Presence of two strains of Neisseria gonorrhoeae in both the cervix and pharynx of a patient with disseminated infection caused by a single strain

Neisseria gonorrhoeae was cultured from the cervix, pharynx and blood stream of an 18-year-old woman who had a disseminated gonococcal infection. Two different phenotypes of N. gonorrhoeae, distinguished on the basis of their protein I serovar, whole-cell protein profile, lectin-type and antibiotic susceptibility, were isolated from both the cervix and pharynx, whereas only one of these phenotypes was isolated from the blood. This finding stresses the importance of blood cultures as a prelude to determining appropriate antimicrobial therapy in cases of disseminated gonococcal infection.

Plasmid content, auxotype and protein-I serovar of gonococci isolated in the Gambia

Twenty-nine strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) and 30 non-penicillinase-producing strains, all isolated in the Gambia, were characterized in terms of their plasmid content, auxotype and protein-I serovar. Sixty-two per cent of the PPNG strains contained the 3.2 MDa penicillinase-coding plasmid, and 38% had the 4.4 MDa plasmid. All the PPNG strains contained the 2.6 MDa cryptic plasmid but lacked the 24.4 MDa conjugative plasmid. In contrast, 46.7% of the non-PPNG strains harboured only the cryptic plasmid while 16.7% contained both the cryptic and conjugative plasmids. Seventeen per cent of the non-PPNG strains contained the conjugative plasmid only and 20% lacked plasmids. The PPNG and non-PPNG strains also differed in terms of their protein-I serovar. Eighty-six per cent of the PPNG strains belonged to serogroup 1 A, whereas the majority (60%) of non-PPNG strains belonged to serogroup 1 B. There was no significant difference in the auxotypes of the PPNG and non-PPNG strains, with both groups consisting predominantly of prototrophic and proline-requiring strains, with a minority of strains requiring arginine. When the 59 strains were each characterized in terms of their combined plasmid profile, auxotype and serovar, 39 different combinations were noted, which indicates the heterogeneous nature of the gonococcal population found in the Gambia.

Pili on Gardnerella vaginalis studied by electronmicroscopy

Fourteen recently isolated strains and two laboratory strains of Gardnerella vaginalis were examined by electronmicroscopy for the presence of pili. All strains isolated recently from both men and women were heavily pilated. In contrast only a few pili were seen on organisms of the two laboratory strains, with many of the organisms having no pili. The importance of multiple subculture in this loss was supported by the observation that the degree of pilation of one freshly isolated strain decreased on repeated subculture. Other findings suggested that this was probably due to gradual loss of pili and not to selection of organisms that were non-pilate originally.

Resistance of Gardnerella vaginalis to bactericidal activity of human serum

To assess the sensitivity of Gardnerella vaginalis to the complement mediated bactericidal activity of serum, six laboratory strains were incubated with normal human serum and two strains freshly isolated from women with non-specific vaginitis (NSV) were each incubated with homologous patient serum. There was no significant difference between the number of organisms recovered from unheated or heat inactivated serum after incubation at 37 degrees C for one hour with any of the strains tested. A suspension of G vaginalis incubated at 37 degrees C for one hour in heat inactivated homologous mouse antiserum with unheated normal human serum as a source of complement did not show any less viability than the control mixture using heat inactivated human serum. In contrast, a serum resistant strain of Neisseria gonorrhoeae incubated in heat inactivated homologous mouse antiserum with unheated normal human serum showed noticeably less viability than the control. G vaginalis therefore seems to be resistant to the bactericidal activity of both normal and immune serum.

Loss of ciliary activity in organ cultures of rat trachea treated with lipo-oligosaccharide from Haemophilus influenzae

Organ culture of rat trachea was used as an experimental model to examine the ability of lipo-oligosaccharide from Haemophilus influenzae to damage respiratory tract mucosal tissue. Lipo-oligosaccharide from two strains of H. influenzae produced a significant decrease in the ciliary activity of tracheal rings observed over a 3-5 day period. No loss of ciliary activity was observed with the lipid-free moiety of the lipo-oligosaccharide.

