A comparison of brain heart infusion blood agar sterilized by filtration and heat on the growth of Neisseria gonorrhoeae.

The growth of Neisseria gonorrhoeae on brain heart infusion blood agar in which the base was sterilized by filtration has been compared with growth on the same medium sterilized by heat. Colonies were larger on the unheated medium, and autoclaving at 115 degrees C of 121 degrees C for 15 minutes was accompanied by a progressive decrease in colony size. Viable counts on the three media showed no difference in end points. Colonies on the unheated medium were usually large enough to be easily recognizable after overnight incubation.

A comparison of the absorbed fluorescent treponemal antibody (FTA-ABS) test and other screening tests for treponemal disease in patients attending a venereal disease clinic.

Screening tests-absorbed fluorescent treponemal (FTA-ABS), the Reiter protein complement-fixation (RPCFT), VDRL slide test, automated reagin-and cardiolipin Wassermann reaction-were carried out on 1922 consecutive new patients attending the Whitechapel Clinic over a three-month period.Taking the FTA-ABS test results as an index, the most efficient combination of conventional tests was found to be the RPCFT and automated reagin test. The cardiolipin WR proved to be under-sensitive and of little value compared with the other tests.Forty-two per cent of the 107 sera reactive in the FTA-ABS test were not detected by the RPCFT or ART tests. An assessment based on the TPI test results and clinical findings in these patients is presented. The scope and limitations of the FTA-ABS test as a screening procedure are discussed.

A comparison between sorbent and Reiter sonicate in the absorbed fluorescent treponemal antibody test.

Some syphilitic sera still fluoresce with Reiter treponemes as the antigen after treatment with the sorbent used in the FTA-ABS test; this finding indicates incomplete removal of group antitreponemal antibody. Levels of this antibody in normal sera have been studied in relation to the titration of sorbent for use in the test. A comparison has been made of the results of FTA-ABS tests with sorbent and Reiter sonicate and the TPI test on 1141 selected problem sera. Results with the sonicate displayed closer agreement (60.9%) with those of the TPI test than did tests with sorbent 40.8%). The use of sonicate as the sorbing agent is thought to improve the performance of the FTA-ABS test without diminishing its sensitivity.

The problems of haemorrhage due to trauma from large vessels in the abdomen.

The major problems of blood loss from large vessels in the peritoneal cavity because of trauma in 48 patients are discussed. There were 21 patients with inferior vena-caval injuries, and 8 with injuries of the aorta. Bleeding from other large vessels was also encountered. The problems relate to rapid transport to hospital, early recognition of bleeding, energetic resuscitation--including rapid replacement of blood, tamponade of bleeding areas until the sites of bleeding vessels can be identified, or tamponade or temporary clamping of the aorta or inferior vena cava proximally and distally.

Injuries of the stomach. An analysis of 95 cases.

In this series the stomach was involved in 8% of patients undergoing surgical exploration for abdominal injuries (most commonly by penetrating trauma). The stomach has strong walls and these are not torn by blunt trauma unless it is severe. Such trauma commonly involves adjacent vascular organs such as the liver, spleen and pancreas, resulting in dangerous haemorrhage. Careful search of both walls of the stomach and the diaphragm, especially after penetrating blunt trauma, is mandatory if complications are to be avoided. The mortality in this series was mostly caused by associated injuries.

Injuries of the large bowel.

An analysis of 120 patients with colonic injuries showed that minor injuries, especially if caused by penetrating trauma, can be treated satisfactorily by suturing without resorting to colostomy.

Injuries of the duodenum.

The incidence of duodenal injury in patients operated on for abdominal injury by the Accident Service of Johannesburg Hospital was 2.71%. A study was made of 33 patients. From the results of treatment it is concluded that minor injuries of the duodenum are adequately treated by suturing and nasogastric suction, but more severe injuries require resection and additional decompression with a jejunostomy or gastrostomy.

Injuries of the jejunum and ileum. A series of 188 patients.

Bullet and stab wounds accounted for approximately 70% of penetrating jejunum and ileum injuries. Blunt injuries were the result of motor vehicle accidents. Injuries were most common in men in the 21-30-year age group. Treatment was by suture or resection. Complications related to the bowel injury occurred in 10 patients, and were the cause of death in 6 (3%).

Injuries of the pancreas.

Pancreatic injuries were most common in patients in the 21-30-year-old age group. In two-thirds of patients the pancreatic duct was torn by blunt injury. Pancreatitis progressing to pseudocyst formation occurred in 5 patients after blunt trauma. Penetrating injury always involved adjacent viscera (stomach, liver, spleen). Drainage was used for contusions and minor wounds. Large wounds were sutured or distal pancreatectomy was carried out. Six patients died; haemorrhage was the cause of death in 3.

Injuries of the liver. A series of 338 patients treated by an accident service.

An analysis of 338 patients with injuries of the liver, among 1,214 patients all operated on for abdominal injuries, is presented. Motor vehicle accidents were the major cause of trauma. Liver injury was accompanied by other abdominal injuries in 196 patients (58%) and chest injuries in 147 patients (43%). Haemostasis alone or suturing alone were employed in the majority of patients. Haemorrhage was both the principal complication and the main cause of death.

Injuries of the kidneys. An analysis of 117 cases.

Renal trauma in 117 patients who underwent laparotomy is reviewed. Sixty-six per cent of the injuries occurred in motor vehicle accidents and were usually associated with other damage, most commonly to the liver and spleen. Dipstick urine tests were too sensitive for diagnostic purposes. Intravenous pyelography was performed in all patients with macroscopic haematuria and, in the absence of hypotension, when there was no concentration of dye, this was followed by renal angiography. Thrombosis of the renal artery occurred in 4 patients. The overall mortality rate was 13%.

Rupture of the spleen. An analysis of 421 cases.

A detailed analysis of a prospective series of 421 patients with rupture of the spleen, who all underwent laparotomy, is presented. Delayed rupture occurred in 8% of cases. In 37% of patients with blunt injury there were additional intraperitoneal injuries that required laparotomy, and also in 79% with penetrating injury. Fifty per cent of patients with blunt trauma had chest injuries; 18% of ruptured spleens were sutured. Only 3 patients died from haemorrhage due to splenic injury--less than 1%.

Review of diagnostic methods in abdominal trauma.

The diagnostic methods used in examining 1,214 patients who underwent laparotomy for abdominal injury are evaluated. Diagnosis was based on clinical examination and the results of tests. Peritoneal lavage was useful for the early detection of bleeding, especially in unconscious patients, paraplegics and intoxicated patients. Radiological examination of the abdomen was unreliable in patients with blunt injury. Routine radiography of the pelvis was rewarding. Intravenous pyelography is now used only in patients with frank haematuria. Transurethral cystography was reliable when 350-400 ml contrast fluid was used. A radiograph of the chest should seldom be omitted in patients with blunt injury.

Traumatic rupture of the diaphragm. An analysis of 121 cases.

Rupture of the diaphragm from blunt injury occurred in 4.4% of patients submitted to surgery for abdominal injury. Rupture should be suspected when there are physical signs of a crush injury to the lower chest or upper abdomen. Typical radiological signs are often obscured by a haemothorax. Passage of a nasogastric tube before radiography for blunt injury or the placing of metal markers on wounds in the 'nipples to umbilicus' area assist in diagnosis. Peritoneal lavage may be negative. Prognosis depends on associated injuries. Only 2 deaths in this series were directly related to the diaphragmatic injury.