Appeals from disciplinary rulings of patients' complaints regarding physicians' conduct.

In 1984 and 1985 the Danish National Board of Health received a total of 1,062 complaints from patients regarding alleged physician negligence. The board has disciplinary powers over physicians in cases of negligence, and advises the Attorney General in cases of gross negligence which are referred to the court. The investigation found that 17% of the board's rulings were taken on appeal, of these 9% were either wholly or partly upheld. Physicians did not appeal frequently (2%), but their appeals were more often upheld (32%) than was the case in respect of patients' appeals (15% and 4.4% respectively). Evaluation of the cases taken on appeal did not provide support for extending the right to appeal. The consequences of such an extension are, however, discussed in the light of subsequent limitations imposed on the right to appeal and the more well-established and comprehensive provisions for appealing that exist in some neighbouring countries.


Medical and biological progress and the European Convention on Human Rights.

The advances made in life sciences are one of the most significant features of the 20th century scientific revolution and human rights obviously enjoy prominence among the legal issues affected by the development of medicine. The case law of the organs of the European Convention on Human Rights arising from developments in the biomedical sciences is reviewed. The approach of especially the European Commission on Human Rights to the consequences of advances in the life sciences on the protection of the individual's physical integrity and the protection of freedom of thought and private and family life is analysed. 'Contrary to what we are led to believe, it is not from the starting-point of biology that a particular idea of man can be formed; on the contrary, it is from the starting-point of a particular idea of man that biology can be used to serve him': F Gros, F Jacob & P Royer Life Sciences and Society (1979) 288.


New Zealand's medical manslaughter.

Doctors in New Zealand may be prosecuted for manslaughter if patients die as a consequence of the doctor's failure to exercise reasonable knowledge, skill and care. The requirement to use reasonable knowledge, skill and care has been held to be breached in New Zealand if a doctor is merely careless. No distinction is made between 'criminal negligence' and the negligence standard applicable in civil law. This article examines New Zealand's law relating to medical manslaughter with particular reference to the case of R v Yogasakaran [1990] 1 NZLR 399 which was the subject of a petition to the Privy Council on 30 January 1991.


The neglected intermediate premise in the forensic expert's testimony.

The testimony of most expert witnesses is reducible to a syllogism: The expert derives a relevant opinion (the conclusion) by applying a general theory or technique (the major premise) to the specific facts of the case (the minor premise). Legal commentators have tended to focus on the expert's major premise to the neglect of the minor premise. Thus, legal analysts have devoted little attention to the question of the forensic expert's use of proper test protocol. This neglect can result in the admission of erroneous scientific testimony. The neglect also represents a missed opportunity--the legal system's opportunity to give the forensic community additional incentive scrupulously to follow correct test procedures.


Legal aspects of forensic psychiatry in South Africa.

The current political changes in South Africa have focused attention on matters such as the availability of medical and psychiatric services for all. These services have been stretched to breaking point due to waves of crimes of violence which seem to go in tandem with the process of democratization. These questions are discussed and some possible inadequacies of the forensic sciences in the criminal justice system are considered.


Preventive outpatient civil commitment and the right to refuse treatment: can pragmatic realities and constitutional requirements be reconciled?

This article examines the concept of preventive outpatient civil commitment as a mechanism for controlling the behaviour of the chronically mentally ill. The goal of preventive outpatient civil commitment is to intervene at an early stage to prevent further deterioration of a mentally ill person's state. In the jurisdictions in the United States which have enacted preventive outpatient civil commitment statutes, there is a lesser standard required for outpatient commitment than for inpatient commitment. For outpatient commitment, there generally only needs to be a finding of mental illness and a conclusion that without treatment a person's mental illness will further deteriorate. This standard often clashes with the civil liberties of those being committed, particularly with the right to refuse treatment. This article explores preventive outpatient civil commitment in relation to the historic right to refuse treatment by examining the antithetical positions of the state's authority to treat and the mental health client's interest in liberty. The article concludes that both of these positions ignore the possibility that, through the development of an adequate community care service system, the reality of the mentally ill in the community may be reconciled with a civil liberties perspective. '[The] [c]onstitutional right to privacy...is an expression of the sanctity of individual free choice and self-determination as fundamental constituents of life. The value of life as so perceived is lessened not by a decision to refuse treatment, but by the failure to allow a competent human being the right of choice.'


Infanticide: new medical considerations.

A relationship between disturbed hormonal and metabolic equilibrium during puerperium and ensuing mental and emotional imbalance has been postulated for a long time. In England and Wales this consideration has resulted in the crime of infanticide being reduced from murder to manslaughter. Recent data indicate that the therapeutic and even routine administration by physicians of powerful vasoactive agents during puerperium, and particularly that of ergot derivatives, is probably the most frequent factor leading to 'pure puerperal psychosis'. It is proposed, therefore, that this psychosis is in fact, in most instances, a form of ergotism and its signs and symptoms and consequences, including coincidental infanticide, themselves are actually manifestations of acute ergot poisoning. It is suggested that based on this information a thorough re-evaluation of the relevant legal concepts is necessary.


International migration and medical credentialling.

The Single European Act of July 1987, coupled with various other regional and national laws, the purposes of which open borders to the free movement of peoples, goods and services, is soon to be put into operation. Although awaited with much eagerness and expectation, there is also a need for strategic planning in order adequately to address new and possibly ominous legal and medical practice problems. In the United States, a National Practitioner Data Bank, which went into full operation in September 1990 was created to monitor physicians, nurses and other health care providers involved in negligence actions which result in the payment of moneys by settlement or by verdict, and to prevent those whose licences have been suspended, revoked or restricted in any fashion in one state from practising in another based upon reciprocity licensure or board certification criteria. In order to protect patients from abuse by uncredentialled individuals or dangerous clinicians, and further to protect institutions from liability incurred by inadequate credentials checks or through ostensible liability, the creation of a practitioner data bank utilizing modern data gathering, storage and retrieval methods is proposed for the European Community. It should be created under the auspices of the United Nations--possibly through the World Health Organization which already accredits medical education and training programmes--and should be charged with creating uniform standards of professional practice; certifying professionals; and serving as a credentials' clearing house for the health care industry.


New Israeli psychiatric legislation.

For about 35 years, the 1955 Mental Act served as the main legal tool applied in the treatment of admitted patients in Israel. The law was wearing out, although 'patched up' repeatedly, and could no longer express 'the spirit of the times'. After many vicissitudes, a new Mental Act was implemented in 1991. The various areas dealt with in the new law are described and discussed. Special attention is focused on two issues: patients' rights and the decisions pertaining to enforced examination, hospitalization and treatment.


The insanity defense: a South African perspective.

The insanity defence has always been a contentious issue. This study was carried out on a sample of 95 consecutive forensic, psychiatric observation cases. The cost-effectiveness of ordering routine investigations during the observation period appeared to be questionable since the results of selective special investigations yielded more useful information. It was found that there was little calculated abuse of the insanity defence, but that the situation was rather one of barely literate persons naively attempting to use it, especially in cases of serious crime. The incidence of these naive users might have been greatly reduced had there been adequate screening before the accused were sent for observation. The court generally accepted the psychiatrist's opinion with regard to mental illness and criminal responsibility. It, however, differed on occasion when it came to the disposal of those accused who were found to be mentally ill.


Some psychological reactions of rape victims.

This article delineates the psychological reactions of rape victims from a psychodynamic vantage point. Rape, an act of violence, results in psychic trauma. The authors attempt an understanding of the psychological sequelae of rape.


Intramarital illegitimacy.

Discovering cases of children born to married women by men not their husbands is generally difficult. Legal involvements with regard to paternity, divorce and litigious paranoids also have applicability to cases of pregnancy by donor insemination. The child's right to information regarding paternity is the same in both types of cases, and is relevant with respect to matters of heredity as well as, in some cases, counselling and psychotherapy.


Escherichia coli: rapid identification by chromogenic tests.

A system has been assessed for the identification of Esch. coli using a rapid triple chromogenic test which relies on the ability of the organism to produce a beta-galactosidase, a beta-glucuronidase, and indole. Coliforms which had been fully identified were tested by this system. Of 512 non-Esch. coli strains there were no false positives, whereas of 514 Esch. coli strains 486 (94.5%) were found to give positive results. Two hundred and twenty-one coliforms that had been isolated from blood cultures were also tested using the colistrip in advance of, or without knowledge of the API 20E result. The test was found to be 100% specific and 94% sensitive for the 105 Esch. coli strains. The test was rapid, simple to perform and economical.


High level gentamicin resistance in enterococcal and streptococcal isolates from blood culture.

The combination of an aminoglycoside with a cell wall active agent is often necessary for the satisfactory management of serious enterococcal and streptococcal infections. High level gentamicin resistance (MIC > 1000 micrograms/ml) eradicates the synergy between these two classes of antibiotics and treatment of these infections becomes difficult. Over a four year period we assessed the susceptibility of blood culture isolates of enterococci, Streptococcus agalactiae (group B), and clinically significant viridans-type streptococci. The susceptibility of the organisms to gentamicin could be determined utilizing high content aminoglycoside discs. We report an increasing prevalence of high level gentamicin resistance in enterococci in South London, with 44% of isolates being resistant in the first quarter of 1991. None of the streptococcal isolates demonstrated high level gentamicin resistance. We recommend screening for high level gentamicin resistance in all enterococcal and streptococcal cases where aminoglycoside-penicillin synergy is desired.


Speech recognition and the clinical microbiology laboratory.

Keyboard entry of large amounts of diagnostic data is a laborious task. Any transcription errors that occur may pass undetected by 'non-technical staff' employed to input these data. The object of this project was to design a system, based on a Marconi 'Macrospeak' Speech Recogniser, for 'on line' laboratory entry of data generated from the microbiological examination of specimens of urine. Six parameters considered important to the success of the system were assessed: accuracy, speech recognition, reproducibility, speed, user friendliness, and cost effectiveness. The system performed well under the test conditions examined. 'On line' hands free entry of diagnostic data, using speech recognition, may be a practical alternative to more conventional means of data entry.


