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Two outbreaks of Cl. perfringens food poisoning which occurred in Florence during 1976 have been described. The first one involved three hundred primary school children; processed re-heated turkey meat was thought to have been the vehicle of infection in the school meal. The clinical symptoms consisted of mild diarrhoea in all cases and the duration of the illness was about 12 hours. The possible part played by food storage temperature, post-cooking periods and food trolleys in the spread of infection is discussed. The other outbreak interested three people who ate a dish with gravy in a restaurant; one of these suffered severe haemorrhagic enteritis and died after two weeks. Necroscopy was performed and the results of post-mortem examination as well as histological and bacteriological findings certified that the cause of death was severe enteritis (Necrotizing enteritis) in elderly debilitated patient (with diabetes, chronic bronchitis, arteriosclerosis and previously gastroresected).
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PMID:[Two outbreaks of "Clostridium perfringens" food poisoning: epidemiological remarks (author's transl)]. 20 62

A summary of the literature shows that there are well-marked seasonal variations in mortality for total deaths, for respiratory and cardiovascular diseases and for diabetes, the mortality rate being higher in winter than in summer. These seasonal variations in mortality are seen in infants under 1 year of age and in older people but not in youths and young adults. The amplitude of the seasonal variation in mortality increases with increasing age because of the higher incidence of cardiovascular and respiratory mortality in older people. Seasonal variations in air temperature are a more important determinant of seasonal variations in respiratory and cardiovascular deaths than are fluctuations in air pollution; there is usually a time-lag of up to a week in the change in air temperature before the mortality rate for these diseases increases; a run of 4 - 5 days of stressful temperatures (either hot or cold) has more effect on mortality than an isolated hot or cold day. Examination of the seasonal variations in all causes of death of the four population groups in South Africa shows that Whites and Asians display the typical pattern of a winter high and a summer low mortality of populations in developed countries. The seasonal variation in mortality of Coloureds and Blacks is quite different. It shows two peaks, one in winter and one in summer. This bimodal pattern in the seasonal variation is due to the fact that one-third of all Coloured and Black deaths occur in infants under 1 year of age and most of these deaths occur in summer as a result of gastro-enteritis. Comparison was made of the seasonal variations in mortality rates for all causes of death and for respiratory and ischaemic heart disease (IHD) deaths of Whites over 40 years of age in Durban and Johannesburg. This showed that the seasonal variation for all causes of death is greater in Johannesburg than in Durban, i.e. proportionately more older Whites die during winter in Johannesburg than in Durban. The reason for this difference is that the seasonal variation in respiratory disease mortality is much greater in Johannesburg than it is in Durban, but the seasonal variation in IHD mortality is the same in the two cities.
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PMID:Climate and disease. 69 79

Over 625 patients having gastric bypass for the treatment of morbid obesity are currently being followed at the University of Iowa. Many innovations have increased operative exposure, greatly reduced operating time, and improved the effectiveness and safety of the operation. Recent weight figures show that a 55 percent loss of excess weight can be expected. Several comparative studies between gastric and jejunoileal bypass show that gastric bypass, while producing identical weight loss, has few of the many complications such as liver failure, renal and gallstone formation, diarrhea, enteritis, that are commonly associated with jejunoileal bypass. Stomal ulcer occurrence has been only 2 percent. Imporvements in diabetes mellitus and hypertension can be expected with weight loss. Other effects of gastric bypass were determined by use of a questionnaire. It is concluded, by surgeons having experience with both gastric and jejunoileal bypass, that gastric bypass is the treatment of choice for morbid obesity when nonoperative measures fail.
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PMID:Gastric bypass for obesity after ten years experience. 71 64

The outcome of 31 patients with severe radiation enteritis treated by total parenteral nutrition (TPN) was analyzed. Before initiation of parenteral nutrition, 18 of the patients had not had abdominal surgery, while 13 had either a resection or an intestinal bypass for radiation enteritis. Median follow-up was 2 1/2 years (range: 1 month to 12 years) from the time of initiation of parenteral nutrition. Surgery was required in 15 cases because parenteral alimentation could not be continued. Only eight of these 15 were able to resume a normal oral intake. Total parenteral nutrition allowed oral feeding to be resumed in 11 (36%) after a median follow-up of 40 months (range: 6-142 months). In general, total parenteral nutrition was well tolerated and was associated with low morbidity. Eighteen patients died, 13 of complications due to radiation therapy, four of cancer recurrence, and one of an unrelated cause. Survival probability was 58% at one year and 36% at five years. When possible, prognostic factors present either before or at initiation of total parenteral nutrition were analyzed. Age, predisposing vascular factors (hypertension, diabetes mellitus, or vascular disease), and enteric fistula and/or perforation were found to have prognostic value. The probability of clinical radiation enteritis recurrence was 34% at one year and 47% at two years. A clinical recurrence of symptoms was more frequent but not significantly so after parenteral nutrition as compared to surgical therapy of radiation enteritis. Although TPN corrected denutrition and allowed deferred surgery in some patients, severe radiation enteritis remains a poorly predictable progressive disease with numerous relapses.
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PMID:Long-term outcome of severe radiation enteritis treated by total parenteral nutrition. 161 54

