Insect associates of Ceratocystis albifundus and patterns of association in a native savanna ecosystem in South Africa.

Species of Ceratocystis Ellis and Halstead s.l. include important plant pathogens such as C. albifundus Morris, De Beer, and M. J. Wingfield that causes a serious wilt disease of non-native, plantation-grown Acacia mearnsii De Wild. trees in Africa. The aim of this study was to identify the insects associated with C. albifundus in South Africa and to consider the means by which the pathogen spreads. Insects were collected weekly for 77 wk in a native ecosystem using modified pitfall traps. Trapped insects were identified, and fungi were isolated using carrot baiting and by plating them onto malt extract agar. Fungi were identified using morphological characteristics and DNA sequence comparisons. Three different nitidulid (Coleoptera: Nitidulidae) beetles, Brachypeplus depressus Erichson, Carpophilus bisignatus Boheman, and Ca. hemipterus L, were collected, of which the most common were the Carpophilus spp. Two Ceratocystis spp., namely C. albifundus and C. oblonga R. N. Heath and Jolanda Roux, were isolated from all three insect species. Insect numbers and fungal isolates decreased significantly in the colder months of the year. Of the two Ceratocystis spp., C. oblonga was most abundant, occurring on 0.5% of the Carpophilus spp. C. albifundus was isolated from 1.1% of the Brachypeplus individuals and from 0.01% of the Carpophilus individuals. This study presents the first record of insects associated with C. albifundus and C. oblonga and provides an indication of environmental influences on fungal and insect populations, which could contribute to future disease management.

Audit of provincial gastroenterology services in the Western Cape.

BACKGROUND: While disorders such as gastro-oesophageal reflux disease, gastrointestinal (GI) cancers and inflammatory bowel disease are prevalent among all racial groups in the Western Cape, there is little knowledge of local GI service provision. The state of equipment, facilities and staffing is largely unrecorded and to date unknown. The aim of this study was to audit the availability of GI facilities in the provincial sector, which provides care for the majority of people in the Western Cape. METHOD: All hospitals in the Western Cape providing endoscopy were evaluated by means of a hands-on audit, to identify available organisational infrastructure. Data including staffing, details and utilisation of existing equipment, maintenance and disinfection techniques and delays in service provision were collected. RESULTS: Over a period of 12 months, 17 Western Cape hospitals were visited: 3 tertiary, 5 regional and 9 district-level institutions. There are currently 89 GI endoscopes in state service, with an average age of 6.1 years (range 1-23 years). While most institutions utilise video endoscopy, in many instances equipment is near the end of its economic life. A total of 26,434 endoscopic procedures were performed over a 12-month period. Overall at least 60% of all adult endoscopy was undertaken at tertiary institutions. The mean delay from consultation until gastroscopy or colonoscopy was 9.25 weeks (range 0.5-28 weeks) and 8 weeks (range 1-20 weeks), respectively. Only 1 tertiary and 1 regional hospital employed fully trained, registered nurses, and the majority of institutions did not conform to internationally accepted standards for the maintenance and disinfection of endoscopic equipment. CONCLUSION: While endoscopy equipment is widely distributed throughout the province, it is evident from this study that services in the Western Cape fall short of international standards, with delays in endoscopic provision, lack of adequate equipment, inadequate scope maintenance and disinfection and a shortage of trained staff. As such, much of the population reliant on state facilities has poor access to GI health care. These deficiencies need to be addressed.

Unique influence of stimulus duration and stimulation site (glabrous vs. hairy skin) on the thermal grill-induced percept.

BACKGROUND: The application to the skin of spatially interlaced innocuous warm (40 °C) and cool (20 °C) thermodes (termed a thermal grill--TG) can produce an unusual thermal percept, but the mechanisms remain unclear. METHODS: We compared the percept quality and intensity over a 120-s period evoked by each of three configurations of a 6-bar thermal stimulator (6 TS): all 40 °C(WARM); all 20 °C(COOL); alternating bars 40/20 °C (TG) at two body sites (forearm and palm). RESULTS: Both unpleasantness and pain were significantly greater for the TG-induced (vs. either COOL- or WARM-induced) percept. Unpleasantness ratings were significantly higher than pain intensity ratings. Several emotional qualitative descriptors were unique to the TG-induced percept. TG palmar (vs. forearm) stimulation produced a more intense percept and was perceived as painful in more subjects. Temporal profiles of intensities of TG-induced percepts differed from those induced by the COOL or WARM thermodes alone. For both unpleasantness and pain, the site differences in the temporal profile were also unique for TG versus the COOL- or WARM-evoked percepts. Qualitative characteristics of the TG-induced percept varied over time and between subjects. CONCLUSIONS: The TG percept intensity and temporal profile were different from those evoked by either of its component parts. The perceived quality is person-specific. These differences suggest that the classic 'TG illusion' results from complex central integration of several types of peripheral afferent inputs activated by the TG. Differing body site-related roles of thermosensory afferents in discrimination versus temperature homeostasis may explain site-related variations in the percept.

