Fecal Fluid Research Articles

Diagnosis of Strongyloides and hookworm infections: comparison of faecal and duodenal fluid microscopy

Faecal microscopical diagnosis of Strongyloides and hookworm infections is insensitive. We have therefore compared duodenal fluid and faecal microscopy for detection of these parasites in a group of 292 patients being investigated for gastrointestinal symptoms who were examined by both techniques. Thirty-three of these patients (8%) were infected with Strongyloides stercoralis and 88 (30%) had hookworm infections. Microscopical examination of up to 3 faecal specimens detected only 33% and 65% of patients with Strongyloides and hookworm infections, respectively. Microscopical examination of a single specimen of duodenal fluid was more sensitive for detection of strongyloidiasis, identifying 76% of patients; the parasite was found exclusively in duodenal fluid (and not in faeces) in 67% of patients. For hookworm, the diagnostic sensitivity was similar with both techniques but duodenal fluid microscopy detected some patients (35%) who had not been identified by faecal microscopy. This study confirms previous work indicating the insensitivity of faecal microscopy in these infections and emphasizes the need to consider routine examination of duodenal fluid to exclude chronic strongyloidiasis. This may have particular relevance for south-east Asian war veterans and immunocompromised patients.

Cold-restraint stress increases rat fecal pellet output and colonic transit

Increased fecal pellet output that occurs during cold-restraint stress (CRS) was evaluated systematically. Free-feeding rats, which exhibit a reduced occurrence of gastric ulcers under these conditions, were studied. CRS significantly increased fecal pellet production and fluid content. However, the fecal output produced during CRS was not associated with increased gut secretory activity or somatic motor activity associated with cold restraint and did not occur in anesthetized animals. Cold and restraint stress were additive in producing increased fecal output. Significant dose-related decreases in fecal output were produced by drugs that decrease gut transit (i.e., B-HT 920, clonidine, Lomotil, loperamide, and lidamidine). Anticholinergic-antisecretory drugs, antidepressants, and tranquilizers had little effect on fecal output or fluid content. Changes in gastrointestinal transit did not contribute to the increased fecal output during CRS. Transit in the lower small intestine was not altered, but the cecum tended to empty more contents into the large intestine during CRS. Colonic transit was dramatically affected by CRS, which eliminated retrograde transit and produced the evacuation of the majority of colonic contents. The increased colonic transit produced by CRS was decreased in a dose-related fashion by hexamethonium, nifedipine, loperamide, and B-HT 920. In several time-response and drug-inhibition studies during CRS, both fecal pellet output and colonic transit were affected similarly. These data indicate that CRS appears to change central nervous system output to the colon and that it alters colonic smooth muscle motility in a manner that facilitates colonic transit and evacuation. Small intestinal transit is not involved in this phenomenon and is regulated differently during CRS.

Mechanical aspects of rabbit fecal dehydration

The hydrostatic pressure required to reduce the water content of rabbit feces in an odometer from greater than 80 to less than 65% was approximately 5 atm. This pressure was unaffected by raising the temperature from 20 to 37 degrees C. It became progressively more difficult to dehydrate feces as consolidation occurred, as is evident from the significant (P less than 0.001) reduction in the fecal consolidation coefficient (Co) from 1.76 +/- 0.25 X 10(-6) (n = 4) to 1.35 +/- 0.093 X 10(-7) m2/s (n = 4) and the fecal fluid permeability coefficient (k) from 4.10 +/- 0.51 X 10(-8) (n = 4) to 1.42 +/- 0.12 X 10(-10) m/s (n = 4), concomitant with the reduction in fecal water content. The results suggest that rabbit hard feces are unlikely to be produced, under physiological conditions, by mechanical pressure exerted by the wall of the colon or by a prolonged retention time of hard feces by the distal colon. The hypertonic absorbate (1,000 mosmol/kg) produced by rabbit descending colon is of sufficient magnitude to overcome the fecal resistance to dehydration.

