Helicobacter pylori gastric infection in gnotobiotic beagle dogs

Establishment of infection with Helicobacter pylori and gastritis in nonhuman species is currently only successful in gnotobiotic piglets. This study was designed to determine whether H. pylori will colonize the gastrointestinal tract of gnotobiotic dogs. Gnotobiotic beagle pups were derived by standard methods. Group A (five dogs) was orally challenged with 3 x 10(8) H. pylori at 7 days of age. Group B (two dogs) received only peptone water but was contact-exposed beginning on day 23 postinfection (p.i.). Necropsy was performed on dogs on day 30 p.i. H. pylori colonized the stomach of all dogs (groups A and B). Urease map analysis correlated with the microbiologic findings and indicated that the density of colonization was less than that observed in human tissue. Organisms were also recovered from the pharynx, esophagus, duodenum, and rectum of 1, 2, 2, and 1 dog, respectively. All group A and one group B dog developed serum immunoglobulin G specific for H. pylori by day 30 p.i. Gross lesions were restricted to the stomach and consisted of small (less than 1 mm) lymphoid follicles. Microscopically, there were focal to diffuse lymphoplasmacytic infiltrates with follicle formation and mild to moderate infiltration of neutrophils and eosinophils in the gastric lamina propria. With the Warthin-Starry silver stain, organisms were seen on the surface of the gastric epithelial cells, beneath the mucus layer. We conclude that H. pylori colonizes the stomachs of gnotobiotic dogs for at least 1 month and the lesions resemble those seen in humans. H. pylori is transmissible by contact from infected to noninfected dogs.

Signature patterns of DNA restriction fragments of Helicobacter pylori before and after treatment

The genomic DNA of Helicobacter pylori was studied by electrophoretic analysis of restriction endonuclease fragments. Twenty seven isolates from eight patients in the United Kingdom, obtained before and after treatment with nitrofurantoin, and two reference strains from Australia and Peru were investigated. Digestion of DNA with HaeIII, which gave the clearest band pattern of the 20 enzymes tested, showed that each set of isolates from a single patient had a unique band pattern. The DNA signature band patterns of strains from different patients were less than or equal to 62% similar (average 43%); similarities of patterns from the same patient were generally greater than or equal to 86%. Some minor but reproducible polymorphisms (less than or equal to five bands) in the signature region were detected in most consecutive isolates. Plasmid DNA was detected in isolates from five patients, but major pattern differences were attributed to genomic variation. It is concluded that the HaeIII DNA digest signature fingerprints provide a reproducible and sensitive method of discriminating between isolates of H pylori.

Antibody to cytotoxin in infection by Helicobacter pylori

Gastrointestinal disease and colonization by Helicobacter pylori were determined in 36 asymptomatic volunteers and 30 symptomatic individuals undergoing endoscopy and biopsy. Serum antibody immunoglobulin G (IgG) and IgA to H. pylori were measured by enzyme-linked immunosorbent assay. Serum antibody to a cytotoxin produced by H. pylori was detected with a neutralization assay. Serum IgG was 95% predictive of infection by H. pylori, and serum IgA was 88% predictive. Antibody to the cytotoxin was detected in 12 of 18 infected individuals. Antibody to the cytotoxin was a highly specific (96%), but not a very sensitive (67%), indicator of infection by H. pylori. The neutralization assay was 87% predictive of infection. These data confirm the diagnostic value of serum antibody to H. pylori for the detection of infection. The toxin-neutralizing activity of sera from individuals infected with H. pylori suggests that the cytotoxin is produced in vivo. It may therefore contribute to disease associated with H. pylori.

Persistence of Helicobacter pylori in conventionalized piglets

Gnotobiotic piglets were challenged at 3 days of age with Helicobacter (Campylobacter) pylori and then transferred to conventional housing at 24 days of age. Piglets were sacrificed 43-45, 57-60, and 87-90 days after challenge. H. pylori was recovered from the stomachs of all piglets challenged except for two piglets sacrificed 45 days after challenge. H. pylori was not recovered from uninfected control piglets. In addition to H. pylori, Lactobacillus and Bacillus species were recovered from conventionalized piglets. Serum from infected piglets contained H. pylori-specific IgG, IgM, and IgA. IgM titers peaked at 14 days after challenge and then declined. IgG and IgA titers continued to rise over the course of the experiment. Piglets in both uninfected control and challenged groups demonstrated lymphofollicular gastritis, but the gastritis was more severe in challenged piglets.

Decontamination of instruments and control of cross infection in general practice

OBJECTIVE

To assess the effectiveness of decontamination procedures in general practice.

DESIGN

Anonymous postal questionnaire survey of 600 general practitioners randomly selected from the national register.

SETTING

General practices throughout the United Kingdom.

SUBJECTS

382 General practitioners, a response rate of 65%.

RESULTS

186 General practitioners had autoclaves but 125 used hot water disinfectors or chemical disinfectants to reprocess instruments. 22% (474/2132) Of high risk instruments were inadequately decontaminated. Decontamination was performed by the practice nurse or receptionist in 306 practices. Knowledge of treatment of spillages of blood fluids was uncertain, and only 114 general practitioners used effective methods for dealing with spillages.

