Peritonitis from Starch Glove Powder

Contamination of surgical wounds by starch glove powders has produced peritoneal inflammation and adhesions in many patients. Some have required surgical operation because of possible infection, others because of obstruction of the intestine. Resolving granulomas and fibrosis have been observed as incidental asymptomatic lesions in some patients during reoperation for other conditions.Starch granules are probably capable of producing inflammation in any patient, and the degree is believed to be related to the amount of starch present.Care in removing glove powder from gloves before they are worn in an operation will diminish or eliminate the problem. Removal can be accomplished by rubbing the gloves with a moist sterile towel or laparotomy tape.     

DIFFERENTIAL DIAGNOSIS OF OPERABLE DISEASE OF THE ESOPHAGUS

The time interval between ingestion and regurgitation and the stage of digestion in regurgitated food may be factors helpful in diagnosing disease of the esophagus. In most cases diagnosis can be made by x-ray alone, but where x-ray evidence is insufficient esophagoscopy is often justified.X-ray investigation for foreign bodies should include films of the neck. Cough is a common symptom of the presence of foreign bodies; obstruction may result from inflammation or edema.Perforation is most often caused by foreign bodies or by instrumentation. Esophagoscopy is hazardous in this condition and the findings are not likely to affect the course of treatment.Hiatal hernia, although probably occurring to some degree in 10 per cent of adults, seldom causes symptoms. Inflammation resulting from hernial obstruction may be mistaken for carcinoma.Esophageal carcinoma occurs most frequently in elderly persons and in men more than in women. Operation is necessary in many cases to prevent starvation. The postoperative mortality rate is as low as 11 to 24 per cent, and the proportion of five-year survivals is increasing.Achalasia or cardiospasm can generally be recognized by x-ray appearance. Bouginage is the usual treatment, but operation may be necessary.Late regurgitation of food is a common symptom of esophageal diverticulum.Atresia in a newborn infant is a dangerous condition. The effect of any of the four types of anomaly is the same: diversion of fluids from the stomach to the bronchi. Coughing, choking and cyanosis are the common symptoms in a newborn infant.Hematemesis may arise from a number of causes; esophageal hemorrhage most commonly is owing to varicosity from portal hypertension. Esophagoscopy is the quickest and safest method of determining whether hematemesis is of esophageal origin.     

Actue Cholecystitis Following Unrelated Surgery

In a series of 26 cases of acute cholecystitis occurring after an operation for an unrelated condition, 88% of the patients were over 50 years of age and males outnumbered females by 2 to 1. In some of the cases diagnosis was difficult and delay was responsible for the death of one patient. Acalculous cholecystitis occurred in 20% of the cases and in these gangrene or perforation supervened early in the course of the disease.Efforts should be directed to ensuring adequate hydration after operation; resumption of a diet low in fat may be important. Even in the absence of a history of biliary disease, there is a place for the radiological study of the biliary tract before major elective operations are performed. If gallstones are discovered on the occasion of the initial surgery, cholecystectomy should be performed whenever it is feasible. In any patient with postoperative cholecystitis early operation is generally indicated.     

National general practice study of epilepsy: the social and psychological effects of a recent diagnosis of epilepsy.

OBJECTIVES--To determine the nature and extent of psychosocial problems in epilepsy and their associations. DESIGN--A postal survey was used drawing data from prospective consecutive cases. Data on demographic, medical, and social backgrounds were collected. A specially designed, validated attitude questionnaire examined 14 areas of psychosocial adjustment to epilepsy. SETTING--124 primary care general practices. SUBJECTS--Adults (aged over 17) with a recent diagnosis of epilepsy (within previous 36 months). They were registered with the national general practice study of epilepsy and had a confirmed diagnosis according to the usual criteria. 216 subjects were approached for the survey by their general practitioners; 192 returned questionnaires. RESULTS--Problems in at least one area were experienced by 175 (91%) of the 192 subjects. Problems were generally mild, which contrasts strongly with findings in chronic cases. The areas of greatest concern were fear of seizures (80% of cases; 72% moderate or severe) and fear of stigma in employment (69% of cases; 40% moderate or severe). A highly significant relation was found between psychosocial effects and the frequency and recency of seizures. CONCLUSIONS--In the early stages of epilepsy psychosocial effects are closely related to the severity of the medical condition, suggesting that the argument for the stigmatising effect of the diagnosis by itself is less important than previously thought. The findings also suggest that problems may evolve as the condition becomes chronic.     

