Pseudomonas cepacia in 16 non-fatal cases of postoperative bacteremia derived from intrinsic contamination of the anaesthetic fentanyl. Clinical and epidemiological observations in Denmark and Holland

From Nov. 15 to Dec. 17, 1977, Pseudomonas cepacia was isolated from the blood of 16 patients in Odense, Denmark, and Nijmegen, Holland, 2--5 days after an operation with general anaesthesia. The fever started 14--70 h after operation and lasted 2--4 days. All patients recovered. 14/15 patients examined 7--51 days later had agglutinating antibody titres of 400-3,200 against the epidemic strain. Ps. cepacia with identical biochemical characters and sensitivity pattern was isolated from unbroken vials containing the anaesthetic fentanyl, which had been given to all 16 patients. Two batches were contaminated, one heavily so (10(4)--10(5) cfu/0.1 ml). Seven other batches examined yielded no growth. The preservative added to the vials was a mixture of methyl- and propyl-p-hydroxybenzoates which not only allowed growth of the Ps. cepacia strain but could also serve as a carbon source as did citric and malonic acids. The concentration of preservative was not reduced in contaminated vials. The vials had not been sterilized after closure; too much reliance had been placed on an aseptic technique and insufficient preservatives.

Reliability of histo-pathological diagnosis of squamous epithelial changes of the uterine cervix

The reliability of histological diagnosis of squamous epithelial changes was tested by letting 13 pathologists read 1,001 consecutive cervical biopsies twice. Intra-observer and inter-observer agreement, variance, and deviation of diagnosis were determined. The diagnostic ability showed great individual variation and no significant correlation to experience in pathology. The diagnosis of invasive cancer had a high diagnostic specificity, and the diagnostic sensitivity of the diagnosis of no significant epithelial changes was high too. The reliability of the diagnosis of dysplasia and carcinoma in situ proved unsatisfactory.

N1--P2 component of the auditory evoked potential during alcohol intoxication and interaction of pyrithioxine in healthy adults

The auditory evoked potential was used to assess the effect of alcohol intoxication (1 g/kg) and pyrithioxine (7 mg/kg) on 9 adult subjects. Its components in the latency range 50--250 msec (N1--P2) were studied for 6 g 30 min, during a constant level of alertness. Four periods were considered: alcohol alone, alcohol plus pyrithioxine, pyrithioxine plus alcohol and placebo. With alcohol alone the N1--P2 amplitude was small in the first part of the test and large in the second part as compared to placebo values. Pyrithioxine antagonism was greatest after alcohol had been resorbed. The placebo period indicated that amplitude changes were not due to long-term habituation, when the subject was kept alert.

Pharmacokinetics of dextropropoxyphene in acute poisoning

Dextropropoxyphene (DP) is a commonly used medicament for suicide attempts in Denmark. Death may occur from respiratory depression or cardiac arrest. Mechanical hyperventilation which induces hypocapnia seems to reduce the occurrence of cardiac complications. In an attempt to relate the clinical events to the plasma concentrations of DP and the major metabolite norpropoxyphene (NP) we studied patients with acute poisoning treated either for 48 h with induced hypocapnia by hyperventilation or under a conservative regime. Hypocapnia was found to lead to a significant increase in the plasma half-life of DP. Under conservative treatment the plasma half-life was 17.9 +/- 6.7 (S.D.) h (n = 6), while under induced hypocapnia the mean of values from 5 patients was 30.5 +/- 6.9 (S.D.) h. Maximum serum levels of DP and NP were, however, significantly higher in the intensively treated patients (n = 7) than in those treated conservatively (n = 9), though less marked for NP compared to DP (DP: 4.9 +/- 2.1/2.4 +/- 1.0 mumol/l, NP: 6.3 +/- 2.4/4.1 +/- 1.7 mumol/l). A concentration dependent renal clearance of NP was not demonstrable. Possible explanations are the following: 1) A change in disposition pattern blood/tissue of DP during hypocapnia. 2) A reduced metabolism DP to NP during hypocapnia. 3) A reduction in other routes of elimination.

Fermentation pattern in the bovine rumen after feeding straight feeds

The influence of straight feeds on the fermentation pattern in the bovine rumen was investigated by feeding with hay, grass pellets, dried beet pulp with molasses and rolled oats. The study comprised 3 rumenfistulated dairy heifers, and the parameters measured were ammonia, pH and volatile fatty acids (VFA) in the rumen fluid, and non-glucogenic/glucogenic ratio (NGGR) in the VFA mixture.

Typical differences related to the structure and chemical composition of the diets were demonstrated by the parameters measured. Fermentation of the easily digestible feeds resulted in so extensive variations that representative means could be obtained only by analyzing samples collected frequently throughout the feeding cycle.

Rumen pH was found highly correlated to total VFA concentration for all the feeds examined, and the regression coefficients showed that diets, based upon beets and oats, were fermented under low buffering capacity.

Effect of feeding frequency on fermentation pattern and microbial activity in the bovine rumen

The influence of the feeding frequency on the fermentation in the bovine rumen was investigated by a single reversal trial with restricted supply of feed. The study comprised 6 rumen-fistulated dairy heifers fed a complete diet, low in crude fibre, at 2 frequencies. The effect of the treatment was assessed by the parameters: Concentration of microbial metabolites, total counts of microorganism, concentration of adenosine triphosphate (ATP), and fermentative activity in the rumen.

