Rapid Confirmation Research Articles

Detection of koi herpesvirus DNA in tissues of infected fish

A newly recognized herpesvirus, koi herpesvirus or KHV, causes a lethal disease in common carp, Cyprinus carpio, and its colourful strain known as koi or fancy carp. In this study, we report new outbreaks of the disease, present initial characterization of the KHV genome, and describe assays for detection of KHV DNA in infected cells and tissues of infected fish. Restriction endonuclease (RE) profiles of viral DNA derived from two epidemiologically distinct KHV isolates were identical to each other. Cloned KHV BamHI and SphI DNA probes specifically hybridized to KHV DNA, but not to DNAs derived from a variety of other fish herpesviruses. The KHV DNA probes detected KHV DNA in tissues of experimentally infected koi fish by DNA hybridization. The KHV specific polymerase chain assays (PCR) were developed for rapid detection and confirmation of KHV DNA in tissues of infected fish.

Does Rapid Diagnosis of Influenza Affect Emergency Department Management

Source: Sarma V, Dowd MD, Slaughter AJ, et al. Effect of rapid diagnosis of influenzae virus type A on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med. 2002;156:41–43.One aim of the evaluation of the febrile infant and young child is to distinguish between bacterial and viral illnesses. This is especially dif. cult in winter when rates of influenza infection may reach as high as 10–40% because the symptoms of influenza (fever, cough, and irritability) can raise concerns of bacterial pneumonia, bacteremia, or meningitis. These authors from Children’s Mercy Hospital, Kansas City, Missouri, sought to determine the effect of rapid diagnosis of influenza virus type A (IVTA) on the clinical management of febrile infants and toddlers in a pediatric emergency department (ED). An electronic medical record review over 2 consecutive winter seasons identified 2,772 children 2–24 months old with temperature greater than 39°C who presented to the ED. During the first season (1998–99) the rapid test for IVTA was only available 5 days/week, 8 hours/day, whereas in the 1999–2000 season it was available 24 hours/day, 7 days/week. Of 183 (6.6%) children tested for IVTA, 72 were positive. Two groups of children with positive results were compared: an early diagnosis group whose results were known before discharge from the ED (n=47) and a late group whose diagnosis became available only after discharge from the ED. The groups did not differ significantly for age, triage category, temperature, white blood cell count, chest radiograph performed, mean length of stay in the ED, mean charges, or admission to an inpatient unit. Fewer patients in the early diagnosis group received ceftriaxone (2% versus 24%, P=.006) when compared to those in the late diagnosis group and there were fewer urinalyses (2% versus 24%, P=.006) and complete blood counts performed (17% versus 44%, P=.02). The authors conclude that rapid confirmation of IVTA infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED.While history and physical examination often suffice to differentiate viral from bacterial illness, the uncertainty of “non-specific viral illness” may lead to unnecessary testing and use of antibiotics. In fact, in a recent study 48% of pediatricians surveyed said that parents often pressure them to prescribe unnecessary antibiotics and 34% of them occasionally or more frequently comply with these requests.1 The study abstracted above suggests that if the underlying diagnosis is known early it can modify the patient’s evaluation and management. There are some important limitations to this study. Only a small subset of the 2,772 eligible febrile children were tested at the discretion of the managing physician and the results were analyzed retrospectively. The authors do not report the average time delay for influenza test results in either the early or late groups, or when the influenza test was done relative to other laboratory or radiologic testing. Furthermore, we do not know whether the positive influenza test led to fewer follow-up visits to the primary care provider or the ED, or if any of these patients were subsequently diagnosed with serious bacterial infections.To be sure, many influenza-like illnesses are not due to the influenza virus but, rather, to other respiratory pathogens such as rhinoviruses, respiratory syncytial viruses, parainfl uenza virus, or adenovirus. Moreover, bacterial illness can complicate the course of influenza. However, a rapid test, if positive, can focus further management as we have seen with the wide use and impact of rapid group A streptococcal testing. The availability of a rapid, specific test for influenza at a reasonable cost may eventually lead to less lab testing, radiography, empiric antibiotic use, and hospitalization. One caveat: since the study excluded infants less than 2 months of age, it remains unclear whether a positive IVTA in that age group should limit testing for bacterial illnesses.

Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic

Background: Polymerase chain reaction (PCR) has well established advantages over culture for diagnosis of herpes viruses, but its technical complexity has limited its widespread application. However, recent methodological advances have...

Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers.

Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined. To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital. A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared-those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis). Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%, P =.006); there were fewer urinalyses (2% vs 24%, P =.006) and complete blood cell counts performed (17% vs 44%, P =.02). Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.

Incidence and Polymerase Chain Reaction Assay of Listeria monocytogenes from Raw Milk in Gyeongnam Province of Korea

A total of 50 raw milk samples from Gyeongnam Province of Korea were examined for the incidence of Listeria monocytogenes between July 1998 and August 1998. L. monocytogenes isolated by biochemical test was confirmed by polymerase chain reaction (PCR) with two sets of primers designed from the invasion-associated protein (iap) gene. After standard PCR with external primers, the amplified DNA was confirmed by a second round of PCR with internal primers (nested PCR). Both the external and internal primers generated 468-bp and 287-bp products, respectively. Only one (G9 strain) of the three suspect samples that tested positive in biochemical tests for L. monocytogenes from 50 raw milk samples was also PCR positive. Following this procedure, PCR-positive G9 strain was confirmed by Southern blot using the 287-bp internal iap probe again. The detection limit of G9 strain by standard PCR assay was as few as 102 cells, equivalent to approximately 1 pg of L. monocytogenes DNA. These PCR assays may be useful for novel detection as well as rapid confirmation for L. monocytogenes from food samples and the field.

Rapid confirmation by RFLP of transfer to vaccine candidate reassortment viruses of the principal ‘high yield’ gene of influenza A viruses

Influenza vaccines must be revised constantly on almost a yearly basis because of the sequential mutations (antigenic drift) that occur as the virus responds to immunologic pressure. New, high yield (hy) reassortant viruses have proved essential to meet production needs for the supply of new vaccines. We have devised a method for simple, rapid and precise identification of the principal influenza A virus RNA segment (RNA 7) associated with hy and transferred from the hy donor virus, A/PR/8/34 (H1N1). The method entails the use of a single restriction enzyme, Bsgl, in analysis by restriction fragment length polymorphism (RFLP) of reverse transcriptase-polymerase chain reaction (RT-PCR)-generated DNA amplicons. The method clearly distinguishes the RNA coding for the M proteins of the donor virus from that of representative and epidemiologically significant human wild type viruses of the past 60 years. In the course of this methodological study further evidence has been found of the variability of the so-called ‘invariant’ and stable M1 and M2 proteins of the virus. Another finding of potentially basic significance that merits further study is the occurrence of a consistent change at the same amino acid (aa) site of the donated RNA 7 upon its transfer to reassortant viruses.

Minimally invasive, radioguided surgery for primary hyperparathyroidism.

Primary hyperparathyroidism affects 1 in 700 individuals in the United States. A single adenoma is responsible in over 85% of cases. Surgery remains the most effective treatment. This study was designed to assess the feasibility of minimally invasive radioguided parathyroidectomy (MIRP) with confirmation of excision by ex vivo radioactivity alone. Seventy-five consecutive patients with primary hyperparathyroidism were prospectively studied. Following sestamibi scan, patients underwent unilateral neck exploration guided by a handheld gamma probe, which was also used to measure ex vivo radioactivity of excised tissue. The sestamibi scan was positive in 88% of the patients. A small incision (mean, 3.2+/-0.3 cm) was sufficient. Ectopic gland sites were localized in five patients with positive scans and single adenomas. Mean operative time was 48 minutes (range, 15-125 minutes), with shorter procedures after the initial 20 cases (mean, 24 vs. 72 minutes; P < .01). Radioguided parathyroidectomy was successful in 97%, with a mean follow-up of 11 months (range, 1-26 months). As noted previously, adenomatous parathyroid glands contained more than 20% of the background radioactivity. MIRP is a feasible alternative to bilateral dissection with the advantages of guided dissection and rapid confirmation, and may become the procedure of choice for primary hyperparathyroidism.

