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BACTERIAL CONTAMINATION IN AN EYE HOSPITAL
1322
A valuable set of results shows the increase of iron loss in the urine in many of their patients. By the method described, an excretion of more than 0-5 mg. of iron in 24 hours is excessive. Judged by this criterion, 71 % of the patients with aortic-valve replacements were excreting excessive amounts of iron-one patient lost as much as 5-62 mg. In the patients with mitral-valve replacement, 43% had increased urinary iron loss. Some patients were in fact receiving oral iron treatment at the time of this estimation, but Slater and Fell have found that oral iron in standard dosage does not affect iron excretion in the urine and was not responsible for the high excretion-rates in their patients. Among their 16 anxmic patients, 11 had evidence of actual iron deficiency; the serum-iron levels were often low, and hypochromia was seen in the red cells; they suggest that this iron deficiency was due mostly to the excess loss of iron in the urine. They therefore gave oral iron treatment to 6 of their affected patients, with good results. Slater and Fell reasonably conclude that every patient with a Starr-Edwards artificial valve should have not only a blood-count but also a check of the urine for haemosiderin excretion at regular intervals; the check should be particularly applied to anyone who has had an aortic-valve replacement. If there is hsemosiderinuria, oral iron therapy should prevent anaemia in most patients. It is certainly desirable to avoid anaemia in any patient with an artificial heartvalve, since anaemia inevitably increases the work of the heart and the flow through the valve. The actual causes of the destruction of red cells are still being explored. Mechanical damage is probably largely responsible, but how this is brought about is debatable. Possible factors, in addition to malfunction of the prosthesis, are the presence of leaks at the suture areas, the presence or absence of cloth covering, and the actual geometrical configuration of the different valves. Myhre et al.4 investigated the incidence of anaemia in 56 patients fitted with two different types of Starr-Edwards aortic valves and came to the conclusion that the size of the valve and its actual construction were the most important factors; paravalvular leakage did not cause increased haemolysis in patients with competent prostheses. They found that the newer type of valve fitted with ’ Stellite’ metallic balls caused more anaemia than the older type with silastic rubber balls; Slater and Fell’s patients had the metal-ball valves. Further investigation is being pursued, and eventually we shall surely get an artificial heart-valve which causes only minimal destruction of red cells and iron loss in the urine.
amount of dust entering the theatre. Unfortunately, just before the theatre was to be reopened, bacteriological specimens collected from various sites in the hospital environment showed contamination with Streptococcusfacalis and occasional One unusual colonies of Pseudomonas cvrugii7osa. feature was the presence of large numbers of Streptococcusfeecalis in the air. Several settle-plates exposed in the wards yielded many colonies of this organism and it was necessary to suspend new admissions to the hospital while these findings were assessed. Subsequent investigation by the Hospital Infection Research Laboratory in Birmingham has shown that the contamination, which was only slight, had probably arisen from sources inside the hospital and was unrelated to the demolition work in progress outside. Ps. aruginosa was isolated from only one settle-plate and from a swab taken from a window-ledge near a sink, which It seems was also contaminated with Ps. ceruginosa. that Str. isolated from surfaces and likely faecalis was associated with settle-plates cleaning equipment. Mops and pails in use in the hospital were contaminated with this organism and large numbers were also found on the brushes of two polishing-machines. It is
reduce the
not easy to
establish whether the contamination of the
cleaning materials preceded or followed the contamination of the environment, but the contamination of the polishing-brushes could presumably lead to dispersion of bacteria into the air. The association of the building site with the environmental contamination is not clear, but organisms isolated from the soil of the building site and the surrounding air were mainly spore-bearing bacilli. There was no evidence of sewage leakage, and air studies did not reveal any potential pathogens entering the eye hospital. The available evidence suggests that there is no increased risk of infection in the present situation, but the presence of excessive dust is a separate and important problem and is being investigated.
BRONCHIAL ADENOMA—A NON-ENTITY As lately as 1950, bronchial adenoma was described as " the only common simple tumour in the lung ",1I but the term is now more often used for a group of
malignant or potentially malignant tumours which are similar grossly and include carcinoid tumour of the lung, cylindroma (adenoid cystic carcinoma), mucoepidermoid carcinoma, and true adenoma (a very rare benign, gland-like proliferation of bronchial mucousgland origin).2 The tumours may be " central " or peripheral " : central means bronchoscopically visible, and this type is commonly associated with radiographic features of pulmonary, lobar, or segmental shrinkage and airlessness; peripheral tumours cannot be seen with the bronchoscope, and on radiographs they often show as spherical opacities. With central tumours, therefore, the radiographic abnormality is not a measure "
BACTERIAL CONTAMINATION IN AN EYE HOSPITAL DEMOLITION work immediately adjacent to the Birmingham and Midland Eye Hospital, which is in the centre of Birmingham, has been causing some concern. In the early part of May, surgical operations at the hospital were suspended because of excessive dust in the unventilated operating-theatre. Since that time a new ventilating system has been installed to 4.
Myhre, E., Dale, J., Rasmussen, K. Circulation, 1970, 42, 515
of tumour size-the endobronchial tumour may in fact be quite small, although sufficient to occlude the lumen. In the peripheral type, the radiographic 1. 2.
Dick, B. Edinb. med. J. 1950, 57, 265. Donahue, J. K., Weichert, R. F., Ochsner, J. L. Ann. Surg. 1968, 167, 873.
