Learning Curve of a Laparoscopic Pancreaticoduodenectomy Program at a Second Institution

BACKGROUND

Historically, pancreaticoduodenectomy (PD) has been performed via a laparotomy, but increasingly, laparoscopic and robotic platforms are being employed for PD. Laparoscopic PD has a steep surgeon specific learning curve and programmatic elements that must be optimized. These factors may limit a surgeon who is proficient at laparoscopic PD to develop a program at another institution. We hypothesize that the learning curve for a surgeon transferring a program to a second institution is shorter than the initial laparoscopic PD learning curve for the same surgeon.

METHODS

A retrospective review of patients who underwent laparoscopic PD for any indication at the first institution (FI) from 2012 to 2017 and the second institution (SI) from 2018 to 2021 was conducted. Standard statistical analysis was performed. The learning curve was identified using one-sided CUSUM analysis of operative times.

RESULT

We identified 110 participants, 90 from the FI and 20 from the SI. More patients at the FI were diagnosed with periampullary adenocarcinoma on final pathology compared to the SI (65.6% vs 40.0%, P = .0132). FI operative times stabilized after the 25th laparoscopic PD and SI operative times stabilized after the 5th operation. No statistically significant difference was identified in postoperative complications.

CONCLUSIONS

The learning curve and average operative time of an SI laparoscopic PD program was shorter than the initial learning curve for a single surgeon with comparable outcomes. This suggests that complex minimally invasive surgical programs can be safely transferred to another high-volume institution without significant loss of progress.

Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm

BACKGROUND

The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure.

METHODS

Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression.

RESULTS

Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7-22.9).

CONCLUSION

Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.

Innovative Imaging Techniques Used to Evaluate Borderline-Resectable Pancreatic Adenocarcinoma

A diagnosis of pancreatic cancer carries a 5-y survival rate of less than 10%. Furthermore, the detection of pancreatic cancer occurs most often in later stages of the disease due to its location in the retroperitoneum and lack of symptoms (in most cases) until tumors become more advanced. Once diagnosed, cross-sectional imaging techniques are heavily utilized to determine the tumor stage and the potential for surgical resection. However, a major determinant of resectability is the extent of local vascular involvement of the mesenteric vessels and critical tributaries; current imaging techniques have limited capacity to accurately determine vascular involvement. Surrounding inflammation and fibrosis can be difficult to discriminate from viable tumor, making determination of the degree of vascular involvement unreliable. New innovations in fluorescence and optoacoustic imaging techniques may overcome these limitations and make determination of resectability more accurate. These imaging modalities are able to more clearly discern between viable tumor tissue and non-neoplastic inflammation or desmoplasia, allowing clinicians to more reliably characterize vascular involvement and develop individualized treatment plans for patients. This review will discuss the current imaging techniques used to diagnose pancreatic cancer, the barriers that current techniques raise to accurate staging, and novel fluorescence and optoacoustic imaging techniques that may provide more accurate clinical staging of pancreatic cancer.

Detection of pulmonary tuberculosis in patients with a normal chest radiograph

OBJECTIVES

To describe the early symptoms of pulmonary tuberculosis (TB) when the chest radiograph (CXR) is normal.

SETTING

Centralized, provincial TB control program.

SUBJECTS

Twenty-five patients with culture-positive pulmonary TB and a normal CXR were identified from a review of 518 consecutive patients with culture-positive pulmonary TB in the province of Saskatchewan from January 1, 1988 to March 31, 1997. Patients with abnormal CXRs at the time of diagnosis were excluded from the analysis.

RESULTS

Twenty-three of the 25 patients (92%) were symptomatic at the time of diagnosis, with cough/sputum (76%) being reported most commonly. Eleven patients were identified because of contact tracing from cases of infectious pulmonary TB, while the other 14 patients were identified because of an investigation of symptoms. Twenty-four patients (96%) exhibited one or more symptoms of cough for > 1 month, fever for > 1 week, or skin-test conversion after contact with infectious TB. The sputum smear of only one patient was positive. Two patients were pregnant at the time of diagnosis, one patient was HIV-positive, and one patient demonstrated isoniazid-resistant organisms on sensitivity testing. Five patients were diagnosed as having primary TB associated with Mantoux skin-test conversion. The incidence of culture-positive pulmonary TB with a normal chest radiograph was < 1% in the period from 1988 to 1989 and steadily increased to 10% in the period from 1996 to 1997.