SUSCEPTIBILITY TESTING: Phenotypic and Genotypic Tests for Bacteria and Mycobacteria

Genotypic-based methods hold promise for the rapid and accurate detection or confirmation of antimicrobial resistance; however, phenotypic methods will continue to have an advantage when resistance to the same antimicrobial agent may be caused by several different mechanisms. The diversity of genetic mechanisms may exceed the capabilities of current molecular technology. Genotypic assays have the ability to detect resistance but not susceptibility. Although resutls can be obtained rapidly, many molecular methods are labor-intensive, expensive, and lack standardization. Clinical studies will be required to validate the genotypic approach to detection of antimicrobial resistance. Molecular assays are also at risk for false-positive results because of contamination of specimens by other specimens that carry the DNA targeted for the assay, or carryover of amplified target DNA (amplicons) from a previous PCR assay during sample preparation. Detection of certain genetic resistance loci in clinical specimens must be interpreted with caution, because organisms in normal flora may also harbor the same loci. All these factors must be taken into consideration when introducing a genotypic method in the clinical laboratory. Other considerations include cost, turnaround time, and assay performance. It must be emphasized that the bedside assessment of the patient should always be considered in addition to the results of antimicrobial susceptibility tests (whether phenotypic or genotypic) so that the best outcome is assured for the patient.

Molecular Genetics of Type 1 Glycogen Storage Disease

Glycogen storage disease type 1 (GSD 1) comprises a group of autosomal recessive inherited metabolic disorders caused by deficiency of the microsomal multicomponent glucose-6-phosphatase system. Of the two known transmembrane proteins of the system, malfunction of the catalytic subunit (G6Pase) characterizes GSD 1a. GSD 1 non-a is characterized by defective microsomal glucose-6-phosphate or pyrophosphate/phosphate transport due to mutations in G6PT (glucose-6-phosphate translocase gene) encoding a microsomal transporter protein. Mutations in G6Pase and G6PT account for ∼80 and ∼20% of GSD 1 cases, respectively. G6Pase and G6PT work in concert to maintain glucose homeostasis in gluconeogenic organs. Whereas G6Pase is exclusively expressed in gluconeogenic cells, G6PT is ubiquitously expressed and its deficiency generally causes a more severe phenotype. Rapid confirmation of clinically suspected diagnosis of GSD 1, reliable carrier testing, and prenatal diagnosis are facilitated by mutation analyses of the chromosome 11-bound G6PT gene as well as the chromosome 17-bound G6Pase gene.

Detection of Mycobacterium bovis in bovine clinical specimens using real-time fluorescence and fluorescence resonance energy transfer probe rapid-cycle PCR.

Nucleic acid sequence capture extraction was coupled with LightCycler PCR amplification and product detection using real-time fluorescence for rapid, definitive detection of Mycobacterium bovis in lymph node specimens from 38 cattle with bovine tuberculosis lesions. PCR amplification of sequence-captured DNA using both a conventional heating block thermocycler and a LightCycler thermocycler was compared with culture and histopathological analyses. Conventional PCR enabled detection of 26 of 28 culture-positive specimens (93%) in approximately 9 h, and the LightCycler PCR detected 20 of 28 culture-positive specimens (71%) in only 30 min. Specific confirmation of Mycobacterium tuberculosis complex DNA was achieved by LightCycler PCR amplification using Syb Green 1 and an M. tuberculosis complex-specific Cy5-labeled fluorescence resonance energy transfer probe. The system described here enabled rapid and specific laboratory confirmation of bovine tuberculosis, and this is the first report of the detection of M. bovis in tissues using LightCycler PCR. The fluorescence technology used in the study has potential to allow development of a high-throughput molecular diagnostic test for bovine tuberculosis.

Short communication: Lassa fever in Sierra Leone: UN peacekeepers are at risk.

