Biomedical subjects
J Thompson
Publications and source records attributed to J Thompson.
Ocular infections associated with Eikenella corrodens.
Eikenella corrodens is a gram-negative, facultative rod-shaped anaerobe that colonizes the human mouth, nasopharynx, gut, and genitourinary tract. We treated a corneal ulcer from which E. corrodens was the primary isolate in an otherwise healthy man. We treated another patient who had recurrent bacterial endophthalmitis from which Eikenella was identified in mixed culture. Named for its ability to form pits in agar, the corroding bacillus is gaining recognition for its role in head and neck infections. Certain E. corrodens strains are mobile on moist surfaces and elaborate an endotoxin, which may destroy human tissues directly and indirectly by means of the immune system. The organism is usually resistant to aminoglycosides and penicillinase-resistant penicillins yet is susceptible to penicillin and some cephalosporins.
The effects of dietary manipulation upon the respiratory exchange ratio as a predictor of maximum oxygen uptake fixed term maximal incremental exercise in man.
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Evaluation of a reassortant rhesus rotavirus vaccine in young children.
A candidate live attenuated rotavirus vaccine representative of serotype 1 was administered orally to 26 children, 14 of whom were undergoing primary exposure to rotavirus. The vaccine was derived by reassortment between rhesus rotavirus strain, MMU 18006, and the human serotype 1 strain Wa. The resultant virus has the gene coding for the major surface glycoprotein VP-7 from the human strain and all other genes from the attenuated rhesus parent which is a serotype 3 strain. Prior natural exposure to rotavirus determined the infectivity and immunogenicity of the vaccine. Only two of 12 seropositive children had evidence of reinfection while all 14 seronegative children were infected. Mild febrile illness was seen in vaccinees, however there was no evidence of gastrointestinal disease. As determined by neutralization of the human strains, the resultant serum antibody was entirely strain specific. However, heterotypic neutralization was seen when the rhesus strains were used, suggesting that neutralizing antibody can be directed to shared components of the donor and reassortant strain presumably VP-4, the other major surface protein.
A chaplain's personal view of intensive care.
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Cerebral blood flow and carbon dioxide reactivity in children with bacterial meningitis.
We examined total and regional cerebral blood flow (CBF) by stable xenon computed tomography in 20 seriously ill children with acute bacterial meningitis to determine whether CBF was reduced and to examine the changes in CBF during hyperventilation. In 13 children, total CBF was normal (62 +/- 20 ml/min/100 gm) but marked local variability of flow was seen. In five other children, total CBF was significantly reduced (26 +/- 10 ml/min/100 gm; p less than 0.05), with flow reduced more in white matter (8 +/- 5 ml/min/100 gm) than in gray matter (30 +/- 15 ml/min/100 gm). Autoregulation of CBF appeared to be present in these 18 children within a range of mean arterial blood pressure from 56 to 102 mm Hg. In the remaining two infants, brain dead within the first 24 hours, total flow was uniformly absent, averaging 3 +/- 3 ml/min/100 gm. In seven children, CBF was determined at two carbon dioxide tension (PCO2) levels: 40 (+/- 3) mm Hg and 29 (+/- 3) mm Hg. In six children, total CBF decreased 33%, from 52 (+/- 25) to 35 (+/- 15) ml/min/100 gm; the mean percentage of change in CBF per millimeter of mercury of PCO2 was 3.0%. Regional variability of perfusion to changes in PCO2 was marked in all six children. The percentage of change in CBF per millimeter of mercury of PCO2 was similar in frontal gray matter (3.1%) but higher in white matter (4.5%). In the seventh patient a paradoxical response was observed; total and regional CBF increased 25% after hyperventilation. Our findings demonstrate that (1) CBF in children with bacterial meningitis may be substantially decreased globally, with even more variability noted regionally, (2) autoregulation of CBF is preserved, (3) CBF/CO2 responsitivity varies among patients and in different regions of the brain in the same patient, and (4) hyperventilation can reduce CBF below ischemic thresholds.
Comparison of oscillation with three other methods for measuring nasal airways resistance.
In this study we have compared the sensitivity and reproducibility of nasal airways resistance measurements made using an oscillometer, with those made by passive anterior, active anterior and active posterior rhinomanometry. Nasal airways resistance values were compared in 12 patients with rhinitis and 15 normal subjects, of whom ten had additional measurements after a vasoconstrictor spray, oxymetazoline. The coefficients of variation of 6-8 technically satisfactory measurements were 9-19%. The decongestant effect of oxymetazoline was detected by all methods, with no decrease in reproducibility. Post vasoconstrictor nasal airways resistance fell by 28% (passive anterior), 35% (active anterior), 36% (active posterior) and 58% (oscillometry). In conclusion, the oscillation method for deriving nasal airways resistance is a useful, new, simple and noninvasive way of assessing nasal airways patency. Results compare favourably with other, more established techniques.
