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PubMed1976

Cellulitis due to Haemophilus influenzae type B. Antigenemia and antibody responses.

The techniques of serum countercurrent immunoelectrophoresis, hemagglutinating (HA), and bactericidal (BC) antibody determinations were applied to seven patients with Haemophilus influenzae type B cellulitis. Capsular antigen was detected (greater than or equal to 10 ng/ml) in two patients at the time of admission and was found in two additional patients two days following hospitalization. Antibody responses in the patients with cellulitis were deficient, similar to those in children under 2 years of age with H influenzae type B meningitis. One of the patients with cellulitis had HA and BC antibody present in convalescent serum, and two additional patients demonstrated BC activity. The clinical presentations of our patients were typical except that violaceous discoloration of overlying skin was noted in only one of the seven. Two additional patients had atypical facial swelling that closely resembled angioneurotic edema and initially led to incorrect diagnosis. Countercurrent immunoelectrophoresis may be helpful in the diagnosis of patients with Haemophilus cellulitis, particularly if serial serum determinations are performed. Bacterial cultures obtained from blood and aspirates of the lesion appear to be more sensitive in determining the cause of H influenzae type B cellulitis.

Antibodies, Bacterial↗
PubMed1993

Laparoscopic resection of a splenic artery aneurysm.

Laparoscopic resection of a 2.5 cm splenic artery aneurysm in a 64-year-old woman is presented. The diagnosis was suspected on plain roentgenograms of the lumbosacral spine and confirmed by abdominal CT scan and selective splenic arteriography. The hospital course was uneventful and she was discharged 2 days postoperatively. This new endoscopic approach offers a useful alternative to the surgical management of splenic artery aneurysms, and may have some theoretical advantages, including less postoperative pain and shorter convalescence.

Aneurysm↗
PubMed1995

Serological testing in a microbiology laboratory of specimens from patients with suspected infectious disease.

AIMS: To determine how the microbiology laboratories of one region process serological requests from patients with suspected infectious illness, referred to as "clinical syndrome" type patients in this study; to consider areas where improvement in the associated serology service could be made. METHODS: A prospective two month collection of data on all serological requests from patients with suspected infectious illness was undertaken. A questionnaire on laboratory policies/procedures was also completed by the 10 departments taking part. RESULTS: Serology specimens from "clinical syndrome" patients accounted for 1-2% of total microbiology samples. There was significant variation in some of the policies/procedures carried out by the 10 laboratories when handling serological requests. Differences were seen in the use of laboratory protocols for test processing, range of tests performed, demand for second (convalescent) serum samples, storage of serum samples, and reporting of results. CONCLUSIONS: The laboratory management of "clinical syndrome" type requests is complex. Individual pathology departments vary in the way they handle serology specimens but this study highlighted areas which may contribute to improving the appropriateness of testing and the more efficient use of serology resources. These include improving (1) clinician education, (2) pathology request forms to encourage better clinical information, (3) appropriate laboratory protocols to aid decision making on test selection, (4) percentage of convalescent serum samples received together with longer serum sample storage, and (5) turnaround times of serology reports.

Clinical Protocols↗
PubMed2006

Rodent-associated Bartonella febrile illness, Southwestern United States.

Serum specimens from 114 patients hospitalized with a febrile illness were tested with an indirect immunofluorescence assay (IFA) using Bartonella antigens prepared from 6 species of sigmodontine rodents and 3 known human Bartonella pathogens: B. henselae, B. quintana, and B. elizabethae. Acute- and convalescent-phase serum samples from 5 of these patients showed seroconversion with an IFA titer >512 to rodent-associated Bartonella antigens. The highest titer was against antigen derived from the white-throated woodrat (Neotoma albigula), although this rodent is not necessarily implicated as the source of infection. Three of the 5 who seroconverted showed no cross-reaction to the 3 Bartonella human pathogens. Common clinical characteristics were fever, chills, myalgias, leukopenia, thrombocytopenia, and transaminasemia. Although antibodies to Bartonella are cross-reactive, high-titer seroconversions to rodent-associated Bartonella antigens in adults with common clinical characteristics should stimulate the search for additional Bartonella human pathogens.