Toxicity effects of latex gloves on boar spermatozoa

It is known that several materials used in semen collection have been found to be detrimental to spermatozoal motility. In this study, examinations for toxic effects of latex and vinyl gloves, used with and without talcum powder on boar spermatozoa, were performed. Ten boars of known fertility with >/=80% sperm motility were divided into two groups (n = 5 boars each) for in vitro and in vivo studies. In the in vitro study, semen was collected from each of the five boars and was divided into five separate aliquots (5 ml each). One aliquot from each of the boars remained as the control, while the remaining aliquots were divided into individual treatments exposing the semen to a l cm(2) piece of latex or vinyl glove with or without talcum powder. In the in vivo experiment, semen from each of the five boars was collected using a gloved hand. During collection, the first half of the sperm-rich fraction was collected into a filtered sterile container, while the second half of the fraction was allowed to run through the palm of either a latex or vinyl powdered glove prior to collection in the container. In both experiments, semen sample motility was assessed by two independent observers at 1 minute after exposure. Results of both experiments consistently showed a significant (P<0.05) effect of latex gloves (with or without talcum powder) on boar semen when compared with the control semen. Motility was at or near 0% at 1 min after exposure to latex. No significant difference (P>0.05) in motility was observed between the control semen and the semen exposed to talcum powdered vinyl gloves. These results show that latex gloves are detrimental to boar spermatozoa. Therefore, it is suggested that when collecting boar semen vinyl gloves should be used.     

Subacute thyroiditis

Twenty-one cases of thyroiditis, generally considered a rare disease, were observed in the Los Angeles area in a period of less than two years. Eight of them were observed at one clinic in the course of six months.Although diagnosis of the disease usually is made hesitantly or apologetically, and misdiagnosis is not uncommon, the clinical pattern is fairly characteristic. Subacute thyroiditis may cause pronounced disability. Treatment with propylthiouracil or roentgen radiation appeared to be the most effective.     

SUBACUTE THYROIDITIS

Twenty-one cases of thyroiditis, generally considered a rare disease, were observed in the Los Angeles area in a period of less than two years. Eight of them were observed at one clinic in the course of six months.Although diagnosis of the disease usually is made hesitantly or apologetically, and misdiagnosis is not uncommon, the clinical pattern is fairly characteristic.Subacute thyroiditis may cause pronounced disability. Treatment with propylthiouracil or roentgen radiation appeared to be the most effective.     

The “Reservation Effect”: Implications for Background Comparisons

A difficult challenge in ecological risk assessment can be determining what constitutes the “background” or ground-state condition for a site. This is because off-site conditions may not reflect to any relevant degree the history of the site itself and may therefore not be appropriate as benchmarks. One of the more important concerns is that underestimates may be made regarding contaminant-related impacts on-site because observations may indicate that community or population quality on-site equals or surpasses that observed off-site. In other cases, overestimates of the degree of contaminant impact may be made if environmental resources on-site are highly managed or devoid of natural communities. As such, management decisions may be confounded by artifacts of non-toxicant-related human influence and will not necessarily appropriately address the contaminant-related issues. Examples of these conditions are discussed herein.     

