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A case of Group G streptococcal arthritis in a previously healthy man is reported. The 2nd and 3rd metatarso-phalangeal joints of the left foot were simultaneously affected. Unusual erosive joint destruction occurred in spite of early therapy and clinical improvement. Circulating immune complexes were raised and were not completely normal at 1 year. [ABSTRACT FROM AUTHOR]

The hypothesis that an increase in salivary concentration of certain electrolytes (Ca × K) is a sign of digitalis intoxication was tested in 16 untreated health volunteers, 29 digitalised heart failure patients and four further healthy volunteers given digoxin. Salivary electrolyte levels were raised in only about half the digitalised patients and blood levels of digoxin were not always higher in these patients than in those with normal electrolyte concentrations. The salivary electrolyte levels of the healthy volunteers given digoxin remained normal. These findings would seem to rule out the possibility that digitalis is responsible for the changes in salivary electrolytes observed in certain cases of heart failure. A very marked correlation (P<0.00002 by Fisher's exact probability test) was found, however, between an increase in the product of salivary calcium and potassium (Ca × K) and the presence of clinical signs of poorly compensated heart failure. It is suggested that this might be a result of adrenergic stimulation, which is known to occur in heart failure, affecting the salivary glands. [ABSTRACT FROM PUBLISHER]

A man with a quiescent Reiter's disease presented with abrupt upper chest pain. This symptom resulted from a septic arthritis of the manubriosternal joint due to staphylococcus aureus cultured from the synovial fluid. [ABSTRACT FROM AUTHOR]

A young heterosexual man, suffering from a low-grade, idiopathic proctitis, who developed severe rectal ulcerations at the time of a primary cytomegalovirus (CMV) infection is described. CMV was cultured from the rectum on two occasions. Sero-conversion and the appearance of a specific IgM antibody response to CMV were documented, suggesting that this was a case of a primo-infection by CMV, and not one of reactivation of latent CMV infection. [ABSTRACT FROM AUTHOR]

One major goal in plant evolutionary ecology is to address how and why tritrophic interactions mediated by phytochemical plant defences vary across species, space, and time. In this study, we tested three classical hypotheses about plant defences: (i) the resource-availability hypothesis, (ii) the altitudinal/elevational gradient hypothesis and (iii) the defence escalation hypothesis. For this purpose, predatory soil nematodes were challenged to hunt for root herbivores based on volatile cues from damaged or intact roots of 18 Alpine Festuca grass species adapted to distinct climatic niches spanning 2000 meters of elevation. We found that adaptation into harsh, nutrient-limited alpine environments coincided with the production of specific blends of volatiles, highly attractive for nematodes. We also found that recently-diverged taxa exposed to herbivores released higher amounts of volatiles than ancestrally-diverged species. Therefore, our model provides evidence that belowground indirect plant defences associated with tritrophic interactions have evolved under two classical hypotheses in plant ecology. While phylogenetic drivers of volatile emissions point to the defence-escalation hypothesis, plant local adaptation of indirect defences is in line with the resource availability hypothesis.

Biological invasions are a major concern in conservation, especially because global transport of species is still increasing rapidly. Conservationists hope to anticipate and thus prevent future invasions by identifying and regulating potentially invasive species through species risk assessments and international trade regulations. Among many introduction pathways of non-native species, horticulture is a particularly important driver of plant invasions. In recent decades, the horticultural industry expanded globally and changed structurally through the emergence of new distribution channels, including internet trade (e-commerce). Using an automated search algorithm, we surveyed, on a daily basis, e-commerce trade on 10 major online auction sites (including eBay) of approximately three-fifths of the world's spermatophyte flora. Many recognized invasive plant species (>500 species) (i.e., species associated with ecological or socio-economic problems) were traded daily worldwide on the internet. A markedly higher proportion of invasive than non-invasive species were available online. Typically, for a particular plant family, 30-80% of recognized invasive species were detected on an auction site, but only a few percentages of all species in the plant family were detected on a site. Families that were more traded had a higher proportion of invasive species than families that were less traded. For woody species, there was a significant positive relationship between the number of regions where a species was sold and the number of regions where it was invasive. Our results indicate that biosecurity is not effectively regulating online plant trade. In the future, automated monitoring of e-commerce may help prevent the spread of invasive species, provide information on emerging trade connectivity across national borders, and be used in horizon scanning exercises for early detection of new species and their geographic source areas in international trade., (© 2015 Society for Conservation Biology.)

