Neomycin blood agar as a selective medium for vancomycin resistant Enterococcus faecium.
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Agar↗
Biomedical subjects
J D Perry
Publications and source records attributed to J D Perry.
Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response.
OBJECTIVE: To assess the efficacy of a single intra-articular injection of triamcinolone hexacetonide (THA) in knee osteoarthritis (OA) and examine factors which may relate to treatment efficacy. METHODS: Eighty four patients with clinical and radiographic evidence of knee OA were recruited and randomly allocated to receive either THA (20 mg in 1 ml) or placebo (0.9% normal saline, 1 ml). Follow up assessments evaluated the following outcome variables: patient opinion of overall change in the treated knee, visual analogue pain score (VAS), distance walked in one minute (WD), and Health Assessment Questionnaire modified for lower limb function (HAQ). RESULTS: Seventy eight percent of THA and 49% of placebo treated patients reported overall improvement at week 1 (p < 0.05). At week 6, improvement was reported in 57% and 55% of patient groups, respectively. VAS improved in both groups at week 1 (THA, p < 0.001; placebo, p < 0.05) and week 6 (both p < 0.01). Improvement in VAS was significantly greater among THA treated patients at week 1 only (p < 0.01). Subgroup analysis of THA treated patients revealed greater improvement in VAS among patients with clinical evidence of an effusion (p < 0.05), and those who had synovial fluid successfully aspirated at the time of injection (p < 0.01). WD improved in THA treated patients at week 1 (p < 0.001), and in both groups at week 6 (THA, p < 0.001; placebo, p < 0.01). Improvements in HAQ were seen in THA patients only at weeks 1 and 6 (p < 0.05). Regression analysis did not identify any additional clinical, radiographic, or synovial fluid characteristics which influenced the response. CONCLUSIONS: THA provided short term pain relief in knee OA. Increased benefit was associated with both clinical evidence of joint effusion and successful aspiration of synovial fluid at the time of injection.
Administration, Topical↗
Blood monocytes in rheumatoid arthritis are highly adherent to cultured endothelium.
Monocytes from 17 patients with rheumatoid arthritis (RA) were more adherent than monocytes from 17 control patients to monolayers of pig aortic endothelium irrespective of whether sera was included (median 27-34% increase; p = 0.002) or omitted (median 27% increase; p = 0.022) from the culture media. When human umbilical vein endothelial cells were used as the adherence substrate, rheumatoid monocytes from an additional 21 patients demonstrated a median 31% (p = 0.004) and 20% increase (p = 0.004) in adhesion when compared with monocytes from 21 normal healthy subjects in the absence and presence of autologous sera, respectively. Activation of control monocytes with muramyl dipeptide or treatment with RA sera increased their attachment to endothelium (mean 34 +/- 14% increase; p < 0.001). The expression of the adhesion molecules CD11b (p < 0.005), CD18 (p < 0.005), CD62L (p = 0.01) was enhanced on rheumatoid monocytes, but antibody-blocking studies suggested that CD18 and CD62L were not responsible for the augmented binding of the rheumatoid cells. A subpopulation of rheumatoid monocytes possessed a very low net negative surface charge, a property that favours binding to vessel walls. We propose that many rheumatoid monocytes are predisposed for sheer-resistant adhesion to vascular endothelium.
Adult↗
Therapeutic beds: the Trojan horses of the 1990s?
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Beds↗
Susceptibility of enterococci to ciprofloxacin.
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Ciprofloxacin↗
Use of cephalexin-aztreonam-arabinose agar for selective isolation of Enterococcus faecium.
Cephalexin-aztreonam-arabinose agar (CAA), a new selective agar, was examined in comparison with nalidixic acid-colistin agar for the differentiation of Enterococcus faecium from other enterococci and the ability to isolate the organism from feces. Two hundred sixteen enterococcus isolates and a variety of gram-positive and gram-negative control strains were inoculated onto both media. All control strains of E. faecium were easily differentiated from Enterococcus faecalis and Enterococcus durans on the basis of arabinose fermentation on CAA. Differentiation of E. faecium from other enterococci or Streptococcus bovis was not possible on nalidixic acid-colistin agar. Increased isolation of E. faecium was demonstrated on CAA when both media were compared for the isolation of the organism from feces. CAA has been shown to possess excellent differential and selective features allowing the simple and effective isolation of E. faecium from heavily contaminated sites.
