Bacteriological

Am J Dent, 2003 Sep, 16 Spec No, 25A - 30A
Treatment of root caries lesions with chlorhexidine-containing varnishes and dentin sealants; Wicht MJ et al.; PURPOSE: To evaluate the effects of chlorhexidine-containing varnishes and dentin sealants on the progress of demineralization, cariogenic bacteria and clinical appearance of root caries lesions . METHODS: 68 lesions in 22 adult patients, with a mean age of 51.3 +/- 13.8 years were enrolled in this study . After the removal of soft, infected dentin, all lesions were randomly sealed with (1.) Cervitec, used as control (CE), (2.) EC 40 (EC), (3.) Prime and Bond NT (PB) or (4.) Seal & Protect (SP) . Clinical appearance, laser fluorescence diagnosis (DIAGNOdent) and bacteriological status were recorded at intervals of 1 and 3 months . RESULTS: Regarding alteration of surface texture and color of the lesions, differences between the groups were not detected . Application of EC resulted in suppressed MS counts after 3 months (P < 0.05) . Initial lower MS counts were observed in the CE group (P = 0.053) . Laser fluorescence values increased in the chlorhexidine groups (CE = 27.9 +/- 17.5, EC = 28.3 +/- 26.0) but remained stable in the sealant groups (PB = 15.1 +/- 22.0, SP = 10.2 +/- 7.3), (P < 0.05).

J Dairy Sci, 2003 Nov, 86(11), 3460 - 5
Relationship between udder and leg hygiene scores and subclinical mastitis; Schreiner DA et al.; The objective of this study was to determine the relationship between udder and leg hygiene scores of lactating dairy cattle and measures of subclinical mastitis . Study animals (n = 1250) consisted of lactating dairy cows from eight commercial dairy farms . Herds were enrolled during December 2000 and January 2001 and were visited bimonthly for a total of five visits per herd . Udder and leg hygiene scores were recorded by one person using a four-point scale ranging from one (very clean) to four (very dirty) . Udder and leg hygiene scores were compared to bacteriological cultures of milk samples and monthly individual SCC values . Mean hygiene scores were 2.09 and 2.33 for udders and legs, respectively . Udder hygiene scores (UHS) were significantly associated with leg hygiene scores and varied among farms . Linear somatic cell scores increased as udder hygiene score increased . Significant differences in somatic cell scores were observed for all contrasts of udder hygiene score, except between scores of 1 and 2 and of 3 and 4 . Linear somatic cell scores were associated with leg hygiene scores, but the only significant contrast was between leg hygiene scores of 2 and 4 . There was a significant association between the prevalence of intramammary contagious pathogens and udder hygiene score . The prevalence of intramammary environmental pathogens was significantly associated with udder hygiene score and was 7.7, 10.0, 10.6, and 13.5% for UHS of 1, 2, 3, and 4, respectively . The prevalence of environmental pathogens was not associated with LHS . Cows with udder hygiene scores of 3 and 4 were 1.5 times more likely to have major pathogens isolated from milk samples compared with cows with hygiene scores of 1 and 2.

JAMA, 2003 Dec 10, 290(22), 2968 - 75
Trends in pertussis among infants in the United States, 1980-1999; Tanaka M et al.; CONTEXT: Reported cases of pertussis among adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination among infants and children . However, severe pertussis morbidity and mortality occur primarily among infants . OBJECTIVE: To describe the trends and characteristics of reported cases of pertussis among infants younger than 12 months in the United States from 1980 to 1999 . DESIGN, SETTING, AND PARTICIPANTS: Cases of pertussis in infants younger than 12 months in the United States reported to the National Notifiable Disease Surveillance System of the Centers for Disease Control and Prevention between 1980 and 1999, and detailed case data from the Supplementary Pertussis Surveillance System . MAIN OUTCOME MEASURES: Incidence and demographic and clinical characteristics of cases . RESULTS: The incidence of reported cases of pertussis among infants increased 49% in the 1990s compared with the incidence in the 1980s (19 798 vs 12 550 cases reported; 51.1 cases vs 34.2 cases per 100 000 infant population, respectively) . Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged 4 months or younger, contrasting with a stable incidence of cases among infants aged 5 months or older . The proportion of cases confirmed by bacterial culture was higher in the 1990s than in the 1980s (50% and 33%, respectively); the proportion of hospitalized cases was unchanged (67% vs 68%, respectively) . Receipt of fewer doses of vaccine was associated with hospitalization, when cases were stratified by age in months . CONCLUSIONS: The incidence of reported cases of pertussis among infants increased in the 1990s compared with the 1980s . The limited age group affected, the increased rate of bacteriologic confirmation, and the unchanged severity of illness suggest that an increase in infant pertussis has occurred apart from any change in reporting . Strategies are needed to prevent the morbidity and mortality from pertussis among infants too young to be fully vaccinated, according to the current recommended schedules of vaccination in the United States.

Chemosphere, 2004 Feb, 54(8), 1267 - 71
Effects of ionic strength on the production of short chain volatile hydrocarbons by Dunaliella salina (Teodoresco); Munoz J et al.; The effect of ionic strength on the production of short chain volatile hydrocarbons was studied in cultures of Dunaliella salina . Axenic cultures of D . salina were grown at three different ionic strengths 0.5, 2 and 3 M of NaCl in Johnson (J/1) culture medium {Journal of Bacteriology 95 (1968) 1461} under the following laboratory growth conditions: a 12:12 h photoperiod, 300 micromolm(-2)s(-1) of photosynthetic active radiation (PAR) provided by a fluorescent lamp of 40 W combined with a 100 W incandescent lamp at 20 +/- 1 degrees C at pH 7.5 . C1 to C5 hydrocarbons were detected using a head space technique and GC-FID . Cell numbers and growth rate was greatest at 2 M NaCl 4.3 x 10(6) cellml(-1) after a 15 days period of culture . Maximum hydrocarbon production was measured in the concentration of 0.5 NaCl with lower production rates in the more concentrated solutions . The principal hydrocarbon was pentane at 0.5 M but was ethane in 2 and 3 M solutions . Production rates for individual compounds ranged between 0.13 and 22 x 10(-15) microgCcell(-1)h(-1) . It is suggested that the ability to produce and release volatile organic compounds of D . salina is related to osmotic conditions established by the ionic strength of growth solution.

Klin Khir, 2003 Sep, (9), 28 - 31
{Clinical and functional characteristics of patients late after pneumonectomy with complicated course of postoperative period}; Heints VT et al.; Results of examination of 65 patients, to whom twenty years before pneumonectomy was performed for pulmonary tuberculosis and chronic nonspecific pulmonary diseases, were analyzed . Peculiarities of postoperative period course were determined in patients with early complications, including the tuberculosis reactivation . Methods of examination: clinical investigation, standard laboratory tests, bacteriologic investigation of phlegm, roentgenography, multiradial roentgenoscopy of thoracic cage, bronchography, computeric tomography, roentgenokymography, spirography, pneumotachometry . Specific and nonspecific changes in lungs, which resided, were revealed accordingly in 20 and 23.3% patients . The tuberculosis reactivation is possible twenty years after the operation . Pneumonectomy performance permits to eliminate an active tuberculosis in 70-80% patients . The tuberculosis changes in residual lung worsen the patients quality of life after pulmonectomy performance due to progress of respiratory insufficiency.

Klin Khir, 2003 Sep, (9), 15 - 6
{Application of magnetic therapy in acute paraproctitis}; Kondratenko PG et al.; There were studied the possibilities and perspectives of application of the magnetically liquefied layer as an instrument for better purulent and putrefactive wounds clearance after intervention for an acute paraproctitis . Together with clinical signs the results of bacteriological investigation were controlled as well . There was established high efficacy of the method proposed and expedience of its application.

