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Demonstration of Helicobacter pylori in tracheal secretions.

A new gram-negative bacterium, Helicobacter pylori, has been found in gastric secretions. In view of an almost 9% incidence of unidentified gram-negative bacteria in aspiration pneumonia, the authors set out to prove that H pylori could be found in tracheal secretions. Eighteen sequential patients admitted to the intensive care unit who had endotracheal or nasogastric intubation for 24 hours or longer were studied. Of 20 sets of specimens from 18 patients. Helicobacter was recovered from 2(10%) of the endotracheal specimens. The authors conclude that H pylori can gain access to the endobronchial tree and therefore may contribute to the origin of pneumonia due to unidentified gram-negative bacteria.

Aged↗

[An oesophagotracheal Fistula following prolonged intubation (author's transl)].

Attention is drawn to the case of an oesophagotracheal fistula following prolonged intubation. A combination of physical factors, the use of unsuitable cuffs and a nasogastric feeding tube, are considered to be the cause. Surgical repair of the fistula is advised as soon as possible. While primary closure of the oesophageal defect is always possible, suture of the membraneous trachea may be impossible and a graft may be necessary to cover the defect. For this is recommended oral mucosa, which achieved very good result in this reported case.

Humans↗

Small bowel bacterial flora in normal and in children with acute diarrhea.

The aerobic bacteria microflora of the upper small bowel in normal children and in children with acute diarrhea was studied. Forty one children aging between 2 months and 5 years were divided in 3 groups: Group I--13 wellnourished children with no signs of gastrointestinal abnormalities remained intubated for less than 4 hours; Group II--11 wellnourished children that remained intubated for a period of time varying from 4 to 24 hours; Group III--17 children with acute diarrhea. There was a striking difference in the bacterial pattern between children from groups I and II and these findings were attributed to the prolonged time of intubation. In group I the jejunal fluid was sterile in approximately 40% of the children and in the others there was only growth of a GRAM positive flora while in group II the jejunal fluid never presented as a sterile one, and in approximately 73% of the cases there was a growth of a mixed GRAM positive and GRAM negative microflora, mainly due to Enterobacteria. In group III an aerobic microflora different from that one verified in group I was found in 76,4% of the patients. In 47.05% of the cases a bacterial growth equivalent to the fecal flora has been observed, in 5.89% Pseudomonas aeruginosa was located and in 23.52% yeasts were cultured from the jejunal fluid. These data confirm the hypothesis that bacterial and fungi infections are most prevalent in underdeveloped countries. This is probably due to the poor sanitary conditions observed in these countries associated with a high index of environmental contamination.

Acute Disease↗

Nitric oxide mediates mechano- and chemoreceptor-activated intestinal feedback control of gastric emptying.

The effect of nitric oxide (NO) synthase inhibition on the gastric emptying of nutrient and nonnutrient meals was investigated in nine dogs. The inhibition of NO synthase delayed the gastric emptying time of both nutrient and nonnutrient meals, but the percentage delay of nutrient meals was significantly greater than that of nonnutrient meals. The inhibition of NO synthase during the emptying of nonnutrient meals enhanced mainly the amplitude of antral, pyloric, and distal duodenal contractions. However, NO synthase inhibition during the emptying of nutrient meals stimulated several spatial and temporal parameters of gastropyloroduodenal contractions. We conclude that NO is one of the neurotransmitters of intestinal feedback that regulates the gastric emptying of both nutrient and nonnutrient meals. The nature and intensity of intestinal feedback by the stimulation of both chemo- and mechanoreceptors by nutrient meals is different from that by the stimulation of mechanoreceptors only by the nonnutrient meals.

Animals↗