Detection of a species-specific antigen of Gardnerella vaginalis by Western blot analysis

Western blot analysis was used to identify antigenic components of Gardnerella vaginalis. Polypeptides bound to nitrocellulose membranes were probed with murine antisera raised to two strains of G. vaginalis, and antibody-antigen complexes were detected with 125I-labelled antimouse immunoglobulin followed by autoradiography. Although there was inter-strain variation in immunogenic polypeptide profiles, all 23 strains of G. vaginalis examined contained a common antigen of molecular mass 41 kDa. This antigen was not found in any of six other bacterial genera.

Pathogenesis and immunology of chlamydial infections of the genital tract

In recent years there has been a steady increase in our understanding of the pathogenesis and immunobiology of lower genital tract infections caused by Chlamydia trachomatis. Much of this increase in knowledge has stemmed from two areas of research: clinical, pathologic, and immunologic observations of patients and the development and study of animal models. Research on patients has included the use of techniques such as histologic examination of biopsy specimens and measurement of levels of antibody and/or leukocyte responses to chlamydial antigens. The animal models that have been developed include experimental genital tract infections not only with C. trachomatis but also with appropriate Chlamydia psittaci organisms, such as the agent of guinea pig inclusion conjunctivitis. Continued investigation of the pathophysiologic and immunologic bases of chlamydial genital tract disease should lead to the rational development of potential control measures, such as vaccines or other forms of prophylaxis or therapy.

Test procedures for continuous-flow anaesthetic apparatus

Equipment management arrangements in hospitals, including safety and function testing, relating to continuous-flow anaesthetic apparatus have been found wanting following examination of a number of recent incidents. A problem exists with the complexity of the tests required and the number of necessary test instruments. In this article the required tests are examined, and a specially designed test set to make fuller testing a practical proposition for hospital staff and for manufacturers' service technicians is described.

Susceptibility of different serovars of Chlamydia trachomatis to inactivation by normal human serum

The ability of a panel of normal human serum samples to inactivate 12 strains of Chlamydia trachomatis, each of a different serovar, was investigated. A wide range of antichlamydial activity was observed, with survival rates of C trachomatis varying from less than 1% in some experiments to 100% in others. The strain specificity of the anti-chlamydial activity exhibited by individual serum samples was not, however, related to the antigenic cross reactivity between serovars demonstrable by microimmunofluorescence testing, which suggested that type specific antigens were not predominantly involved in the inactivation process.

Azlocillin levels in human tears and aqueous humor

We administered 4 g of azlocillin sodium intravenously to 24 patients scheduled to undergo elective intraocular surgery and collected specimens of serum, tears, and aqueous humor from zero to six hours after infusion for assay by high-pressure liquid chromatography. We found that azlocillin is distributed into tears and penetrates into the aqueous humor of human volunteers with noninflamed eyes after a single intravenous dose. Levels of 4.17 micrograms/ml and 4.44 micrograms/ml were achieved in tears and aqueous humor, respectively.

Gentamicin, tobramycin, amikacin, and netilmicin levels in tears following intravenous administration

Peak and trough tear and serum concentrations were determined in 27 human volunteers undergoing intravenous (IV) gentamicin sulfate, tobramycin sulfate, amikacin sulfate, and netilmicin sulfate therapy. Although effective serum concentrations were achieved, tear levels were subtherapeutic. The mean peak tear concentrations were 0.4 microgram/mL, 0.5 microgram/mL, 1.7 micrograms/mL, and 0.3 microgram/mL for gentamicin, tobramycin, amikacin, and netilmicin, respectively. These levels did not approach the minimum inhibitory concentrations for Pseudomonas and raise some concern regarding the risk-benefit ratio of IV antibiotics for bacterial keratitis.

Demonstration by electron microscopy of pili on Gardnerella vaginalis

Eight strains of Gardnerella vaginalis were examined by electron microscopy for the presence of pili. Narrow pili ranging from 3.0 to 7.5 nm in diameter were seen on bacteria from five of the strains studied.

