broiler experiments indicated that production parameters on the Kti SB treatments were significantly lower (P<0.05) than on the two commercial control SB treatments. However, the Kti treatments were superior to the raw SB treatments. 5. Pancreas weight increased with increasing inclusion of both raw and Kti SB, suggesting that a TI was causing the depression in performance. The AME of the Kti SB was similar to that of commercial FFSB meal. After steam conditioning, the raw SB meal AME value of 9.5 MJ/kg dry matter (DM) was improved to 14.1 MJ/kg DM by reduced TI activity, but this AME improvement with TI activity reduction, plus the supplementation with DL-methionine on birds fed the raw SB had no effect (P>0.05) on any parameter evaluated in experiment 2. 6. The layer experiment showed that hens on the Kti SB treatments had significantly greater live weight gain (LWG), egg weight and daily egg mass than birds given raw SB. A reduced food intake (FI) was observed in the Kti treatments but egg mass was generally similar to that on the FFSB control diet, indicating that Kti SB supported excellent egg production at an inclusion of 110 g/kg. The depressed performance observed for broiler chicks suggest that younger birds are more susceptible to the effects of SB TI.

A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection

OBJECTIVES

To determine the prevalence of resistance amongst urinary tract pathogens against antimicrobials used to treat urinary tract infections (UTIs) in the UK to provide data to help direct empirical therapy.

METHOD

During 1999-2000, a total of 1291 bacterial isolates causing UTI were collected from 8 centres in the UK. Isolates were cultured from patients with (1). community-acquired UTI in those less than 65 years old (397), (2). hospital-acquired UTI other than those admitted with pyelonephritis (394), (3). pyelonephritis (108) and (4). community-acquired UTI in those greater than 65 years old (392). After re-identification, MICs for a range of antimicrobials were determined and interpreted using NCCLS procedures and interpretive guidelines.

RESULTS

Escherichia coli was the predominant pathogen in all categories but the total percentage for each category varied (56.3-77.3%). The next three pathogens of importance were Enterococcus faecalis, Klebsiella pneumoniae and Proteus mirabilis which varied in prevalence slightly from category to category. The activity of amoxycillin against E. coli (51.3% susceptible) was greatly reduced as a result of beta-lactamase production and only partially restored by the addition of clavulanic acid (78.8% susceptible). Cefuroxime was very active against E. coli using parenteral form breakpoints (97.1% susceptible) but less so using oral form breakpoints (68.6% susceptible). Cefuroxime was inactive against Enterococcus spp. and Pseudomonas spp. Nitrofurantoin was very active against isolates of E. coli (96.3% susceptible) and E. faecalis but not against K. pneumoniae, P. mirabilis or Pseudomonas aeruginosa. Overall susceptibility to trimethoprim ranged from 58.1% to 84.5% for the most prevalent pathogens. Ciprofloxacin was highly active against the UTI pathogens examined in this study with susceptibilities of between 88.6% and 97.7% for the most prevalent pathogens (E. coli, n=864, 97.7% susceptible) and was the only oral agent tested with activity against Pseudomonas spp.

CONCLUSION

These data provide much needed information on the prevalence of antimicrobial resistance amongst pathogens currently causing UTI in the UK.

Molecular characterization of macrolide resistance mechanisms among Streptococcus pneumoniae and Streptococcus pyogenes isolated from the PROTEKT 1999-2000 study

In this study, the distribution of macrolide resistance mechanisms was determined for isolates of Streptococcus pneumoniae and Streptococcus pyogenes obtained from the PROTEKT 1999-2000 study (a global, longitudinal study of the antibacterial susceptibility of bacterial pathogens associated with community-acquired lower respiratory tract infections). The global macrolide resistance mechanism distribution results for 1043 macrolide-resistant S. pneumoniae isolates collected from 25 countries were as follows: 35.3% mef(A), 56.2% erm(B), 6.8% both mef(A) and erm(B), 0.2% erm(A) subclass erm(TR) and 1.5% negative for mechanisms tested. Mechanisms of macrolide resistance were found to vary widely between countries and different geographical regions with mef(A) predominating in North America and erm(B) in Europe. Approximation of genotype from macrolide MIC without molecular determination of the mechanism of resistance resulted in an error of 10.2% (106 isolates). Overall, for 143 macrolide-resistant S. pyogenes isolates, 46.1% of the isolates tested were mef(A), 30.8% were erm(B), 23.1% were erm(A) subclass erm(TR) and no isolates were negative for all the genetic markers tested. Again, the distribution varied widely between countries and geographical regions. This study provides valuable baseline data for the continued monitoring of the evolution of macrolide resistance development in these important respiratory tract pathogens. The ketolide telithromycin retained excellent anti-pneumococcal activity irrespective of macrolide resistance mechanism, having a MIC(90) of 0.25, 0.5 and 0.5 mg/L against mef(A), erm(B) and mef(A)+erm(B) macrolide-resistant S. pneumoniae, respectively. It also exhibited potent activity against S. pyogenes that had become resistant to macrolides via either mef(A), (MIC(90 )0.5 mg/L) or erm(TR), (MIC(90) 0.03 mg/L).

