Biomedical subjects
Publications and source records attributed to E Hemmer.
For many hospitals, billing and receivables management are inefficient and costly. Economic recession, increasing costs for patient and provider alike, and cost-containment strategies will only compound difficulties. The author describes the foundations of an automated billing system that would save hospitals time, error, and, most importantly, money.
Fungal cultures, unstained smears and histological assessment of endoscopically obtained particles from ulcers in rectum, colon or terminal ileum were obtained in a prospective study of possible fungal infection in 78 patients with colitis of various aetiologies (Crohn's disease - 46; ulcerative colitis - 21; infectious colitis - 5; ischaemic colitis - 2; radiation colitis - 1; non-classifiable colitis - 3). Positive fungal culture was obtained in 13 patients (16.7%). The germ count was low (2--8 colonies per biopsy piece). The demonstrated fungi were almost exclusively Candida or Torulopsis. The potentially pathogenic mycelia phase of the fungi were never seen, either histologically or in unstained preparations. Stool specimens, obtained at the same time, were examined in 54 patients: positive cultures were obtained in 14 (25.9%). Only rarely were there concordance of positive fungal findings in both ulcer particles and faeces. It is concluded that (1) there is little danger of secondary fungal infection in colitis of various aetiologies; (2) positive faecal fungal culture is apparently of no pathogenic significance if the germ count is less than 10(6) per gram stool; (3) in the lower as well as the upper gastro-intestinal tract pathogenic fungal infection can be demonstrated only by endoscopy and biopsy.
In a prospective study of 132 cases of gastroduodenal ulcer, proven by endoscopic biopsy, there were 59 in which fungi were cultered (44.7%). There was no significant difference in incidence between gastric ulcer (46.2%) and duodenal ulcer (42.6%), or between benign and malignant gastric ulcer (47.2 and 42.1%, respectively). Most of the fungi were yeasts of the genus Candida and Torulopsis. The mycel phase was demonstrable only in the native or histological preparation (16.7% [native] and 10.6% [histological] positive findings). In all those cases in which pseudomycels were demonstrated the culture count was especially high (more than 20 colonies). In most of these there was an additional disease which may be associated with immunological insufficiency (e.g. diabetes, chronic alcoholism, malignoma). The presence of pseudomycelia or more than 20 colonies in the culture from gastroduodenal ulcers are thus less of a pointer as to whether the local lesion is benign or malignant than to a general weakening of the organism's defence mechanisms.
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