Urinary amphetamines, benzodiazepines and methadone: cost-effective detection procedures.

Cost-effective immunoassays for the detection of amphetamines, benzodiazepines, and methadone in urine have been developed using Syva EMIT reagents and a Cobas Bio centrifugal analyser. With this method up to 2470 samples can be assayed with a single 100 test EMIT kit while maintaining acceptable precision. Mean CVs of 3.8-6.6% were obtained for concentrations around the manufacturer's recommended threshold level (300 micrograms/l). Comparison of the methods with the Abbott TDx system showed good correlation for methadone. The methods compared less well for amphetamines, and it was not possible to obtain a useful correlation for benzodiazepines. Heat treatment prior to analysis did not affect the detection of benzodiazepines and methadone; there was a mean decrease of 14% for amphetamines.


Carbamylation and glycosylation of haemoglobin in vitro: effects of cyanate and glucose.

An in vitro system that is independent of any haemodynamic influence and other physiological controls was designed to study the formation of carbamylated and glycosylated haemoglobin, by the use of cyanate and glucose respectively, incubated with whole-blood from normal healthy subjects. In this system the formation of glycosylated haemoglobin is more favourable than that of carbamylated haemoglobin. The effect of glucose in reducing the formation of carbamylated haemoglobin is greater than the effect of cyanate on the formation of glycoslyated haemoglobin. There is a strong correlation coefficient (r = 0.9, P < 0.005) for the relationship between the formation of carbamylated and glycosylated haemoglobin in this system.


Immunohistochemical demonstration of B and T-lymphocyte cell surface markers: an assessment of tissue transport/storage media.

A number of solutions were tested on lymphoid tissue with a view to devising a tissue transport/long-term storage medium which would preserve the morphology and antigenicity of lymphocytes, for demonstration of B- and T-cell surface markers using monoclonal antibodies. Some of the solutions produced total loss of any recognisable tissue structure, but one newly-devised medium gave excellent preservation of morphology and nuclear detail, together with extremely good monoclonal antibody staining. This sterilised medium, Carmichael's medium*, contains a buffer and cryoprotectant: it forms a gel at 4 degrees C, but it is easily liquefied in warm water just prior to immersion of the biopsy. Sections from tissue preserved in Carmichael's Medium were found to be of equally good quality as, and in some cases better than, those which had been fresh frozen. *International patents are currently pending on the formulation of this medium, which will be available commercially through Raymond Lamb Ltd, London, England, UK.


Anti-paternal lymphocyte antibodies: a modified cellular enzyme-linked immunospecific assay (CELISA).

A cellular enzyme-linked immunospecific assay is described which is ideally suited to measuring the IgG antibody response to donor-specific lymphocyte infusions. The procedure is simple, sensitive, specific and objective.


Syphilis diagnosis: screening by enzyme immunoassay and variation in fluorescent treponemal antibody absorbed (FTA-ABS) confirmatory test performance.

Four fluorescent treponemal antibody absorbed (FTA-ABS) test kits were evaluated with 86 treponemal and 84 non-treponemal sera selected with enzyme immunoassay (EIA). Agreement between all four kits was 63% for treponemal, and 50% for non-treponemal, sera. Discrepancies with treponemal sera were associated with low levels of antibody characterised by T. pallidum haemagglutination assay (TPHA) titres < or = 160 and a negative Venereal Diseases Research Laboratory (VDRL) test. Discrepancies with non-treponemal sera were significantly associated with false reactivity on screening with EIA. Possible reasons for the differences obtained between kits, the importance of screening policies for pre-selecting sera, and the significance of equivocal (borderline) reactions on positive and negative predictive values are discussed.


Glutamate pyruvate transaminase as an indicator of infection with Plasmodium falciparum.

A correlation is shown between the presence of trophozoites and/or gametocytes of Plasmodium falciparum in thick and/or thin blood films, with the enzyme glutamate pyruvate transaminase (GPT) and a marked increase in serum GPT as a probable consequence of the presence of malaria parasite inferred. It is suggested that serum GPT levels may be used as a reliable marker for malaria infection, but only complementary to microscopic detection of falciparum malaria, rather than being specifically diagnostic.


Anti-HBs detection: a modified passive haemagglutination assay.

Modification of a commercial haemagglutination assay for the detection of anti-HBs has reduced the test time from over one hour to approximately 25 min. increased sensitivity ten-fold without any prozoning, maintained specificity and reduced costs by 90%. The modification consists of diluting the reagent cells ten-fold; these are then added to dilutions of test serum in a V-well microplate. After incubation, plates are centrifuged and then inclined at 70 degrees. Positive and negative reactions can be clearly distinguished within approximately 10 minutes.


Colorectal cancer.

Two current areas of interest regarding colorectal cancer are identification of its genetic and environmental causes, and evaluation of the possibilities of implementing screening programmes for asymptomatic disease in the general population. These issues are addressed in the various studies outlined in this update.


Diagnosis of bacterial vaginosis in a routine diagnostic laboratory.

Vaginal swabs from 299 hospital and general practitioners' patients were examined for Gardnerella vaginalis by Gram film and by culture, G. vaginalis was isolated in 12% of cultures. Comparison between the 'clue' cell and culture methods suggested that the former is a rapid, acceptable routine screening method for the detection of G. vaginalis. The value of the traditional method of identifying G. vaginalis by sensitivity testing is questioned. All specimens were also examined by Gram film and culture, for the presence of Mobiluncus spp, which was detected in 8.4% of specimens by Gram film but only 0.7% by culture. From a questionnaire returned by 84% of clinicians, metronidazole was found to be the most commonly used antimicrobial agent for the treatment of G. vaginalis, and in all but one case appeared to be clinically effective.


Serum low density lipoprotein separation: a simple procedure.

Reference methods for serum low density lipoprotein (LDL) separation are time-consuming and the salts used in density-gradient ultracentrifugation may cause chemical and/or immunological changes in the lipoprotein structure. A method has been developed to provide native LDL suitable for chemical and immunochemical studies. The three step procedure involves firstly the separation of very low density lipoproteins by non-density adjusted ultracentrifugation, secondly the separation of low from high density lipoproteins by LDL precipitation with PEG-6000, and finally the re-dissolution of the pellet in NaCl 150 mmol/l. The effectiveness of LDL separation, as well as the preservation of the electrophoretic mobility of the LDL molecules, was verified by electrophoresis in agarose gel, and the maintenance of the immunochemical reactivity of apolipoprotein B was verified by an immunochemical assay.


Expression and characterization of the cloned Salmonella typhimurium enterotoxin.

Earlier, our laboratory reported the cloning of a chromosomally encoded cholera toxin (CT)-like enterotoxin gene from Salmonella typhimurium Q1 into pBR322. Cell lysates from the plasmid clone pC1, containing a 4.8 kb EcoR1 DNA fragment from Salmonella, caused elongation of Chinese hamster ovary (CHO) cells and this biologic activity was neutralized by anti-CT. However, this cloned gene product did not elicit fluid secretion in the rabbit intestinal loop (RIL) model, because of poor expression. We report here, subcloning of a 4.8 kb EcoRI and a 2.7 kb HindIII/Eco Rl fragment into a high expression T7 RNA polymerase/promoter system. Cell lysates from these clones elicited fluid secretion in the RIL model, caused firm induration in rabbit skin and elongated CHO cells. These biological activities were neutralized by anti-CT. SDS-PAGE and subsequent fluorographic analysis of Escherichia coli, harboring recombinant plasmids in a T7 expression system, revealed the presence of two prominent 35S-labeled polypeptides of 25 and 12 kDa, which were immunoprecipitated with anti-CT. The enterotoxin appeared to be 125 kDa in size, based on chromatography on a P-300 column, had a pl of 6.6 to 6.8, and was heat-labile (60 degrees C/5 min). Unlike cloned CT and heat-labile enterotoxin (LT-l), which were localized in the periplasm, the Salmonella enterotoxin was cytoplasmic in nature.


Deposition of circulating streptococcal lipoteichoic acid in mouse tissues.

The tissue binding properties of streptococcal lipoteichoic acid (LTA) were studied using normal and passively immunized BALB/c mice. After intraperitoneal injection in non-immunized mice, 3H-LTA concentrations in blood, heart, kidney and liver were highest between 24 and 30 h post-injection. LTA deposits in heart remained high for the next 24 h, whereas other tissue levels decreased. Constant amounts of 3H-LTA were detected in urine throughout the 48 h period. In passively immunized mice, the amount of tissue deposition of 3H-LTA was inversely proportional to the ratio of antibodies to LTA. Autoradiography revealed focal deposits of 3H-LTA in heart, kidney and liver. These observations indicate that LTA, released by streptococci growing at remote body sites, can be carried by the blood to internal organs where it can accumulate and participate in pathogenesis.


Growth phase and SpvR regulation of transcription of Salmonella typhimurium spvABC virulence genes.

The 90 kb virulence plasmid of Salmonella typhimurium is required for bacterial growth beyond the small intestine to deeper tissues such as the spleen and liver of orally inoculated mice. We constructed transcriptional lacZ fusions within the cloned plasmid-borne virulence genes spvA, spvB and spvC of S. typhimurium to demonstrate that spvR encodes a trans-acting positive regulator for the transcription of spvA, spvB and spvC. Data suggesting that the activation of spvABC transcription is dependent on the growth phase of both S. typhimurium and Escherichia coli grown in Luria Broth (LB) are also presented. Complementation experiments for virulence in mice confirmed that at least spvR and spvC are virulence genes and further suggested that the spvRABC gene cluster consists of at least three transcriptional units containing spvR, spvC and spvABC, respectively. Reinitiation of transcription at spvC was confirmed in vitro, using a lacZ fusion, and was shown to be independent of SpvR-mediated control in LB.


Modulation of surface antigen expression by Klebsiella pneumoniae in response to growth environment.