During the six-year period from 1978-1983 968 so-called "enteritis Salmonellae" were isolated in our laboratory. 50 of them (= 5,2%) were primary isolations from extraintestinal specimens, first of all from blood, abscess smear and urine. The greater part of the patients with an atypical course of enteritis salmonellosis showed clinical signs of septicemia (44%) or local suppuration (24%). In atypical salmonellosis advanced age and sex distinctly prevailed compared to the distribution of age and sex of patients suffering from typical Salmonellae enteritis. 80% of the patients with atypical salmonellosis had mostly resistance lowering basic diseases, first of all diabetes mellitus, or were treated with immunosuppressive therapy. The spectrum of "enteritis Salmonellae" isolated only from feces during the same period differed significantly (p = 0,01) from the spectrum of Salmonellae types found in extraintestinal specimens. An atypical course was relatively often caused by S. enteritidis, S. panama and S. virchow.
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PMID:[Atypical course of infections with enteritis salmonellas]. 390 47

A rapidly fatal case of enteritis necroticans in a 24 year old man with diabetes was caused by Clostridium perfringens type C. The role of beta toxin in the disease is discussed. This type has not been previously described as a causative agent in necrotising bowel disease of man outside endemic areas.
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PMID:Clostridium perfringens type C causing necrotising enteritis. 608 90

Reported causes of death (1899-1911) and of admission to hospital (1884-1910) of Indian migrants to Natal are analysed, and an attempt is made to relate them to the circumstances and way of life of the community. The most frequently reported causes of death were pneumonia, enteritis and pulmonary tuberculosis; the commonest reason for admission was venereal disease. Fluctuations in reported mortality and morbidity from year to year were most marked for malaria, with a formidable epidemic in 1905-1906. Typhoid fever and diphtheria were uncommon, as were diabetes and the sequelae of arteriosclerosis.
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PMID:Nostalgia and alligator bite--morbidity and mortality among Indian migrants to Natal, 1884-1911. 636 94

A 15-year-old girl with ischemic stricture of the jejunum, probably due to microangiopathy caused by diabetes mellitus is presented. Laparotomy revealed two circular strictures in the proximal jejunum, and histology showed ischemic enteritis with ulceration, granulation with microvascular proliferation, inflammatory cell infiltration, marked fibrosis, and hemosiderin deposition. Uncontrolled diabetes mellitus often causes ketoacidosis, increased blood viscosity and platelet aggregation, dehydration in addition to hyperglycemia, and occasionally results in occlusive or non-occlusive vascular disease of the intestine. Ischemic stricture of the bowel in the diabetic state is probably related to moderate ischemia resulting in ulceration and scar formation in the intestine.
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PMID:Ischemic jejunal stricture developing after diabetic coma in a girl: a case report. 832 18

The incidence of postoperative infections, especially due to multi-drug resistant strains such as Pseudomonas sp., Enterococcus sp., and Methicillin resistant Staphylococcus aureus (MRSA), is high in compromised hosts. Among them, respiratory infection, catheter sepsis, and drug-associated enteritis are frequently observed and respiratory infection is liable to fall into serious illness. These infections have characteristics in causative organisms. Pseudomonas aeruginosa or MRSA are frequently isolated in respiratory infections and Candida or coagulase-negative staphylococcus are frequently isolated in catheter sepsis. G-test in addition to blood culture is necessary for early diagnosis of Candida sepsis, vancomycin should be administered in early phase of antibiotic-associated enteritis, since this infection is usually caused by MRSA or Clostridium difficile and frequently falls into serious illness. The patients with protein-calorie malnutrition, liver cirrhosis, renal failure, diabetes melitis, administration of anticancer drugs and/or radiation therapy, serious injury, or severe operative stress are considered to be compromised hosts in surgical field, and the adequate perioperative managements according to these disorders should be carried out against postoperative infections.
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PMID:[Perioperative managements for postoperative severe infections in compromised host]. 903 82

There have been substantial improvements in the health of Australian Aboriginal children over the past 2 decades. These include lower infant and toddler mortality rates and a significant decline in rates of hospitalization for conditions such as gastro-enteritis and lower respiratory tract infection. In addition, the degree of illness among these children on presentation is now generally much less severe than previously. There is evidence also of some improvement in birthweight, growth and nutritional status over the past 20 years. Incidence rates of infections among Aboriginal children, however, are still much higher than among their non-Aboriginal counterparts and much of this is due to unsatisfactory standards of living and community and personal hygiene. This is aggravated by widespread inadequate infrastructures for providing better housing, water supplies, solid and liquid waste disposal and the provision of regular, clean and nutritious food supplies in Aboriginal communities. These issues and more effective and culturally acceptable methods of disease prevention and health promotion are now being accorded high priority. But serious concerns remain about early Aboriginal "lifestyles" that may have important implications for health and mortality patterns among Aborigines during young to middle-age adult life. These include proneness to non-insulin-dependent diabetes mellitus, hypertension, cardiovascular disease, particularly ischaemic heart disease, and stroke which are likely to have their origins in childhood. The recent increase in rates of motor vehicle accidents, sometimes fatal, homicide and suicide, and the increasing rate of tobacco smoking and the use of addictive drugs, including the sniffing of petrol, glue and other volatile substances, is cause for serious concern for the future health and well-being of Aboriginal youth and their families.
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PMID:Australian Aboriginal child health. 987 69


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