Medical management of critical limb ischaemia: where do we stand today?

Critical limb ischaemia (CLI) is a severe form of peripheral arterial disease (PAD). CLI often causes disabling symptoms of pain and can lead to loss of the affected limb. It is also associated with increased risk of myocardial infarction, stroke and death from cardiovascular disease. The aims of management in patients with CLI are to relieve ischaemic pain, heal ulcers, prevent limb loss, improve function and quality of life and prolong survival. Here, current evidence regarding the medical management of CLI is reviewed. Cardiovascular risk factors should be assessed in all patients with CLI; smoking cessation and treatment of hypertension, hyperlipidaemia and diabetes all reduce the mortality rate in those with PAD. Antiplatelet agents (either aspirin or clopidogrel) are recommended to reduce both the incidence of cardiovascular events and risk of arterial occlusion. By contrast, routine use of anticoagulation (either warfarin or heparin) is not recommended. Treatment of the limbs themselves is often more challenging. Prostanoids may have some efficacy for treating rest pain and for ulcer healing, and iloprost shows favourable results in reducing the risk of major amputations, but long-term follow-up data regarding disease progression are lacking. There is insufficient evidence to support the use of naftidrofuryl or cilostazol, and pentoxifylline is not beneficial. Furthermore, there is no evidence of proven benefit of hyperbaric oxygen. A number of angiogenic growth factors have been studied in Phase I studies and randomized controlled trials (RCTs). They appear to be safe, but efficacy results have been mixed. Treatment with stem cells also shows some potential from early trials, but further larger RCTs are needed to demonstrate clear benefit. Thrombolysis may be an alternative for patients who develop acute limb ischaemia and are unsuitable for surgical intervention. However, newer endovascular techniques are likely to have a greater role in the future.

Stroke-like episodes in autosomal recessive cytochrome oxidase deficiency

Stroke-like episodes, defined as periods of acute localized neurological dysfunction during which brain imagery suggests cerebral ischemia but vascular anatomy is normal, occurred in 3 patients with autosomal recessive Saguenay-Lac St-Jean (SLSJ) cytochrome oxidase (COX) deficiency. The patients developed focal neurological deterioration and frontal hypodensities on cerebral computerized tomography (CT). Arteriography, performed in 1 patient during an acute episode, showed normal vascular anatomy. Nevertheless, capillary shunting was evident both in regions that appeared abnormal on the initial cerebral CT study and in regions that appeared normal but subsequently developed Leigh disease. Stroke-like episodes did not exacerbate systemic acidosis, and acidotic decompensations occurred independently of stroke-like episodes. In conclusion, stroke-like episodes occur in autosomal recessively inherited congenital lactic acidoses as well as in those caused by mitochondrial DNA mutations. In some cases, acute localized neurovascular changes occur in regions that subsequently develop Leigh disease.

Capnography for monitoring non-intubated spontaneously breathing patients in an emergency room setting

OBJECTIVE

To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients.

METHODS

Patients with potential respiratory compromise admitted to the resuscitation room were assessed for widespread expiratory wheeze. This was taken as clinical evidence of airways obstruction. Expiratory capnograms of these patients and patients who had no wheeze were obtained. The traces were analysed for basic morphology and where appropriate the slope ratio (SR) between phase 1 (S1) and phase 2 (S2) of the trace was obtained.

RESULTS

Thirty eight patients with a variety of clinical conditions causing potential or actual respiratory impairment were studied. All patients tolerated the nasal capnogram cannulae. Twelve had no clinical evidence of airway obstruction and all had capnograms with normal morphology. Eleven of these were analysed further. The mean value for SR was 7.57 (SEM 0.18), 95% confidence interval 6.37 to 8.77. Twenty six patients had clinical evidence of airway obstruction "sharks fin" morphology. Fourteen of these were analysed to determine SR. The mean value was 31.9 (4.46), 95% CI 22.9 to 40.8. There was a significant difference in the mean value for SR between the two groups (P << 0.001).

CONCLUSIONS

Capnography may be used as a means of continuous respiratory monitoring in non-intubated acutely ill patients. Capnogram analysis may be used to indicate airway obstruction in these patients. Further work is required to correlate curve indices to degree of airway obstruction.