Adolescent↗
PubMed1986

Epidemiological investigations following an outbreak of hemorrhagic fever with renal syndrome in Greece.

Epidemiological investigations were conducted following an outbreak of hemorrhagic fever with renal syndrome (HFRS) which occurred in the state of Epirus, northwestern Greece, in July and August 1983. A total of 8 patients were hospitalized during the outbreak; 3 were severely ill and 1 died. A serosurvey made in May 1984 sampled 184 of the approximately 400 residents of the village of Tsepelovo, where 4 patients resided, and found 12 (6.5%) persons, including convalescent sera from 4 patients, with antihantaviral antibody by immunofluorescent antibody (IFA) tests. Small mammal collections found house rats common in the village, but none exhibited anti-hantaviral antibody. Collections in nearby fields and mountains found Apodemus flavicollis rodents common, and 2 (6%) of 33 captured had high IFA anti-hantavirus antibody. Virus isolation attempts from rodent tissues were unsuccessful. Testing of convalescent patients' sera by IFA and plaque reduction neutralization tests indicated that the etiological agent was neither Puumala virus nor Seoul virus, but appears to be a strain of Hantaan virus or perhaps a new virus. The rodent host of this virus may be A. flavicollis, and the distribution of this species corresponds with previously reported cases of severe HFRS described elsewhere in central Europe.

Adolescent↗
PubMed1999

Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study.

BACKGROUND: Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass. METHODS: Thirty-eight pediatric patients were randomly assigned to undergo conventional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12). Perioperative, cardiopulmonary, and cytokine (tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10) data were collected for statistical analysis. RESULTS: Compared with patients in the conventional ultrafiltration and control groups, patients undergoing venovenous modified ultrafiltration had the greatest volume of ultrafiltrate removed (46. 9 +/- 8.4 mL/kg vs 20.1 +/- 5.0 mL/kg and 0 mL/kg for conventional ultrafiltration and control groups, respectively; P =.0001), least increase in total body water (1.91% +/- 1.49% vs 3.90% +/- 1.86% and 8.24% +/- 3.41%; P =.05), greatest rise in hematocrit (39.7% +/- 1. 7% vs 33.8% +/- 2.1% and 29.6% +/- 2.3%; P =.006), and shortest length of hospital stay (4.41 +/- 0.28 days vs 6.69 +/- 1.47 days and 8.38 +/- 1.11 days; P =.03, P =.03). CONCLUSIONS: Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.

Cardiopulmonary Bypass↗
PubMed1975

Direct solid-phase radioimmunoassay (dSP-RIA) for detection of antibody to hepatitis B surface (HBs) antigen.

Using direct solid-phase radioimmunoassay (dSP-RIA) which was shown to be specific and about 10000 times more sensitive than immunodiffusion and even 10 times more sensitive than the radioimmunoprecipitation test used by us before, anti-HBs was detected in 90% of hepatitis B convalescents who were followed up for a one year observation period and who had eliminated HBs antigen from their sera (60/68). In 13% of these patients (8/60 anti-HBs was only temporarily detectable. In 50% of all patients who developed antibody within a two to twelve months observation period (n = 151), anti-HBs appeared within three to four months after height of disease. In 16.5% of patients with HBs antigen negative hepatitis (32/193) anti-HBs was observed to develop during convalescence indicating a type B infection despite a negative finding for HBs antigen in the acute stage of disease. Using dSP-RIA anti-HBs was found in 5.5% of voluntary blood donors (n = 1036), in 20.2% of hospitalized patients without clinical hepatitis (n = 252), and in 30.6% of hospital staff (n = 304). Anti-HBs increases with age: in 14 year olds we found 0.5%, in 60 year olds, 14%. The fact that at least 70% of the anti-HBs positive normal persons and medical staff groups had no history of hepatitis illustrates the frequency and importance of subclinical hepatitis B infections.