Cytological examination of the whole endobronchial brush in bronchoscopic diagnosis of lung cancer

The combination of cytological and histological techniques has significantly increased the accuracy of fibreoptic bronchoscopy (FOB) in the diagnosis of lung cancer. We tested the hypothesis that cytological examination of material obtained from the whole endobronchial brush might increase the diagnostic yield in patients where conventional brush specimens were negative. Fifty patients who had undergone FOB for suspected lung cancer were studied prospectively. Bronchial lavage, bronchial biopsy and conventional brushing were performed. The whole endobronchial brush was then cut off the end of its wire and transported in a universal pot containing Shandon cytospin collection fluid. The material was dislodged from the whole brush using a vortex and the remaining fluid was centrifuged at 2,000 r.p.m. The fluid concentrate was used to maketwo cytopsin preparations. Papanicolaou stain was used. Fifty patients were studied, of which thirty-nine (78%) had endoscopicaly visible tumour. Of those, bronchial biopsy conventional brushing lavage and whole brush were positive for malignant cells in 31 (79.4%), 29 (74.3%), 21 (53.8%), and 16 (41%) of cases, respectively. A diagnosis of lung cancer was confirmed in 35 (89.7%) cases of endoscopicaly visible tumour. Conventional brushing was positive in two out of 11 (18.2%) cases with no visible tumour. Whole brush analysis was not positive in any of the cases with negative conventional brushings and was the least sensitive test in detecting malignancy Whole endobronchial brush analysis has no advantage in bronchoscopic diagnosis of patients with suspected lung cancer.

Urinary screening for Neisseria gonorrhoeae in asymptomatic individuals from Queensland, Australia: an evaluation using three nucleic acid amplification methods

A comparison between three nucleic acid amplification methods (COBAS AMPLICOR NG, Abbott LCx NG and in-house cppB gene PCR) for the detection of Neisseria gonorrhoeae was undertaken using non-consecutive urine specimens collected from a high prevalence asymptomatic population (260 patients) from multiple sites in Queensland, Australia. Sensitivity, specificity, positive predictive value and negative predictive value were as follows: COBAS 97.9, 93.9, 78.0, 99.5%; LCx 95.7, 100, 100, 99.1%; cppB 97.9, 100, 100, 99.5%. The results provide further evidence that false-positive COBAS AMPLICOR NG PCR results are a significant problem in our population, and that the Abbott NG LCx is a suitable alternative for screening asymptomatic populations with a high prevalence of N. gonorrhoeae carriage.

Detection of macrolide resistance mechanisms in Streptococcus pneumoniae and Streptococcus pyogenes using a multiplex rapid cycle PCR with microwell-format probe hybridization

In this study, a multiplex rapid cycle PCR with microwell-format probe hybridization method was developed to perform high-volume screening for macrolide resistance determinants in isolates of Streptococcus pneumoniae and Streptococcus pyogenes. The method was then utilized to determine the distribution of macrolide resistance mechanisms in recent isolates of S. pneumoniae and S. pyogenes from Great Britain and Ireland. For 83 strains of macrolide resistant S. pneumoniae tested, 51 (61.4%) were positive for mef(A), 29 (34.9%) erm(B), two (2.4%) double mechanisms mef(A) + erm(B), and one (1.2%) negative for all mechanisms tested. For 56 strains of macrolide-resistant S. pyogenes tested, 33 (58.9%) were positive for erm(A) subclass erm(TR), 18 (32.1%) mef(A) and five (8.9%) erm(B).

