Escherichia coli O157:H7 Infections among Visitors to a Dairy Farm

An outbreak of Escherichia coli O157:H7 infections was traced to a dairy and petting farm. The 51 patients (median age, four years) included 8 in whom the hemolytic–uremic syndrome developed. Contact with calves was associated with an increased risk of infection. Thirteen percent of the farm's 216 cattle were colonized with the same strain of E. coli that was isolated from the patients.

This study provides evidence of direct transmission of E. coli O157:H7 from farm animals and their environment to young visitors, especially those who petted the calves. The importance of this mode of transmission may be greater than previously recognized. Careful hand washing after visiting a farm is one strategy to make farms safer for children.

Related Editorial

Minimally Invasive Coronary-Artery Bypass Surgery

Minimally invasive bypass surgery and coronary stenting are both alternatives to standard bypass surgery for the management of stenosis of the proximal left anterior descending artery. In this randomized trial, stenting provided excellent short-term results with fewer periprocedural events, but minimally invasive surgery proved better at six months in terms of freedom from angina and the need for repeated procedures.

Minimally invasive bypass surgery is attractive since it does not require cardiopulmonary bypass, but it is technically challenging because of the limited operative field. Whether it will prove superior to drug-eluting stents, which were not used in this trial, will require additional study.

Related Perspective

Radical versus Total Mastectomy

A trial to compare the efficacy of radical mastectomy with that of total mastectomy began in 1971 and enrolled 1665 women with breast cancer. After 10 years of follow-up, radical mastectomy was not superior to total mastectomy. Now, after 25 years of follow-up, 293 of the women are alive and free of breast cancer; radical mastectomy did not show an advantage over total mastectomy.

This pioneering trial led to a vast improvement in the quality of life for women with breast cancer. It spelled the end of radical mastectomy and started the trend toward less extensive surgery, which culminated in the lumpectomy. Although the treatments used in 1971 for breast cancer are now outmoded, this historic trial set the management of breast cancer on a new course.

Brief Report: Paternal Mitochondrial DNA

This report describes a 28-year-old man with lifelong exercise intolerance. Evaluation revealed a mitochondrial myopathy due to a novel 2-bp mitochondrial DNA deletion in the ND2 gene, which codes for a subunit of enzyme complex I of the mitochondrial respiratory chain. Studies of the patient and his immediate family members revealed that the abnormal mitochondrial DNA was paternal in origin and accounted for 90 percent of the mitochondrial DNA in the patient's muscle.

This finding challenges the assumption that mitochondrial DNA is always maternal in origin.

Related Editorial

Special Article: Experiences of Oregon Nurses and Social Workers with Patients Who Requested Assistance with Suicide

Physician-assisted suicide was legalized in Oregon with the passage of the Death with Dignity Act in 1997. Seventy-one of the 91 patients who have died by assisted suicide received hospice care. This study reports the results of a survey of hospice nurses and social workers about patients who received prescriptions for lethal medications. Like physicians who responded to a similar survey, hospice nurses and social workers reported that patients chose assisted suicide because they wished to control the circumstances of death, not because they were depressed, lacked social support, or were concerned about being a financial burden. As compared with other hospice patients and their families, patients who received prescriptions for lethal medications appeared to have less pain, depression, and anxiety, and their family caregivers appeared to be less burdened.

The reports of hospice nurses and social workers in Oregon suggest that the legalization of physician-assisted suicide has not led to its widespread use by the most vulnerable terminally ill patients, such as those who are depressed or socially isolated.

Mechanisms of Disease: Thrombotic Microangiopathies

This article reviews the substantial progress made in understanding the thrombotic microangiopathies. The mechanisms of both thrombotic thrombocytopenic purpura and the hemolytic–uremic syndrome are considered.

The discovery of the role of unusually large multimers of von Willebrand factor and of the metalloprotease that cleaves these multimers has ignited a new wave of research in thrombotic thrombocytopenic purpura. The mapping of the molecular action of Shiga toxins has illuminated our understanding of the hemolytic–uremic syndrome. These advances are likely to lead to major advances in the treatment of thrombotic thrombocytopenic purpura and the hemolytic–uremic syndrome.

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