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Cardiac hydatid disease is rare, but life threatening. A pedunculated hydatid cyst which mimicked a left atrial myxoma was diagnosed on two-dimensional echocardiography. The degree of cardiac involvement at necropsy was much greater than indicated by either echocardiography or limited cardiac catheterization. The suggestion that only echocardiography be performed before surgery is undertaken may be inappropriate in many cases. [ABSTRACT FROM PUBLISHER]

In a prospective study of patients admitted to a coronary care unit, the incidence of isotopically diagnosed deep venous thrombosis was found to be related to the severity of illness rather than to the duration of bed rest. In addition, no negative correlation was found between cigarette smoking and deep venous thrombosis. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--To examine the concentration of circulating tumour necrosis factor alpha (TNF alpha) in patients with severe congestive heart failure (New York Heart Association class IV) during one year and to correlate changes in this cytokine with changes in plasma noradrenaline, plasma renin activity, and weight. DESIGN--A prospective study of the role of TNF alpha in severe chronic heart failure. Blood samples were collected at intervals of three months. SETTING--Medical research centre of a teaching hospital. PATIENTS--16 patients with chronic stable severe heart failure. INTERVENTIONS--Vasodilator treatment with captopril or flosequinan. MAIN OUTCOME MEASURES--Changes in TNF alpha and the correlation with changes in plasma noradrenaline, plasma renin activity, and weight during optimal medical treatment for one year. RESULTS--The mean concentration of TNF alpha was greater than the upper 95% confidence interval for healthy controls throughout the year of the study but there was considerable between and within patient variation. No correlation was seen between TNF alpha and plasma noradrenaline, plasma renin activity, or weight. CONCLUSIONS--The stimulus resulting in enhanced plasma concentrations of TNF alpha in congestive heart failure remains unclear and concentrations at any particular time were not prognostic. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--To follow the change in streptokinase neutralisation titres in a group of patients after treatment with streptokinase for acute myocardial infarction. DESIGN--Venous blood samples suitable for analysis were obtained up to 866 days after treatment with 1.5 million units of streptokinase in 189 patients. The ability of the patient's plasma to inhibit lysis of a thrombin clot by streptokinase was assessed. SETTING--A coronary care unit in a district general hospital. PATIENTS--A retrospective review of coronary care records and the district health authority computer showed that 329 patients who had received streptokinase were alive. All were invited for venepuncture and 220 (67%) attended. Satisfactory samples were obtained from 189 patients. RESULTS--Raised titres of antibody sufficient to neutralise a standard dose of 1.5 million units of streptokinase were found in 90% of patients. There was a fall in streptokinase neutralisation titre with increasing time after administration of streptokinase (r = -0.35, P < 0.0001) and though there was considerable variation among the group the neutralisation titre was higher than in the general population in all patients, even those who had received streptokinase at least two years previously. CONCLUSION--The ability of streptokinase to lyse a thrombin clot was appreciably inhibited in vitro by the plasma from patients who had received 1.5 million units of streptokinase. High streptokinase neutralisation titres persisted for a long time after the use of streptokinase as thrombolytic treatment for acute myocardial infarction. Readministration of streptokinase may not be efficacious for considerably longer than the one year currently advocated. Until the in vivo effects of streptokinase readministration are known a non-antigenic thrombolytic agent should be used instead. [ABSTRACT FROM PUBLISHER]

Congenital anomalies of the superior vena cava are rare and often coexist with other cardiac abnormalities. In this report, we present a case of absent bilateral superior vena cava with no associated cardiac anomaly. Blood from the arms, head, and upper torso returned to the right atrium through the azygos vein and the inferior vena cava, mimicking chronic superior vena cava obstruction.

Hypersensitivity pneumonitis (HP) in workers exposed to metal removal fluids (MRFs) is increasing. This study supports the hypothesis that aerosolized mycobacteria colonizing the MRFs likely cause the disease. Three case studies of HP outbreaks among metal workers showed potentially high exposures to a rare and newly proposed Mycobacterium species. Retrospective review of samples submitted to our laboratory showed an association between presence of mycobacteria and HP.

