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PubMed1982

The bedside Sherlock Holmes.

There are a multitude of diagnostic clues contained in clothing, jewelry, possessions and other extracorporeal attachments that each patient brings with him or her to a physician. Because of the emphasis of classic physical diagnosis on the body of a patient solely, and because of modern practices that may have patients stripped of these articles before the first encounter with their physician, these interesting and enlightening findings are often ignored or unavailable. Incorporation of these observations into the panoply of data obtained from the history and physical examination will enhance both the accuracy and adventure of differential diagnosis. Such exercises in observation, moreover, may increase general physical diagnostic skills as well as enliven bedside rounds.

Clinical Competence↗
PubMed1993

Sherlock Holmes.

Explore the source record for details and available documents.

Diagnosis↗
PubMed2003

[Elementary, my dear Watson].

Sherlock Holmes, the greatest detective who never lived, draws a great amount of influence from the medical world. Arthur Conan Doyle, Sherlock Holmes creator and the author of his many adventures, was a physician, before devoting himself to writing. Doyle was fascinated with the incredible abilities of his legendary teacher, Dr. Joseph Bell, to draw conclusions based on apparently minor unimportant details. At a later stage, Doyle admitted that Sherlock Holmes' character was based upon Joseph Bell way of practicing medicine. Sherlock Holmes' adventures are paved with medical descriptions of various illnesses. This article reviews the connection between the author, the detective and the medical world.

England↗
PubMed1976

Fibropolycystic disease of the hepatobiliary system and kidneys.

This complicated case of fibropolycystic disease of the hepatobiliary system and kidneys was ably and incisively analyzed by Professor Sheila Sherlock. Her clinical acumen was revealed by her ability to differentiate congenital hepatic fibrosis, Caroli's disease, and adult polycystic disease of the liver and kidney. Interesting histologic features of this case included hepatic fibrosis with intact limiting plates anc central veins and the presence of bile plugs in the ducts, but the absence of bile statsis in the parenchyma. A percutaneous transhepatic cholangiogram demonstrated the dilated intrahepatic and extrahepatic ducts. Washing out the "gunk" from the biliary tract by T-tube drainage has great limitations in this type of case. Therefore, Dr. Adson suggested irrigation of the biliary ductal system using tubed placed transhepatically, plus a wide choledojejunostomy. Dr. Sherlock questioned this surgical approach. The use of chenodeoxycholic acid for this "gunk" was suggested. In spite of the dilated ducts and pathologic changes in the liver, the patient was not jandiced and did not have stones in her biliary tract. The genetics of this patient's problems was discussed.

Adult↗
PubMed2006

Screening for microbial markers in Miocene sediment exposed during open-cast brown coal mining.

Viable microorganisms were found in Miocene lacustrine clays of the cypris formation excavated from 200-m below the surface as spoil during open-cast brown coal mining (Sokolov Brown Coal Basin, North-Western Bohemia, Czech Republic). Both saprotrophic microfungi of the genera Penicillium, Verticillium, Cladosporium and Aspergillus as well as heterotrophic bacteria were isolated from an intact sediment cores. Heterotrophic bacteria were classified by the MIS Sherlock System as representatives of genera Nocardiopsis, Arthrobacter, Micrococcus, Kocuria, Rothia, Clavibacter, Bacillus, Paenibacillus, Brevibacillus, Microbacterium, Acinetobacter and Pseudomonas. A bacterium found among the strains had an atypical fatty acids profile enriched by branched fatty acids and polyunsaturated fatty acid (18:3 omega 6) and gave no MIS Sherlock match. Phospholipid fatty acids analysis indicates a relatively high (535 pmol g(-1)) but inhomogeneously distributed viable microbial biomass. Fatty acids analyses of non-fractioned lipids (representing viable, storage and dead biomass; 8390 pmol g(-1)) detected rich and homogenous profiles with fungal, bacterial and actinomycetal markers but no protozoan and algal fatty acids markers.

Bacteria↗
PubMed2005

Content and composition of fatty acids in normal and inflamed gingival tissues.