A valuable set of results shows the increase of iron loss in the urine in many of their patients. By the method described, an excretion of more than 0-5 mg. of iron in 24 hours is excessive. Judged by this criterion, 71 % of the patients with aortic-valve replacements were excreting excessive amounts of iron-one patient lost as much as 5-62 mg. In the patients with mitral-valve replacement, 43% had increased urinary iron loss. Some patients were in fact receiving oral iron treatment at the time of this estimation, but Slater and Fell have found that oral iron in standard dosage does not affect iron excretion in the urine and was not responsible for the high excretion-rates in their patients. Among their 16 anxmic patients, 11 had evidence of actual iron deficiency; the serum-iron levels were often low, and hypochromia was seen in the red cells; they suggest that this iron deficiency was due mostly to the excess loss of iron in the urine. They therefore gave oral iron treatment to 6 of their affected patients, with good results. Slater and Fell reasonably conclude that every patient with a Starr-Edwards artificial valve should have not only a blood-count but also a check of the urine for haemosiderin excretion at regular intervals; the check should be particularly applied to anyone who has had an aortic-valve replacement. If there is hsemosiderinuria, oral iron therapy should prevent anaemia in most patients. It is certainly desirable to avoid anaemia in any patient with an artificial heartvalve, since anaemia inevitably increases the work of the heart and the flow through the valve. The actual causes of the destruction of red cells are still being explored. Mechanical damage is probably largely responsible, but how this is brought about is debatable. Possible factors, in addition to malfunction of the prosthesis, are the presence of leaks at the suture areas, the presence or absence of cloth covering, and the actual geometrical configuration of the different valves. Myhre et al.4 investigated the incidence of anaemia in 56 patients fitted with two different types of Starr-Edwards aortic valves and came to the conclusion that the size of the valve and its actual construction were the most important factors; paravalvular leakage did not cause increased haemolysis in patients with competent prostheses. They found that the newer type of valve fitted with ’ Stellite’ metallic balls caused more anaemia than the older type with silastic rubber balls; Slater and Fell’s patients had the metal-ball valves. Further investigation is being pursued, and eventually we shall surely get an artificial heart-valve which causes only minimal destruction of red cells and iron loss in the urine.
amount of dust entering the theatre. Unfortunately, just before the theatre was to be reopened, bacteriological specimens collected from various sites in the hospital environment showed contamination with Streptococcusfacalis and occasional One unusual colonies of Pseudomonas cvrugii7osa. feature was the presence of large numbers of Streptococcusfeecalis in the air. Several settle-plates exposed in the wards yielded many colonies of this organism and it was necessary to suspend new admissions to the hospital while these findings were assessed. Subsequent investigation by the Hospital Infection Research Laboratory in Birmingham has shown that the contamination, which was only slight, had probably arisen from sources inside the hospital and was unrelated to the demolition work in progress outside. Ps. aruginosa was isolated from only one settle-plate and from a swab taken from a window-ledge near a sink, which It seems was also contaminated with Ps. ceruginosa. that Str. isolated from surfaces and likely faecalis was associated with settle-plates cleaning equipment. Mops and pails in use in the hospital were contaminated with this organism and large numbers were also found on the brushes of two polishing-machines. It is
reduce the
not easy to
establish whether the contamination of the
cleaning materials preceded or followed the contamination of the environment, but the contamination of the polishing-brushes could presumably lead to dispersion of bacteria into the air. The association of the building site with the environmental contamination is not clear, but organisms isolated from the soil of the building site and the surrounding air were mainly spore-bearing bacilli. There was no evidence of sewage leakage, and air studies did not reveal any potential pathogens entering the eye hospital. The available evidence suggests that there is no increased risk of infection in the present situation, but the presence of excessive dust is a separate and important problem and is being investigated.
BRONCHIAL ADENOMA—A NON-ENTITY As lately as 1950, bronchial adenoma was described as " the only common simple tumour in the lung ",1I but the term is now more often used for a group of
malignant or potentially malignant tumours which are similar grossly and include carcinoid tumour of the lung, cylindroma (adenoid cystic carcinoma), mucoepidermoid carcinoma, and true adenoma (a very rare benign, gland-like proliferation of bronchial mucousgland origin).2 The tumours may be " central " or peripheral " : central means bronchoscopically visible, and this type is commonly associated with radiographic features of pulmonary, lobar, or segmental shrinkage and airlessness; peripheral tumours cannot be seen with the bronchoscope, and on radiographs they often show as spherical opacities. With central tumours, therefore, the radiographic abnormality is not a measure "
BACTERIAL CONTAMINATION IN AN EYE HOSPITAL DEMOLITION work immediately adjacent to the Birmingham and Midland Eye Hospital, which is in the centre of Birmingham, has been causing some concern. In the early part of May, surgical operations at the hospital were suspended because of excessive dust in the unventilated operating-theatre. Since that time a new ventilating system has been installed to 4.
Myhre, E., Dale, J., Rasmussen, K. Circulation, 1970, 42, 515
of tumour size-the endobronchial tumour may in fact be quite small, although sufficient to occlude the lumen. In the peripheral type, the radiographic 1. 2.
Dick, B. Edinb. med. J. 1950, 57, 265. Donahue, J. K., Weichert, R. F., Ochsner, J. L. Ann. Surg. 1968, 167, 873.