Adolescent↗
PubMed1984

Comparison of open and endoscopic meniscectomy.

Fifty-eight patients who had undergone meniscal surgery were reviewed. Half had undergone conventional open meniscectomy, and half had been treated by arthroscopic meniscectomy. Each patient in the open group was matched with a patient in the endoscopic group by age, sex, and type of meniscal lesion. Patients with ligamentous injuries were excluded. Twelve patients in the endoscopic group were operated on as outpatients; the mean post-operative hospital stay in the 17 hospitalized patients in the endoscopic group was one day as compared with a mean of 3.3 days for the patients in the open group. Sick leave for the endoscopic group was only one-third of that of the open group. Operating time was 74.5 +/- 38.7 minutes in the open group compared with 55.9 +/- 25.0 minutes in the endoscopic group. At follow-up evaluation (mean follow-up period, 38 months) the percutaneous group showed a knee function score (88.7 points) similar to that of the open group (85.3 points) at 51 months. A three-year follow-up study of patients operated on endoscopically for a single meniscal lesion demonstrated that results with endoscopy are as satisfactory as those obtained by conventional surgery. Advantages of endoscopy include decreased hospitalization and shorter sick leave, with a corresponding reduction in the cost of patient care.

Adolescent↗
PubMed1996

[Lymph transfusion in surgical care].

Scientifically grounded transfusion of lymph and its components was first used to treat 123 patients with severe surgical abnormality concurrent with secondary immunodeficiency, dysproteinemia and lipid deficiency. The treatment led to early improvement of the patients' general condition as shown up by normalized body temperatures, diminished intoxications events, reduced pus discharged from wounds, and early activation in patients. At the same time, the postoperative mortality rates decreased from 43 to 20.3%, the number of postoperative complications reduced from 18.2 to 13.4%, and their course abated. The patients' hospital stay reduced from 28.3 to 21.7 bed/days and the time of their disability dropped from 49.1 to 38.3 days.

Convalescence↗
PubMed1998

A new-born baby outbreak of echovirus type 33 infection.

OBJECTIVES: In 1994, an outbreak of echovirus type 33 (EV33) infection occurred in a maternity hospital in Japan. Nine new-born babies were infected, some presenting symptoms of encephalitis or disseminated intravascular coagulopathy. EV33 was isolated from the faeces or cerebrospinal fluid of all seven of the patients sampled, and serum antibody titres against EV33 were significantly elevated in the convalescence phase sera in all cases. SUBJECTS AND METHODS: To study what public health situations EV33 may become a serious pathogen for new born babies, serum EV33 antibody positivity in the general population was examined. Sera were obtained 649 samples before the outbreak, and 344 samples after the outbreak from aged 7 days to 65 years old. RESULTS: The average positive rate was 12.0% and the rate increased depending on age. Comparison of positive rates before and after this outbreak showed no increase in any age group. However, the positive rate was found to average only 5.6% in persons aged 16-30 years old, including pregnant women. This low positive rate in young adults would result in a lack or only a low level of antibodies in newborn babies. CONCLUSIONS: In conclusion, our findings suggest that EV33 infection in the new-born baby with no or low level of maternal neutralizing antibody may cause serious symptoms.

Adolescent↗
PubMed1990

[An outbreak of influenza in hospital personnel].