Clin Nucl Med, 2003 Dec, 28(12), 971 - 4
Tc-99m exametazime-labeled leukocyte scans in the study of infections in skull neurosurgery; Liberatore M et al.; Diagnosis and follow-up of skull infections are usually performed by neurologic examination, laboratory tests and instrumental diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI) . These have, however, shown some limitations for specificity . The aim of the current study was to evaluate the overall contribution of Tc-99m exametazime-labeled leukocyte imaging scan Tc-99m hexamethylpropyleneamine (HMPAO) labeled white blood cells (WBC) in the diagnosis and management of infections in skull neurosurgery . Thirty-four patients were subdivided into 4 groups on the basis of the suspected pathology: intracerebral lesions on CT or MRI (group A, n = 20), suspected postsurgical infections (group B, n = 6), suspected deep infection of the surgical wound (group C, n = 4), and suspected infection of the ventriculoperitoneal shunt (group D, n = 4) . All patients underwent CT, MRI, and Tc-99m HMPAO WBC imaging . Patients in group C also underwent bacteriologic and culture examinations of wound secretions if present . In positive cases in group A, Tc-99m HMPAO WBC imaging was repeated . The scintigraphic results were compared with histologic findings in patients who underwent surgery and with the results of a 12-month clinical follow-up in the remaining patients . Tc-99m HMPAO WBC scans correctly detected the infections in all groups . Furthermore, such imaging proved to be able to document recovery from the disease in all of the assessed cerebral abscesses . This study may have an important role both in the diagnosis and in the management of infections in skull neurosurgery, which, it is hoped, will be confirmed in the future.

Int J Syst Evol Microbiol, 2003 Nov, 53(Pt 6), 1701 - 2
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; International Journal of Systematic and Evolutionary Microbiology; The purpose of this announcement is to effect the valid publication of the following new names and new combinations under the procedure described in the Bacteriological Code (1990 Revision) . Authors and other individuals wishing to have new names and/or combinations included in future lists should send three copies of the pertinent reprint or photocopies thereof to the IJSEM Editorial Office for confirmation that all of the other requirements for valid publication have been met . It is also a requirement of IJSEM and the ICSP that authors of new species, new subspecies and new combinations provide evidence that types are deposited in two recognized culture collections in two different countries (i.e . documents certifying deposition and availability of type strains) . It should be noted that the date of valid publication of these new names and combinations is the date of publication of this list, not the date of the original publication of the names and combinations . The authors of the new names and combinations are as given below, and these authors' names will be included in the author index of the present issue and in the volume author index . Inclusion of a name on these lists validates the name and thereby makes it available in bacteriological nomenclature . The inclusion of a name on this list is not to be construed as taxonomic acceptance of the taxon to which the name is applied . Indeed, some of these names may, in time, be shown to be synonyms, or the organisms may be transferred to another genus, thus necessitating the creation of a new combination.

Pediatrics . 2003 Dec;112(6 Pt 1):e467.
Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children; Tissieres P et al.; OBJECTIVE: To compare the sensitivity of 3 different criteria-von Reyn, Duke, and modified Duke-in diagnosing infective endocarditis (IE) in children . STUDY DESIGN: Retrospective case study in a tertiary pediatric hospital . METHODS AND RESULTS: Between 1985 and 2001, 41 episodes of IE were documented in 40 children (median: 7 years old; range: 1 week to 18 years) . The diagnosis was based on echocardiographic and microbiologic or pathologic findings . The initial echocardiogram suggested IE in 95% of the cases . Main findings were vegetations in 36, perivalvular abscess in 4, and/or new valvular leaks in 6 cases . In 31 (76%) of the 41 episodes, the causative organisms were identified directly by specimen bacteriology or blood cultures (BCs) or indirectly by polymerase chain reaction or serology . Sensitivities of the von Reyn, Duke, and modified Duke criteria in diagnosing IE were 63%, 81%, and 88%, respectively . In 10 cases (22%), the diagnosis of IE was "rejected" by the von Reyn criteria but was "definite or possible" by the Duke and modified Duke criteria . In 3 cases, the diagnosis of IE was "possible" by the Duke but "definite" by the modified Duke criteria: 2 of the 3 cases had 1 major and >or=3 minor symptoms, and 1 had Q fever . Five episodes (12%) were classified as "possible" IE by the modified Duke criteria: although major findings were present on echocardiography, no organism was identified on repeat BCs . Positive BC was the only criterion that differentiated "definite" from "possible" IE . CONCLUSIONS: The modified Duke classification was more sensitive in diagnosing IE in children than the von Reyn and Duke criteria . Still, 12% failed to be classified as "definite" IE by the modified Duke criteria . This illustrates the importance of positive BCs as a major IE criterion while significant echocardiographic findings are less considered by the presently used criteria.

Hist Cienc Saude Manguinhos, 2003, 10(Suppl 1), 361 - 96
Fight for survival: the life of a Hansen's disease sufferer through his correspondence with Adolpho Lutz; Benchimol JL et al.; This project presents the complete set of letters between the family of a Hansen's disease (leprosy) sufferer in the state of Maranhao, in the Northeast of Brazil, and the doctor and bacteriologist Adolpho Lutz . For more than twenty years Fabricio Caldas de Oliveira and Numa Pires de Oliveira, father and son, exchanged a steady flow of letters with the scientist in pursuit of a cure for the disease that had assailed Numa since childhood . The 24 letters compiled here paint a unique portrait of the medical and social drama confronted by this family, and the results of the use of chaulmoogra oil and other medications in their search for alternative treatments.

Hepatology, 2003 Dec, 38(6), 1508 - 15
Bacterial translocation up-regulates GTP-cyclohydrolase I in mesenteric vasculature of cirrhotic rats; Wiest R et al.; In cirrhosis, arterial vasodilation and the associated hemodynamic disturbances are most prominent in the mesenteric circulation, and its severity has been linked to bacterial translocation (BT) and endotoxemia . Synthesis of nitric oxide (NO), the main vasodilator implicated, is dependent on the essential cofactor tetrahydrobiopterin (BH(4)) . The key enzyme involved in BH(4) synthesis is GTP-cyclohydrolase I (GTPCH-I), which is stimulated by endotoxin . Therefore, we investigated GTPCH-I activity and BH(4) biosynthesis in the mesenteric vasculature of cirrhotic rats with ascites, as well as their relationship with BT and endotoxemia, serum NO, and mean arterial pressure (MAP) . GTPCH-I activity and BH(4) content in mesenteric vasculature was determined by high-performance liquid chromatography . BT was assessed by standard bacteriologic culture of mesenteric lymph nodes (MLNs) . Serum endotoxin was measured by a kinetic turbidimetric limulus amebocyte lysate assay, and serum NO metabolite (NOx) concentrations were assessed by chemiluminescence . BT was associated with local lymphatic and systemic appearance of endotoxin and was accompanied by increases in serum NOx levels . GTPCH-I activity and BH(4) content in mesenteric vasculature were both increased in animals with BT and correlated significantly (r = 0.69, P <.01) . Both GTPCH-I activity and BH(4) levels significantly correlated with serum endotoxin and NOx levels (r = 0.69 and 0.54, 0.81 and 0.53, P <.05) . MAP (a marker of systemic vasodilatation) correlated with endotoxemia (r = 0.58, P <.03) and with GTPCH-I activity (r = 0.69, P <.01) . In conclusion, in cirrhotic animals BT appears to lead to endotoxemia, stimulation of GTPCH-I, increased BH(4) synthesis, and further enhancement of vascular NO production that leads to aggravation of vasodilatation.

