Combined use of cultivation-dependent and cultivation-independent methods indicates that members of most haloarchaeal groups in an Australian crystallizer pond are cultivable.

Haloarchaea are the dominant microbial flora in hypersaline waters with near-saturating salt levels. The haloarchaeal diversity of an Australian saltern crystallizer pond was examined by use of a library of PCR-amplified 16S rRNA genes and by cultivation. High viable counts (10(6) CFU/ml) were obtained on solid media. Long incubation times (> or =8 weeks) appeared to be more important than the medium composition for maximizing viable counts and diversity. Of 66 isolates examined, all belonged to the family Halobacteriaceae, including members related to species of the genera Haloferax, Halorubrum, and Natronomonas. In addition, isolates belonging to a novel group (the ADL group), previously detected only as 16S rRNA genes in an Antarctic hypersaline lake (Deep Lake), were cultivated for the first time. The 16S rRNA gene library identified the following five main groups: Halorubrum groups 1 and 2 (49%), the SHOW (square haloarchaea of Walsby) group (33%), the ADL group (16%), and the Natronomonas group (2%). There were two significant differences between the organisms detected in cultivation and 16S rRNA sequence results. Firstly, Haloferax spp. were frequently isolated on plates (15% of all isolates) but were not detected in the 16S rRNA sequences. Control experiments indicated that a bias against Haloferax sequences in the generation of the 16S rRNA gene library was unlikely, suggesting that Haloferax spp. readily form colonies, even though they were not a dominant group. Secondly, while the 16S rRNA gene library identified the SHOW group as a major component of the microbial community, no isolates of this group were obtained. This inability to culture members of the SHOW group remains an outstanding problem in studying the ecology of hypersaline environments.

Nocturnal dosage regimen of sucralfate in maintenance treatment of gastric ulcer.

Sixty-six patients with recently healed gastric ulcers were entered into a double-blind, placebo-controlled, six-month maintenance trial to determine whether sucralfate 2 g at night reduces the liability to recurrent ulceration. Thirty-three patients were randomly assigned to treatment with sucralfate and 33 were assigned to placebo. Endoscopy was performed at the time of entry into the study and at 24 weeks, or earlier if clinical relapse occurred during this period. Of the patients available for analysis, endoscopic recurrences were found in eight of the 29 patients (28 percent) randomly assigned to sucralfate and in 15 of the 27 patients (56 percent) assigned to placebo. Eight of the recurrences noted at 24 weeks were asymptomatic and, of these, five were in the placebo-treated group. The cumulative relapse rate at 24 weeks was significantly lower in the sucralfate-treated group (p less than 0.05), and the Cox-Mantel text showed a significant difference between the cumulative relapse curves of the two treatment groups over the 24-week period (p less than 0.05). The results indicate that a single maintenance dose of sucralfate 2 g at night reduces the relapse rate in patients with recently healed gastric ulceration.

The epidemiology of inflammatory bowel disease in Cape Town 1980-1984.

Patients with inflammatory bowel disease diagnosed in the greater Cape Town area between the years 1980 and 1984 inclusive were studied to establish the incidence and presenting features of these diseases. Case details were obtained from the records of the Groote Schuur Hospital group and Tygerberg Hospital as well as from questionnaires completed by 97% of 731 medical practitioners in the area. There were 134 patients with Crohn's disease, 197 with ulcerative colitis and 16 with indeterminate colitis. The incidences of Crohn's disease in the coloured, white and black population groups were calculated to be 1.8, 2.6 and 0.3/100 000 per year respectively and those for ulcerative colitis 1.9, 5.0 and 0.6/100 000 respectively. Among Jews the incidence was higher for both Crohn's disease (10.4/100 000) and ulcerative colitis (17.0/100 000). Of patients with ulcerative colitis 35% had limited proctitis, 26% proctosigmoiditis, 12% left-sided disease and 27% total colitis. Of patients with Crohn's disease 27% had colonic involvement alone, 37% ileocolitis and 36% small-bowel involvement alone. The incidence of inflammatory bowel disease has increased in the greater Cape Town area over the last 10 years, while the pattern of disease has remained similar to that previously reported for this geographical area.

The risk of abdominal surgery in irritable bowel syndrome.

The incidences of appendicectomy, hysterectomy and ovarian surgery have been compared in 145 patients with irritable bowel syndrome (IBS) and 63 patients with ulcerative colitis (UC). The appendicectomy rate in IBS patients (34.5%) was more than 4 times greater than that in UC patients (7.9%). Likewise, 55.2% of 87 women with IBS underwent hysterectomy or ovarian surgery compared with only 18.5% of 27 women with UC. This increased incidence of abdominal surgery in patients with IBS is probably part of a pattern of chronic illness behaviour; doctors should be aware of this problem when dealing with these cases.

Smoking in inflammatory bowel disease and the irritable bowel syndrome.

The smoking habits of 145 patients with irritable bowel syndrome (IBS) were compared with those of 63 patients with ulcerative colitis and 25 patients with Crohn's disease. Patients with IBS and ulcerative colitis smoked significantly less than those with Crohn's disease. There was no significant difference in the smoking prevalence between ulcerative colitis and IBS patients. There were significantly more ex-smokers in the ulcerative colitis group and two-thirds of these patients developed their colitis within a year of stopping smoking. It is suggested that any protective role postulated for smoking in the pathogenesis of ulcerative colitis should also be considered for IBS.

The irritable bowel syndrome--a study from private practice.