The balance of essential fatty acid is important for good health and normal development. Essential fatty acids (EFA) are the precursors of prostaglandins (PGs), thromboxanes and leukotrienes (LT). The aim of this clinical study was to determine the total fatty acid level of polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), saturated fatty acids (SFA) and each fatty acids level of inflamed and normal gingival tissues. Twenty-seven subjects were included the present study. Nineteen samples of inflamed human gingival tissue (nine of fibrous hyperplasia (FH), ten of peripheral giant cell granuloma (PGCG) and eight samples of normal human gingival tissue were analyzed. The characteristics of inflammation were assessed histologically. Variance analyses were performed to assess the differences among tissues. The total cellular fatty acid profiles of the tissues in inflamed human gingival tissue and in eight samples of normal human gingival tissue were determined by gas chromatography using Sherlock microbial identification system (MIS) software (Microbial ID, Newark, DE, USA) with a database of FAME profiles for eukary. PUFAs, MUFAs, and SFAs were quantified by Sherlock microbial identification system (MIS) or database gas chromatography (DGC). There were statistically significant differences between the concentrations in inflamed (FH, PGCG) and healthy gingival tissues for PUFA and MUFA (P<0.001, P<0,011, respectively). There were statistically significant differences among the concentrations in FH, PGCG, and healthy gingival tissues for SFA (P<0.0001). Arachidonic acid, docosahexaenoic acid, linoleic acid were increased in inflamed tissue. The results of this study showed that unsaturated fatty acids (PUFA and MUFA) significantly increased in inflamed gingival tissues.

Chromatography, Gas↗
PubMed1998

Comparison of phenotypic and genotypic techniques for identification of unusual aerobic pathogenic gram-negative bacilli.

Rapid and accurate identification of bacterial pathogens is a fundamental goal of clinical microbiology, but one that is difficult or impossible for many slow-growing and fastidious organisms. We used identification systems based on cellular fatty acid profiles (Sherlock; MIDI, Inc., Newark, Del.), carbon source utilization (Microlog; Biolog, Inc., Hayward, Calif.), and 16S rRNA gene sequence (MicroSeq; Perkin-Elmer Applied Biosystems Division, Foster City, Calif.) to evaluate 72 unusual aerobic gram-negative bacilli isolated from clinical specimens at the Mayo Clinic. Compared to lengthy conventional methods, Sherlock, Microlog, and MicroSeq were able to identify 56 of 72 (77.8%), 63 of 72 (87.5%), and 70 of 72 (97.2%) isolates to the genus level (P = 0.002) and 44 to 65 (67.7%), 55 of 65 (84.6%), and 58 of 65 (89.2%) isolates to the species level (P = 0.005), respectively. Four Acinetobacter and three Bordetella isolates which could not be identified to the species level by conventional methods were identified by MicroSeq. In comparison to the full 16S rDNA sequences, the first 527 bp provided identical genus information for all 72 isolates and identical species information for 67 (93.1%) isolates. These data show that MicroSeq provides rapid, unambiguous identification of clinical bacterial isolates. The improved turnaround time provided by genotypic identification systems may translate into improved clinical outcomes.

Carbon↗
PubMed2000

Differentiation between Candida dubliniensis and Candida albicans by fatty acid methyl ester analysis using gas-liquid chromatography.

Candida dubliniensis is often found in mixed culture with C. albicans, but its recognition is hampered as the color of its colonies in primary culture on CHROMagar Candida varies. Furthermore, definite identification of C. dubliniensis is difficult to achieve, time-consuming, and expensive. Therefore, a method to discriminate between these two closely related yeast species by fatty acid methyl ester (FAME) analysis using gas-liquid chromatography (Sherlock Microbial Identification System [MIS]; MIDI, Inc., Newark, Del.) was developed. Although the chromatograms of these two species revealed no obvious differences when applying FAME analysis, a new library (CADLIB) was successfully created using Sherlock Library Generation Software (MIDI). The amount and frequency of FAME was analyzed using library training files (n = 10 for each species), preferentially those comprising reference strains. For testing the performance of the CADLIB, clinical isolates genetically assigned to the respective species (C. albicans, n = 32; C. dubliniensis, n = 28) were chromatographically analyzed. For each isolate tested, MIS computed a similarity index (SI) indicating a hierarchy of possible strain fits. When using the newly created library CADLIB, the SIs for C. albicans and C. dubliniensis ranged from 0.11 to 0.96 and 0.53 to 0. 93 (for all but one), respectively. Only three isolates of C. albicans (9.4%) were misidentified as C. dubliniensis, whereas all isolates of C. dubliniensis were correctly identified. Resulting differentiation accuracy was 90.6% for C. albicans and 100% for C. dubliniensis. Cluster analysis and principal component analysis of the resulting FAME profiles showed two clearly distinguishable clusters matching up with two assigned species for the strains tested. Thus, the created library proved to be well suited to discriminate between these two species.