Insurers are investing in information technology to provide the data that are essential to the management of their delivery systems. A Blue Cross and Blue Shield medical director explains some practical applications, including outcomes evaluation, provider selection and practice pattern comparisons.

Streptokinase neutralisation titres were measured in a series of 25 patients who received streptokinase for the treatment of acute myocardial infarction. Before treatment, neutralisation titres were low (0.3 X 10(6) neutralisation units or less) in all patients. 3 months after treatment, neutralisation titres in 24 were such that a typical therapeutic dose of 1.5 million units of streptokinase would have been fully neutralised. At 4 1/2-8 1/2 months, 18 of 20 patients had neutralisation titres such that at least 50% of a dose of 1.5 million units of streptokinase would have been neutralised. After 8 months, neutralisation titres ranged from 0.4 to 2.0 million units in 8 patients. A decision to readminister streptokinase within 8 months (and probably up to 1 year) of previous thrombolytic treatment should take account of the neutralising capacity of plasma and the dose should be adjusted accordingly.

Insectivorous bats have influenced the development of antipredator behavior in moths, green lacewings, crickets, and mantids; until recently, such adaptations were unknown in katydids. Foliage-gleaning bats in Panama can use the female-attracting, airborne calling songs of nocturnal katydids to locate prey. They also feed heavily on these insects. Katydid species sympatric with these bats exhibit markedly reduced calling song duty cycles. Males supplement shortened songs with complex, species-specific tremulations that generate vibrations that are inaudible to bats but reach conspecific females through a shared plant substrate. Female katydids do not call audibly but are also preyed on in large numbers, perhaps as a result of moving toward calling males.

We compared two Campylobacter serotyping systems by using 1,405 isolates of Campylobacter collected from human, animal, and environmental sources during epidemiologic investigations and special studies. We found 96.1% of isolates to be typable by the Penner method for heat-stable antigens, which involved the use of an indirect hemagglutination technique, and 92.1% of isolates to be typable by the Lior method for heat-labile antigens, which involved the use of a slide agglutination technique and absorbed antisera. Absorbed antisera were not required for the Penner method, making that method less difficult to implement. The Lior method was simpler to perform and gave more rapid results than did the Penner method. Cultures frequently reacted in multiple antisera with the Penner method, whereas multiple reactions were rare with the Lior method. Thus, results were easier to interpret with the Lior system. Strains of a single serotype in one system were sometimes found to be multiple serotypes in the other system; hence, the two methods have the potential to be complementary. Both systems were comparable in serotyping isolates from human and nonhuman sources and for evaluating the relationship of strains collected during outbreak investigations.

We conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-"enteropathogenic" serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. col.

Recovery of Shigella spp. from fecal specimens transported in buffered glycerol saline and Cary-Blair media held at frozen, refrigerated, or room temperature was compared with recovery by direct plating of fecal specimens. Buffered glycerol saline was the better transport medium for the recovery of Shigella spp. Refrigerated or frozen transport temperatures were superior to room temperature for recovery from either medium.

Only in the last few years has Yersinia enterocolitica been recognized as an etiologic agent. The organism, however, is widespread in both the animate and inanimate environments. It has been isolated and recovered from a variety of sources including fecal material, foodstuffs, and water, but vehicles of disease transmission are not fully delineated or understood. The bacteriology of Y. enterocolitica is reviewed and recommended laboratory methodology is described.