Studies on the distribution of starchy and sugary leaves in monocotyledonous plants

About a hundred monocotyledonous plants endemic to Japan were studied with reference to carbohydrate storage in leaves. As has been considered for a long time, the majority of monocotyledonous plants have sugary leaves in which starch is not generally formed. On the contrary, Commelinales, Dioscoreales and many aquatic plants including Butomales, and some members of Liliales are characterized by storing starch together with soluble sugars. The relative proportion of these components seems to be species-specific. These findings may serve as a useful tool for the studies on chemotaxonomy or lineage of monocotyledonous plants.     

Aspiration biopsy cytology, mammography and clinical exploration: a modern set up in diagnosis of tumors of the breast.

Six hundred and two mammary tumors were examined clinically, by mammography and cytology, with a histologic checkup following surgical biopsy. There were 247 cases of malignoma and 355 benign cases. The limited reliability of the individual methods is demonstrated, and it is shown that their combined use can improve the diagnosis. More malignomas are detected, and preoperative diagnosis is made more safely. If all three methods yield identical results, as was the case in 50.2% of the malignant and 32.7% of the benign lesions, the probability of diagnostic error is less than one per cent. With a malignoma thus established, surgical treatment may follow immediately, or irradiation can be started. In benign cases a surgical biopsy may be foregone and further developments may be awaited with due provision for regular control. If the three methods yield conflicting or doubtful results, elucidation by surgical biopsy and histology is indicated.     

From anther and pollen ripening to pollen presentation

The events and processes occurring between pollen maturation, opening of the anther and presentation of pollen to dispersing agents are described. In the final phases of pollen development, starch is always stored; this occurs before the anther opens. Depending on the species, this starch may be totally or partially transformed into: (a) other types of polysaccharides (fructans and rarely callose); (b) disaccharides (sucrose); (c) monosaccharides (glucose and fructose, all situated in the cytoplasm. While awaiting dispersing agents and during dispersal, polysaccharides, especially fructans, and sucrose may be interconverted to control osmotic pressure and prevent loss and uptake of water. Opening of the anther is preceded by disappearance of the locular fluid and in many cases by partial dehydration of the pollen. Pollen generally has a water content between 5 and 50%. Pollen with a high water content may or may not be able to control water retention during pollen exposure and dispersal. Pollen may be dispersed in monads or grouped in pollen dispersing units by the following mechanisms: (i). tangling of filamentous pollen; (ii). adhesion by viscous substances (pollenkitt, tryphine, elastoviscin) derived from the tapetum; (iii). common walls. When the anther opens, the pollen may be dispersed immediately, remain until dispersed (primary presentation), or be presented to pollinators in another part of the flower (secondary presentation).     

Granule-bound starch synthase I. A major enzyme involved in the biogenesis of B-crystallites in starch granules.

Starch defines a semicrystalline polymer made of two different polysaccharide fractions. The A- and B-type crystalline lattices define the distinct structures reported in cereal and tuber starches, respectively. Amylopectin, the major fraction of starch, is thought to be chiefly responsible for this semicrystalline organization while amylose is generally considered as an amorphous polymer with little or no impact on the overall crystalline organization. STA2 represents a Chlamydomonas reinhardtii gene required for both amylose biosynthesis and the presence of significant granule-bound starch synthase I (GBSSI) activity. We show that this locus encodes a 69 kDa starch synthase and report the organization of the corresponding STA2 locus. This enzyme displays a specific activity an order of magnitude higher than those reported for most vascular plants. This property enables us to report a detailed characterization of amylose synthesis both in vivo and in vitro. We show that GBSSI is capable of synthesizing a significant number of crystalline structures within starch. Quantifications of amount and type of crystals synthesized under these conditions show that GBSSI induces the formation of B-type crystals either in close association with pre-existing amorphous amylopectin or by crystallization of entirely de novo synthesized material.     

