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Introduction Ultrasound imaging has many clinical applications, but there is a lack of data about its use by infectiologists. The aim of this study was to describe ultrasound performed routinely by infectiologists and to assess the diagnostic performance of ultrasound with aspirate and fluid analysis in prosthetic joint infections. Methods Retrospective study between 1st June 2019 and 1st June 2020 in an infectious and tropical diseases unit in a tertiary University Hospital. Results One hundred and thirty-one ultrasounds were performed on 127 patients by the infectious diseases team. These included 64 musculoskeletal ultrasounds (31 in native joints and 33 in prosthetic joints including 15 knees, 13 hips and 5 spacers) and 33 led to a fluid aspirate. Fourteen lung ultrasounds were done, 11 confirmed pneumopathy and 7 resulted in pleural puncture. Twenty-three vascular ultrasounds were done, 17 to insert a catheter, and four to perform a blood test. Five ultrasounds explored adenopathy, of which one node tuberculosis and one Bartonella infection were diagnosed. In prosthetic joint infections, sensitivity and specificity of ultrasound with fluid aspirate and analysis were respectively 100% and 100% for the knee and 40% and 100% for the hip. Conclusion Ultrasound performed by infectiologists is useful and contributes to a faster diagnosis. Furthermore, the specificity of ultrasound with aspirate and fluid analysis is very high in prosthetic joint infection. Ultrasound training courses should be considered for infectiologists including residents.

Despite numerous descriptive publications, the guidelines for treatment of cervical spinal tuberculosis (TB) are not very clear. The authors report a case of a young girl with cervico-thoracic spinal TB extending from C5 to T3 vertebrae presenting with weakness of the right hand and unsteady gait. An 11-year-old female who is an immigrant to the UK from Afghanistan, presented to our clinic with a 10-day history of difficulty in walking with an unsteady gait and 3-month history of progressive weakness in both her arms, the right side more affected than the left. Her immunisation history was unclear. Examination of the arms showed bilateral thenar and hypothenar wasting, more so on the right than the left. An MRI scan revealed a large para-spinal abscess extending from C3/4 to T4/5 with a significant anterior epidural cord compression from C5/6 to T2/3. Therapeutic/diagnostic aspiration was performed under ultrasound guidance and the aspirate was sent for microbiology. She was started empirically on multidrug anti-tubercular treatment and steroids. Although Ziehl–Neelsen stain was negative for acid-fast bacilli, microbiological confirmation of TB was obtained by positive TB culture sensitive to all first-line anti-TB drugs. She made a dramatic improvement within 3 weeks of anti-tubercular treatment. A follow-up MRI scan at 8 months showed complete resolution of the abscess. At 2 years of follow-up, she was a healthy looking child, back to her school with no residual clinical signs/symptoms of the disease. Our case of cervico-thoracic tuberculous abscess in a young child suggests that even with incomplete neurological deficit caused by epidural cord compression, ultrasound (or CT)-guided aspiration and anti-tubercular medication provide acceptable results at 2 years of follow-up.

An eight-year long reanalysis of atmospheric composition data covering the period 2003-2010 was constructed as part of the FP7-funded Monitoring Atmospheric Composition and Climate project by assimilating satellite data into a global model and data assimilation system. This reanalysis provides fields of chemically reactive gases, namely carbon monoxide, ozone, nitrogen oxides, and formaldehyde, as well as aerosols and greenhouse gases globally at a horizontal resolution of about 80 km for both the troposphere and the stratosphere. This paper describes the assimilation system for the reactive gases and presents validation results for the reactive gas analysis fields to document the data set and to give a first indication of its quality. Tropospheric CO values from the MACC reanalysis are on average 10-20% lower than routine observations from commercial aircrafts over airports through most of the troposphere, and have larger negative biases in the boundary layer at urban sites affected by air pollution, possibly due to an underestimation of CO or precursor emissions. Stratospheric ozone fields from the MACC reanalysis agree with ozonesondes and ACE-FTS data to within ±10% in most seasons and regions. In the troposphere the reanalysis shows biases of -5% to +10% with respect to ozonesondes and aircraft data in the extratropics, but has larger negative biases in the tropics. Area-averaged total column ozone agrees with ozone fields from a multi-sensor reanalysis data set to within a few percent. NO2 fields from the reanalysis show the right seasonality over polluted urban areas of the NH and over tropical biomass burning areas, but underestimate wintertime NO2 maxima over anthropogenic pollution regions and overestimate NO2 in northern and southern Africa during the tropical biomass burning seasons. Tropospheric HCHO is well simulated in the MACC reanalysis even though no satellite data are assimilated. It shows good agreement with independent SCIAMACHY retrievals over regions dominated by biogenic emissions with some anthropogenic input, such as the eastern US and China, and also over African regions influenced by biogenic sources and biomass burning. © Author(s) 2013., SCOPUS: re.j, info:eu-repo/semantics/published