CONCLUSIONS

A comprehensive central code of practice for control of infection is needed for primary health care staff.

Behavioral-Response of Brushtail Possums, Trichosurus-Vulpecula, to Baits Used in Pest-Control

The behavioural responses of captive possums (Trichosurus vulpecula) were observed during first encounters with non-toxic and toxic carrot and pellet baits used in pest control programmes. Possums confronted with new baits first used smell in a highly discriminating way, and then taste, which sometimes changed their initial response. Toxic carrot baits were rejected by 27.5% of possums, equally by smell and taste aversion, and toxic pellet baits by 34% of possums, mainly by taste aversion. Few (5-7%) rejected non-toxic baits. Such non-learned aversion mechanisms therefore have an important role in the feeding behaviour of possums. A range of flavours tested, using barley as a food base, showed that only orange-flavored barley was significantly preferred to non-flavoured barley; 19 flavours had no significant effect, and 19 others significantly reduced barley consumption. Orange and cinnamon, which was ranked fourth and repels some bird species, were tested as masks for 1080 baits. Both flavours effectively masked the aversive smell and taste of 1080. The levels of toxic flavoured bait rejection were low and did not differ from those of non-toxic (flavoured or non-flavoured) baits. Very few possums were observed vomiting, a behaviour in other species that may assist survival.

Evaluation of a selective enrichment technique for the isolation of Campylobacter pylori

To cultivate Campylobacter pylori from contaminated biopsy specimens, Brucella broth was supplemented with 10% fetal calf serum, 1% Vitox, 1000 units/ml polymyxin B sulfate, 10 micrograms/ml vancomycin, and 2 micrograms/ml amphotericin B. Pseudomonas aeruginosa, Candida albicans, and Enterococcus fecalis were cocultivated with C. pylori. All four strains of C. pylori were recoverable at 24 h. When 21 C. pylori strains were studied in pure culture, 86% grew in the selective enrichment medium. In a clinical study, the selective enrichment technique resulted in isolation of C. pylori from 50% of patient samples, compared with isolation from only 36% of samples with agar cultivation. The selective enrichment technique may be more sensitive than techniques currently employed to isolate C. pylori from gastric tissue.

Campylobacter pylori virulence factors in gnotobiotic piglets

Thirty-three gnotobiotic piglets from four litters were challenged with motile and nonmotile strains of Campylobacter pylori. The most motile strain, 26695, was the most virulent, with a 100% infection rate. The least motile strain, Tx30a, was the least virulent, with an infection rate of only 17%. Strain 60190 was weakly motile and had intermediate virulence, with an infection rate of 40%. Strains recovered from piglets were more motile than the challenge strains. The challenge strains also differed in cytotoxin production. The least virulent strain, Tx30a, was nontoxigenic, while the other two strains produced high levels of cytotoxin. Thus, virulence of C. pylori for gnotobiotic piglets correlated very well with motility and not as well with cytotoxin production.

Strain variation in Campylobacter pylori detected by numerical analysis of one-dimensional electrophoretic protein patterns

A total of 21 clinical isolates of Campylobacter pylori from Peru and the United Kingdom and two reference strains (from Australia), including the type strain (NCTC 11637T), were characterized by high resolution one-dimensional SDS-polyacrylamide gel electrophoresis of cellular proteins. The protein patterns contained more than 40 discrete bands and the approximate molecular weights of the major bands were 22, 27, 46, 57, 60, 65 and 93 kD. The total patterns were used as the basis of numerical analysis. Most strains were clustered in four phenons at 91% similarity with the exception of six ungrouped strains. Overall similarity was high with all strains linked in the phenogram at greater than or equal to 81%. Variation among strains was attributable principally to qualitative and quantitative band differences in the 47 to 56 kD (hypervariable) region of the C. pylori protein profile. From the analysis, ten different electropherotypes (EP-types) were identified. We demonstrated that differences were detectable among isolates from widely separated geographical locations as well as from the same location, although multiple isolates from two Peruvian patients had the same electropherotype. Our results indicate that determination of protein profiles provides the basis of a reproducible method for characterization of C. pylori isolates.

Angiofollicular lymph node hyperplasia with amyloidosis

Two cases of angiofollicular lymph node hyperplasia are described, one of the solitary plasma cell type the other of the multicentric hyaline vascular type. Both cases illustrate the wide ranging clinical and pathological findings associated with this condition but both also have unusual features. The solitary plasma cell lesion had an exceptional 32 year clinical history and was associated with systemic amyloidosis of AL type. The multicentric hyaline vascular case was associated with coexistent multiple myeloma and amyloid deposition also of AL type. These cases are presented with a review of the relevant literature.

Needlestick injuries: how can we teach people better about risk assessment?

At work people run some small risk of death or injury which is directly attributable to their occupation. In biomedical sciences the accidental puncture of the skin by hypodermic needles, other instruments or broken glass has long been regarded as an occupational hazard and there is increasing concern that staff could become infected with a range of micro-organisms, including hepatitis B and the Human Immunodeficiency Virus (HIV). Needlestick injuries should be preventable if staff are trained effectively and take care about disposal of used syringes and needles. Staff at risk must be offered pre-exposure vaccination for hepatitis B and resources must be provided for special training. Fundamental changes may be required in methods and equipment and a number of new ways of targeting groups of health care staff with information are discussed.