The clinical features of 150 consecutive patients with irritable bowel syndrome are reported. All patients were referred to a private practice. There was a marked female preponderance and a wide range of ages. Diarrhoea was predominant in 61,3%. The common symptoms were altered bowel habit, abdominal pain, emotional disturbance, flatulence and distension. Fatigue, weight loss, upper gastrointestinal symptoms, backache and urinary symptoms were frequent. The rectum showed nonspecific loss of vascular pattern, oedema and congestion in 11,4% of patients, but this was readily distinguished from inflammatory bowel disease on histological examination. The incidence of non-smokers in the group was 78,1%. The overall appendicectomy rate was 34%, and 65% of the 92 women had had gynaecological operations. A positive diagnosis was made on a typical history and simple basic investigations. More extensive investigations were required for those patients with markers of organic disease, but these yielded few associated lesions.

Rectal spirochaetosis--symptomatic response to metronidazole and mebendazole. A case report.

A white homosexual man presented with a 6-week history of intermittent diarrhoea, abdominal pain, nausea and malaise. Threadworm infestation was present, but other gastro-intestinal infection was excluded. Rectal spirochaetosis was found on examination of a rectal biopsy specimen. The patient's symptoms disappeared and the rectal tissue returned to normal on biopsy after treatment with metronidazole and mebendazole. It is suggested that the symptoms were directly related to the presence of rectal spirochaetosis, which responded to the antibiotic.

Vitamin A therapy in patients with Crohn's disease.

Vitamin A therapy has been claimed in isolated reports to be of benefit to patients with Crohn's disease. To investigate this further, 86 patients were entered into a long-term double-blind study of vitamin A, 50,000 U twice daily, as compared with placebo. After a mean of 14.1 mo of treatment there was no significant difference between the groups as measured by a variety of activity indices (including the National Cooperative Crohn's Disease Activity Index), the number of acute attacks, and the surgical rate. No toxic effects of vitamin A were observed during the study. In this study vitamin A has not been shown to be of benefit to patients with Crohn's disease who are in remission.

Inflammatory bowel disease in Cape Town, 1975-1980. Part I. Ulcerative colitis.

Previously documented and new patients with ulcerative colitis seen between 1975 and 1980 in the Gastro-intestinal Clinic of Groote Schuur Hospital were studied to establish the local incidence and clinical features of this disease. There were 220 patients and the mean follow-up was 7,7 +/- 0,4 years. Sixty per cent of patients were White, 37% Coloured and 3% Black. The incidence for the Coloured and White population was calculated to be 1,3 and 2,4/100 000 per year during 1970-1974 and 1,6 and 2,1/100 000 per year during 1975-1980, respectively. In Jews the rates were 8,5 and 10,4/100 000 per year for the two periods. Insufficient data are available to calculate an incidence for the Black population. The disease was limited to less than 15 cm above the anus in 14% of patients, to the rectosigmoid colon in 45%, and to the rest of the colon in 40%. Although the severity of symptoms was related to the extent of disease, 22% of patients with extensive colitis had mild symptoms, while 15% with disease limited to the rectum had severe symptoms. The clinical features were similar in the White and Coloured population groups. A total colectomy was performed on 20% of patients with extensive colitis; in 2% the disease was complicated by colonic carcinoma.

Inflammatory bowel disease in Cape Town, 1975-1980. Part II. Crohn's disease.

Patients with Crohn's disease seen in the Gastro-intestinal Clinic of Groote Schuur Hospital between 1975 and 1980 were studied to establish the incidence and clinical features of this disease. There were 117 patients and the mean (+/- SEM) follow-up was 6,1 +/- 0,5 years. Of these patients 72% were White, 37% Coloured and 1% Black. The incidence for the Coloured and White population groups was calculated to be 0,4 and 0,9/100 000 per year during 1970-1974 and 1,3 and 1,2/100 000 per year during 1975-1980 respectively. In Jews the rates were 5,0 and 7,2/100 000 per year for the two periods. Insufficient data are available to calculate an incidence for the Black population. The disease involved the ileum in 39%, the colon in 17% and both areas in 44% of patients. At presentation 18% of patients had mild, 37% moderate, and 45% severe disease. The severity of symptoms was not related to the extent of the disease. A peri-anal fistula was present in 24% of patients. There was no difference in clinical features between the different population groups. Surgical resection had been performed in 50% of patients and 29% of these had had two or more resections. The surgical rate in the ileitis group was 63%, in the ileocolitis group 49% and in those with colitis 20%.

The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients.

The records of 88 patients with radiation-induced proctosigmoidosis seen over an eight year period were reviewed. Eighty-four (95 per cent) had been irradiated for a gynaecological malignancy. The peak incidence of bleeding occurred after a latent period of nine months from the time of irradiation. Twenty-five subjects (28 per cent) had associated injury to the urinary tract. A wide spectrum of radiological abnormalities found on barium enema is described. Twenty-four patients (27 per cent) underwent operations for radiation-induced injury to the colon and urinary tract. Operations on the bowel were attended by a high complication rate (79%). A clinical classification based on bowel symptoms is presented. Those whose only symptom was low grade rectal bleeding (Group I) had the most favourable outcome and of these, 35 per cent stopped bleeding spontaneously by six months. Patients who required frequent transfusions (Group II) had an increasing mortality rate with the passage of time. Patients whose predominant symptoms were pain and bowel dysfunction (Group III) had the highest death rate but some did well after an operative procedure.

Combination of timolol maleate, hydrochlorothiazide and amiloride hydrochloride in the treatment of hypertension: A multicentre trial.

The effect of a single dose of timolol, hydrochlorothiazide and amiloride in fixed combination (Moducren; MSD) in patients with mild to moderate essential hypertension was tested in an open study during 1978. Ninety-one and a half per cent of the patients studied responded with a fall in diastolic blood pressure of 20 mmHg or more. In 72% a single daily tablet of the combined preparation was sufficient to achieve and maintain control. Patient compliance was excellent and adverse reactions were generally of a minor nature.