The effect of high-dose right upper quadrant lithotripsy on normal swine tissue

To assess the effects of high doses of shock waves to organs in the right upper quadrant of the abdomen, 36 adolescent swine were given one treatment of either 2,000 (2k), 6,000 (6k), or 10,000 (10k) shock waves at 24 kV peak pressure using a spark-gap lithotriptor. Shock waves were sonographically focused on the lumen of the gallbladder. Blood and tissue were examined for each group at 48 hours, at 35 days, and at 6 months. This study showed that administration of up to five times the accepted upper limit of shock waves produced no permanent damage. Transient injury, most commonly hematoma, was encountered. No posttreatment intra-abdominal catastrophes occurred. Although no renal injury was seen, it should be noted that the focus of maximum energy was 5 cm cephalad to the right kidney. This study suggests that an increased number of shock waves may be administered safely to this area of the abdomen.

Effect of a preprinted form on the management of acute asthma in an accident and emergency department

OBJECTIVE

To assess the effect of a preprinted form on the documentation of clinical data and compliance with the national guidelines for the management of asthma.

METHODS

Prospective audit six months before and after introduction of the form.

RESULTS

Use of the form improved the documentation of past asthma history (69% v 93%, P < 0.001), current treatment (81% v 95%, P < 0.01), predicted peak flow (23% v 75%, P < 0.001), per cent predicted peak flow (1% v 62%, P < 0.001), and respiratory rate (81% v 95%, P = 0.007). Compliance with the British recommendations for treatment improved with use of the form (50% v 89%, P < 0.001) The prescription of steroids on discharge did not improve significantly (26% v 44%, P > 0.05).

CONCLUSIONS

The preprinted form resulted in enhanced documentation of data and conformity with current guidelines for the management of asthma.

Chronic persistent asthma presenting to an accident and emergency department--compliance with B.T.S. guidelines

Forty-six patients, known to suffer from asthma, attending an inner-city accident and emergency (A&E) department, were screened for the presence of chronic symptoms and their current treatment documented. The patients were asked if they knew their optimum peak expiratory flow rate (PEFR) or if they possessed a peak flow meter. The treatment being used by each of the 26 patients with evidence of chronic persistent asthma was compared to that as advised by the British Thoracic Society (B.T.S.) and it was found that only three patients were receiving adequate treatment. Most often the treatment regimes were suboptimal due to the absence of an inhaled anti-inflammatory agent. Patient awareness of their own PEFR or possession of a peak flow meter was uniformly low in both the well-controlled patients and those with chronic persistent asthma.

Allelic association and linkage studies in Wilson disease

We have studied 21 families with Wilson disease (WND), using restriction fragment length polymorphisms (RFLPs) in the 13q14.3 region, to measure linkage of these markers to the disease locus. In addition to previously described markers, we include linkage data for a newly isolated marker (D13S86) and an established marker (D13S56), which were previously not placed on the genetic map in the region of the WND locus. Our data, including those from two recombinant families, support the location of WND between the markers D13S31 and D13S59. We have examined the distribution of marker alleles at the loci studied and have found that D13S31 and D13S228, and associated microsatellite marker, show a non-random distribution on chromosomes carrying the WND mutation. The significant linkage disequilibrium indicates that these two markers must be close to the WND locus.

Hyperammonemia-hyperornithinemia-homocitrullinuria syndrome: neurologic, ophthalmologic, and neuropsychologic examination of six patients

We report the clinical, electrophysiologic, ophthalmologic, and neuropsychologic features of six patients with hyperammonemia-hyperornithinemia-homocitrullinuria syndrome, an inborn error of ornithine metabolism. Pyramidal signs, decreased vibration sense, bucco-facio-lingual dyspraxia, and learning difficulties or subnormal intelligence were found in the majority. Anomalies of peripheral nerve conduction velocity and of evoked potentials were common, and one patient had markedly abnormal white matter images on cranial magnetic resonance imaging. One patient had retinal depigmentation and chorioretinal thinning. The clinical severity varied greatly among patients; in general, the three younger patients had less neurologic and intellectual impairment than did the three older patients. Only two of our patients have had episodes of symptomatic hyperammonemia. We conclude that hyperammonemia-hyperornithinemia-homocitrullinuria syndrome can be associated with widespread manifestations in the central and peripheral nervous systems. Although the control of hyperammonemia is an essential element in the treatment of these patients, the relationship of hyperammonemia to the chronic neuropsychologic problems of these patients is unclear.

Nutritional vitamin B12 deficiency: two cases detected by routine newborn urinary screening

We describe two asymptomatic newborns with nutritional vitamin B12 deficiency in whom increased urinary methylmalonic acid was detected by routine neonatal screening at 3 weeks of age. Both infants were exclusively breast-fed. One mother suffered from pernicious anaemia, and the other was a strict vegetarian. Both mothers had no clinical or haematological abnormality, aside from a borderline mean corpuscular volume for the vegetarian mother. This report illustrates the early appearance of functional vitamin B12 deficiency in breast-fed infants of vitamin B12-depleted mothers. It also demonstrates that urinary methylmalonic acid measurement is a sensitive indicator of tissue vitamin B12 deficiency.

