Comparison of locked plate fixation and nonoperative management for displaced proximal humerus fractures in elderly patients

Use of locked plate fixation for proximal humerus fractures in elderly patients has increased markedly in recent years. We conducted a study to compare outcomes of operative (locked plate fixation) and nonoperative management of these fractures. From our database, we identified 207 displaced proximal humerus fractures that met all inclusion and exclusion criteria. For patients who accepted our invitation to return for evaluation, clinical outcome was assessed using several questionnaires: Constant; DASH (Disabilities of the Arm, Shoulder, and Hand); SMFA (Short Musculoskeletal Functional Assessment); and Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test. Of the 207 patients, 61 were managed operatively and 146 nonoperatively. Operative patients had lower rates of malunion but higher rates of complications, which included screw perforation, loss of fixation, infection, and secondary surgical procedures. Forty-seven patients (a mix of operative and nonoperative) accepted our invitation to return for clinical evaluation at a mean follow-up of 3.3 years. The 2 groups' clinical outcomes were similar.

Does fluoroscopy improve acetabular component placement in total hip arthroplasty?

BACKGROUND

The success of THA largely depends on correct placement of the individual components. Traditionally, these have been placed freehand using anatomic landmarks, but studies have shown poor accuracy with this method.

QUESTIONS/PURPOSES

Specifically, we asked (1) does using fluoroscopy lead to more accurate and greater likelihood of cup placement with the Lewinnek safe zone than does freehand cup placement; (2) is there a learning curve associated with the use of fluoroscopy for cup placement; (3) does the use of fluoroscopy increase operative time; and (4) is there a difference in leg length discrepancy between freehand and fluoroscopic techniques?

METHODS

This series consisted of 109 consecutive patients undergoing primary THA, conversion of a previous hip surgery to THA, and revision THA during a 24-month period. No patients were excluded from analysis during this time. The first 52 patients had cups placed freehand, and then the next 57 patients had acetabular components placed using fluoroscopy; the analysis began with the first patient treated using fluoroscopy, to include our initial experience with the technique. The abduction, version, and limb length discrepancy were measured on 6-week postoperative pelvic radiographs obtained with the patient in the supine position. Operative time, sex, age, BMI, diagnosis, operative side, and femoral head size were recorded as possible confounders.

RESULTS

Cups inserted freehand were placed in the ideal range of abduction (30°-45°) and anteversion (5°-25°) 44% of the time. With fluoroscopy, placement in the Lewinnek safe zone for both measures significantly increased to 65%. The odds of placing the cup in the Lewinnek safe zone for abduction and version were 2.3 times greater with the use of fluoroscopy (95% CI, 1.2-5.0; p = 0.03). Patients undergoing primary THAs (32 freehand, 35 C-arm) had cup placement in the safe zone for abduction and version 44% of the time freehand and 57% of the time with fluoroscopy, which failed to reach statistical significance. There was no difference in operative time, patient age, sex, operative side, diagnosis, limb length discrepancy, or femoral head size between the two groups.

CONCLUSIONS

The use of fluoroscopy to directly observe pelvic position and acetabular component placement increased the success of placement in the Lewinnek safe zone in this cohort of patients having complex and primary THAs. This is a simple, low-cost, and quick method for increasing successful acetabular component alignment. The study population included a large proportion of patients having complex THAs, and further validation of this technique in patients undergoing straightforward, primary THAs needs to be done to understand if similar gains in accuracy for component placement can be expected in that group.

LEVEL OF EVIDENCE

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures

INTRODUCTION

Reported initial success rates after lateral locked plating (LLP) of distal femur fractures have led to more concerning outcomes with reported nonunion rates now ranging from 0 to 21%. Reported factors associated with nonunion include comorbidities such as obesity, age and diabetes. In this study, our goal was to identify patient comorbidities, injury and construct characteristics that are independent predictors of nonunion risk in LLP of distal femur fractures; and to develop a predictive algorithm of nonunion risk, irrespective of institutional criteria for clinical intervention variability.

PATIENTS AND METHODS

A retrospective review of 283 distal femoral fractures in 278 consecutive patients treated with LLP at three Level1 academic trauma centers. Nonunion was liberally defined as need for secondary procedure to manage poor healing based on unrestricted surgeon criteria. Patient demographics (age, gender), comorbidities (obesity, smoking, diabetes, chronic steroid use, dialysis), injury characteristics (AO type, periprosthetic fracture, open fracture, infection), and management factors (institution, reason for intervention, time to intervention, plate length, screw density, and plate material) were obtained for all participants. Multivariable analysis was performed using logistic regression to control for confounding in order to identify independent risk factors for nonunion.