Rapid-cycle PCR method to detect Bordetella pertussis that fulfills all consensus recommendations for use of PCR in diagnosis of pertussis

No standardized PCR method is available for the laboratory diagnosis of the pertussis syndrome. Consensus recommendations for the use of PCR in the diagnosis of Bordetella pertussis infections have been proposed, and the aim of this study was to develop a method that fulfills all of these criteria. A rapid-cycle shared-primer PCR method with a microwell format and probe hybridization detection step (POR) was developed using novel oligonucleotides targeted to the outer membrane porin gene (Bordetella spp.). In specimens positive for Bordetella spp., B. pertussis was differentiated from Bordetella parapertussis and Bordetella bronchiseptica by hybridization with organism-specific oligonucleotide probes. An internal control was developed using overlap extension PCR and mouse beta-actin DNA. The analytical specificity was 100%. The analytical sensitivity was comparable to that of nested IS481 and IS1001 PCR ( approximately 1 organism per reaction). The clinical sensitivity and specificity were ascertained using 705 specimens (from 705 patients). The results were compared to those of a nested-PCR method targeting the insertion sequences IS481 and IS1001. Fifty-one specimens were positive for B. pertussis by POR and IS481 PCR. Two specimens which fulfilled a clinical definition of pertussis were positive by POR and negative by IS481 PCR. A total of 652 specimens were negative by both methods. B. parapertussis was not detected in any specimens. PCR inhibition was detected in 21 out of 705 specimens (2.98%). Thus, a rapid (4 h, including specimen preparation) PCR method which fulfills all of the consensus recommendations was developed and validated for the detection of B. pertussis.

Optimum inclusion of field peas, faba beans, chick peas and sweet lupins in poultry diets. I. Chemical composition and layer experiments

1. Experiments were undertaken to determine the chemical composition and apparent metabolisable energy (AME) of field peas, faba beans, sweet lupins and chick peas and the production of hens when each was included in nutritionally similar diets at 250 g/kg in 2 experiments. 2. Amino acid composition, crude protein and AME agreed well with previously published measurements. Detailed analysis of the non-starch polysaccharides (NSPs) showed that sweet lupins were much higher than the other grain legumes in the soluble NSPs and that the NSPs were particularly high in arabinose. The condensed tannin content was highest in field peas followed by faba beans. 3. In the 1st layer experiment over 40 weeks, hen-day egg production was lowest on the faba bean-based diet and egg weight and egg mass were also lowest. Relative viscosity of digesta in the small intestine of hens fed on the sweet lupin-based diet was highest, followed by that of hens fed on field peas. Enlargement of the pancreas was observed in hens consuming chick peas. 4. In experiment 2, in which only sweet lupins and faba beans were used, steam or cold pelleting showed few effects, nor did dehulling of faba beans but egg weight was lower when diets were steam pelleted. Daily food intake was 5.7 g/bird lower on the steam than cold pelleted diets and food conversion ratio tended to be improved (P=0.082). 5. It was concluded that field peas could support good production at 250 g/kg of layer diet. Although chick peas and sweet lupins supported good performance, there was concern about the increased weight of the pancreas and high gut viscosity respectively. Faba beans showed similar hen-d egg production in the 2nd experiment to that of sweet lupins but egg weight tended to be about 0.8 g lower than when on the sweet lupin-based diets.

Optimum inclusion of field peas, faba beans, chick peas and sweet lupins in poultry diets. II. Broiler experiments

1. Three experiments were undertaken to determine the optimum inclusion rates of field peas, faba beans, chick peas and sweet lupins in broiler starter and finisher diets in amounts up to 360 g/kg. 2. In experiment A chickens in cages grown to 21 d on diets with field peas and faba beans gave better growth rate and feed efficiency than those with sweet lupins and chick peas. Growth rate and Food conversion ratio (FCR) improved with increasing amounts of faba beans in the diet while for chick peas growth rate and FCR declined. Digesta viscosity and excreta stickiness scores were much higher on diets with sweet lupins. Steam pelleting improved growth rate and FCR on all diets. 3. In experiment B birds were in cages and grown from 21 to 42 d. There were no differences between grain legumes (when combined for all inclusions) for growth rate, food intake or FCR. Viscosity was again much higher on the sweet lupin-based diets while the pancreas was significantly enlarged on the diets with chick peas, as observed previously in chickens grown to 21 d. Steam pelleting of diets gave a consistent and positive response for weight gain and FCR. 4. Experiment C was carried out in pens each holding 60 birds under semi-commercial conditions and grown to 42 d on starter and finisher diets with the same grain legumes as used previously but each at 2 rates of inclusion similar to those in commercial practice. Field peas at 200 to 300 g/kg and chick peas at 150 to 220 g/kg gave inferior growth to faba beans (150 to 180 g/kg) and sweet lupins (120 g/kg). 5. The results of these experiments allowed tentative recommendations to be made to industry for inclusion rates of these cultivars of the 4 grain legumes. These were: field peas 300 g/kg; faba beans 200 g/kg, chick peas 100 g/kg and sweet lupins <100 g/kg. Wet droppings and high gut viscosity were serious problems with sweet lupins although these were not so obvious in experiment C.