Am J Ind Med, 2003 Dec, 44(6), 600 - 10
Cancer incidence among laboratory workers in biomedical research and routine laboratories in Israel: Part I-the cohort study; Shaham J et al.; BACKGROUND: Laboratory work is associated with exposure to a mixture of carcinogens . METHODS: The cohort is comprised of 4,300 laboratory workers . Cancer incidence was followed from 1960 to 1997 . RESULTS: A total of 230 cases were included in the cohort . The overall cancer standardized incidence ratio (SIR) was 1.04 (0.91-1.18) . When a 20-year latency was introduced, SIR was increased significantly: 1.35 (1.13-1.61) . Among routine workers and researchers, SIR was elevated significantly for the total population and for women, when a 20-year latency was introduced . SIR was also elevated significantly in research, routine, bacteriology and virology, and isotope laboratories . With respect to specific sites, significantly increased SIR was observed in breast, ovary, and thyroid cancer among women; and prostate cancer, leukemia, and melanoma among men . CONCLUSIONS: We suggest that work in research and biomedical laboratories might involve an increased risk of certain types of cancer . Am . J . Ind . Med . 44:600-610, 2003 .

Antibiot Khimioter, 2003, 48(7), 20 - 3
{Cefepime treatment efficacy in surgical patients}; Bogomolova NS et al.; Clinical and bacteriologial efficacies of cefepime were studied in the treatment of 20 surgical patients . Intraoperative prophylaxis is with the use of cefepime alone and postoperative prophylaxis with the use of cefepime in combination with some other drugs were applied to 10 patients . No postoperative complications in the group of the 10 patients were stated . The other 10 patients were subjected to intraoperative and postoperative combined prophylaxis with some other antibiotics . In 6 patients of the latter group postoperative complications developed . Obvious clinical advantages of cefepime were demonstrated.

Zentralbl Chir, 2003 Oct, 128(10), 858 - 61
{Severe acute pancreatitis: role for laparoscopic surgery}; Pavars M et al.; Minimally invasive surgery is a new and promising treatment modality in the management of patients with severe acute pancreatitis (SAP) . Aim of our study was the evaluation of our first experiences with laparoscopic surgery in the management of patients with SAP . METHODS: A total of 65 patients complied with Atlanta recommendations for SAP and were included into this retrospective study . Indications for laparoscopic surgery were SAP presented with intraabdominal or retroperitoneal exudates and detected by ultrasound (US) and/or contrast enhanced computer tomography (CT) scan, and the presence of acute calculous cholecystitis when 3 to 5 days of conservative treatment did not show clinical improvement and surgical treatment was considered . Patients with improvement after initial therapy received conservative therapy only . Bacteriological cultures were done for abdominal exudates and necrotic tissue obtained during surgery . RESULTS: Totally, 39 patients were operated and 26 were treated conservatively only . Laparoscopic surgery was started in 31 patients and completed in 26 patients . The overall conversion rate was 16.1 % . Laparoscopic drainage of the intraabdominal exudate was done in 26 patients including drainage of the lesser sac in five of them . Laparoscopic cholecystectomy in 25 cases and laparoscopically assisted jejunostomy in 6 cases were performed as a part of the procedure . Conventional surgery was the primary procedure in 8 patients . Peripancreatic abscess formation was observed in one case one month after laparoscopic procedure and was cured with conventional surgical drainage . Bile leakage from the cystic stump was successfully treated with endoscopic papillotomy in one case . All patients survived after laparoscopic procedures . Overall complication rate was 7.7 % and mortality reached 3.1 % . CONCLUSIONS: Laparoscopic drainage of the abdominal cavity, drainage of the lesser sac and revision of the retroperitoneal compartment can be safely carried out as an alternative to the conventional surgical approach . Laparoscopic cholecystectomy and/or jejunostomy may be additionally performed if indicated.

An Med Interna, 2003 Nov, 20(11), 569 - 74
{Infective endocarditis in the elderly}; Cruz JM et al.; BACKGROUND: The influence of age on the clinical presentation and on the prognosis of infective endocarditis (IE) is unclear . Our aim was to analyse the epidemiologic, clinical and bacteriological characteristics of IE in the elderly compared with younger adult patients . PATIENTS AND METHODS A retrospective study of all patients with IE non intravenous drug users diagnosed in our hospital during the period from 1990 to 2000 . We used the Duke criteria to compare the characteristics of 46 episodes of definitive IE in elderly patients (>65 years old ) and of 46 episodes in younger adult patients (20-64 years of age ) . RESULTS: No significant differences were observed among the two groups with respect to the delay in diagnosed, possible source of infection, the frequency of positive blood cultures and the type of infective organism, clinical presentation and evolution of the IE . Elderly patients more often had risk factors predisposing (degenerative valvular disease, prosthetic valve and pacemaker ), which decreased the sensitivity of transthoracic echocardiography to 46.5% compared with 64.4% in the younger patients . Transesophageal echocardiography improved the diagnostic of IE in the 37.2% in elderly patients . The patients in the both groups underwent surgical therapy with similar frequency (36.9% in the elderly and the 39.1% in the younger adult patient ) and the mortality rate not was significantly higher in the elderly (19.5%) than in the younger adult patients (10.8%) . CONCLUSIONS: The age itself is not a poor prognostic, and should not be used prejudicially in denying a early and aggressive treatment of the patients with IE.

Arch Otolaryngol Head Neck Surg, 2003 Nov, 129(11), 1240 - 2
Malakoplakia of the neck; Schmerber S et al.; Malakoplakia that presents in the head and neck is very rare . We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia . To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck . Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host . The symptoms are nonspecific and the diagnosis is based on the histologic findings . In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia . Bacteriologic analysis identified Escherichia coli . The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.

Transfus Med, 2003 Oct, 13(5), 315 - 7
False-positive result of sterility testing after a supposed adverse transfusion reaction; Strobel E; We report on the case of a woman who suffered from chills and fever when she was transfused with two units of red blood cell concentrate . Immunohaematological evaluation of the adverse reaction was inconspicuous, as well as sterility testing of one unit, but bacteriological evaluation of the second unit showed growth of Stenotrophomonas maltophilia . The sample for sterility testing of this unit had been drawn from the distal end of the transfusion device that was still connected to the blood bag . Later, two samples were drawn from the blood bag itself and were found to be sterile, whereas another sample drawn from the distal end of the transfusion device also showed growth of S . maltophilia . We conclude that reflux of the patient's blood into the transfusion device has caused a false-positive result of sterility testing of the second unit when the sample was drawn from the distal end of the device.

J Vet Sci, 2000 Jun, 1(1), 33 - 7
Detection of Lawsonia intracellularis in diagnostic specimens by one-step PCR; Suh DK et al.; Lawsonia intracellularis is not culturable with a standard bacteriologic culture . One step PCR assay as a clinical diagnostic method was developed for the rapid detection of porcine proliferative enteritis (PPE) caused by L . intracellularis . Primers were designed based on the p78 DNA clone of L . intracellularis . The one step PCR resulted in the formation of a specific 210-bp DNA product derived from L . intracellularis . The nonspecific amplification product was not detected with swine genomic DNA or other bacterial strains causing similar symptoms to L . intracellularis infection . The one step PCR was as sensitive as 100 pg of L . intracellularis genomic DNA . We applied this method to field specimens diagnosed as PPE by macroscopic observation . Of 17 mucosal scraping specimens, 16 (94%) were identified as positive to PPE and 15 (88%) of 17 feces specimens . These results suggest that the one step PCR can be used as a rapid diagnostic method for L . intracellularis infection.