Cytotoxic activity in broth-culture filtrates of Campylobacter pylori

Broth-culture filtrates of Campylobacter pylori induced non-lethal cytopathic effects in vitro in 7 of 9 mammalian cell lines tested. Transmission electronmicroscopy revealed that the response consisted of intracellular vacuolisation. Intestine 407 cells were among the most responsive and were used for routine assay. About 55% of isolates of C. pylori tested, originating from four geographic regions worldwide, produced cytotoxic activity. The activity was neutralisable by specific antisera to broth-culture filtrates or to sonicated bacteria but not by antisera to other bacterial preparations. Cytotoxic activity was heat-labile (70 degrees C for 30 min), was protease-sensitive and ammonium-sulphate precipitable. It did not pass through an ultrafiltration membrane with a nominal mol.-wt limit of 100 X 10(3). It was concluded that C. pylori can produce a factor that alters cultured cells in vitro. The relevance of this factor to the pathogenesis of gastritis associated with C. pylori remains to be determined.

Establishment of gastric Campylobacter pylori infection in the neonatal gnotobiotic piglet

Campylobacter pylori, a gram-negative microaerophilic bacterium, has been implicated in the genesis of human gastritis, dyspepsia, and gastroduodenal ulceration. Previous attempts to reproduce the diseases in conventional laboratory animal species have been unsuccessful. To determine if neonatal gnotobiotic piglets were susceptible to C. pylori, we orally challenged two litters (n = 17) with 10(9) CFU after pretreating them with cimetidine. Controls housed in separate units received nothing or peptone water alone. Piglets were examined 1, 2, 3, and 4 weeks after challenge. Colonization by the bacterium and inflammation of the gastric mucosa persisted throughout the study period. Organisms were revealed by Warthin-Starry silver stain to reside between the mucus layer and the gastric epithelium. Culturing of samples from sites along the gastrointestinal tract revealed that the bacterium colonized essentially only the gastric and proximal duodenal mucosae. Gross pathological changes were restricted to the stomachs of infected piglets and consisted of submucosal edema, increased gastric mucus production, and progressive development of mucosal lymphoid follicles. Microscopic lesions consisted of transient neutrophilic infiltrates followed by diffuse and follicular infiltrations of mononuclear leukocytes into the mucosa and submucosa. Alcian blue-periodic acid-Schiff stains suggested that the infection resulted in the depletion of mucopolysaccharide production by deep gastric glands. These data indicate that gnotobiotic piglets reproduce many of the features of diseases associated with C. pylori in humans.

Growth of Campylobacter pylori in liquid media

Until recently, broth cultivation techniques for Campylobacter pylori were unavailable. We developed a method to cultivate bacterial cells within 24 h in liquid media. Cultivation in broth depended on the adequate dispersion of appropriate gases. A static broth at 37 degrees C in a GasPak jar (BBL Microbiology Systems, Cockeysville, Md.) with a CampyPak (BBL) envelope did not support growth after 5 days of incubation. A broth placed in a flask on a Gyrotory water bath shaker (150 rpm; New Brunswick Scientific Co., Inc., Edison, N.J.) fitted with a gassing hood connected to a gas mixture of 10% CO2, 5% O2, and 85% N2 supported good growth. An initial inoculum of 10(5), 10(3) to 10(4), or 10(2) CFU/ml resulted in greater than or equal to 10(8) CFU/ml after incubation for 24, 48, or 72 h, respectively. Under these conditions, the bacteria grew as motile, spiral bacilli rather than the oval and coccal bacilli occasionally reported. Several bases supported good growth when supplemented with serum. For the determination of basal growth conditions, brucella broth base was used. Fetal calf serum (1%) provided maximum growth. Vitox was not necessary for growth and did not augment growth. C. pylori grew over a wide optimal pH range of 5.5 to 8.5.

Ploidy, proliferative activity, cluster differentiation antigen expression and clinical remission in high-grade non-Hodgkin's lymphoma

Using a large range of monoclonal antibodies to specific cluster differentiation antigens the phenotypes of a series of high-grade non-Hodgkin's lymphomas of B- and T-cell type were investigated. Cell ploidy and proliferative fraction were assessed by fluorescent staining of DNA and flow cytometry and data on the incidence of complete clinical remission were obtained. With the exception of some lymphoblastic lymphomas, high-grade B-cell lymphomas normally expressed the pan B-cell antigens CD19 and CD22 but only immunoblastic lymphomas consistently expressed the pan B marker CD20. Variable, generally weak expression of CD21 was observed whilst CD23 expression was most prevalent in rapidly proliferative cases and in Burkitt's and centroblastic lymphomas. A rapidly proliferative, multilobated B-cell lymphoma displayed phenotypic properties intermediate between centroblastic and immunoblastic lymphomas. The T-cell lymphomas generally showed low proliferative activity and expression of CD4 prevailed over CD8. Most cases also showed CD2 and CD5 positivity with some also showing CD3 and CD7 expression. Patients with rapidly proliferative diploid or DNA aneuploid tumours obtained complete remission more readily than patients with lowly proliferative diploid tumours. An excess of early deaths occurred among T-cell cases.