RESULTS

28 of the 283 fractures were treated for nonunion, 13 were referred to us from other institutions. Obesity (BMI>30), open fracture, occurrence of infection, and use of stainless steel plate were significant independent risk factors (P<0.01). A predictive algorithm demonstrates that when none of these variables are present (titanium instead of stainless steel) the risk of nonunion requiring intervention is 4%, but increases to 96% with all factors present. When a stainless plate is used, obesity alone carries a risk of 44% while infection alone a risk of 66%. While Chi-square testing suggested no institutional differences in nonunion rates, the time to intervention for nonunion varied inversely with nonunion rates between institutions, indicating varying trends in management approach.

DISCUSSION

Obesity, open fracture, occurrence of infection, and the use of stainless steel are prognostic risk factors of nonunion in distal femoral fractures treated with LLP independent of differing trends in how surgeons intervene in the management of nonunion.

Influence of animal age on the tenderness of beef: Muscle differences

Animal age effects on the mechanical properties of cooked samples from muscles able to cold shorten (Mm. longissimus dorsi, LDA, and semimembranosus, SMA from Achilles tendon hung sides) and muscles partially restrained from shortening (LD muscles from pelvic hung sides, LDP) from groups of animals aged 9, 16, 27 and 42 months were studied. Age effects on stretched muscles (SM muscles from pelvic hung sides, SMP) were determined using groups aged 2 and 120 months in addition to those of 9, 16, 27 and 42 months. Taste panel, Warner-Bratzler shear and Instron compression results for stretched SMP muscles indicated that tenderness decreased systematically as animal age increased. In contrast, Warner-Bratzler peak force values of LDA muscles decreased by half; linearly, as animal age increased from 9 to 423 months, a reflection of less postmortem shortening in samples from the heavier carcasses of older animals. It is suggested that results of age/tenderness studies depend on the age range, differences in carcass weight, the muscle(s) chosen and the cooling rate of muscles and hence on chilling conditions, cooking conditions and the method(s) used to assess the mechanical properties of the cooked muscle(s).

A survey of Eimeria species in commercially-reared chickens in France during 1994

In a survey of chicken coccidia in France during 1994, samples of litter were collected from 41 farms. On 31 of these farms, eimerian oocysts were abundant enough to allow monitoring of their numbers in the litter. Peak total oocyst counts on these farms ranged from 16,200 to 1,254,000/g of litter, but no coccidiosis was observed. The chickens reared without anticoccidial agents in their food (poulets biologiques) produced higher and earlier peak oocyst counts in litter than the chickens given medicated food (poulets labels). The oocysts in litter samples from 22 farms (13 poulet biologique, five poulet label, two standard broiler, one breeder and one layer) of the original 41 were identified. Six of the seven eimerian species known to parasitize chickens were found, using combinations of five methods (oocyst morphology, intestinal lesions, enzyme electrophoresis, growth in embryonating eggs and prepatent time). Multispecific infections predominated (95% of 22 farms), up to six species occurring together. Of farms where oocysts were detected, the percentages with each species were: Eimeria acervulina (100%), E. mitis (82%), E. tenella (77%), E. maxima (73%), E. praecox (45%) and E. brunetti (27%). These appear to be the first definite records of E. mitis and E. praecox for France. Although E. necatrix was not found in this survey, it had recently been detected by other workers in France, so that all seven chicken Eimeria species were known to be contemporaneous.

Hemodynamic and pulmonary fluid status in the trauma patient: are we slipping?

Recent reports point to problems in the clinical assessment of the cardiopulmonary system in hemodynamically unstable patients, especially with the decreasing usage of pulmonary artery catheters. Our purpose was to evaluate the hypothesis that clinical judgment alone is inadequate for a reliable estimate of cardiopulmonary status in critically ill patients. Physician assessments (high, normal, or low) of cardiac index (CI) and thoracic fluid content (TFC) were made in 68 acute trauma cases and compared to the results obtained with impedance cardiography (ICG). Physician assessment using clinical judgment alone was correct only 42 per cent and 57 per cent, respectively, for CI and TFC. There was very little difference in heart rate (HR), blood pressure (BP), Glasgow Coma Score (GCS), and the number of injured systems between the incorrect and correct assessments of CI. However, the mean Injury Severity Score (ISS) was markedly higher for the incorrect than the correct CI values (18.8 +/- 9.3 vs 14.2 +/- 9.8, P = 0.0589). Thus, there is a need for an objective measurement of CI and TFC especially in the more severely injured patient. The inaccuracy of the clinical exam strongly suggests the need for a supplemental measurement, which the new and improved ICG monitor could provide.