Nested duplex PCR to detect Bordetella pertussis and Bordetella parapertussis and its application in diagnosis of pertussis in nonmetropolitan Southeast Queensland, Australia

A duplex PCR to detect Bordetella pertussis and Bordetella parapertussis was developed with the insertion sequences IS481 (B. pertussis) and IS1001 (B. parapertussis) and evaluated with specimens from 520 consecutive patients presenting with possible pertussis. No culture-positive-PCR-negative results occurred, giving the method a sensitivity of 100%. For B. pertussis, 58 of 520 patients (11.2%) were positive by PCR compared to 17 of 520 patients positive (3.3%) by culture. For B. parapertussis, 7 of 520 patients (1.3%) were positive by PCR compared to 2 of 520 patients positive (0.4%) by culture. Two patients were positive for both B. pertussis and B. parapertussis. Patient records were reviewed to determine the validity of PCR-positive-culture-negative results. Forty-two of 49 patients who could be evaluated fulfilled the criteria for a case definition of pertussis, with 32 patients being <1 year of age and having classical pertussis symptoms. The seven patients who did not fulfil the criteria were aged 7 to 55 years and had a persistent cough for >2 weeks. The method was also used to investigate a classroom outbreak in which B. pertussis culture was positive for 5 of 28 patients. All five culture-positive specimens were confirmed by PCR, and an additional eight were positive by PCR. Of 25 patients from a suspected pertussis outbreak in a girls' dormitory, seven of seven specimens were negative for B. pertussis, although 13 of 25 patients were positive for B. pertussis immunoglobulin M (IgM) (2 of which produced equivocal IgA results, with 23 of 25 patients being negative). Five symptomatic patients were subsequently found to be positive (by IgM and particle agglutination assays) for Mycoplasma pneumoniae, demonstrating the value of PCR in rapidly excluding B. pertussis infection in an outbreak situation. Twenty-two of 71 (30. 1%) throat swabs were positive by PCR compared to 2 of 71 (2.8%) throat swabs positive by culture, indicating that a reassessment of the use of throat swabs should be considered, particularly for older patients, in contact tracing, and in situations in which specimen collection is difficult.

Evaluation of AMPLICOR Neisseria gonorrhoeae PCR using cppB nested PCR and 16S rRNA PCR

Certain strains of Neisseria subflava and Neisseria cinerea are known to produce false-positive results with the AMPLICOR Neisseria gonorrhoeae PCR (Roche Diagnostic Systems, Branchburg, N.J.). The analytical sensitivity and analytical specificity of three PCR tests were assessed with 3 geographically diverse N. gonorrhoeae strains and 30 non-N. gonorrhoeae Neisseria spp. The sensitivities of the in-house nested cppB gene and the 16S rRNA PCR methods were greater than that of the AMPLICOR N. gonorrhoeae PCR with purified DNA from all 3 N. gonorrhoeae strains. Six of 14 clinical strains of N. subflava (1 from a vaginal swab, 5 from respiratory sites) produced false-positive AMPLICOR N. gonorrhoeae PCR results and were negative by the two other PCR methods. When applied to 207 clinical specimens selected from a population with a high prevalence ( approximately 9%) of infection, the results for 15 of 96 (15.6%) AMPLICOR-positive specimens and 14 of 17 (82.3%) AMPLICOR-equivocal specimens were not confirmed by the more sensitive nested cppB PCR method. Only 2 of 94 (2.1%) of AMPLICOR N. gonorrhoeae PCR-negative specimens from the same population tested positive by the nested cppB method. These results suggest that for this population the AMPLICOR N. gonorrhoeae PCR test is suitable as a screening test only and all positive results should be confirmed by a PCR method that is more specific and at least as sensitive. This study also illustrates that caution should be used when introducing commercially available nucleic acid amplification-based diagnostic tests into the regimens of tests used for populations not previously tested with these products.

Strategies to improve the nutritive value of rice bran in poultry diets. III. The addition of inorganic phosphorus and a phytase to duck diets