Performance characteristics of a dual-energy detector for digital scan projection radiography

An energy discriminating x-ray detector has been developed for dual-energy, scan projection digital radiography. The detector is comprised of a pair of x-ray intensifying screen/linear photodiode arrays, aligned one behind the other. Energy discrimination is achieved by employing a low atomic number phosphor in the front screen and a high atomic number phosphor in the back screen. The x-ray response, modulation transfer function, and defective quantum efficiency of the detector are reported along with the experimental methodology utilized for the measurements. Also presented is an analysis which indicates that in a typical patient's lung field, the detector can resolve the projected density (g/cm2) of a 3-mm-thick, 1-cm2 area of bone to better than 1.5%.

Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for travelers' diarrhea. A placebo-controlled, randomized trial

The efficacy of ciprofloxacin was compared with that of trimethoprim-sulfamethoxazole in a placebo-controlled trial of the 5-day treatment of acute diarrhea among 181 adults recently arrived in Guadalajara, Mexico. Both antimicrobial agents were significantly (p less than 0.0001) more efficacious than placebo in the treatment of diarrhea, with the average duration of diarrhea being 29, 20, and 81 hours, respectively, in the ciprofloxacin, trimethoprim-sulfamethoxazole, and placebo treatment groups. The antimicrobial agents were also more efficacious than placebo in treating diarrhea caused by enterotoxigenic Escherichia coli, invasive enteropathogens, and unknown pathogens. Both antimicrobials were effective in treating mild-to-moderate and moderate-to-severe disease, and both were well tolerated. Ciprofloxacin appears to be a logical alternative to trimethoprim-sulfamethoxazole in the initial treatment of acute travelers' diarrhea.

Lack of emergence of resistant fecal flora during successful prophylaxis of traveler's diarrhea with norfloxacin

Norfloxacin, a new quinolone carboxylic acid derivative, was compared with an identical-appearing placebo preparation in a prospective, randomized, double-blind trial for prevention of traveler's diarrhea among 120 U.S. students arriving in Mexico. Prophylaxis was continued for 2 weeks. Diarrhea was defined as four unformed stools in 24 h plus an additional symptom of enteric disease. In the norfloxacin prophylaxis group, 4 of 56 subjects (7%) experienced diarrhea, compared with 36 of 59 subjects (61%) in the placebo group. The difference was significant (P less than 0.0001). In contrast to our previous experience with use of trimethoprim-sulfamethoxazole to prevent traveler's diarrhea, quantitative stool cultures in the norfloxacin-treated group revealed a significant decline of normal aerobic fecal flora during prophylaxis (P less than 0.0005). Among stool samples from norfloxacin-treated subjects, 32 of 38 (84%) cultured on day 7 and 34 of 37 (92%) cultured on day 14 had no gram-negative bacilli. After norfloxacin was discontinued, fecal flora returned to pretreatment levels. No gram-negative aerobic flora resistant to norfloxacin were found during weekly quantitative cultures before, during, or after therapy.

DNA content and prognosis of non-Hodgkin's lymphoma

Ninety cases of non-Hodgkin's lymphoma diagnosed prior to the use of modern therapeutic regimens (1963-67) and 88 cases treated with such chemotherapy (1980-85) were studied using conventional morphology and flow cytometry. DNA aneuploidy as determined by flow cytometry was more common among high grade (38%) than low grade (19%) tumours (P less than 0.01). Measurements of proliferative index (S + G2 phase cells) revealed significantly increased values for high grade as compared with low grade lymphomas (P less than 0.001). In the first group of cases (1963-67) the relationship between histological grade and survival just failed to reach statistical significance over the long term (20 yr) (P = 0.1) but proved significant over 3 yr (P = 0.012). Differences in ploidy and proliferative index status were not associated with survival. In the second patient group (1980-85) attainment of complete remission following chemotherapy was associated with the presence of DNA aneuploidy in high grade tumours (P less than 0.05). The limited follow up of this group precluded assessment of survival in relation to ploidy.

Role of a novel antidiarrheal agent, BW942C, alone or in combination with trimethoprim-sulfamethoxazole in the treatment of traveler's diarrhea

The efficacy of BW942C, a novel enkephalinlike pentapeptide antidiarrheal agent, was compared with the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) and the combination of the two agents in a placebo-controlled trial of the 72-h treatment of acute diarrhea. Subjects with diarrhea but without bloody stools or fever greater than 102 degrees F (38.9 degrees C) were enrolled. Administered to 134 U.S. adults with diarrhea that developed shortly after their arrival in Guadalajara, Mexico, BW942C was more efficacious than TMP-SMX in relieving diarrhea and cramps in the first 12 h of therapy, especially among subjects with diarrhea caused by enterotoxigenic E. coli. In the BW942C treatment group, 25% of subjects eventually took additional therapy because their diarrhea did not respond to BW942C alone. Neurological side effects such as dizziness and light-headedness occurred more frequently among BW942C-treated subjects. Therapy for 3 days with TMP-SMX provided lasting relief comparable with previously reported 5-day therapy. Use of the combination of both agents provided the benefits of prompt relief afforded by BW942C and lasting relief afforded by TMP-SMX. BW942C might prove to be an agent suitable for the treatment of acute diarrhea, with TMP-SMX reserved for treatment of those who do not respond adequately. The empiric use of the combination of BW942C and TMP-SMX appears appropriate for the treatment of severe nondysenteric disease.