Promotion and regression of atherosclerosis in vervet monkeys by diets realistic for westernized people.

We have described and measured aortic and arterial atherosclerosis in adult female Vervet monkeys (n = 61) after application of dietary treatments for 47 months. The diets were compounded entirely of normal food items for westernized people, with no extra cholesterol added. A 'Western' diet (WD), known to induce hypercholesterolaemia, was found to be atherogenic in aortas and some arteries. A more 'prudent' diet (PD) induced much less lipid infiltration into aortic intimas and was not associated with serious atherosclerotic changes. However, when this PD was used as a treatment for 27 months, following 20 months of nutrition by the WD, minimal regression of cholesterol crystals and non-lipid components of atherosclerotic plaque was detected. There was no significant coronary artery or myocardial disease in these adult females after 47 months of feeding on the WD whereas males do develop coronary atherosclerosis and myocardial fibrosis. For this model the PD would be more effective in preventing atherosclerosis than treating advanced lesions. We believe this is the first time that the pathology of atherosclerosis promoted by realistic diets has been modelled in adult females of this species.

Chronic atrophic gastritis, gastric pH, nitrites and micronutrient levels in a population at risk for gastric carcinoma.

One hundred and seventy-eight patients at risk for gastric carcinoma had upper gastrointestinal endoscopy. Twenty-seven selected patients with the type B of chronic atrophic gastritis, 32 patients with normal mucosa and 47 non-scoped healthy controls were tested for plasma vitamin C, retinol and tocopherol. The total vitamin C level was also assessed in gastric juice of scoped patients. Micronutrient levels were related to gastric pH, nitrites and gastric mucosal pathology. The study showed a higher level of pH (greater than 4) and high nitrites in gastric juice in patients with chronic atrophic gastritis, gastric malignant and dysplastic lesions. Neither the hypochlorhydria nor gastric nitrites affected the prevalence of C. pylori in gastric mucosa. Low gastric and plasma concentrations of vitamin C observed in patients with chronic atrophic gastritis showed an inverted relationship with pH level, and an inter-relationship of other vitamins with antioxidant properties (vitamins A and E).

Oesophageal mucosal pathology in a population at risk for gastric and oesophageal carcinoma.

Statistical studies of oesophageal and gastric carcinoma at Groote Schuur Hospital during a 4 year period and a detailed pathological assessment of oesophageal mucosal biopsies of 526 rural outpatients are reported. A statistically suggested high incidence of oesophageal carcinoma was confirmed by endoscopical studies. Oesophageal carcinoma was detected endoscopically in 1.14% of patients with dyspepsia. Oesophagitis and glycogenic acanthosis were common findings which were related to smoking and alcohol intake, but were not related to cancer risk. Precursor lesions for oesophageal carcinoma are discussed.

Lack of effect of amitriptyline on risperidone pharmacokinetics in schizophrenic patients.

The interaction between plasma concentrations of the tricyclic antidepressant amitriptyline and the metabolism of the new antipsychotic risperidone was studied in 12 patients with chronic schizophrenia. Each patient received 3 mg risperidone twice a day for 28 days. Amitriptyline was coadministered at doses of 50 mg/day on day 15 and 100 mg/day on days 16 to 21. Amitriptyline did not significantly affect the mean plasma concentrations or pharmacokinetics of risperidone in schizophrenic patients or influence the antipsychotic fraction (the total concentration of risperidone and 9-hydroxyrisperidone, its primary and biologically active metabolite). These results suggest that risperidone dose need not be adjusted when coadministered with amitriptyline at doses up to 100 mg/day in schizophrenic patients.

Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance.

