Septicemia due to beta-lactamase-positive Kingella kingae.
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Biomedical subjects
Publications and source records attributed to R Sood.
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A new scale for assessing negative symptoms in schizophrenia, the Negative Symptom Assessment (NSA), was administered to 101 male chronic, inpatient schizophrenia patients. Factor analysis of the NSA yielded seven factors, but most of the explained variance resided in Factor 1, Restricted Affect/Emotion. The factors that emerged from this study closely resembled NSA factors derived from an earlier study of outpatient schizophrenia patients, which indicates the factor structure of the NSA is robust. A constellation of variables reflecting long-term or chronic illness were significantly related to six of the seven factors. These results suggest that "institutionalism" may play a role in the evolution of some negative symptoms.
A retrospective study of 81 patients with penetrating gluteal wounds was performed to determine if the site of penetration was useful in predicting the likelihood of associated vascular or visceral injury. There were 53 gunshot wounds and 28 stab wounds, including one impalement. The gluteal region was divided into upper and lower zones by determining whether entry occurred above or below the greater trochanters. Sixty-six percent of all penetrating gluteal wounds entered the upper zone. Thirty-two percent of patients with upper zone penetration had associated vascular or visceral injury. Only one of 27 patients with lower zone penetration sustained major injury. The site of entry plays a critical role in determining the likelihood of serious injury associated with penetrating gluteal wounds. Wounds penetrating above the greater trochanters demand thorough evaluation, especially gunshot wounds.
CFTR, the protein defective in cystic fibrosis is regulated during differentiation of intestinal epithelial cells. The undifferentiated cells (Caco-2 and HT-29) show a lower level of CFTR mRNA, while a 10-fold increase is seen in differentiated cells. These differences correlate well with those of other intestinal-specific genes, including sucrase-isomaltase, villin and alpha 1-antitrypsin, indicating that the regulation is cell specific. In Caco-2 cells the increase in CFTR mRNA cannot be accounted for by increased transcription of the gene. These data indicate that CFTR mRNA stabilizing factor(s) might be present in differentiated cells. The higher levels of CFTR mRNA in differentiated cells are accompanied by decreased protein levels, indicating, as well, involvement of translational control in the regulation of CFTR in these cells. Finally, fully differentiated cells show lowered levels of cyclic AMP-activated C1- transport, the characteristic function of CFTR. Thus, CFTR function in differentiated cells is modulated by a complex interaction of regulatory elements. Caco-2 and HT-29 cells provide a suitable in vitro system in which to study the mechanism of regulation of CFTR.
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As a first step in our efforts to delineate the role of CFTR in cellular phenotypes we have studied its expression in cultured human intestinal epithelial cells. In particular we have examined the effect of cellular differentiation on CFTR gene expression. CFTR mRNA was measured by quantitative densitometry of Northern blots and normalized to the amounts of pyruvate dehydrogenase message. We have found that in T84 cells the levels of CFTR mRNA do not change as the cells grow to confluence. In contrast, levels of CFTR mRNA increase by a factor of 10-20 as Caco2 cells grow after subculture. This change in the levels of CFTR mRNA is correlated with the morphological differentiation that occurs in Caco2 cells during culture. The potential significance of this observation is discussed.
Although the success of replantation and revascularization is in part related to the length of the ischemic interval, it is important to bear in mind that microsurgical intervention must be given appropriate priority relative to the patient's other injuries. Very few patients die as a result of upper extremity trauma. However, the economic, psychologic, and physical debility of a chronic hand injury will be the ultimate handicap in patients who survive multisystem trauma. Therefore, management of the injured extremity has an important place in the overall scheme of trauma care.
This essay places the concept of "primary acquired melanosis" of the conjunctiva in historical perspective and shows that it and its analogs, namely, lentigo-melanosis (Hutchinson), melanotic freckle (Hutchinson), melanose circonscrite precancereuse (Dubrueilh), melanotische precancerose (Miescher), lentigo maligna (Clark), precancerous melanosis (Reese), benign, precancerous, and cancerous melanosis (Zimmerman), atypical melanocytic hyperplasia (Silver et al.), and benign acquired melanosis (Zimmerman), are synonyms for melanoma in situ. The issue is not merely semantic or philosophical; it is urgently practical. If a clinician takes literally the meaning of a lesion designated "benign melanosis" and considers it to be benign, rather than the malignant melanoma that it actually is, a patient who bears that flat pigmented lesion may one day die of metastasis from an elevated sequella of it. The same is true of "primary acquired melanosis," which is not simply a condition of blackening by melanin, but a flat melanoma that, if not removed completely, may give rise one day to metastases that cause death. To avoid such misconstructions, we advocate naming melanomas in all organs "melanoma" and those that are confined to epithelial structures "melanoma in situ." Euphemisms like lentigo maligna and primary acquired melanosis are evasions of the diagnosis of melanoma, and use of them may be harmful. For that reason, they should be eschewed.