Cutaneous infection in normal and immunocompromised mice

Since a model of staphylococcal skin infection adequately reflecting human disease was unavailable, a self-limiting animal infection model specific for virulent Staphylococcus species was developed. A virulent strain of S. aureus, NCTC 9789 (ATCC 27700), was used to develop an infection model in adult, male CF-1 mice treated with 0 to 150 mg of cyclophosphamide (CY) per kg 4 days before challenge. Bacteria were inoculated onto the dorsal side of shaved mice at 0 to 10(6) CFU per mouse. Simultaneously, the skin was gently scraped to remove the superficial layers without drawing blood. The wound was occluded with impermeable film secured with surgical tape. At a CY dose of 50 mg/kg and an inoculum of 10(5) CFU, 89% of the mice (96 of 108) developed large abscesses (approximately 15-mm diameter). Mice which were not immunocompromised developed fewer abscesses (20 of 68). Generally, no abscesses formed when the mice were not wounded (1 of 62), occluded (0 of 89), or inoculated (11 of 50). The abscesses developed 24 to 48 h after challenge and persisted for 2 to 3 weeks. The challenge organism was isolated from the abscesses. The rates of abscess formation of three additional S. aureus strains varied widely in normal and CY-treated mice. Three strains of S. epidermidis, one of Micrococcus varians, and one of S. saprophyticus failed to cause abscesses. Bacterial proliferation studies demonstrated that a strain of S. aureus and a strain of S. epidermidis proliferated to the same levels 48 h after challenge. Immunosuppression and wounding had little effect on the levels of proliferation of S. aureus (P greater than 0.2). Without occlusion, however, S. aureus proliferated to significantly lower levels (P less than 0.005). This model may be be useful for screening topical anti-infective agents or studying the mechanisms of bacterial pathogenesis and host response.

Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea

Loperamide hydrochloride was compared with bismuth subsalicylate for the treatment of acute nondysenteric travelers' diarrhea in 219 students visiting seven countries in Latin America. Subjects whose condition was not improved with therapy could elect to take trimethoprim-sulfamethoxazole. Persons receiving loperamide passed fewer unformed stools when compared with the bismuth subsalicylate group during the first four hours of therapy, from four to 24 hours, and from 24 to 48 hours after therapy was initiated. Among subjects with disease due to enterotoxigenic Escherichia coli, Shigella sp, other pathogens, and unknown agents, fewer unformed stools were passed by the loperamide-treated subjects than the bismuth subsalicylate-treated subjects for all time periods studied. No significant prolongation of disease was seen in subjects with shigellosis treated with loperamide. Eight of the loperamide-treated subjects experienced constipation compared with one in the bismuth subsalicylate-treated group; otherwise, there was no difference in minor side effects experienced between both treatment groups. We conclude that loperamide is a safe and effective alternative to bismuth subsalicylate for the treatment of nondysenteric travelers' diarrhea.

Primary small intestinal lymphoma: a study of 39 cases

Thirty-nine cases of primary small intestinal lymphoma were studied by morphological and immunohistochemical methods. The adjacent uninvolved mucosa was also examined for features suggestive of coeliac disease. Employing the immunogold silver staining (IGSS) technique and polyclonal primary antisera against alpha-l-antitrypsin, lysozyme and kappa and lambda light chains, 29 cases (74.5 per cent) were found to be B-cell lymphomas, seven (18 per cent) histiocytic tumours, one (2.5 per cent) Hodgkin's disease and two (5 per cent) remained unclassified. No specific lymphoma subtype was found to be associated with cases having the histological features of coeliac disease in the uninvolved adjacent mucosa. In 35 cases sufficient clinical information was available to assess the significance of histological type and stage in relation to survival. Although the histological type did not correlate with survival, stage did and tumours extending beyond the local lymph nodes were associated with a significantly worse prognosis.

Lack of correlation between known virulence properties of Aeromonas hydrophila and enteropathogenicity for humans

Five strains of Aeromonas hydrophila were selected for use in volunteer challenge trials. All five strains produced cytotoxin, hemolysin enterotoxin, lysine decarboxylase, acetylmethylcarbinol, and DNase. Two strains hydrolyzed esculin. All strains produced purulent hemorrhagic fluid accumulation in rabbit ileal loops, but failed to induce keratoconjunctivitis in guinea pigs. None of the strains produced mannose-resistant hemagglutinins. In challenge studies, diarrhea was demonstrated in only 2 of 57 human volunteers with doses ranging from 10(4) to 10(10) CFU. One person experienced mild diarrhea with 10(9) CFU of strain 6Y. A second person developed moderate diarrhea with 10(7) CFU of strain 3647. At higher doses, no diarrhea was seen in any of the volunteers. The other three strains (B158, SSU, 3284) failed to cause diarrhea and were not recovered from stools of volunteers. Additional virulence properties of A. hydrophila need to be sought before enteropathogenicity for humans can be established.

