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.

A systems approach to cardiovascular disease research

Research in cardiovascular disease is fragmented and difficulties arise in communication between workers in different disciplines. There is no shortage of facts but rather a deficiency in concepts which can accommodate the facts. Systems analysis is suggested as a way to develop a conceptual framework for the assimilation of existing and new information, and to give a basis for decisions about priorities in research. A model of mechanisms in cardiovascular disease is presented to illustrate the approach.

Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding

A case of acute and spontaneous spinal epidural hemorrhage is described in which there was no history or evidence of trauma, conventional anticoagulant therapy, hemophilia or vascular anomalies. A recent history of excessive ingestion of an aspirin-containing medication was obtained and the clinical and laboratory picture of an aspirin-induced bleeding disorder was documented. We have discussed the mechanism and hematological considerations of the syndrome of aspirin induced bleeding.

Human fallopian tubes in organ culture: preparation, maintenance, and quantitation of damage by pathogenic microorganisms

An experimental organ culture model has been developed in which rates of damage to fallopian tube mucosa by agents of sexually transmitted diseases can be quantitated. This required assessment of the effect on organ cultures of such variables as the anatomic area of the fallopian tube employed, endocrinological status of the donor, and composition of media. Organ cultures established from the ampulla of tubes of nonpregnant, premenopausal women and maintained with Eagle minimal essential medium containing 0.05 M N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid buffer were most suitable for quantitative studies. Various means of quantitating damage to fallopian tube mucosa were evaluated. Of these, sequential estimations of ciliary vigor and percentage of the periphery of fallopian tube pieces with active cilia proved the most successful. To assess the specificity of the model, fallopian tube organ cultures were infected with Neisseria gonorrhoeae or N. pharyngis, a commensal Neisseria. Damage by N. gonorrhoeae was significantly greater than that by N. pharyngis at each period of observation (P less than 0.001), suggesting that, by using the model, differences in virulence can be determined in vitro that reflect differences in virulence for humans. This model is a potentially valuable tool for studying the interaction of human genital mucosa with known or suspected agents of sexually transmitted diseases.

An international haematological survey

Haematological surveys of adult population samples were conducted simultaneously in 12 countries, all but one of which are in Europe. Haematological estimations on samples from nine of the countries were made in one central laboratory. Differences between countries in the mean levels of haemoglobin (and haematocrit and red cell count) were found to be relatively small, and the prevalence of levels below the arbitrary WHO levels for anaemia were, on the whole, low. In males, the evidence suggests a fall in haemoglobin level throughout adult life, which increases slightly in advanced age. In females, there is no evidence of any important relationship between age and haemoglobin level.