Immunol Lett, 2003 Nov 15, 90(1), 3 - 11
Alteration of intestinal intraepithelial lymphocytes and increased bacterial translocation in a murine model of cirrhosis; Inamura T et al.; Alterations in immunological defense in the gut may lead to the bacterial infection that is frequently associated with cirrhosis of the liver . The aim of this study was to investigate the changes in distribution and function of intestinal intraepithelial lymphocytes (IELs) in relation to intestinal barrier dysfunction in experimental cirrhosis . Cirrhosis was induced in mice by treatment with carbon tetrachloride (CCl4) intraperitoneally with 5% alcohol in drinking water for 12 weeks . Bacterial translocation was assessed in mesenteric lymph nodes (MLNs) by the transport of fluorescence-labeled latex beads and by bacteriological cultures . The lymphocyte subpopulation was compared in three groups (cirrhosis, alcohol alone and controls) . IFN-gamma production from isolated IELs was determined by ELISA after stimulation with anti-CD3 or IL-12/IL-18 . The total number of IELs significantly increased in the cirrhosis and alcohol groups . There was a preferential increase in TCRgammadelta+CD8+ population in the alcohol group, but no change in cirrhosis . Bacterial translocation was negative in the control group, and a small number was noted in the alcohol group, whereas it was significantly noted in the cirrhosis group . Although the number of IEL was significantly increased in the cirrhosis group, their proliferative response was decreased, and IFN-gamma production from each IEL was markedly diminished in either stimulation by anti-CD3 or IL-12/IL-18 . These changes were more remarkable in the cirrhosis group than in the alcohol group . In conclusion, bacterial translocation due to intestinal barrier dysfunction in cirrhosis may be closely correlated with the alteration of the immune function in IELs.

J Clin Pathol, 2003 Nov, 56(11), 835 - 9
The nodular form of hepatic tuberculosis: a review with five additional new cases; Huang WT et al.; BACKGROUND: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare . A greater awareness of this rare clinical entity may prevent needless surgical intervention . AIMS: To help characterise this distinctly rare presentation of tuberculosis, five new cases are presented, together with a review of the world literature . The clinical, laboratory, radiological, and pathological features of these patients are described . METHODS: Polymerase chain reaction (PCR) assay of the liver tissue was carried out in all cases to confirm an aetiological diagnosis of Mycobacterium tuberculosis infection . RESULTS: All five patients (44-71 years old; two women, three men) underwent surgery, and had a preoperative diagnosis of malignant hepatic neoplasm and a postoperative histological diagnosis of chronic granulomatous inflammation, suggestive of tuberculosis . None of them had a known previous history of tuberculosis . All of them were positive for M tuberculosis by PCR analysis of the liver tissue . CONCLUSIONS: This report illustrates the difficulty in reaching a correct preoperative diagnosis . It is usually unsuspected and confused with primary or metastatic carcinoma of the liver, especially when it coexists with other malignancies . A high index of suspicion is required for diagnosis, which can be made only by histological and bacteriological studies, and PCR analysis.

Tip Tarihi Arastirmalari, 1999, 9, 229 - 35
{Evaluation of the last 50 years of the progress in immunology in our country}; Dogan H; Different methods of vaccination have been observed in the ancient civilizations, to protect themselves from diseases . Pontus King, Mitridates Eupaton (132-63 B.C.), established the basic principles of Immunology unconsciously . Since he was scared of being poisoned all the time, he looked for an antidote . He gave the poison in little amounts to the prisoners and found a way to be immune against poisons with immunization . He turned out to be the first immunologist . The essential idea of immunology was established by the idea of immunity developed by Jenner and Pasteur, against cholera and smallpox . In our country, immunology has evolved from bacteriology and virology, as well . Actually, in the ancient times, Turks used variolation in their daily lives (from human to human) . In the last 50 years, immunology progressed both in our country and in the world rapidly and played an important role in the etiopathogenesis of the diseases of different systems . Also, through a philosophical point of view, it brought the necessity of a holystic evaluation for the description of human health.

Vestn Ross Akad Med Nauk, 2003, (9), 39 - 44
{Laser fluorescence in assessing the hygienic status of oral cavity}; Aleksandrov MT et al.; The issue related with an objective evaluation of a hygienic status of the oral cavity and a method to solve it by modern laser technologies are addressed in the paper . The efficiency of bacteriological and of laser-fluorescence express-diagnostics is comparatively analyzed . A hygienic index and its clinical value are substantiated.

Probl Tuberk Bolezn Legk, 2003, (9), 26 - 9
{Accelerated determination of blood bacteriostatic activity in patients with tuberculosis by using the semiliquid culture medium}; Manicheva OA; Blood bacteriostatic activity (BBA) was studied in 87 patients with respiratory tuberculosis . Clinical Mycobacterium tuberculosis (MBT) strains and different culture media, such as solid (Lowenstein-Jensen and Middlebrook), liquid (modified Soton) and semiliquid (SM developed for accelerated determination of drug resistance in MBT) media were used . With isoniazid-resistance of MBT, the use of solid media yielded underestimated BBA . The SM medium based on the Soton medium added by 0.35% of culture agar and 25% equine serum was optimal, which provided evidence for BBA on day 7 (visual recording of MBT growth) . Examination of BBA by means of SM revealed a clear inverse correlation between the degree of BBA and the bacteriological parameters of sputum study . The small numbers of sputum MBT cultures (a high correlation, r = -0.88; p = 0.01) and short bacterial isolation (average correlation, r = -0.65; p = 0.01) corresponded to the high values of BBA.

J Int Med Res, 2003 Sep-Oct, 31(5), 434 - 47
Moxifloxacin in the treatment of acute maxillary sinusitis after first-line treatment failure and acute sinusitis with high risk of complications; Gehanno P et al.; This multicentre, prospective study evaluated the efficacy and safety of 7-day oral moxifloxacin (400 mg/day) for treatment of acute maxillary sinusitis after first-line treatment failure (group 1), and acute sinusitis with high risk of complications (group 2) . Two hundred and fifty-eight patients with radiologically confirmed acute sinusitis were enrolled by 52 investigators; 216 patients (83.7%) qualified for per protocol efficacy analysis (group 1, n = 175; group 2, n = 41), and 92 for bacteriological analysis . Samples were collected from the middle meatus . The clinical success rate 7-10 days post-treatment was 92.6% . Bacteriological success rates were 95.7% after 3-4 days of treatment, and 97.2% and 95.2%, in group 1 and group 2, respectively, at 7-10 days post-treatment . Drug-related adverse events, including abdominal pain (2.4%), nausea (2.4%) and diarrhoea (1.2%), were reported in 12.2% of patients . Overall, moxifloxacin therapy resulted in rapid bacteriological eradication, with a high rate of clinical success.

Rev Med Liege, 2003 Jul-Aug, 58(7-8), 456 - 60
{Male infertility}; Demoulin A; In 2/3 of infertility problems, the male partner is, partially or entirely, responsible . His investigation starts with a careful history and is followed by a thorough physical examination . Then, comes the spermogram . In addition to an assessment of the number, motility, and morphology of spermatozoids, this examination must involve a spermocytogram, tests of anti-spermatozoid immunity, and a bacteriological analysis . The biological study of the seminal plasma is also of considerable value . Electron microscopy of sperm is valuable in asthenospermic men . A genetic and hormonal investigation is, nowadays, almost mandatory in all cases . Testicular biopsy with cryopreservation of testicular tissue and demonstration of a possible varicocele can also, in selected cases, be of great help . The overall strategy will be decided on the basis of the whole investigation.

An R Acad Nac Med (Madr), 2003, 120(1), 79 - 93
{Eugenio Espejo, the Quito physician: pioneer of bacteriology in the Americas}; Fierro Benitez R; Eugenio Espejo (1747-1795) . Mestizo . Was born in the Royal Audience of Quito . Today, the Republic of Ecuador . The 18th century was isf illustration and enlightment for the Quitenos . Espejo's extraordinary erudition is explained by the full access he had to yhe libraries created in Quito by the Jesuits . The best in the continent at that time . His work, Reflections on Smallpox, makes or Espejo outstanding in his field . Pioneer in bacteriology and of the biopathological observations in America . The first newspaper in Quito, Primicies of the culture of Quito, was his own work . Furthermore, Espejo is considered the precursor of the independence of Hispanoamerica.