Clinical trial of clonidine hydrochloride as an antisecretory agent in cholera

Clonidine hydrochloride (an α2-adrenoceptor agonist) was tested for antisecretory effects in patients with cholera in a randomized controlled trial. Nineteen adults with diarrhea due to Vibrio cholerae were treated with clonidine (0.9 mg/24 h orally for 72 h) and 18 served as controls. During the first 24 h of treatment and for 24 h afterwards, the mean ± SD concentrations of sodium (in millimoles per liter) in the stools of clonidine-treated patients were 120.6 ± 10.9 and 112.3 ± 11.9, which were significantly lower than 135.5 ± 17.1 and 125.0 ± 16.4 in the controls (p < 0.01). Stool chloride concentrations (in millimoles per liter) were also significantly less in the clonidine group during the same periods: 82.1 ± 16.8 and 62.4 ± 19.4 vs. 92.1 ± 18.3 and 78.0 ± 23.0, respectively (p < 0.05). Concentrations of potassium but not bicarbonate were also significantly reduced in the stools of clonidine-treated patients (p < 0.05). However, there were no significant differences in the mean ± SD stool volumes (in liters) between the clonidine and the control group in any of the six 12-h periods after treatment or in the cumulative volumes in 72 h (24.2 ± 10.6 and 22.9 ± 8.3, respectively). We conclude that clonidine causes modest reduction of stool electrolyte loss but does not significantly reduce fecal fluid loss in patients with cholera.

Use of colonic eicosanoid concentrations as predictors of relapse in ulcerative colitis: double blind placebo controlled study on sulphasalazine maintenance treatment.

To establish whether concentrations of eicosanoids determined by equilibrium in vivo dialysis of faeces and equilibrium in vivo dialysis of rectum might predict a relapse in ulcerative colitis, 23 patients with completely inactive disease, maintained on sulphasalazine, stopped treatment and entered a prospective study. Concentrations of prostaglandin E2 were determined by radioimmunoassay on purified faecal and rectal dialysates at entry, at two weeks, and at two, six, and 12 months. If the above concentrations exceeded control concentrations (0.5 ng/ml and 1.0 ng/ml in faecal and rectal fluid, respectively) at any study day, the patient was allocated at random to double blind treatment with sulphasalazine 2 g/day, or placebo for six months. A relapse, defined as recurrence of symptoms accompanied by endoscopic inflammation occurred in none of six and in four of five patients allocated to sulphasalazine and placebo, respectively (p less than 0.05). In no case a normal rectal prostaglandin E2 concentration was associated with a relapse in the short term, but only two of 12 patients observed passively remained in remission. In retrospect, leukotriene B4 was a less sensitive predictor of relapse than prostaglandin E2. We conclude that raised concentrations of prostaglandin E2 in rectal dialysis fluid identify patients with a substantial risk of relapse.

Serotyping and subgrouping of some rotavirus strains in China.

This article reports for the first time in China the results of serotyping and subgrouping of some rotavirus strains obtained from faecal fluids of cases with infant diarrhoea. Infant diarrhoea rotavirus serotype 1 (Wa strain)-specific and serotype 2 (KUN strain)-specific hyperimmune sera, and infant diarrhoea rotavirus serotype 3-specific, rotavirus subgroup I-specific and subgroup II-specific monoclonal antibodies were used in serotyping and subgrouping by means of enzyme-linked immunosorbent assay of 14 rotavirus strains which had been identified by electron microscopy. Results showed that three out of four Beijing strains in 1982 belonged to serotype 2 and subgroup I rotavirus, one belonged to serotype 3 and subgroup II rotavirus; one out of nine Beijing strains in 1984 belonged to serotype 1 and subgroup II rotavirus, seven belonged to serotype 2 and subgroup I rotavirus, one belonged to serotype 3 and subgroup II rotavirus; and one Kunming strain in 1984 belonged to serotype 3 and subgroup II rotavirus.