1. In the first of 2 experiments ducklings grown from 2 to 19 d were given diets with 0, 200 or 400 g rice bran, with or without a phytase and with 1 or 3 g inorganic phosphorus (Pi) per kg for rice bran-based diets only. In the 2nd experiment rice bran concentrations were 0, 300 or 600 g rice bran per kg with or without a phytase and 1 g Pi/kg. Ducks were grown from 19 to 40 d of age. 2. In experiment 1, a response to phytase was observed for weight gain and food intake on most diets except those with 200 g rice bran (3 g Pi) and 4.00 g rice bran (1 g P)i/kg. Main effects showed that 400 g rice bran depressed growth rate and food conversion ratio (FCR); increasing Pi depressed food intake, while food phytase increased food intake and growth rate over 2 to 19 d. There were several interactions. Dry matter and P retention were reduced but N digestibility improved when rice bran was increased from 200 g to 400 g/kg at 2 to 10 d of age; apparent metabolisable energy (AME) and calcium retentions were improved, similar results being seen at 10 to 19 d of age. Calcium and P retentions increased with the addition of food phytase and, at 10 to 19 d of age, phytase increased dry matter digestibility. Increasing Pi improved calcium and P retention, but only at 2 to 10 d of age. 3. Tibia ash (g or g/kg) content of bone was lowest on the diet without rice bran and without phytase; Pi concentration had no effect but phytase increased tibia ash on diets with 0 and 200 g rice bran and 1 g Pi/kg. Retention of several minerals in tibia ash declined at the highest rice bran inclusion rate; Pi level and phytase both increased Mg retention. 4. In experiment 2, food intake and growth rate of ducks, but not FCR, declined as rice bran inclusion increased from 0 to 600 g/kg. Phytase improved growth rate but not food intake and FCR on all 3 diets. Dry matter digestibility declined with increasing rice bran inclusion, but AME increased; retention of P and Mg declined but those of Ca and Fe increased. Phytase improved dry matter digestibility and retention of N and P. AME also increased but this was only on diets with 0 and 600 g rice bran/kg. There were reductions of 8% and 10% in P excreted in experiments 1 and 2 respectively when food phytase was added. 5. Tibia ash declined with increasing dietary inclusion of rice bran. Zn and Mn in ash tended to decline and Mg to increase; Ca and P showed no change in concentration in tibia ash. Again, phytase increased tibia ash content in bone. 6. It was concluded that there were a number of unexpected benefits from adding a food phytase to these diets, which resulted in improved nutrient yield and bird performance, although several of the diets appeared to be adequate in available P.

Strategies to improve the nutritive value of rice bran in poultry diets. IV. Effects of addition of fish meal and a microbial phytase to duckling diets on bird performance and amino acid digestibility

1. Ducklings were given diets with vegetable protein (VP) and 0 or 600 g rice bran/kg; fish meal (60 g/kg) and a phytase (+, -) were added to the diets (VP + AP). An additional 40 g soyabean meal/kg was added to the diet with rice bran (VP ++). Amino acid digestibility and mineral retention were measured in the lower ileum of ducklings killed at 23 d of age. Acid insoluble ash was used as an inert marker. Trypsin and amylase activities were also measured and weights of the pancreas and small intestine recorded at slaughter. 2. Addition of soyabean meal (VP ++) to the diet with rice bran improved growth rate and food intake compared to the diet without (VP) and gave the same food intake and growth rate as the comparable basal diet (VP) without rice bran. Fish meal improved growth rate on the diets without rice bran and improved food intake on this diet (VP + AP). Rice bran depressed growth rate and food conversion ratio (FCR); protein source affected growth rate, food intake and FCR; phytase increased food intake only. There were several interactions. 3. Determined total amino acid composition of the diets appeared to meet the essential amino acid requirements of ducklings. Rice bran depressed the ileal digestibility of virtually all amino acids and phytase had no direct effect, although there were interactions. Fish meal addition to diets with rice bran improved the apparent digestibility of several essential amino acids as well as that of dry matter and crude protein. 4. Ileal retention of some minerals and tibia ash content were reduced by rice bran. Fish meal and phytase inclusion increased P retention and ash in tibia. 5. Higher intestinal trypsin activity and increased pancreas size were seen in ducklings on diets with rice bran compared to those without. Intestinal amylase activity was reduced in ducklings given rice bran, probably because of its low starch content. 6. The stimulating effect of fish meal on duckling performance was probably caused in part by the improvement in the digestibility of some amino acids. The addition of small amounts of minerals in fish meal may have increased mineral retention. Phytase gave benefits anticipated from our previous work, but also improved lysine and threonine digestibility in diets containing vegetable protein only.