Growth in pooled human body fluids [urine, serum and peritoneal dialysate (HPD)] modulated the expression of cell envelope antigens in virulent (serotype O1:K1) and avirulent (serotype O1:K66) Klebsiella pneumoniae strains. Marked variations in the outer membrane protein (OMP) and lipopolysaccharide (LPS) profiles were noted when broth-grown cells were compared with those of bacteria cultured in body fluids. In particular, for the O1:K1 serotype strain, growth in the latter resulted in: (a) the expression of at least five iron-regulated OMPs in the 74-87 kDa range, the pattern of which was medium dependent; (b) alterations in the migration of the LPS core polysaccharide; and (c) the reversion of isogenic O-:K+ and O-:K- mutants to the O+ phenotype after growth in fresh serum but not in heat-inactivated serum, urine or HPD. Similar results were obtained for the O1:K66 serotype, although no variation in the migration of the LPS core was noted. For both O1:K1 and O1:K66 serotypes, neither the surface exposure of O1 serotype LPS nor the production of K-antigen (capsular polysaccharide) was affected by growth in body fluids. No reversion of K- mutants to the K+ phenotype was observed. These data illustrate the phenotype flexibility of this opportunistic pathogen and emphasise the crucial role of the O- rather than the K-antigen in protecting K. pneumoniae from complement-mediated serum killing.


Genetic control of resistance to enterotoxigenic Escherichia coli in infant mice.

DBA/2 and CBA infant mice orally challenged with bovine enterotoxigenic Escherichia coli (ETEC) strain B80 presented resistance and susceptibility respectively, as measured by mortality rates 6 days after inoculation. Serum antibodies agglutinating ETEC strain B80 had very low titers in both mouse strains. Mendelian analysis of resistance on F1 and on segregating back-crosses showed that resistance is genetic and dominant. Dominance may be explained either by a mixed control with an overdominant major gene or by a polygenic control with a large heterosis effect.


Transcription analysis and nucleotide sequence of tox promoter/operator mutants of corynebacteriophage beta.

The production of diphtheria toxin (DT) by Corynebacterium diphtheriae C7 (beta) is transcriptionally regulated by the iron-dependent diphtheria toxin repressor, DtxR. Transcription of the tox gene was studied in wild-type C. diphtheriae C7 (beta) and in lysogens carrying mutants of beta that determine insensitivity to inhibition of DT production by iron. Under low iron conditions in all strains, tox-specific mRNA appeared and DT production began during late-log phase, and they increased to maximal levels at stationary phase. Under high iron conditions, tox-specific mRNA and DT production were strongly repressed in C7 (beta) but only partially repressed in C7 (beta tox-202) and C7 (beta tox-201). Under high and low iron conditions, DT production and tox-specific mRNA levels were greater in C7 (beta tox-201) and C7 (beta tox-202) than in wild-type C7 (beta). Addition of iron or rifampicin to low iron cultures of C. diphtheriae C7 (beta) repressed tox-mRNA production promptly and with a similar time course. In contrast, repression of tox-mRNA synthesis in C. diphtheriae C7 (beta tox-201) occurred promptly after addition of rifampicin but more slowly after addition of iron. Nucleotide sequence analysis revealed single G to A mutations at positions -47 and -48, within the preferred '-10' sequence of the tox promoter, in beta tox-201 and beta tox-202, respectively. The single nucleotide substitutions in the tox-201 and tox-202 regulatory alleles, therefore, have pleiotropic effects, causing increased activity of the promoter and partial resistance of the operator to iron-dependent repression.


Physiologic alteration of fibrinogen levels: influence upon patency of microvenous anastomoses.

High baseline levels of plasma fibrinogen have been correlated with increased risk for cardiovascular disease. Since fibrinogen plays a central role in both coagulation and platelet aggregation and is a primary component of thrombi, this study was designed to assess the relationship of circulating fibrinogen concentration and vein anastomotic patency. Subcutaneously injected turpentine was used to increase, and intravenous ancrod (snake venom) to decrease, plasma fibrinogen levels. Rat femoral vein anastomoses were performed, and patency was assessed after 120 min of flow. Rat tail bleeding times were obtained, and blood samples were drawn to determine fibrinogen and plasma protein concentrations, Lee-White clotting times, and activated partial thromboplastin times (APTT). Increased patency was found in the ancrod group (88%) (P < 0.05 vs. controls); turpentine-treated and control groups were not significantly different (71% and 63%, respectively). The ancrod group also showed significantly prolonged tail bleeding times and APTT. Fibrinogen levels were significantly decreased in the ancrod group (1.73 mg/ml) and elevated in the turpentine group (4.91 mg/ml) vs. controls (2.34 mg/ml; P < 0.005). These results indicate that elevated fibrinogen levels, in particular when triggered by an acute-phase response, do not appear to predispose small vessel repairs toward thrombosis. Furthermore, this study supports the use of ancrod as an anticoagulant for microvascular surgery.


Modified anastomotic technique for 1 millimeter internal diameter polytetrafluoroethylene arterial grafts in the rat.

Reported patency rates after standard end-to-end anastomoses for microvascular prosthetic grafts have been inconsistent and usually disappointing. A modified anastomotic technique is described in which the prosthetic graft is invaginated inside the arterial lumen. In this study of 6 cm lengths of 1 mm internal diameter polytetrafluoroethylene femoro-femoral bypass grafts in the rat, 6 (40%) of 15 grafts with standard anastomoses were patent at 6 months compared to 28 (90%) of 31 grafts using the modified anastomotic technique (P < 0.001). With invagination of the prosthetic graft inside the arterial lumen, reliable high patency rates can be achieved with microvascular prostheses long enough for potential clinical applications.


Long-term results of 1 millimeter arterial anastomosis using the 3M precise microvascular anastomotic system.

The 3M Precise Microvascular Anastomotic System has been tested experimentally in long-term studies of arteries of 1 mm in diameter for the first time. The device was placed, using a newly described technique, in the infrarenal aorta of 25 rats. At different intervals (2 weeks, 16 weeks, and 1 year), the section containing the 3M Precise Microvascular Anastomotic System was removed and processed for light microscopy and scanning electron microscopy. All the anastomoses were found to be patent. Using a new device to process the material, both light microscopy and scanning electron microscopy at 2 weeks showed a perfect reparative process at the junction site and the presence of a continuous endothelial layer. Media atrophy was responsible for wall thinning within the device. At 16 weeks, the atrophy of the media was even more marked, reducing the vessel wall thickness within the device to one-third of normal. At 1 year, this atrophy of the media was complete; smooth muscle cells disappeared and were replaced by fibrous tissue. Adventitia was not present over the long term within the device. The continuous endothelial layer, however, was still viable. These long-term results suggest that scar tissue forms within the device, while a continuous endothelial layer remains viable internal to this.


Use of fibrin glue to minimize bleeding of microvascular repairs in hypertensive rats.

The purpose of this study is to describe our technique of applying fibrin glue at the microvascular anastomotic site and to evaluate the effect of fibrin glue on anastomotic hemostasis and patency under various high pressure states using dopamine-induced acute hypertension in rats. A total of 72 male Wistar Kyoto rats, 10 weeks old, were used in this study. Under urethane anesthesia, end-to-end anastomosis of the left femoral artery was performed using 10-0 nylon suture by the standard interrupted suture technique. Pasteurized fibrin glue was then topically applied upon the suture line of the anastomosis. Thirty-six normotensive rats were divided into three groups based on the number of sutures (4, 6, or 8) used to complete the anastomosis. Groups were subdivided, half receiving fibrin glue application and half without. Thirty-six dopamine-induced acutely hypertensive rats were divided into three groups based on the blood pressure levels of 150, 200, and 250 mmHg, respectively. These groups were again subdivided, with half receiving glue applications. Microvascular anastomosis was performed using 6 nylon sutures. Patency rates and anastomotic bleeding were evaluated. The results revealed that successful anastomoses could be performed with fewer sutures when fibrin glue was used as a reinforcement at the anastomosis. Fibrin glue was also effective at the maximum blood pressure (250 mmHg) with no anastomotic leakage and no decrease in postoperative patency rate. These results suggest that conventional microsurgical suturing technique combined with fibrin glue would be effective in the prevention of leakage in microsurgical repairs, even under conditions of high blood pressure.


Microsurgical approach to the abdominal thoracic duct in the rat: considerations in the collection of lymphocytes.

In experiments involving the collection of thoracic duct lymphocytes the anatomy of the abdominal thoracic duct in the rat has been further defined. In general, the abdominal thoracic duct lies posterior and to the left of the aorta between the renal arteries and the diaphragm. There are variations in the microsurgical approach to the classically described location of this organ that should be noted by investigators attempting to identify and dissect this structure.


Development of a new rabbit ear model for the longitudinal study of digital pathophysiology.

A rabbit ear model has been developed in which arterial pressure, auricular blood flow conductance, and microvascular perfusion can be followed continuously in conscious animals. Conductance is measured with a transit-time flow probe placed around the auricular artery, arterial pressure is measured with an abdominal aortic catheter, and cutaneous microvascular perfusion is assessed using laser Doppler fluxmetry. Placement of a femoral vein catheter permits administration of vasoactive substances. To date, rabbits have been instrumented for 90 days or longer. Auricular and abdominal arterial pressures were equal, permitting the calculation of auricular artery conductance. Microvascular perfusion as measured by laser Doppler fluxmetry followed changes in overall blood flow. The presence of postsynaptic alpha 2-receptors was confirmed by determining auricular conductance before and after the administration of intravenous alpha-agonists. The development of this unique model will help to advance the understanding of the pathophysiology of human digital thermoregulatory vascular abnormalities.


Variability of venous anatomy of rat testis: application to experimental testicular surgery.

The venous drainage of the testis of the laboratory rat was observed in 31 animals. The right testicular (internal spermatic) vein drained directly into the right common iliac vein in 77.4%, and into the inferior vena cava in 22.6% of the animals.  The left testicular vein drained into the left common iliac vein in all animals, but in 90.3% there was also an accessory branch of the testicular vein draining into the left renal vein. These observations suggest that in the rat the exact anatomy of the venous drainage of each testis should be identified prior to undertaking any surgical procedure on the testis where the venous vasculature plays a major role such as testicular transplantation or the creation of an experimental varicocele.