The effect of repeated tuberculin skin testing of cattle on immune responses and disease following experimental infection with Mycobacterium bovis

The comparative intradermal skin test, in which a delayed type hypersensitivity (DTH) response to purified protein derivative of tuberculin (PPD) from Mycobacterium bovis and M. avium is assessed and compared, may be used repeatedly on non-infected animals on farms where bovine tuberculosis (TB) has occurred. A skin test is known to affect subsequent skin tests in infected animals. The reported study was to determine whether repeated skin testing prior to infection with M. bovis might affect the development of the comparative skin test and IFNgamma response subsequent to exposure to virulent M. bovis. The comparative intradermal skin test was applied to one group of six calves five times at 8-week intervals. These and six control calves were subsequently inoculated intratracheally with a dose of M. bovis that produced mild disease. The development of the DTH reaction, IFNgamma, IL-10 and proliferative responses were compared in the two groups of animals. No differences in IFNgamma, IL-10 and proliferative responses were seen between the two groups of calves prior to challenge. After infection with M. bovis no differences in the development of the DTH and IFNgamma responses to PPD were noted as a consequence of the repeated skin testing prior to challenge. No differences between the groups were evident when ESAT-6 was used as antigen and IFNgamma was assayed, although two animals that responded to PPD did not respond with ESAT-6. However, there did appear to be subtle effects of repeated skin testing on the immune response post-challenge that did not affect the diagnostic tests. After challenge control animals showed greater proliferative responses than animals given repeated skin tests prior to challenge, indicating that the procedure did have consequences for immune responses following infection. In both groups a marked reduction in the intensity of the skin test and in the number of animals that would be recognized as reactors was evident when animals were tested 15 weeks post-infection compared to their responses 8 weeks earlier that could have consequences for diagnosis of TB. An antibody response was not evident as a result of repeat skin testing prior to infection but was seen in both groups of calves following skin testing performed 7 weeks after infection.

Talar fractures: three case studies

Three case studies of fractures are presented that demonstrate the potential morbidity that these injuries can cause as well as the acceptable outcomes if treated appropriately. Two of the cases are talar fracture dislocations; the third is an osteochondral fracture of the talus. The importance of early treatment with open reduction and internal fixation is demonstrated. Success following surgical intervention in a nonhealed osteochondral fracture of the talus is also demonstrated.

Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents

OBJECTIVES

We developed this study to assess the procedural outcome, complications, and clinical follow-up in patients treated with different antiplatelet regimens after intracoronary stent implantation with small stents. Three hundred sixty-one consecutive patients, in whom at least one 3.0-mm intracoronary stent was implanted, were studied.

METHODS

The study was a prospective, observational registry of unselected consecutive patients treated in our institution. Patients who underwent stent implantation between December 1997 and July 1998 were treated with aspirin and ticlopidine; those who received stents between August 1998 and February 1999 were treated with aspirin and clopidogrel.

RESULTS

In the group treated with ticlopidine, there were 190 patients who had 253 lesions treated with 274 stents. Mean age was 59.1 years, 72% were male, 31% had unstable angina, 64% had 1 stent, 36% had >1 stent, and 23% had multivessel intervention. In the group treated with clopidogrel, there were 171 patients who had 226 lesions treated with 245 stents. Mean age was 60.4 years, 79% were male, 26% had unstable angina, 70% had 1 stent, 30% had >1 stent, and 26% had multivessel intervention. Complications at 30 days in the ticlopidine group were death in 1 (0.5%), stent occlusion in 3 (1. 6%; all reopened with repeat angioplasty), non-Q-wave myocardial infarction in 2 (1%), and urgent revascularization in 4 (2%). Complications at 30 days in the clopidogrel group were noncardiac death in 1 (1.2%), cardiac death in 1 (1.2%), stent occlusion in 0, non-Q-wave myocardial infarction in 3 (1.8%), and urgent revascularization in 0. Follow-up was available in 100% of patients in both groups (mean 253 +/- 75 days in the ticlopidine group, 198 +/- 53 days in the clopidogrel group). Complications at >30 days in the ticlopidine group were death in 1 and clinical restenosis in 11 (5.8%); 1 additional patient had an admission with unstable angina to the local hospital. Hence, recurrent angina as a consequence of target lesion restenosis occurred in 5.8%. Complications at >30 days in the clopidogrel group were death in 0 and clinical restenosis in 8 (4.7%); 2 additional patients were admitted with unstable angina to the local hospital, and 1 patient had a myocardial infarction 164 days after stent implantation. Hence, recurrent angina as a consequence of target lesion restenosis occurred in 4.7%. There were no significant differences in complications between the 2 groups.