Agar↗
Leukocyte activation and function-associated antigens in inflammatory disease.
Expression of adhesion molecules, CD11a, CD11b and CD18, and of the function-associated molecules CD3, CD4, CD8, CD16, CD19, CD56 and CD57 was assayed on peripheral blood leukocytes from normal control subjects (n = 10), and from patients with adult periodontitis PD (n = 9), ankylosing spondylitis AS (n = 11) and rheumatoid arthritis RA (n = 14). A novel rapid fixation leukocyte preparation technique was used which prevents artefactual up-regulation of surface antigens. In RA patients, the percentage of CD18+ lymphocytes was decreased and that of CD11b+ neutrophils was increased. On lymphocytes the mean fluorescence intensity (MFI) of both CD11b and CD18 was decreased whereas that of CD57 was increased. In AS patients the percentages of CD11b+ lymphocytes and neutrophils were increased and CD18+ lymphocytes and neutrophils were decreased. On lymphocytes the MFIs of CD11b and CD18 were decreased, whilst that of CD16 was increased. On neutrophils the MFI for CD18 was increased. No significant differences (p < 0.01) were seen for the periodontitis patients. It is suggested that the antigen expression on peripheral blood cells from RA and AS patients is consistent with leukocyte activation.
Antigens, Differentiation, T-Lymphocyte↗
Abnormal binding properties of blood monocytes in rheumatoid arthritis.
Blood monocytes from patients with RA exhibited a greater binding to monolayers of umbilical cord vein endothelium than monocytes from control subjects (mean 42% increase; p < 0.01). When control monocytes were added to TNF or IL-1 treated endothelium their adhesion was enhanced (mean 24% increase; p < 0.05), whereas the number of monocytes from RA patients binding to TNF or IL-1 treated monolayers was less than that adhering to untreated endothelial cells (mean 22% inhibition; p < 0.02). The surface expression of CD11b/CD18 on RA monocytes was increased and pretreatment of normal and RA cells with an anti-CD18 monoclonal antibody inhibited their attachment to untreated and cytokine-treated endothelial cells. Normal blood monocytes activated with LPS demonstrated an enhanced binding to untreated cultures (mean 23% increase; p < 0.05) and an inhibited attachment to cytokine-treated endothelial cells. This study suggests that blood monocytes in RA may be activated and that this property modifies the attachment of these cells to normal and "inflammatory" endothelium.
Arthritis, Rheumatoid↗
Studies on the immediate and delayed leucocytosis elicited by brief (30-min) strenuous exercise.
Eight healthy male volunteers exercised for two 30-min sessions starting 3 h apart on an electronically braked cycle ergometer at a work load (mean 155.9 W, SD 33.4 W) which required an oxygen consumption that was 70% of their maximal rate of oxygen uptake. Venous blood samples were taken through an indwelling cannula over a period of 6 h beginning shortly before the first bout of exercise and were analysed for routine haematological parameters and for lactate, noradrenaline, adrenaline and cortisol. Both bouts of exercise induced an immediate leucocytosis due to rises in lymphocytes and neutrophils but only the first exercise bout induced a substantial delayed neutrophilia. In at least five subjects, changes in lymphocyte and platelet numbers were correlated (Spearman's rank procedure, P less than 0.05) with simultaneous changes in the plasma concentrations of lactate, noradrenaline and adrenaline over the 6-h period studied. Increases in the plasma concentration of cortisol due to exercise correlated positively with the percentage changes in neutrophil numbers at 3 h and 6 h. These results are consistent with the suggestion that the immediate and delayed leucocytosis induced by exercise are mediated respectively by catecholamine and by cortisol.
Adult↗
Exercise, injury and chronic inflammatory lesions.
