Relation between the mucosal flora and Paneth cell population of human jejunum and ileum.

The Paneth cell population in surgically resected human jejunum and ileum was estimated using image analysis of the granule area in patients who had not received antibiotics. The mucosa was cultured aerobically and anaerobically. In the jejunum 22 samples were sterile and five yielded bacteria; in the ileum four were sterile and three were non-sterile. The mean Paneth cell granule area in the sterile jejunum was 122.7 +/- 37.2 micron2 and in the non-sterile samples 67.2 +/- 36.6 micron2 (p less than 0.006). The corresponding values for the ileum were 137.9 +/- 109.8 and 100.5 +/- 9.1 (NS). Thus an increase in the Paneth cell population may occur in response to changes in the intestinal luminal environment. Failure of this response and resultant Paneth cell deficiency may lead to bacterial overgrowth.

Mucosal flora of the small intestine and the effect of preoperative antibiotics.

Samples of mucosa from the small intestines of 100 patients undergoing intestinal surgery were examined bacteriologically. Sixty four patients had received chemotherapy, 12 for more than 24 h before operation. Most of the jejunal samples were sterile unless there was a carcinoma, previous surgery, or potential intestinal stasis. Ileal mucosa was more likely to contain intestinal organisms. Most of the strains isolated were sensitive in vitro to the antibiotics given in vivo, but short term treatment may not have allowed sufficient time for the treatment to have become effective. The findings suggest that antibiotics are not needed for most operations on the duodenum or jejunum but may be required for operations on the ileum.

Effect of topical trifluridine on Thygeson's superficial punctate keratitis.

Six eyes of four patients with Thygeson's superficial punctate keratitis were treated with trifluridine 1% drops. Five of the six treated eyes responded favorably to topical trifluridine therapy. Symptoms and later the signs of the disease disappeared, but more slowly than observed following topical corticosteroid therapy. One patient with an 11-year history of topical corticosteroid dependence for clearing of lesions was treated successfully with trifluridine, and his eyes have remained clear for over one year without therapy. Mild irritation and transient limbal follicle formation were the only recognized side effects. Trifluridine is thus an effective and safe alternative to corticosteroids in the treatment of this condition and may offer a means of treating the steroid-dependent patient.

The preparation of simulated water samples for the purpose of bacteriological quality control.

As part of the bacteriological quality control programme of the Public Health Laboratory Service, we were asked to investigate the possibility of providing simulated water samples for distribution to the laboratories. For this purpose it was necessary to find some means whereby suspensions of coliform organisms and Escherichia coli could be kept relatively stable in number at room temperature for a period of 7-10 days. This, it was finally found, was best achieved by adding selected strains of the organisms to improved formate lactose glutamate medium (Gray, 1964) without the lactose but with added boric acid to a final concentration of 1-8%. The procedures adopted in the successful quality control programme are described.