CONCLUSIONS

Culture-positive pulmonary TB with a normal CXR is not uncommon, and the incidence of this presentation is increasing. Patients with this presentation of TB are typically symptomatic and/or are detected by contact tracing to infectious cases of pulmonary TB. The results suggest that patients presenting with a cough for > 1 month, with a fever for > 1 week, or with documented skin-test conversion < 2 years after known exposure to infectious TB should have sputum submitted for a Mycobacterium tuberculosis smear and culture despite a normal CXR.

Bacterial and fungal flora of dust deposits in a pig building

OBJECTIVE

The purpose of the study was to investigate the bacterial and fungal flora of dust deposits in a newly built pig grower finisher building. Viable bacterial counts and microbial species found in a barn which had never housed pigs were compared with those in a barn housing 144 pigs.

METHODS

The quantitative streak plate method was used to measure viable bacterial counts on nutrient agar or sheep blood agar. Viable bacterial counts of the dust deposits were expressed as the number of colony forming units (CFUs)/mg of dust. Gram positive cocci and Gram negative bacilli were identified by an automated system. Identifications with a confidence interval > 90% were accepted at the species level. Fungi were identified to the genus level with slide culture preparations on cereal agar.

RESULTS

The lowest viable bacterial count (4.8 x 10(4)/mg of dust) was found in the barn with no pigs. In the barn with pigs the highest viable bacterial count (2.1 x 10(6)/mg of dust) was in dust from the top of a partition close to pig activity. Six species of bacteria or fungi were found in dust from the room with no pigs, whereas 22 different microorganisms were detected in dust from the room with pigs. With the exception of Enterobacter agglomerans no other species of the family Enterobacteriaceae was found in dust deposits in this new pig building. Twelve species of Gram positive bacteria were found in the room housing pigs.

CONCLUSIONS

The pig is not only a source but also a disperser of airborne bacteria in pig buildings. Speciation of the microbial flora in dust from the pig building suggests that many of the microorganisms were either of human or environmental origin. Nevertheless as some of these microorganisms are known opportunistic pathogens or allergens and because of the documented increased incidence of chronic respiratory symptoms in pig workers, precautions to reduce inhalation of microbial or dust particles by pig workers seem prudent.

Association of flagellum expression and intracellular growth of Legionella pneumophila

We examined the role of the flagella of Legionella pneumophila in the infection of amoebae and human monocyte-like cells. Insertional mutants were constructed with mini-Tn10. Ten mutants (F-) which did not react with polyclonal L. pneumophila antiflagellar antisera were identified. Ten randomly selected mutants (F+) that did react with the polyclonal antiflagellar antiserum were also identified. The infectivity of these 20 mutants in Hartmannella vermiformis and human U937 cells was characterized. Seven of the 10 F- mutants were attenuated in their ability to multiply in the amoebae during the first 3 days of coincubation and failed to multiply in U937 cells. Three of the 10 F- mutants multiplied as well as the wild-type parent strain did in amoebae and to a limited degree in U937 cells. None of the 10 F+ mutants were attenuated in either the amoebae or U937 cells. While the flagellar structure is not essential for virulence, the ability of L. pneumophila to infect amoebae and human phagocytic cells appears to be linked to flagellar expression. We believe that the attenuated F- mutants contain insertions in genes critical to both flagellum expression and the infection process.

Pneumonia with pleural effusion due to Legionella pneumophila serogroup Lansing 3

We describe a case of pneumonia with pleural effusion due to Legionella pneumophila serogroup Lansing 3 in a human immunodeficiency virus-infected person. The 55-year-old man had been treated with immunosuppressive agents for hypersensitivity pneumonitis.

Comparison of arbitrarily primed polymerase chain reaction, ribotyping, and monoclonal antibody analysis for subtyping Legionella pneumophila serogroup 1

Arbitrarily primed polymerase chain reaction (AP-PCR) was used to characterize Legionella pneumophila serogroup 1. Cells from a single colony could be subtyped by AP-PCR within a few hours. The discrimination between strains of L. pneumophila serogroup 1 by AP-PCR was equivalent to that by monoclonal antibody analysis and ribotyping. Four strains representing the monoclonal antibody pattern most frequently associated with outbreaks all yielded unique amplicon patterns by AP-PCR.