During the last week of December 1989, an outbreak of respiratory system infection involved 32 hospital personnel and 2 patients was detected in Gazi University Medical Faculty Hospital. White blood cells count of the patients were either normal or there were a slight leucopenia. Throat cultures of the most patients were normal. Serum ASO, CRP, bilirubin, AST and ALT were usually within normal limits. According to symptoms, signs and laboratory data we considered a viral disease, especially influenza. All patients recovered without any sequelae. Of 34 in-patients, 8 paired sera, 2 acute phase sera, and 10 convalescent phase sera were tested for the presence of Hemagglutination Inhibition (HI) antibody to three influenza virus strains recommended by WHO in the 1989-1990 season: Influenza A/Taiwan/1/86 (H1 N1), Influenza A/Shanghai/11/87 (H3 N2), Influenza B/Victoria/2/87. All of the sera were negative for Influenza B/Victoria/2/87. There were no significant rises in HT antibody titer for Influenza A/Taiwan/1/86 (H1 N1). The sera for 4 of 8 patients examined both acute and convalescent phase sera had fourfold or greater rise in HI antibody for Influenza A/Shanghai/11/87 (H3 N2). Four patients examined only convalescent sera had 1/40 or greater rises in HI antibody for this influenza subtype. It was considered that this influenza outbreak was probably caused by Influenza A/Shanghai/11/87 (H3 N2).

Antibodies, Viral↗
PubMed1995

Evaluation of subgroup-specific peptides of the G protein of respiratory syncytial virus for characterization of the immune response.

Two synthetic peptides, designated peptides 12G(A) and 12G(B), representing amino acids 174-188 of the G glycoprotein of respiratory syncytial virus (RSV) subgroup A (strain A2) and subgroup B (strain CH18537) were evaluated for their properties as subgroup-specific antigens for enzyme immunoassay (ELISA). These peptides were used to characterize the immune response of children with naturally occurring RSV infection during six annual epidemics in the Huntington area, West Virginia, USA; viz. 1978-1979, 1979-1980, 1980-1981, 1983-1984, 1989-1990, and 1990-1991. The study group comprised 43 paired sera from 42 infants and children, who ranged in age between 1 month and 5.5 years of age (median age 16 months). The inclusion criteria were subgroup identification of RSV, respiratory tract illness requiring admission to hospital, and the availability of paired sera. Five of 30 children with subgroup A and 3 of 13 children with subgroup B infections developed homologous or dual fourfold or greater antibody responses to peptides 12G(A) and 12G(B) during convalescence; six of these eight children also developed antibody rises to whole virus antigens. Twenty children (14 subgroup A and 6 subgroup B) developed such responses in antibody only to whole virus (not to the peptides), and 15 children (11 subgroup A and 4 subgroup B) failed to develop a rise in antibody. Children who developed rises in antibody to the peptides were usually less than 9 months of age, suggesting that a response to peptides was more likely to occur during primary infection. Peptides 12G(A) and 12G(B) of RSV G protein lacked sufficient sensitivity and specificity to serve as antigens for ELISA for characterizing the subgroup-specific immune responses to RSV infection in infants and children.

Aging↗
PubMed1981

Zika virus, a cause of fever in Central Java, Indonesia.

In 1977 and 1978 selected in-patients at the Tegalyoso Hospital, Klaten, Indonesia who had recent onsets of acute fever were serologically studied for evidence for alphavirus and flavivirus infections. A brief clinical history was taken and a check list of signs and symptoms was completed on admission. Acute and convalescent phase sera from 30 patients who showed evidence that a flavivirus had caused their illnesses were tested for neutralizing antibodies to several flaviviruses which occur in South-east Asia. Paired sera from seven patients demonstrated a fourfold rise in antibody titre from acute to convalescent phase. The most common clinical manifestations observed in this series of patients included high fever, malaise, stomach ache, dizziness and anorexia. None of the seven patients had headache or rash despite the fact that headache and rash had been associated with two of the three previously studied. The onsets of illness clustered toward the end of the rainy season when populations of Aedes aegypti, a probable vector in Malaysia, were most abundant.

Adolescent↗
PubMed1984

A large outbreak of keratoconjunctivitis due to adenovirus type 8.