Radial nerve rupture after a traction injury: a case report

A case in which a patient sustained a closed rupture of the radial nerve at the lateral intramuscular septum from a traction injury is presented. No humeral fracture occurred, and the patient regained substantial function after delayed primary repair.

Cloning and expression of rat histidase. Homology to two bacterial histidases and four phenylalanine ammonia-lyases

Histidase (histidine ammonia-lyase, EC 4.3.1.3) catalyzes the deamination of histidine to urocanic acid. Apart from phenylalanine ammonia-lyase, which is not expressed in animals, histidase is the only enzyme known to have a dehydroalanine residue in its active site. The amino site precursor and the mechanism of formation of dehydroalanine are not known. As an initial step to determining the precursor of dehydroalanine in histidase, we have isolated a functional cDNA clone for histidase from a rat liver cDNA library using an affinity-purified antiserum. The 2.2-kilobase cDNA has a 1,971-base pair open reading frame coding for a 657-amino acid polypeptide with a predicted molecular mass of 72,165 Da. The cDNA has a rare polyadenylation signal (AAUACA) that appears to inefficiently direct polyadenylation in transfected COS monkey kidney cells. Conversion of this sequence to the consensus polyadenylation signal (AAUAAA) resulted in increased levels of stable mRNA. COS cells transfected with a histidase expression vector produce active histidase. The formation of active histidase in cells that have no endogenous histidase activity suggests either that the requisite modifying enzyme is present in these cells or that the dehydroalanine residue forms by an autocatalytic mechanism. Rat histidase was found to have 41 and 43% amino acid identity to Pseudomonas putida and Bacillus subtilis histidases, respectively. Phenylalanine ammonia-lyases from parsley, kidney bean, and two yeast strains were also found to have approximately 20% amino acid identity to rat histidase. On the basis of the similarity of function of histidase and phenylalanine ammonia-lyase, dehydroalanine at the active sites, and the sequence conservation over a large evolutionary distance (mammals, bacteria, yeast, and plants), we propose that the genes for histidase and phenylalanine ammonia-lyase have diverged from a common ancestral gene, of which the most conserved regions are likely to be involved in catalysis or dehydroalanine formation.

[Hypocarnitinemia in patients affected by a primary defect of ammonia metabolism treated with sodium benzoate]

We have studied the plasma and urinary levels of free and esterified carnitine in 18 patients affected by a primary defect of ammonia metabolism, which had been managed with or without a therapy of sodium benzoate. None of these patients presented with any acute neurologic or digestive symptoms during the study. Our group of non-treated patients showed an increase in the levels of plasma esterified carnitine and an elevation of urinary concentration of free carnitine, while the levels of urinary esterified carnitine clearly approached the superior limits of normal values. The group treated with sodium benzoate showed a more profoundly disturbed plasma and urinary carnitine profile: a significantly lower plasma and urinary free carnitine, accompanied by a clearly increased esterified/free carnitine ratio. We did not find any evidence of a relationship between the plasma levels of free or esterified carnitine and the protein intake or the plasma ammonia concentration. We are proposing a hypothesis to explain the hypocarnitinemia seen in our patients being treated with benzoate, along with other modifications observed in the carnitine profile. We believe that a supplement of carnitine could be beneficial in the management of some of these patients.

An arresting injury

Three cases of branchial plexus injury due to handcuffing with the hands behind the back are presented.

Pasteurella caballi, a new species from equine clinical specimens

The name Pasteurella caballi is proposed for a group of organisms represented by 29 strains isolated from respiratory and other infections in horses. P. caballi strains are gram-negative, oxidase-positive, nonmotile, fermentative rods with the key characteristics of the genus Pasteurella. These strains differed from other Pasteurella species in that all were aerogenic and catalase negative, and some strains produced acid from myo-inositol and L-rhamnose. The levels of DNA relatedness of 28 P. caballi strains with labeled DNA from the proposed type strain averaged 91 and 85% (hydroxyapatite method at 55 and 70 degrees C). P. caballi was 13 to 53% related to strains representing 22 other species of the family Pasteurellaceae. The guanine-plus-cytosine content of the DNA of four strains was 41 to 42 mol%. The type strain is 83851 (=ATCC 49197).