Double labelling of cells with tritiated thymidine and bromodeoxyuridine reveals a circadian rhythm-dependent variation in duration of DNA synthesis and S phase flux rates in rodent oral epithelium.
We describe a double labelling method for estimating the duration of DNA synthesis (Ts) and the flux of cells into and from the S phase of the cell cycle, based on labelling with tritiated thymidine [( 3H]TdR) followed by bromodeoxyuridine (BrdU) and combining immunohistological detection of BrdU with conventional autoradiography. In practice, the change in size of a window of double labelled cells occurs as the time interval between the two labels increases. In mouse tongue epithelium there is a marked circadian variation in the number of cells in DNA synthesis. From 0900 to 1500 h this labelling index (LI) falls, but from 2100 to 0300 h it increases. Our results show that the circadian decrease in LI is associated with a short Ts (5.8 +/- 0.3 h), a high S phase efflux and an initially low influx of cells from G1 into S. Conversely, the rising circadian LI is associated with a longer Ts (9.4 +/- 0.1 h), an initially low efflux and a moderate to high influx. Two time-points exist on the circadian LI curve when influx and efflux rates change abruptly. At 0100 h the efflux rate rises from low (5 cells %/h) to high (15-16 cells %/h) and simultaneously the influx rate changes from high to low. Similarly at 1300-1400 h, efflux rate falls from high (19-20 cells %/h) to low (4-8 cells %/h) values and influx rates change from low to high. This double labelling method has revealed that the duration of DNA synthesis varies across the circadian cycle, as do influx and efflux values which generally fall within a discrete range of high or low values. The timing of the changes in flux suggests the presence of two 'control' points on the circadian LI cycle that were previously unrecognized.
Regulation of fructose metabolism and polymer synthesis by Fusobacterium nucleatum ATCC 10953.
Energy for the anaerobic growth of Fusobacterium nucleatum ATCC 10953 can be derived from the fermentation of sugar (fructose) or amino acid (glutamate). During growth on fructose, the cells formed large intracellular granules which after extraction yielded glucose by either acid or enzymatic hydrolysis. The endogenous polymer was subsequently metabolized, and after overnight incubation of the cells in buffer, the glucan granules were no longer detectable by electron microscopy. Anaerobically, washed cells grown previously on fructose fermented this sugar to a mixture of lactic, acetic, and butyric acids, and little intracellular glucan was formed. Aerobically, the cells slowly metabolized fructose to acetate. Provision of glutamic acid as an additional energy (ATP) source elicited rapid synthesis of polymer by glycolyzing cells. Intracellular granules were not present in glutamate-grown cells, and under anaerobic conditions, the resting cells failed to metabolize [14C] fructose. However, the addition of glutamic acid to the suspension resulted in the rapid accumulation of sugar by the cells. Approximately 15% of the 14C-labeled material was extractable with boiling water, and by 31P nuclear magnetic resonance spectroscopy, this phosphorylated derivative was identified as [14C]fructose-1-phosphate. The nonextractable material represented [14C]glucan polymer. Fructose-1-phosphate kinase activity in fructose-grown cells was fivefold greater than that in glutamate-grown cells. We suggest that the activity of fructose-1-phosphate kinase and the availability of ATP regulate the flow of fructose into either the glycolytic or polymer-synthesizing pathway in F. nucleatum.
Simultaneous loss of N5-(carboxyethyl)ornithine synthase, nisin production, and sucrose-fermenting ability by Lactococcus lactis K1.
A spontaneous derivative of Lactococcus lactis subsp. lactis K1 (formerly Streptococcus lactis K1) lacking N5-(carboxyethyl)ornithine synthase (EC 1.5.1.24) was isolated. This mutant had also lost the abilities to ferment sucrose and to produce the antibiotic nisin. Hybridization studies indicate that these linked traits are encoded on the chromosome of L. lactis K1 and that they may be located on a conjugative transposon.
Cloning of the complete gene for carcinoembryonic antigen: analysis of its promoter indicates a region conveying cell type-specific expression.