The effects of mild hypoxia on a logical reasoning task

In an attempt to replicate the findings of Crow and Kelman (1969) and Denison et al. (1966), which suggest that the performance of novel tasks can be impaired at altitudes below 3,050 m, 150 subjects were divided into five independent groups and their performance tested on a logical reasoning task. One group was tested at ground level in a lecture room; the remaining groups were tested in a decompression chamber, one at 305 m, one at 2,440 m, one at 3,050 m and one at 3,660 m. Significant differences were identified between the 'lecture room' and 'chamber' groups in both speed of work and error rate (p less than 0.05); this finding is interpreted as the effect of apprehension on the naive subjects. A significant difference was found between the group tested at 3660 m and the remaining groups for error rate (p less than 0.05); this finding is interpreted as the effect of apprehension on the naive subjects. A significant difference was found between the group tested at 3660 m and the remaining groups for error rate (p less than 0.05) but not for speed of work. However, no effect of altitude on the way in which the task was learned could be demonstrated.

Detector for dual-energy digital radiography

A detection scheme is described that allows one to accomplish dual-energy scanned projection digital radiography without switching the x-ray tube voltage. The method employs a high/low atomic number detector sandwich that simultaneously separates the x-ray beam transmitted by the patient into low and high energy components. To test the method, the response of a scanning linear array of energy-sensitive detectors was simulated, and bone and soft tissue images of an anthropomorphic chest phantom were obtained at 140 kVp. These were compared with similar images obtained by switching the x-ray tube voltage from 80 kVp to a heavily filtered 140 kVp. For comparable entrance skin exposures, the dual-energy detector images required a lower tube load and resulted in higher noise levels. The latter is attributable to the fact that the separation in energy between the high and low energy components is smaller with the dual-energy detector than with the voltage switching technique, and to misregistration problems associated with the simulation methodology. A detector design is also discussed that would result in improved energy separation and lower noise levels. In view of this possibility and the tube loading advantage, the method looks promising for digital scanned projection radiography.

Evaluation of BW942C, a novel antidiarrheal agent, against enterotoxins of Escherichia coli and Vibrio cholerae

BW942C, an enkephalin-like pentapeptide with anti-diarrheal activity, was tested against crude toxins of Escherichia coli and Vibrio cholerae in the Y-1 adrenal cell assay, rabbit ileal loop assay, and suckling mouse assay. The effects of BW942C on in vitro ion transport were measured in rabbit ileum mounted in Ussing chambers. In vitro, BW942C decreased basal short-circuit current (2.26 and 3.15 mueq cm-2 h-1 in experimental samples and controls, respectively; n = 7, P less than 0.05) and increased basal net Cl absorption (1.59 and 0.50 mueq cm-2 h-1 in experimental samples and controls, respectively; P less than 0.025). Net Na absorption was also increased, but not significantly. BW942C did not block the secretory response to a maximal dose of purified heat-stable toxin. BW942C directly enhanced intestinal fluid absorption. In the Y-1 adrenal cell assay, 5 mg of BW942C per ml inhibited the cytopathic effect caused by cholera toxin or heat-labile enterotoxin of E. coli. In the rabbit ileal loop assay, E. coli heat-stable toxin, E. coli heat-labile enterotoxin, and cholera toxin were inhibited 35 to 70% by administration of BW942C. With the suckling mouse model, the fluid accumulation caused by E. coli heat-stable toxin was ablated by prior treatment with BW942C. The drug is currently being evaluated in patients with acute secretory diarrhea to determine its effect on clinical symptoms.

Measured performance characteristics of a solid-state linear detector array

Experimental studies of a solid-state linear detector array developed for a prototype scanning slit digital chest radiographic unit have been completed. The detector consists of a strip of scintillating material, optically coupled to a linear silicon photodiode array. Measured performance characteristics of the detector, such as sensitivity, modulation transfer function, and detective quantum efficiency, are presented for several different scintillators. Results indicate that direct x-ray absorption events in the silicon photodiode can degrade detective quantum efficiency. Results also indicate that the inexpensive preamplifier circuits used in the digital chest prototype contribute negligible noise at diagnostic x-ray photon fluence rates.

A newly recognized cause of travelers' diarrhea: enteroadherent Escherichia coli

Adherence to HEp-2 tissue culture cells has been proposed as a virulence characteristic of enteropathogenic Escherichia coli (EPEC). A preliminary study revealed that E. coli that adhered to HEp-2 cells, but did not produce conventional enterotoxins and did not belong to recognized EPEC serogroups, could be isolated from adults from the United States who acquired diarrhea in Mexico. The purpose of this study was to determine the prevalence of these enteroadherent E. coli (EAEC) in 188 travelers with diarrhea and in 92 well travelers. EAEC were found in 14.9% of patients with diarrhea and in 7.6% of well individuals. Compared with well travelers, patients with diarrhea in whom no recognized enteropathogen could be identified had a 30.4% prevalence of EAEC (P less than .0003). These results further support our finding that EAEC are associated with diarrhea in travelers to Mexico and may help to explain the effect of antibiotics in the prevention and therapy for travelers' diarrhea in patients with no recognized bacterial enteropathogens.