The role of pulse oximetry in the accident and emergency department

Prompt recognition and treatment of hypoxia is an important part of management in the accident and emergency (A & E) department. Until recently the only reliable method of detecting hypoxia was by estimation of the arterial blood gases (ABG). Continuous monitoring of the arterial oxygen saturation (Sao2) is possible using an infra-red pulse oximeter. This study assessed the usefulness of this instrument in the A&E setting. The Sao2 was measured in 50 patients using a pulse oximeter. In 15 patients simultaneous ABG estimations were obtained. The Sao2 correlated closely with calculated values for Sao2. The use of the oximeter identified 21 patients (42%) with clinically unsuspected hypoxia. The pulse oximeter proved simple to use, accurate and a useful addition to our resuscitation equipment.

Molecular structure of the human asparagine synthetase gene

The human gene for asparagine synthetase has been isolated and the molecular organization has been determined by mapping and DNA sequencing of intron-exon boundaries. The gene spans 35 kb and contains 13 exons. The structure of the human gene has a high degree of similarity to that of the hamster asparagine synthetase gene, with identical positions for all but one of the intron regions. The 5' upstream region of this gene, like other housekeeping genes, lacks conventional TATA and CAAT boxes. Comparisons of the 5' upstream sequences of the human and hamster genes show limited similarity; however, both have a very high G + C content which may play a role in expression through DNA methylation.

Cellular fatty acid compositions and isoprenoid quinone contents of 23 Legionella species

The cellular fatty acid compositions and ubiquinone contents of 182 Legionella strains representing 23 species were determined by capillary gas-liquid chromatography and reverse-phase high-performance liquid chromatography, respectively. Except for the type strain of Legionella erythra (ATCC 35303T), all Legionella species contained large (40 to 90%) amounts of branched-chain fatty acids and only trace to small (less than 0.5 to 5%) amounts of ester-linked hydroxy acids. The 23 species were placed in three major fatty acid groups on the basis of differences in the relative amounts of 14-methylpentadecanoic (Ci16:0), hexadecanoic (C16:1), and 12-methyltetradecanoic (Ca15:0) acids. All Legionella species contained ubiquinones with 9 to 14 isoprene units in the side chains and were divided into five different ubiquinone groups. The species were further differentiated into 16 groups on the basis of qualitative and quantitative differences in their fatty acid compositions and ubiquinone contents. Both of these chemical characteristics can be used to distinguish Legionella species from other gram-negative bacteria and rapidly and accurately identify suspected isolates before serologic and other tests are done.

Human disease associated with "Campylobacter upsaliensis" (catalase-negative or weakly positive Campylobacter species) in the United States

Catalase-negative or weakly positive (CNW) thermotolerant campylobacteria, first isolated from dogs in 1983, were recently recognized as a new species, "Campylobacter upsaliensis," but their association with human illness has not been established. Twelve human isolates received at the Centers for Disease Control between 1980 and 1986 were identified as CNW campylobacteria by biochemical tests, cellular fatty acid composition, and antimicrobial susceptibility patterns. Eleven CNW Campylobacter strains tested by DNA-DNA hybridization (hydroxyapatite method) were all highly related and were related to two "C. upsaliensis" strains at the species level (86% under optimal conditions and 76% under stringent conditions). Clinical information was obtained for 11 human isolates from three stool and eight blood specimens. They were isolated from four female and seven male patients 6.5 months to 83 years of age residing in 10 different states. The patients had a wide spectrum of illnesses. The stool isolates were obtained from two previously healthy persons during episodes of acute gastroenteritis and from one immunocompromised patient with persistent diarrhea and fever. The blood isolates were obtained from two infants with fever and respiratory symptoms; a young woman with a ruptured ectopic pregnancy; three elderly men with underlying chronic diseases; and two immunocompromised adults. In a bactericidal assay to assess sensitivity to serum, seven of eight blood isolates showed some resistance to killing by pooled normal human serum. These observations suggest that "C. upsaliensis" is a potential human pathogen associated with both gastroenteritis and bacteremia in normal hosts and with opportunistic infection in immunocompromised individuals.