OBJECTIVE: To compare the effect of isoenergetically-dense, high-protein (HP), high-fat (HF) or high-carbohydrate (HC) breakfasts (at 08.30) on subjective hunger, fullness and appetite (measured hourly on a 100 mm visual analogue scale), macronutrient balance and ad libitum energy intake (EI), at a test meal (13.30) and throughout the rest of the day (until 23.00). DESIGN: Six men each spent 24 h in a whole-body indirect calorimeter on three separate occasions during which they received breakfasts designed to match 75% of BMR and that comprised, on average 3.1 MJ of protein (HP), carbohydrate (HC) or fat (HF), respectively, the remainder being split between the other two macronutrients. Every item of the ad libitum diet comprised 13% protein, 40% fat and 47% carbohydrate by energy, with an energy density of 550 kJ/100 g. RESULTS: Subjectively-rated pleasantness did not differ between the breakfasts, or any of the subsequent ad libitum meals. Subjective hunger was significantly greater during the hours between breakfast and lunch after the HF (26) treatment relative to the HP (18) or HC (18 mm) meals (P < 0.001), although the HP treatment suppressed hunger to a greater extent than the other two treatments over 24 h. However, mean ad libitum lunch intakes were similar at 5.38, 5.30 and 5.18 MJ (NS) on the HP, HC and HF treatments, respectively. After-lunch intakes were also very similar at 6.14, 6.18 and 5.83 MJ (NS). Mean 24-h energy expenditure amounted to 11.12, 11.14 and 10.93 MJ, respectively, producing energy balances of 5.71, 5.83 and 5.04 MJ (NS), respectively. The HP, HF and HC breakfasts led to enhanced P, F and C oxidation, respectively (P < 0.003). CONCLUSIONS: Large HP, HC or HF breakfasts led to detectable changes in hunger that were not of sufficient magnitude to influence lunch-time intake 5 h later, or EI for the rest of the day. A single positive balance of each macronutrient can be buffered by oxidation and storage capacity, without leading to changes in meal-to-meal EI, when subjects feed ad libitum on unfamiliar diets of fixed composition.

Influence of cisapride, metoclopramide and loperamide on gastric emptying of normal volunteers as measured by means of the area under the curve of the cumulative fraction absorbed-time profiles of paracetamol.

The present study with paracetamol was designed to compare the effects of 40 mg cisapride, 20 mg metoclopramide and 4 mg loperamide given orally on gastric emptying under fasting conditions in normal volunteers. The well known bioavailability parameters of absorption and the area under the curve of the fractional absorbed time profiles up to 30 min were used as an index of gastric emptying. As reflected by the AUC of the fractional absorbed time profiles, it was concluded that pretreatment with cisapride speeded up the gastric emptying under fasting conditions. Tmax was the only normal bioavailability parameter that showed any significant change after cisapride treatment. Pretreatment with therapeutic doses of loperamide and metoclopramide did not significantly modify stomach emptying.

The mean cumulative fraction absorbed-time profiles of paracetamol as an index of gastric emptying.

The purpose of this study was to measure gastric emptying by using the cumulative fraction absorbed-time profiles of paracetamol. To evaluate the validity of the method as an index of gastric emptying, six healthy male volunteers were entered into an ethically approved trial using different regimens of cholinergic enhancing (i.e. metoclopramide and neostigmine) and blocking agents (i.e. atropine and pirenzepine) and the results were compared with the bioavailability (i.e. Cmax, Tmax, AUC) parameters of paracetamol as an index of gastric emptying. The cumulative fractional absorption of paracetamol appears to be a valuable index for the measurement of gastric emptying.

A foreshortened method of measuring liquid gastric emptying in normal volunteers.

The purpose of this study was to compare the cumulative fraction absorbed-time profile method of paracetamol with the shorter proportional area under the curve method of paracetamol by pretreating normal volunteers with cisapride, codeine and metoclopramide with and without neostigmine. Both methods are sensitive and comparable in defining early phase liquid gastric emptying, with the proportional area under the curve method having the advantage of providing the relevant information with a two-hour study period.

A noninvasive evaluation of baroreceptor sensitivity with the Valsalva maneuver and phenylephrine methods.

In a double-blind crossover study, we compared baroreceptor sensitivity (BS) and latency, derived from the phenylephrine method with BS and latency derived from phase IV of the Valsalva maneuver (VM), using the Finapres, a noninvasive blood pressure monitor. Ten healthy volunteers were enrolled in the study and BS was determined with placebo, atropine (0.03 mg/kg) and atenolol (10 mg) and was expressed as the linear relation between the change in RR interval following the blood pressure rise induced by either phenylephrine or phase IV of the VM (i.e., after cessation of straining). Baseline baroreceptor sensitivity (p<0.001) and baroreceptor sensitivity in the presence of atropine (p<0.02) was smaller with the VM but no differences in baroreceptor sensitivity between the two methods were evident after atenolol. Although no linearity existed between the two methods under any of the experimental conditions, baroreceptor sensitivity in the presence of atropine was significantly smaller (p<0.01)(and latency delayed (p<0.08)) compared to atenolol-induced changes with both methods. We found excellent correlation between baroreceptor sensitivity derived from the ECG tracing and Finapres recorded beat-to-beat pulse intervals (p<0.001; r>0.8, under all conditions) although the correlation after atropine was not as close (p<0.01; r=0.7). The smaller baroreceptor sensitivity induced by the Valsalva maneuver with placebo and atropine, but not with atenolol, suggests a parasympathetically influenced vasodilation, and sympathetically medicated tachycardia during phase IV of the VM.