The increasing frequency of injury over the last two decades reflects the activities of a more exercise conscious public. However, all too often injury may be due to ill-advised or inappropriate exercise and can be prevented by relatively simple modification of technique, equipment or gait abnormalities. Nevertheless, many injuries may simply reflect overtraining and the effects of repetitive strain on soft tissue and bony structures. This has led to an urgent need to understand better the mechanisms of injury, the importance of chronic inflammation and the factors involved in recovery of soft tissue strength. In the case of injuries to tendons or ligaments it is often difficult to define the contribution to symptomatology of collagen breakdown or chronic inflammation as a response to this. Furthermore, radiological changes at tendon and ligament attachments (entheses) through overuse can be indistinguishable from chronic inflammatory conditions such as spondarthritis, adding weight to the view that the body has a limited number of ways in which it can react to a variety of chronic stimuli. Marathon runners or footballers, for example, may develop symphysitis through chronic loading and radiologically there may be apparent erosive changes. Rheumatologists, dealing primarily with the chronic inflammatory arthritides, are beginning to understand better the factors involved in chronic inflammation and the effects of exercise. The Sports Physician must equally be aware of some of the pitfalls of misdiagnosis because of the masquerading of some primary inflammatory conditions as soft tissue injury or 'traumatic' joint effusion. This article will therefore review advances in current understanding of the influence of exercise on chronic inflammation and on recovery of tissue strength in sporting injuries. Improving understanding should lead to more defined rehabilitation programmes and a reduction in the all too common reinjury cycle.
Adult↗
Morphological evidence that activated polymorphs circulate in the peripheral blood of patients with rheumatoid arthritis.
Purified peripheral blood polymorphonuclear leucocytes (PMNs) from patients with rheumatoid arthritis (RA) have been found to differ from purified PMNs from normal subjects in ways that are consistent with their prior activation. However, it is currently contentious whether activated PMNs really circulate in patients with RA, or whether they are produced as an in vitro artefact of purification. Recently developed rapid leucocyte fixation and preparation technique showed that the proportion of polarised (activated) PMNs (36.9 (24.7)%, mean (SD); n = 31) was increased relative to that in control subjects (8.1 (5.6)%; n = 12). Serum cytidine deaminase levels, a biochemical marker of PMN lysis, were also increased in patients with RA (11.59 (7.26) U/ml) compared with those in controls (6.82 (3.78) U/ml), but the proportion of polarised PMNs and the levels of cytidine deaminase activity were unrelated to clinical assessments of inflammatory disease activity. Twelve patients who were not receiving drugs or who were receiving only non-steroidal anti-inflammatory drugs (NSAIDs) had more polarised PMNs than 19 patients receiving second line treatment in addition to NSAIDs (patients receiving NSAIDs, 49.6 (25.9)%; patients receiving second line treatment, 27.5 (21.1)%). Fluorescence activated cytometric analysis of CR1 and CR3 expression on PMNs from a randomly selected subgroup of patients with RA showed that the serum level of cytidine deaminase activity was correlated positively with the expression of CR1 (the C3b receptor) on the cell surface and that the proportion of polarised PMNs was positively correlated with the expression of CR3 (or CD11b/CD18), the iC3b receptor that is upregulated on activation. It is suggested that the polarised PMNs which circulate in blood samples from patients with RA represent cells which have been activated but not yet marginated, or activated cells which have marginated but subsequently returned to the circulating pool.
Adult↗
Leucocyte integrin and CR1 expression on peripheral blood leucocytes of patients with rheumatoid arthritis.
Expression of the leucocyte integrins (CD11a, b, c/CD18) and of CD35 (CR1) on leucocytes from the peripheral blood of patients with rheumatoid arthritis (RA) (n = 14) and control subjects (n = 12) was measured by flow cytometry using a rapid fixation and leucocyte preparation procedure. The mean (SE) percentages of lymphocytes expressing CD11a (RA 93.4 (1.7)%; controls 97.2 (1.8)%) and CD18 (RA 91.3 (2.3)%; controls 97.0 (2.6)%) were lower and the percentage of monocytes expressing CD11b (RA 86.9 (11.4)%; controls 78.4 (11.9)%) and CR1 (RA 62.6 (15.5)%; controls 36.6 (17.6)%) were higher in patients with RA than in controls. In addition, the mean fluorescence intensity of CD18 (RA 22.1 (2.3); controls 30.7 (2.5)) on lymphocytes was decreased and that of CD11b (RA 4.5 (0.8); controls 2.9 (0.9)) and CR1 (RA 2.4 (0.4); controls 1.5 (0.5)) on monocytes was increased in patients with RA compared with controls. The functional importance (if any) of the altered expression of the antigens on lymphocytes is not yet known. Altered expression on monocytes is consistent with activation within the circulation.
