Acute abdominal pain: computer aided diagnosis by non-medically qualified staff.

This report explores the role of computer aided diagnosis in acute abdominal pain when applied by non-medically qualified personnel. Clinical features of 153 patients (75 males, 78 females, aged range 6-92 years, median 35 years) suffering from less than one weeks' abdominal pain were recorded. Junior doctors' diagnostic accuracy with (65 cases) and without (70 cases) structured computer history sheets were compared with first year clinical medical students using the computer system (46 cases: 28 also seen by doctor, 18 cases student only). These students had no previous surgical training or experience. Doctors' diagnostic accuracy of 51% rose significantly to 69% with the use of structured history forms (chi 2 = 4.53, P = less than 0.05). Computer assisted clinical students' diagnostic accuracy matched the improved doctors' accuracy (69.5%). These results have implications not only for medical education but also for isolated paramedical personnel who should be supplied with structured diagnostic forms and, where appropriate, a microcomputer.

The separation of beta-glucanases produced by Cytophaga johnsonii and their role in the lysis of yeast cell walls.

1. When Cytophaga johnsonii was grown in the presence of suitable inducers the culture fluid was capable of lysing thiol-treated yeast cell walls in vitro. 2. Autoclaved or alkali-extracted cells, isolated cell walls and glucan preparations made from them were effective inducers, but living yeast cells or cells killed by minimal heat treatment were not. 3. Chromatographic fractionation of lytic culture fluids showed the presence of two types of endo-beta-(1-->3)-glucanase and several beta-(1-->6)-glucanases; the latter may be induced separately by growing the myxo-bacterium in the presence of lutean. 4. Extensive solubilization of yeast cell walls was obtained only with preparations of one of these glucanases, an endo-beta-(1-->3)-glucanase producing as end products mainly oligosaccharides having five or more residues. Lysis by the other endo-beta-(1-->3)-glucanase was incomplete. 5. The beta-(1-->6)-glucanases produced a uniform thinning of the cell walls, and mannan-peptide was found in the solution. 6. These results, and the actions of the enzyme preparations on a variety of wall-derived preparations made from baker's yeast, are discussed in the light of present conceptions of yeast cell-wall structure.

The glucan components of the cell wall of baker's yeast (Saccharomyces cerevisiae) considered in relation to its ultrastructure.

1. Commercial pressed baker's yeast, and cell walls prepared from it, were extracted in various ways and the products examined by a number of techniques, including infrared spectroscopy and electron microscopy. 2. The glucan components of the walls cannot be extracted from intact yeast cells by 3% (w/v) sodium hydroxide at 75 degrees , but at least one-third of the glucan of cell wall preparations is dissolved under these conditions, and more will dissolve after ultrasonic treatment. 3. If intact cells are given a preliminary treatment with acid the wall glucans dissolve in dilute aqueous alkali. 4. Acid conditions as mild as sodium acetate buffer, pH5.0, for 3hr. at 75 degrees are sufficient for this preliminary treatment; the glucan then dissolves in 3% sodium hydroxide at 75 degrees leaving a very small residue, which contains chitin and about 1% of the initial glucan of the wall. Dissolution is hindered by exclusion of air, or by a preliminary reduction with sodium borohydride, suggesting that some degradation of the glucan by alkali is taking place. 5. After treatment with 0.5m-acetic acid for 24hr. at 90 degrees the glucan dissolves slowly at room temperature in 3% sodium hydroxide, or in dimethyl sulphoxide. The extraction with acetic acid removes glycogen and a predominantly beta-(1-->6)-linked glucan (not hitherto recognized as a component of baker's yeast), but none of the beta-(1-->3)-glucan, which remains water-insoluble. 6. Without treatment with acid, the glucan is not significantly soluble in dimethyl sulphoxide, but can be induced to dissolve by ultrasonic treatment. 7. These results are interpreted by postulating the presence of an enclosing membrane, composed of chitin and glucan, that when intact acts as a semipermeable membrane preventing the escape of the alkali- and dimethyl sulphoxide-soluble fraction of the glucan. Mild acid treatments damage this membrane, and ultrasonic and ballistic disintegration disrupt it. 8. Some support for this hypothesis is given by the effects of certain enzyme preparations, which have been found to render a substantial part of the glucan extractable by dimethyl sulphoxide.