Effects of pretreatment with dexfenfluramine and fluoxetine on metoclopramide-induced aldosterone secretion in healthy volunteers.

OBJECTIVE: The present placebo-controlled study was designed to compare the effect of acute pretreatment with dexfenfluramine and fluoxetine on the plasma aldosterone response to metoclopramide. STUDY PARTICIPANTS AND DESIGN: Ten healthy ambulatory male volunteers participated. Following a single-blind, randomised design, each volunteer received metoclopramide as an intravenous bolus of 10mg at 0700 hours on each experimental day. Participants were pretreated at 2200 hours the previous evening and 0500 hours in the morning with one of the following: fluoxetine 20mg, dexfenfluramine 30mg, or placebo. RESULTS: In response to metoclopramide administration, the maximum concentration was significantly higher (p = 0.004) than baseline with placebo, fluoxetine and dexfenfluramine. The area under the curve of dexfenfluramine was significantly larger than that with both placebo (p = 0.007) and fluoxetine (p = 0.004), while that of fluoxetine was significantly larger than that of placebo (p = 0.01). CONCLUSION: Acute pretreatment with both dexfenfluramine and fluoxetine caused an enhancement of metoclopramide-induced aldosterone secretion, probably by augmenting serotonergic neurotransmission via serotonin (5-HT)(4) receptors. The plasma aldosterone levels were significantly higher with dexfenfluramine compared with fluoxetine, probably as a result of larger 5-HT concentrations being available for stimulation of glomerulosa cell activity.

Patients' rights in New Zealand: complaints resolution and quality improvement.

"Patients' rights" has become a familiar catchword in western countries in recent years. In New Zealand the Office of the Health and Disability Commissioner was established in 1994 to promote and protect patients' rights. The Commissioner also facilitates the resolution of complaints relating to the infringement of patients' rights as set out in the Code of Health and Disability Services Consumers' Rights. Victims of medical misadventure in New Zealand are compensated through a no-fault, state-funded rehabilitation and compensation scheme. The regulatory environment is rehabilitative rather than punitive. This framework is consistent with a systems approach to reducing errors and improving patient safety, and the Commissioner seeks to use the resolution of individual complaints as a tool for improving the quality of care throughout the health care system.

Left main bronchus compression as a result of tuberculous lymphnode compression of the right-sided airways with right lung volume loss in children.

RATIONALE: The superior mediastinal space is confined by the sterno-manubrium anteriorly and the vertebral column posterior. An abnormal relationship between the superior mediastinal structures may result in compression of the left main bronchus. In patients with right-sided pneumonectomy an exaggerated compensatory response may lead to stretching and compression of the remainder of the intra-thoracic airway. Lymphobronchial TB mimics pneumonectomy when it causes compression of the bronchus intermedius, between nodal lymphnode groups with resultant volume loss in the right lung and displacement of the mediastinum to the right. The left main bronchus may be at risk of compression due to rotation and displacement of the major vessels. AIM: To report pediatric cases of right-sided lymphobronchial TB with volume loss, demonstrate the use of angle measurements to quantify mediastinal dynamics and support a pathogenetic theory for left main bronchus compression. MATERIALS AND METHODS: CT scans in children with TB and right lung volume loss, were compared retrospectively with controls using angle measurements based on descriptions of the aorta-carinal syndrome and the post-pneumonectomy syndrome. The Mann-Whitney U-test was used to compare groups. RESULTS: The "Pulmonary bifurcation angle" between the main pulmonary arteries reached statistical significance (P = 0.025). The "Pulmonary outflow tract rotation" angle (pulmonary trunk with the mid sagittal plane) approached statistical significance (P = 0.078). The left main bronchus ranged from complete obliteration in two patients to 0.7 cm. In 16 of 30 patients the size was reduced to less than 75% of expected. CONCLUSION: In children with right lung volume loss from TB, the compression of the contralateral bronchus is due to narrowing of the pulmonary artery bifurcation angle as the main trunk rotates towards the midline. This is comparable to the post-pneumonectomy syndrome.