Vet Res, 2003 Sep-Oct, 34(5), 565 - 78
Indicators of inflammation in the diagnosis of mastitis; Pyorala S; Mastitis affects the quality of milk and is a potential health risk for the other cows . In a well managed dairy herd, in addition to clinical mastitis, subclinical mastitis should be efficiently detected . Bacteriological sampling is not feasible as a routine test to identify subclinical mastitis, and indirect tests of mastitis are more suitable for selecting cows with intramammary infections for subsequent bacteriological sampling . Mastitis affects the composition of milk, and the degree of changes depends on the infecting agent and the inflammatory response . Indicators of inflammation in the milk which can be determined using rapid, reliable and easy routine techniques, can be used for the early detection of mastitis . The measuring of the somatic cell count in milk is the standard method, but the analysis technique is problematic for routine use in herds . The most promising parameters for monitoring subclinical mastitis are milk N-acetyl-beta-D-glucosaminidase activity, lactose, and electrical conductivity along with some other indicators such as optical and milk flow measurements, preferably with an inter-quarter evaluation included in the test . Acute phase proteins, haptoglobin and serum amyloid A, are also potential candidates for mastitis monitoring . New mastitis detection systems which can be adapted into on-line use are urgently needed, since dairy units are growing bigger and automatic milking systems are being taken into use.

Int J Tuberc Lung Dis, 2003 Oct, 7(10), 1010 - 2
Assessment of the Mycobacteria Growth Indicator Tube for the bacteriological diagnosis of tuberculosis; Diraa O et al.; Fast, accurate diagnosis is necessary for rapid treatment of patients and to prevent the spread of Mycobacterium tuberculosis strains . The rate of recovery, mean time to detection and contamination rates of the Mycobacteria Growth Indicator Tube (MGIT) were compared with Lowenstein-Jensen (LJ) medium for mycobacterial cultures performed on 405 clinical specimens decontaminated by the trisodium phosphate method without benzalkonium chloride . The recovery rate of M . tuberculosis using MGIT was 45/61 (73.8%) compared with the reference LJ . The mean times to detection of M . tuberculosis in smear-positive specimens were 11.9 days with MGIT and 20 days with LJ . For smear-negative samples, the mean times were respectively 18.6 and 31 days, and the contamination rates were respectively 4% and 1.2% . When the trisodium phosphate decontamination method is used, MGIT cannot be used alone for isolation of mycobacteria, but may be used in combination with LJ.

J Am Vet Med Assoc, 2003 Oct 1, 223(7), 993 - 8
Assessment of plasma concentrations of doxycycline in budgerigars fed medicated seed or water; Flammer K et al.; OBJECTIVE: To determine whether plasma doxycycline concentrations considered effective for treatment of avian chlamydiosis could be safely established and maintained in budgerigars via administration of doxycycline in water or seed . DESIGN: Prospective study . ANIMALS: 68 healthy mature budgerigars . PROCEDURE: In 14-day trials, plasma doxycycline concentrations were measured in budgerigars provided with water containing 0, 50, 100, 200, or 400 mg of doxycycline hyclate/L or a hulled seed diet containing 0, 100, 200, or 400 mg of doxycycline hyclate/kg . On the basis of these results, birds were fed seed containing 300 mg of doxycycline/kg for 42 days, and a control group received unmedicated seed . Blood samples for plasma doxycycline analysis were collected either in the morning on treatment days 4, 7 14, 21, 28, 35, and 42 or in the afternoon on days 12, 26, and 40 . Birds were observed daily . On days 14, 28, and 42, physical and plasma biochemical variables, PCV, and total solids concentration were measured; cloacal specimens were obtained for bacteriologic and fungal culture . RESULTS: During a 14-day period, treatment with water containing < or = 400 mg of doxycycline/L did not maintain plasma doxycycline concentrations of > or = 1 microg/mL, but seed containing 300 mg of doxycycline hyclate/kg maintained mean plasma doxycycline concentrations > 0.98 microg/mL for 42 days without notable adverse effects . CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that hulled seed containing 300 mg of doxycycline hyclate/kg can safely establish and maintain plasma doxycycline concentrations that are considered adequate for treatment of chlamydiosis in adult nonbreeding budgerigars.

Presse Med, 2003 Sep 27, 32(31), 1445 - 9
{Acute mastoiditis in children: clinical and bacteriological study of 17 cases}; Moriniere S et al.; OBJECTIVE: Acute mastoiditis (AM) represents the most frequent complication of acute otitis media (AOM) in children . In the literature, its incidence is stable but with an impressive increase in pneumococci with reduced sensitivity to penicillin (PRSP) . The aim of this study was to assess the incidence of AM in the area of Tours and the prevalence of PRSP . METHOD: This was a retrospective study of children admitted to the regional paediatric centre in the Tours area, between January 1994 and May 2001 . The coded AM files were analysed, excluding all the sub-acute forms or those complicating a cholesteatoma . The criteria studied concerned the clinical signs on admission, the imaging data and the bacteriological samples and the results of treatment . RESULTS: Seventeen children (8 boys, 9 girls) were admitted for an AM during the study period . Their mean age was of 3.2 years (range: 6 months to 13 years) . In 24% of cases, the mastoiditis existed on admission and in 59% of cases it complicated an AMO already treated with antibiotics . In 3 cases (18%), the AM was complicated on admission with peripheral facial paralysis in one case and thrombosis of the lateral sinus in 2 cases . The germ responsible was identified in 14 cases (82%) with a predominance of pneumococci (11 cases) . Eight were PRSP-type . Scan of the pars petrosa identified a subperiosteal abscess in 13 cases . Fourteen mastoidectomies were performed and the mean duration of antibiotic therapy was of 23 days . The outcome was always good . CONCLUSION: Over the past 7 years, the incidence of AM has been estimated at 1.2/100 000 children aged under 15 per year . The prevalence of PRSP is high but does not change the principles or the results of the treatment of AM.

Ned Tijdschr Geneeskd, 2003 Sep 20, 147(38), 1825 - 9
{Delay in the diagnosis of tuberculosis}; van Hest NA et al.; In five patients, a 46-year-old Surinamese man, a 45-year-old Dutch barkeeper, a 41-year-old woman from Eritrea, and an 18-year-old Afghan woman and her 43-year-old mother, tuberculosis was diagnosed and treated after a considerable delay . Such a late diagnosis and subsequent treatment is not uncommon for tuberculosis as the symptoms, physical examination, laboratory tests, imaging techniques and bacteriological results are often not very specific . However under certain circumstances, tuberculosis (including the extrapulmonary manifestations) should be considered at an earlier stage, especially among certain risk groups such as the homeless, drug addicts, immigrants and asylum seekers . In the five patients discussed the causes of delay were identified as: delay caused by the asymptomatic phase of the disease, the patient's delay in presenting, a delay on the part of the physician, a delay in diagnostic confirmation and a delay in the treatment.

J Clin Microbiol, 2003 Oct, 41(10), 4901 - 3
Paronychia due to Prevotella bivia that resulted in amputation: fast and correct bacteriological diagnosis is crucial; Riesbeck K; Prevotella bivia is mainly associated with endometritis . The case of a patient with paronychia in a thumb due to P . bivia resulting in osteitis and amputation is reported . The species was not acknowledged in the first bacterial culture 2 weeks before surgery.

Ned Tijdschr Geneeskd, 2003 Sep 13, 147(37), 1778 - 83
{Clinical reasoning and decision making in practice . A 41-year old with periodic fever of unknown origin}; Koopmans RP et al.; A 41-year-old man presented with unexplained bleeding from the right tonsil . He subsequently developed periodic fever, cervical lymphadenopathy and hepatosplenomegaly . Despite extensive bacteriological, serological and radiographic investigations for infectious disease, rheumatic disease and malignancy no diagnosis was made . Although the fever pattern was very suggestive of Pel-Ebstein fever--commonly associated with lymphoproliferative disease--multiple biopsies of lymph nodes, bone marrow, tonsils and liver all proved negative . Empirical glucocorticoid therapy gave some temporary improvement lasting for a month . Splenectomy or splenic biopsy was not carried out because of the risk of excessive bleeding . Eventually the patient died of multi-organ failure and sepsis . At autopsy, a T-cell lymphoma with an unusual phenotype and focal involvement of bone marrow, liver and spleen was found . Clinicians are sometimes faced with the dilemma of whether to perform multiple, invasive and possibly harmful diagnostic tests or to start empirical therapy . Empirical therapy may only be started if the diagnosis has been made on strong clinical grounds and, if this is not the case, only after further diagnostic tests . The question of whether a potentially harmful diagnostic test is justified depends on the clinical course, the sensitivity and specificity of the test and the therapeutic possibilities.