Strategies to improve the nutritive value of rice bran in poultry diets. II. Changes in oil digestibility, metabolisable energy and attempts to increase the digestibility of the oil fraction in the diets of chickens and ducklings

1. In experiment 1, the effects of age on oil digestibility and apparent metabolisable energy (AME) were measured in chickens and ducklings between 3 and 28 d of age on a diet with 400 g rice bran/kg. In experiment 2, a biosurfactant and a food lipase were added to diets of chickens containing 200 and 400 g rice bran/kg. In experiment 3, chicken diets containing 0 or 400 g rice bran/kg were supplemented with a food lipase (2 concentrations) or a food enzyme or their combination. 2. In experiment 1, oil metabolisability and AME increased substantially as chickens aged. Oil metabolisability was much higher in ducklings, when comparisons were made with chickens of similar age. 3. In experiment 2, lipase or biosurfactant gave no improvement in bird performance. Growth rate and food conversion ratio were, respectively, 23% and 10% better on diets with 200 compared to 400 g rice bran/kg. 4. In experiment 3, there was a significant growth response to lipase plus the enzyme mixture on the diet with 200 g rice bran/kg. On the diet with 400 g rice bran/kg, growth improvement was seen with the enzyme mixture only. 5. In experiment 3, enzyme addition did not increase oil metabolisability or AME. At 4 to 8 d of age AME was higher on the diet without rice bran but oil metabolisability was the same as on the diet with rice bran. At 19 to 23 d of age AME was similar but oil metabolisability was higher on the diet with rice bran than without. Droppings' dry matter was higher on diets without than with rice bran (32.4 vs 27.1%). 6. The response to lipase and the combination of this and a food enzyme suggest that there may be benefit in examining this interaction further although they had no effect on oil metabolisability or on AME. It is concluded that a stable AME for rice bran cannot be provided for chickens until at least 21 d of age.

Enrichment of hen eggs with n-3 long-chain fatty acids and evaluation of enriched eggs in humans

Eggs enriched with n-3 polyunsaturated fatty acids (PUFAs) were produced by hens fed diets containing fish oil or a combination of fish and vegetable oils. In a sensory evaluation, 78 untrained volunteers could not distinguish between ordinary and enriched eggs. Storage life was also not significantly different between egg types. A food intake survey of 4 groups of 14 subjects each who consumed 7 eggs/wk for 24 wk showed that intakes of the major dietary components were not significantly different for 4 different egg types. Mean (n = 56) plasma cholesterol and triacylglycerol concentrations were not significantly different at the start and finish of the study. Body weight and HDL concentrations increased during the study (P < 0.05). For the last 2 wk of the experiment (weeks 23-24), mean egg consumption was increased from a total of 14 to a total of 21 eggs, resulting in a small increase in plasma triacylglycerols only. There were no significant differences (P > 0.05) in body weight, blood pressure, or plasma lipid components among treatment groups consuming the 4 different egg types. Blood samples taken after 16 and 22 wk from fasted subjects showed significant increases in eicosapentaenoic acid, docosahexaenoic acid, and total n-3 PUFAs in subjects consuming enriched eggs compared with controls. In addition, the ratio of n-6 to n-3 PUFAs in plasma was significantly reduced from 12.2:1 to 6.5-7.7:1 in subjects consuming enriched eggs compared with controls. Consumption of only one enriched egg daily can contribute substantially to the recommended daily intake of n-3 PUFAs.

Strategies to improve the nutritive value of rice bran in poultry diets. I. The addition of food enzymes to target the non-starch polysaccharide fractions in diets of chickens and ducks gave no response

1. Three experiments were undertaken to test the efficacy of 2 enzymes targeting mainly the non-starch polysaccharides (NSPs) in rice bran. 2. In experiment one, 400 g rice bran/kg depressed chick performance and there was a significant decline in growth rate and food intake with increasing inclusion of rice bran (0, 200, 400 g). Neither enzyme had any benefit. 3. In experiment two, rice bran (inclusion 200 and 400 g/kg), did not alter growth rate, food intake or food conversion ratio of duckling (3 to 17 d of age). Again enzyme addition gave no response. 4. In experiment three, 300 g rice bran/kg stimulated duck (19 to 35 d of age) growth while 600 g rice bran/kg depressed growth but not food intake. Enzymes gave no response. 5. Relative gut viscosity declined with increasing rice bran inclusion as did dry matter in ileal digesta. There were differences between ducklings and chickens. 6. It was concluded that NSPs were not a significant factor in altering the nutritive value of rice bran and the enzymes used were therefore unlikely to be of benefit.

Do intensive care drug infusions support microbial growth?

The potential for commonly infused drug solutions to support or inhibit microbial growth was explored in this study. Drugs examined were midazolam HCl, morphine sulphate, fentanyl citrate, pethidine HCl, bupivacaine HCl, atracurium besylate, vecuronium bromide, adrenaline, dopamine, dobutamine, noradrenaline, isoprenaline, glyceryl trinitrate, sodium nitroprusside and propofol. All drugs were studied in both diluted and undiluted forms. Of the 15 medications investigated, all except propofol were found to be bactericidal and to reduce fungal growth.

