Asymptomatic carriage of Clostridium difficile in patients with cystic fibrosis.

Faecal samples from 37 patients with cystic fibrosis and 40 control patients at the Brompton Hospital and the London Chest Hospital were examined for the presence of Clostridium difficile. The organism was isolated from 2 (17%) of control patients who were receiving antibiotics and from one (3.6%) of control patients who had no antimicrobial treatment. Thirty two per cent of the patients with cystic fibrosis excreted C difficile, though none of them had diarrhoea. Two of the three isolates from control patients and nine of the 12 isolates from patients with cystic fibrosis produced toxin B (cytotoxin) in vitro. Toxin B was present in the stools of one of the control patients and three of the patients with cystic fibrosis; toxin A (enterotoxin) was not detected in the faeces of the patients with cystic fibrosis. Two cytotoxigenic strains of C difficile isolated from patients with cystic fibrosis were examined in hamsters; both were virulent, and the animals died.

The value of flexor hinge hand splints.

Functional hand splints have been in use in a number of spinal injury units in the USA since the early 1950s. The splints are designed to provide a pinch-grip either by harnessing wrist dorsiflexion or by external power. Such devices are little used in the United Kingdom. This paper describes the results of late provision of 62 such splints in a Disabled Living Unit. A proportion of tetraplegic patients found such splints of considerable functional value. It is estimated that some 30--60 patients each year would benefit from them if appropriate facilities for early fitting were available.

Some studies of the bacterial flora associated with the mucosa of the human gastrointestinal tract.

Specimens of mucosal tissue of the small and large bowel obtained either by a colonoscope or during surgical operations were investigated quantitatively for their bacterial flora. A detailed prescription of the methodology using an anaerobic chamber is given. Most of the mucosal specimens of the small intestine as well as all the specimens of the large intestine contained bacteria (about 10(4) germs/g). Predominantly, Bacteroides, gram-positive rods, and cocci were isolated. In contrast to the gut lumen flora anaerobic bacteria of the mucosal flora did not outnumber the aerobes. In patients with inflammatory bowel disease or with carcinoma of the colon the mucosal flora showed no demonstrable alterations even after undergoing a sulphonamide therapy.

Antibody responses to antigens of Streptococcus mutans in monkeys (Macaca fascicularis) immunized against dental caries.

Immunization of rabbits or monkeys with walls prepared from Streptococcus mutans by a procedure including extraction with SDS at room-temperature induced antibodies to three antigens (A, B and C) detectable by crossed immunoelectrophoresis. Antigens A and B have previously been characterized as proteins of molecular weight 29 000 and 190 000, respectively. Antigen C was characterized as having a molecular weight of 70 000 and was purified by immunosorbent affinity chromatography and hydrophobic interaction chromatography. Another wall protein, antigen D, of molecular weight 13 000, was extracted from walls with Triton X-100. Immunization of monkeys with walls prepared from cultures of S. mutans grown at a high (D = 0.5 h-1) or low (D = 0.05 h-1) dilution rate in a chemostat showed that only the latter induced protection against dental caries. There was a positive correlation between levels of antibody to antigens A and C and induction of protection and a negative correlation between protection and the level of antibody to antigen B. No antibody to antigen D was detected in protected monkeys and an experiment in which monkeys were immunized with pure antigen D confirmed that it does not induce protection.

The effects of phthalylsulphathiazole on the bacteria of the colonic mucosa and intestinal contents as revealed by the examination of surgical samples.

The isolation of a bacterial flora specifically associated with the colonic mucosa of patients undergoing large-bowel surgery is described. This flora differed from that of faeces in both the numbers and the types of bacteria isolated. The most striking difference was the reduction in the number of anaerobic bacteria isolated from the colonic mucosa. The ratio of anaerobic to aerobic was approximately 1:1 for mucosa compared with 100:1 for faeces.