Renovascular Hypertension: Pathophysiology,Diagnosis, and Treatment

Renovascular hypertension can result from renal artery lesions involving the main renal artery, or its branches. It is generally felt that the elevation of blood pressure results from excessive systemic vasoconstriction secondary to enhanced renin secretion by one or part of one kidney. Renin secretion is enhanced because of constriction of the renal artery and resultant intrarenal ischemia. Clinically patients cannot be distinguished from those with essential hypertension and diagnosis must be made with arteriography although urography and isotope renography may suggest the diagnosis. Surgical cure can be predicted if differential renal vein renin ratios lateralize but a non-lateralizing study does not necessarily mean that surgery will fail. In properly selected patients, surgical results are excellent.     

Glove powder reduction and alternative approaches

This article addresses the role of glove powder in facilitating allergic reactions to natural rubber latex (NRL) and to the chemical additives in synthetic and NRL gloves as well as its role in eliciting postsurgical complications. Various dusting powders have been used historically to prevent gloves from sticking to each other and to facilitate donning. All have manifested adverse consequences for health care professionals and patients. Manufacturing methods for powder reduction and elimination are presented. The recently developed ASTM methods for the quantitation of powder on powder-free and powdered gloves are reviewed along with the new ASTM maximum powder limits for all medical gloves. Caution must be exercised when methods of protein and powder reduction are implemented to minimize the possibility of creating other adverse consequences.     

Isolation of Anaerobic Bacteria from Human Gingiva and Mouse Cecum by Means of a Simplified Glove Box Procedure

An anaerobic glove box constructed of clear flexible vinyl plastic is described. It is sufficiently inexpensive and simple in operation to be used not only in research but also in a clinical laboratory by technicians without special training. Conventional bacteriological techniques may be used inside the glove box for culturing and transferring anaerobic bacteria. The box may be heated to 37 C and thus serve as an anaerobic incubator as well, permitting inspection of cultures at any time. Media may be prepared and agar plates may be poured on the laboratory bench in the conventional manner. An overlay of trace amounts of palladium black catalyst over plated agar media reduces the medium to an oxidation-reduction (O-R) potential of - 300 mv within 2 days after introduction into the glove box. In spite of its greater simplicity, the system matched or excelled the roll tube method with respect to all parameters tested, including O-R potential obtainable in the media, O(2) concentration in the gas phase, and efficiency in isolating anaerobic bacteria from the mouse cecum. Comparative studies indicate that the conventional anaerobic jar method was inadequate for the isolation of strict anaerobes from human gingival specimens and from the mouse cecum. This was due to the exposure of specimens and media to air during plating on the open laboratory bench. Anaerobic jars were adequate for maintaining the proper conditions for growth of anaerobic bacteria once these had been established in the glove box.     

INDICATIONS FOR ANGIOCARDIOGRAPHY

Angiocardiography is indicated in selected cases of heart disease in which a definite diagnosis cannot be made by ordinary methods or in which there is reasonable expectation that the information so obtained may influence the treatment of the patient. Whenever possible, angiocardiography should be done in conjunction with cardiac catheterization. The main indication for angiocardiography is cyanotic congenital heart disease; primarily those cases in which there is a right-to-left shunt. Angiocardiography is occasionally of value in diagnosis of other types of congenital heart disease and in acquired heart disease.     

PRIMARY CARCINOMA OF THE DUODENUM

As the only hope for patients with malignant disease of the duodenum depends upon early diagnosis and prompt and adequate operation, suspicion must be alert even though the condition is relatively rare. The incidence is highest in persons between 50 and 70 years of age, and two or three times as high in males as in females.The onset is insidious. The patient usually gives a history of fairly good health and no other related symptoms until about a year before diagnosis. Early symptoms are loss of appetite, loss of weight, and moderate pain in the right upper quadrant of the abdomen, sometimes associated with epigastric fullness which is relieved by belching. Vomiting and constipation are late symptoms. There may be occult blood in the stools, moderate anemia in some cases, and frequently jaundice.The radiological findings are irregularity of the mucosal pattern in the region of the tumor and often constriction of the involved portion of duodenum.A report is made herein upon four cases of primary carcinoma of the duodenum observed at one hospital in a period of only a little more than two years.     