Efficacy of bicozamycin in preventing traveler's diarrhea

Bicozamycin was compared with a placebo in a prospective, randomized, double-blind study of the prevention of acute diarrhea among 30 American travelers newly arrived in Guadalajara, Mexico. None of the 11 subjects given bicozamycin orally for 3 wk at a dosage of 500 mg four times a day developed diarrhea as compared with an incidence of 53% diarrhea (10 of 19 subjects) in the placebo group (p = 0.003). Bicozamycin was well tolerated. Studies of changes in predominant aerobic fecal flora among the 11 subjects treated with bicozamycin showed the appearance of only one highly resistant Citrobacter freundii at the end of 1 wk of therapy and only a total of six resistant isolates at the end of 3 wk. All resistant isolates failed to transfer this resistance to a recipient Escherichia coli. Bicozamycin seems to be well suited and safe as a prophylactic agent against traveler's diarrhea.

Cytotoxicity of leukocytes from normal and Shigella-susceptible (opium-treated) guinea pigs against virulent Shigella sonnei

Intraepithelial lymphocytes were collected from the ileum of adult Hartley strain guinea pigs and used as effector cells in a 60-min bactericidal assay with virulent Shigella sonnei as target cells. Natural killer cytotoxicity (NKC) and antibody-dependent cellular cytotoxicity (ADCC) were measured and correlated with the resistance of the animals to infection by S. sonnei. Normal guinea pig intraepithelial lymphocytes exhibited mean NKC and ADCC values of 22.8 +/- 5.0 and 34.1 +/- 13.6, respectively. These animals were resistant to oral challenge with virulent S. sonnei. Intraepithelial lymphocytes from guinea pigs which were fasted for 4 days demonstrated NKC and ADCC values similar to those of normal animals (31.0 +/- 8.1 and 41.7 +/- 6.7, respectively). These animals also were resistant to oral challenge. Intraepithelial lymphocytes from guinea pigs which were given 1 ml of deodorized tincture of opium 2 h before cell collection demonstrated deficient NKC (4.7 +/- 4.2) and ADCC (5.3 +/- 4.9) values but remained resistant to infection by S. sonnei. When guinea pigs were fasted for 4 days and given opium, deficient NKC (2.0 +/- 2.0) and ADCC (1.3 +/- 1.3) values were demonstrated; this group of animals was susceptible to infection by S. sonnei (P less than 0.04). These experiments demonstrated that opium treatment depresses one form of gut immunity. When combined with starvation, opium treatment may increase susceptibility to infection by shigellae by modulation of immunity in addition to the effects on gut motility and bacterial flora.

Cytotoxicity of human peripheral blood and colostral leukocytes against Shigella species

We examined the ability of human peripheral blood leukocytes to kill strains of Shigella sonnei and Shigella flexneri by using a modified bactericidal assay. Antibody-dependent cellular cytotoxicity (ADCC) was demonstrated in the presence of specific rabbit immune serum directed against S. sonnei. With peripheral blood leukocytes from adults, ADCC was found only in the mononuclear cell and purified lymphocyte populations. Monocyte-macrophages and polymorphonuclear leukocytes were unable to demonstrate ADCC. Lymphocyte ADCC, which was not affected by the addition of phenylbutazone (an inhibitor of phagocytosis), was mediated by a non-T, Fc receptor-positive, HNK-1- cell. ADCC (using antiserum directed against virulent S. sonnei) was demonstrated against virulent S. sonnei but not against virulent S. sonnei or virulent S. flexneri. In contrast to leukocytes from adults, both mononuclear and polymorphonuclear cells from neonatal cord blood and from a patient with chronic granulomatous disease mediated anti-Shigella ADCC. Breast milk leukocytes (BMLs) collected 1 to 3 days postpartum were used as effector cells against virulent S. sonnei. The entire BML population, BMLs which did not adhere to plastic and BMLs which passed through nylon wool columns mediated both natural killer cytotoxicity and ADCC. In paired experiments, natural killer cytotoxicity and ADCC were significantly lower (30 to 45% inhibition) but not ablated, when phenylbutazone was added to BMLs and nylon wool-purified BMLs (P less than 0.05). These experiments suggest that colostral leukocytes mediated both extracellular and intracellular bacteriolysis in the presence and absence of specific antiserum. These mechanisms may be active in vivo in protection against shigellosis.

Single-slit digital radiography: some practical considerations

Clinical evaluation of an experimental digital chest unit using a solid-state linear detector array has provided information regarding the postpatient photon flux required for clinically acceptable images. Results from computer simulation show that energy subtraction imaging of the chest by the method of x-ray-tube voltage switching will be unsuccessful unless it can be demonstrated clinically that a much lower number of photons per pixel is acceptable in energy subtracted images. In addition, x-ray-tube loading limitations preclude imaging of the abdominal and pelvic regions with this technology.