Total pancreatectomy for chronic pancreatitis

The operation of total pancreatectomy is performed rarely. Its role in the management of patients with chronic pancreatitis remains to be elucidated. We have reviewed our series of 29 total pancreatectomies for benign disease [14 women median age 39 years; 15 men median age 34 years]. Twelve underwent standard total pancreatectomy, in 17 duodenum preserving total pancreatectomy (DPTP) was performed. There was one death (mortality 3.4%). In no patient was the total pancreatectomy the first operative procedure. The patients were compared with age and sex matched diabetic control subjects selected on a best fit basis from the diabetic clinic database. The aetiology of the pancreatitis was idiopathic nine, pancreas divisum nine, alcohol eight and other causes three. The indication for surgery was pain 27, acute pancreatitis one and cholangitis with pancreatitis one. The complications of the procedures were mainly caused by infection [wound three, chest six and central line sepsis four] and in two there was a leak from the duodenum; no patient required re-operation. The postoperative stay [standard total, median 21 days (range 13-98) DPTP median 31 days (range 17-49)] has lengthened over the period due to greater attention to analgesic, diabetic and enzyme deficiency control before discharge. In standard total pancreatectomy there were five major hypoglycaemic episodes with only two in 17 DPTP patients. The per cent ideal body weight, the insulin requirement and the HbAl compared less well in standard total pancreatectomy group compared with controls than did DPTP. With both groups large doses of enzyme replacement were required, and this proved of importance in diabetic control. Our experience with total pancreatectomy suggests that pain will be improved in over 80% of patients and that the results of surgery will improve with prolonged follow up provided attention is given to analgesic abuse, enzyme deficiency and diabetes.

Campylobacter hyointestinalis associated with human gastrointestinal disease in the United States

Campylobacter hyointestinalis was isolated from stool specimens of four persons, all of whom were experiencing nonbloody, watery diarrhea. The youngest (8 months of age) and the oldest (79 years of age) individuals were females, and the other two were homosexual men. C. hyointestinalis was the only clinically significant pathogen isolated from stool specimens for three of the individuals. In case 3 (involving a 37-year-old homosexual man), Entamoeba histolytica and Shigella sonnei were also present in the stool. The identification of all C. hyointestinalis strains was made biochemically and confirmed by DNA hybridization. This study documented the isolation of C. hyointestinalis from four patients with diarrhea, and our findings suggest that the clinical significance of Campylobacter species must be expanded to include C. hyointestinalis as a potential cause of human gastrointestinal disease.

Differentiation of Campylobacter and Campylobacter-like organisms by cellular fatty acid composition

The cellular fatty acid compositions of 368 strains of Campylobacter species or Campylobacter-like organisms were determined by gas-liquid chromatography. Most of the strains (339) were placed in one of three groups based on differences in fatty acid profiles. Group A contained Campylobacter jejuni (97%) and most C. coli (83%) strains and was characterized by the presence of a 19-carbon cyclopropane fatty acid (19:0 cyc) and 3-hydroxytetradecanoic acid (3-OH-14:0). Group B included all C. laridis and some C. coli (17%) strains; its profile was similar to that of group A, except that 19:0 cyc was absent. Group C contained C. fetus subsp. fetus and C. fetus subsp. veneralis and was characterized by the presence of 3-OH-14:0 and 3-hydroxyhexadecanoic acid (3-OH-16:0) and the absence of 19:0 cyc. Twenty-nine isolates were placed in four additional groups. Group D included the type strain of "C. cinaedi" and 14 other isolates, which were differentiated by the presence of dodecanoic acid (12:0), 3-hydroxydodecanoic acid (3-OH-12:0), and 3-OH-16:0 and the absence of hexadecenoic acid (16:1) and 3-OH-14:0. Group E contained the type strain of "C. fennelliae" and two additional isolates, which were differentiated by the presence of a 16-carbon aldehyde and a 16-carbon dimethylacetyl and the absence of 16:1. Group F included the type strain and one reference strain of C. cryaerophila and six human isolates whose phenotypic characteristics were similar to those of this species; this group was distinguished by the presence of two isomers of 16:1, tetradecenoic acid (14:1), and 3-OH-14:0. Group G included three stains of C. pyloridis and was characterized by the presence of 19:0 cyc, 3-OH-16:0, and 3-hydroxyoctadecanoic acid (3-OH-18:0) and by the absence of 16:1 and 3-OH-14:0.

Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis

The classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end-stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow-up 9.5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full-time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the diabetes.

Molecular cloning of cDNA for rat argininosuccinate lyase and its expression in rat hepatoma cell lines

Using antibody and plaque hybridization screening, we isolated rat argininosuccinate lyase (AS lyase) cDNA clones from a liver cDNA library prepared in the phage expression vector lambda gt11. Five overlapping cDNAs covering 1.7 kilobases of the estimated 2.0-kilobase AS lyase mRNA were characterized and confirmed as AS lyase sequences by hybrid selection. We examined the differential expression of AS lyase in rat liver and four rat hepatoma cell lines (7800C1, H4, HTC, and MH1C1). These cells exhibited a 60-fold range of AS lyase enzyme activity, with a direct correlation between activity, amount of AS lyase immunoreactive protein, and quantity of specific AS lyase mRNA. These observations suggest that the differences in AS lyase expression between rat liver and the hepatoma cell lines result from variations in AS lyase transcriptional activity or alterations in nuclear processing of AS lyase RNA.