Adherence of Staphylococcus aureus to rabbit corneal epithelial cells

A system for the in vitro study of adherence of Staphylococcus aureus to rabbit corneal epithelial cells has been developed. Bacteria isolated from normal eyes showed the same adherence capacity, on the average, as bacteria from infected eyes. Adherence was not inhibited by preincubation of bacteria with bovine serum albumin, D-mannose, or N-acetyglucosamine.

Piperacillin levels in human tears and aqueous humor

Thirty patients scheduled to undergo elective intraocular surgery were each given 4 g of piperacillin intravenously. Specimens of serum, tears, and aqueous humor were collected from zero to nine hours after infusion and assayed for piperacillin content by high pressure liquid chromatography. In noninflamed eyes piperacillin sodium distributed into tears and aqueous humor in concentrations exceeding the minimum inhibitory concentration required for many gram-positive and gram-negative organisms. Higher levels of piperacillin were anticipated in patients with inflamed eyes who possessed an altered blood-aqueous barrier, and in patients receiving serial doses of this agent.

Radiotherapy for jugulo-tympanic paragangliomas (glomus jugulare tumours)

Sixty patients with glomus jugulare tumour, seen at St. Bartholomew's Hospital, London, over forty years, have been reviewed. The term 'jugulo-tympanic paraganglioma' is suggested as a more accurate name for these tumours. The following simple classification is recommended: Group I tumours (tympanic paragangliomas) are those with or without VIIth nerve palsy, but with no other cranial nerve involvement. Group II tumours (jugular paragangliomas) are those with involvement of any cranial nerve other than the VIIth. The method and results of treatment by radiotherapy are discussed. It is concluded that surgery and radiotherapy give comparable results in Group I tumours, but radiotherapy gives superior results in Group II tumours.

A study of the susceptibility of three species of primate to vaginal colonization with Gardnerella vaginalis

In an attempt to develop an animal model of Gardnerella-associated vaginitis, several strains of Gardnerella vaginalis were inoculated into the lower genital tract of female pig-tailed macaques, tamarins and chimpanzees. G. vaginalis was not recovered from either tamarins or chimpanzees, but was recovered from each of 1O pig-tailed macaques inoculated with either of two freshly isolated Gardnerella strains, colonization persisting for 11-39 days. Examination of Gram-stained vaginal smears obtained from infected pig-tailed macaques failed to demonstrate clue cells, a feature which is pathognomonic of Gardnerella-associated vaginitis in humans. Other features characteristic of non-specific vaginitis, namely an increase in vaginal pH, and an increase in the ratio of succinate to lactate (S/L ratio) in vaginal fluid were not found. However, the physiology of the macaque vagina was found to be different from that of the human, the vaginal pH and S/L ratio of uninfected macaques both being higher than that seen in humans. The physiological differences between the macaque and human vagina may be due, in part, to a difference in their anaerobic vaginal flora. While these inter-species differences in vaginal physiology and microbiology limit the relevance of the pig-tailed macaque as a model of Gardnerella-associated vaginitis, the ease with which macaques are colonized with G. vaginalis may prove useful in studying bacterial adhesion and local immunity.

A colposcopic and histological study of experimental chlamydial cervicitis in marmosets

A total of 14 marmosets were inoculated intra-vaginally with Chlamydia trachomatis and the development of genital tract disease was assessed microbiologically, by colposcopic examination of the cervical and vaginal mucosa and by cytological and histological examination of biopsy and autopsy specimens. Eight animals had infections which persisted microbiologically for 2-5 weeks, and six animals, three of which had been inoculated on multiple occasions in a previous study, apparently eliminated their infection within 1 week of inoculation. Colposcopic examination showed that four of the eight infected animals developed acute cervicitis characterized by erythema, occasional slight oedema, and the presence of cloudy or purulent cervical mucus. The other four infected animals showed minimal signs of cervical inflammation. Three of the six animals which rapidly cleared their infections developed slight cervical inflammation characterized by erythema and cloudy cervical mucus during the fortnight after inoculation. Six control animals inoculated with medium displayed minimal cervical changes. The diagnosis of acute cervicitis in the infected animals was confirmed by examination of histological sections and cervical smears, which revealed the presence of polymorphonuclear leucocytes, with lymphocytes occasionally being seen. Although inflammatory changes were occasionally noted in specimens from control animals, the changes were relatively mild and occurred at a later time than those seen in infected animals. Intracytoplasmic chlamydial inclusions in epithelial cells were not detected in any of the specimens studied. Examination of genital tract tissue obtained at autopsy from five inoculated animals generally showed inflammation of the cervix and vagina, but in only one of these animals was there evidence of endometriosis and salpingitis.(ABSTRACT TRUNCATED AT 250 WORDS)