Faecal lysozyme: determination, reference intervals and some data in gastro-intestinal disease

After diluting faecal samples with a solution of Brij and saline and subsequently ultrafiltrating the faecal mixtures, lysozyme concentration can be reproducibly measured in the obtained faecal fluids, using a turbidimetric method. Measuring faecal lysozyme concentration enables discrimination normal individuals and patients with irritable bowel syndrome between patients with inflammatory bowel disease and colonic cancer. Lysozyme distribution in stools appears to be homogeneous. Faecal lysozyme concentration is stable when samples are stored during at least 1 wk at 6 ° C. It appears that the lysozyme activity is directly correlated with the clinical status and severity of the disease. Faecal lysozyme may thus serve as an important tool both in diagnosis and in follow-up in the out-patients clinic for gastroenterology.

Faecal osmolality and electrolyte concentrations in chronic diarrhoea: do they provide diagnostic clues?

Osmolality, pH, and electrolyte concentrations in faecal fluid were measured in 23 patients referred to our department because of diarrhoeal disorders. The aim of the study was to ascertain whether such measurements could provide valuable diagnostic information in patients with diarrhoea. The patients were studied on a fat-restricted diet (70 g fat/day) and during fasting. Osmolality, pH, and concentrations of electrolytes in faecal water showed wide variations but were within normal ranges in most of the patients. The patients were grouped into secretory and osmotic diarrhoea on the basis of: 1) current assumptions on the pathogenesis of diarrhoea in different disorders; 2) persistence versus resolution of diarrhoea during fasting (resolution = decrease of stool mass to less than 200 g/24 h); and 3) an osmotic gap (measured osmolality -2 X (Na + K]. The accordance between these three ways of grouping was very incomplete. It is concluded that measurements of faecal fluid osmolality and electrolyte concentrations are of little value as diagnostic procedures in chronic diarrhoea. Determination of the osmotic gap and/or of the decrease of stool mass during fasting may help to elucidate the pathogenesis of diarrhoea in different disorders but does not seem diagnostically useful. Three patients turned out to be laxative abusers, and laxative ingestion should always be considered in chronic unsettled diarrhoea.

Starch utilization by the human large intestinal microflora

High levels (2-565 units/g) of amylase activity were observed in human faeces. Over 92% of amylase activity in faeces obtained from healthy persons was extracellular, whereas only about 9% of activity was associated with particulate material and washed cells. Bacterial cell-bound amylases were considerably more efficient in breaking down starch, however, than were the soluble enzymes which occurred in cell-free faecal supernatant fluids. Cell population densities of anaerobic starch-hydrolysing bacteria in the stools of ten persons ranged from 1.1 X 10(10) to 3.3 X 10(12)/g of faeces. Identification of 120 starch-hydrolysing colonies isolated from the stools of six subjects showed that the predominant amylolytic bacteria belonged to the genera Bifidobacterium, Bacteroides, Fusobacterium and Butyrivibrio. Mixed populations of gut bacteria rapidly fermented starch with the production of volatile fatty acids and organic acids. Lactate was observed to be a major, though transient intermediate during starch fermentation by these cultures. Approximately 60% of starch utilized was converted to volatile fatty acids, which in the human colon would be potentially available for absorption.

Evaluation of gastrointestinal toxicity following cytostatic chemotherapy.

A number of clinical and chemical parameters related to the gastrointestinal tract in patients treated with intensive chemotherapy for disseminated malignant melanoma were evaluated in order to find quantitative indicators for gastrointestinal toxicity and to investigate the cause of diarrhea after chemotherapy. In 11 patients 17 courses of polychemotherapy with bleomycin, DTIC, vindesine, and actinomycin D were administered, while the patients received complete liquid enteral nutrition. As clinical parameters for toxicity the diarrhea grading system according to the WHO criteria and the daily fecal consistency were used. Furthermore, in the feces Na+, K+, and Cl- (mmol/24 h), Na+/K+ ratio, dry and wet weight (g/24 h), lactate and bile acids (mmol/24 h), fat (g/24 h), pH, and osmolarity were determined. Both clinical parameters were closely correlated. The most important effects of the chemotherapy on the chemical parameters were an increased fecal fluid, K+, and fat excretion. The fecal wet weight and K+ excretion showed a high correlation with the two clinical parameters for gastrointestinal toxicity. We conclude that mucosal injury resulting from chemotherapy probably leads to increased small intestinal fluid and electrolyte secretion inducing diarrhea and that fecal wet weight and K+ excretion are probably the best quantitative indicators for gastrointestincal toxicity.

