Burkholderia cepacia is resistant to the antimicrobial activity of airway epithelial cells.

There has been much interest recently in the antimicrobial properties of cationic peptides called beta-defensins from epithelial cells. Human beta-defensin (hBD)-1 and -2 have been particularly implicated in cystic fibrosis (CF) patients, where their inhibition by high salt concentrations may explain in part the susceptibility of the CF lung to bacterial infection. In this work, we have employed a simple co-culture system using the 16-HBE human bronchial epithelial cell line to assess growth inhibitory activity against Pseudomonas aeruginosa and Burkholderia cepacia. In medium alone, P. aeruginosa proliferated more than 100,000-fold, whereas in the presence of 16-HBE cells or 16-HBE-conditioned medium, bacterial proliferation was less than 100-fold. Raising the salt concentration of cell-free 16-HBE conditioned medium to approximately 200 mM significantly reduced this growth inhibitory activity. In contrast, there was no evidence of epithelial-derived growth inhibitory activity against two strains of B. cepacia. RT-PCR analysis indicated expression of the hBD-2 mRNA in 16-HBE cells, but not hBD-1. These data demonstrate for the first time that B. cepacia is resistant to epithelial-derived antimicrobial substances and argue against them being important in the defense against this organism in the lung.

Teaching and evaluation of basic surgical techniques: the University of British Columbia experience.

Surgical technical education has traditionally followed an apprenticeship format. The need for innovative undergraduate programs using dry and wet labs prior to clinical exposure continues to be an area of debate. Specific programs have been described to improve surgical skills; however, an accepted platform for training and evaluation of surgical skills programs has not been recognized. Therefore, introduction of specific programs to teach undergraduate medical students surgical skills is essential. This article describes the Basic Surgical Technique (BST) program taught at the University of British Columbia and reports the effectiveness of this program in improving the practical skills of undergraduate medical students. The program includes BST I for third-year students performed in a dry lab setting, and BST II for medical student interns (MSI) performed at the animal laboratories using female domestic swine as subjects. A total of 87 students participated in the study. The program is designed using Piaget's and Vygotsky's pedagogical philosophy of "learning by doing." A semiquantitative method is used to measure and analyze the outcome of this project. Data were validated using student self-evaluation tests and by quantitative evaluation by surgical staff from the surgical wards. Results of this prospective project indicated that the BST program significantly (p < .05) improved the surgical performance of undergraduate students, and that the time lapse between BST I and II has had a negative impact in retention of acquired surgical skills. This study concludes that the BST program taught at the University of British Columbia significantly improves the surgical skills of medical students and improves their self-confidence during their internship.

A formal system of approval for monographs in the pharmacopoeia of culture media--statement from the IUMS-ICFMH working party on culture media.

A categorization system for monographs on culture media is outlined which will lead to more rapid publication and a formal division into three classifications; draft, proposed and approved. This should assist the quality assurance and accreditation processes in food microbiology laboratories.

Perforation of the jejunum secondary to AIDS-related gastrointestinal Kaposi's sarcoma.

Intestinal perforation in human immunodeficiency virus-positive patients due solely to Kaposi's sarcoma (KS) has rarely been described. A homosexual man with acquired immunodeficiency syndrome-related KS who presented with an acute abdomen is presented. He was found to have a jejunal perforation through a small KS lesion. There were no infectious organisms identified at the site of perforation.

Media used in the detection and enumeration of Staphylococcus aureus.

Over the years a range of selective and diagnostic media have been developed to assist in the detection and enumeration of Staphylococcus aureus in routine food surveillance programmes and food poisoning investigations and these are reviewed here. Baird-Parker agar remains, however, the medium of choice for direct plating and enumeration of S. aureus in both Europe and the US. This paper also reports on a comparison of the productivity and selectivity of trypticase soy broth with 10% NaCl and 1% sodium pyruvate (PTSBS) with trypticase soy broth (TSB) for the isolation of S. aureus. Using three strains of S. aureus and a strain of S. hyicus the productivity ratio of PTSBS to TSBS ranged from -0.17 to 0.57. In the recovery of heat-injured cells of S. aureus, PTSBS offered little or no improvement over TSB with sodium chloride but no pyruvate in a three-tube MPN assessment. Of the seven other bacterial cultures tested, none grew well on the PTSBS. Selectivity ratios of 4.4-7 were found.

On bad luck: Job and jesus.

I reflect on certain random events that befall us and to those we love, random events we never would have chosen because of the pain and suffering they involve. A distinction is drawn between the bad luck of physical assaults, such as genetic defects and the bad luck growing out of value conflicts. Illuminated by the writings of two philosophers- Wilcox and Wolterstorff-I examine the story of Job's maturing response to bad luck. I conclude with some reflections on Christ's response to pain and suffering and its implications for our response to bad luck.

Recurrence after lumpectomy for comedo-type intraductal carcinoma of the breast.

The morphologic subgroups of intraductal carcinoma in situ (DCIS) of the breast may be biologically different. Thirty-eight patients with comedo-type DCIS treated with local resection with or without radiotherapy are presented. Thirteen of 35 patients had a family history of breast cancer, with 11 patients having an affected first-degree relative. This is significantly increased over other series of breast cancer patients. Recurrence was ipsilateral in all patients and occurred at the site of the original disease. Recurrence occurred in 4 of 30 patients treated with local resection only and 2 of 8 treated with local resection plus radiotherapy. The length of mean follow-up was 39 months. Because of the paucity of studies, these results cannot be compared with others, but there does appear to be a significant incidence of local recurrence after resection for comedo-type DCIS. Immunohistochemical and oncogene studies as they relate to comedo-type DCIS are discussed.