Thigh adductor flap: an experimental model for free flap transfer in the rat.

A new model of rat muscle free flap transfer is presented. The flap is based on a long pedicle originating from the femoral vessels and continuing down to the distal saphenous margin at the ankle. The distal portion of the semitendinosus muscle is harvested along with the saphenous artery and great saphenous vein. A larger muscle flap may be harvested by including the distal portions of the posterior and anterior gracilis muscles. The flap can be transferred to remote sites on the animal, with a vascular pedicle of up to 3 cm in length. The diameters of the vessels repaired are of standard microsurgical size. This model has distinct advantages of simplicity, speed of dissection, high success rate after microvascular transfer, and versatility in placement of the muscle mass (due to the long pedicle).


New rapid technique for renal transplantation in the rat.

Present techniques for renal transplantation in the rat include a period of 20-25 minutes warm ischemia. Our method combines a recently described sleeve anastomotic technique for the renal artery, conventional end-to-end anastomosis of the renal vein, and implantation of the ureter into the bladder. This has resulted in a reproducible ischemic interval of 12-14 minutes. Plasma creatinine and histological features in animals sacrificed from 10 to 30 days after transplantation were within normal limits with no evidence of ischemic damage. A further advantage of the technique is that kidneys can be exchanged between the donor and recipient. It is recommended that this procedure, which reduces the ischemic interval by up to 50%, should be learned and employed in studies of renal transplantation in the rat, especially if such studies include the prior administration of cyclosporine, which may aggravate the effects of ischemia.


Small bowel transplantation in the mouse: development of a model.

The rat has been used as a model to study the significance of graft and host interactions in small bowel transplantation (SBTX). A mouse model of SBTX would allow investigators to apply the knowledge of the well-defined genetics in the mouse to this field of study. Therefore, we have developed a mouse model of heterotopic SBTX using syngeneic C57BL6/J mice. Animals were anesthetized with a combination of ketamine and xylazine. Donor animals underwent midline laparotomy, with isolation of a segment of bowel as an isograft for transplantation to a recipient animal. The bowel was flushed in situ prior to removal of the graft with a Carrel patch of aorta and portal vein. The recipient animal underwent midline laparotomy and preparation of its infrarenal aorta and inferior vena cava for end-to-side anastomosis of the graft with 10-0 nylon. After vascular reperfusion of the graft the ends of the isografted bowel were brought out as stomata. Successful grafts were later assessed for viability by laparotomy or histological examination at the time of sacrifice. Areas of technical difficulty in this model and issues that might improve the experimental results are discussed. This model should allow investigators to apply the well-defined genetics of the mouse to probe the challenging field of intestinal transplantation.


Free flap failure due to venous occlusion secondary to previous intravenous cannulation: a case report.

A case of failure of a free radial forearm flap is presented. It is surmised that this was due to venous thrombosis in the cephalic vein which showed evidence of recanalization of an old thrombus. The patient had received intravenous erythromycin some months previously.


[New approach to the system of training of medical professionals in the realization of current objectives with regard to workers' health care].

In view of the changes in the health care for workers, there is a need to modify the existing system of training for occupational health care professionals in order to secure successful implementation of the new principles. An activity was undertaken at the Postgraduate Training Unit, Institute of Occupational Medicine, Lódź, Poland, to determine new directions, objectives and training curricula in that area. First proposals, based on the review of the new objectives of the occupational health care system and of the presently available staff, concentrate on the indication of three major groups of professionals for which the new training contents should be designed. These three groups include: occupational health care organizers, public health experts and physicians specializing in specific health care for industrial workers.


[A computerized system for the protection of the hearing of workers exposed to noise].

The periodical audiometric examinations carried out in order to identify persons with high susceptibility to acoustic trauma is very important in the hearing protection projects concerning workers occupationally exposed to noise. The authors present a computerized system which allows collection and analysis of the results of medical and audiometric examinations. Computer analysis of audiometric data helps to select and protect the workers with dynamic progression of hearing impairment. We believe that the hearing protection system we propose may improve medical care for the workers at risk.


[Effects of selected factors on the degree of psychomotor efficiency of welders in a railroad car factory with automated work stations (robots)].

The study of 64 welders employed at automated work stands in the railway car factory conducted in 1989 and 1990 has shown that the psychomotor efficiency level in the examined workers (except for a few cases) was normal. The psychomotor efficiency of the welders studied depended on their age, work day phase and, to a small degree, on the detected biochemical and toxicological disorders.


[Changes in the levels of tissue polypeptide antigen and carcinoembryonic antigen in the blood of workers exposed to aromatic amines].

The tissue polypeptide antigen (TPA) and carcinoembryonal antigen (CEA) are the markers used for screening and treatment monitoring of the bladder cancer. A study was carried out in a group of 38 workers chronically exposed to aromatic amines in a dye factory. The findings were compared with those of he study on CS2 exposure and for the non-exposed workers. The results revealed a statistically significant differences between TPA values in the exposed and non-exposed workers. This finding does not apply to CEA. No significant differences between the markers' values were found in the group of workers exposed to CS2. The highest percentage of abnormal values, 29.2%, refers to the workers with a low acetylation phenotype; taking into account the smoking habit the TPA value would amount to 102 U/L in the smokers and to 64.8 U/L in the non-smokers. The studies indicate the higher usefulness of TPA as a marker of the effects of exposure to aromatic amines than that of CEA.


[Immunological profile of workers occupationally exposed to chlorine].

Immunological profile of 42 men working under exposure to chlorine for a period from 2 to 38 years was analysed. Toxicological analyses of air samples which were carried out for 20 years showed similar chlorine concentration ranging from 0.21 to 1.05 mg/m3. The number of B, T, and non-B, non-T lymphocytes was determined as well as the C3c, C4 complement components and proteins of acute phase reaction: alpha 1-acid-glycoprotein, haptoglobin and ceruloplasmin in the serum. Chronic exposure to chlorine produced a stimulating effect on the immune system, which was manifested by elevated IgA, IgD and IgM levels, the concentration of acute phase reaction proteins and increased number of B lymphocytes. The observed phenomenon had no influence on the antibacterial and anticancer immunity of the workers.


[Chronic bronchitis and respiratory capacity of the lungs in miners from a specific coal mine].

In the group of 3317 miners of one coal mine, who were employed for over 8 years, the prevalence of chronic bronchitis (ch.b.) and lung ventilation disorders was analysed. The frequency of ch.b. in the subjects under study was almost twice as high as in the general male population in Poland and significantly more frequent in miners with pneumoconiosis than in those without pneumoconiosis. Simple pneumoconiosis and ch.b. contributed to decreased ventilatory capacity of the lung.


[Evaluation of the immune system in workers engaged in the production of coal derivatives].

The study involved 361 people, 161 of whom were workers of coke plants and the remaining 200 constituted the control group. The coke plant workers were divided into the exposed and non-exposed groups. All of them were subject to the following tests: rosette test, determination of B lymphocytes, determination of the concentration of IgG, IgA, IgM immunoglobulins, and NBT granulocyte reduction test only were found in group I. Subgroups Ia, IIa, IIIa were established, in which subpopulations of T, TH-helper, TS-suppressor, TH and NK (Natural Killer) lymphocytes were discovered in group Ia. The above observations can probably be associated with exposure to tar substances which contain pyrenes.


[Morbidity among workers exposed to lead--review of epidemiological studies].

The paper presents a review of morality studies for workers occupationally exposed to lead. The authors highlighted the limitations which most of the reviewed analyses suffer from and which are due mainly to incomplete characteristics of the exposure in question. As follows from the results of morality studies carried out so far, lead-exposed workers are subject to an increased risk of death from stomach and lung cancer, though the epidemiologic evidence for the latter is not quite explicit. The single reports on the risk of cerebrovascular diseases probably concerns only the high-level exposure. Relatively best documented is the death risk due to nephritis. The authors believe that further research is necessary in order to evaluate delayed health effects of chronic exposure to lead.


[An atypical case of acute zinc poisoning].

The paper discussed a case of acute zinc intoxication in a 48-year old welder, after four days of cutting zinc-plated pipes with an oxy-acetylene torch, in poorly ventilated places. The zinc fever has been diagnosed on the basis of the symptoms and confirmed by laboratory findings: high zinc blood and erythrocyte concentration and increased urinary excretion of zinc. One year the intoxication the manifestations of the psycho-organic syndrome with predilection to pseudoneurotic reactions were still present. The non-standard factor in this case is the very short time of exposure to zinc oxide and the occurrence of chronic encephalopathy is also singular.


Molecular characterization of the trypanothione reductase gene from Crithidia fasciculata and Trypanosoma brucei: comparison with other flavoprotein disulphide oxidoreductases with respect to substrate specificity and catalytic mechanism.

Trypanothione reductase belongs to the family of flavoprotein disulphide oxidoreductases that include glutathione reductases, dihydrolipoamide dehydrogenases and mercuric reductases. Trypanothione reductase and its substrate, trypanothione disulphide, are unique to parasitic trypanosomatids responsible for several tropical diseases. The crystal structure of the enzyme from Crithidia fasciculata is currently under investigation as an aid in the design of selective inhibitors with a view to producing new drugs. We report here the cloning and sequencing of the genes for trypanothione reductase from C. fasciculata and Trypanosoma brucei. Alignment of the deduced amino acid sequences with 21 other members of this family provides insight into the role of certain amino acid residues with respect to substrate specificity and catalytic mechanism as well as conservation of certain elements of secondary structure.


Use of a cis-acting mutation to study the role of FLP-mediated recombination in the maintenance of native yeast 2 micrometer plasmids.

