Fermentation in ileostomy bags: Control of excessive gas with diet, pH and antibiotics

The composition of early morning gas from the bags of 10 ileostomates was determined using gas chromatography. Seven of the 10 had a predominance of gases attributable to bacterial fermentation (H₂ and CO₂, 70 ± 12%). The remaining three contained mainly atmospheric gases, N₂ and O₂, with only small amounts of fermentation gases (7 ± 3%).
When a controlled low fibre (0.7 g) dinner was substituted for a high fibre (13.5 g) evening meal, there was a corresponding decrease in the volume of fermentation gas in the ileostomy bag the next morning ( P < 0.05).
Gas production from ileostomy effluent was inhibited in vitro by 10 < pH < 5 and by antimicrobial agents. The most effective were metronidazole, chloramphenicol, tetracycline, erythromycin and chlorhexidine. These reduced fermentation gas by more than 95%.
It was concluded that the majority of the gas produced by ileostomates is formed by bacterial fermentation of the faecal waste in their ileostomy bag and that this may be controlled by careful manipulation of their diet.     

Is the Outcome of Coronary Stenting Worse in Elderly Patients?

Initial reports of percutaneous transluminal coronary angioplasty (PTCA) in the elderly (≥: 75 years) showed a significantly lower primary success rate, higher in-hospital mortality, and a higher risk of emergency or elective coronary artery bypass graft (CABG) compared to younger patients. There are few data concerning acute outcomes and clinical follow-up after the use of coronary stenting in the elderly compared to < the 75-year-old age group. We evaluated 82 elderly patients and 280 younger patients who received Palmaz-Schatz stents during 1995, at a time when high pressure deployment and antiplatelet therapy was routinely used. The success rate and acute major complications were not significantly different between the elderly and younger patients. Clinical events (death, myocardial infarction [MI], repeat PTCA, or CABG) during 6-month follow-up were also not significantly different. Coronary stenting in the elderly can be carried out with a high success rate and low incidence of acute major complications. Thus, short-term clinical outcomes in elderly patients appear similar to results obtained in younger patients.     

Econology: integrating health and sustainable development Part two: guiding principles for decision-making

Part One of this article explored three relationships (health-environment,health-economy and economy-environment) inherent in integratinghealth and sustainable development. Information about theserelationships (and in some instances the lack of informationor intrinsic uncertainty in the relationship) give rise to anumber of principles that can be used to guide sustainable developmentdecision-making. The 12 principles developed in this articleare not exhaustive, but do capture the essential imperativesemanating from each of the three key relationships. The 12 principles,which comprise a mutually reinforcing packaged set, are: thenecessity of principle-based decision-making, the inclusivenessof information, shrinking global inequities, shrinking nationalinequities, empowering equally, producing fairly and healthily,sustaining com munities, replenishing and replacing internalizingall costs, sustaining diversities, nurturing the intangibles,and planning across the generations. An interpretive commentaryaccompanies each principle. The article concludes with a discussionof the role of health promo tion professionals in sustainabledevelopment policy debates and program developments.     

DIETARY FATTY ACIDS AND ALCOHOL: EFFECTS ON CELLULAR MEMBRANES

The consumption of ethanol has been shown to exert profoundeffects on cellular membranes which result in damage and/oradaptation. Both membrane lipids and proteins are affected,but because of the physicochemical properties of ethanol, manyof the membrane effects are directly related to the interactionof ethanol with the lipid component of the membrane. In additionto the direct lipid-ethanol interaction, ethanol has been shownto dramatically alter lipid metabolism. Triacylglycerol accumulatesdramatically in the liver, and biosynthesis of the polyunsaturatedfatty acids seems to be altered via effects upon the acyl-CoAdesaturases. Because precursors of both families of unsaturatedfatty acids, i.e     

MICROCYSTIC ADNEXAL CARCINOMA: IN VITRO GROWTH CHARACTERISTICS AND EFFECT ON STROMAL COLLAGEN PRODUCTION

Background. Microcystic adnexal carcinoma (mac ) is a locally aggressive cutaneous neoplasm, which is characterized by follicular and sweat gland differentiation and a stroma of dense collagen. Methods. mac cells were studied and characterized in vitro through phase microscopy and proliferation assays. Additionally, to delineate a possible role of soluble mediators in bringing about the dense stromal collagen seen in association with these tumors, the effect of conditioned media derived from the tumor cells on the level of collagen production by normal fibroblasts was examined. Results. A significant morphologic difference between the mac cells and normal keratinocytes was not noted. Proliferation assays demonstrated a significantly slower rate of growth of the MAC cells in comparison to controls. Media conditioned by mac cells did not induce an increase in collagen synthesis by cultured fibroblasts, but rather, there appeared to be an inhibitory effect on the level of collagen synthesis. Conclusions. The increased stromal collagen seen in mac histologically is not the result of growth factors or cytokines produced by the mac cells.     

Young people's alcohol consumption in public drinking places: reasoned behaviour or related to the situation?

Two contrasting perspectives are used to study correlates of young people's (16–25 years) alcohol consumption in public drinking places. One perspective is the theory of reasoned behaviour, or the Fishbein-Ajzen model, extended with self-efficacy. The other perspective assumes that exposure to drinking situations and aspects of the actual drinking situation (size of drinking group and group pressure) determine young people's alcohol consumption. Multiple regression analysis shows that variables indicating situational influences are correlated with the alcohol consumption of young men and women, even when controlling for the Fishbein-Ajzen variables. Among young men frequency of visiting public drinking places contributes more to the explained variance than the four Fishbein-Ajzen variables together. Young people's alcohol consumption in public drinking places appears to be less fully controlled by alcohol-specific beliefs, norms and perceived skills than the Fishbein-Ajzen model assumes. The Fishbein-Ajzen variables are only weakly correlated with the variables indicating situational influences. It is concluded that, from the individual's perspective, the influence of situational factors means that pan of his consumption is determined by more or less accidental circumstances like the opportunities to drink, the size of the drinking group and group pressure.