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5566. Is Clostridium difficile endemic in chronic-care facilities?
作者: B S Bender.;R Bennett.;B E Laughon.;W B Greenough.;C Gaydos.;S D Sears.;M S Forman.;J G Bartlett.
来源: Lancet. 1986年2卷8497期11-3页
An apparent outbreak of Clostridium difficile diarrhoea on the chronic hospital ward of a long-term care facility prompted an investigation lasting seven months. Approximately a third of patients had stools that were positive for C difficile by either toxin or culture. Attempts to eradicate the infection by simultaneously treating all toxin-positive patients with metronidazole, limiting antibiotic use, and implementing enteric isolation were unsuccessful. New cases were both nosocomially acquired and imported into the facility. Of the C difficile toxin-positive patients, 34% had diarrhoea and 19/49 (38%) died during the study period. C difficile is not routinely sought by most clinical microbiology laboratories and may therefore be endemic in many long-term care facilities for the elderly.
5567. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.
作者: D C Cumberland.;T A Sanborn.;D I Tayler.;D J Moore.;C L Welsh.;A J Greenfield.;J K Guben.;T J Ryan.
来源: Lancet. 1986年1卷8496期1457-9页
A metal-tipped laser fibre was used during percutaneous angioplasty of femoral/popliteal or iliac artery occlusions in 56 patients. Primary success was achieved in 50 (89%) of these total occlusions, providing a channel for subsequent balloon dilatation. Before the procedure, 18 lesions had been judged untreatable by conventional angioplasty and four of the six failures were in these. Complications directly attributable to the laser probe were one case of vessel perforation and two cases of entry into vessel walls; these had no sequelae. Other acute complications were a distal thrombosis in a non-heparinised patient, requiring local streptokinase treatment, and two reocclusions and one transient peripheral embolic episode in the first 24 hours. The laser probe technique has potential for increasing the proportion of patients suitable for angioplasty.
5568. Evidence for down-regulation of beta-2-adrenoceptors in cirrhotic patients with severe ascites.
The density and affinity of beta-2-adrenoceptors on mononuclear cells from peripheral blood were studied in fifteen patients with cirrhosis of different severity and in thirteen controls. There was no significant difference between cirrhotic patients and controls in density or affinity of beta-2 binding sites. Within the cirrhotic group, however, the number of binding sites per cell was significantly lower in patients with severe ascites than in patients with mild to moderate or no ascites. This down-regulation of beta-adrenoceptors could influence the haemodynamic response to beta-blockers.
5570. Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial.
作者: A Sommer.;I Tarwotjo.;E Djunaedi.;K P West.;A A Loeden.;R Tilden.;L Mele.
来源: Lancet. 1986年1卷8491期1169-73页
450 villages in northern Sumatra were randomly assigned to either participate in a vitamin A supplementation scheme (n = 229) or serve for 1 year as a control (n = 221). 25 939 preschool children were examined at baseline and again 11 to 13 months later. Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later. Among children aged 12-71 months at baseline, mortality in control villages (75/10 231, 7.3 per 1000) was 49% greater than in those where supplements were given (53/10 919, 4.9 per 1000) (p less than 0.05). The impact of vitamin A supplementation seemed to be greater in boys than in girls. These results support earlier observations linking mild vitamin A deficiency to increased mortality and suggest that supplements given to vitamin A deficient populations may decrease mortality by as much as 34%.
5571. Fetal neuronal grafts in monkeys given methylphenyltetrahydropyridine.
作者: D E Redmond.;J R Sladek.;R H Roth.;T J Collier.;J D Elsworth.;A Y Deutch.;S Haber.
来源: Lancet. 1986年1卷8490期1125-7页
Fetal substantia nigra cells of two different gestational ages were successfully transplanted into the brains of three methylphenyltetrahydropyridine-treated monkeys with severe parkinsonian motor and behavioural deficits. Functional improvement continued for 10 weeks after cell grafts into the striata of two monkeys with substantial numbers of tyrosine-hydroxylase-positive fetal neurons at necropsy. Behavioural improvement was correlated with increases in cerebrospinal fluid (CSF) homovanillic acid (HVA) concentrations after the transplants. A control monkey with inappropriately placed transplanted cells of an earlier gestational age remained severely parkinsonian and died during a similar period. CSF HVA fell slightly in this monkey from the low level seen before the transplants. Fetal dopamine neurons of two different gestational ages appear to survive transplantation in primates and have biochemical and functional effects.