Pancreatology, 2003, 3(5), 383 - 8 Epub 2003 Sep 24.
Is late antibiotic prophylaxis effective in the prevention of secondary pancreatic infection?
Cinar E, Ateskan U, Baysan A, Mas MR, Comert B, Yasar M, Ozyurt M, Yener N, Mas N, Ozkomur E, Altinatmaz K.
BACKGROUND: Secondary infection of the inflamed pancreas is the principal cause of death after severe acute pancreatitis (AP) . Although patients are not always managed early in the course of AP in clinical practice, prophylactic antibiotics that were used in experimental studies in rats were always initiated early after induction of pancreatitis . The effectiveness of antibiotics initiated later is unknown . AIM: The aim of this study was to compare the effectiveness of ciprofloxacin and meropenem initiated early versus later in the course of acute necrotizing pancreatitis (ANP) in rats . METHODS: 100 Sprague-Dawley rats were studied . ANP was induced in rats by intraductal injection of 3% taurocholate . Rats were divided randomly into five groups: group I rats received normal saline as a placebo, group II and IV rats received three times daily meropenem 60 mg/kg i.p . at 2 and 24 h, respectively and group III and V rats received twice daily ciprofloxacin 50 mg/kg i.p . at 2 and 24 h, respectively, after induction . At 96 h, all rats were killed for quantitative bacteriologic study . A point-scoring system of histological features was used to evaluate the severity of pancreatitis . RESULTS: Meropenem and ciprofloxacin initiated 2 h after induction of pancreatitis significantly reduced the prevalence of pancreatic infection (p < 0.001 and p < 0.04, respectively) as compared to controls . Neither of the antibiotics initiated later during the course of AP caused a significant decrease in pancreatic infection in rats (p > 0.05) . Although the rats treated early infected less frequently than the rats treated later, the comparison reached statistical significance only in the meropenem group (p < 0.02) . CONCLUSION: Early antibiotic treatment reduces pancreatic infection more efficiently than late antibiotic treatment in ANP in rats .

Probl Tuberk Bolezn Legk, 2003, (8), 34 - 7
{Comparison of nitrate reductase and automatic BACTEC MGIT 960 AST techniques for determining the drug sensitivity of mycobacteria tuberculosis}; Golyshevskaia VI et al.; The accelerated nitrate reductase method (NRM) developed at the Central Research Institute of Tuberculosis versus the automatic assay of drug sensitivity by means of a BACTEC 960 bacteriological analyzer was assessed . NRM was carried out, by using the Lowenstein-Jensen medium for 10 days . It is based on the detection of alive Mycobacteria tuberculosis, by recording their enzymatic activity . The study showed a good agreement of the results obtained by NRM with those obtained on a BACTEC 960 analyzer . Agreements were found for 52 isolates in 47 (90.4%) cases, the results disagreed in the testing of 5 (9.6%) cultures . The results of NRM were identical to those for 21 of the 22 cultures sensitive on a BACTEC 960 device; the coincidence was 95.5% . The sensitivity of NRM ranged from 88.2% (for rifampicin) to 96.3% (for isoniazid) and the specificity did from 96% (for isoniazid) to 100% (for streptomycin, rifampicin, and ethambutol) . The positive prognostic value of NRM was 100% (for streptomycin, rifampicin, and ethambutol) and 96.3% (for isoniazid) . The negative prognostic value of NRM ranged from 94.6 to 96.8% for individual drugs . The efficiency of NRM (a ratio of the number of correct results to the total number of results) was greater than 0.96, which suggests that this method and the BACTEC MGIT 960 AST technique may be regarded as rather comparable . The testing of NRM versus the automatic BACTEC MGIT 960 AST technique has indicated that the former may be successfully used to determine the sensitivity of Mycobacteria to the critical concentrations of first-line antituberculous agents.

Intern Med, 2003 Sep, 42(9), 806 - 11
A large outbreak of Legionnaires' disease due to an inadequate circulating and filtration system for bath water--epidemiologic manifestations; Nakamura H et al.; OBJECTIVE: To study the epidemiologic manifestations of a large outbreak of Legionnaires' disease due to an inadequate circulating and filtration system for bath water . PATIENTS: In June 2000 at Ishioka City, Ibaraki Prefecture, a large outbreak of Legionnaire's disease occurred, as a result of an inadequate circulating and filtration system for communal bath water . This outbreak was the worst ever experienced in Japan, involving a total of 34 patients (20 confirmed, 14 probable), 3 of whom died . MEASUREMENTS AND RESULTS: Legionella pneumophila serogroup 1 was isolated from sputum culture in two patients . Bacteriological culture of the public bath water subsequently yielded large numbers of Legionella species . Cleavage of genomic DNA showed that restriction fragment patterns coming from clinical and environmental isolates of L . pneumophila serogroup 1 were closely related, focusing the inquiry to a public bathhouse where a circulating filtration system was suspected as the source of infection . CONCLUSIONS: It was later concluded that the circulating filtration system adopted for bath water was marred by a serious design flaw that subsequently caused the mass outbreak . Specifically, a line of the bath water was being returned to the bath without undergoing heat exchange or sterilization by chlorine; and the Legionella species that had proliferated in the filter and the bright stone filtration unit were allowed to return to the bath, eventually culminating in a mass infection.

Indian J Med Sci, 2003 Jan, 57(1), 12 - 5
Mycobacterial cervical lymphadenitis in childhood; Jindal N et al.; A study of 190 children of chronic cervical lymphadenitis showed tuberculous etiology on histopathological examination in 92 (48.4%) and bacteriological evidence of mycobacterial infection (smear and/or culture) in 42 (22.1%) . Of these 42, twelve (28.6%) showed histopathological diagnosis of non-specific lymphadenitis . Positive culture for mycobacteria was obtained in 40, of which 30 (75%) were typical M . tuberculosis and 10 (25%) were atypical mycobacteria . The most predominant species of typical mycobacteria was M . scrofulaceum (60%) followed by M . avium intracellulare (40%) . There was no remarkable difference in the histopathological pattern of those in which M . tuberculosis was grown and those in which bacterial growth was that of atypical mycobacteria . The diagnosis of chronic cervical lymphadenitis should therefore be taken a step beyond histopathology, up to complete bacteriological examination, especially to confirm the cases of mycobacterial lymphadenitis caused by atypical mycobacteria.

Ophthalmic Surg Lasers Imaging, 2003 Sep-Oct, 34(5), 409 - 12
Tuberculous osteomyelitis and optic neuritis; Das JC et al.; This case report describes a rare instance of bilateral optic papillitis associated with histologically and bacteriologically proven tubercular osteomyelitis of the right sphenoid and temporal bone of the orbit in a 30-year-old woman . This case also highlights the usefulness of computerized axial tomography of the orbits, skull, and paranasal sinuses to evaluate optic neuritis and its pathophysiology in the event of no obvious cause or contributing systemic disease.

