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Mycobacterium ulcerans (M. ulcerans) causes Buruli ulcer, a very debilitating disease that affects the skin and other tissues. The disease occurs mainly in children in sub-Sahara Africa. While contracture, fibrosis and functional limitation of range of motion are frequent complications of Buruli ulcer, no fundamental or clinical studies have investigated the impact of M. ulcerans infections on skeletal muscle. In the present study, we subcutaneously infected mice in the proximity of the right biceps muscle to evaluate the histological, biochemical and functional impact of M. ulcerans on skeletal muscles. The concentration of mast cells decreased but the number of neutrophils and macrophages increased steadily in proximate-infected biceps muscles. Pro- and anti-inflammatory cytokines as well as fibrogenic growth factor mRNA also increased. Significantly more membrane damage and fibrosis occurred in proximate-infected biceps muscles than in control and sham muscles. Passive biomechanical testing also revealed that the presence of M. ulcerans increased muscle stiffness. These findings show for the first time that M. ulcerans can induce local and chronic inflammatory responses in skeletal muscles that are associated with muscle fiber damage and fibrosis.

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Olanzapine, a new atypical antipsychotic drug, has been prescribed in the treatment of schizophrenia and psychotic mood disorders for approximately 2.3 million patients worldwide. Considering the increase in olanzapine prescriptions and the increased risk of suicide in this patient population, the number of reported cases of olanzapine overdose may be expected to increase. This report describes the clinical course and serum concentrations in a patient who consumed an olanzapine overdose (800 mg). Profound central nervous system depression and tachycardia without arrhythmia occurred within 2 hours after the ingestion. Additional clinical findings (ie, fever, mutism, agitation, dystonia, akathisia, elevated creatine kinase, and increased leukocyte count) were similar to those of neuroleptic malignant syndrome. After intubation, gut decontamination, and supportive care, the patient recovered and was discharged.

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Adherence of bacteria to various milk contact sites was examined by scanning electron microscopy and transmission electron microscopy. New gaskets, endcaps, vacuum breaker plugs and pipeline inserts were installed in different areas in lines carrying either raw or pasteurized milk, and a routine schedule of cleaning-in-place and sanitizing was followed. Removed cleaned and sanitized gaskets were processed for scanning or transmission electron microscopy. Adherent bacteria were observed on the sides of gaskets removed from both pasteurized and raw milk lines. Some areas of Buna-n gaskets were colonized with a confluent layer of bacterial cells surrounded by an extensive amorphous matrix, while other areas of Buna-n gaskets showed a diffuse adherence over large areas of the surface. Most of the bacteria attached to polytetrafluoroethylene (PTFE or Teflon) gaskets were found in crevices created by insertion of the gasket into the pipeline. Examination of stainless steel endcaps, pipeline inserts, and PTFE vacuum breaker plugs did not reveal the presence of adherent bacteria. The results of this study indicate that biofilms developed on the sides of gaskets in spite of cleaning-in-place procedures. These biofilms may be a source of post-pasteurization contamination.

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We conducted a study to compare the effectiveness of patient-controlled analgesia (PCA) technique to conventional analgesic therapy (CAT) after coronary artery bypass graft (CABG). The PCA group received hydromorphone 0.1 mg.hr-1 basal infusion and bolus doses of 0.2 mg Q 5 min (maximum 1.2 mg.hr-1) while the CAT group received morphine 2.5 mg iv Q 30 min prn until extubation followed by prn meperidine 1 mg.kg-1 im Q 4 hr or acetaminophen 325 mg with codeine 30 mg po (1 or 2 tablets) when oral intake was possible. The degree of pain was assessed using a Visual Analogue Scale (VAS) starting after extubation and every 6-8 hr for the next 60 hr. Holter monitoring was initiated one hour after patient arrival in the Intensive Care Unit (ICU) and continued for 72 hr. Other measured variables were pulmonary function, sedation, side effects and total opioid requirements. Results show that the day-to-day VAS pain score decreased in the PCA group (P < 0.001) while it remained unchanged in CAT patients. The PCA patients had lower VAS pain scores at extubation (P < 0.05). During the third postoperative day, the PCA group had a lower VAS pain score, a lower incidence of severe pain defined as a score > 5 on the VAS scale, and a reduced incidence of myocardial ischaemia (P < 0.01). However, there was no difference in the duration, severity, area under the curve (AUC), or heart rate during ischaemic events. Postoperative pulmonary function was abnormal in both groups (NS) with minimal recovery by the fourth day.(ABSTRACT TRUNCATED AT 250 WORDS)

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In late October 1991, an outbreak of gastroenteritis, following the consumption of raw oysters involving more than 200 people, was reported in five locations in Quebec, Canada. Bacteriological analysis of the oysters involved indicated low levels of fecal coliforms, but direct electron microscopy of stool samples obtained from two people involved in the outbreak revealed that both contained 27-34 nm, small, round Norwalk-like viruses. Immunoelectron microscopy, using acute sera obtained from these individuals and convalescent serum from another person related to the outbreak, revealed antibody coatings on these Norwalk-like viruses with all three sera. Solid-phase immunoelectron microscopy demonstrated that these viruses were also antigenically similar or related to a Norwalk-like virus isolated as the cause of a gastroenteritis outbreak in a home for the aged between December 1988 and January 1989 in Thunder Bay, Ontario. From these findings and the symptoms of the illness, the Norwalk-like virus was considered as the causal agent of the outbreak due to the consumption of contaminated oysters. How the oysters became contaminated was not determined. Oysters harvested from the areas initially thought to have been the origin of the implicated shellfish were tested for the presence of viral fecal indicators using tissue culture and electron microscopy with negative results. It is most likely that the implicated lot also contained oysters harvested from another area, also open, but which was downstream from an identified source of human fecal contamination.