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Five G/C-containing oligonucleotides that include the recognition sequences of rare-cutting restriction enzymes have been used to isolate almost 100 different genomic segments from chromosome 7 that contain recognition sites for those enzymes. Hybridization and washing at 27 degrees C allow the use of 8-bp radiolabeled oligonucleotides to detect specific G/C-containing sequences in less than 1 ng of cloned DNA. This method was used to isolate 9 positive clones from 138 previously isolated single-copy probes from a flow-sorted chromosome 7 library. The specificity of the method was confirmed by showing that clones that gave positive hybridization signals also contained the corresponding restriction site. The oligonucleotides were also used to analyze approximately 12,000 kb of genomic sequence from a newly constructed chromosome 7 cosmid library that yielded 88 positive cosmids from 350 analyzed. The average distances between binding sites ranged from 200 to 690 kb and was independent of the number of CpG residues present in the oligonucleotide. Confirmation that clones containing restriction sites for these rare-cutting enzymes are located near genes was obtained by hybridization to RNA and cross-species DNA blots.
We have characterized and genetically mapped two new DNA markers (DXS311 and DXS312) with respect to 10 existing loci in Xq26----Xq28 in a set of 15 families in which the fragile-X [fra(X)] syndrome was segregating. Two-point and multipoint linkage analyses were performed taking into account the incomplete penetrance of the fra(X) mutation. The most likely order on the basis of these data is centromere-DXS79-DXS10-DXS311-DXS86-(F9-DXS99 )-(DXS98-DXS312)-fra(X)-DXS52- DXS15-F8C-telomere. DXS98 and one of the new loci, DXS312, were found to be the proximal markers closest to the fra(X) locus. The order F9-(DXS98-DXS312)-fra(X) was found to be 5.9 x 10(4) times more likely than the order (DXS98-DXS312)-F9-fra(X).
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Gravity and natural position of the kidney have emerged as important factors in the nucleation, growth and postoperative recurrences of renal stones. A new operation technique is described to alter the position of the kidney, hence countering all obstacles to urinary flow. Recurrence of stones after the new operation (8.1%) were compared with controls (15.0%). Recurrence rates revealed from history data at two years (15-28%) and life-time recurrences deduced therefrom (25-80% or more) were used for comparison. Postnephropexy figures were 5.97% and 10-25% respectively. It strengthened our belief that to check inevitable postoperative recurrences, this new operation should be applied whenever open surgery is performed for nephrolithiasis.
In adult tuberculous meningitis (10), delayed skin hypersensitivity to DNCB was significantly impaired, whereas to tuberculin not altered. Lymphocyte migration (LMI) index was lower in comparison with pulmonary tuberculosis (20) and healthy adults (20). Lower LMI index was statistically not significant than pulmonary tuberculosis. Serum IgG and IgM levels were higher than in healthy adults. In comparison with pulmonary tuberculosis, only IgM levels were raised. We conclude that in adult tuberculous meningitis, cell mediated immune response is impaired and non-specific antibody response is increased than pulmonary tuberculosis and healthy adults.
Stab wounds of the chest may be associated with a spectrum of injuries ranging from the lethal to the insignificant. The management of asymptomatic patients with stab wounds of the chest is controversial. The results of previous reports have asserted that asymptomatic patients with stab wounds of the chest do not have delayed complications develop if roentgenograms of the chest taken six hours after the injury are normal. This "rule" has not been validated. A three year, prospective study of patients with stab wounds of the chest was done. Patients were excluded from the study if they had symptoms on arrival, evidence of physiologic derangement caused by intrathoracic injury, wounds near the subclavian vessels or precordial wounds. Patients with lower thoracic stab wounds were evaluated by diagnostic peritoneal lavage. If findings from lavage were negative, the patients were included in the study. One hundred and five patients met the criteria for inclusion in the study group. All of the patients were hospitalized and examined serially. All had roentgenograms of the chest performed at admission, at six hours and at 24 hours. Four patients had a pneumothorax or hemothorax develop between the time of admission and six hours of hospitalization. In the remaining 101 patients, none had a pneumothorax or hemothorax between six and 24 hours. No patient asymptomatic on admission had a tension pneumothorax develop later. No patient had delayed evidence of abdominal injury. An asymptomatic patient with a stab wound of the chest that is not precordial, not in proximity to the subclavian artery and not suspected of diaphragmatic penetration should be serially examined and have a follow-up roentgenogram of the chest at six hours. If the patient remains asymptomatic and the six hour film is normal, delayed complications are rarely, if ever, encountered and the patient does not require further studies or hospitalization. The six hour rule for stab wounds of the chest is valid.
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