In the period from May through June 1994, an increase in the number of domestic cases of Shigella sonnei infection was detected in several European countries, including Norway, Sweden, and the United Kingdom. In all three countries epidemiological evidence incriminated imported iceberg lettuce of Spanish origin as the vehicle of transmission. The outbreaks shared a number of common features: a predominance of adults among the case patients, the presence of double infections with other enteropathogens, and the finding of two dominant phage types among the bacterial isolates. In Norway 110 culture-confirmed cases of infection were recorded; more than two-thirds (73%) were adults aged 30 to 60 years. A nationwide case-control study comprising 47 case patients and 155 matched control individuals showed that the consumption of imported iceberg lettuce was independently associated with an increased risk of shigellosis. Epidemiological investigation of a local outbreak incriminated iceberg lettuce from Spain, consumed from a salad bar, as the source. The presence of shigellae in the suspected food source could not be documented retrospectively. However, high numbers of fecal coliforms were detected in iceberg lettuce from patients' homes. Three lettuce specimens yielded salmonellae. The imported iceberg lettuce harbored Escherichia coli strains showing resistance to several antimicrobial agents, including ampicillin, ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole. During the outbreak it is likely that thousands of Norwegians and an unknown number of consumers in other countries were exposed to coliforms containing antibiotic resistance genes.

Rotatory subluxation of the atlantoaxial joint in adults is a rare, but potentially life-threatening injury. Delayed or missed diagnosis can lead to catastrophic consequences. Early recognition and prompt treatment is paramount to avoid long-term morbidity and disability. We report on an instance of bilateral atlantoaxial rotatory subluxation (AARS) in a 25-year-old female who presented to the Casualty Department with a painful neck, right-sided hemiparesis and torticollis after a road traffic collision. Reduction was achieved by controlled cervical traction followed by immobilization in a four-post Halo brace, with complete resolution of her symptoms. At the 12-month follow-up, she had normal neck movements with no signs of instability.

The aim of this study was to evaluate the short-term radiological and functional outcome of surgical treatment for symptomatic, low-grade, adult isthmic spondylolisthesis. Twelve patients underwent a monosegmental fusion for symptomatic spondylolisthesis. Posterior reduction with pedicle screw instrumentation was followed by second-stage anterior interbody fusion with a cage. All patients underwent a decompressive laminectomy. At an average of 2.1 (range 1.4–3.0) years following surgery, all patients completed the Oswestry questionnaire, VAS back pain score and a questionnaire detailing their work status. Radiographs were evaluated for maintenance of reduction and fusion. The patients (nine male, three female; mean age 42, range 22–54 years) had experienced preoperative symptoms for an average of 38 (range 6–96) months. An average preoperative slip of 21% (range 11–36%) was reduced to 7% (range 0–17%). Reduction of slip was maintained at latest follow-up, at which time the average VAS score was 2.8 (range 0–8) and the average Oswestry score was 13 (range 0–32). All patients achieved a successful fusion. There were no postoperative nerve root deficits. All patients stated that they would be prepared to undergo the same procedure again if required. Seventy-five percent returned to their pre-symptom work status. Our findings suggest that posterior reduction and anterior fusion for low-grade adult isthmic spondylolisthesis may yield good functional short-term results. A high fusion rate and maintenance of reduction with a low complication rate may be expected. Further follow-up is necessary to evaluate long-term outcome.