The reliability of Microscan conventional and rapid panels to identify Staphylococcus aureus and detect methicillin resistance: an evaluation using the tube coagulase test and mecA PCR

Microscan (Dade Diagnostics, Brisbane) Positive Combo Type 6 (312 panels) and Rapid Positive Breakpoint Type 1 (62 panels) were evaluated for Staphylococcus aureus identification, using the tube coagulase test (TC), and oxacillin susceptibility, using mecA. A total of 374 consecutive clinical staphylococci were tested, with TC and Microscan having 100% correlation (335 identified as S. aureus and 39 as coagulase negative staphylococci by both methods). A 93% correlation was observed between Microscan and mecA PCR for oxacillin susceptibility. No very major errors (0/374 false oxacillin susceptibility) and 26 (7%) major errors (26/374 false oxacillin resistance) were found showing false resistance to oxacillin to be a problem in our population. Oxacillin Etest (AB Biodisk, Sweden) was performed on all oxacillin resistant isolates. A bimodal distribution was observed between mecA positive and negative isolates. A testing algorithm (using the Microscan panels and Etest) was developed for this laboratory to detect mecA encoded methicillin resistance. Retrospective application of this algorithm to the 374 isolates gave 100% correlation with mecA detection.

Comparison of growth performance and nutrient retention of weaner pigs given diets based on casein, free amino acids or conventional proteins

In two experiments the potential value of diets based on casein or free amino acids (FAA) for amino acid utilization experiments were examined. In Expt 1 the optimum dietary electrolyte balance (dEB) for a casein-based diet was estimated by supplemention with 10 or 20 g NaHCO3/kg, to produce diets containing 64, 183 or 302 mmol/kg. In addition, piglet growth performance and efficiency of nutrient deposition of piglets given the casein diets were compared with two multiple protein source diets; Supercreep, a commercial multiple protein source diet or CFS (casein-fish-soyabean-sugar) or a FAA-based diet. Expt 2 was designed to compare piglet response to FAA diet stored at -15 degrees with twice daily feeding, with FAA diet stored at ambient temperature (13-30 degrees) and offered ad libitum. A CFS diet was used as a positive control and the experiment was conducted over the 10-20 kg growth phase. Expt 1 used forty-eight piglets weaned at 20-22 d of age and allocated to one of six treatments formulated to contain at least 0.84 g lysine/MJ digestible energy in a randomized block design. Piglets given the CFS and Supercreep diets produced superior growth rates (518, 491 g/d) to those given a FAA diet (353 g/d) or casein diet containing 0, 10 or 20 g NaHCO3/kg respectively (365, 417, 390 g/d) between 5 and 20 kg live weight. Piglets given the casein and FAA diets had higher amino acid digestibilities than those given the Supercreep and CFS diets. The increase in the dEB of the casein diet from 64 to 183 mmol/kg improved piglet growth performance between 5 and 20 kg by 14%. All piglets given casein diets had similar ileal and faecal digestibilities, empty-body compositions, nutrient deposition rates and retention ratios. The results of Expt 2 showed that there was no beneficial effect on piglet performance of storing the FAA diet at -15 degrees and feeding twice daily. Based on the results of these two experiments, neither the casein (0, 10, 20 g NaHCO3/kg) nor FAA diets were suitable for estimating amino acid utilization by the piglet. There remain unidentified factors which limit the growth performance of piglets given the casein and FAA diets.

Rapid screening of cervical smears as a method of internal quality control. For how long should we rescreen?

OBJECTIVE

To compare the effectiveness of rapid screening of cervical smears as a method of internal quality control with 10% random rescreening.

STUDY DESIGN

From June 5 to July 14, 1995 (6 weeks), all consecutive cervical smears received in the department (n = 8,800) were entered into the study and were prescreened for a duration of 30 seconds (n = 2,938), 1 minute (n = 2,925) or 2 minutes (n = 2,937) over a period of 2 weeks each.

RESULTS

Rapid screening of all negative and unsatisfactory smears detected more cytologic abnormalities than would be expected with 10% random rescreening. Thirty-second rapid screening of all negative and unsatisfactory smears was more efficient in detecting false negatives than screening a proportion of the smears for longer periods of time. Rapid screening was also a very effective method of detecting severe cytologic abnormalities in unscreened smears, detecting over 90% of high grade lesions.

CONCLUSION

Rapid rescreening of negative and unsatisfactory cervical smears is recommended as a very effective method of internal quality control. It is superior to 10% random rescreening in reducing the false negative rate. Thirty-second rapid rescreening is the most efficient period for which smears should be screened. Rapid screening of unscreened smears could be used as a means of selecting patients for prompt referral when a laboratory backlog exists.