A study of inactivation of Chlamydia trachomatis by normal human serum

To assess the effect of human serum on the viability of Chlamydia trachomatis, organisms were mixed with unheated and heat inactivated homologous serum, and the numbers surviving after incubation at 37 degrees C for 1 hour were compared. With a pool of sera obtained from 12 donors, the number of chlamydiae surviving incubation in unheated serum was less than 1% of that surviving incubation in heat inactivated serum. The antichlamydial activity of the unheated pooled serum samples could be noticeably reduced by treatment with Mg-EGTA (ethyleneglycolbis (beta-amino ethyl ether)-N,N'-tetra-acetic acid). This indicated a requirement for calcium ions and showed that the alternative pathway of complement activation played only a minor role, if any, in the inactivation process. When 12 serum samples were tested individually it was found that four inactivated chlamydiae to an extent comparable with that seen with the pooled serum. The other eight samples showed only moderate (or slight) antichlamydial activity, with survival rates in unheated serum of 20-60% (or more than 60%) of those in heat inactivated serum. There was no correlation between the titres of antichlamydial antibodies and antichlamydial activity, all serum samples having undetectable or low concentrations of antibody on measurement by micro-immunofluorescence. The antichlamydial activity destroyed by heating was restored, however, when heat inactivated serum was mixed with an equal volume of an unheated serum that was not inhibitory to chlamydiae. When the latter serum was heated before addition antichlamydial activity was not restored, indicating the requirement of both a heat stable and a heat labile factor. This observation and the need for calcium ions for inactivation of chlamydiae are compatable with killing mediated by antibody and complement. Thus serum samples from individuals with no clinical or serological evidence of infection with chlamydiae vary in their ability to inactivate the organism, some having antichlamydial activity which is possibly mediated by antibody and complement.

Scanning electron microscopy of the interaction between Haemophilus influenzae and organ cultures of rat trachea

Organ cultures of rat trachea inoculated with either a type b or a non-capsulated strain of Haemophilus influenzae showed loss of ciliary activity and disruption of the mucosal surface. Examination of tissue pieces by scanning electronmicroscopy showed that mucosal damage was due to the sloughing of epithelial cells. Bacteria associated with the epithelial surface were seen infrequently and this, together with the observation that sloughed cells were usually free of adherent bacteria, indicated that bacterial attachment was not a necessary prerequisite for the production of tissue damage.

A study of the relationship between ABO blood groups, secretor status and infection with Neisseria gonorrhoeae

The distribution of ABO blood groups and secretor status among 216 male caucasian patients with gonorrhoea was not significantly different from that in 2043 male caucasians who formed a comparison population.

The pathogenic potential of commensal species of Neisseria

Although Neisseria species other than N gonorrhoeae and N meningitidis normally comprise part of the commensal bacterial flora of the oropharynx, they may occasionally act as opportunistic pathogens. Infections in which these organisms have been implicated include cases of endocarditis, meningitis, septicaemia, otitis, bronchopneumonia and possibly genital tract disease. In this paper, the clinical and pathological features of such infections are described, together with a discussion of factors that may contribute to their development.

The "limiting proximal gastric pouch": the evolving solution of morbid obesity

Seventy-five patients received the "limiting proximal gastric pouch." The technique used is the complete transverse gastric stapling with Roux-en-Y reconstruction of gastrointestinal continuity. There was one death, 13 patients required rehospitalization, and five patients required reoperation because of complications. Both the weight loss and percentage of excess weight loss were satisfactory. The patients' acceptance was very high. The limiting proximal gastric pouch is evolving as the procedure of choice for morbid obesity.