An outbreak of gastroenteritis occurred in March-April 1981, in Wichita, Kansas, and involved more than 250 persons who drank raw milk from a single local dairy. Campylobacter jejuni was recovered from 60 of 116 (52%) persons in households that had one or more ill family members. A cohort study of families that belonged to a food cooperative that purchased raw milk from the implicated dairy showed a significant association between illness and having drunk raw milk. Thirty-nine of 55 (71%) persons who drank raw milk became ill compared with four of 36 (11%) persons who did not drink raw milk (p less than 0.01, t test, accounting for clustering). Peak (convalescent) antibody titers to C. jejuni, determined by indirect immunofluorescence, in 20 raw-milk drinkers showed a geometric mean of 1:27 in contrast to geometric mean titer of 1:6 in 10 well persons from the cohort who did not drink raw milk (p less than 0.002, t test). C. jejuni was recovered from 21 of 34 (66%) raw-milk drinkers, versus none of 26 people who did not drink raw milk (p less than 0.001, Fisher's exact test, one tailed). C. jejuni of the same serotype was isolated from the case-patients and from rectal swabs of cows in the dairy. These findings indicate that raw milk contaminated by Campylobacter was the vehicle for this outbreak.

The Moore swab method was shown to be a practical and sensitive technique for the isolation of Vibrio cholerae from sewage. In each of three instances in which cholera patients lived in homes connected to municipal sewers, V. cholerae was isolated from the community sewage plant intake at the time of the patients illness. Sewer systems became negative within 1 day after patients were treated with tetracycline. Sewer surveillance using the Moore swab also found evidence of infections occurring in areas where surveillance of diarrheal illness failed to detect cholera. Culturing community sewage by the Moore swab method proved to be an economical and effective way of determining areas where V. cholerae infections were occurring.

The test for hippurate hydrolysis is critical for separation of Campylobacter jejuni and C. coli strains. Glycine and benzoic acid are formed when hippurate is hydrolyzed by C. jejuni. The test used in most laboratories is one of several variations of the ninhydrin tube test described by Hwang and Ederer (M. Hwang and G. M. Ederer, J. Clin. Microbiol. 1:114-115, 1975) for detection of glycine. We evaluated three modifications of the Hwang and Ederer method and the gas-liquid chromatographic (GLC) method described by Kodaka et al. (H. Kodaka, G. L. Lombard, and V. R. Dowell, Jr., J. Clin. Microbiol. 16:962-964, 1982) for detecting benzoic acid. Campylobacter strains comprised 22 C. jejuni, 11 C. coli, and 8 C. laridis strains. The species identification of each strain was confirmed by DNA relatedness. All strains of C. jejuni were positive and all strains of C. coli and C. laridis were negative by the GLC method for detecting hippurate hydrolysis, whereas three strains of C. jejuni gave negative or variable results in the tube tests. The GLC method is more sensitive than the tube methods for detecting hippurate hydrolysis and should be used on cultures yielding variable or questionable test results.

Cary-Blair medium retains its ability to serve as a transport medium after 19 months of aging at room temperature. This eliminates the necessity for the frequent replacement of the stored supplies of this medium.

A family outbreak of foodborne shigellosis caused by an unusual strain of Shigella is described. The strain was a mannitol-positive variant of Shigella dysenteriae and agglutinated in antiserum prepared against provisional serotype 3341-55.

Out of 305 general practitioners sent a questionnaire asking how they would treat three hypothetical patients with heart attacks 231 (76%) replied. Of these, only 179 were prepared to make an unqualified choice of home or hospital treatment for a middle-aged man with an uncomplicated attack, 70 (39%) saying that they would keep the patient at home. Practitioners qualifying before 1960 were more likely to do this than those qualifying in 1960 or later. If a patient declined hospital treatment 161 (70%) of the practitioners would keep him in bed for a week or less, but the date of the practitioners' qualification significantly affected the time they would advise him to remain off work. Faced with a patient acutely ill after a heart attack, 162 (70%) of the practitioners would arrange his immediate admission to hospital and 51 (22%) would send him to hospital after initial treatment at home. The numbers of partners in the practice, the nature of the premises, and the location of the practice in urban or rural areas affected the practitioners' attitude to the management of severely ill patients but not to the management of patients with uncomplicated attacks.

643 orthopaedic surgeons were sent a questionary asking how they attempted to prevent and diagnose deep venous thrombosis (D.V.T.) in patients with hip fractures. 411 (64%) replied. Of those who replied, 51% offered no prophylaxis, only 3% routinely used oral anticoagulation, and 85% relied on clinical signs in the diagnosis.