CONCLUSIONS

Our observations suggest that clopidogrel can be used instead of ticlopidine in patients treated with stents with a diameter of </=3.0 mm, without any increase in major adverse cardiac events, both within the first 30 days and at medium-term follow-up. Clopidogrel has significant cost advantages over ticlopidine, and carries a superior side-effect profile. We suggest that, in combination with aspirin, clopidogrel should replace ticlopidine as standard antiplatelet therapy after intracoronary stent implantation.

Pediatric all-terrain vehicle trauma: a 5-year statewide experience

BACKGROUND/PURPOSE

This is a retrospective review of the pediatric all-terrain vehicle trauma victims who presented to the five major trauma centers serving the state of West Virginia during the 5-year period from January 1991 to December 1995. The purpose of this research is to characterize the nature of the injuries and the individuals injured to better appreciate the magnitude of the problem of ATV-related injuries in the pediatric population.

METHODS

This study is a retrospective review of these 218 consecutive pediatric patients from trauma registry data and their medical records.

RESULTS

Two hundred eighteen patients between the ages of 2 years and 16 years presented during the study period. Boys outnumbered girls three to one. The average Injury Severity Score (ISS) was 8.76, the average Glasgow Coma Score (GCS) was 14.4, and the average Trauma Score (TS) was 15.2. The most common injuries were orthopedic followed by head and facial injuries. The majority of the children did not wear helmets, and their injuries resulted in an average hospital length of stay of 4.3 days. Thirty-eight percent of the children required surgery. There were a total of four deaths for a mortality rate of 1.8%. The estimated total hospitalization cost for the 218 patients was $1,918,400.00.

CONCLUSIONS

All-terrain vehicle-related trauma remains an ongoing safety concern facing society today. Every physician who cares for children should address this important issue when talking to children and parents about safety issues and injury prevention.

Comparative in vitro activity of doxycycline and oxytetracycline against porcine respiratory pathogens

Minimum inhibitory concentrations of doxycycline and oxytetracycline were determined against 55 Pasteurella multocida strains, 59 Actinobacillus pleuropneumoniae strains and 26 Mycoplasma hyopneumoniae strains isolated from the respiratory tract of pigs. An additional set of 76 P multocida strains isolated from pneumonic pigs was tested for their minimum inhibitory concentrations of doxycycline. The P multocida and A pleuropneumoniae strains were isolated in France and the minimum inhibitory concentrations were determined by an agar dilution method. The M hyopneumoniae strains were isolated in the United Kingdom and minimum inhibitory concentrations were determined by a serial broth dilution method. All the strains tested were susceptible to doxycycline whereas 15 per cent of the P multocida strains and 22 per cent of the A pleuropneumoniae strains were resistant to oxytetracycline. Doxycycline concentrations inhibiting 90 per cent of strains were 1 microgram/ml for P multocida and 2 micrograms/ml for A pleuropneumoniae. The ratio of the minimum inhibitory concentrations of doxycycline and oxytetracycline ranged between 1/1 and 1/4 for the oxytetracycline-susceptible strains and between 1/16 and 1/64 for the oxytetracycline-resistant strains. All the M hyopneumoniae strains were susceptible to doxycycline and oxytetracycline, the concentrations inhibiting 90 per cent of strains being 1 microgram/ml and 2 micrograms/ml, respectively. These data confirm that doxycycline has a higher in vitro activity against pig respiratory pathogens than oxytetracycline.