The 2 micrometer plasmid encodes a mechanism that ensures the partitioning of the plasmid at cell division. Little is known about the detailed mechanism of this partitioning system; for example, is there equal or unequal distribution of the plasmid molecules at mitosis? The plasmid also encodes a site-specific recombination system that is thought to be involved in plasmid copy-number amplification, although to date there has been no direct evidence that the recombination process itself is important for maintenance. We have identified a natural 2 micrometer variant that has a cis-acting mutation in the FLP-mediated recombination system. We show that this plasmid is unable to amplify in vivo. Our results demonstrate that the average copy number per cell is not affected for the mutant but there is a large clonal variation. This is a direct demonstration that plasmid partitioning results in an unequal distribution of plasmids and that FLP-mediated amplification compensates for this and therefore has an important role in maintenance.


DNA sequence determination and functional characterization of the OCT-plasmid-encoded alkJKL genes of Pseudomonas oleovorans.

The alkBFGHJKL and alkST operons encode enzymes that allow Pseudomonas putida (oleovorans) to metabolize alkanes. In this paper we report the nucleotide sequence of a 4592 bp region of the alkBFGHJKL operon encoding the AlkJ, AlkK and AlkL polypeptides. The alkJ gene encodes a protein of 59 kilodaltons. The predicted amino acid sequence shows significant homology with four flavin proteins: choline dehydrogenase, a glucose dehydrogenase and two oxidases. AlkJ is membrane-bound and converts aliphatic medium-chain-length alcohols into aldehydes. The properties of AlkJ suggest that it is linked to the electron transfer chain. AlkJ is necessary for growth on alkanes only in P. putida alcohol dehydrogenase (AlcA) mutants. AlkK is homologous to a range of proteins which act by an ATP-dependent covalent binding of AMP to their substrate. This list includes the acetate, coumarate and long-chain fatty acid CoA ligases. The alkK gene complements a fadD mutation in Escherichia coli, which shows that it indeed encodes an acyl-CoA synthetase. AlkK is a 60 kilodalton protein located in the cytoplasm. AlkL is homologous to OmpW, a Vibrio cholerae outer membrane protein of unknown function, and a hypothetical polypeptide encoded by ytt4 in E. coli. AlkL, OmpW and Ytt4 all have a signal peptide and end with a sequence characteristic of outer membrane proteins. The alkL gene product was found in the outer membrane of E. coli W3110 containing the alk-genes. The alkL gene can be deleted without a clear effect on growth rate. Its function remains unknown. The G+C content of the alkJKL genes is 45%, identical to that of the alkBFGH genes, and significantly lower than the G+C content of the OCT-plasmid and the P. putida chromosome.


Molecular and symbiotic characterization of exopolysaccharide-deficient mutants of Rhizobium tropici strain CIAT899.

We studied the symbiotic behaviour of 20 independent Tn5 mutants of Rhizobium tropici strain CIAT899 that were deficient in exopolysaccharide (EPS) production. The mutants produced non-mucoid colonies, were motile, grew in broth cultures at rates similar to those of the parent, and produced significantly less EPS than did CIAT899 in broth culture. A genomic library of strain CIAT899, constructed in pLA2917, was mobilized into all of the mutants, and cosmids that restored EPS production were identified. EcoRI restriction digests of the cosmids revealed nine unique inserts. Mutant complementation and hybridization analysis showed that the mutations affecting EPS production fell into six functional and physical linkage groups. On bean, the mutants were as efficient in nodulation and as effective in acetylene reduction as strain CIAT899, induced a severe interveinal chlorosis, and all but one were less competitive than CIAT899. On siratro, CIAT899 induced nodules that were ineffective in acetylene reduction, whereas the EPS-deficient mutants induced effective nodules. Microscopic examination of thin sections showed that nodules from both siratro and bean plants inoculated with either CIAT899 or an EPS-deficient mutant contained infected cells. These data indicate that EPS is not required for normal nodulation of bean by R. tropici, that it may contribute to competitiveness of R. tropici on bean, and that the loss of EPS production is accompanied by acquisition of the ability to reduce acetylene on siratro.


A novel transcriptional regulation mechanism in the flagellar regulon of Salmonella typhimurium: an antisigma factor inhibits the activity of the flagellum-specific sigma factor, sigma F.

We have studied the molecular mechanism of the negative regulation by flgM of the late operons of the flagellar regulon of Salmonella typhimurium. A 7.8 kDa protein that was identified as the flgM gene product was purified to homogeneity; its amino-terminal sequence was identical to the deduced sequence except for the lack of the initiating methionine. The purified FlgM repressed transcription from the fliC promoter, one that is activated by the sigma factor, FliA (sigma F). No DNA-binding activity was detected in FlgM. Chemical cross-linking experiments showed that the purified FlgM bound to sigma F and disturbed its ability to form a complex with RNA polymerase core enzyme. These results indicate that FlgM is a novel type of negative regulator that probably inactivates the flagellum-specific sigma factor through direct interaction, i.e. it is an anti-sigma factor.


A putative anaerobic coproporphyrinogen III oxidase in Rhodobacter sphaeroides. II. Analysis of a region of the genome encoding hemF and the puc operon.

The puc operon of Rhodobacter sphaeroides encoding polypeptides of the major light-harvesting complex, LH2, has been found to be linked to hemF, a gene encoding a putative anaerobic coproporphyrinogen III oxidase. The puc-hemF region of the R. sphaeroides genome has been investigated by insertional mutagenesis, complementation analysis of these insertional mutants and DNA sequencing. A third gene, designated pucC, has been found immediately downstream of pucA and has been shown to be essential for LH2 expression. pucC is cotranscribed with pucB and pucA; however, hemF and the pucBAC operon were found not to be transcriptionally linked. Ultrastructural studies indicated that the morphology of the intracytoplasmic membrane may depend upon expression of pucC as well as pucBA.


Cloning, mapping and nucleotide sequencing of a gene encoding a universal stress protein in Escherichia coli.

The response of non-differentiating bacteria to nutrient starvation is complex and includes the sequential synthesis of starvation-inducible proteins. Although starvation for different individual nutrients generally provokes unique and individual patterns of protein expression, some starvation stimulons share member proteins. Two-dimensional polyacrylamide gel electrophoresis revealed that the synthesis of a small (13.5 kDa) cytoplasmic protein in Escherichia coli was greatly increased during growth inhibition caused by the exhaustion of any of a variety of nutrients (carbon, nitrogen, phosphate, sulphate, required amino acid) or by the presence of a variety of toxic agents including heavy metals, oxidants, acids and antibiotics. To determine further the mode of regulation of the protein designated UspA (universal stress protein A) we cloned the gene encoding the protein by the technique of reverse genetics. We isolated the protein from a preparative two-dimensional polyacrylamide gel, determined its N-terminal amino acid sequence, and used this sequence to construct a degenerate oligonucleotide probe. Two phages of the Kohara library were found to contain the gene which then was subcloned from the DNA in the overlapping region of these two clones. The amino acid sequence, deduced from the nucleotide sequence of the uspA gene, shows no significant homology with any other known protein. The uspA gene maps at 77 min on the E. coli W3110 chromosome, and is transcribed in a clockwise direction. The increase in the level of UspA during growth arrest was found to be primarily a result of transcriptional activation of the corresponding gene. The induction was independent of the RelA/SpoT, RpoH, KatF, OmpR, AppY, Lrp, PhoB and H-NS proteins during stress conditions that are known to induce or activate these global regulators. The -10 and -35 regions upstream of the transcriptional start site of the uspA gene are characteristic of a sigma 70-dependent promoter.


Some of the out genes involved in the secretion of pectate lyases in Erwinia chrysanthemi are regulated by kdgR.

The out genes of Erwinia chrysanthemi are required for the translocation across the outer membrane of pectate lyases and cellulases. We present the characterization and the nucleotide sequence of five genes of the out cluster. The products of outS, B, C, D and E have significant homology with the PulS, B, C, D and E proteins necessary to the secretion of pullulanase in Klebsiella pneumoniae. An open reading frame, outT, located between outB and outC has no homology with the pul cluster but is involved in secretion. outC, outD and outE form an operon while outS, outB and outT constitute independent transcription units. outT and the outCDE operon are regulated by kdgR, the negative regulatory gene controlling pectinase production. outB and outS seem to be expressed constitutively.


Molecular rearrangement of lactose plasmid DNA associated with high-frequency transfer and cell aggregation in Lactococcus lactis 712.

High-frequency conjugation of the lactose plasmid pLP712 is associated with a constitutive cell aggregation phenotype and is facilitated by cointegration with a sex factor. Analysis of 23 independently derived enlarged lactose plasmids revealed that the sex factor DNA present in cointegrates varied in size. This suggested that more than simple cointegration with a sex factor plasmid was involved. Further analysis led to the discovery of a chromosomally located sex factor that could excise and be lost or exist as labile plasmid DNA. Cointegration with this sex factor was shown to be promoted by transposition of a copy of ISSI present on the lactose plasmid, and models are presented to account for the complex and variable structures of the resulting enlarged lactose plasmids.


The bgl1 gene encoding extracellular beta-glucosidase from Trichoderma reesei is required for rapid induction of the cellulase complex.

We have used a targeted gene deletion event to remove the coding region for the bgl1 gene encoding an extracellular beta-glucosidase from the genome of the cellulolytic fungus Trichoderma reesei. The bgl1 null mutants were used to investigate the role of beta-glucosidase in the hydrolysis of cellulose and induction of the other cellulolytic enzyme components. In the absence of extracellular beta-glucosidase, growth of bgl1 null strains on several carbon sources was the same as that of the parent (as measured by mycelial dry weight). However, levels of extracellular protein and total endoglucanase production were seen to lag relative to those levels observed in the control strain. The mRNA levels of the CBHI, CBHII, EGI, and EGII cellulase genes (cbh1, cbh2, egl1 and egl3) showed a corresponding lag in induction, suggesting that the absence of extracellular beta-glucosidase has an effect on the co-ordinate regulation of the other cellulase genes at the level of transcription. The addition of a potent inducer of the cellulase complex (sophorose) resulted in normal rates of cellulase gene mRNA production and extracellular protein release. This indicates that the absence of beta-glucosidase is not affecting some intrinsic cellular ability to produce mRNA or secrete protein. These data suggest that a functional beta-glucosidase is at least partially responsible for the efficient induction of the depolymerase enzymes of the cellulase complex. The observation that the cellulase complex is induced, albeit after a lag, suggests that other enzymes are present that can substitute for the function of beta-glucosidase during induction.