Management techniques in the use of the Blom-Singer valve

The use of a valve to restore functional speech following a total laryngectomy has been well described. We have encountered problems in both the formation of the tracheo-oesophageal fistula and stenosis of the tracheostome if the valve is used by itself for long periods. A simple technique to establish the fistula is described, and a modification of the valve with a stoma button is suggested.

Effect of various analgesics and lubricants on isolation of Chlamydia trachomatis and Neisseria gonorrhoeae

Five preparations used as analgesics or lubricants in surgical, obstetrical, gynecological, and investigative procedures were tested for their effect on the isolation of Chlamydia trachomatis. Three lignocaine preparations and a lubricating jelly containing 2% phenol were inhibitory to chlamydiae. In contrast, K-Y lubricating jelly was relatively nontoxic to chlamydiae. Since K-Y jelly also had only slight toxic activity against gonococci, it is recommended for the lubrication of instruments which need to be used for the efficient isolation of these microorganisms.

Chlamydial genital tract infections. Experimental infection of the primate genital tract with Chlamydia trachomatis

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Host species-specific damage to oviduct mucosa by Neisseria gonorrhoeae lipopolysaccharide

The selective toxicity of gonococcal lipopolysaccharide for the mucosa of human fallopian tubes, which is demonstrated in these studies, may be responsible in part for the specificity of naturally occurring gonococcal infections for humans.

Immunity to reinfection of the genital tract of marmosets with Chlamydia trachomatis

Eleven marmosets inoculated intra-vaginally with either of 2 serotypes (D/E and H) of Chlamydia trachomatis developed a self-limited infection which persisted usually for 10-42 days. Animals re-inoculated on one or more occasions were, however, infected generally for a shorter duration, usually 3-7 days. Curtailed infections were observed after re-inoculation with either the same or a different serotype, indicating that immunity was not serotype specific but cross-protective. IgM and/or IgG chlamydial antibody, measured by micro-immunofluorescence, developed in most of the marmosets on primary infection and was not serotype specific. The antibody titres were boosted on re-infection and there was a correlation between pre-existing high antibody titres and infections of short duration. Chlamydial infection of the genital tract was accompanied by acute inflammation which persisted in about half of the immune animals for up to several weeks despite rapid clearance of the organisms. These features of the experimental infection should help to provide a greater understanding of the immunobiology and pathogenesis of chlamydial genital-tract infections of humans.

A microbiological study of non-gonococcal proctitis in passive male homosexuals

In a study of 180 male homosexual patients attending a venereal disease clinic, a correlation was sought between symptoms and signs of proctitis and the isolation of Neisseria gonorrhoeae, group B streptococci, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and herpes simplex virus. Faecal specimens were examined for enteric pathogens and serological tests for hepatitis B virus, syphilitic and chlamydial infections were performed.

There was no association between proctitis, as diagnosed by examination of a Gram-stained rectal smear, and the isolation of any micro-organism or detection of a positive serological test. There was, in addition, no association between any symptom or abnormal physical sign and any positive microbiological findings. Since 23% of patients from whom N. gonorrhoeae was isolated had no abnormal physical signs, it is difficult to assign a pathogenic role to other micro-organisms isolated from patients with and without clinical signs of proctitis. Approaches to further investigation of the problem are discussed.

Clinical and microbiological study of non-gonococcal urethritis with particular reference to non-chlamydial disease