Listeria innocua isolated from a case of ovine meningoencephalitis

This paper reports a naturally occurring case of meningoencephalitis associated with Listeria innocua in a Polled-Dorset ewe. The ewe was one of a housed group of twenty-five, fed ad lib. on wrapped baled silage. L. innocua was isolated after one week from cold enrichment culture of brain and pituitary tissue. Its identity was confirmed by conventional biochemical tests, API Listeria (BioMerieux UK Ltd), the absence of hly and prfA genes using PCR assay and sequencing two variable regions of 16S rDNA. Histological examination demonstrated lesions of vasculitis and perivascular cuffing in the midbrain which were consistent with listeriosis although limited in distribution and severity.

Pathogenicity of porcine intestinal spirochetes in gnotobiotic pigs

Twelve intestinal spirochete strains of porcine origin were characterized on the basis of their phenotypic properties, by multilocus enzyme electrophoresis, and by pathogenicity testing in gnotobiotic pigs. The spirochetes used included two strains of Serpulina hyodysenteriae (B204 and P18A), two strains of Serpulina innocens (B256 and 4/71), one strain from the proposed new genus and species "Anguillina coli" (P43/6/78), and seven non-S. hyodysenteriae strains recently isolated from United Kingdom pig herds with a history of nonspecific diarrhea and typhlocolitis. By multilocus enzyme electrophoresis, five of these were identified as S. innocens, one was identified as an unspecified Serpulina sp., and one was identified as "A. coli." S. hyodysenteriae B204 and P18A, "A. coli" P43/6/78 and 2/7, and three (22/7, P280/1, and 14/5) of the five S. innocens field isolates induced mucoid feces and typhlocolitis in gnotobiotic pigs. None of the other spirochetes produced clinical signs or large intestinal pathology in this model. The "A. coli" strains induced a more watery diarrhea, with lesions present more proximally in the large intestine, than did the other pathogenic spirochetes. S. innocens 22/7 was also tested for pathogenicity in hysterotomy-derived pigs that had previously been artificially colonized with a spirochete-free intestinal flora and shown to be susceptible to swine dysentery. Despite effective colonization, strain 22/7 did not produce any disease, nor was there any exacerbation of large intestinal pathology or clinical signs when pigs with an experimentally induced existing colitis caused by Yersinia pseudotuberculosis were superinfected with strain 22/7. Certain non-S. hyodysenteriae spirochetes are therefore capable of inducing disease in gnotobiotic pigs, but their role as primary or opportunistic pathogens in conventional pigs remains equivocal.

Hypoxemia after blunt chest injury: right-to-left intracardiac shunt managed non-operatively

A case of patent foramen ovale with right-to-left intracardiac shunt after blunt chest injury is presented. The association of pulmonary contusion, pulmonary hypertension, and patent foramen ovale in a previously healthy subject is discussed. In such a case reduction of the afterload on the right ventricle is the suggested modality of treatment for hypoxemia due to the right-to-left shunt.

Nurses' performance of inhalation technique with metered-dose inhaler plus spacer device

OBJECTIVE

To determine if nurses could correctly use a metered-dose inhaler plus spacer (MDI-spacer) device after a brief description and demonstration of proper use by a clinical pharmacist.

DESIGN

Pretest, educational intervention, posttest.

SETTING

University hospital.

PARTICIPANTS

Twenty-three nurses.

INTERVENTIONS

Nurses were asked to use the MDI-spacer (Aerochamber) and were scored using a nine-point checklist (pretest). Educational intervention by the clinical pharmacist consisted of a five-minute discussion and correct demonstration of the device. Nurses were then asked to use the device again (posttest).

MAIN OUTCOME MEASURES

Pre- and posttest scores.

RESULTS

Total scores were improved after the educational intervention (66 percent pretest vs. 88 percent posttest, p = 0.0001). In an item analysis, four of the nine steps had improved significantly.

CONCLUSIONS

A brief discussion and demonstration of correct use of MDI-spacers is effective in improving nurses' skill in using the device.