Lassa fever is endemic in much of West Africa, particularly in Guinea, Sierra Leone and Liberia. The conflict and population migrations in this part of the world have led to the deployment of United Nations (UN) forces who are at risk of infection. We describe a Lassa case in this group. On July 12th 2000, a member of the Indian contingent of the United Nations Mission in Sierra Leone (UNAMSIL) peacekeeping forces stationed in Daru, Kailahun District, developed the clinical symptoms of Lassa fever ( McCormick et al. 1987 ). He presented with persistent fever (103–104 °F), myalgia, headache, abdominal pain, hypotension and facial flushing. On the eighth day he developed exudative tonsillar patches, subconjunctival haemorrhage, facial oedema and ecchymosis, then developed bilateral pleural effusions and started to bleed from venipuncture sites. He was treated for 10 days with intravenous ribavirin in the UNAMSIL referral hospital in Freetown, and survived. Presently no diagnostic facilities for Lassa fever are available in Sierra Leone, and the disease often does not present with specific symptoms allowing an early clinical diagnosis. The European Community supports a research project for the surveillance of Lassa fever, yellow fever and Ebola in Côte d’Ivoire and the Republic of Guinea. Coordinated by Epicentre, laboratory back up is provided by the University of Marburg, the Pasteur Institute in Paris and the Bernhard Nocht Institute, Hamburg. After a field investigation in Daru, UNAMSIL sent serum samples from the suspected Lassa case, possible contacts and from healthy villagers by helicopter to the project laboratory in Conakry. The samples were subjected to two different Reverse Transcription/PCR reactions (targeting the glycoprotein (GP) ( Demby et al. 1994), and nucleoprotein (NP) ( ter Meulen et al. 1998) genes) and indirect immunofluorescence for detection of anti-Lassa IgM and IgG antibodies. Lassa-IgM antibodies were detected in three consecutive serum samples of the Daru case and in pleural exudate, with IgM titres ranging from 1:40 to > 1:320. IgG antibody titres ranged from undetectable to > 1:640. Viral RNA was detected only in the first serum sample, taken on day three of ribavirin treatment, and Lassa virus was successfully isolated in Marburg (biosafety level 4). Sequencing of the PCR products revealed 93% homology for the GP gene with the prototypic Lassa virus strain Josiah from Sierra Leone, and 94% for the NP gene. On the aminoacid level, homologies were 97% for both GP and NP. Nine staff members of the Indian contingent who were considered contacts of the index case tested negative both in PCR and immunofluorescence. All four samples collected from male inhabitants of villages surrounding the UNAMSIL camp were PCR and IgM negative, but three samples tested positive for IgG (titres up to 1:160), consistent with the presence of Lassa transmission in that area. Lassa fever is endemic in many regions of Sierra Leone and can be transmitted to humans through food contaminated by rodent excreta or aerosolized rodent urine. UN peacekeepers are now protected by measures to reduce human-rodent contact (proper food storage, rodent control). Prompt ribavirin treatment of clinically suspected Lassa cases remains mandatory in endemic areas, since the drug is effective only if given early in the course of the disease. However, rapid laboratory confirmation of suspected cases is desirable for clinical and epidemiological purposes. Until diagnostic facilities can be re-established in Sierra Leone, the facility in Conakry can provide screening of suspected Lassa fever cases.

Detection and differentiation of CAV-1 and CAV-2 by polymerase chain reaction.

Canine adenovirus type 1 (CAV-1) and type 2 (CAV-2) can be categorized in the laboratory by haemagglutination and neutralization tests, but they are difficult to differentiate from each other in specimens, especially when infection occurs in the digestive tract. The object of this study was to develop a simple method of detecting and differentiating them. One pair of common primers was designed and synthesized according to the sequences of the E3 and flanking regions and a polymerase chain reaction (PCR) assay was established using these two primers to amplify the virus-specific DNA fragment from clinical specimens as well as from cell cultures. After elecctrophoresis, under the same amplification conditions, 508 bp and 1030 bp PCR products were observed for CAV-1 and CAV-2, respectively. These were further shown to be adenovirus specific by dot hybridization and sequencing. As only one pair of primers was involved in the PCR procedure, it was faster and easier to perform than any of the other assays used for detecting canine adenovirus, making it applicable in the rapid confirmation of diagnosis and differentiation of the two types of canine adenoviruses.

Diagnostic value of echocardiography in cardiac tamponade.

Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, and hypotension are important clues to the diagnosis, but are non-specific. Echocardiography allows rapid confirmation of the presence or absence of an effusion, and enables assessment of its hemodynamic impact. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiographically-guided pericardiocentesis with catheter drainage is the primary treatment strategy of choice for most large or hemodynamically significant effusions. In contemporary clinical practice, echocardiography is the gold standard for diagnosis of tamponade and is essential for directing treatment.