A new method for chemical analysis of faeces

By using a centriflo membrane cone filter it has become possible to obtain an ultrafiltrate from a 24-h stool specimen. In this faecal fluid several clinical chemical parameters were analysed, such as pH, osmolality, creatinine, sodium, potassium, calcium, magnesium, chloride, bicarbonate, phosphate and lactate. Reference intervals for these substances were obtained in healthy individuals. The data of this control group were compared to those of patients with diarrhoea due to active inflammatory bowel disease, irritable bowel syndrome, lactose intolerance and persons with an ileostomy.

Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery: A prospective, randomized double-blind clinical trial

In a prospective, randomized double-blind trial, the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients. The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days. Whole gut irrigation was completed without any discomfort in 87 percent of the patients. In 3 percent, the irrigation was stopped and the patients were excluded from the study. Abdominal wound infection developed in 32 percent of the patients after whole gut irrigation, and the addition of metronidazole decreased this incidence to 22 percent (not significant). The incidence in wound infections in the group receiving metronidazole as well as ampicillin was 2 percent, and this difference was highly significant compared with both other groups. No significant difference was found for the incidence of intraabdominal abscesses (p = 0.06), infection of the perineal wound, or anastomotic leakage. No difference in the postoperative infection rate was found between a bowel containing fecal fluid or fecal masses, but when a bowel was clean, significantly fewer infectious complications were found. Whole gut irrigation is a rapid, well-tolerated, easily performed, and safe form of preoperative bowel preparation in elective colorectal surgery if combined with systemic antimicrobial prophylaxis consisting of antimicrobial agents effective against anaerobic and aerobic organisms.

Watery diarrhea-hypokalemia-achlorhydria syndrome and carcinoma of the esophagus

The watery diarrhea-hypokalemia-achlorhydria syndrome associated with ectopic secretion of vasoactive intestinal peptide has only been conclusively documented with tumors originating in the pancreas or sympathetic chain. We report here the case of a 50-yr-old woman who developed this syndrome 3 wk after an apparently effective course of radiotherapy for an obstructing, mixed-cell carcinoma of the esophagus. High concentrations of vasoactive intestinal peptide were found in plasma (100–200 pmol/L; normal < 20 pmol/L) and in the metastatic skin nodules (750 pmol/g) that later developed and that contained one of the two cell types from the original tumor. Stool volumes reached a plateau of 15–20 L/day, and potassium requirements were > 1000 mmol/day. Symptoms failed to respond to any of the regimens previously described as effective in this syndrome. After 14 wk of massive fecal fluid and electrolyte losses, symptoms resolved dramatically with the first dose of 5-fluorouracil. Plasma vasoactive intestinal peptide concentration returned to normal, where it remained despite subsequent evidence of renewed tumor spread. This case illustrates the unpredictability of the response of this syndrome to medical treatment, and suggests that vasoactive intestinal peptide secretion may occur in a wider range of tumors than has so far been described.

Clinical and nutritional implications of radiation enteritis

The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value.

Prevention of drug-resistant Escherichia coli colonization in chickens by treatment with a faecal fluid.

This study was performed to prove that intestinal colonization in chickens by resistant Escherichia coli strains present in the environment might be prevented when faeces in which sensitive E. coli strains were dominant was administered to newly hatched chicks. The appearance of resistant E. coli strains was markedly reduced. Escherichia coli O49:H12 was the sensitive E. coli strain which formed the major colonizer in the intestinal tract. In young chickens, this strain persisted as a major component, and even when it was a minor colonizer in the faecal fluid administered, it appeared as a major component soon afterwards. This strain is considered to be a good colonizer in the gut of young chickens.