Miliary Mycobacterium bovis induced by intravesical bacille Calmette-Guérin immunotherapy

Intravesical instillation of bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is the treatment of choice for many patients with bladder cancer. In a small percentage, this therapy is associated with systemic side effects including pneumonitis. It is uncertain whether these systemic manifestations are due to dissemination of infection or due to hypersensitivity, an etiologic distinction that has important therapeutic implications. We report the first case in which miliary M. bovis was proven to be the responsible mechanism, by culture of M. bovis biovar BCG from a transbronchial lung biopsy and complete resolution on anti-tuberculous chemotherapy.

Characterization of an axenic strain of Hartmannella vermiformis obtained from an investigation of nosocomial legionellosis

A free-living amoeba identified as Hartmannella vermiformis was isolated from a water sample obtained during an investigation of nosocomial legionellosis. Hartmannella vermiformis is known to support the intracellular multiplication of Legionella pneumophila. This strain of H. vermiformis, designated CDC-19, was cloned and established in axenic culture to develop a model for the study of the pathogenicity of legionellae. Isoenzyme patterns of axenically-cultivated strain CDC-19 were compared with two strains of H. vermiformis derived from the type strain, one axenic (ATCC 50236) and the other grown in the presence of bacteria (ATCC 30966). Enzyme patterns suggested that all three strains are assignable to the species H. vermiformis. Axenic H. vermiformis strain CDC-19 has been deposited with the American Type Culture Collection (ATCC 50237) and should prove useful in the study of protozoan-bacterial interaction.

Increased recovery of Legionella micdadei and Legionella bozemanii on buffered charcoal yeast extract agar supplemented with albumin

The recovery of Legionella micdadei and L. bozemanii serogroups 1 and 2 from infected guinea pig spleens was evaluated by using two culture media: buffered charcoal yeast extract agar with 0.1% alpha-ketoglutarate (BCYE alpha) and the same medium supplemented with 1% bovine serum albumin (ABCYE alpha). At the lowest dilution of spleen tissue (10(-1)), recovery of all strains of L. micdadei and L. bozemanii was more efficient on ABCYE alpha than on BCYE alpha. L. micdadei strains had higher recovery rates on ABCYE alpha after another 10-fold dilution, but recoveries of L. bozemanii were similar on both media. Recovery rates for most test strains were comparable on BCYE alpha and ABCYE alpha at the highest dilution (10(-3)) of tissue tested. The presence of albumin in BCYE alpha increased the recovery rate of L. micdadei more than that of L. bozemanii. The use of ABCYE alpha medium in place of BCYE alpha may improve the recovery of L. micdadei and L. bozemanii from clinical specimens. Preliminary studies indicate that this medium also enhances recovery of certain Legionella spp. from environmental samples.

Effects of transport temperature and medium on recovery of Bordetella pertussis from nasopharyngeal swabs

We compared relative recoveries of Bordetella pertussis from simulated nasopharyngeal (NP) specimens incubated in three separate transport media at different temperatures. Transport media included one-half-strength Regan-Lowe (RL.5), Regan-Lowe with one-half-strength agar (RL.5A), and buffered charcoal-yeast extract agar supplemented with alpha-ketoglutarate, lincomycin, and anisomycin (BCYE alpha LA). For each transport medium, recovery of B. pertussis was least efficient after storage at 25 degrees C. The highest recovery of B. pertussis from a mixed culture was achieved with RL.5 at 4 degrees C. Overall, RL.5 and RL.5A were comparable as transport media whether held at 4 or 25 degrees C, but fewer organisms were recovered from BCYE alpha LA. In addition, Regan-Lowe (RL), Bordet-Gengou, and cyclodextrin media were compared as primary isolation media for recovering B. pertussis from simulated NP swabs held at 4 and 35 degrees C in RL.5 medium. The highest recovery of B. pertussis was obtained on RL primary isolation medium. Bordet-Gengou medium recovered only 80% and cyclodextrin medium recovered less than 60% of the numbers recovered on RL medium. Based on these results, refrigeration (4 degrees C) of NP swabs shipped in RL.5 transport medium and using RL as the primary isolation medium are recommended for recovering B. pertussis from swab specimens.