The examinations were performed in 418 patients with malignancy or an ulcer of the stomach. In all cases the Cancer Registry of Norway was asked for the final diagnosis and date of death. The diagnosis of malignancy was based on histology on operated or autopsy specimens, and the surviving cases were re-examined by answering a questionnaire. At the time of the primary examination a total of 103 cases of malignancies were found, of whom 41 were women. 84 patients had not been operated on previously. Among these 7 cases of early carcinoma were found. In 19 patients a partial gastrectomy had been performed. A false diagnosis of benign lesion was given on biopsy in 2 per cent, by gastroscopy in 8, and by X-ray examination in 31 per cent. A definite diagnosis of malignancy was made correctly by the same procedures in 95, 53 and 16 per cent, respectively. After 30 months of observation 16 cases of malignant lesions were reported among the patients (315) who had an ulcer of the stomach with benign histology on directed biopsy at the primary examination. A false benign diagnosis had been made in 33 per cent of 119 with malignancy by X-ray examination, in 10 per cent by gastroscopy, and in 15 per cent by histology on biopsy. The corresponding percentages in the total material of cases with benign and malignant lesions were 10.2, 2.9, and 4.3, respectively. In cases with previous partial gastrectomy, and in those with early cancers much higher rates of false negative diagnosis of malignancy has so far been suggested in 12 per cent of cases with benign ulcers, a gastroscopical diagnosis has been suggested in 22 per cent, and a bioptical in none. A combination of diagnostic procedures provided a correct diagnosis of malignancy in 118 out of 119 patients.

Bismuth preparations are used world-wide for the management of peptic ulcer disease, for eradication of Helicobacter pylori, and in the prevention and treatment of diarrhoea. However neurological toxicity of bismuth has always been a major concern and evidence has been found of the absorption of bismuth. Recent studies have suggested that the absorption of bismuth increases when bismuth salts are used with ranitidine hydrochloride. The absorption and deposition of bismuth as a result of the use of the new drug ranitidine bismuth citrate have not been yet clarified. After 15 days of twice daily oral gavage with bismuth subcitrate, 13·7 mg kg−1 day−1 to eight rats, deposition of bismuth was found in all the tissues studied, especially the kidney (30·81 ± 8·59 μg g−1 dry weight). A similar pattern of distribution and tissue concentrations was found when bismuth subcitrate was given with ranitidine hydrochloride 8·6 mg kg−1 day−1 to another eight rats, although this combination resulted in lower brain levels (3·12 + 1·31 μg g−1 dry weight) than after administration of bismuth subcitrate alone (4·77 ± 0·97 μg g−1 dry weight). When six rats were given ranitidine bismuth citrate by gavage at 22·8 mg kg−1 day−1 for 15 days, kidney levels were lower (4·24 ± 1·75 μg g−1 dry weight) and brain levels were below detection limits; the bismuth concentrations in the faeces from this group were also significantly lower (1603 ± 104·0 μg g−1 dry weight) than for the two other groups. After dosing with bismuth alone or in association with ranitidine hydrochloride, bismuth was detected in several organs and deposition was not influenced by gastric pH. Blood levels correlate poorly with organ deposition and brain deposition was not always associated with encephalopathy. After administration of ranitidine bismuth citrate, significantly lower concentrations of bismuth were found in the kidney and bismuth was not detectable in the brain, suggesting lower bismuth absorption. This was confirmed by higher levels in the faeces after dosing with ranitidine bismuth citrate. Thirty days after dosing with ranitidine bismuth citrate or bismuth subcitrate, bismuth could not be detected in any of the organs examined but could be found in the urine. In conclusion, bismuth was deposited in the kidney, brain, lung and liver of rats after oral dosing with bismuth subcitrate. After oral dosing with an equivalent amount of bismuth in the form of ranitidine bismuth citrate, significantly lower concentrations of bismuth were deposited in the kidney; in the brain bismuth was not detectable.