Analysis of mycolic acid cleavage products and cellular fatty acids of Mycobacterium species by capillary gas chromatography

After growth and experimental conditions were established, the mycolic acid cleavage products, constituent fatty acids, and alcohols of representative strains of Mycobacterium tuberculosis, M. smegmatis, M. fortuitum complex, M. kansasii, M. gordonae, and M. avium complex were determined by capillary gas chromatography. Reproducible cleavage of mycolic acid methyl esters to tetracosanoic (24:0) or hexacosanoic (26:0) acid methyl esters was achieved by heating the sample in a high-temperature muffle furnace. The major constituent fatty acids in all species were hexadecanoic (16:0) and octadecenoic (18:1 omega 9-c, oleic) acids. With the exception of M. gordonae, 10-methyloctadecanoic acid was found in all species; moreover, M. gordonae was the only species tested which contained 2-methyltetradecanoic acid. M. kansasii was characterized by the presence of 2,4-dimethyltetradecanoic acid, M. avium complex by 2-eicosanol, and M. tuberculosis by 26:0 mycolic acid cleavage product. The mycolic acid cleavage product in the other five species tested was 24:0. Although a limited number of strains and species were tested, preliminary results indicate that this gas chromatographic method can be used to characterize mycobacterial cultures by their mycolic acid cleavage products and constituent fatty acid and alcohol content.

Isoprenoid quinone content and cellular fatty acid composition of Campylobacter species

A total of 36 strains of Campylobacter species were examined for isoprenoid quinones and cellular fatty acids. The isoprenoid quinone content was determined by reverse-phase high-pressure liquid chromatography, and the fatty acids were determined by capillary gas-liquid chromatography. All Campylobacter species contained menaquinone-6 (2-methyl-3-farnesyl-farnesyl-1,4-naphthoquinone) and a methyl-substituted menaquinone-6 (2,[5 or 8]-dimethyl-3-farnesyl-farnesyl-1,4-napthoquinone) as the major isoprenoid quinones. The latter menaquinone has not been reported in other bacteria and may prove to be a useful chemical marker of Campylobacter species. Campylobacter jejuni and most Campylobacter coli were distinguished from other campylobacteria by the presence of a C19 cyclopropane acid, and Campylobacter sputorum subsp. mucosalis differed from other species by the presence of lauric acid.

Legionella sainthelensi: a new species of Legionella isolated from water near Mt. St. Helens

Six strains of a new species, Legionella sainthelensi, were isolated from freshwater in areas affected by the volcanic eruptions of Mt. St. Helens in the state of Washington. Strains of L. sainthelensi are culturally and biochemically similar to other legionellae. They grow on buffered charcoal yeast agar but not on media that lack cysteine. They are gram-negative, nonsporeforming, motile rods that are positive in reactions for catalase, oxidase, gelatin liquefaction, and beta-lactamase. They are negative in reactions for urease, hydrolysis of hippurate, reduction of nitrates, fermentation of glucose, and blue-white autofluorescence. Their cell wall fatty acid composition is qualitatively similar to those of other legionellae, with 50 to 62% branched-chain fatty acids. They contain the isobranched-chain 14- and 16-carbon acids and anteisobranched-chain 15- and 17-carbon acids and relatively large amounts of straight-chain 16-carbon acid. All strains of L. sainthelensi contain approximately equal amounts of ubiquinones Q9, Q10, Q11, and Q12, a pattern similar to those of Legionella bozemanii, Legionella dumoffi, and Legionella longbeachae. Serological cross-reactions were observed between L. sainthelensi, both serogroups of L. longbeachae, and Legionella oakridgensis. Three strains of L. sainthelensi were greater than 90% related by DNA hybridization. The type strain of L. sainthelensi, Mt. St. Helens 4, was 36% related to the type strain of L. longbeachae and 3 to 14% related to the other nine described Legionella species.

Comparison of the effects of acid and base hydrolyses on hydroxy and cyclopropane fatty acids in bacteria

The cellular fatty acid compositions of Legionella oakridgensis, Brucella suis, Pseudomonas aeruginosa, and Francisella tularensis were compared after base hydrolysis (saponification), acid hydrolysis, and acid methanolysis procedures were used to release the fatty acids. The branched-chain, unsaturated, saturated, and ester-linked hydroxy acids were released as effectively with saponification at 100 degrees C for 30 min as with acid hydrolysis or acid methanolysis at 85 degrees C for 16 h. Although the amide-linked hydroxy acids were released more effectively by acid hydrolysis or acid methanolysis, these methods degraded the cyclopropane fatty acids, producing a number of new peaks or artifacts in the chromatograms. Cyclopropane fatty acids were not degraded by saponification, and at least 50% of the hydroxy acids were released when the cells were saponified with 15% NaOH in 50% aqueous methanol. Thus, the results show that saponification for 30 min at 100 degrees C with 15% NaOH, followed by methylation is an excellent method for routine fatty acid analysis of bacteria and for screening cultures whose identity and fatty acid composition are unknown.

