[Mosaic genes and moderate sensitivity to penicillin in Neisseria meningitidis].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to J Campos.
Explore the source record for details and available documents.
BACKGROUND: To know the incidence, clinical presentation, differential diagnosis and resistance level to antibiotics in pediatric meningitis. METHODS: 173 cases of meningitis (bacterial: 69, viral: 104) have been prospectively followed during 1988 according to a previously established clinical and laboratory protocol. RESULTS: Meningitis attack rate was 60 cases/100,000 children younger than 15 years per year (meningococcal: 25/100,000, Haemophilus: 2/100,000). Mortality was 1.4%. 40% of bacterial meningitis received previous antibiotic treatment. Sensitivity of culture, Gram stain, and direct antigen detection by latex and EIA was 79%, 61.7%, 20.5% and 34%, respectively. Bacterial and viral differential diagnosis, by the application of Boyer's score was 95% sensitive and 98% specific. Four out of six cases of Haemophilus meningitis were ampicillin and chloramphenicol resistant; 39% of meningococcus had their penicillin susceptibility decreased between 2 and 8 times, although no therapeutic failures were seen. CONCLUSIONS: Laboratory parameters might not separate bacterial and viral meningitis at early stages of illness. Gram stain is an excellent and sensitive method of bacterial detection in CSF. Moderate resistance to penicillin in meningococcus is very frequent but clinical failures are not yet present.
A case of a ruptured aneurysm arising from a duplicated segment of the intracranial portion of the vertebral artery is reported. This particular association, which can be explained by the embryological development of the vertebral artery, has not been described previously.
Conflicting data are available concerning left ventricular (LV) function in patients after total correction of tetralogy of Fallot (TOF). The response to afterload stress determined by methoxamine challenge and the peak systolic blood pressure-end-systolic volume relationship were evaluated echocardiographically in 20 postoperative TOF patients (age range 9 to 15 years, mean 12 +/- 2). All patients were without significant residual shunts or pulmonary stenosis. Results were compared with those in 10 control subjects (age range 9 to 15 years, mean 11 +/- 2). The TOF group had higher mean end-diastolic (76.9 +/- 14.4 vs 66.2 +/- 7.2 ml.m-2 P less than 0.05) and mean end-systolic (36.7 +/- 8.5 vs 29.6 +/- 3.9 ml.m-2, P less than 0.05) volumes than controls. Stroke volume index (SVI) and LV ejection fraction were similar in the two groups. In normal subjects, methoxamine caused a decrease in SVI in seven out of 10 patients and a mild increase in three; the mean value of SVI at rest was not significantly different from the mean value at peak pressor effect (36.5 +/- 4.4 vs 35.9 +/- 4.0 ml.m-2, P = NS). In the TOF group, methoxamine induced a reduction in SVI in all patients; the mean value of SVI at peak pressor effect was significantly lower than the mean value at rest (31.3 +/- 5.4 vs 40.2 +/- 6.9 ml.m-2, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
One of the problems of patients with facial asymmetry is that two dimensional analysis of such patients does not give a satisfactory picture of the underlying problem. Various methods have been suggested to overcome this problem, such as stereophotogrammetry (Burke et al. 1983) and Moire fringes (Takasaki 1970, Xenofos and Jones 1979). These methods are time consuming and are not fully automated. At present no 3D method is available which provides a readily analysable, global description of change in the face due to the limitations of the techniques which have been used. The 3D changes in shape of the face which occur during growth and with surgical intervention remain undetermined, either qualitatively or quantitatively. Although the importance of such a development has been pointed out, no method of 3D analysis has been developed. (Cutting et al. 1986). Attempts at three dimensional (3D) measurement of the face for monitoring the growth of children with facial deformities usually use hazardous and invasive techniques of ionizing radiation and metallic implants to assess the growth of the skull. Over the past 10 years the Departments of Orthodontics and Medical Physics and Bio-Engineering at University College London have collaborated in the development of a computer graphics based 3D system for the simulation, planning and prediction of maxillo-facial surgery. The laser scanning system developed measures over 20,000 points over the surface of the face in 10 seconds using a non-invasive and completely non-hazardous technique (Arridge et al. 1985, Moss et al. 1987, Moss et al. 1988). The data acquired is accurate to approximately 0.5 mm. Analytical programmes have been developed to handle the enormous quantity of data produced. These programs form the basis of a practical, user-friendly, clinical system whose performance has been evaluated and is now in routine use (Moss et al. 1989).
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We studied the susceptibilities of relatively penicillin G-resistant and -susceptible strains of Neisseria meningitidis, as well as Neisseria lactamica and Neisseria polysaccharea, to penicillin, ampicillin, and several cephalosporins. The MICs of penicillin, ampicillin, cephalothin, and cefuroxime for moderately resistant meningococci have increased two- to sixfold in relation to MICs for susceptible strains. For these strains of meningococci, N. lactamica, and N. polysaccharea, penicillin, ampicillin, cephalothin, and cefuroxime MICs for 50 and 90% of strains were similar. By genetic transformation of a penicillin-susceptible strain of N. meningitidis to low-level penicillin resistance with DNA from penicillin-resistant strains of N. meningitidis, N. lactamica, N. polysaccharea, and N. gonorrhoeae, isogenic strains with the same pattern of resistance to beta-lactams were obtained, suggesting that these commensal Neisseria spp. could be the source of meningococcal resistance genes.
