Evaluation of Dichloran-Rose Bengal Agar for Enumeration of Fungi in Foods 1

Samples of flour, corn meal, ground meat and carrots were analyzed by standard procedures for presence of fungi using both Dichloran-Rose Bengal (DRBC) and Plate Count agar with antibiotics. Bacterial contamination was so extensive with ground meat and carrot samples on DRBC that meaningful fungal counts could not be obtained. Therefore, DRBC is not recommended for routine enumeration of fungi in foods.

High performance liquid chromatographic separation of stereoisomeric bile acids as their UV-sensitive esters

High performance liquid chromatographic separation of a series of mono-, di- and trihydroxylated 5 beta-cholanic acids, which differ only in position and configuration of hydroxyl groups at positions C-3, C-7 and/or C-12, is reported. The C-24 free acids were derivatized to four different classes of UV-sensitive esters, i.e., p-bromophenacyl (BP), m-methoxyphenacyl (MP), 4-nitrophthalimidemethyl (NPM) and 9-anthrylmethyl (AM) esters, and chromatographed on two variants of C18 reversed-phase columns (Nova-Pak C18 and Zorbax ODS) with methanol-water systems as mobile phase. Separation efficiency and elution order of some isomeric pairs were influenced by both the structure of the C-24 ester groups and the nature of the columns used. Excellent chromatographic properties were found for those derivatives, particularly for the NPM esters.

Intraplaque hemorrhage: its significance in cerebrovascular disease

Recently, carotid plaque factors, specifically intraplaque hemorrhage, have been studied with respect to the production of cerebrovascular symptoms. Ninety-five carotid endarterectomies were performed and the plaques that were removed were examined for intraplaque hemorrhage. Patients were separated into three groups: those with specific neurologic symptoms, those with nonlateralizing symptoms, and those who were asymptomatic. In the group of patients who presented with specific neurologic symptoms, correlation was made between the age of the intraplaque hemorrhage and the timing of symptoms. The vast majority of patients with specific neurologic symptoms exhibited carotid plaque hemorrhage, but patients with nonlateralizing symptoms and those who were asymptomatic also demonstrated an unexpectedly high percentage of intraplaque hemorrhage. Moreover, our results show a poor relationship between the timing of symptoms and the age of the intraplaque hemorrhage. These data do not refute the concept that intraplaque hemorrhage may play a role in the production of cerebrovascular symptoms, but they do refute the notion that the mere presence of hemorrhage causes specific neurologic symptoms and they also refute the previous report that demonstrates a good correlation between the timing of symptoms and the age of the intraplaque hemorrhage.

Acute diverticulitis. Comparison of treatment in immunocompromised and nonimmunocompromised patients

The clinical course and required treatment of diverticulitis were reviewed in 76 nonimmunocompromised patients and 10 immunocompromised patients. The immunocompromised patients presented with either minimal or no symptoms and findings. Therefore, to make the diagnosis of acute diverticulitis in this group, a high index of suspicion must be maintained. The required treatment varied considerably between the two groups. In 45 nonimmunocompromised patients (76 percent), medical therapy was successful. Medical treatment failed in the other 14 patients (24 percent). However, the compromised group had no patients in whom medical therapy was successful (100 percent failure rate). Thirty-one of the nonimmunocompromised patients (41 percent) required an operation, whereas 100 percent of the immunocompromised patients with acute diverticulitis required an operation. By relating postoperative complications, we were unable to determine the initial operative procedure of choice in the nonimmunocompromised group; however, in the immunocompromised group, colostomy and resection had fewer surgical complications than colostomy and drainage. The immunocompromised patient with acute diverticulitis requires operation. We believe the operation of choice is colostomy and resection of the involved segment.