Vet Ther, 2003 Summer, 4(2), 145 - 54
Effects of oral selenium supplementation on mastitis markers and pathogens in Estonian cows; Malbe M et al.; The effects of selenium supplementation on mastitis parameters in milk and on glutathione peroxidase (GPx) levels in blood were evaluated . Fifty-five Estonian dairy cows were allocated to selenium-supplemented (n=39) and nonsupplemented (n=16) groups . The supplemented group received 0.2 ppm organic selenium in the form of selenium yeast in their diet daily for 8 weeks . The nonsupplemented cows received their standard diet with no selenium supplementation . Mastitis parameters (i.e., bacteriologic findings and somatic cell count, N-acetyl-beta-D-glucosaminidase, and bovine serum albumin concentration) and GPx levels were monitored . The increase in the activity of GPx was significantly (P<.001) greater in selenium-supplemented cows than in nonsupplemented ones . Milk samples from each quarter were examined before and 8 weeks after initiation of the study . The proportion of quarters still pathogen-free after 8 weeks was significantly (P<.01; odds ratio {OR}=9.7) higher in selenium-supplemented cows than in nonsupplemented cows . However, when quarters milk-tested as pathogen-infected at the start of the study were reexamined after 8 weeks, there was no significant (P=.14; OR 3.6) difference in the proportion of pathogen-free quarters between selenium-supplemented cows and nonsupplemented cows . Differential positive rate (Youden's index) revealed that individual quarters were more prone to be infected by pathogens when the blood GPx activities in cows were below the cutoff value of 3.3 microkat/g hemoglobin than when GPx activity was above this value . It was concluded that selenium supplementation in cows with low GPx activity seems to support udder defense mechanisms that favor reduction of the incidence of new mastitis cases.

Presse Med, 2003 Aug 9, 32(26), 1208 - 12
{Audit on antibiotic prescriptions in a department of infectious diseases}; Zahar JR et al.; OBJECTIVES: France is one of the countries that prescribe the most antibiotics . The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria . This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases . METHODS: Over a two-month period, all the antibiotics treatments were analysed prospectively . The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Societe de pathologie infectieuse de langue francaise (Spilf)) and then with regard to the bacteriological results . RESULTS: One hundred and five prescriptions were analysed during the study period . Thirty-five percent of prescriptions were inadequate with regard to the criteria used . In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate . Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04) . CONCLUSION: This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.

Ann Dermatol Venereol, 2003 Jun-Jul, 130(6-7), 639 - 42
{Cutaneous T-cell lymphoma bullosa: 2 cases}; Heliot I et al.; INTRODUCTION: Since the first case described by Kaposi in 1887, bullous forms of cutaneous T-cell lymphomas are extremely . CASE-REPORT: We describe an unusual case of mycosis fungoides bullosa with palmoplantar dyshidrosis-like eruption and, to our knowledge, the first case of pleomorphic cutaneous T-cell lymphoma bullosa . DISCUSSION: Cutaneous T-cell lymphoma bullosa can be very misleading, particularly when the bullous lesions are inaugural . Differential diagnosis have to be excluded (autoimmune blistering diseases or contact dermatitis during topical treatment of lymphoma or bacterial or viral cutaneous infections) by biopsy, direct immunofluorescence and bacteriological examinations . In these cutaneous lymphoma bullosa, the blisters appear to de due to excessive epidermotropism and/or toxicity of the tumoral infiltrate.

Curr Med Res Opin, 2003, 19(5), 411 - 20
Short-course therapy of acute bacterial exacerbation of chronic bronchitis: a double-blind, randomized, multicenter comparison of extended-release versus immediate-release clarithromycin; Nalepa P et al.; OBJECTIVE: The objective of this study was to compare the efficacy and safety of two clarithromycin formulations given for 5 days to patients with acute bacterial exacerbation of chronic bronchitis (ABECB) . PATIENTS AND METHODS: This was a double-blind, randomized, multicenter study of ambulatory patients between 40 and 75 years of age with a medical history of chronic bronchitis, chronic obstructive pulmonary disease and a presumptive diagnosis of ABECB who met Anthonisen Type 1 criteria (increased dyspnea, increased sputum volume and increased sputum purulence) . Eligible patients received a 5-day course of clarithromycin extended-release (ER) 500 mg once daily or clarithromycin immediate-release (IR) 250 mg twice daily . Clinical cure, bacteriological cure and pathogen eradication rates were determined at the end of therapy and at a follow-up visit . RESULTS: Clinical cure rates were similar at the test-of-cure visit for evaluable patients in the clarithromycin ER group (97%, 298/307) and clarithromycin IR group (98%, 300/307) (95% CI (-3.2, 1.9)) . The bacteriological cure rate was 89% and the pathogen eradication rate was 90% in both treatment groups . Resolution or improvement in cough, sputum production, sputum volume and sputum appearance was observed in > 90% of evaluable patients in each treatment group . The incidence of study drug-related adverse events was 6.6% (23/351) in the clarithromycin ER group and 5.4% (19/352) in the clarithromycin IR group . The most frequently occurring study drug-related adverse events were abdominal pain, diarrhea and taste perversion . CONCLUSION: Clarithromycin ER 500 mg once daily for 5 days is equivalent to clarithromycin IR 250 mg twice daily for 5 days in treating adults with ABECB . Both regimens were effective in resolving clinical signs and symptoms of ABECB and eradicating the target pathogens, and were well tolerated.

Vestn Otorinolaringol, 2003, (4), 42 - 4
{Halotherapy in combined non-puncture therapy of patients with acute purulent maxillary sinusitis}; Grigor'eva NV; Halotherapy was applied for non-puncture treatment of 45 patients with acute purulent maxillary sinusitis . The response was evaluated by changes in clinico-immunological, cytological, x-ray and bacteriological parameters . Halotherapy was found effective in the treatment of acute purulent maxillary sinusitis without puncture.

J Radiol, 2003 Jul-Aug, 84(7-8 Pt 1), 861 - 4
{Tuberculosis of the knee: MRI findings in two pediatric cases}; Aloui N et al.; Osteo-articular tuberculosis is rare in infants . The MRI findings reported for adolescents and young adults mainly relate to spinal involvement . Two cases of osteo-articular tuberculosis of infants located at the knee are presented . Vaccination has been correctly done . Skin test and chest radiography were normal . Evolution was insidious for one case . Osseous, medullary, cartilaginous and soft tissue abnormalities revealed by MRI were suspicious for tuberculosis . Diagnosis was confirmed at histology for both cases and bacteriology for one case . The aim of this study is to report the MRI features of osteo-articular tuberculosis in pediatric patients.

Oral Dis, 2003, 9 Suppl 1, 54 - 62
Diagnostic testing as a supportive measure of treatment strategy; Sixou M; The bacteriological tests in periodontology have been available to clinicians since the end of the 1980s . Despite the vast and varied information that they contribute to the literature on this topic, some controversy has arisen with regard to the use of these tests . Clinicians faced with a multitude of clinical forms of periodontal disease in their patients can count on laboratory examinations to help them in the therapeutic process . These biological examinations can offer help in five areas of application: support in diagnosis and prognosis, verification of the efficiency of the treatment, indication of the correct antibiotic therapy and choice of the most appropriate molecules . The clinician's needs determine the type of bacteriological technical analysis used: bacterial culture or genetic identification using the molecular techniques . Each technique has its advantages and disadvantages . Knowing these limits allows the most appropriate choice to be made, depending on the clinical situation . The richness of information provided by culture in the anti-microbial susceptibility test and the non-targeted aspect of this test make this technique very interesting for the diagnosis of periodontitis . However, the targeted aspect of molecular techniques (PCR), their excellent sensibility and their rapidity make them prevail, particularly in the control and maintenance phases . Furthermore, despite the constant development of bacterial identification techniques, these examinations are little used by dental surgeons as these examinations are little known . They are also difficult to interpret and generate heavy additional costs.

