Sore nipples in breast-feeding women: a clinical trial of wound dressings vs conventional care.

BACKGROUND: Sore nipples in breast-feeding mothers are a common cause of premature weaning, and are difficult to treat owing to recurrent trauma and exposure to the infant's oral flora. OBJECTIVE: To compare the safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding. DESIGN: Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maximum of 3 follow-up visits within 10 days, or until the resolution of symptoms. SETTING: The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh. PATIENTS: A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or chronic unrelated pain conditions were excluded from the study. INTERVENTION: After informed consent, patients were randomized to receive either a hydrogel wound dressing or breast shells and lanolin. All patients underwent a history, physical examination of the infant and the mother's breasts, assessment of breast-feeding technique, and breast-feeding instruction. MAIN OUTCOME MEASURES: The degree of pain on self-report questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding. RESULTS: Although both treatments, in association with instruction in breast-feeding technique, were effective, greater improvement was seen in the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pain (P<.05). There were significantly more infections in the dressing group (P<.05), which resulted in early discontinuation of the study. CONCLUSIONS: Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings. Lanolin and shells should remain first-line therapy.

Treatment of a metabolic disease, scurvy, by administration of the missing enzyme.

Reaction of immunoprecipitated L-gulonolactone oxidase with glutaraldehyde allows multiple administrations of large amounts of this enzyme extracted from either chicken or rats to guinea pigs. L-Gulonolactone oxidase converts L-gulonolactone to ascorbic acid, and its absence from guinea pigs and primates results in their requirement for this vitamin. By administration of this enzyme guinea pigs are able to survive on an ascorbic-acid-deficient regimen.

A new simple method for microbiological sampling of meat surfaces.

A new method for sampling meat surfaces using abrasive discs has been tested against the spray gun technique already described by Clark (1965). Evenly inoculated beef and pork slices were sampled after 1, 48, and 120 h of incubation at 4 degrees C for beef and 1, 48, and 72 h at 4 degrees C for pork. The new method was slightly less efficient than the spray gun in recovering bacteria during the early stages of incubation but was about 600% more efficient after 72 and 120 h.

Acetic acid and hydrogen metabolism during coculture of an acetic acid producing bacterium with methanogenic bacteria.

Two microorganisms originally existing as a mixed culture obtained from an anaerobic digester fluid were separated for pure and coculture studies. One of these was motile, Gram-negative, and non-sporeforming, and it required yeast extract for growth and acetic acid production. This isolate produced H2 and did not need H2 and (or) CO2 for growth and acetate formation. The other isolate was a methanogen whick resembled Methanobacterium arbophilicum in morphology and substrate specificity. Coculture growth of the two isolates in yeast extract broth (80% N2--20% CO2 gas phase) indicated that the non-methanogen produced up to four to five times more H2 than when grown separately. Although the growth of the non-methanogen was not enhanced by the removal of H2 by the methanogen, the hydrogen produced was essential for the growth of methanogen. Similar results were obtained when the non-methanogen was cocultured with Methanospirillum hungatti GP1. Cultivation of the non-methanogen in the presence of M. hungatti GP1 (under abundance of 80% H2--20% CO2) indicated that the acetate produced was consumed by M. hungatii, without inhibiting the growth of the other culture.

Effect of sodium chloride on growth and methane production of methanogens.

The effect of up to 263.7 mM sodium chloride on the growth and methane production by pure cultures of Methanospirillum hungatii GP1, Methanobacterium MOH, Methanobacterium thermoautotrophicum, and an unidentified methanogen was studied. Growth and methane production by M. hungatii GP1 were not affected up to 97.3 mM NaCl but there was some inhibition of growth at higher concentrations. Growth of Methanobacterium MOH was independent of sodium chloride concentration within the range investigated. For the unidentified methanogen, optimum growth and methane production occurred at 15.2 mM NaCl, while growth of M. thermoautotrophicum was not affected by sodium chloride concentrations up to 15.2 mM. Concentrations over 15.2 mM were inhibitory to these two organisms. The 15 mM sodium chloride concentration used by some investigators appears suitable for isolation and cultivation of methanogens since all the organisms tested in this study exhibited good growth and methane production at this salt concentration.

Characterization of a strain of Methanospirillum hungatti.

The results of morphological, base ratio, nutritional, temperature, and pH studies on a strain of Methanospirillum hungatii, isolated from an anaerobic pear waste digester, are described. The isolate, designated as strain GP 1, was compared with some of the characteristics of type-strain M. hungatii JF 1. Strain GP 1 is Gram-negative, weakly motile, and a strict anaerobe with a guanine plus cytosine (G +C) content of 46.5 mol%. The preferred substrates for methane production are hydrogen, carbon dioxide, and formate. Acetate is used under certain conditions but its specific contribution to cell carbon and (or) methane formation was not established. The optimum temperature for both growth and methane production is 35 degrees C, but growth and methane production occur over the range 25-45 degrees C. Methane production is optimal at pH 7.0.

Effect of lactobacilli and carbon dioxide on the growth of Microbacterium thermosphactum on fresh beef.

Studies with articifially inoculated fresh beef showed that lactobacilli markedlyrestrict the growth of Microbacterium thermosphactum when the beef is vacuum-packaged. High concentrations of carbon dioxide (up to 75%) had little effect on the growthof M. thermosphactum under either aerobic or anaerobic conditions. Tests were madewith samples of lean beef inoculated with pure cultures of lactobacilli and (or) M. thermosphactum and stored unpackaged in air, in air enriched with carbon dioxide, in nitrogen-carbon dioxide mixtures, or vacuum-packaged as in commercial practice. On vacuum-packaged meat, growth of M. thermosphactum was extensive in the absence of lactorbacilli, but was restricted in the presence of lactobacilli. On unpackaged meat (i.e.stored in air) this inhibition did not occur, showing that anaerobic conditions are necessary for it to take place. These results show the import ance of lactobacilli on the storage life of vacuum-packaged fresh beef.