Targeted gene replacements in a Streptomyces polyketide synthase gene cluster: role for the acyl carrier protein.

A methodology was developed to construct any desired chromosomal mutation in the gene cluster that encodes the actinorhodin polyketide synthase (PKS) of Streptomyces coelicolor A3(2). A positive selection marker (resistance gene) is first introduced by double crossing-over into the chromosomal site of interest by use of an unstable delivery plasmid. This marker is subsequently replaced by the desired mutant allele via a second high-frequency double recombination event. The technology has been used to: (i) explore the significance of translational coupling between two adjacent PKS genes; (ii) prove that the acyl carrier protein (ACP) encoded by a gene in the cluster is necessary for the function of the actinorhodin PKS; (iii) provide genetic evidence supporting the hypothesis that serine 42 is the site of phosphopantetheinylation in the ACP of the actinorhodin PKS; and (iv) demonstrate that this ACP can be replaced by a Saccharopolyspora fatty acid synthase ACP to generate an active hybrid PKS.


The HsdS polypeptide of the type IC restriction enzyme EcoR124 is a sequence-specific DNA-binding protein.

The HsdS and HsdM polypeptides of the type IC restriction enzyme EcoR124 have been purified independently and used in a set of gel retardation experiments to determine the minimum requirements for sequence-specific recognition of DNA by this enzyme. The HsdS polypeptide alone is able to bind to DNA in a sequence-specific manner. In addition, whilst the presence of the HsdM polypeptide gives rise to a stimulation of DNA binding by the HsdS subunit it is not clear whether, under the conditions of the experiments reported here, the HsdS subunit maintains the same interactions with the HsdM subunits observed in the absence of DNA.


Mental models, pictures, and text: integration of spatial and verbal information.

In the past several years, there has been an acceleration in the publication of cognitive research on the interplay between linguistic and pictorial/spatial information. To report on and encourage this sort of research, we organized a symposium at the 1991 meeting of the Midwestern Psychological Association. The articles in this special section of Memory & Cognition are based on the work presented at the symposium. In this introduction, we offer a suggestion for why the integration of linguistic and spatial information is not only a possibility, but a requirement for effective communication. Our suggestion follows the linguistic analysis of the closed-class elements that convey spatial relations, the prepositions (Talmy, 1983). The structure of language provides but a small set of prepositions to encode the vast number of spatial relations that we can perceive. Thus, to understand a situation that a speaker or a writer is conveying, the listener or reader must combine linguistic information with (perhaps metric) spatial information derived from pictures, the environment, or memory.


Pictures and anaphora: evidence for independent processes.

Pictures enhance our comprehension of written texts, but the perceptual and cognitive processes that underlie this effect have not been identified. Because integrating the information contained in a text places demands on working memory, the effect of a picture may be to expand the functional capacity of working memory and thereby to facilitate comprehension. Reasoning thus, we predicted that the availability of a diagram would interact with the difficulty of resolving anaphoric references in texts. The resolution of an anaphor distant from its antecedent (which should stress working memory) should benefit greatly from the presentation of a picture, whereas the resolution of an anaphor near to its antecedent should benefit less from the presentation of a picture. Picture availability and distance separating the anaphor from its antecedent were manipulated in experiments involving both cumulative and moving window presentations of texts. Although picture presence and ease of anaphor resolution significantly improved comprehension of the material, no evidence was found for an interaction of these factors. The results are interpreted as consistent both with dual code theory and with aspects of working memory management that do not involve anaphor resolution.


Pictorial enhancement of text memory: limitations imposed by picture type and comprehension skill.

We examined the kinds of information in a prose passage that is better remembered when depictive illustrations are embedded in the passage than when the passage contains no illustrations. Experiment 1 showed that (1) pictures depicting details effectively increased recall of those details and (2) pictures depicting relationships effectively increased recall of that relational information (relative to a no-picture control condition). In Experiment 2, comprehension skill was found to modulate the general effects obtained in Experiment 1. Detail pictures enhanced the recall of targeted details for all skill levels. Relational pictures enhanced recall of pictured relational information for highly skilled and moderately skilled comprehenders, but not for less skilled comprehenders. Because there were no recall differences across the different skill levels in the no-picture control condition, it is suggested that pictures may serve to enable processing in which readers would not necessarily engage under ordinary circumstances. Pictures, however, did not appear to compensate for limitations reflected in lower scores on a standardized test of reading comprehension.


Descriptions and depictions of environments.

Subjects studied maps with the expectation that they would draw or describe them from memory. In fact, subjects did both. Order of drawing or describing landmarks revealed the mental organization of environments. Organization was quite similar across maps and descriptions of the same environments, revealing hierarchical structures based on spatial and functional features of the environments and on conventions for sequencing the landmarks.


Structural properties of visual images constructed from poorly or well-structured verbal descriptions.

Previous research has found a linear relation between distance and scanning times for spatial configurations when the spatial configurations were learned perceptually and when they were constructed from well-structured verbal descriptions. The current research replicated the time-distance relation when the images were constructed from repetitions of well-structured descriptions but not when the images were generated from three repetitions of a description that presented information in a random order. Six exposures to the randomly ordered information yielded the expected time-distance relation in image scanning. We posited that additional exposure to the poorly structured information allowed the image to develop the structural coherence and resolution needed to support consistent scanning. Thus, the structure of descriptions can affect the intrinsic structure of images of described objects and hence the mental operations performed subsequently on these images. Another experiment indicated that image coherence and resolution improves even after the verbal description is accurately recalled.


Switching points of view in spatial mental models.

In six experiments, subjects read narratives describing varying spatial scenes with more than one point of view. They were probed with questions about objects located in six directions from each character's point of view. Subjects' response times were consistent with a one place-one perspective rule. They seemed to form separate mental models for separate places and to take a character's perspective when there was only one relevant character in a scene, but they seemed to take a neutral perspective when there was more than one probed point of view, rather than switch perspectives.


The representation and integration in memory of spatial and nonspatial information.

A series of experiments investigated whether people could integrate nonspatial information about an object with their knowledge of the object's location in space. In Experiments 1 and 3, subjects learned the locations of cities on a fictitious road map; in Experiments 2, 4, and 5, subjects were already familiar with the locations of buildings on a campus. The subjects then learned facts about the cities on the maps or the buildings on the campus. The question of interest was whether or not these nonspatial facts would be integrated in memory with the spatial knowledge. After learning the facts, subjects were given a location-judgment test in which they had to decide whether an object was in one region of the space or another. Knowledge integration was assessed by comparing levels of performance in two conditions: (a) when a city or a building name was primed by a fact about a neighboring city or building, and (b) when a city or a building name was primed by a fact about a distant city or building. Results showed that responses in Condition a were faster or more accurate, or both faster and more accurate, than responses in Condition b. These results indicate that the spatial and nonspatial information were encoded in a common memory representation.


Abstract versus modality-specific memory representations in processing auditory and visual speech.

Serial recall of lip-read, auditory, and audiovisual memory lists with and without a verbal suffix was examined. Recency effects were the same in the three presentation modalities. The disrupting effect of a suffix was largest when it was presented in the same modality as the list items. The results suggest that abstract linguistic as well as modality-specific codes play a role in memory for auditory and visual speech.


Individual differences in bridging inference processes.

The role of individual differences in bridging-inference processing was studied. Students (n = 135) read passages of short to moderate length. After each one, they answered corresponding questions about inferences that bridged causally related ideas that were either near or far apart in the text. The main hypothesis was that local bridging-inference processing is facilitated by the reader's predisposition to access pertinent knowledge during comprehension. Regression analyses provided support for this proposal and indicated that greater working-memory capacity and vocabulary knowledge promote inference processing. The following relationships between the predictors and inference processing were proposed: Knowledge access promotes the co-occurrence in working memory of the text ideas and knowledge needed to compute the bridge. Working-memory capacity enhances the likelihood that needed antecedent ideas will be available to the bridging processes. Vocabulary knowledge may promote inference processing because unfamiliar word meanings place more demands on working-memory resources than do familiar meanings.


Dissociations among memory measures in memory-impaired subjects: evidence for a processing account of memory.

Deficits in conceptual transfer on both implicit and explicit memory tests were obtained for memory-impaired temporal lobe epileptic (TLE) subjects in three studies. In Experiment 1, in which a generate-read paradigm was employed, memory-impaired TLEs failed to show normal generation effects on conceptually driven tests of semantic cued recall and general knowledge questions, although their data-driven memory as measured by word-fragment completion and graphemic cued recall tasks was normal. In Experiment 2, memory-impaired patients having left temporal lobe seizure foci were tested on these four tasks and compared with nonimpaired TLEs having right temporal foci. The left TLEs showed deficits on conceptually driven tasks and normal memory for data-driven tests. These findings were extended in Experiment 3, in which left TLE patients failed to show any benefit from blocked study, as compared with random study, on category production and semantic cued-recall tests, although right TLEs and normal controls showed blocking effects on both tasks. These findings may be accommodated by a processing framework of memory in which memory-impaired patients are characterized as having deficits in conceptual, but not in data-driven, processing capabilities.


In search of a strong visual recency effect.

When a sequence of visual stimuli is presented in a fixed location, immediate serial recall of the sequence is characterized by only a small recency effect. According to Battacchi, Pelamatti, and Umiltà (1990), the distribution of visual stimuli over space, as well as time, greatly enhances the recency effect. After an initial failure to find a strong visual recency effect with distributed presentation (Experiment 1), in the remaining experiments an attempt was made to more closely approximate Battacchi et al.'s methodology by eliminating articulatory suppression (Experiments 2-7), using their stimuli (Experiments 3-7), blocking conditions (Experiments 4-7), requiring written rather than typed responses (Experiments 5-7), and using their list length (Experiments 6 and 7). Nevertheless, even when their method was followed as closely as possible (Experiment 7), distributed presentation did not produce a strong visual recency effect. The influence of distributed presentation on the visual recency effect would seem to be, at best, limited.