A large nosocomial outbreak of keratoconjunctivitis due to adenovirus type 8 is described. Two hundred cases were identified, 123 by isolation of the virus and 77 by detecting HI antibodies in convalescent sera. Infection usually presented as a severe keratoconjunctivitis, and 107 (54%) of infected patients developed sub-epithelial corneal opacities. The majority (66%) of infections were acquired at the accident and emergency department attached to a large urban eye hospital when patients attended for other reasons; trauma to the eye, especially corneal foreign bodies, was the most frequent cause for the initial attendance. Transmission of virus within the family occurred in 13% of cases, but there was little spread outside family or hospital environments. The outbreak lasted from May to September, 1982, but it was not confirmed by isolation of the virus until the end of June when control measures were instituted. Delay in applying control measures was probably the major factor accounting for this large, prolonged outbreak of epidemic keratoconjunctivitis.

Adenoviridae Infections↗
PubMed2001

Partridge osteosynthesis: a prospective clinical study on the use of nylon cerclage bands and plates in the treatment of periprosthetic femoral shaft fractures.

OBJECTIVE: To evaluate the clinical use of the Partridge osteosynthesis in periprosthetic femoral fractures. DESIGN AND SETTING: Prospective nonrandomized clinical study. PATIENTS: Over a ten-year period, 222 patients presenting with femoral fractures near the tip of a hip prosthesis were treated with the Partridge system, which employs elevated cerclage nylon bands and flexible elevated nylon plates. Sixty-five fractures were located cranial to the tip of the prosthesis (Whittaker Type I), 116 at the tip (type II), and forty-one distal to the tip of the prosthesis (Type III). The population consisted of 172 female and fifty male patients, with a mean age of 79.5 years. The mean duration between the index procedure and occurrence of the second fracture was 1.5 years. In 78 percent of the patients (173 out of 222), surgery was undertaken within forty-eight hours. Fracture reduction was open, and two nylon plates set at right angles to each other were secured to the femur with six to eight nylon bands. The mean operating time was fifty-five minutes, with an average blood loss of 550 milliliters. RESULTS: There were minor wound healing problems in eighteen patients (12.6 percent); there were no deep wound infections. Thirty-three elderly patients died within the first month from medical complications. Of the 189 remaining patients, 60 percent regained their prefracture functional level within six months postoperatively, whereas 25 percent required a higher level of care. The mean time of the in-hospital stay was thirty-three days. Ninety-three percent of the fractures consolidated with abundant callus during the follow-up period of one year. CONCLUSION: The indication for the use of this simple osteosynthesis method is swift convalescence by splinting the periprosthetic femoral fractures. Even with a loose prosthesis, the fracture often healed with abundant callus and the patient could be mobilized.

Aged↗
PubMed1985

Absorption and tolerance of lactose in infants recovering from severe diarrhea.

Nineteen infants were challenged during their convalescence from severe diarrhea with a lactose-containing meal. Twenty-four hour intake, pre- and post-challenge breath H2 levels, clinical responses, and growth were measured at approximately biweekly intervals for 3 months beginning 1 month after hospital discharge. Ten lactose-tolerant infants were assigned randomly to receive one of two formulas similar in composition except for carbohydrates: lactose (Group L) (n = 6) and sucrose (Group S) (n = 4). Infants in Group L had greater intakes and growth rates during the initial 15 days of the study. No difference in weight for age z-scores was detected between groups at the end of the observation period. Infants in Group L had higher baseline and peak breath H2 levels indicating greater colonic carbohydrate fermentation than infants in Group S: however, breath H2 levels were not predictive of tolerance to lactose-containing meals. Carbohydrate absorption by infants in Group S appeared to exceed that of infants in Group L. Thus, colonic fermentation of malabsorbed carbohydrate may have prevented diarrhea and allowed acceptable rates of catch-up growth.

Diarrhea, Infantile↗
PubMed1982

Incidence of wound infection for common general surgical procedures.

Postoperative wound infection remains a ubiquitous problem with serious consequences, especially with regard to prolonged convalescence and in a source of physical and financial burden to the patient. Wound infection occurred in 13 of 1,346 of the patients during a single recent 12 month period with commonly performed surgical procedures at a large midwestern hospital. The bacteriologic findings of these infections was diverse.

Humans↗