Protocol for sampling environmental sites for legionellae

A protocol for sampling environmental sites was developed and used to identify possible sources of Legionella species in support of epidemiologic investigations at two hospitals. In hospital A, legionellae were isolated from 43 of 106 (40%) different sites. Three separate Legionella pneumophila serotypes and a previously unrecognized species were present in different combinations in the positive samples. Two of five cooling towers contained the same L. pneumophila serogroup 1 monoclonal type (1,2,4,5) as was isolated from patients. The same monoclonal type was also isolated from make-up water for the two cooling towers, a hot water tank, water separators in four main air compressor systems for respiratory therapy, and cold and hot water faucets. In hospital B, 13 of 37 (38%) sample sites contained legionellae, all of which were L. pneumophila serogroup 1. The monoclonal type matching isolates from patients (1,2,4,5) was found at the highest concentration in a hot water tank, but it was also present at four other sample sites. Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken.

Isolation of protozoa from water associated with a legionellosis outbreak and demonstration of intracellular multiplication of Legionella pneumophila

At the site of a legionellosis outbreak, amoebae and two ciliates, Tetrahymena sp. and Cyclidium sp., were isolated from cooling-tower water containing Legionella pneumophila. The Tetrahymena sp. and the amoebae repeatedly showed the ability to support intracellular multiplication of L. pneumophila. Both were isolated from cooling towers specifically implicated as the source for the spread of legionellosis. These protozoa may be reservoirs supporting the survival and multiplication of virulent legionellae in cooling-tower water.

Religiosity and United States suicide rates, 1972-1978

Related annual variations in United States suicide rates between 1972 and 1978 to annual variations in church attendance of representative subpopulations of the United States. Variations in the suicide rates of white males, black males, white females, and black females were significantly, inversely correlated with variations in the attendance of the respective subpopulations. No significant differences were found between the correlations for white and black females and for white and black males nor between those for black females and males and for white females and males. The general hypothesis that religiosity deters suicide was supported.

Proliferation of Legionella pneumophila as an intracellular parasite of the ciliated protozoan Tetrahymena pyriformis

In a series of experiments, we have determined that Legionella pneumophila will proliferate as an intracellular parasite of the ciliated holotrich Tetrahymena pyriformis in sterile tap water at 35 degrees C. After 7 days of incubation, serpentine chains of approximately 10(3) L. pneumophila cells were observed throughout the cytoplasm of the protozoan infected initially with 1 to 30 L. pneumophila cells. The overall L. pneumophila population increased from ca. 1.0 X 10(2) to ca. 5.0 X 10(4) cells per ml in the coculture within this time frame. The interactions between the protozoan and the bacterium appear to depend upon their concentrations as well as temperature of incubation. L. pneumophila did not multiply in sterile tap water alone, in suspensions of lysed T. pyriformis, or in cell-free filtrates of a T. pyriformis culture. In addition to establishing an ecological model, we found that addition of T. pyriformis to environmental specimens served as an enrichment method that improved isolation of legionella from the specimens.

Selective enrichment broth medium for isolation of Campylobacter jejuni

A new selective Campylobacter enrichment broth for the isolation of Campylobacter jejuni has been tested with fecal specimens of human, poultry, and bovine origin. We compared the isolation rate with that from the simultaneous direct plating of a duplicate specimen. Of the 380 duplicate specimens examined comparatively, we obtained a 46.3% increase in isolation of C. jejuni by using the new Campylobacter enrichment broth medium.

Bottled beverages and typhoid fever: the Mexican epidemic of 1972-73

A chloramphenicol resistant strain of S. typhi which caused a very large epidemic of typhoid fever in Mexico in 1972-73 survived in opened bottles of one carbonated drink with a pH of 4.6 for two weeks and in another such drink with a pH of 5.1 for six months. Bottled beverages are potential sources of large outbreaks of enteric disease, and deserve the same type of standards sand monitoring as comparable fluids such as milk.

Legionella gormanii sp. nov

A new species of Legionella was isolated from soil collected from a creek bank. The name Legionella gormanii sp. nov. is proposed.