AIDS-Related Opportunistic Infections↗
PubMed2004

Use of MIDI-fatty acid methyl ester analysis to monitor the transmission of Campylobacter during commercial poultry processing.

The presence of Campylobacter spp. on broiler carcasses and in scald water taken from a commercial poultry processing facility was monitored on a monthly basis from January through June. Campylobacter agar, Blaser, was used to enumerate Campylobacter in water samples from a multiple-tank scalder; on prescalded, picked, eviscerated, and chilled carcasses; and on processed carcasses stored at 4 degrees C for 7 or 14 days. The MIDI Sherlock microbial identification system was used to identify Campylobacter-like isolates based on the fatty acid methyl ester profile of the bacteria. The dendrogram program of the Sherlock microbial identification system was used to compare the fatty acid methyl ester profiles of the bacteria and determine the degree of relatedness between the isolates. Findings indicated that no Campylobacter were recovered from carcasses or scald tank water samples collected in January or February, but the pathogen was recovered from samples collected in March, April, May, and June. Processing generally produced a significant (P < 0.05) decrease in the number of Campylobacter recovered from broiler carcasses, and the number of Campylobacter recovered from refrigerated carcasses generally decreased during storage. Significantly (P < 0.05) fewer Campylobacter were recovered from the final tank of the multiple-tank scald system than from the first tank. MIDI similarity index values ranged from 0.104 to 0.928 based on MIDI-fatty acid methyl ester analysis of Campylobacterjejuni and Campylobacter coli isolates. Dendrograms of the fatty acid methyl ester profile of the isolates indicated that poultry flocks may introduce several strains of C. jejuni and C. coli into processing plants. Different populations of the pathogen may be carried into the processing plant by successive broiler flocks, and the same Campylobacter strain may be recovered from different poultry processing operations. However, Campylobacter apparently is unable to colonize equipment in the processing facility and contaminate broilers from flocks processed at later dates in the facility.

Animals↗
PubMedDate not supplied

[Estimating the efficiency of DNA isolation methods in semen, blood and saliva stains using the QuantiBlot system].

The aim of this study was to compare and select the optimal method of DNA isolation from blood, semen and saliva stains, as well as to determine appropriate conditions for employing amplification kits for identification of individual persons [brak w polskim tekście]. The materials analyzed in this study consisted of stains of blood, semen and saliva samples stored for a year, and stains of blood stored for a month. Seven various methods of isolation were compared: the Fast DNA kit (Qbiogene), phenol/chloroform extraction, Sherlock (DNA II Gdansk), Dneasy (Qiagen), Wizard Genomic Purification Kit (Promega), Chelex 100 (Biorad) and salting out proteins method. After the isolation, the quantity of DNA was measured with QuantiBlot [brak w polskim tekście]. The highest DNA concentration in bloodstains stored for one year and one month was observed employing the salting out proteins method. The phenol-chloroform extraction method was also found to produce reasonably good results. Isolation from blood and semen with salting-out method appeared to be the most effective. The phenol/chloroform method was dependent on the age and origin of the materials [brak w polskim tekście]. The Sherlock kit was proven to be effective in blood samples stored for one year. DNA concentration values obtained in semen and saliva samples were very low and characterized by a low repeatability.

Analysis of Variance↗
PubMed1977

Clinicopathological Conference. Diagnostic difficulties in a case of polypharmacy. Demonstrated at the Royal College of Physicians of London.

The fifteenth quarterly clinicopathological conference was held at the Royal College of Physicians of London on 29 July 1976. The conference was chaired by Professor Sheila Sherlock (1). She began by introducing Professor Jean-Pierre Benhamou (2), professor of gastroenterology at the Beaujon-Clichy Hospital, University of Paris, who was to open the discussion of the case. Professor Sherlock emphasised that this case had no great dénouement but was more a talking point for various aspects of hepatology, a review of the state of the art. Dr James Scott (3) presented the case, and Dr R Dick (4) described the radiological findings.

Acute Kidney Injury↗