Effect of local context of responding on human judgment of causality.

Two experiments examined the effect of various relationships between a response (pressing the space bar of a computer) and an outcome (a triangle flashing on a screen) on judgments of the causal effectiveness of the response. In Experiment 1, when responses were required to be temporarily isolated from each other prior to an outcome, ratings of the causal effectiveness of the responses were higher than in a condition in which the probability of an outcome following a response was the same but in which no temporal isolation was required. In Experiment 2, when a number of responses were required to be emitted temporally close to the outcome, ratings of the causal effectiveness of the responses were lower than in a condition in which the probability of an outcome following a response was the same but in which no temporal proximity was required. These results suggest that, in addition to the overall probability that an outcome will follow a response, the local context of responding at the time an outcome is presented is critical in influencing ratings of causal effectiveness.


Cuing effects and associative information in recognition memory.

Item recognition requires discrimination of studied words from nonstudied words. Associative recognition requires subjects to discriminate studied word groups from recombinations of words from different groups. Cued recognition requires the same old-new discrimination as item recognition, but list items are presented as cues along with the test item. The results from three experiments show (1) little or no effect of cuing for low-frequency words, but (2) positive cuing effects for high-frequency words; (3) increasing levels of overall performance with increases in study time, but (4) unchanging effects of cuing with study time; and (5) stronger positive cuing effects for two cues than for one cue. Five models (Independent Cue Model, Matrix model, MINERVA 2, SAM, and TODAM) were fit to the data of Experiment 1. Each model has trouble with at least one aspect of the results. Theoretical implications and modifications are discussed at length.


Attitudes of Vietnamese women to baby feeding practices before and after immigration to Sydney, Australia.

The purpose of this study was to explore Vietnamese women's attitudes, behaviour and beliefs towards baby feeding practices before and after immigration to Sydney. Findings from 70 questionnaires and 20 in-depth face-to-face interviews with ethnic Vietnamese women indicated that Vietnamese women's preference towards baby feeding practices was shaped by their health beliefs, which in turn were influenced by the social, cultural and economic environment of the host country. Changing to bottle feeding was an adaptation process, a bridge between the old and the new environments. Recommendations have been made regarding ways of promoting breast feeding among immigrant women.


Systems of midwifery care in use in Scotland.

A survey was undertaken to identify the different systems of midwifery care in use in hospital and community settings in Scotland. The 53 units which responded provided 90% of the maternity care in Scotland. Of the 53 units, the 28 integrated units undertook 83% of Scottish births and were more likely than the non-integrated units to have implemented systems designed to reduce fragmentation of care. Nearly a fifth of units had five different systems of care in operation. More than half the units had at least one of the following systems of care in operation or under planning: individualised care plans; 'patient allocation'; DOMINO schemes; nursing/midwifery process or model; and team midwifery. The most frequently used system was planning individualised care (88% of the units). 'Patient allocation', nursing/midwifery process or model and the DOMINO scheme were in over 60% of the units. The least used system was team midwifery, which was in operation in 21% of the units and being planned for a further 30%. The use of the different systems in combination within a number of units demonstrates that approaches to the objective of continuity of care are complex. There is a need for further research into continuity of care as this is a commonly cited advantage of all five systems of care.


The impact of research findings on current practice in relieving postpartum perineal pain in a large district general hospital.

In order to study the impact of research findings on current clinical practice 100 members of midwifery and medical staff of a large district general hospital were surveyed regarding their treatment of postpartum perineal pain. Of the 76 who responded only 20 (26%) referred to research findings to support their clinical practice and in only one case was the research appropriate to the population in question. Important research findings were not applied, while the majority of the reported practice was not research-based. Research-based practice is not only the responsibility of the individual clinician but also of those at educational and management levels. Local strategies should be developed and resources made available to facilitate research utilisation and implementation.


Early postpartum discharge--an alternative to traditional hospital care.

In a predictive study of early postpartum discharge data were collected to justify a proposal that was being developed by a city hospital and the Local Board of Health to provide maternity care for women who wished to be discharged early from hospital following childbirth. In this paper the findings of the predictive study are presented and then compared with the findings from the evaluation of the project which was implemented by the hospital and the Local Board of Health. Overall, the findings from the predictive study were accurate when compared to the findings from the evaluation study. The similarity of findings in both studies demonstrates the value of undertaking a predictive study prior to planning changes in delivery of health care to a specific population.


A preliminary evaluation of education material prepared for the Safe Motherhood Initiative Educational Project.

Maternal death is a tragedy which is all too familiar in much of the world. As part of the Safe Motherhood Initiative the World Health Organization is developing and producing a learning package designed specifically for midwives. Through a modular system of learning incorporating aspects of community, prevention, treatment and follow-up the package seeks to address the five main causes of maternal mortality. In this paper the first pre-testing of the educational material in an African country is described. The extent of the evaluation is limited at this early stage but the initial analysis of the results is encouraging and have led to modifications of the original package. The evaluation has confirmed that a tool such as this package can be a valuable resource for midwife teachers attempting to improve the relevance of education for their midwifery students. The midwifery students whilst being 'with woman' in childbirth are also grappling with the realities of death in their everyday practice. The educational package has also reinforced the sense of urgency fundamental to completing this extensive project so that it can be made available to midwives throughout the developing world at the earliest opportunity.


Electrophoretic mobility and immunoblot analysis of the outer membrane proteins of Aeromonas hydrophila, A. sobria and A. caviae.

The outer membrane profiles of three species of the genus Aeromonas were examined by means of SDS-PAGE and immunoblotting to identify species-specific polypeptides and antigens which could presumably be applied to differentiate Aeromonas spp. at the species or subspecies level. Profiles on an 11% discontinuous SDS-PAGE showed common band sharing at the 52 kD position. Species-specific bands for the three strains could also be detected. Immunoblots using heterologous LPS-adsorbed polyclonal antisera revealed demarcated common and uncommon antigens within the three species. Outer membrane preparations were immunoblotted against whole cell polyclonal antisera. The previously documented host pathogenicity of A. sobria correlated well with the immunoblots which showed antigenicity, especially due to the LPS, when compared with the other two species.


Susceptibility of sixty-five non-oral clinical isolates of the Streptococcus milleri group to seven antimicrobial agents.

Antimicrobial susceptibilities of sixty-five non-oral Streptococcus milleri group clinical isolates to penicillin, gentamicin, lincomycin, ampicillin, chloramphenicol, tetracycline and erythromycin were determined by an agar dilution method. All strains were penicillin-sensitive (MIC < or = 0.031 microgram/ml) and the majority (64/65) were susceptible to erythromycin (MIC < or = 0.125 microgram/ml). Low-level resistance to gentamicin was observed, and the majority of strains possessed an MIC of 8 micrograms/ml. Lincomycin and ampicillin at 0.5 microgram/ml inhibited 52/65 and 61/65 strains, respectively. Of the isolates 92% were inhibited by chloramphenicol at < or = 2 micrograms/ml. Twenty-two S. milleri group strains (of which thirteen were vaginal isolates) were resistant to tetracycline (MIC > or = 8 micrograms/ml).


beta-N-acetylhexosaminidases from Serratia marcescens.

Two forms of beta-N-acetylhexosaminidase from Serratia marcescens with an optimum pH of 5.0 and 6.5, respectively, to 4-methylumbelliferyl-2-acetamido-2-deoxy-beta-D-glucopyranoside were separated by DEAE-cellulose chromatography and Sephacryl S-200 chromatography. On the basis of their molecular weights, thermal stability, substrate specificity and isoelectric points, the form with an acidic pH optimum resembled hexosaminidase B, whereas the form with a neutral pH optimum resembled hexosaminidase C. Lectin binding studies showed that the acidic form does not bind to concanavalin-A-Sepharose, Tetragonolobus purpurea-agarose, wheat germ-agglutinin-Sepharose or Ricinus communis-agglutinin-agarose, whereas the neutral form binds to the last two lectin columns.


Inhibition of the electron transport system in Staphylococcus aureus by trimethylamine-N-oxide.

Trimethylamine-N-oxide (TMAO) inhibited the growth of Staphylococcus aureus but not of S. epidermidis, which is the main flora in ripening squid, the Japanese traditional sea food Ika-shiokara. This selective inhibition of S. aureus was based on the inhibition of the electron transport system. The cytochrome fraction isolated from S. aureus was converted from the reduced to the oxidized form by the addition of TMAO. It is suggested that the inhibition occurred between cytochrome B and cytochrome o.


The significance of testing for Pseudomonas aeruginosa in recreational seawater beaches.

The occurrence of Pseudomonas aeruginosa and faecal coliforms in Mediterranean sea water from beaches was investigated. Water samples (1,598 in toto) were tested and P. aeruginosa was found in 222 samples (14%). In 31% of samples where P. aeruginosa was detected, faecal coliforms of less than ten bacteria per 100 ml were found. In a group of 98 samples which had > 500 faecal coliforms per 100 ml, 41% had no detectable P. aeruginosa. The inclusion of P. aeruginosa as an additional parameter for approving beaches for recreational activity is recommended.


In vitro activity of fosfomycin against 'problem' gram-positive cocci.

Fosfomycin was active in vitro against 54 of 60 'problem' Gram-positive cocci (20 methicillin-resistant Staphylococcus aureus, 20 coagulase-negative staphylococci and 20 enterococci). Its activity was significantly greater under anaerobic conditions, especially against coagulase-negative staphylococci. Mutants resistant to fosfomycin were readily demonstrated, but their growth was prevented by rifampicin or ciprofloxacin. The combinations rifampicin+fosfomycin and ciprofloxacin+fosfomycin showed MIC synergy. It is concluded that fosfomycin in an appropriate combination would be a valuable addition to the small and dwindling range of antibiotics active against problem Gram-positive cocci.