The role of Ureaplasma urealyticum in adverse pregnancy outcome

We investigated Ureaplasma urealyticum genital tract colonization rates in an Australian population to determine whether colonization was associated with adverse pregnancy outcome. Women attending an antenatal clinic were evaluated for lower genital tract colonization at their first antenatal visit (162 women) and at 28 weeks' gestation (120 women). Placentas from 92 women were cultured. U. urealyticum was the predominant isolate from the lower (57.4%) and upper (17.4%) genital tract in this population of pregnant women. U. urealyticum was a persistent colonizer during mid-trimester of pregnancy (in 88% of women colonized) whereas M. hominis, G. vaginalis, and Group B streptococcus were present as transient flora of the lower genital tract. Lower genital tract colonization during pregnancy was not directly associated with adverse pregnancy outcome. However preterm delivery in afebrile, asymptomatic women, could possibly be associated with chorioamnionitis (4 of 16 preterm births). Screening of women with a history of preterm birth may prevent upper genital tract infections and preterm delivery.

Primary malignant melanoma of the bronchus

A rare case of primary malignant melanoma of the bronchus is described. Before considering this diagnosis, metastasis from an occult primary must be convincingly excluded and the tumour should conform to certain guidelines. This patient presented with a solitary lung tumour for which she underwent left lower lobectomy and continues to be tumour free 54 months after surgery. Two possible mechanisms of aetiology are suggested.

Immunohistochemical expression of endothelial markers in left atrial myxomas: a study of six cases

Vascular endothelial cells are antigenically heterogeneous and therefore it has been recommended that a range of immunohistochemical markers is employed to show the presence of cells of endothelial origin in surgical pathology. In this study we applied three monoclonal antibodies--to factor VIII-related antigen, JC70 (CD31), QBend 10 (CD34)--and Ulex europaeus agglutinin type 1 lectin (UEA-1), to six consecutive cases of left atrial myxoma. We found that JC70 and QBend 10 consistently stained myxoma cells in all their different growth patterns contrasting with factor VIII-related antigen expression and UEA-1 binding which were restricted to areas which showed morphological evidence of vascular differentiation. These findings suggest that the constituent cells of atrial myxomas show more widespread endothelial differentiation than has previously been recognized and that differences in immunohistochemical staining may reflect the maturation status of these cells.

Polydactyly in the pre-adolescent foot: an unusual case presentation with impending pathologic fracture

Polydactyly of the foot is a common congenital deformity. The authors report a case of postaxial polydactyly with impending pathological fracture. Successful surgical correction was performed with an uneventful 10-month follow-up. Pertinent literature was reviewed and presented regarding classification systems, etiology, and treatment recommendations.

Comparison of PCR/nucleic acid hybridization and EIA for the detection of Chlamydia trachomatis in different populations in a regional centre

Culture on McCoy cell monolayers has been accepted as the reference method for the detection of Chlamydia trachomatis. Recent studies have shown that polymerase chain reaction (PCR)/nucleic acid hybridization based methods have increased sensitivity over culture while still retaining specificity. In situations where organism viability is of concern, due to factors such as transportation delays, culture is inappropriate. Regional laboratories therefore have not been able to utilize the reference method and have been forced to use less reliable methods. The aims of our study were to assess the feasibility of performing PCR to diagnose infections due to C. trachomatis in a regional laboratory using a new commercial kit--Amplicor (Roche Molecular Systems, Branchburg, NJ) and to compare the current enzyme-immunoassay (EIA) based-methods used in our laboratory (VIDAS [bioMerieux Vitek, Hazelwood MO] and IDEIA [Novo Nordisk Diagnostics, Cambridge, UK]) against PCR. Thirteen positive Amplicor specimens were found in 267 urine specimens collected from asymptomatic adolescent males and females. All 13 were confirmed positive using major outer membrane protein gene PCR (MOMP). VIDAS and IDEIA showed 100% correlation to each other but only detected 5/13 positives. Of 140 consecutive patients attending the regional sexual health clinic, 13 were Amplicor positive, 11/13 MOMP positive and 10/13 positive by VIDAS. Five of 254 patients attending the hospital antenatal clinic were positive by Amplicor, all being confirmed by MOMP. No PCR inhibition was detected in a random sample of 100 varied negative Amplicor tests using a modification of the Amplicor kit. No contamination was experienced. The Amplicor kit was shown to be suitable for use in the routine clinical laboratory with minimal disruption to workflow. For regional laboratories this kit should provide more accurate results than EIA based methods, particularly in the detection of asymptomatic persons.