Biomedical subjects
Publications and source records attributed to S L Green.
Anaerobic pleuropulmonary infections usually arise from aspiration of oral bacteria. The degree of virulence depends on host factors, especially state of tissue oxygenation, and on size of inoculum. Fetid sputum, if present, frequently is diagnostic. Use of penicillin G is preferred therapy for all forms of anaerobic pleuropulmonary infection.
A case of clostridial endomyometritis and sepsis necessitating total abdominal hysterectomy which occurred 12 hours following abortion induced with intraamniotic administration of prostaglandin F2 alpha and laminaria tent insertion is discussed. Cultures from cervical, blood, and surgical specimens all yielded Clostridium perfringens. Intrauterine contamination with this microorganism most likely followed the insertion of laminaria tents through the cervical os, which was colonized with C. perfringens. Since C. perfringens may be present in the microflora of the lower female genital tract, great care must be taken to cleanse this area prior to intracervical laminaria tent insertion.
This case illustrates progressive anaerobic pleuropulmonary infection caused by Bifidobacterium eriksonii that eventually was fatal. Aspiration pneumonia, lung abscess, empyema, and finally necrotizing pneumonia characterized the clinical course. The organism is difficult to recover, but there is reason to suspect that it may be of greater etiologic importance than heretofore recognized in debilitated patients with pleuropulmonary infections. This patient was a 52-year-old alcoholic with periodontal disease. Both conditions are well-known factors underlying anaerobic pleuropulmonary infection. Alcoholism probably predisposed the patient to aspiration of oral secretions, the likely source of the infection.
A brief perioperative course of ampicillin was recommended for high-risk patients undergoing cesarean section at our institution. High-risk patients were defined as those with two or more of the following factors: general anesthesia, obesity, hematocrit less than or equal to 30%, and labor prior to delivery. Fifteen percent of high-risk patients who received prophylactic antibiotics experienced postoperative febrile morbidity compared to 63% for the high-risk untreated group (P less than 0.001). Twenty-five percent of low-risk patients (less than 2 risk factors) developed this complication. Endometritis was the leading cause of postoperative febrile morbidity. Postoperative stay was only slightly decreased in the prophylactically treated group (5.9 vs 6.2 days). Prophylactic amplicillin given perioperatively was an effective agent in reducing post-cesarean-section febrile morbidty among high-risk patients.
A high incidence of post cesarean section febrile morbidity has caused a number of investigators to recommend using prophylatic antibiotics for patients undergoing this procedure. Recent data suggest that such prophylactic antibiotics should be reserved for high-risk patients. Since previous studies have not adequately defined the high-risk patient, we analyzed 129 patients undergoing cesarean section to identify the factors which predispose to postoperative febrile morbidity. Two different statistical programs identified four factors (general anesthesia, obesity, hematocrit less than or equal to 30%, and labor prior to delivery) which were significantly associated with post cesarean section febrile morbidity (P less than 0.025). Patients with 2 or more of these risk factors were highly likely to experience this postoperative complication (P less than 0.001).
A prospective study was performed to determine the prevalence and persistence of group B streptococcal colonization among obstetric (high-risk) and nonobstetric (low-risk) personnel. Seventy-four individuals participated in the study and the following sites were sampled: throat, rectum, vagina (females) and anterior urethra (males). The overall colonization rate was 32.4% and no statistical difference was found between high- and low-risk groups. The most frequently recovered serotypes were type III (37.5%) and type II/Ic (33.3%). Individuals older than 30 years were more likely to carry type II/Ic, whereas personnel in their twenties were most frequently colonized with type III. The rectum was the most frequently colonized site (83.3%). The vagina/urethra was colonized in 62.5% and the throat in 8.4% of carriers. Twenty-three culture-positive individuals were recultured from all sites three to six months later and persistent colonization was found in 56.5%. There was no statistical difference in persistence between the high- and low-risk groups. Type III carriers tended to become culture-negative, whereas type II/Ic carriers were significantly more likely to remain colonized with group B streptococci.
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As early discharge from the hospital and initiation of outpatient iv therapy have become more common, physicians have found that although their role as care giver has not diminished, compensation by insurers for that care has. Therefore, physicians may wish to establish their own office-based programs for providing cost-effective, quality care for patients who can be treated on an outpatient basis. Important factors in the establishment of such a program are obtaining the services of a nurse skilled in administration of iv antibiotics and the services of a cooperative pharmacist, utilizing treatment consent forms and instructive handouts for patients, and providing 7-day-per-week nursing care. Physicians must immediately hospitalize program participants who experience complications. To ensure cooperation from third-party payers, familiarity with their codes for procedural terminology is necessary. It is also highly advisable to obtain written approval for a patient's participation in the program from the medical director or another key official of the insurance company.