Carcinoembryonic antigen (CEA) is a widely used tumor marker, especially in the surveillance of colonic cancer patients. Although CEA is also present in some normal tissues, it is apparently expressed at higher levels in tumorous tissues than in corresponding normal tissues. As a first step toward analyzing the regulation of expression of CEA at the transcriptional level, we have isolated and characterized a cosmid clone (cosCEA1), which contains the entire coding region of the CEA gene. A close correlation exists between the exon and deduced immunoglobulin-like domain borders. We have determined a cluster of transcriptional starts for CEA and the closely related nonspecific cross-reacting antigen (NCA) gene and have sequenced their putative promoters. Regions of sequence homology are found as far as approximately 500 nucleotides upstream from the translational starts of these genes, but farther upstream they diverge completely. In both cases we were unable to find classic TATA or CAAT boxes at their expected positions. To characterize the CEA and NCA promoters, we carried out transient transfection assays with promoter-indicator gene constructs in the CEA-producing adenocarcinoma cell line SW403, as well as in nonproducing HeLa cells. A CEA gene promoter construct, containing approximately 400 nucleotides upstream from the translational start, showed nine times higher activity in the SW403 than in the HeLa cell line. This indicates that cis-acting sequences which convey cell type-specific expression of the CEA gene are contained within this region.
Prognostic implications of hyperglycemia and reduced cerebral blood flow in childhood near-drowning.
We retrospectively examined the clinical courses of 20 children with severe near-drowning and divided their outcomes into 3 groups: normal (4), persistent vegetative state (9), and dead (7). We reviewed serial blood glucose levels and cerebral blood flow measured by stable xenon computed tomography within the 1st 48 hours of admission to determine whether they were predictive of outcome. Total, frontal gray, frontal white, and temporal and parietal gray matter cerebral blood flows were significantly decreased in children who died compared with those who completely recovered. Only 1/2 the children surviving in a vegetative state had decreased flows compared with those who recovered. An elevated initial blood glucose was highly predictive of those patients who died (mean, 511 +/- 110 mg%) or those with vegetative survival (465 +/- 104 mg%) compared with those who recovered completely (238 +/- 170 mg%). The predictive value of initial blood glucose alone (68%) or CBF alone (50%) was similar to that of clinical rating scales or immersion/resuscitation times. The combination of blood glucose with CBF improved predictability to 79%. Our results suggest that CBF measurements are predictive of eventual death but cannot differentiate normal from vegetative survival. Combining multiple laboratory studies may be of value in predetermining the eventual outcome in near-drowning.
Suspected scaphoid fractures. The value of radiographs.
Twenty observers reported independently on the presence or absence of a fracture of the scaphoid on 60 sets of radiographs; these included initial and 2- to 3-week views in patients in whom the outcome was known, normal scaphoids and random copies of these. Analysis of variance of the accuracy of observations revealed that the 2- to 3-week radiographs did not improve diagnostic ability and that this was independent of the experience or seniority of the observer. For normal radiographs, 20% of the observations reported a fracture. Reproducibility of opinion improved with experience but this did not help with accuracy. Radiographs without accurate clinical observation should not determine the management of the suspected scaphoid fracture.
When a colleague commits suicide: how the staff reacts.
1. A literature review on the subject of suicide by mental health professional indicates that research has been limited to family member survivors. There is some data on reactions to patient suicide by psychiatrists and psychologists. 2. The results of this study show that mental health professional survivors of peer suicide experience similar reactions to the studied groups. These include anger, guilt, loss of self-esteem, disruption of relationships, and concern about assessing for suicidality. 3. Subjects felt the victim did not reach out for help because she feared stigmatization; mental health professionals are not permitted to have serious problems. 4. The clinical nurse specialist can perform an important role by addressing this dynamic and working to provide a supportive and nonpunitive environment for mental health professionals experiencing problems.
A united stand prevents falls. Team effort builds safety foundation.
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Native valve endocarditis due to Corynebacterium group JK.
We report a case of a 32-yr-old woman on chronic intermittent haemodialysis, who developed endocarditis due to a Corynebacterium group JK, involving both the native aortic and mitral valves. Despite a four-week treatment with vancomycin, an aortic root abscess developed. The diagnosis was confirmed on autopsy.
Pneumococcal endocarditis in adult patients. A report of five cases and review of the literature.
A retrospective survey of patients with pneumococcal infective endocarditis at the University Hospital, Leiden, over a 10-year period (1976-1986) yielded five cases. Applying strict case definitions, four patients had definite and one patient possible pneumococcal endocarditis. The commonest presenting signs and symptoms were malaise, fever, and congestive heart failure. Predisposing conditions were previous splenectomy in one case and a valve prosthesis in another. The aortic valve was the most common site of infection. In four of the five patients the diagnosis of endocarditis was made during life. These patients were treated appropriately, i.e. with antibiotics to which S. pneumoniae is sensitive. In three patients, surgical intervention was performed in the acute phase because of progressive heart failure. Paravalvular abscesses were observed at surgery in all these cases. The four patients treated in our series recovered fully; the single fatal case constituted an unrecognized case of pneumococcal endocarditis. If recognized and treated appropriately (particularly with early selective surgery) endocarditis can be cured. In a statistical analysis of 36 patients with pneumococcal endocarditis reported during the past five years, we found a significantly higher occurrence and mortality in men than in women; no other clinical features were associated with a poor outcome of illness.