Application of a chromogenic medium and the PCR method for the rapid confirmation of L. monocytogenes in foodstuffs

Detection of Listeria monocytogenes in foodstuffs by conventional cultivation methods carried out according to EN ISO guidelines is rather time-consuming. Therefore, two alternative methods were applied for rapid confirmation of L. monocytogenes in foodstuffs. Inoculum from liquid selective broth was plated on PALCAM and OXFORD agar and on chromogenic agar medium RAPID L. mono. Suspect colonies from PALCAM were confirmed according to EN ISO standards and by the multiplex PCR method. In total, 990 samples of foodstuffs were investigated and 63 strains of L. monocytogenes were isolated. The chromogenic medium RAPID L. mono provided results comparable to PCR, it is easier to handle and provides considerable financial savings.

Helicobacter pylori infection is associated with milder gastro-oesophageal reflux disease.

We have previously demonstrated a negative relationship between the prevalence of Helicobacter pylori and gastro-oesophageal reflux disease (GERD). To study the effects of H. pylori infection on the severity of GERD. Ethnic Chinese patients with frequent heartburn and/or endoscopic oesophagitis were studied. Endoscopic examination was performed to assess the severity of oesophagitis (modified Savary-Miller grading) and the presence of hiatus hernia. Biopsies were taken for rapid urease testing and confirmation of Barrett's oesophagus. Risk factors which may affect the severity of oesophagitis (age, sex, smoking, drinking, diabetes mellitus, hiatus hernia, H. pylori status and body mass index) were evaluated by a multiple regression model. The cagA status of H. pylori infected GERD and age-and-sex matched controls were determined by Western blot. Age-and-sex matched non-reflux patients were recruited as controls for comparison. Two hundred and twenty-five patients with GERD were studied, of whom 77 (34%) were infected with H. pylori. Oesophagitis and Barrett's oesophagus were found in 140 patients (62%) and six patients (3%), respectively. H. pylori infected patients had significantly less severe oesophagitis compared to the uninfected group (P=0.022). All patients with Barrett's oesophagus were uninfected. Factors that predicted severe oesophagitis included age over 60 years (P < 0.001) and hiatus hernia (P < 0.001). H. pylori infection was the only factor that showed a negative correlation with severe oesophagitis (P=0.011). The prevalence of the cagA positive strain in endoscopy-negative GERD, erosive oesophagitis and control subjects was 70, 76 and 78%, respectively (P=0.75). H. pylori infection is associated with milder GERD.

Rapid confirmation of previously detected prenatal mosaicism by fluorescence in situ hybridization in interphase uncultured amniocytes.

Fluorescence in situ hybridization (FISH) of chromosome-specific probes to interphase uncultured amniocytes was performed in cases in which follow-up amniocenteses were done for confirmation of previously detected mosaicism. FISH results were informative in all seven cases included in the study, and confirmed by subsequent cytogenetic analysis. FISH analysis provides rapid results for referral physicians and in most cases reassurance for patients within 24 hours of the follow-up aminocentesis. Although FISH studies are not considered accurate in determining a primary diagnosis of mosaicism in uncultured cells, the analysis is accurate and clinically useful when the diagnosis is known and mosaicism involving a specific chromosome needs to be confirmed in follow-up testing.

Ligase chain reaction assay is clinically useful in the discrimination of smear-positive pulmonary tuberculosis from atypical mycobacterioses

We evaluated the usefulness of the ligase chain reaction (LCR) (Abbott LCx Mycobacterium tuberculosis assay) during the initial diagnosis of tuberculosis. LCx was carried out in parallel with conventional methods for the analysis of clinical samples. Out of 86 patients who were examined clinically, 53 were suspected of having pulmonary tuberculosis, eight had residual X-ray scars from previous tuberculosis and 25 served as asymptomatic controls. Ten bronchoscopy samples and 237 sputum samples were analysed by direct microscopy, culture and LCx. All 11 smear-positive and two of three smear-negative tuberculosis patients had at least one LCx-positive specimen. All samples that were both LCx and smear-positive were culture-positive for M. tuberculosis. The smear-positive samples from the five patients with atypical mycobacteriosis were LCx-negative. There were three false-positive results: one in a smear-negative sample from a patient with M. malmoense infection and two from two pneumonia patients. All samples from controls and patients with previous tuberculosis were LCx-negative. The sensitivity, specificity and the positive and negative predictive values of LCx in patient analysis were 92.9%, 95.8%, 81.3% and 98.6%, respectively. LCx assay of M. tuberculosis is useful in rapid confirmation of tuberculosis or atypical mycobacteriosis from a smear-positive sample and may aid in diagnosing smear-negative tuberculosis.

Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review.

Diquat is a potent redox cycler and is readily converted to a free radical which, in reaction with molecular oxygen, generates superoxide anions and subsequently other redox products. These products can induce lipid peroxidation in cell membranes, and potentially cause cell death. Over the period 1968-1999, only 30 cases of diquat poisoning were reported in detail in the literature, of which 13 (43%) were fatal. Local and systemic effects have been reported following diquat exposure, with systemic features being invariably associated with ingestion. In severe and usually fatal cases, gastrointestinal mucosal ulceration, paralytic ileus, hypovolemic shock, acute renal failure, and coma have been reported. After rapid confirmation of the diagnosis using a qualitative urine test, gut decontamination may be considered in patients who present within 1 hour of a life-threatening ingestion (>6 g). Supportive measures including fluid and electrolyte replacement should then be employed. Although hemofiltration and hemodialysis are of proven value if renal failure supervenes, there is no clinical evidence that hemodialysis or hemoperfusion removes toxicologically significant amounts of diquat, thereby reducing the risk of organ failure and preventing a fatal outcome in severe cases.

Gas chromatographic profiling and screening for phenols as isobutoxycarbonyl derivatives in aqueous samples

An efficient method is described for the simultaneous determination of phenol and 49 substituted phenols present in aqueous samples. The method is based on the extractive two-phase isobutoxycarbonyl (isoBOC) derivatization with subsequent solid-phase extraction (SPE) for the direct analysis by gas chromatography (GC) and gas chromatography–mass spectrometry (GC–MS). Phenolic hydroxyl groups in acidic aqueous solutions were allowed to react with isobutyl chloroformate present in the dichloromethane phase containing triethylamine. The resulting isoBOC derivatives were then recovered by SPE using Chromosorb P in normal-phase partition mode, followed by direct GC and GC–MS analysis. Using this combined procedure, linear detector responses were obtained in the concentration range of 0.5–8 μg ml −1, with correlation coefficients varying from 0.925 to 0.999 for most of the phenols studied except for 2,4-dinitorphenol (0.789). The temperature-programmed retention index ( I) sets as measured on DB-5 and DB-17 dual-capillary columns of different polarity were characteristic of each isoBOC phenol derivative and thus, useful in the screening for isomeric phenols by I matching only. The mass spectral patterns, exhibiting characteristic [ M−100] +, [ M−200] + and [ M−300] + ions for the mono-, di- and trihydroxybezenes, respectively with common ions at m/z 57, facilitated their rapid structural confirmation. The present method allowed rapid screening for phenols when applied to water samples spiked with phenols.

Current evaluation of cardiac stab wounds

Background. Patients with penetrating cardiac injuries may be stable or only mildly shocked, especially if the laceration has sealed off and the patient has been aggressively resuscitated. Clinical signs, chest roentgenograms, pericardiocentesis, and subxiphoid window are not always helpful in establishing the diagnosis. We reflect on the current evaluation based on 128 patients.Methods. There were four groups of patients, ranging from lifeless (group I) to stable (group IV). Patients in groups I and II were prepared immediately for operation. Those in groups III and IV were often investigated further (chest roentgenogram and cardiac ultrasound).Results. Mortality was 8%. Significant findings were a precordial stab, central venous pressure of more than 15 cm of water, one or more clinical signs of tamponade, and initial shock. Cardiac ultrasound was performed in 5 patients in group II (15%), 14 patients in group III (48%), and 37 patients in group IV (86%). There were no false positives, and 6 false negatives (11%). Thirty-one patients (24%) had clotted lacerations. There were no negative sternotomies.Conclusions. Efficient fluid resuscitation and rapid confirmation of diagnosis with cardiac ultrasound should decrease mortality. Stable patients with a precordial wound should undergo cardiac ultrasound or echocardiogram. Diagnosis may be reliably confirmed in these patients whose clinical signs often fluctuate (or rapidly deteriorate).