A young girl developed an intracranial abscess and necrotizing cellulitis following penetrating injury from a lawn dart. Initial identification of a gram-positive rod growing aerobically from clinical specimens was as a Bacillus organism, but the observation that the isolate grew poorly in subcultures for susceptibility testing but quite well under standard anaerobic culture techniques led to the identification of the organism as an aerotolerant Clostridium tertium. Early management of penetrating head trauma should include cranial imaging studies to detect fractures and intracranial pathology. Clinical microbiologists and clinicians should be aware of the phenomenon of aerotolerance in anaerobic bacteria to avoid errors in choice of antibiotic therapy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Antimicrobial resistance determinants and plasmids present in 10 multiply antibiotic-resistant strains of Hemophilus influenzae isolated from patients in different geographic regions of Spain were characterized. Conjugative plasmids with molecular sizes of 38-50 MDa encoded resistance to ampicillin, chloramphenicol, kanamycin, streptomycin, sulfamethoxazole, and tetracycline. Trimethoprim resistance was not linked to the other antibiotic resistance determinants and trimethoprim-resistant transconjugants and transformants lacked detectable plasmid DNA, suggesting that this determinant is chromosomal. Restriction endonuclease analysis revealed similarities among the plasmids, but several restriction patterns could be distinguished. Three hybridization patterns were found with DNA probes coding for H. parainfluenzae beta-lactamase and chloramphenicol-acetyltransferase. Resistance to kanamycin was due to drug modification by aminoglycoside-phosphotransferase (3')I. In Spain, it appears that multiple antibiotic resistance phenotypes in H. influenzae did not arise from acquisition of a single R plasmid; rather, both plasmid and chromosomal resistance evolved independently from several sources.
A 30-year-old woman underwent surgical partial callosotomy (posterior half) for removal of an arteriovenous malformation. The patient submitted to neuropsychological evaluation before and after surgery for a period of 8 months. There was transient dysfunction attributable to disconnection of parietal, temporal, and occipital connections. Because the symptoms disappeared over time, we conclude that the transcallosal surgical approach can, in the long term, be considered a relatively harmless method.
Genotypic and phenotypic diversity among 16 penicillin G-resistant (Penr) isolates of Neisseria meningitidis recovered from human blood or cerebrospinal fluid in Spain was compared with that among 12 penicillin-susceptible (Pens) isolates by the use of multilocus enzyme electrophoresis, serotyping, auxotroph testing in chemically defined media, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of penicillin-binding proteins (PBPs). Thirteen distinctive multilocus enzyme genotypes (electrophoretic types [ETs] ) were identified among the 28 isolates. There was slightly less genetic diversity among the eight ETs of Penr isolates (H = 0.385) than among the eight ETs of Pens isolates (H = 0.431). Cluster analysis demonstrated two distinctive complexes of ETs and one ET that was not closely related to either complex. The possibility of a singular clonal origin of penicillin G-resistant isolates was excluded by the observations that resistance occurred in isolates of each of the two distantly related complexes of ETs, that three of the four ETs represented by multiple isolates included both susceptible and resistant strains, and that serotypes and growth requirements were not associated with the resistance phenotype. The 28 isolates showed a relatively homogeneous pattern of four PBPs, with apparently reduced penicillin G binding by PBP 3 of the Penr isolates.
Five cases of thalassaemia intermedia are reported, they being considered from clinical and biologic standpoints. All patients had long-lasting anaemia, variable enlargement of spleen and low transfusion requirements. The ferro-erythrokinetic pattern was that of chronic haemolysis with effective erythropoiesis, and some comments are included on the different patterns found in each genetic variety. None of the patients is subjected to a defined transfusion protocol.
We report on 47 patients, surveyed and treated by us, diagnosed of primary vesical diverticula, having thus excluded all those secondary to lower obstructive anomalies, such as urethral valves and neurogenic bladder. Only seven out of the 47 patients were females: two of them had a iatrogenic cause and the remainder were of small size and associated with vesicoureteral reflux. All the cases have been documented by means of an intravenous pyelography (IVP), an excretory cystogram and a voiding cystourethrogram (VCUG). Many diverticula may go unnoticed when screened by IVP, whereas the cystogram and preferentially the VCUG are a 100 for 100 diagnostic. A 45 for 100 of these children (22 cases) had an attendant reflux and 23 for 100 (11 cases) had some other concomitant renal disease. Three further cases were iatrogenic, as a result of the methods employed for antireflux ureteral reimplantation. A 77 for 100 of the patients had urinary tract infection demonstrated by a urinary sediment and a positive culture. Surgery was performed on 34 patients, the indication being made on the basis of the big size of the diverticulum, its clinical repercussion, or because of its association with vesicoureteral reflux or any other kidney malformation. We employ an intravesical approach for the small diverticula with attendant reflux, but for resection of the sizeable ones, irrespective of the existence of reflux, we prefer the combined extra and intravesical approach, which allows a most accurate extravesical dissection, as well as the recognition and control of the ureter and the deferes duct, structures both that are usually anatomically distorted.