The use of δ¹5N signatures of translocated macroalgae to map coastal nutrient plumes: improving species selection and spatial analysis of metropolitan datasets.

The definition of the spatial footprint of land-derived nutrient plumes is a key element to the design of initiatives to combat eutrophication in urbanised coastal regions. These plumes, however, are difficult to monitor because of their inherent high-frequency temporal and spatial variability. Biomonitoring with macroalgae provides time-integration of bioavailable nitrogen inputs through the measurement of δ¹5N signatures in tissues, and adequate spatial coverage through translocation to desirable monitoring locations. In this study, we used laboratory incubations to compare three different species of macroalgae as bioindicators, and a field experiment to investigate the applicability of the technique for the large-scale mapping of nutrient plumes. Cladophora valonioides was selected for the field experiment as it showed rapid changes in δ¹5N values in the laboratory incubations, was abundant in shallow depths making collection cost-efficient, and had tough thalli capable of withstanding deployment in open water. Ecklonia radiata also performed well in the laboratory incubations, but field harvest from subtidal depths was comparatively more expensive. Ulva lactuca had fragile thalli, and large nitrogen reserves that acted to mask the isotopic signal of newly acquired nitrogen. Cladophora valonioides was translocated to 246 sites covering an area of ∼445 km² along the highly urbanized temperate coast of Adelaide, South Australia. The resulting isotopic signatures of nitrogen in tissues were spatially interpolated to produce maps of land-derived nutrient plumes, to model probability and standard error in the predictive surface, and to optimize sampling design.

Effectiveness of topical non-steroidal anti-inflammatory drugs in the management of breast pain.

A prospective study of the effectiveness of the topical application of non-steroidal anti-inflammatory drugs (NSAIDs) as a gel preparation was carried out in 26 women with severe breast pain. The results showed a satisfactory relief of pain in 81% of the women: 11 of 13 with cyclical pain, eight of 11 with non-cyclical pain, and in two women with severe scar pain after lumpectomy and radiotherapy. Topical NSAID gel was applied as required; the relief of severe pain was rapid and no side effects were reported. These factors compare favourably with established recommended treatments which usually involve months of continuous treatment, tailoring of drug dosages and a significant incidence of intolerable side effects. This study has shown that topical NSAID application is an effective, safe, acceptable and easily administered treatment for severe cyclical and non-cyclical breast pain.

Needle prick injury to the surgeon--do we need sharp needles?

Needle prick injury is a well known hazard for surgeons and their assistants. This carries a risk of transmitting HIV and hepatitis infection. In this study the high incidence of sharp needle injury was confirmed (18.9%), with more than one third (8.7%) resulting in skin puncture. The highest incidence of injury occurred during hernia repair (27%) and abdominal wound closure (52%), where injury was sustained to the left index and middle finger as would be expected in right-handed surgeons. Blunt-tipped needles were used in 78 different procedures with technically satisfactory outcome particularly in abdominal wall wound closure and hernia repair, and even in colonic anastomosis, only two glove injuries were reported, with no skin injury. We concluded that the used of blunt-tipped needles is a practical option in eliminating needle prick injury to surgeon's hands.

Postsplenectomy sepsis and its mortality rate: actual versus perceived risks.

A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12,514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.

The role of the spleen in the immune response following naturally acquired exposure to encapsulated bacteria.

Female New Zealand White Rabbits following splenectomy (n = 9), splenectomy with 50% splenic autotransplantation (n = 8) and sham laparotomy (n = 9) have been serially exposed to type 2 Streptococcus pneumoniae and Haemophilus influenzae by aerosol inhalation. Animals were sampled for 3 weeks after exposure and the IgG and IgM type-specific antibody response measured by enzyme-linked immunosorbent assay. Haemophilus influenzae initiated a substantial anti-haemophilus IgG response which was not diminished by splenectomy. The anti-haemophilus IgM response was present in sham-operated animals, absent following splenectomy, and partially restored by splenic autotransplantation. Type 2 Streptococcus pneumoniae induced a minimal IgG and IgM antibody response in all animals irrespective of the presence or absence of a spleen. The results support the role of the spleen in mediating IgM production against polysaccharide encapsulated bacteria. The differential degree of immune response produced by the two organisms may explain in part the differential frequency with which these two organisms infect man following splenectomy.

Blood clearance and tissue distribution of 99Tc-labelled pneumococci following splenectomy in rabbits.

Female New Zealand White rabbits, following sham laparotomy, total splenectomy and splenectomy with 50% splenic autotransplantation, have been injected intravenously with 99Tc-labelled type 2 Streptococcus pneumoniae. The blood clearance of isotope has been measured and the numbers of circulating bacteria quantitated by blood culture. On sacrifice of the animals the tissue uptake of the isotope has been measured. The results indicate 98% bacterial clearance from the blood within 7 min. The liver is the principal organ for reticuloendothelial uptake of the bacteria accounting for 60% of the total injected dose; 15% of the isotope clearance occurred in the lungs, and the spleen contributed only 3% of the total bacterial clearance. There was no difference in the observed pattern of clearance following splenectomy and following splenic reimplantation. Following the uptake of the bacteria in the tissues, the isotope dissociated from the bacterium and was excreted in the urine. The secondary rise in blood isotope level consequent upon this release was not accompanied by a secondary bacteraemia.

Perforated jejunal diverticulitis.

Perforated jejunal diverticulitis is very rare. We describe two cases seen in one surgical unit in a four month period. The problems in early diagnosis are discussed and the need for prompt surgical intervention emphasised if mortality is to be reduced.

Mechanical bowel preparation for colonic resection and anastomosis.

In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.

Long-term metabolic effects of truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer.

In a review of 305 consecutive patients who had undergone truncal vagotomy and gastrojejunostomy for duodenal ulceration 5-15 (mean 10.5) years before, symptomatic and metabolic sequelae were related to a dietary survey in 109 patients. The incidence of post vagotomy symptoms was related to the incidence of weight loss and reduced dietary energy intake. The dietary survey did not show any trends in the incidence of weight loss since operation. Biochemical steatorrhoea occurred in 48% of 96 patients, but this was not related to dietary fat intake, or to weight loss unless diarrhoea was also present. Anaemia was noted in 13% of patients, but the incidence was not related to dietary survey, age, symptoms or post-vagotomy gastric acid output.

Randomized trial of truncal vagotomy with either pyloroplasty or pyloric dilatation in the surgical management of chronic duodenal ulcer.

A randomized trial of 41 patients undergoing truncal vagotomy with pyloroplasty (TV + P) or truncal vagotomy with graded pyloric dilatation (TV + PD) for chronic duodenal ulcer is reported after mean follow-up of 34 months. There was no evidence of gastric stasis in patients who did not have a pyloroplasty. Liquid gastric emptying studies showed an increased rate of gastric emptying postoperatively in patients both with and without pyloroplasty. Overall clinical gradings at review were similar in both groups although there were more patients who were completely symptom free in the group with pyloric dilatation accompanying vagotomy.