1. The results of treatment of 117 tuberculous and fourteen other types of infection of the spine in adults by anterior fusion and chemotherapy have been reviewed. 2. It is suggested that anterior fusion is justified because: a) it permits isolation of the organism, and hence the determination of drug sensitivities and appropriate chemotherapy; b) removal of the diseased tissue and the stabilisation of the affected segment by iliac bone grafts can be effected, leading to rapid healing by bony fusion with little further collapse; c) rehabilitation of the patient is hastened; and d) the incidence of reactivation is probably diminished.
SYNOPSISThe haemagglutination test for antileucocidin is frequently positive in cases of bone tuberculosis in the absence of obvious staphylococcal infection. This test is therefore of little practical use in the differentiation of staphylococcal and tuberculous bone disease, and its use has been discontinued at the Royal National Orthopaedic Hospital.The antigamma haemolysin test in bone tuberculosis appears to give rise to few false positive results. Our observations confirm that the anti-alpha haemolysin and antigamma haemolysin tests used together reveal about 80% of cases of staphylococcal bone infection on first presentation or relapse.
SUMMARY In two cases of infected total hip replacements, Peptococcus magnus was isolated in pure culture from the implant when it was removed. Fluorescent antibody and ELISA studies have shown that both patients developed an antibody response to this anaerobic coccus soon after the replacement operation. These results suggest that the organism is a true infective agent, which was probably responsible for the failure of the arthroplasty operation.
Material and methods
BACTERIOLOGICAL EXAMINATION OF PRO STHESESExamination of prostheses in our laboratory has been designed to ensure isolation of both aerobic and anaerobic bacteria and also to allow estimation of the numbers of any organisms present in the material. This quantitation of the bacterial population was made so that small numbers of airborne or skinderived organisms, which might contaminate the prosthesis during its removal, would not be given undue significance.Immediately after the surgeon had removed the prosthesis it was placed in a sterile container in the operating theatre for immediate transfer to the bacteriology department. In the laboratory 20 ml of digest broth was added to the container, which was then manipulated by hand so that the whole surface of the prosthesis was washed. Two pour-plates were made by adding 1 ml of this broth to 15
Our work with the diphtheria intracellular toxin is exceedingly interesting. From the experiments that we have made we conclude that the intracellular toxin of diphtheria is not identical with the soluble toxin. Commercial diphtheria antitoxin protects animals against the soluble diphtheria toxin, but fails to protect against the intracellular toxin. This offers, apparently, a plausible explanation for the fact which has been observed by others that natural immunity to diphtheria toxin may be possessed by animals which are not immune to diphtheria infection.The cell substance of the Micrococcus prodigiosus and of the lemon and yellow sarcines are toxic in varying amounts, depending largely on the extent to which the cells are purified from the mucilaginous substance sur¬ rounding them in the culture medium.
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