Chemical defense of a rove beetle (Creophilus maxillosus)

The abdominal defensive glands ofC. maxillosus secrete a mixture (70μg/beetle) of isoamyl alcohol (I), isoamyl acetate (II), iridodial (III), actinidine (IV), dihydronepetalactone (VE), and (E)-8-oxocitronellyl acetate (X). When disturbed, the beetle everts the glands and revolves the abdomen so as to wipe the glands against the offending agent. Fecal fluid is commonly emitted at the same time and may become added to the glandular material. Ants (Formica exsectoides) are effectively fended off by the beetle and were shown in bioassays (Monomorium destructor) to be repelled by the four major components of the secretion (II, III, X, VE); the principal component (VE) was the most active. Some anatomical features of the glands are described.

A Manual of Laboratory Diagnostic Tests

Care-givers' responsibilities blood studies urine studies fecal studies cerebrospinal fluid studies chemistry studies microbiological studies immunodiagnostic studies nuclear medicine studies common X-ray studies cytology and genetic studies common endoscopic studies ultrasound studies pulmonary function studies - blood gas analyses special system and organ function studies prenatal diagnosis and tests of foetal well-being. Appendix: SI units infection control.

Generation of ammonia from non-urea sources in a faecal incubation system.

1. A 25% faecal suspension in sodium chloride solution, incubated anaerobically at 37 degrees C for 48 h, showed excellent survival of all the main groups of faecal bacteria. 2. All faecal incubation systems studied generated large amounts of ammonia, particularly those in which bacterial counts fell during incubation. As normal faeces contain negligible amounts of urea this ammonia must have been generated from sources other than urea. 3. Ammonia was also generated by faeces delivered by sodium chloride enema, and by ileostomy fluid, indicating that the phenomenon is not confined to distal colonic contents. 4. Ammonia generation by incubated faeces was inhibited by prior autoclaving of the sample, but not by sterilization with gamma-irradiation. 5. Generation of ammonia by incubated stool was accompanied by release of large amounts of organic anion and a fall in pH. 6. These observations are interpreted as evidence that ammonia generated within the colon in situ is not derived exclusively from urea, but also from bacterial deamination of amino acids, peptides and proteins. Simultaneously bacterial activity generates large amounts of organacid. The presence of living bacteria is not essential for ammonia generation, provided that bacterial enzymes are present. 7. Bacterial generation of organic solute in faeces which have left the body is sufficiently rapid to cast serious doubts on the validity of faecal centrifugation, or other time-consuming techniques involving lengthy handling of faeces, as methods of obtaining extracellular faecal fluid for measurements of organic constituents or ammonia.

Activity of faecal fluid of a leaf-cutting ant toward plant cell wall polysaccharides

The faecal fluid of the leaf-cutting ant, Atta colombica tonsipes, has been shown to contain enzymes active in the degradation of pectin, sodium polypectate, xylan, and carboxymethylcellulose. In addition, glycosidase activity has been detected in the faecal fluid using various naturally occurring disaccharides and synthetic p-nitrophenyl glycosides as substrates. The importance of these enzymes in the symbiosis between A. c. tonsipes and its food fungus is discussed, with particular emphasis on the rôle of the pectin-degrading enzymes.

CONGENITAL CHLORIDE DIARRHEA /CCD/, CLINICAL EXPERIENCE WITH 21 CASES

21 children with CCD have been treated by us since the disease was first diagnosed in Finland in 1961. All were born from a pregnancy complicated by hydramnios /2–6 l/, and 19/21 2 or more weeks before term. Watery diarrhea /about 1000 ml/m2/day/ was present from the first day of life, with Cl concentration of the fecal fluid exceeding 100 meq/1. Absence of meconiurn was recorded in 14/21. Hyponatremia and hypochloridemia tended to develop, and later hypopotassemia and alkalosis with extreme dehydration. The diarrhea only decreased with dehydration. Normal fluid composition and hydration could be maintained through adequate water and electrolyte replacement. For this a solution of NaCl and KCl was used. The dose and Na/K-ratio were adjusted to maintain normal pH and electrolyte concentration, chloriduria, normal renin and aldosterone activity and normal body content of potassium. Normal development was thus achieved and renal changes could be avoided.