Isolation of Actinobacillus seminis from rams in the United Kingdom

Actinobacillus seminis was isolated from the semen of five rams on four farms. Four of the rams had abnormal semen and three were also infertile. The isolates of A seminis showed similar phenotypic profiles and electrophoretic protein patterns to the type strain of A seminis but were distinct from Histophilus ovis previously isolated from rams with epididymitis in Scotland. The infection appeared to be subclinical but two of the five rams had palpable abnormalities of their testes. Three rams were treated with antibiotics but the infection persisted. No gross lesions were found in the genitalia of two of three rams examined post mortem but one had necrotic abscesses in the testes and epididymis. A seminis was isolated from the seminal vesicles and epididymis of one ram without gross lesions but not from the genitalia of the other two. On one farm the infection in a recently purchased ram led to the detection of another case as a result of the bacteriological screening of 11 stock rams not in contact with the initial case. These five subclinical cases, which included a supposedly healthy stock ram, suggest that A seminis infection may be widespread and should be considered in cases of infertility.

Protein recovery from the all-agarose ProSieve gel system

Electrophoresis in polyacrylamide gels is one of the most powerful tools used for the analysis of proteins. However, this technique is not widely used for protein purification for a variety of reasons such as the following: less than quantitative recoveries; involved, time-consuming methodologies; and impurities in the protein preparations from gel-polymerization by-products that can modify the proteins and interfere with subsequent experiments. As an alternative, we have developed a simple and quantitative recovery procedure for proteins separated by electrophoresis in the all-agarose ProSieve gel system. Using this procedure, greater than 90% of each protein examined was recovered, and these proteins were unaffected by the recovery procedure.

A three-year study of Salmonella dublin infection in a closed dairy herd

Over a period of three years, Salmonella dublin was isolated occasionally from the faeces of nine adult cattle in a closed dairy herd. The organism was also isolated from 12 of the samples collected after parturition; isolations were made from newborn calves on 11 occasions, from a vaginal swab once and from a milk sample once. Nine of the isolations from the calves were made from swabs obtained within 24 hours of birth. Throughout the investigation isolations were made from heifers, steers and older calves and 11 infected animals were detected. S. dublin was widespread in the farm environment and it was concluded that environmental contamination was an important source of infection for animals of all ages, some of which may have become latent carriers. The family history of one cow, seven of whose offspring were infected with S dublin, suggested the possibility of vertical transmission. Without reliable tests to detect latent carriers, it is suggested that control of this infection must be based on improved hygiene and the use of vaccination to improve the immunity of the herd.

Training functional skills following herpes simplex encephalitis: a single case study

This paper presents a treatment program for the development of personal hygiene behavior in a patient who was 5 years post herpes simplex encephalitis. The patient has severe memory and organizational problems, but is of average overall intelligence. The program consists in part of chaining a series of nine discrete activities by using linking phrases. The program allowed the patient to structure his behavior and wash in a well-organized nonrepetitive way. Results are discussed in the light of previous failures to affect behavior using apparently similar methods.

Pathology of calves with diarrhoea in southern Britain

Twenty-one moribund calves with diarrhoea were purchased from 11 farms, their faeces examined for enteropathogens and samples of intestinal tissue removed under anaesthesia. Lesions and presence of enteropathogens on the mucosal surface were scored by histological examination of immunostained paraffin sections. Two or more enteropathogens were detected in 19 calves. Cryptosporidium appeared to be the principal cause of diarrhoea in six calves, rotavirus in four, Salmonella typhimurium in two, bacteria adherent to the surface of the large intestine in two, coronavirus in one and K99+ Escherichia coli in one calf. Diarrhoea in four calves was the consequence of mixed infections in which no one enteropathogen appeared to predominate. In one calf no enteropathogen was detected. Diarrhoea was associated with infections and lesions throughout the small and large intestines. The enteropathogens most frequently associated with lesions in the small intestines were rotavirus, coronavirus and cryptosporidium; in the large intestines they were coronavirus and bacteria apparently adherent to the mucosal surface.