5572. Use of cultured epidermal autografts and dermal allografts as skin replacement after burn injury.
An adult with burns over 55% of body surface area (80% of which were third degree) was treated with cadaver skin allografts. The allografts were later abraded to remove allogeneic epidermis and resurfaced with autogenous keratinocyte cultures. Complete reconstitution of skin, consisting of epidermal autograft and dermal allograft, was achieved.
5573. HLA-DQ beta-chain polymorphism linked to myasthenia gravis.
作者: J Bell.;L Rassenti.;S Smoot.;K Smith.;C Newby.;R Hohlfeld.;K Toyka.;H McDevitt.;L Steinman.
来源: Lancet. 1986年1卷8489期1058-60页
The HLA-DR3 haplotype is associated with increased risk of myasthenia gravis (MG) and a number of other autoimmune diseases, including insulin-dependent diabetes mellitus (IDDM), coeliac disease, and premature ovarian failure (POF). With a cDNA probe for a DQ beta gene, a 15 kb Hinc II restriction fragment has been demonstrated in genomic DNA from 7 of 16 HLA-DR3 patients with MG, 1 of 19 healthy DR3 controls, and none of 24 DR3 patients with IDDM, coeliac disease, or POF. The HLA-DQ polymorphism may be closely linked to a genetic locus regulating immune responsiveness to acetylcholine receptor and susceptibility to MG.
5574. Attrition of trisomies as a maternal screening device. An explanation of the association of trisomy 21 with maternal age.
Analysis of published data indicates that the increased rate of trisomy 21 pregnancies with advancing maternal age is due to failure of a postulated maternal screening process between fertilisation and recognition. This mechanism may also operate in other trisomies.
5577. Oral ciprofloxacin therapy of infections due to Pseudomonas aeruginosa.
The efficacy and safety of oral ciprofloxacin, a fluoroquinolone, were evaluated in the treatment of infection due to Pseudomonas aeruginosa. 96 infections in 71 patients were treated. Substantial underlying disease was present in most of the patients, and 25 (35%) were seriously ill. 52% of pseudomonas isolates were carbenicillin-resistant, and 31% gentamicin-resistant. The overall clinical response rate was 77%-28 of 35 exacerbations of cystic fibrosis respiratory disease, 17 of 19 urinary infections, 4 of 6 osteomyelitis, and 11 of 15 soft tissue infections. The bacteriological cure rate was 34%-0 of 35 cystic fibrosis, 4 of 17 respiratory infections, 17 of 19 urinary infections, 4 of 6 osteomyelitis, and 8 of 15 soft tissue infections. Ps aeruginosa developed resistance to ciprofloxacin in 25 of 96 infections. Side-effects were generally slight with nausea in 14 (15%) the most common, and there were only two substantial superinfections.
5578. Lower risk of thromboembolic disease after total hip replacement with non-cemented than with cemented prostheses.
During the course of a prospective, randomised trial comparing dextran 40 with antithrombin III plus heparin as prophylaxis against thrombosis after total hip replacement, an unexpectedly low incidence of postoperative thromboembolic disease was found in patients receiving non-cemented (0 of 23) rather than cemented prostheses (4 of 13, 31%). Despite the small number of patients, the difference was significant and necessitated modification of the protocol. These preliminary findings suggest that the type of hip replacement used was more important than the type of antithrombotic medication in preventing venous thrombosis and pulmonary embolism.
5580. Leishmania donovani: an opportunistic microbe associated with progressive disease in three immunocompromised patients.
Three cases are described showing that Leishmania donovani can cause progressive disease in immunocompromised hosts. The first patient was receiving corticosteroid therapy for ulcerative colitis and the second corticosteroids and cyclophosphamide for proliferative glomerulonephritis; in the third patient, leishmaniasis occurred after a long episode of hepatosplenic schistosomiasis and salmonella bacteraemia which was treated with chloramphenicol. In two cases, the patients had moved away from areas of L donovani transmission many years before the progressive disease occurred, consistent with long-term survival of the organism in normal hosts. L donovani should be added to the growing list of opportunistic microbial infections.
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