Shigellosis in the Marshall Islands: epidemiologic aspects of an outbreak

An outbreak of diarrheal illness caused by Shigella flexneri 1b and associated with 11 deaths occurred in the Marshall Islands during June and July 1977. A house-to-house survey on Majuro indicated an attack rate of 6.2%. Neither the survey nor a case-control study uncovered a common source of exposure on Majuro, and it is believed that transmission was mainly person-to-person. Socioeconomic factors, type of water supply, distance to municipal water supply, and type of sanitary facility could not be related to the occurrence of illness, but a poor sanitary rating was associated with increased rate of household transmission. Absence of stool culturing for bacteria and false-positive identifications of amebae in stool specimens led to the outbreak's being attributed to Entamoeba histolytica. Subsequent parasitologic examinations and serologic studies indicated that E. histolytica played no role in the outbreak, and suggested that fecal leukocytes were being mistaken for amebae. Improved bacteriologic capabilities will be important in improving the approach to diarrheal illness in the Marshall Islands.

Epidemic salmonellosis from cheddar cheese: surveillance and prevention

On August 3, 1976, ongoing Salmonella surveillance in Colorado first detected an epidemic of Salmonella heidelberg infections that eventually totaled 339 isolates. The majority of the cases occurred between July 23 and August 12 in two widely separated cities: Denver and Pueblo. Epidemiologic investigation successively incriminated 1) recent dining at Mexican-style restaurants (p less than 0.001), 2) eating foods containing cheese in these restaurants (p = 0.029), and 3) consumption of cheddar cheese from a single shipment of a single manufacturer (p less than 0.01). The prompt investigation enabled an embargo of 2087 kg (41%) of the contaminated cheese. S. heidelberg was isolated from seven production lots of the incriminated cheese. Surveillance and the epidemiologic investigation may have resulted in prevention of 25,000 diarrheal illnesses.

Fatal nosocomial Legionnaires' disease: clinical and epidemiologic characteristics

The occurrence, clinical, and epidemiologic characteristics of fatal nosocomial Legionnaires' disease were ascertained by examining a sample of autopsy specimens submitted by hospitals participating in the National Nosocomial Infections Study. Sections of lung tissue from 263 patients were submitted by 40 hospitals in 24 states. Legionnaires' disease was identified in 10 patients (3.8%) from six hospitals in five states. The clinical and epidemiologic characteristics of sporadic fatal nosocomial Legionnaires' disease were similar to those from cases that occurred during epidemics of Legionnaires' diseases. A case-control study showed that cases of Legionnaires' disease were associated with an increased occurrence of Legionnaires' disease during the period June through November, temperatures greater than 39.2 degrees C, and administration of corticosteroids before onset of pneumonia. Legionnaires' disease can occur as a fatal nosocomial pneumonia and has clinical and epidemiologic features that may be helpful in differentiating it from nosocomial pneumonia of other causes.

Isolation of the Legionnaires' disease bacterium from environmental samples

We analyzed 24 environmental samples collected in or near the Indiana Memorial Union, where an epidemic of Legionnaires' disease occurred in early 1978. We conducted fluorescent antibody analyses and culture on F-G and charcoal yeast extract agars of each sample directly; splenic tissue of guinea pigs inoculated with the sample; and yolk sacs from embryonated eggs inoculated with splenic tissue of guinea pigs injected with the sample. Legionnaires' disease (LD) bacterium was isolated from seven of the 24 samples: one water sample from the air-conditioner cooling tower of the Union; three water samples from a stream near the Union; and three mud samples from the same stream. The LD bacterium strains were of three different serotypes. These findings indicate that LD bacteria may be widespread in nature.

Raw hamburger: an interstate common source of human salmonellosis

An interstate common-source outbreak of salmonellosis was first detected in the United States in September and October, 1975, when a tenfold increase in Salmonella newport isolates was noted through routine salmonella surveillance by the Colorado Department of Health. Eighteen primary cases with a distinctive antibiotic resistance pattern (tetracycline, streptomycin, and sulfonamides) were evaluated in a case-control study, and illness was found to be associated with eating raw hamburger (p less than .001) from any store of one grocery chain (p less than .001). A Dallas, Texas, processing plant that supplied the Colorado markets also supplied other states, and these other states were alerted. Maryland discovered nine S. newport isolates with the same antibiogram and, as in the Colorado outbreak, illness was associated with eating raw or very rare ground beef from the same grocery chain (p less than .03). A third outbreak of S. newport with the same antibiogram occurred on a Florida military base. S. newport with the same antibiogram and a phage lysis pattern identical to those of the human epidemic isolates was cultured from frozen hamburger recovered in Colorado and Florida. The associated hamburger originated at the same Dallas, Texas, processing plant. A source of the epidemic strain was not identified, but the organism probably originated before delivery to the plant.

