WHAT THIS PAPER ADDS There is no universally accepted aortic graft infection case definition and clinical approaches to this complex condition differ widely with variable outcomes. Here, the Management of Aortic Graft Infection Collaboration (MAGIC), involving clinicians from several English hospital National Health Service Trusts with large vascular services, propose a formal case definition, derived by a process of multidisciplinary, expert consensus. The definition is readily applied in routine practice and aids early recognition. Importantly and towards development of evidence-based clinical guidelines that are presently lacking, it provides a consistent diagnostic standard, essential for clinical trial design and meaningful comparison between diagnostic and therapeutic strategies. Objective/Background: The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI. Methods: A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition. Results: Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stent-graft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever 38 C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid (7 weeks and 3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source. Conclusion: This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database

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Since laserinduced shock wave lithotripsy of gallstones is possible for treatment of common bile duct stones, the percutaneous transhepatic laserlithotripsy of stones in the gallbladder is examined in an animal study. In 8 animal experiments it could be shown that puncture of the gallbladder, dilatation of the working channel, (laserinduced) shock wave lithotripsy, removal of the fragments and the instruments are possible in one session. Neither when performing simple closure of the wound by suture nor by fibrinsealing severe side-effects could be recognized. After laserlithotripsy ablation of epithelium and hematomas can be observed, which are restituted within one month. The experiments show that in organ-saving shockwave lithotripsy there is no need for waiting for the development of a fistula and the percutaneous approach can be simplified.

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A STUDY of the purposes, technique and interpretation of the bacteriological analyses of farm water supplies has to include several considerations which are not significant in the sanitary control of urban water supplies. In the first instance, the former are derived from a much more varied type of source. While storage, filtration and chlorination have become practically universal for urban supplies, only a very small proportion of farms have access to treated water. Holdings in Wales rely mainly on untreated upland surface water, shallow wells, springs, streams and rivers.Frequent routine examination by means of a simple test is obviously impossible in the case of the water supplies of the 28,500 farms milk selling in Wales. The examination of about 1,000 of these farm water supplies has shown that only 18% were adequately protected from risks of contamination. On the other hand, close on a third were heavily polluted, consistently containing over 500 presumptive coliform organisms per 100 ml. water. In theory, the protection of the source of small rural supplies ic relatively simple, but it had been found that quite a number of the farm supplies installed during recent years are contaminated at certain times of the year.Water supplies satisfactory from a public health standpoint may not always be suitable for dairy purposes. Most of the investigational work on this problem has been done on types of water organisms which cause deterioration in cream, butter and cheese, and it has been assumed that since the holding time of market milk is relatively short, spoilage from such organisms should be rather limited. Nevertheless, this aspect is of sufficient importance to demand consideration in the planning of the type and frequency of examination of farm water supplies.The present survey was designed to provide further information on 1i. the general and seasonal variations in the bacterial content of ii. the frequency and type of analyses desirable for dairy purposes iii. the value of a method of indicating the influence of polluted water different types of farm water supplies, and on the keeping quality of milk. METHODS OF TESTINGSeven representative types of water supplies used at 31 farm dairies in Mid and South Wales were surveyed. Samples of about 500 ml. were taken in blood transfusion bottles by the writers and two County 19Dairy Advisory Officers (M. Davies and M. Thompson). The sampling was done at regular monthly intervals at each farm during a twelve months' period. The water was examined within 6 hr. of sampling, by the following tests :-(a) Presumptive coIiform test at 37" C. (Report, 1940). (b) Direct faecal coli test a t 44" C. (Report, 1940).(c) Colony count on nutrient agar, 3 days 22" C. (Report, 1940). (d) Colony count on yeastrel milk agar, 5 days 30" C. (Memorandum, (e) Milk souring organisms test, 48 hr. 30" C. (Thomas and Thomas, 1937). 1947).RESULTS A comparison of the results of the 5 tests is given in Tables I and 11. Water from the avtesiiiiz zL~eIIs was consistently satisfactory on both c...