Microbiology of calf diarrhoea in southern Britain

Faeces samples from calves with diarrhoea in 45 outbreaks were examined for six enteropathogens. Rotavirus and coronavirus were detected by ELISA in 208 (42 per cent) and 69 (14 per cent) of 490 calves respectively; calici-like viruses were detected by electron microscopy in 14 of 132 calves (11 per cent). Cryptosporidium were detected in 106 of 465 (23 per cent), Salmonella species in 58 of 490 (12 per cent) and enterotoxigenic Escherichia coli bearing the K99 adhesin (K99+ E coli) in nine of 310 calves (3 per cent). In the faeces of 20 per cent of calves with diarrhoea more than one enteropathogen was detected; in 31 per cent no enteropathogen was found. Faces samples from 385 healthy calves in the same outbreaks were also examined. There was a significant statistical association of disease with the presence of rotavirus, coronavirus, Cryptosporidium and Salmonella species (P less than 0.001). Healthy calves were not examined for calici-like viruses and the association of K99+ E coli with disease was not analysed because there were too few positive samples. Rotavirus infections were more common in dairy herds and single suckler beef herds whereas Salmonella infections were more often found in calf rearing units. Cryptosporidium were more common in single and multiple suckler beef herds. K99+ E coli were found in one dairy herd and one multiple suckler beef herd both with unhygienic calving accommodation. Variations in coronavirus detection among different farm types were not statistically significant. In this survey rotavirus was the most commonly detected agent in calf diarrhoea and Cryptosporidium were found in approximately one quarter of affected calves. Infection with Salmonella species was widespread, but K99+ E coli infections were less common in the United Kingdom than in other countries.

Characterization of c-myc proteins from avian bursal lymphoma cell lines

We have used a rabbit antiserum directed against a portion of the MC29 viral myc protein expressed in bacteria to characterize the cellular myc protein from three different avian bursal lymphoma cell lines (1104HI, 1104BI S13, BK25), and from normal chick embryo cells. The phosphorylated myc proteins immunoprecipitated from these cells varied in molecular weight from 58 to 62 kDa and localized to the cell nucleus, as shown by cell fractionation experiments. Pulse-chase experiments established that these proteins had short half-lives ranging from 12 min for the myc proteins from the 1104BI S13 cell line to 25 min for myc proteins from both the 1104HI and the BK25 cell lines. The structural relatedness of the proteins was established by comparing their partial proteolytic digestion products (Cleveland analysis) with the partial proteolytic digestion products of the MH2 viral myc protein. The anti-myc-serum also immunoprecipitated a 48-kDa protein from each of the bursal cell lines. We have identified this protein as a breakdown product of the bursal cell myc proteins. The different size and number of these bursal cell myc proteins may be a direct result of the specific site of integration as well as the orientation of the retrovirus LTR sequence relative to the adjacent cellular myc allele.

Isolation of antibodies specific for avian viral and cellular myc proteins

The myc gene has been implicated in the genesis of various neoplasms in birds, mice, and humans and was originally identified as the cellular homologue of the transforming gene (v-myc) of the avian myelocytomatosis virus MC29. For specific antisera to be obtained for the myc gene product, a bacterial expression vector was constructed in which the coding sequences for approximately 20 kd of MC29 p110gag-myc (amino acid residues 502 to 678) were placed between the coding sequences for the amino terminal 13 kd of Rous sarcoma virus pp60src and the coding sequences for 112 kd of beta-galactosidase. Expression of this tripartite gene was driven by a hybrid trp-lac promoter under lac repressor control. Induction of expression resulted in the production of a 145-kd hybrid protein containing src, myc, and beta-galactosidase sequences. The hybrid protein was purified and injected into rabbits to produce antisera. The resultant antisera immunoprecipitated p110gag-myc and p58myc -p60myc from MC29- and MH2-infected nonproducer quail fibroblasts, respectively. In addition, the antisera also immunoprecipitated a 58-kd protein from the bursal lymphoma cell line BK25, which was identified as chicken c (cellular)-myc gene product.

Dysentery caused by Escherichia coli (S102-9) in calves: natural and experimental disease

A dysentery syndrome was recognized among the Institute's calves at 18 to 21 days of age. It was reproduced experimentally in gnotobiotic calves with an atypical Escherichia coli (S102-9) isolated from the affected calves. In both natural and experimental disease the calves passed copious bright red blood in the feces and developed diarrhea. Walls of the colon and rectum were thickened, and the mucosa was reddened and covered by an exudate that contained mucus and blood clots. Bacteria were seen closely adherent to the luminal surfaces of enterocytes, often in cup-shaped depressions or on cytoplasmic pedestals. Microvilli were distorted, disorientated or absent. There was exfoliation of infected enterocytes and a mild acute inflammation of the underlying lamina. In two of five calves with natural disease, the adherent bacteria did not stain by the immunoperoxidase method with antisera raised against E. coli (S102-9). This indicated that there was possibly more than one bacterial cause of the syndrome. Lesions in experimentally infected calves were indistinguishable from those produced by some E. coli which are enteropathogenic for man, rabbits, and pigs.