Mutations in Cu/Zn superoxide dismutase (SOD1), a major cytosolic antioxidant enzyme in eukaryotic cells, have been reported in approximately 20% of familial amyotrophic lateral sclerosis (FALS) patients. Hereditary canine spinal muscular atrophy (HCSMA), a fatal inherited motor neuron disease in Brittany spaniels, shares many clinical and pathological features with human motor neuron disease, including FALS. The SOD1 coding region has been sequenced and cloned from several animal species, but not from the dog. We have mapped the chromosomal location, sequenced, and characterized the canine SOD1 gene. Extending this analysis, we have evaluated SOD1 as a candidate for HCSMA. The 462 bp SOD1 coding region in the dog encodes 153 amino acid residues and exhibits more than 83% and 79% sequence identity to other mammalian homologues at both the nucleotide and amino acid levels, respectively. The canine SOD1 gene maps to CFA31 close to syntenic group 13 on the radiation hybrid (RH) map in the vicinity of sodium myo/inositol transporter (SMIT) gene. The human orthologous SOD1 and SMIT genes have been localized on HSA 21q22.1 and HSA 21q21, respectively, confirming the conservation of synteny between dog syntenic group 13 and HSA 21. Direct sequencing of SOD1 cDNA from six dogs with HCSMA revealed no mutations. Northern analysis indicated no differences in steady-state levels of SOD1 mRNA.
We describe endometriosis in an aged rhesus macaque. There was a large mass and a related paraovarian cyst, typical of the disease. Endometriosis is a common finding in nonhuman primate. In this report, we also review the pathophysiology of the disease and summarize the historical and more recent relevant literature. Given the frequency of endometriosis in the rhesus monkey and the long-life spans (15-30 years) of nonhuman primates in captivity, endometriosis should be suspected in animals displaying the earliest signs of the disease: anorexia, dysmenorrhea, menorrhagia, irregular menstrual cycles, or infertility. Despite recent advances in the diagnosis and therapeutic strategies for endometriosis in women, the disease remains a significant cause of morbidity and ultimately, a cause of mortality, in the older nonhuman primate.
The case records of 20 horses with tetanus referred to the Ontario Veterinary College-Veterinary Teaching Hospital between 1970 and 1990 were reviewed. The fatality rate was 75%. There was a strong association with previous vaccination and survival (P = .03). Most of the animals had been injured an average of 9 days (range 2 to 21 days) prior to development of clinical signs. Hyperesthesia and prolapse of the third eyelid were the most common clinical signs. Treatment regimens varied during hospitalization; however, all horses received parenteral penicillin, tranquilizers, tetanus toxoid, and antitoxin. Five of the nonsurviving animals were given intrathecal tetanus antitoxin. One animal had seizures as a complication of intrathecal treatment. The prognosis was best for horses that (1) had been vaccinated prior to the injury, (2) responded to the phenothiazine tranquilizers, and (3) did not rapidly (over 24 to 48 hours) become recumbent. Considering the species susceptibility, potential for contaminated wounds, and the increased survival of vaccinated horses, yearly revaccination is recommended.
Hereditary canine spinal muscular atrophy (HCSMA) is an inherited motor neuron disease affecting a kindred of Brittanies. We have examined the clinicopathologic abnormalities in 57 animals with HCSMA, including 43 affected adult dogs and 14 homozygote pups. We also measured selected biochemical indices of oxidative stress: serum vitamin E (alpha-tocopherol) and Se concentrations; serum concentrations of Cu, Zn, Mg, and Fe; and total superoxide dismutase and glutathione peroxidase activities in red blood cells. Dogs with HCSMA had the following abnormalities: regenerative anemia, hypoglobulinemia, hypochloremia, and abnormally high creatine kinase and liver alkaline phosphatase activities. Serum Cu concentration was significantly (P = .01) increased in adult dogs with HCSMA compared to control dogs. Serum vitamin E concentrations tended to be lower in adult dogs with HCSMA compared to controls, and were significantly (P = .01) lower in homozygote pups compared to control pups.
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