Cellular fatty acid composition and ubiquinone content of Legionella feeleii sp. nov

The cellular fatty acid composition of Legionella feeleii was determined by capillary gas-liquid chromatography, and the ubiquinone content was determined by reverse-phase high-pressure liquid chromatography. As in other Legionella species, this new species is characterized by relatively large amounts of branched-chain fatty acids and by major amounts of ubiquinones with more than 10 isoprene units in the side chain.

Legionella oakridgensis: unusual new species isolated from cooling tower water

We describe a new species of Legionella represented by 10 strains isolated from industrial cooling towers. Legionella oakridgensis differed genetically from the other seven species of Legionella in DNA hybridization studies and differed serologically in direct fluorescent-antibody tests. The new species, unlike all other species except L. jordanis, did not require added L-cysteine for growth in serial transfer on charcoal-yeast extract agar. L. oakridgensis, as well as three other species tested, required L-cysteine for primary isolation from animal tissues. L. oakridgensis was the only species of Legionella that failed to produce alkaline phosphatase at pH 8.5. In all other respects, it resembled other species of Legionella, including having a high content of branched-chain cellular fatty acids and being pathogenic for guinea pigs. These bacteria have not yet been associated with human disease, but they are potential causes of legionellosis.

Analysis of short-chain acids from anaerobic bacteria by high-performance liquid chromatography

A standard mixture of 25 short-chain fatty acids was resolved by high-performance liquid chromatography, using an Aminex HPX-87 column. The acids produced in culture media by anaerobic bacteria were analyzed by high-performance liquid chromatography after extraction with ether and reextraction into a small volume of 0.1 N NaOH. The presence of fumaric acid in culture extracts of Peptostreptococcus anaerobius was confirmed by gas chromatography-mass spectrometry analysis of the trapped eluent fractions from the high-performance liquid chromatography column.

30 years of campylobacters: biochemical characteristics and a biotyping proposal for Campylobacter jejuni

Several biochemical test systems were studied for their potential usefulness for the examination of strains of Campylobacter species. Most (81%) of the C. jejuni strains hydrolyzed sodium hippurate, but strains of C. fetus, C. sputorum, and C. fecalis did not. Some (46%) of the C. jejuni strains and all of the C. sputorum subsp. sputorum, C. sputorum subsp. bubulus, and C. fecalis strains hydrolyzed DNA, but the C. fetus and C. sputorum subsp. mucosalis strains did not. Strains of all species of Campylobacter grew on charcoal-yeast extract agar, but 47% of the C. jejuni strains did not. Alkaline phosphatase activity was recorded for some strains of C. jejuni, but all other species were negative for this activity. Aryl sulfatase activity was detected in 7% of the C. jejuni, 15% of the C. fetus subsp. fetus, and all of the C. sputorum subsp. sputorum, C. sputorum subsp. bubulus, and C. fecalis strains, but it was not detected in the C. fetus subsp. venerealis and C. sputorum subsp. mucosalis strains. Most (93%) of the C. jejuni but none of the other Campylobacter strains contained lactobacillic acid when examined for cellular fatty acids. On the basis of results from three of these tests (hippurate hydrolysis, DNA hydrolysis, and growth on charcoal-yeast extract agar), clinical strains of C. jejuni were placed in eight biotypes.

Gas-chromatographic analysis of mycolic acid cleavage products in mycobacteria

Mycolic acids were detected in both reference strains and clinical isolates of mycobacteria using gas chromatography of fatty acid methyl esters prepared by acid methanolysis. The methyl esters were extracted with hexane, concentrated, and analyzed with a gas chromatograph by using two different injector temperatures. When the samples were analyzed at high injector temperatures of 300 to 350 degrees C, characteristic thermal cleavage products from mycolic acids, C22:0, C24:0, or C26:0 fatty acid methyl esters, were detected. When analyzed at injector temperatures of 235 degrees C or lower, the mycolic acids were heat stable and the characteristic methyl ester cleavage products were not observed.

Production of p-hydroxyhydrocinnamic acid from tyrosine by Peptostreptococcus anaerobius

Peptostreptococcus anaerobius was found to metabolize tyrosine to p-hydroxyhydrocinnamic acid [3-(p-hydroxyphenyl)propionic acid]. This acid was detected in spent growth media by gas-liquid chromatography, and its identity was confirmed by mass spectrometry.