Cholera on Guam, 1974: epidemiologic findings and isolation of non-toxinogenic strains

In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains imptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of differentV. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.

Laboratory investigation of diarrhea in travelers to Mexico: evaluation of methods for detecting enterotoxigenic Echerichia coli

A laboratory investigation was conducted on cultures collected from travelers before, during, and after a trip to Mexico to characterize the etiology of traveler's diarrhea. Four laboratory methods for detecting enterotoxigenicity of Escherichia coli were evaluated: the infant mouse assay, the Chinese hamster ovary (CHO) cell assay, the Y1 adrenal cell assay, and the rabbit ileal loop. Although a number of common enteric pathogens were identified as a cause of traveler's diarrhea, including six serotypes of Salmonella, two serotypes of Shigella, Vibrio parahaemolyticus, Giardia lamblia, and Entamoeba histolytica, enterotoxigenic Escherichia coli was most commonly isolated. Strains were identified that produced only heat-labile enterotoxin (LT), only heat-stable enterotoxin (ST), or both LT and ST. The infant mouse assay yielded results falling into two distinct groups, providing a clear separation of positive and negative cultures. The CHO assay also formed two groups, with positive cultures producing 11% or more of the elongated cells. There was good agreement between the CHO and the Y1 adrenal cell assays for detection of LT. The adrenal cell system for detection of LT was more suitable than the CHO assay for processing large numbers of specimens because of the miniculture modification of this method utilized in this study. The infant mouse method was a simple and reliable method for detecting ST.

An outbreak of nosocomial Proteus rettgeri urinary tract infection

Between December 1, 1971, and November 30, 1972, 11 patients on a single physical rehabilitation ward in a large St. Louis, Missouri, community hospital developed Proteus rettgeri urinary tract infections; P. rettgeri isolates from each patient were indole-negative and resistant in vitro to all antibiotics tested. Infected patients were more likely to have indwelling urinary tract catheters than were matched control patients, and all had previously received systemic antibiotic therapy. Retrospective epidemiologic investigation and microbiologic samplig at the time of the investigation failed to detect a common source of infection. Infected patients appeared to be the major reservoir of the epidemic strain, and indirect-contact transmission of the organism via nursing personnel probably occurred. Data collected from a prospective study suggested that placing catheterized patients in rooms that did not contain other catheterized patients may be an effective control measure.

Waterborne shigellosis at a public school

In November 1972 an outbreak of gastrointestinal illness occurred at a public school in Stockport, Iowa. One hundred ninety-four (72%) of 269 pupils and 14 (16%) of 23 staff members were affected. The etiologic agent was a strain of Shigella sonnei resistant to multiple antimicrobials. Waterborne transmission of shigellosis was documented epidemiologically and by isolation of the organism from the school water system. Ninety-seven (14%) of 698 of the students' household contacts developed diarrhea, and possible secondary cases also occurred in 3 (9%) of 32 household contacts of school staff.

Nationwide epidemic of septicemia caused by contaminated infusion products. IV. Growth of microbial pathogens in fluids for intravenous infusions

Septicemia caused by contaminated infusion fluid is a newly appreciated hazard of intravenous infusion therapy. Microorganisms of the tribe Klebsielleae (Klebsiella, Enterobacter, and Serratia) have predominated in these infections. Members of this tribe found to possess a selecive ability over common non-Klebsielleae microbial pathogens to proliferate rapidly in commerical parential fluids contaning clucose at room temperautre. Fifty-one Klebsielleae strains, washed twice before inoculation of approximately 1 organism/ml, attained a mean normalized 24 hr concentration of 1.11 x 10-5 organisms/ml in 5% dextrose in water at 25 C. In contrast, 48 of 49 non-Klebsielleae bacterial strains (clinical isolates of Staphylococcus, Proteus, Escherichia coli, Herelea, and Pseudomonas aeruginosa) slowly died (mean 24-hr concentration, 0.2 organism/ml). Five Candida albicans strains frew only very slowly (31.3 organisms/ml). Even with concentrations exceeding 10-6 organisms/ml, microbial presence was never visibly detectable. The significant increases in cases of nosocomial spticmia caused by Klebsiella, Enterobacter, and Serratia in recent years might be attribuatble in part to fluid-related spesis accompanying the expanding use of parenteral therapy.