Fine needle cytology of endometriosis: experience with 10 cases

OBJECTIVE: To evaluate whether commonly used cytologic criteria for the diagnosis of endometriosis are sufficiently specific, to assess the possible role of special methods in the differential diagnosis and to assess the clinical meaning and drawbacks of a cytopathologic diagnosis of endometriosis by fine needle aspiration. STUDY DESIGN: We retrieved 10 cases of endometriosis from our files that had been diagnosed primarily by fine needle cytology (FNC) with subsequent tissue study. In some cases additional cytospin preparations and/or smears had been used for cytochemistry (periodic acid-Schiff stain, mucicarmine) or immunocytochemistry (pan-cytokeratin, cytokeratin 7, vimentin, CD10) using a 3-step streptavidin-biotin-immunoperoxidase reaction. RESULTS: The cell pattern and immunocytochemical profile of the cases suggested a diagnosis of endometriosis. All cases were histologically confirmed. CONCLUSION: With optimal preparations a confident cytologic diagnosis of endometriosis may be made with ease, permitting correct treatment of the disease and, in selected cases, planning of preoperative pharmacologic therapy.     

Kikuchi's histiocytic necrotizing lymphadenitis. Diagnosis by fine needle aspiration

Two cases of Kikuchi's histiocytic necrotizing lymphadenitis diagnosed by fine needle aspiration (FNA) of enlarged lymph nodes are reported. The FNA smears contained randomly activated lymphoid cells, necrotic debris, karyorrhectic cells and prominent histiocytes, suggesting the presence of reactive lymph nodes. The true nature of the lesions was evident from the examination of cell block sections prepared from tissue fragments in the aspirates, which preserved the architectural relationships of the different cell types. The same patterns were found in retrospectively and subsequently examined excised lymph nodes from these cases. The differential diagnosis of this entity, which may simulate a malignant lymphoma because of the presence of large numbers of activated lymphoid cells, is discussed and the value of preparing FNA cell blocks is emphasized. Though this rare benign disease may be suspected clinically in the more typical cases, such as young women with cervical lymphadenopathy, fever, neutropenia and otherwise excellent condition, the diagnosis cannot be made without a lymph node biopsy, which FNA may be able to provide in some instances.     

Fine needle aspiration cytology of malignant mesothelioma

The results of fine needle aspiration (FNA) cytology in 19 cases of malignant mesothelioma are presented. Adequate material for a diagnosis of malignancy was obtained in 17 cases, and in 8 cases a specific diagnosis of mesothelioma could be made. In four other cases, the findings were either consistent with or suggestive of mesothelioma; in four, accurate distinction from other neoplasms was not possible, and in two cases, adenocarcinoma was suggested. The spectrum of cytologic findings ranged from neoplasms of purely epithelial appearance through more pleomorphic biphasic neoplasms to anaplastic tumors. A combination of epithelial-like cell clusters, pavement-like sheets of epithelial cells with well-defined cell borders and prominent cell separation, dispersed angular cells with dense cytoplasm and some spindle-cell forms was the most specific cytologic pattern for mesothelioma. In four neoplasms, ultrastructural examination of aspirated material provided the additional evidence for a definitive diagnosis. The identification of hyaluronic acid within intracytoplasmic vacuoles, either in smears or in cell blocks, confirmed the diagnosis in three tumors. Only in one case, with a strong clinical background suggesting mesothelioma, was the cytologic preparation sufficient for diagnosis without ancillary diagnostic methods. FNA is of particular value in the diagnosis of pleural mesothelioma in patients who do not present with a pleural effusion. Obtaining material for cell block preparations, cytochemistry or ultrastructural study is generally necessary for definitive tumor typing.