Grand rounds revisited: some comments on current practices.
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Biomedical subjects
Publications and source records attributed to H D Riley.
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The relative genetic diversity of selected proto-oncogenes in the native Hawaiian gene pool was examined by comparing the restriction fragment length polymorphisms of these genes in a group of 23 individuals with at least part Hawaiian ancestry, and in 20 individuals from other ethnic groups. Twenty-one combinations of the proto-oncogenes, c-fms, c-myc, L-myc, c-Ha-ras, and c-Ki-ras, tested with 1 or more of the restriction enzymes Bam HI, Eco RI, Hind III, Pst I, Pvu I and Kpn I were examined. Sixteen of these did not exhibit RFLPs in Hawaiians or in other ethnic groups. Four of the combinations exhibiting RFLPs in native Hawaiians exhibited similar-sized restriction fragments in the other ethnic groups. Only in the case of c-myc digested with Pst I were 5 individuals of Hawaiian ancestry found to have an RFLP which has not been detected in other ethnic groups. These 5 cases exhibited a 13-kb c-myc fragment in addition to the 5.5-kb fragment found in most Hawaiians and always present in other ethnic groups. The presence in Hawaiians of most RFLPs found in other ethnic groups indicates that the genetic diversity of proto-oncogenes in the gene pool of native Hawaiians is not substantially less than that of other ethnic groups.
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The incidence of cutaneous malignant melanoma is rising steadily. Guidelines for early recognition and treatment as well as prevention of this potentially fatal disorder are outlined.
The group B streptococcus has become a leading cause of neonatal infection. Despite the increasing incidence of this infection, recurrence in the same patient is extremely uncommon. This report describes three infants with proved recurrent group B streptococcal disease. All patients were treated with benzylpenicillin for at least 10 days, but, after a symptom-free interval, each developed symptoms again. Whether the illness in these patients represents a relapse or a true reinfection is difficult to determine. Various possibilities are discussed. The development of a recurrent infection indicates that presently recommended therapy may be inadequate in certain instances. Comments about epidemiology, clinical picture, antibiotic sensitivity studies, and immunity are made along with speculations about possible approaches to treatment and prevention of this infection.
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Cephalexin appears to be a highly effective antibiotic. It possesses the qualities of rapid oral absorption, production of high drug levels in the blood and urine, and near absence of side effects. It is effective against infections due to gram-positive cocci infections, with the exception of Enterococcus, and for most infections caused by E. coli and Klebsiella. It is useful in the treatment of a wide variety of infections in infants and children, and particularly valuable with susceptible infections in patients who do not require parenteral antimicrobial therapy.
97 strains of Escherichia coli (49 from urine and 48 from non-urine sources) were isolated from patients at Children's Memorial Hospital, Oklahoma City, and studied for antimicrobial susceptibility. The proportion of highly resistant strains (growth at a concentration of 50 microgram/ml or more) was 27% with ampicillin, 25% with tetracycline, 23% with cephalothin, 6% with kanamycin and neomycin, 4% with chloramphenicol, and zero with colistin, gentamicin, and tobramycin. 23 strains (24%) were found resistant to two or more antibiotics simultaneously. The incidence of strains resistant to ampicillin, cephalothin, kanamycin, neomycin, and tetracycline was higher among urine isolates than among non-urine isolates.
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