Biomedical subjects
Publications and source records attributed to M Wilks.
Spiral organisms were found in close apposition to the jejunal mucosa in a patient with idiopathic intestinal pseudoobstruction. Such organisms are generally not found in the jejunum and their presence in this patient was considered to be related to intestinal stasis, and possibly to diarrhea.
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Volatile fatty acids produced in Robertson's cooked meat medium by a range of clinically relevant anaerobes were compared by gas liquid chromatography with those produced in blood agar. The same volatile fatty acid profiles were obtained in both media, although the concentration of acids was lower in blood agar. We conclude that detection of volatile fatty acids from a pure culture of an organism on solid medium is practicable and offers advantages over the conventional technique.
In an area with the most highly mobile population in Britain 10% of the consultations in one practice were with temporary residents and a further 10% with newly registered patients. We analysed data gathered in 1980 about these two groups and about established patients that included demographic characteristics, the diagnoses made, and the actions taken by the doctors. Temporary residents caused a considerable amount of administration, but they were relatively straightforward to deal with medically and the practice received compensation for the work; with new patients problems were more time consuming, both clinically and administratively, and there was no financial compensation. A practice with a high turnover of its registered patients is at a considerable disadvantage compared with one in a more settled area.
The relationship between vaginal carriage and subsequent neonatal acquisition of Clostridium difficile was investigated. Vaginal carriage of C. difficile was detected in 11% of women attending the Department of Genital Medicine Clinic. C. difficile was isolated from the vagina in 18% of 50 mothers before delivery, and 8% after delivery; 62% of their babies had positive faecal cultures. Eight of nine of the babies whose mothers had positive cultures before delivery became colonised with C. difficile, while 23 of 41 babies whose mothers had negative cultures became colonised. This suggests that both the vagina and the environment may act as sources of neonatal acquisition of C. difficile. Broth enrichment culture proved a more sensitive method for isolating C. difficile from the vagina than direct plate culture and should be used in such investigations.
Samples from the posterior vaginal fornix of 102 women with various clinical conditions were analysed by a quantitative method. Aerobes were isolated from all but one of the specimens at a mean concentration of 7.2 log10 cfu/g and anaerobes from 92 specimens at a mean concentration of 8.1 log10 cfu/g. In most clinical conditions and in a control group of asymptomatic women, anaerobes outnumbered aerobes by about ten to one (one log10 unit). The most common organisms were aerobic and anaerobic lactobacilli, coryneforms, Staphylococcus epidermidis, Bacteroides spp. and anaerobic gram-positive cocci. Lactobacilli did not appear to confer any protective effect by excluding the presence of other organisms such as Gardnerella vaginalis or anaerobes. The isolation of anaerobic organisms from the vagina cannot be regarded as being of pathogenic significance without other supporting evidence.
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In a study of Gardnerella vaginalis and anaerobic bacteria in non-specific vaginitis (NSV) and other genital disease 89 patients attending a genital medicine clinic had vaginal samples examined for conventional pathogens and for quantitative analysis of G vaginalis and aerobic and anaerobic bacterial flora. The overall incidence of G vaginalis was 20%; G vaginalis (mean concentration 7.0 log10/g of secretion) occurred predominantly in patients with NSV (57%) but also in sexual contacts of non-specific urethritis (NSU) (37.5%) and in patients with other conditions (11.8%). G vaginalis is therefore a relatively common isolate in patients with vaginal discharge. The concentration of aerobic and anaerobic bacteria ranged from 4.9-11.0 log10/g of secretion with an anaerobe-to-aerobe ratio of 10:1. Anaerobic bacteria, particularly anaerobic Gram-positive cocci (mean concentrations 7.7 log10/g), were present in patients with NSV and in association with G vaginalis, but they also occurred in other clinical groups and with other pathogens, particularly Trichomonas vaginalis. Anaerobic bacteria may therefore play an important role in the pathogenesis of vaginal infections.
Three recently described methods for quantitative sampling of the bacterial flora of the vagina were evaluated and none proved satisfactory. In a third of the samples, paired swabs showed large differences between the two weights of vaginal secretion collected by this method, and the recovery rate of bacteria deliberately added to test swabs was unsatisfactorily low. A calibrated loop gave a wide variation in the amount of secretion collected, due to variations in density and viscosity of the secretion. When secretion was collected with a calibrated pipette, it was often difficult to expel the collected volume from the pipette for testing. The simple weight-based method was devised in which a loop was used to collect an undefined volume of secretion for weighting in a tube of transport medium before homogenisation and quantitative bacteriological testing. Initial assessment indicates this to be a satisfactory method for quantitative studies of the vaginal bacterial flora.
A metabolic and physiological assessment was carried out in 14 patients who had undergone restorative proctocolectomy with ileal reservoir more than six months previously. The haemoglobin was normal in all but one and plasma electrolytes and serum albumin, calcium, phosphorus, and red cell folate estimations were normal in all. Five patients had low serum iron levels of whom one had an iron deficiency anaemia. The 24 hour faecal fat output was normal in all patients and there was no case of vitamin B12 malabsorption as judged by the Schilling test, although four patients had marginally low values. These were not associated with increased bacterial counts in the faeces within the reservoir and there was no evidence to support a diagnosis of stagnant loop syndrome. Inflammation of the reservoir mucosa was, however, associated with higher counts of aerobic bacteria than in cases where inflammation was absent. Subtotal villous atrophy or inflammation was seen in biopsies of the reservoir in six patients. The mean faecal output per 24 hours was 659 +/- 259 g and the mean reservoir volume was 330 +/- 78 ml. Mean resting anal canal pressure was significantly lower in patients with a mucous leakage per anum than in those without, while manometry of the reservoir showed no alteration of pressure over a period of one hour before and after a meal. A positive rectosphincteric reflex was observed in nine patients.
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We report the case of a critically ill 30-year-old chronic haemodialysis patient with a history of intravenous substance abuse whose intravenous access sites had become exhausted. She subsequently underwent elective insertion of a percutaneous translumbar inferior vena caval paired Tesio catheter and peripherally inserted central catheter (PICC line). This technique has been used successfully in patients who require longstanding central venous access (hyperalimentation, chemotherapy, chronic renal hemodialysis patients). This approach could be an alternative where the standard access routes have become non-viable.
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