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Vero (African Green Monkey Kidney) cells infected with Chlamydia trachomatis (serovar L2) (CT-L2) for 48 hr and superinfected with herpes simplex virus type 2 (HSV-2) were fixed 24 hr later and examined with the transmission electron microscope (TEM) and scanning electron microscope (SEM). Ultrastructural examination of the co-infected cells showed that, although many CT-L2 inclusions were present, most were empty of reticulate bodies or elementary bodies. However, large numbers of viruses were observed in the co-infected Vero cells and, in some instances, were seen inside the CT-L2 inclusions. SEM studies of the co-infected cells revealed a swelling and rounding up of the Vero cells typical of a CT-L2 or HSV-2 infection. The outer surface of the co-infected cells were covered with many long microvilli typical of HSV-2 infection with only a few surface protruberances similar to those found in CT-L2 infected cells.

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In the absence of fixed coronary artery disease, thyrotoxicosis is rarely associated with acute myocardial infarction and/or ischemia. There are no known reports on the association of acute myocardial infarction with iatrogenic or factitious thyrotoxicosis in the absence of fixed coronary artery stenosis or coronary artery spasm. A 68-year-old woman, clinically in a state of thyrotoxicosis as a result of taking 0.3 g/d of exogenous thyroid replacement, sustained a severe, reversible myocardial ischemic event. Echocardiographic and scintigraphic evaluations demonstrated a large apical dyskinetic region. Subsequently, after the original dose of levothyroxine sodium was reduced to 0.15 mg and the patient became euthyroid, two-dimensional echocardiography and scintigraphic and cardiac catheterization studies demonstrated normal left ventricular contractility and normal coronary anatomy. Coronary artery spasm was not induced by ergonovine maleate therapy. Exogenous thyroid administration may directly influence myocardial oxygen supply and demand, exclusive of coronary artery disease and coronary spasm. A critical imbalance may then result in acute myocardial ischemia and reversible left ventricular segmental wall motion abnormalities.

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The authors analyse current aspects of toxicomania in young persons. Addiction to licit or illicit drugs usually originates in the conjunction of the use of a substance and a personality crisis, in a propitious socio-cultural context. Except in cases of overdoses which are the ultimate emergency, the follow-up care of adolescent drug addicts does not require specialist therapy. It is the business of adult counsellors to listen to these adolescents and take full responsibility for them.

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It is standard practice for clinicians to consider echocardiographically-measured left ventricular wall thickness when estimating the severity of aortic stenosis. Most consider the degree of wall thickness above normal limits is in proportion to ventricular hypertrophy. Employment of wall thickness information to assess aortic stenosis severity, while generally reliable, can occasionally be misleading. Two cases are presented with findings of severe, critical aortic stenosis and normal wall thickness. In each case, left ventricular contractile function was markedly impaired and the patient markedly symptomatic.

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Minimally symptomatic patients with ruptured chordae tendineae and severe mitral insufficiency due to myxomatous degeneration of the mitral valve are presented. This unique clinical subset of patients with mitral valve prolapse is described.

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When cells of Rickettsia rickettsii were suspended at different temperatures in growth medium free of host cells, ultrastructural changes were observed in some of these organisms. Depending upon the temperature and length of incubation, loosely organized cells developed into compact, intensely stained, rod-shaped organisms. These compact cells closely resembled the morphology of the original culture of Rickettsia used for inoculation. Morphological changes were primarily noted in cells maintained at 21 degrees C. The viability of the cells was also affected by the temperature of incubation.

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A method is described that improved the detection of viruses in fecal samples by electron microscopy. The virus particles were concentrated, and much of the background debris was removed by adsorption of viruses on meat protein added to the fecal sample at a low pH and a low salt concentration. Viruses were eluted by raising the pH and the salt concentration. Further concentration was achieved by acid precipitation and vacuum dialysis.

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The question of the clinical and economic feasibility of echocardiographic screening for cardiac disease in patients with symptoms of acute cerebral events was assessed by recording M-mode and two-dimensional (2D) echocardiograms in 170 patients. Patients with transient ischemic attacks or cerebral infarctions were included. Of the patients with satisfactory echocardiograms, 96 (56%) had normal diagnostic findings; 74 (43%) had cardiac disorders possibly related to the acute cerebral event. There were 4 patients who fulfilled the standard criteria for mitral valve prolapse and 7 patients who were identified as having probable cardiac thrombosis or vegetation, or both. Thus, M-mode and two-dimensional echocardiography was of limited value in patients referred for these studies for screening to exclude mitral valve prolapse and cardiac thrombosis or vegetation. Although a diverse range of cardiac disorders was demonstrated that may be associated with cerebral ischemia, the overall low yield does not support such screening and should be reserved for selected patients.

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