"Reflections on a peach-seed monkey": Empowering relationships.

The focus of this essay is on human relationships, specifically, the empowering potential of those relationships, and, most particularly, on the empowering potential those relationships have for enabling us to discover our respective possibilities. It is argued that we often discover who we are and what we can become as our possibilities are discovered by another and reflected back to us. This empowering potential of human relationships can be helpfully understood as a manifestation of the redemptive role of God in human life.

The risk of occult invasive breast cancer after excisional biopsy showing in-situ ductal carcinoma of comedo pattern.

Between Jan. 1, 1985 and Aug. 31, 1987, 62 in-situ ductal carcinomas with a predominantly comedo pattern were identified in 61 patients in British Columbia from excisional biopsy of a palpable or mammographically demonstrable lesion of a breast. The biopsies were intended to remove the lesion completely. Fifty-seven (92%) of the 61 patients required wide re-excision or total mastectomy, usually within a month of the initial biopsy. Occult invasive disease was demonstrated in 14 of the re-excision specimens (24.5%) and residual in-situ carcinoma was present in a further 24 (42.1%), giving an overall rate of residual disease of 66.6%. Axillary lymph nodes were sampled in 54 cases. Metastases were found in two cases (3.7%) and each was associated with occult infiltrating ductal carcinoma in the breast. This suggests that in-situ ductal carcinoma having a predominant comedo pattern may be more widespread and associated with a higher incidence of invasive ductal carcinoma than is generally believed.

Picturing god.

All perception and judgment are to some extent the reflection of who we are. Our picture of God, too, is a product of the cave into which we were born. Acknowledging this is an antidote to one form of idolatry-the worship of our symbols for God. This confession that our pictures never perfectly reflect God does not mean, however, that we cannot give reasons for thinking that one picture of God is more adequate than another. The paper attempts to demonstrate this by reference to contrasting pictures of God analyzed by the process thinker Charles Hartshorne.

A comparison of two incubation temperatures for the isolation of gram-negative contaminants from raw materials and non-sterile pharmaceuticals.

Selective and non-selective broth enrichment techniques may be used in the isolation of microbial contaminants from pharmaceutical products. A non-selective method may give better recovery rates for damaged organisms. A trial was carried out to determine whether the recovery of Gram-negative contaminants could be improved by using an incubation temperature of 30 degrees C for 48 h, rather than the more widely used 37 degrees C for 24 h. Contaminants were isolated from 3.2% of samples incubated at the lower temperature compared with 0.8% at the higher temperature. The recovery rate from raw materials improved noticeably (9.0% compared with 0.9%).

Nietzsche: An intellectual Nebuchadnezzar.

The essay introduces and defines the concept of "an intellectual Nebuchadnezzar"-one who, despite his hostility to religion, serves God's purposes by the depth of his ideas. In terms of this notion, some of Friedrich Nietzsche's views are explored. Specifically, Nietzsche's perspective on artistic creativity is analyzed and applied to the notion of creativity in human relationships. In addition to concluding that Nietzsche is himself an "intellectual Nebuchadnezzar," the broader point is made that truth and insight should be welcomed by the religious community even if the source of that truth is one ostensibly hostile to religion.

Microbial contamination of non-sterile pharmaceutical products made in hospitals in the North East Thames Regional Health Authority.

Non-sterile pharmaceutical products made in nine hospitals in the North East Thames Regional Health Authority were examined for microbial contamination as part of a quality assurance programme. The incidence of contamination was found to vary between hospitals, but in all cases improvements were seen during the 3-year monitoring period in the microbiological quality of products made in individual hospitals. The most common isolates were aerobic spore bearers--usually less than 10(2) colony forming units/g or ml. Gram-negative isolates were found in at least one product from each hospital. Pseudomonas spp. were isolated from several samples of peppermint water.

Meaning in life: Discovered or created?

Against the background claims that a meaningful life is more likely to be the product of creation than discovery and that a meaningful life must involve both subjective satisfaction and an objective moral component, three foundations of a meaningful life are discussed. These include the quality of one's relationships, the integrative power of one's goals and projects, and the role of story or stories. Concerning the role of story, the theological challenge is to choose that story or those stories that place life in a genuinely ultimate context.

Breast cancer in association with lobular carcinoma in situ. Clinicopathologic review and treatment recommendation.

A 6 year follow-up study of 80 women with coexisting lobular carcinoma in situ and infiltrating breast cancer has been conducted to emphasize the natural history and management of these cancers. Treatment of the contralateral breast is of utmost importance as lobular carcinoma in situ is a multicentric neoplasm associated with a subsequent high occurrence of invasive cancer. This series has documented a high incidence of bilateral cancer. Six patients (7.5 percent) had simultaneous bilateral tumors and eight patients (10 percent) had the subsequent development of a second primary tumor, representing approximately four times the expected rate. Despite a well structured out-patient department, follow-up was suboptimal. Six of eight metachronous tumors were detected at a late stage (T2 and greater).

Bacteriological contamination of products used for skin care in babies.

Synopsis Two hundred and thirty-two products used in the skin care of babies were examined for bacterial contamination. Contamination rates were compared between unused samples collected from homes, those used in the home, and those used in the maternity wards of a local hospital. Products used and unused, originating from the home had a low incidence of contamination and small bacterial populations. One product used in hospital was found to be susceptible to contamination; several samples were contaminated with Gram-negative rods. The significance of these contaminants in products used on babies is discussed and proposals are put forward for avoiding in-use contamination.