Conditioned taste aversions modify neural responses in the rat nucleus tractus solitarius

Explorations of the neural substrates of conditioned taste aversions (CTAs) have focused principally on diencephalic and telencephalic structures. The nucleus tractus solitarius (NTS) is the initial gustatory relay in the rat's hindbrain. It is worthy of investigation for its part in mediating CTAs in that it is sensitive to several physiological conditions which affect feeding while also being a site of anatomical convergence for vagal afferents from the viscera and centrifugal projections from areas (hypothalamus, amygdala) implicated in emotions and hedonics. We compared single neuron responses from NTS to several taste stimuli in three groups of rats: (1) those receiving exposure to 0.0025 M sodium saccharin without physiological consequences; (2) those made ill through intraperitoneal injections of LiCl but having no obvious gustatory referent for their malaise (sensitization-pseudoconditioning controls); (3) those in which exposure to 0.0025 M sodium saccharin (the CS) was paired with LiCl-induced poisoning (the US), creating a pronounced aversion to the saccharin. According to response profiles, NTS neurons in all three groups could be divided into subsets of about 30%, which showed a sweet-sensitive profile, and 70%, which were primarily sensitive to nonsweet qualities. The major effect of the conditioning procedure was to increase responsiveness to the saccharin CS only among the sweet-sensitive subset. Moreover, the peak of activity which largely accounted for the increase occurred with a latency of 900 msec, perhaps implicating a secondary input to NTS from diencephalic or telencephalic sites. The significance of the results is that: (1) CTAs affect sensory activity at a lower order level than had heretofore been demonstrated; (2) NTS shows sensitivity to yet another physiological condition, reinforcing the involvement of the hindbrain in hedonics and sophisticated taste-related processes; (3) there is a subset of taste neurons, rather distinct according to its sensitivity profile, which is also functionally unique in its response to conditioning by a sweet CS.

Separation of mono-, di-, and trihydroxy stereoisomers of bile acids by capillary gas-liquid chromatography

Capillary gas-liquid chromatographic separation was studied for the complete set of the 26 theoretically possible isomers of mono-, di-, and trihydroxylated 5 beta-cholanic acids, which differ from one another in the number, position, and configuration of hydroxyl groups at C-3, C-7, and/or C-12 in the nucleus, as well as for some of their related acids. The bile acid samples were chromatographed as their methyl ester-trimethylsilyl (TMSi) ether derivatives and analyzed on three capillary columns coated with nonpolar OV-1, slightly polar OV-17, and polar SP-2340 as liquid phases. The retention times on capillary gas-liquid chromatography (GLC) responded dramatically to the minor structural differences, and almost complete separation of the positional and stereochemical isomers was achieved by the combined use of SP-2340 and OV-17 (or OV-1) capillary columns.

The stereospecificity of 3 alpha- and 12 alpha-bile salt hydroxysteroid dehydrogenase systems from four microbial sources

5 beta-Cholanoates, having a hydroxyl group in the 3 alpha and 3 beta and/or 12 alpha and 12 beta configurations, were tested as substrates for two preparation of 3 alpha-hydroxysteroid dehydrogenase (HSDH) and two preparations of 12 alpha-HSDH. When the 3-OH group was in the alpha configuration, both 3 alpha-HSDH preparations reacted, but when it was in the beta configuration, neither 3 alpha-HSDH preparations reacted. This also held true for the 12 alpha-HSDH preparations.

Debridement pancreatectomy for pancreatic abscess

Experience with seven cases of pancreatic abscess is reviewed. All patients were treated with radical pancreatic debridement, large sump drainage with postoperative irrigation, gastrointestinal defunctionalization, antibiotic therapy and nutritional support. One patient died, for a mortality rate of 14 percent. We feel that this regimen will help maximize survival in patients with pancreatic abscess.

Drainage in elective cholecystectomy

This randomized, prospective study evaluates drainage of the subhepatic space in patients undergoing simple, uncomplicated cholecystectomy. One hundred twenty-two patients were divided into open (Penrose) drainage, closed sump drainage and no drainage groups. Open drainage resulted in increased morbidity and a longer postoperative hospital stay. The best results were in patients without drains. Subhepatic drainage is unnecessary in simple, uncomplicated cholecystectomy.

