Previous studies have shown that recolonization of the skin surface occurs after disinfection' but there has been little investigation of this phenomenon. We have studied the rate of recolonization of the skin surface after preparation by the methods in most frequent use and under plastic adhesive drapes with and without slow-release iodophor. MethodsFifteen volunteers lay supine for 3 hours in an empty operating theatre. Five rectangular areas were marked on the abdomen of each volunteer and a different antiseptic preparation was applied to four of the five areas. These were: 3 min painting with chlorhexidine in 70 per cent alcohol; 3 min painting with povidone-iodine in 70 per cent alcohol; 1 min painting with 70 per cent isopropyl alcohol and application of a plastic adhesive drape ('Opsite', Smith and Nephew Ltd); and 1 rnin painting with 70 per cent isopropyl alcohol and application of a plastic adhesive drape containing slow-release iodophor ('Ioban drape' 3M Health Care). The fifth area was used as a control.Samples were taken from a different part of each area after 5,30,60 and 180 min, using Rodac contact sampling plates containing oxoid Columbia agar with 10 per cent horse blood, 1 per cent Tween 80, 0.3 per cent azolectin and 0.3 per cent sodium thiosulphate. After aerobic incubation the bacterial count on each plate was recorded. ResultsThe control values showed a truncated log normal distribution. Initially the methods were equally effective in removing bacteria, each showing a median bacterial reduction of 100 per cent. Recolonization of the skin surface occurred progressively. The distributions of successive samples from prepared areas showed a progressive increase toward the distribution of control values. The rate of recolonization depended upon the preparation used. Differences were apparent at 30 and 60min and increased at 180 min ( Figure I). Recolonization was less after preparation with the slow-release iodophor drape then with the other methods. This difference was significant at 60 min ( P =0.05, Friedman test) and highly significant ( P = 0.01, Friedman test) at 180 min. DiscussionIt has been shown that seeded organisms are removed by antiseptics and do not re-establish themselves'. The behaviour of normal flora may be more relevant to the maintenance of asepsis. Normal skin bacteria can only be reduced to a certain level after which re-emergence from deeper layers, and recolonization of the surface occurs.The contact-culture method employed3 samples organisms on the skin surface which could be mechanically transmitted into a wound. This sampling method is simple and provides a basis for comparing forms of disinfection.All four methods of skin preparation were effective in removing bacteria from the skin surface. Thereafter recolonization proceeded at different rates. Within the duration of the study the slow-release iodophor drape was more effective than the other regimens in delaying bacterial recolonization. Further studies are indicated to determine whether any clinical benefit arise...

Suture line recurrence is an important cause of failure after potentially curative resection for colonic carcinoma. Our aim was to determine whether suture technique affected the incidence of perianastomotic tumours in experimentally induced colonic cancer. Sprague-Dawley rats were randomized into three groups. A 1 cm longitudinal colotomy was repaired with four interrupted 6/0 polypropylene monofilament sutures, using either a transmural technique (n = 18) or a seromuscular technique (n = 18). Control animals (n = 18) had a sham laparotomy. All animals received nine, weekly, subcutaneous injections of azoxymethane (total dose 90 mg/kg) starting 6 weeks after laparotomy. Surviving animals were killed 32 weeks after laparotomy. Five animals from each group were given intraperitoneal bromodeoxyuridine (100 mg/kg) 1 h before being killed. At death, perianastomotic tumours occurred more frequently in animals with transmural sutures than in either controls or those with seromuscular sutures. This difference was associated with a greater mucosal bromodeoxyuridine crypt cell labelling index in the transmural suture group. We conclude that a transmural anastomotic suture technique promotes the development of experimental perianastomotic colonic tumours.

An emaciated, but otherwise physically normal young man presented with an acute psychosis resembling hallucinogenic drug abuse. His behaviour was so strange that the underlying pathology of severe pyloric stenosis was only detected when a chance measurement of urea and electrolytes was made, revealing gross biochemical abnormalities. His abnormal mental state persisted for more than one week and an LSD ‘flashback’ was postulated as the cause of the prolonged psychosis

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SUMMARYSuramin is a polysulphonaled compound which can selectively bind to. and inhibit ihe activity of. a wide range of growth factors. There has been renewed interest rccenlly in suramin as an anti-cancer agent and therefore we have studied its effects on lymphocyte subset populations and recombinant human IL-2 (rhlL-2) activation on lymphocytes in vitro. In tlie presence of rhlL-2 (1000 U/ml), suramin (200 /tg/ml) caused a decrease in percentage of eells expressing the predominantly T cell antigen CD3; no change in percentage of cells expressing the Tsuppressor/cytotoxic subset antigen. CDS; a small rise in those expressing the natural killer cell antigen. CD56: and a large significant fall in those expressing the T helper subset antigen CD4 (48-5r:-.. ier.\us 27-97%; P<()00\). CD4 modulation by suramin was also found on the CD4' cell lines CEM and MOLT-4. The effect of suramin on rhlL-2-indueed activation antigen expression remains equivocal, sinee a small rise in CD25 expression and small falls in CD71 and ilLA-Dr expression were recorded. The modulatory effect of suramin on CD4 expression was not reversible over a 96-h culture period in its continued presence. However, on removal of suramin by extensive washing, recovery of CD4 expression was detected within 24 h. Suramin-indueed modulation, but not PMA-induced modulation, could be partially inhibited by preineubation with lyrphostin (12 fM). a tyrosine kinase inhibitor.