Frequent feeding compared to feeding twice daily resulted in marked reduction of the diurnal variation in the concentration of ruminai metabolites without significant influence on the daily means of total VFA and pH, but the molar composition of the VFA mixture and the production rate of VFA were highly affected. The implications of these observations for improved feed utilization to milk production and fattening are discussed.

Pronounced increment of the concentration of ATP was found by frequent feeding, but the total counts of microorganisms were found almost unaffected. Since the rate of fermentation was highly correlated with the concentration of ATP, the ATP pool may be an indicator of the fermentative activity of rumen microorganisms.

Frequency of mental disorders in old age. Examples of comparability of epidemiological investigations in relation to utility in planning

Due to the increase in the number of old people, diseases of old age have acquired more and more importance. In estimating the need for psychiatric hospitals and nursing homes, epidemiological investigations are necessary. Only relatively few population investigations of the old-age population have been carried out, and most of these have been carried out in countries in Northern Europe, which are closely related culturally and socially. In the present paper nine investigations are described in relation to certain central factors which include the purpose of the investigation, description of the population, selection of probands, and statistical concepts used, the collection of data, and the main results. Seven of the investigations give results in the form of prevalence, two investigations calculate incidence and morbidity risk. It is concluded that comparison of the various results is difficult as most of the authors have not intended their investigations for mutual comparison. It is clear that there are many dissimilarities in the milieus involved, in the methods used, in the prerequisites of the interviewers and assessors, and in the classification of the results. The investigations presented have been used for evaluation of prognosis and planning of care for the old-age population. It must be said that an investigation is an expression of local truth and as such often usable in local planning, but on the other hand it is not often possible to utilize results from investigations carried out in outside regions for more than a rough basis for local prognosis and local planning. It must therefore be stressed that in future investigations more standardized methods and better correlated descriptions are necessary.

Serum immunoglobulin M, G, and A concentration levels in Turner's syndrome compared with normal women and men

Serum concentrations of immunoglobulin G (IgG), immunoglobulin M (IgM) and immunoglobulin A (IgA) were determined in 15 women with a lack of X chromsome material (Turner's syndrome), and compared with the immunoglobulin concentrations in normal men and women. Further, the investigation is supplemented by a comparison of normal women and the Turner group matched according to age. The serum concentrations of IgG and IgA in women with Turner's syndrome were very close to the concentration in serum from normal men, whereas the concentration of IgM was significantly lower. Compared to normal women the concentrations of IgG and IgM were significantly lower, and the concentration of IgA significantly higher in the Turner group. Whether these differences in serum immunoglobulins are determined by hormonal factors or under direct genetic control linked to the X chromosomes, is discussed.

Ammonia, pH and volatile fatty acids in the bovine rumen after feeding with hay

The effect of feeding level and interval between feedings on the fermentation pattern in the bovine rumen have been investigated in experiments with hay. The animals were completely adapted heifers fitted with rumen cannulas, and the parameters measured were ammonia, pH, volatile fatty acids (VFA) and non-glucogenic/glucogenic ratio (NGGR) in the VFA mixture.

Increasing feeding levels, ranging from 2/3 to 4/3 of maintenance level, resulted in higher average concentrations of VFA and lower pH in the rumen fluid. Further the highest level of intake caused a considerable diurnal variation in the pH and the concentration of total VFA, and increased the variation in the molar composition of the VFA mixture.

Three feeding intervals ranging from 8 to 16 hrs., with hay administered at maintenance level, caused no changes in the fermentation pattern.

Typical variations in the concentrations of ammonia and valeric acid as related to time after feeding were demonstrated, but the concentrations of the branched-chain fatty acids in the rumen fluid were found to be quite constant.

It may be concluded that a representative mean value of the parameters measured, except for ammonia and valeric acid, may be based on relatively few samples when feed intake does not exceed maintenance level, whereas sampling every hour is required at higher feeding levels.

Quantum efficiency and instrumental polarization of an optical monochromator

Experiences from a determination of the over-all quantum efficiency and instrumental polarization of an optical monochromator and detection system (near ultraviolet, visible, and near infrared), including application of imperfect polarizers, are discussed and related to atomic and electronic collision studies.

The microflora and concentrations of volatile fatty acids in the rumen of cattle fed on single component rations

The composition of the rumen microflora and the volatile fatty acids were examined in cattle free-grazing on grass or stall-fed on hay, grass pellets, oats or dried beet pulp with molasses. Total and viable counts of anaerobic bacteria were highest on the grass feeding, but viable counts as a percentage of total counts were highest when oats or beet pulp with molasses were fed. Counts of cellulolytic bacteria were lowest on these latter 2 diets, and highest on grass or grass pellet diets. Studies of the anaerobic flora showed that the composition in animals fed on grass pellets resembled more that found in animals free-grazing on grass than in those fed on hay. Counts of aerotolerant bacteria were only a small percentage of the total count, but were highest on the hay diet. On this latter diet and on grass-feeding the streptococci (identified as Streptococcus bovis) were predominant, but contrary to expectation, streptococci were found only in small numbers on the oats diet, where coryneform rods were the major type present. Although a period of 4–6 weeks was allowed for the animals to adapt to the feeds, the 2 periods of feeding on oats and dried beet pulp with molasses markedly affected the composition of the rumen flora in the subsequent periods of feeding grass pellets and hay. Ruinen volatile fatty acid analysis showed a propionogenic effect of oats and the highest percentage of butyric acid when beet pulp with molasses was fed. The expected propionogenic effect of grass pellets was not observed.