Antimicrobial resistance of gram-negative bacteria isolated from foods in Mexico

When trimethoprim-sulfamethoxazole was given to US travelers in Mexico to prevent diarrheal illness, high-level resistance to the drug emerged [2], although in previous studies such resistance had not been observed among enteric flora following administration of trimethoprim-sulfamethoxazole as prophylaxis against urinary tract infection [3]. Since food has been shown to be an important vehicle of transmission of travelers' diarrhea, food samples were examined for the presence of drug-resistant bacteria to explain the acquisition of high-level resistance among enteric flora of individuals taking antibiotics as prophylaxis against traveler's diarrhea. Of 34 strains of ETEC isolated from US students in Guadalajara, Mexico, who had acute gastroenteritis, one was resistant to trimethoprim and one was resistant to trimethoprim-sulfamethoxazole. Eight of the ETEC strains tested demonstrated multiple drug resistance. Twenty-two of 149 isolates from food produced enterotoxin. Only one isolate, which was nontoxigenic, was resistant to trimethoprim, and no coliforms were resistant to trimethoprim-sulfamethoxazole; however, 16 isolates demonstrated multiple drug resistance. Of 235 gram-negative organisms recovered from frozen food samples grown on antibiotic-containing media and tested for enterotoxin production, no isolates were enterotoxigenic. Thirty-four isolates were resistant to trimethoprim, 15 were resistant to trimethoprim-sulfamethoxazole, and 33 demonstrated multiple resistance. Multiple drug resistance was demonstrated among gram-negative organisms isolated from patients' stools and foods in Mexico.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of methods to detect Escherichia coli heat-labile enterotoxin in stool and cell-free culture supernatants

We compared the standard Y-1 adrenal cell (YAC) assay for heat-labile enterotoxin (LT) with newer rapid and economical immunological methods of detection. Stool samples were collected from 164 acutely ill American students in Guadalajara, Mexico. Supernatants were prepared from each stool. Stools were cultured for Escherichia coli by standard techniques. Individual E. coli-like colonies were examined for LT production by the Biken assay. Culture supernatants and stool supernatants were assayed for the presence of LT by the YAC assay, counterimmunoelectrophoresis, and enzyme-linked immunosorbent assay (ELISA). Standard YAC assays of culture supernatants revealed that 40 of the 164 specimens (24%) were LT positive. Counterimmunoelectrophoresis detected 60% and ELISA detected 65% of the 40 known positives when culture supernatants were used. The Biken assay detected 35% of the 40 known positives. With stool supernatants, the YAC assay detected only 18% of the known positives, counterimmunoelectrophoresis detected 60%, and ELISA detected 90%. In addition, ELISA detected 13 LT-positive stool supernatants not detected by the YAC assay of culture supernatants. The ELISA in which stool supernatants are used may be a useful method to detect LT.

Incidence of bacterial enteropathogens in foods from Mexico

We examined food consumption patterns of U.S. students temporarily living in Guadalajara, Mexico. Consumption of foods prepared in Mexican homes was associated with an increased risk of acquisition of diarrhea. Foods from commercial sources and private Mexican homes in Guadalajara were subsequently examined for contamination with coliforms, fecal coliforms, and bacterial enteropathogens. For comparison, selected restaurant foods were obtained in Houston, Tex. Food obtained from Mexican homes showed generally higher counts of coliforms and fecal coliforms than those obtained from commercial sources in Mexico and Houston. The foods in Mexico, both from homes and commercial sources, commonly contained Escherichia coli and occasionally enterotoxigenic E. coli. Foods in Houston were not contaminated with E. coli or enterotoxigenic E. coli. Salmonella (17 isolates), Shigella (4 isolates), and Aeromonas hydrophila (1 isolate) were found only in the foods obtained from Mexican homes. Enterotoxigenic non-E. coli Enterobacteriaceae was recovered with approximately equal frequency from all food sources.

Definitive nonsurgical therapy of epithelial malignancies of the anal canal. A report of 12 cases

Twelve patients with epidermoid carcinoma of the anal region ranging in age from 40-89 years were treated with combined chemotherapy (CT) and radiotherapy (RT) in lieu of abdominal-perineal resection. Ten patients received no prior treatment and two patients were treated for local recurrence following limited surgical excision. Two courses of 5-FU infusion and mitomycin C were given 3-4 weeks apart simultaneously with whole pelvis RT to 3000-4140 rad. One patient received an additional tumor volume dose of 3094 rad by interstitial Iridium implant and one patient received an orthovoltage boost of 1000 rad to the anal ring. All patients completed treatment. Complete regression of the anal mass occurred in all patients. Biopsies of the anal region performed after completion of therapy revealed no evidence of residual cancer. Ten of the 12 patients are alive without evidence of disease 4-24 months (median, 14 months) after completion of treatment. Two patients have died seven months after treatment of unrelated causes and were tumor-free at autopsy. All patients developed proctitis, diarrhea, and moist perineal desquamation which resolved by four weeks posttreatment. Based on their experience and that of others recently reported, the authors conclude that the described CT-RT protocol offers a definitive alternative to surgery of epidermoid cancer of the anal region.