In July 1996 a 43-year-old illiterate Hispanic woman presented with uncontrollable vomiting, palpitations and confusion. In 1994, despite several hospitalisations in other medical centres where a cerebral CT-scan, oesogastroduodenoscopy, colonoscopy and abdominal ultrasound were performed, no satisfactory diagnosis could be found. A psychiatric origin was finally considered. On admission, the laboratory findings showed severe metabolic alkalosis with associated hypokalaemia, confirmatory evidence of vomiting. The ECG showed tremendous P waves (5 mV) in the standard derivations, which can be explained by the hypokalaemia, with multiple supraventricular extrasystoles. Echocardiography and pulmonary scintigraphy ruled out pulmonary hypertension and a pulmonary embolus. After additional discussion with her daughter we discovered that the patient had been treating chronic headaches for years with 4-5 Cafergot-PB suppositories per day. This drug contains 2 mg ergotamine tartrate, 100 mg butalbital, 100 mg caffeine and 0.25 mg belladona alkaloids. As is known, vomiting is a classical symptom of ergotamine intoxication. After rehydration we discovered a megaloblastic anaemia with a folate deficiency compatible with chronic barbiturate intoxication. Folate and iron supplementation allowed a rapid normalisation of the haemoglobin values. Five months after having stopped the Cafergot-PB, the patient was well and did not vomit anymore. The headaches were treated with chlorpromazine with a good result. Despite sophisticated technical means, the diagnosis could only be established after a thorough history taking. This message should be heard in times when high tech medicine tends to obscure the place of a good history taking!

The aim of this study was to determine the extent of the contamination of stethoscopes and their possible role in transmission of microorganisms. The stethoscopes of the medical doctors of the hospital of La Chaux-de-Fonds, Switzerland, were cultured and the date of the last cleaning recorded. 38 of the 62 stethoscopes surveyed were contaminated with microorganisms (61%). The majority of isolated organisms were gram-positive bacteria, primarily Staphylococcus species (89%). The cleaning of the stethoscopes was frequent for 32% of the doctors, rare for 46% and non-existent for 22%. After more than one day without cleaning of the stethoscope, the level of contamination rose from 0% to 69%. Stethoscope use may be an important factor in the spread of infectious agents, so that regular disinfection should be carried out (once a day at the very least).

Dexfenfluramine is one of the most widely prescribed appetite suppressant drugs in Switzerland because of its enhancing effect on certain weight-reducing diets. Nevertheless, the effects of acute intoxication are not well documented. We recently observed a young adolescent girl who ingested large quantities of the drug to achieve a rapid weight loss. She presented with tachycardia, high blood pressure, mydriasis, fever and behavioral disorders. All signs and symptoms cleared after 48 hours. The clinical picture is akin to amphetamine intoxication, in view of the similarity of the two drugs' metabolites.

A 80 year old man, in general good health, presented with a rapidly progressive congestive heart failure, without response to treatment. At echocardiography, there were masses in the right atrium and ventricle. The patient deceased two months after the first clinical manifestations. At autopsy, we found a massive right-sided atrio-ventricular infiltration by a malignant non-Hodgkin's lymphoma of centroblastic type, causing a subtotal obstruction of the tricuspid and pulmonary valves. We observed also four intestinal metastases without other manifestations of lymphoma.

Osteoporosis can be secondary to other diseases. Among these, mastocytosis is easily recognized when typical skin lesions and systemic symptoms are present. When mastocytosis is confined to bone, as in our case, diagnosis is based on the presence in the bone marrow of an increased number of mastocytes with a nodular arrangement near the bone trabeculae. The diagnosis has to be suspected when severe vertebral and peripheral osteoporosis occurs in middle aged people, especially men. Bisphosphonates are the most frequently applied treatment but their efficacy is limited. Early diagnosis is recommended because the use of several drugs, including fluoride, which is frequently used in osteoporosis.

In a group of 29 patients treated with digoxin for cardiac failure, only 16 showed increased calcium and potassium concentrations in saliva. There was no correlation in the 29 patients between serum digoxin levels and concentrations of salivary electrolytes. On the other hand, in 4 normal subjects treated with digoxin no change in salivary electrolytes was noted. It is concluded that modifications in salivary electrolytes seen in patients with cardiac failure treated with digitalis are not due to this drug. However, a retrospective clinical study showed a good correlation between clinical signs of cardiac failure and increased levels of salivary calcium, potassium and CaX Kproduct. It is suggested that this phenomenon is due to the well-known adrenergic stimulation in patients with cardiac failure.

The frequency of venous thrombosis during central vein catheterization was prospectively studied in a group of 51 patients (53 catheterizations) during a 10-month period. 12 catheterizations (23%) resulted in thrombosis as revealed by phlebography. Of these, 11 were due to catheters whose site of entry was the upper limb. No other favoring factors (osmolality of the infused fluids, length or catheterization etc.) were detected. Ideally, to avoid thrombosis, central venous catheters should be inserted via the jugular or the subclavian vein, while bearing in mind that these other routes are not devoid of complications either.