Transparency or pseudo-transparency on the subscales of the Self-perception Inventory

The Self-perception Inventory (Martin, 1968, 1969) has been shown by Braun and Tinley (1970) to be fakable when administered to college Ss under experimental conditions. However, these results were obvious when examining examinee scores which supported the sensitivity of the validity subscales incorporated in the SPI.

Salmonellae in fish meal plants: relative amounts of contamination at various stages of processing and a method of control

Previous studies have shown that Menhaden fish meal, a common ingredient of animal feeds, is frequently contaminated with salmonellae. Animals that eat contaminated feed may become infected. If they, in turn, are eaten by humans, they may be a means by which salmonellae are introduced into the human population. Epidemiological studies of the fish-meal industry were carried out to determine the sources of salmonellae in fish meal and the factors affecting the persistence and survival of salmonellae during the processing of fish meal. Examination of 190 fish immediately after they came from the Gulf of Mexico revealed no salmonellae, but salmonellae were frequently isolated from samples of fish taken from the boats when they arrived at the plants. Salmonellae were also frequently isolated from dockside water at each of the plants. Approximately 50% of the samples taken in the raw fish processing areas were contaminated with salmonellae. The percentage of samples yielding salmonellae decreased progressively through the various sequences of processing, but more than 15% of the samples taken from the finished products were also positive. Salmonellae were isolated from the raw area of the plant most frequently while the plant was operating and less frequently when the plant was idle, whereas in the processing area of the plant the reverse was true. Salmonellae appeared to survive and multiply in the processing area of the plant while the plant was idle, which resulted in contamination of the first portion of each day's production. Salmonellae in the processed fish meal were reduced to nondetectable levels by reprocessing the first 45 min of each day's production.

Self perception inventory: a new test of personality

The SPI appears to be a rather sensitive instrument which may prove useful in the screening of clients and patients and in the evaluation of psychiatric programs. Subscales seem sensitive to scoring trends among various patient and non-patient groups. Several additional validity and reliability studies are currently underway.

Analysis of the abstracting function in reasoning using an experimental test

An experimental “Test of Abstract Reasoning” was tested for content validity by comparing it with the Abstract Reasoning Test, Form A, of the Differential Aptitude Tests and the Gorham Proverbs Test. Two hypotheses were investigated: (1) that the investigator's “Test of Abstract Reasoning” would yield a significant correlation with the other two tests and (2) that males and females would not display significant raw score differences on the new test. The three tests correlated with each other similarly, ranging from .411 to .496 ( N = 48, P < .01). No response differences were found between males and females. The results indicated that the three tests seemed to measure similar intellectual processes in abstract reasoning.

Efficiency of cultures of rectal swabs and faecal specimens in detecting salmonella carriers: correlation with numbers of salmonellas excreted

The comparative efficiency of cultures of rectal swabs and faecal specimens in detecting salmonellas in asymptomatic carriers was determined and then correlated with the number of salmonellas excreted per g. of faeces (wet weight). In six short-term salmonella carriers, 82% of rectal swab cultures taken daily for 11 consecutive days were positive for salmonellas, whereas 94% of faecal specimens cultured were positive. Similarily, in 8 long-term carriers, 58% of the rectal swab cultures were positive as compared with 91% of faecal specimens. The inferiority of the results of rectal swab cultures correlated with their inefficiency in detecting salmonellas when fewer than 1000 salmonellas per g. of faeces were present.

The patterns of salmonella excretion as depicted by estimated salmonella content of faecal specimens showed that all carriers had irregular day-to-day variations. The average number of salmonellas excreted per g. of faeces by short-term carriers was greater than that by long-term carriers, although both groups revealed the same wide variations in number of organisms excreted.

The effect of delayed processing and shipment of specimens upon recovery of salmonellas was also studied. No deleterious effects were noted when specimens were shipped and processing was delayed for up to 3 days.