Adult↗
Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis.
This prospective study describes the ultrasound, computerized tomography and magnetic resonance imaging findings in 16 cases of patellar tendinitis. In all cases tendon enlargement and reduced echogenicity were visible on ultrasound. Computerized tomography demonstrated enlargement of the tendon with reduced attenuation of the central portion. Magnetic resonance imaging showed focal tendon enlargement in all patients with high signal lesions in 88% of cases. This study has shown that patellar tendinitis may be identified with all three modalities. Ultrasound is recommended as the initial investigation in the assessment of patients with this condition.
Adult↗
Brief exercise induces an immediate and a delayed leucocytosis.
Haematological profiles were measured: (1) before and for 5 h 30 min after 30 min sports (squash, swimming, jogging); and (2) before, during and for 2 h 30 min after 30 min cycle ergometry at workloads which required rates of oxygen consumption that were between 48% and 84% of maximal. In both instances exercise induced an immediate leucocytosis (owing to rises in both neutrophils and lymphocytes) which subsided rapidly at the finish of exercise and was followed by a delayed neutrophilia of greater magnitude which peaked at approximately 3 h after the start of exercise. Changes in plasma catecholamines and cortisol recorded during and after exercise (cycle ergometry only) support the hypothesis that the immediate leucocytosis during brief exercise is attributable to elevated catecholamine levels, whereas the delayed neutrophilia is due to raised cortisol levels.
Adult↗
A rapid preparation technique for leucocytes.
A procedure is described for making leucocyte preparations from blood samples fixed ex vivo. Briefly, blood is treated with buffered formaldehyde and the erythrocytes and platelets removed subsequently by lysis and differential centrifugation. The fixed leucocyte preparations can then be processed or fixed further for various types of microscopy as required. In stained preparations examined by light microscopy, the different leucocytes, i.e. lymphocytes, polymorphonuclear leucocytes (PMN) and monocytes, can readily be identified by their characteristic nuclear morphology, and polarized PMN can easily be recognized by their non-spherical shape. Experiments with chemotaxins in vitro indicated that the procedure could be used to determine whether polarized PMN circulate in the blood of normal individuals and patients with inflammatory disease. A study of the blood from eleven normal subjects showed that 84.0 +/- 10.8% (mean +/- 2 SEM) of circulating PMN were spherical, while the majority of the remainder (14.3 +/- 10.5%) were only 'slightly' polarized.
B-Lymphocytes↗
Cervical myelopathy in rheumatoid arthritis: no relationship to surgery.
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Adult↗
Sarcoidosis in a patient presenting with clinical and histological features of primary Sjögren's syndrome.
A patient presenting with bilateral enlargement of parotid and lacrimal glands, xerostomia, and keratoconjunctiva sicca, whose labial biopsy specimen showed changes consistent with Sjögren's syndrome, is described. The patient was initially misdiagnosed as having primary Sjögren's syndrome (SS). Subsequent investigations, however, performed to exclude an associated lymphoma or sarcoidosis, showed histological changes of the latter. The possibility that early infiltrates of the salivary glands in sarcoid may mimic those of SS is discussed.
Diagnosis, Differential↗
Identification by cell electrophoresis of a subpopulation of polymorphonuclear cells which is increased in patients with rheumatoid arthritis and certain other rheumatological disorders.
Two and occasionally three electrophoretic subpopulations of polymorphonuclear cells (PMNs) were identified in the blood of normal healthy subjects and patients with rheumatoid arthritis (RA). Most of the PMNs from both groups of subjects were found in the population with the highest surface charge; the remainder being in the other distributions, which were collectively termed the slow cell population. There was a significant increase in the percentage of rheumatoid PMNs (mean 42%) ascribed to the slow population when compared with PMNs from normal subjects (mean 17%). A similar increase in the slow cell population was also seen in patients with Felty's syndrome (mean 38%) and scleroderma (mean 51%), but not in patients with Behçet's syndrome (mean 18%). Synovial fluid aspirated from the knee joints of patients with RA contained PMNs with the lowest surface charge. With nylon fibre as an adherence substrate cells of a low surface charge were found to be more adherent than those of a high surface charge. An alteration in the electrophoretic distribution of PMNs may represent changes that are related to the expression of functionally related membrane ionogenic groups.
Arthritis, Rheumatoid↗