RESUMEN

The rapid diagnosis and management of bacterial infection are heavily dependent upon clinical assessment. Blood culture may take up to 2 days for results and may be suspect. Surface neutrophil CD64 expression has been shown to be upregulated in cases of bacterial infection. Recently, a standardized kit for the CD64 index was used in neonatal intensive care units, showing high sensitivity and specificity for bacterial infections. Our study was designed to confirm and extend these results to adult hospital patients and to determine the impact of this testing on a clinical laboratory's finances and staffing. CD64 indices were performed with peripheral blood drawn in tandem with blood cultures from 109 patients over a 2-month period. We found that a CD64 index of 1.19 was predictive of an ultimate clinical and/or culture diagnosis of infection with a sensitivity and specificity of 94.6% and 88.7%, respectively. Positive and negative predictive values were 89.8% and 94%, respectively. The CD64 index was easily performed using our flow cytometer and staff, producing minimal alteration in clinical workflow. A 7-day-a-week testing schedule will result in some additional expense but will be more than offset by the expected cost savings. The CD64 index is a useful and inexpensive test for improving the diagnosis and management of hospital patients with bacterial infection. It can be readily performed by clinical laboratories and could result in considerable savings for the institution.

Asunto(s)

RESUMEN

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disease of unknown etiology. Although known to be rare, precise information on the frequency of ALS is essential to anticipate future demands on health resources and as baseline information for epidemiological studies. As part of a new ALS epidemiological initiative in Canada, we conducted a systematic review of published incidence and prevalence research in Canada. METHODS: Electronic searches and bibliographic reviews of pertinent publications were conducted. RESULTS: We identified 6 published studies from 4 Canadian provinces conducted between 1974 and 2004; 2 were available only as abstracts. Reported annual incidence rates were similar and study quality was generally good, but there was insufficient detail to adequately assess the methodological quality of 3 of the studies. The most recent studies reported an annual ALS age-adjusted incidence of 2.13 per 100,000 in Nova Scotia (2003-2004) and a crude mean annual incidence of 2.4 per 100,000 in Newfoundland and Labrador (2000-2004). CONCLUSIONS: There are limited data on the frequency of ALS in Canada. We found no studies from 6 of the Canadian provinces or from the territories. Future research is needed to estimate the frequency of occurrence of ALS in Canada.

Asunto(s)

RESUMEN

OBJECTIVES: To assess the impact of bone growth on the flexion contracture angle at the knee, to measure the bone growth pattern in rats, and to assess the impact of immobility on bone growth. DESIGN: Experimental, controlled study. SETTING: Bone and joint laboratory. ANIMALS: Sixty Sprague-Dawley rats. INTERVENTIONS: Knee joints of 40 rats were immobilized unilaterally in flexion. Sham-operated animals (n = 20) were controls. MAIN OUTCOME MEASURES: The contracture angle and the femur and tibia lengths on radiographs. RESULTS: The angle of flexion increased over time and was largely explained by bone growth (r =.725, p <.01). Femur and tibia grew in rats until they were 11 months old. Immobility enhanced growth in bone length, especially of the femur, after 16 and 32 weeks of immobility (p <.05). CONCLUSIONS: Knee flexion contracture angle increased as a consequence of normal bone growth, a situation that is also encountered in skeletally immature children. The continued growth in length of bones in children may influence the progression of contractures and add to the therapeutic challenge. Ongoing bone growth should be considered when interpreting reports that use animal models for bone and joint diseases.

Asunto(s)

RESUMEN

In this series of experiments, the Unified System components of the HeartSaver Ventricular Assist Device (VAD) version 5.0 were isolated from the controller and power supply for independent assessment. Five systems with external controller/power supply via a percutaneous lead configuration were tested in 13 male calves (101.8+/-4.3 kg). Two studies were ended acutely because of improper filling and air embolism, respectively. Duration of support was from 2.2 hours to 30 days (mean, 99+/-62 hours). The 30 day survivor was euthanized electively. Study termination was related to postoperative complications in five calves: two with bleeding/tamponade, one with thromboembolism caused by inadequate anticoagulation, and two with respiratory insufficiency. Other causes of termination were: one caused by main building power failure, two from errors in communication between the device and controller, and two caused by hydraulic fluid loss related to housing defects. From these experiments, an intrathoracic position for the calf has been defined, the procedure for implantation without cardiopulmonary bypass has been developed, refinements to the controller have been made, and inflow and outflow cannulae have been reinforced. Hydraulic fluid losses will be solved by proceeding with use of a titanium housing instead of polyurethane. In conclusion, the development of the HeartSaver VAD is progressing, in part because of these experimental and informative animal studies. Further in vivo evaluation of the final version will be conducted before clinical trials.

Asunto(s)

RESUMEN

Seventeen cases of Sertoli cell tumor in dogs were found by searching medical records from 1971 to 1985. The average age of affected dogs was ten years, and most animals were of mixed breed. Most of the dogs were presented for reasons unrelated to the Sertoli cell tumor, however, most dogs had one or more clinical signs associated with Sertoli cell tumor. These signs included prostatic changes, alopecia and hyperpigmentation, bone marrow suppression, gynecomastia, and behavioral changes. The association of Sertoli cell tumor with cryptorchidism was obvious in these records, as ten of the dogs had one or both testicles undescended. Histopathological features of the tumors were variable and had no consistent correlation with metastatic potential. Some interesting comparisons can be made regarding these tumors in other domestic animals and in man.

Asunto(s)