Ceratocystis larium sp. nov., a new species from Styrax benzoin wounds associated with incense harvesting in Indonesia.

Styrax benzoin trees, native to the island Sumatra, Indonesia are wounded to produce resin that is collected and burned as incense. These wounds on trees commonly develop into expanding cankers that lead to tree death. The aim of this study was to consider whether Ophiostomatoid fungi, typically associated with wounds on trees might be associated with resin harvesting on S. benzoin. Samples were collected from the edges of artificially induced wounds, and particularly where cankers and staining of the vascular tissue was evident. Tissue samples were incubated in moist chambers and carrot baiting was also used to detect the presence of Ceratocystis spp. Fruiting structures with morphology typical of species in the C. fimbriata s.l. species complex and species in the anamorph genus Thielaviopsis were found, on both the incubated wood and the carrot baits. DNA sequences were generated for the Internal Transcribed Spacer regions 1 and 2 including the 5.8S rRNA gene, part of the beta-tubulin and the Transcription Elongation Factor 1-alpha gene regions. These data were compared with those of other species in the C. fimbriata s.l. species complex and Thielaviopsis using phylogenetic analysis. Morphology of the isolates in culture as well as phylogenetic inference showed that the Thielaviopsis sp. present on the wounds was T. basicola. The Ceratocystis sp. from S. benzoin represents a new taxon in the C. fimbriata s.l. complex described here as C. larium sp. nov.

Effects of enhancement and antagonism of 5-hydroxytryptamine activity on metoclopramide-induced aldosterone secretion in man.

This study examines the contribution of the serotonergic system to metoclopramide-induced aldosterone secretion. Six normal male volunteers, at 13 h, 9 h, and 2 h before the i.v. bolus of 10 mg metoclopramide, received the following pre-treatments in a single-blind cross-over randomized sequence: fluoxetine 20 mg, metergoline 6 mg, pizotifen 0.5 mg, or methysergide 2 mg. One regimen consisted of metoclopramide alone. Pizotifen and fluoxetine pre-treatment increased metoclopramide-induced aldosterone secretion significantly after 15 min, for the duration in the case of fluoxetine, and up to 90 min with pizotifen. The increase with metergoline was never significant, while methysergide had a negligible influence. Serotonin is postulated to play an intermediary role in acetylcholine-facilitated aldosterone release. The mechanism of fluoxetine-mediated serotonin increase is a re-uptake inhibition and that of pizotifen is suggested to be the elimination of an auto-inhibitory mechanism.

Evaluation of gastrointestinal motility using the hydrogen breath test.

The purpose of the study was to evaluate the validity of a model where intestinal transit is increased and decreased by motility modifying drugs. The measurement of breath hydrogen concentrations after ingestion of lactulose was used to estimate small intestinal transit time. After obtaining base-line values, eight healthy volunteers were pretreated on separate occasions with loperamide, diphenoxylate, metoclopramide and cisapride. Diphenoxylate caused a significant increase in small bowel transit time, whereas both metoclopramide and cisapride significantly shortened it. The H2 breath test therefore seems to accurately reflect the expected transit time. Loperamide did not alter significantly intestinal transit. Possibly this drug counteracts its own delaying influence on small bowel transit by hurrying gastric emptying. Alternatively, not enough time was allowed for it to exert its full effect.

Effect of metoclopramide, ondansetron and granisetron on aldosterone secretion in man.

The plasma aldosterone response following the administration of drugs with antagonist and agonist activity at Serotonin 3 and 4 (5-HT3&4) receptors has been examined in 9 healthy male volunteers receiving the following four treatments i.v. in a randomised, cross-over sequence: ondansetron 8 mg, granisetron 3 mg, metoclopramide 20 mg, and saline 20 ml. Metoclopramide significantly increased the mean plasma aldosterone level to 196% of basal level at 5 min. It rose to 234% at 15 min and remained at more than 185% of basal level for the duration of the experiment. The response to ondansetron and granisetron did not differ significantly from placebo. If dopamine antagonism is discounted, the results suggest that metoclopramide-induced aldosterone secretion results from its agonist activity at 5-HT4 receptors, although slow neuronal depolarization via an unidentified receptor remains a possibility. Antagonism at the 5-HT3 receptor plays no role, as the selective antagonist, granisetron, did not elicit a significant response. It seems unlikely that the 5-HT4 receptor is the second, low affinity binding site of ondansetron, unless it had no agonist activity at this receptor.