The incidence and significance of elevations of serum and urinary amylase levels following transcystic duct cholangiography

Transcystic duct cholangiography does not increase the incidence of amylase elevations or clinical pancreatitis postoperatively. Significant rises in serum and two hour urinary amylase following routine cholecystectomy are quite common, regardless of whether or not transcystic duct cholangiography is performed. Many of these elevated amylase levels may arise from sources other than the pancreas.

Abdominal aortic aneurysms. A comparative analysis of surgical treatment of symptomatic and asymptomatic patients

This retrospective study of 120 patients identified three separate variables that influence operative mortality in patients with abdominal aortic aneurysms. These are age, presence or absence of symptoms, and presence of three preoperative risk factors or more. Based on this study and the fact that any aneurysm may rupture without warning, we conclude that observation of good risk asymptomatic patients until symptoms occur is unjustified. Asymptomatic patients less than seventy years old can undergo abdominal aortic aneurysmectomy with minimal mortality. Carefully selected asymptomatic patients more than seventy years old can also under surgical intervention with acceptable results.

Intravenous cholangiography in the diagnosis of acute cholecystitis

We reviewed our experience with intravenous cholangiography in the evaluation of 70 patients with suspected acute cholecystitis. Twenty-one of these patients had visualization of the biliary ducts without opacification of the gallbladder, a roentgenographic finding that was considered diagnostic of acute cholecystitis. Twenty of the 21 patients were noted to have acute cholecystitis during exploratory laparotomy. The remaining patient had a normal gallbladder, but was found to have a liver abscess. Opacification of the gallbladder with evidence of gallstones was found in eight patients; all had acute cholecystitis. Visualization of the gallbladder without gallstones was found in 22 patients, revealing no acute cholecystitis in this group. Many of these patients were admitted to the hospital with a primary diagnosis of acute cholecystitis and were spared an unnecessary surgical exploration. Nineteen patients had nonvisualization of the gallbladder and biliary ducts. This roentgenographic finding may be caused by acute intra-abdominal conditions other than cholecystitis and caution is warranted in its interpretation. This test has been found to be a reliable adjunct in the work-up of patients with suspected acute cholecystitis.

Rupture of the bronchus: Case report of successful resection and anastomosis in a 13-month-old infant

An unusual case of rupture of the bronchus in a 13-month-old child is reported. It is believed that this is the youngest reported case of successful repair and it is documented by an 11-year follow-up.

Massive upper gastrointestinal hemorrhage in the elderly

Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.

Inguinal herniorrhaphy under local anesthesia. A prospective study of 100 consecutive patients with emphasis of perioperative morbidity and patient acceptance

For various reasons, repair of inguinal hernias under local anesthesia is not well accepted. The purpose of this study is to evaluate the effectiveness of local anesthesia in inguinal hernia repairs. One hundred consecutive inguinal herniorrhaphies are reported. The selection of patients, surgical technique, and incidence of intraoperative and postoperative complications are reported. Patient acceptance and their immediate postoperative course are also described. The study demonstrates that inguinal hernias can be easily repaired under local anesthesia, complications are minimal, and patient acceptance, excellent. We strongly recommend thath this form of anesthesia be used in the "routine" repair of inguinal hernias in cooperative patients.

Multifactor evaluations of surgical trainees and teaching services

Surgical education has been exposed to increasing challenges as students have moved from the highly structured environment of a university hospital into a variety of clinical settings within the community. Presented with a general surgical service that uses ten relatively autonomous teaching services in seven hospitals, we have developed a computer-based evaluation system designed to provide quality control and a feed-back loop for trainee, teacher, and service. Trainees were rated by comparing them to their peers, with the chief resident as a reference standard. Profiles of each teaching service also were developed and compared one to the other. The results of both studies over a one year period are presented.