A double-blind placebo-controlled study of minocycline in 221 men with non-gonococcal urethritis (NGU) was undertaken. Techniques were used which enabled diagnoses of chlamydial and mycoplasmal infections to be made within 24 hours of a patient attending a clinic. All patients from whom Chlamydia trachomatis was isolated were treated with minocycline, while patients from whom Ureaplasma urealyticum or Mycoplasma hominis was isolated, or from whom no micro-organisms were isolated, were treated on a double-blind basis with either minocycline or placebo. Chlamydia were isolated from 77 (35%) patients and were eradicated by minocycline from 76 (99%). Ureaplasmas were isolated initially from 96 (43%) patients. Treatment with minocycline eradicated them from 43 of 52 (83%) patients, and they disappeared from six of 31 (19%) patients who were treated with placebo. After one week significantly more patients had responded clinically to minocycline than to placebo. The response to minocycline was not influenced by the microbiological status of the patients, which suggests that ureaplasmas are playing a similar role to chlamydia in the pathogenesis of the disease and that an antibiotic-sensitive micro-organism may be producing disease in the isolate-negative group. An immunological approach is required to resolve the problem of the persistent urethral inflammation which occurred despite eradication of the micro-organisms.

Exteriorized repair in the management of colon injuries

In an attempt to reduce septic complications following colonic injury in penetrating abdominal trauma, we tested the efficacy of the exteriorized repair, also known as primary repair and exteriorization of the injured colonic segment. From June 1973 to August 1979, 50 patients with colonic injuries suitable for exteriorized repair were entered into this study. Their ages ranged from 4 to 47 years; 42 were male, eight, female. Thirty-eight had gunshot wounds, 12 had stab wounds. The majority had various associated injuries, but only five were in shock. In 33 patients (66%) the colonic wounds successfully healed and the exteriorized loop was returned into the peritoneal cavity within 14 days. In 17 patients (34%), fecal leakage developed at the repair site and the exteriorized loops were converted into colostomies without sepsis. There was no mortality and a low complication rare (18%). This method of management for selected patients has a special merit in combining the safety of exteriorization with the economy of primary repair.

Pathogenic mechanisms of Neisseria gonorrhoeae: observations on damage to human fallopian tubes in organ culture by gonococci of colony type 1 or type 4

The relative virulence of isogenic clones of colony type 1 (T1) (piliated) and colony type 4 (T4) (nonpiliated) gonococci was assessed in organ cultures of human fallopian tubes. The rate of damage to fallopian tube mucosa was determined by measurements of ciliary activity and was correlated with the sequential pathologic events observed by light and electron microscopy. During the first 24 hr of the infection, T1 gonococci attached to and damaged the mucosa more rapidly than did T4 gonococci. This damage was manifested primarily by sloughing of ciliated cells. The observation that gonococci attached almost exclusively to nonciliated cells but damaged primarily ciliated cells suggested that this damage was mediated by one or more toxic factors. After attaching, gonococci entered the nonciliated mucosal cells, increased in numbers inside them, and then invaded the subepithelial tissues. Thus, attachment of gonococci to the fallopian tube mucosa may facilitate effective delivery of one or more gonococcal toxins to target cells in the mucosa and may initiate a process by which gonococci traverse the mucosal barrier.

A comparison of the association of Neisseria gonorrhoeae with human and guinea-pig genital mucosa maintained in organ culture

Organ cultures of human and guinea-pig genital mucosa were inoculated with Neisseria gonorrhoeae, and the association of the bacteria with the epithelial surface of each tissue was studied by light microscopy and by scanning electron microscopy. Gonococci attached to the mucosa of human fallopian tube, adhering specifically to the surface of non-ciliated epithelial cells. In contrast, gonococci rarely attached to the mucosal surface of guinea-pig uterine horn, vagina or bladder, although organisms were occasionally seen associated with the submucosal tissue in areas where the epithelium had sloughed, and in extracellular mucus secretions. There is no evidence from this study that gonococci adhere to guinea-pig tissue in a manner analogous to that seen with human genital tissue.

Experimental infection of the marmoset genital tract with Chlamydia trachomatis

A strain of Chlamydia trachomatis isolated in McCoy cells from the urethra of a patient suffering from non-gonococcal urethritis was inoculated into the vagina of 8 female marmosets. Chlamydiae were isolated repeatedly for 10-42 days from the lower genital tract of 7 of the marmosets. Six of the infected animals developed an acute inflammatory reaction in the genital tract and chlamydial inclusions in epithelial cells were seen in smears from 2 of them. In addition, each of 6 infected marmosets examined developed humoral antibodies to C. trachomatis. In contrast, 3 control animals inoculated intravaginally with chlamydia-free McCoy cells showed no evidence of chlamydial infection. Since the marmoset is small and easily bred in captivity, it should provide a useful model for studying the mechanisms of chlamydial pathogenicity.