[The cloning of fragments of the streptomycete plasmid pSG1912 as a part of the vector pUC19].

DNA fragments of plasmid pSG1912 isolated from Streptomyces globisporus 1912 have been cloned into vector pUC19 in the E. coli cells. Stability of inheritance of hybrid derivatives in enterobacteria has been studied. The clones where recombinant plasmids are stably inherited have been chosen. The detailed restriction maps of cloned DNA fragments of pSG1912 have been constructed.


[The comparative characteristics of Vibrio cholerae hemolysins].

Biochemical and biological properties of in vivo and in vitro hemolysins of cholera germs isolated by different authors as well as hemolysins of Vibrio parahaemolyticus and Escherichia coli have been comparatively characterized. According to the above data hemolysin of cholera germ El Tor is a thermolabile protein with molecular mass of 60-80 thou.; it is cytotoxic, enteropathogenic and lyses all the species of erythrocytes. Hemolysins of V. eltor and germs are immunologically related. Hemolysin of the cholera germ is thermostable and has molecular mass of 20-40 thou., that makes it similar to hemolysin of V. parahaemolyticus.


[The properties of cell wall hydrolysates of Streptococcus group A].

Products obtained from lysis in the cell wall of group A streptococcus have been studied in different growth phases: at the end of the exponential phase and in the stationary one. Endo-beta-N-acetylmuramidase extracted from the culture liquid of Streptomyces levoris 96 has been used for lysis of streptococcus. It is stated that streptococcus cell walls isolated at different growth stages differ in the protein and polysaccharide content. High content of protein in the cell wall of a young culture makes lower the initial rate of the walls' hydrolysis by endo-beta-N-acetylmuramidase. However, with the enzyme penetration into peptidoglycan the rate of hydrolysis of cell walls gets higher and after four-hour incubation the lysis degree of walls of the 16- and 8-hour cultures reaches the equal value (63%). Studies in the protein composition of lysates of the streptococcus cell walls have shown that they contain at least 12 proteins most of which are acid and neutral ones.


[The kinetics of glycol destruction by a Pseudomonas putida BS-2 strain].

Destruction of ethylene glycol and diethylene glycol by Pseudomonas putida BS-2 culture under conditions of its batch cultivation has been studied for its physiological regularities. The specific rate of the biomass growth in the region of limiting substrate concentrations depends on the diethylene glycol concentration in the medium and follows the Mono equation. A semisaturation constant for diethylene glycol is 209 +/- 17 mg/d. The specific rate of the culture growth is independent of the ethylene glycol concentration in the medium within a wide range from 0.08 to 10 g/l. Kinetics of the bacteria growth inhibition by excess of substrates is a complex character and obeys none of the known models of the substrate inhibition.


Deaths from snake bite in Australia, 1981-1991.

To obtain and analyse data relating to snake bite fatalities in Australia. Retrospective analysis of case reports and collation of studies carried out at the Commonwealth Serum Laboratories (CSL). 18 deaths attributed to snake bite were reported to CSL over a 10-year period. Eleven of the victims were males and four of these were bitten after either picking up the snake or playing with it. In most cases, no pathological findings of significance were found at autopsy. Venom was detected in post-mortem samples from nine cases. Brown snakes (genus Pseudonaja) were responsible for 11 deaths; tiger snake (Notechus scutatus) for four, taipan (Oxyuranus scutellatus) two and death adder (Acanthophis australis) one. Death after a brown snake bite was often sudden and unexpected. In three patients bitten by tiger snakes and in one bitten by a brown snake, the presence of cerebral haemorrhage was confirmed at autopsy. Not all snake bite deaths in Australia are adequately investigated or reported. Under some circumstances death from snake bite is almost inevitable; two infants who received unwitnessed massive envenomations are tragic examples. Had venom absorption from the bitten area been delayed by correct first aid, some of the patients might have survived. The brown snakes (genus Pseudonaja) must now be considered Australia's most dangerous group of snakes because their venom may cause sudden unexpected collapse and death. The increased incidence of intracranial haemorrhage may in some cases be related to the intravenous use of adrenaline. In at least one case, the prompt administration of a clearly needed antivenom might have altered the outcome.


Quokka bites. The first report of bites from an Australian marsupial.

To describe the incidence and natural history of bites from the quokka, a small wallaby. A prospective case series. Rottnest Island Nursing Post, a small hospital staffed by registered nurses on call 24 hours a day, located on Rottnest Island 18 km off the coast of Western Australia near Perth. All patients presenting after a bite from a quokka. Seventy-two patients (30 males and 42 females) presented after a bite. All but two patients were patting or feeding a quokka at the time of being bitten, and all but two were bitten on a finger or the thumb. Sixty-one per cent of patients were followed up; all wounds healed without complications. No wound pathogens were cultured from either wound swabs or swabs of the mouths of quokkas. Bites from quokkas heal without complications, usually in two to three weeks. Simple first aid and tetanus prophylaxis where appropriate are all that is required. Antibiotics are not indicated.


Scombroid poisoning. A report of seven cases involving the Western Australian salmon, Arripis truttaceus.

To present the clinical findings of scombroid poisoning due to ingestion of the Western Australian salmon, Arripis truttaceus, occurring in two separate outbreaks involving seven patients. Both outbreaks occurred in March and the fish had been caught in South Australian waters. Onset of symptoms in all patients occurred within half an hour of ingestion of the affected fish. The clinical syndrome included erythema and urticaria of the skin, facial flushing and sweating, palpitations, hot flushes of the body, headache, nausea, vomiting and dizziness. The fish implicated in one outbreak was noted to have a peppery taste. The diagnosis of scombroid poisoning was confirmed by the presence of the clinical syndrome, and by demonstration of high histamine levels in the cooked fish. Two patients had minor symptoms which had resolved before seeking medical advice. Another two patients had mild symptoms which disappeared after two hours of observation and required no specific treatment. Three patients had evidence of major toxicity which was successfully treated with parenterally administered promethazine. One of the three patients with major toxicity required overnight admission and repeated doses of promethazine to eradicate her symptoms. No patient had symptoms for longer than 12 hours. Scombroid poisoning is caused by ingestion of fish which has accumulated scombrotoxin during spoilage. The toxin is heat stable and has been identified as histamine. The clinical presentation closely resembles an acute allergic reaction. This similarity in symptoms may result in the diagnosis of scombroid poisoning being missed by clinicians. Patients with the symptom complex may be incorrectly informed that they are allergic to the fish species. Diagnosis is clinical and can be confirmed by analysis of the histamine content of the fish. Treatment is with antihistamines, however major toxicity may require the same aggressive management as acute anaphylaxis.


Crocodile attacks in the Northern Territory of Australia.

To examine crocodile attacks in the Northern Territory with particular reference to risk factors, range of injuries, microorganisms isolated from wounds, and surgical management; and to make recommendations for optimal treatment. The case notes of patients treated at the Royal Darwin Hospital within the last decade were reviewed retrospectively. Autopsy and newspaper reports for the same period were also reviewed. There were 16 reported crocodile attacks in Northern Territory waters from June 1981 to June 1991. Four of these were fatal. Most attacks resulted from swimming or wading in shallow water (13/16). Half the victims were known to be affected by alcohol. The majority of attacks occurred in failing light or at night (10/16). Injuries in survivors ranged from minor lacerations and puncture wounds to major abdominal, chest and limb trauma. Death in fatal attacks was caused by transection of the torso or decapitation. Microorganisms isolated from wound swabs included Pseudomonas, Enterococcus, Aeromonas and Clostridium species. Most attacks in this series could have been prevented by taking adequate precautions. The treatment of crocodile injuries must include (i) adequate wound cultures, (ii) antitetanus prophylaxis, (iii) meticulous wound debridement, (iv) appropriate broad spectrum prophylactic antibiotics and (v) allowing healing by secondary intention or delayed primary closure where appropriate.


Medical litigation. The aetiological role of psychological and interpersonal factors.

The present paper focuses upon psychological factors which may cause patients to make formal complaint or embark upon legal proceedings against a doctor despite competent medical management. Although the principles involved arose from experience of liaison psychiatry in neonatal and obstetric settings, they are more broadly applicable to other areas of medical practice. The corner stone of prevention is appropriate psychological management. One of the most common forms of psychological mismanagement is a failure to share information openly with patients when it becomes available. Sometimes, despite exemplary medical and psychological management, grievance proceedings are still initiated. Often in such cases the cause lies in the patient's psychopathology. Finally, formal complaint or litigation may arise as a result of the patient's unrealistic expectations of the doctor.


Ocular injuries caused by magpies.

This paper presents a series of six patients with ocular injuries resulting from magpie attacks. Five cases involved children. In two cases the penetration was overlooked initially. In one case the keratitis was caused by Bacillus cereus. Full ophthalmic examination, including indirect ophthalmoscopy and microbiological studies, must be undertaken initially to identify unrecognised eye injuries and to prevent the possible sight-threatening complications of vitreal fibrosis with subsequent retinal detachment or endophthalmitis.


The role of foxes Vulpes vulpes in the epidemiology of Echinococcus granulosus in urban environments.

To survey the prevalence of intestinal worms, particularly Echinococcus granulosus, in foxes in Canberra. The locations of foxes seen in Canberra during this study were recorded. Foxes and macropod marsupials killed on the roads of Canberra were collected and examined for the presence of intestinal helminths and hydatid cysts respectively. The intestinal contents of the foxes were washed through a fine sieve and examined microscopically. All helminths recovered were collected and identified. All the internal organs of the macropods were examined for any cystic lesions. Forty-five foxes and 44 macropods were examined. Echinococcus granulosus was found in three of the foxes (7%). Hydatid cysts were not found in the internal organs of any of the macropods examined. Echinococcus granulosus is present in the urban fox population of Canberra. This hitherto unreported aspect of the epidemiology of E. granulosus in Australia could be a potential public health risk to urban populations.