Pathogenesis of osteopetrosis induced by rapid and slow onset plaque isolates of an avian osteopetrosis virus

Examination of bone from chickens infected as 10-day-old embryos with isolates of an avian osteopetrosis virus revealed that MAV-2(O) plaque isolate 32/2/4 caused rapid bone growth, while MAV-2(O) plaque isolate 13 caused a mild form of bone growth. MAV-2(O) plaque isolate 32/2/4 caused anemia when injected into the 8-day-old hatched chick and bone growth in ovo when injected into the 4-day-old embryo. Passive administration of neutralizing antibody protected against MAV-2(O)-induced bone growth when antibody was given to the embryo 1 day after virus. Neutralizing antibody also protected against an acute anemia observed when normal and bursectomized chickens were given MAV-2(O) 32/2/4, but antibody did not prevent the appearance of a chronic anemia or osteopetrosis in bursectomized chickens. Repeated animal passage of a slow onset plaque isolate of MAV-2(O) caused the virus to progressively induce more severe bone growth and anemia.

Rapid induction of osteopetrosis by subgroup E recombinant viruses

Avian osteopetrosis is a proliferative bone disorder initiated at high frequency by MAV-2(O), a subgroup B avian myeloblastosis-associated virus. To examine the role of the MAV-2(O) genome in osteopetrosis induction, a series of recombinant viruses between MAV-2(O) and RAV-O was constructed. Recombinant viruses were selected for rapid growth and subgroup E envelopes. The T1 oligonucleotide fingerprint patterns of viruses selected in this manner demonstrated that they were recombinants and were clonally pure because they had oligonucleotides from each parent, and each oligonucleotide was present in single molar yield. When injected into 10-day-old chicken embryos, approximately 50% of the recombinant viruses induced osteopetrosis within 3 weeks after hatch. Therefore, subgroup E envelope did not inhibit osteopetrosis induction. The osteopetrosis that was induced varied from slight to severe, but none of the recombinant viruses induced osteopetrosis as severe as the MAV-2(O) parent.

Silence as creative therapy: a comtemplative approach to pastoral care

The Quaker experience of the medium of silence for pastoral care has a long tradition, and, in a brief way, this paper attempts to point out the meaning of silence from the point of view of Quakers and the value of silence as a therapeutic medium for the pastoral leader.

Arenavirus inactivation on contact with N-substituted isatin beta-thiosemicarbazones and certain cations

N-methyl and N-ethyl isatin beta-thiosemicarbazones inactivate cell-free Parana and Pichinde viruses as well as three strains of lymphocytic choriomeningitis virus. This antiviral activity is abolished in the presence of the chelating agent EDTA. The rate of virus inactivation by N-methyl isatin beta-thiosemicarbazone is greatly enhanced and controlled by the addition of cupric sulphate. Divalent cations of other first transition series metals are less effective. A difference exists in the copper requirement for fast inactivation of the prototype arenavirus (lymphocytic choriomeningitis) and the Tacaribe Complex of viruses (Parana and Pichinde). In the presence of 20 muM-N-methyl isatin beta-thiosemicarbazone, LCM and Pichinde viruses can be inactivated at about the same rate if 20 muM-CuSO4 is added to the former and 160 muM-CuSO4 is added to the latter. Using 20 muM-N-methyl isatin beta-semicarbazone and CuSO4 the inactivation of LCM is reduced, but not eliminated, in the presence of an equal amount of infectious Pichinde virus. Crude and highly purified Pichinde virus are inactivated at the same rate when exposed to identical concentrations of N-methyl isatin beta-thiosemicarbazone and cupric sulphate. There is little detectable change in the inactivation rates when Pichinde or LCM viruses are grown in a variety of different cell lines.

Evaluation of bis-benzimidazoles in the treatment of murine lymphocytic choriomeningitis virus infections

Seventy percent of the mice receiving (S,S)-1,2-bis(5-methoxy-2-benzimidazolyl)-1,2-ethandiol (A36683) in their drinking water lived at least four times longer than control mice when infected with 10 or 100 mean lethal doses of lymphocytic choriomeningitis virus strain UBC. In the next 4 months, most of the survivors died with lymphocytic choriomeningitis-like symptoms. Drug treatment during the first 7 days after infection was found to have no significant effect on virus titers in various organs. The sparing effect of the drug is discussed in terms of immunosuppression.