A comparison of the sensitivity of immunofluorescence and Giemsa for staining Chlamydia trachomatis inclusions in cycloheximide-treated McCoy cells

In a clinical study of 190 men with non-gonococcal urethritis, Chlamydia trachomatis inclusions were sought in cycloheximide-treated McCoy cells by an indirect immunofluorescent antibody technique. The method was consistently reliable over a period of two years, and the results were obtained within 24 hours of a patient's attendance. The results correlated with those obtained by Giemsa staining in 91.6% of patients, and the new method was at least as sensitive as the established Giemsa-staining method.

Failure of iron to promote attachment of gonococci to human spermatozoa under physiological conditions

The effect of iron on the attachment of gonococci to human spermatozoa was investigated using the three iron salts, ferric chloride, ferric nitrate, and ammonium ferric citrate (AFC). Ferric chloride and ferric nitrate were found to be unsuitable for such studies because they were insoluble at physiological pH values, produced a marked decrease in the pH of unbuffered medium (Ringer's solution), and agglutinated spermatozoa. AFC, in contrast, was soluble at physiological pH, did not affect the pH value of Ringer's solution, and did not agglunate spermatozoa. When gonococci and spermatozoa were mixed together in media with and without AFC, the proportion of spermatozoa with adherent gonococci was approximately the same in each case. Thus, in contrast to previous report, we have found that the addition of iron does not increase the attachment of gonococci to human spermatozoa.

Species specificity of attachment and damage to oviduct mucosa by Neisseria gonorrhoeae

Neisseria gonorrhoeae colony type 1 were inoculated into organ cultures of oviducts obtained from various animal species. Gonococci rapidly attached to extensive areas of the mucosa of human oviducts (fallopian tubes), entered the mucous-secreting cells, and caused histological damage to the tissues. In addition, 2 to 4 days after infection there was complete loss of ciliary activity. In contrast, gonococci attached very scantily or not at all to the mucosa of rabbit, porcine, or bovine oviducts. However, the organisms multiplied in the medium of these organ cultures and were located sometimes in the base of mucosal cells and in large numbers in the submucosa. Despit this, there was no histological evidence of damage, and at least 7 days after infection ciliary activity was maintained equally as well as it was in uninfected control cultures. The host specificity of N. gonorrhoeae appears to be determined, at least in part, by a markedly diminished ability of the organisms to attach to and damage the genital mucosa of nonhuman species.

Pneumonia in mice produced by Neisseria gonorrhoeae

Gonococci of colony type 1 were introduced by intranasal inoculation into the lungs of mice in an attempt to produce infection. The organisms were eliminated from the three strains of mice used within 24 hours of challenge. Cyclophosphamide treatment of mice failed to render them susceptible although the organisms disappeared more slowly. The lungs of immunologically normal animals that had received either viable or heat-killed gonococci were acutely inflamed with infiltration of bronchioles and alveoli by polymorphonuclear and mononuclear leucocytes. Most of the changes had resolved after about four days. In cyclophosphamide-treated mice pulmonary infiltration by polymorphonuclear leucocytes was not evident, suggesting that these cells were not primarily responsible for the clearance of the gonococci. Despite the failure to produce a sustained infection, this model may be valuable for studying the local inflammatory effect of gonococcal endotoxin.

Adenocarcinoma of the cecum manifesting as intussesception in a 16-year-old patient: report of a case

A 16-year-old Negro girl underwent exploratory laparotomy for ileocecal intussusception and was found to have moderately well-differentiated mucin-producing adenocarcinoma of the ileocecal valve. Specific aspects of this disease in children are discussed and an appeal for early diagnostic studies in cases of children who complain of weight loss, chronic constipation, and abdominal pain is made. Finially, on the basis of the natural history of the disease, a "second-look" operation is recommended.