Production of phenylacetic and hydroxyphenylacetic acids by clostridium botulinum type G

Phenylacetic and hydroxyphenylacetic acids were present as major acids in spent growth medium from Clostridium botulinum type G. These aromatic acids were identified by gas-liquid chromatography and mass spectrometry.

Differentiation of Peptococcus and Peptostreptococcus by gas-liquid chromatography of cellular fatty acids and metabolic products

Gas-liquid chromatographic (GLC) profiles of cellular fatty acids and metabolic products were useful in identifying strains of Peptococcus saccharolyticus, Peptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus micros, and Streptococcus intermedius. The GLC results supported the recent taxonomic decision to transfer aerotolerant Peptostreptococcus species to the genus Streptococcus. Because inconsistencies in the results prevented our differentiating Peptococcus prevotii. Peptococcus magnus, and Peptococcus variabilis by GLC, additional strains will have to been examined. These GLC techniques are amenable to routine use; however, for interlaboratory results to be meaningful, the classification and nomenclature of the anaerobic gram-positive cocci should be standardized.

Cellular fatty acids of Peptococcus variabilis and Peptostreptococcus anaerobius

Cellular fatty acids of Peptococcus variables and Peptostreptococcus anaerobius were identified by gas chromatography, mass spectrometry, and associated analytical techniques. Iso- and anteiso-branched-chain acids were major components in both species.

Cellular fatty acid composition of Streptococcus mutans and related streptococci

The cellular fatty acid composition of 18 strains of Streptococcus mutans and 17 isolates of related streptococci were examined by gas-liquid chromatography. The cultures could be divided into two distinct groups on the basis of their fatty acids. The first group, which included S mutans and S salivarius, contained palmitic (16:0), octadecenoic (18:1), stearic (18:0), eicosenoic (20:1), and eicosanoic (20:0) acids. The presence of the two 20-carbon fatty acids distinguished S mutans and S salivarius from all of the other species. Two of the S mutans cultures were further distinguished by the presence of 19-carbon and 21-carbon cyclopropane acids. The second group included S sanguis, S mitis, S uberis, and a culture of Lancefield group C streptococci. The percentages of the major acids (16:0, 18:1, and 18:0) found in these species were essentially identical. A culture of Lancefield group E streptococci contained large amounts of 16:1 and 18:1 and small amounts of two unidentified acids which were not present in any of the other cultures.

Comparison of rapid methods for analysis of bacterial fatty acids

When rapid gas-liquid chromatography methods for determination of bacterial fatty acids were compared, results showed that saponification was required for total fatty acid analysis. Transesterification with boron-trihalide reagents (BF(3)-CH(3)OH, BCl(3)-CH(3)OH) caused extensive degradation of cyclopropane acids and was less effective than saponification in releasing cellular hydroxy fatty acids. Digestion of cells with tetramethylammonium hydroxide was unsatisfactory because of extraneous gas-liquid chromatography peaks and because of lower recovery of branched-chain and hydroxy fatty acids. A simple, rapid saponification procedure which can be used for total cellular fatty acid analysis of freshly grown cells is described.

Use of gas chromatography for detecting ornithine and lysine decarboxylase activity in bacteria

A gas-liquid chromatography (GLC) procedure for the detection of L-ornithine and L-lysine decarboxylase (EC 4.1.1.17 and EC 4.1.1.18, respectively) activities of bacteria was developed and evaluated against Møller's method, a conventional biochemical test. Cultures were incubated for 2 to 4 h in a simple growth medium and tested by GLC for putrescine and cadaverine, the direct decarboxylation products of ornithine and lysine, respectively. Results obtained with various Enterobacteriaceae, pseudomonads, and vibrios showed that the GLC procedure was superior to the conventional test; clear, well-defined results were obtained within 3 to 5 h, even with cultures which gave weak, delayed, or variable reactions by Møller's method. This GLC procedure for the determination of decarboxylase reactions would be useful in microbiological laboratories for culture identification and for various other enzymatic studies.

Use of gas chromatography for determining catabolic products of arginine by bacteria

A rapid and sensitive procedure for determining catabolic products of arginine metabolism by bacteria was developed. The method consists of inoculating a solution of L-arginine with a heavy cell suspension of the test organism. After a 2-hr incubation period, dissimilation products (citrulline, ornithine, agmatine, putrescine) are converted to volatile derivatives and analyzed by gas-liquid chromatography. Compared with conventional microbiological tests, the new procedure is rapid and can be used for sensitive quantitative measurements of specific metabolites from arginine.