Chest, 2003 Sep, 124(3), 893 - 901
Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study; Hara T et al.; STUDY OBJECTIVE: The purpose of this study was to examine the uptake rates of (18)F-fluorodeoxyglucose (FDG) and (11)C-choline in patients with lung cancer, pulmonary tuberculosis, and atypical mycobacterial infection of the lung by positron emission tomography (PET) scanning with relation to their tumor size . DESIGN: Ninety-seven patients with untreated lung cancer, 14 patients with untreated pulmonary tuberculosis, and 5 patients with untreated atypical mycobacterial infection were examined . The diagnosis of lung cancer was confirmed pathologically after biopsy and surgery . The diagnosis of tuberculosis and atypical mycobacterial infection was confirmed by bacterial culture . The uptake rates of FDG and (11)C-choline were presented quantitatively as the standardized uptake value (SUV) . SETTING: International Medical Center of Japan . RESULTS: In lung cancer patients, the SUV of FDG increased with increasing tumor size, whereas the SUV of (11)C-choline was almost constant at around 3.5 for every tumor size . In tuberculosis patients, the SUV of FDG increased with increasing tumor size, whereas the SUV of (11)C-choline was almost constant at around 2 for every tumor size . In atypical mycobacterial infection patients, the SUV of FDG and the SUV of (11)C-choline were equally low at around < or = 2 . CONCLUSION: The differences in the SUVs of FDG and (11)C-choline in patients with lung cancer, tuberculosis, and atypical mycobacterial infection for the same tumor size (tumor size, > 1.5 cm) were distinct . In lung cancer patients, the SUVs of both FDG and (11)C-choline were high . In tuberculosis patients, the SUV of FDG was high, but the SUV of (11)C-choline was low . In atypical mycobacterial infection patients, the SUVs of both FDG and (11)C-choline were low . It may be possible to apply this principle to make a presumptive diagnosis of a solitary pulmonary nodule if it is too small to make a definitive diagnosis pathologically and bacteriologically.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Jul-Aug, (4), 67 - 71
{Enzyme immunoassay and polymerase chain reaction for evaluation of brucella persistence}; Zheludkov MM et al.; The complex approach, including the use of traditional bacteriological and serological methods, as well as the polymerase chain (PCR) reaction and the enzyme immunoassay (EIA), was used for evaluation of Brucella (the causative agents of brucellosis) persistence in the dynamics of the infectious process in patients with the acute and chronic forms of brucellosis as well as in experimentally infected laboratory animals . Sick humans and experimental animals were found to have positive PCR and EIA reactions at different periods of the disease . The use of these methods makes it possible to evaluate indirectly the persistence of Brucella.

Jpn J Thorac Cardiovasc Surg, 2003 Aug, 51(8), 384 - 6
Early valvular obliteration of cryopreserved aortic valve allograft; Saito A et al.; This report describes a 60-year-old male patient who developed early valvular obliteration of a cryopreserved aortic valve allograft with associated severe valvular leakage . The patient had previously undergone two operations for aortic valve insufficiency resulting from infective endocarditis, and prosthetic valve endocarditis: aortic valve replacement with a mechanical prosthesis was done 4 years ago, and two years later aortic root replacement with a cryopreserved allograft was performed . Perforation through the non-coronary cusp of the aortic allograft was found, and valve replacement was achieved using a mechanical prosthesis . The intraoperative findings, histological, immunological, and bacteriological studies of the resected cusps demonstrated negative for infection and rejection, therefore, the valvular perforation might have been caused by an injury or degeneration during management of the homologous graft . The patient showed neither aortic regurgitation on echocardiography nor recurrence of endocarditis 10 months after surgery.

Neurosurg Rev, 2003 May, 26(2), 102 - 7 Epub 2002 Dec 10.
Microsurgical management of postoperative disc space infection; Bavinzski G et al.; We analysed seventeen patients with septic postoperative spondylodiscitis (POD) who were managed by early microsurgical removal of the infected necrotic tissue, application of a closed suction-irrigation system (for a mean of 6.7 days), and early mobilisation . The POD was diagnosed clinically by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values and radiographically by computerised tomography scanning or magnetic resonance imaging . According to the sensitivity studies of the obtained pathogens, systemic antibiotics were given, followed by early mobilisation of all patients in a light cast corset . Immediate pain relief was noted in all patients except one, who required a third operation that was followed by rapid clinical improvement . Bacteriological diagnosis was obtained in 88% of the patients . Excellent or good clinical long-term results were achieved in 82% of the patients, whereas 18% had poor results . Elevated ESR/CRP values returned to normal ranges within 6 to 44 days (mean 15 days) after reoperation . All but one patient tolerated early mobilisation (within 2 to 4 weeks) well without any complication . Early microsurgical removal of the necrotic and infected tissue and application of a closed suction-irrigation system supported by specific antibiotic therapy should be considered an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient.

Pneumonol Alergol Pol, 2003, 71(1-2), 86 - 94
{Purulent lung diseases necessitating surgical treatment--case reports}; Grudny J et al.; Majority of purulent lung diseases are treated with antibiotics . But sometimes this therapy is not successful and surgical treatment is necessary . Two patients are described in this paper . 68 years old woman in whom infiltration in left lung enlarged during antibiotics therapy . CT examination did not allow to differentiate between abscessus and tumor . Results of bacteriologic and cytologic examination of transthoracic biopsy were negative . During thoracothomy abscessus was resected and diagnosis was confirmed by patomorphologic examination . The second case: 16-years old girl was addmitted to hospital because of high temperature and abnormal chest X-ray picture (infiltration and liquid level in lower right lobe) . During puncture the pus was evacuated but bacteria were not cultured . Antibiotics were not effective . Thoracothomy was done and large cysta bronchogenes was resected . In both cases surgical treatment was effective.

Pneumonol Alergol Pol, 2003, 71(1-2), 12 - 6
{Surgical treatment and adjunct hyperbaric therapy to improve healing of wound infection complications after sterno-mediastinitis}; Siondalski P et al.; Although the incidence of wound complications after median sternotomy is less than 1%, it remains a serious complication in patients undergoing cardiac procedures . We suggest that the combination of hyperbaric oxygen therapy and aggressive surgical approach improves clinical outcomes in these patients . Between August 1997 and May 2002, 55 patients with postoperative sternal wound infection and/or mediastinitis were qualified for hyperbaric oxygen treatment in connection to surgical management . Surgical procedure included wound debridment and/or sternum rewiring, omental pedicle flap plasty or sternectomy . Hyperbaric oxygen therapy consisted of 20 to 40 expositions per patient and was carried before and after the surgery . RESULTS: There was no in-hospital death . The total time between the admission and discharge from the hospital varied from 2 to 24 weeks (average 8 weeks) . The infection has been cured in all patients treated for postoperative sternal wound infection . That has been confirmed by negative bacteriological tests, stabilization of the sternum and complete wound healing . CONCLUSIONS: The combination of surgical treatment and hyperbaric oxygen therapy may improve clinical outcome in patients with sterno-mediastinis and poststernotomy wound infection after cardiac surgery.

Med Microbiol Immunol (Berl), 2004 Nov, 193(4), 209 - 17 Epub 2004 Nov.
Prospective study on nontuberculous mycobacteria in patients with and without cystic fibrosis; Leitritz L et al.; Recent reports indicated an increase of nontuberculous mycobacteria (NTM) in cystic fibrosis (CF) patients . However, it is still a matter of discussion whether criteria for diagnosis of NTM pulmonary infection established by the American Thoracic Society (ATS) are applicable for CF patients . We determined incidence and prevalence of NTM in CF patients and non-CF patients without HIV infection, and validity of ATS criteria for CF patients . Over a period of 2 years, 1,251 respiratory samples were investigated for mycobacteria from 91 CF and 162 non-CF patients . For all patients with NTM recovery, we reviewed clinical charts and determined outcome for up to 2 years . Incidence and prevalence for repeated recovery of NTM were higher in CF patients, but not significantly . CF patients with repeated recovery of NTM met clinical and bacteriological ATS criteria, but radiographic criteria were not met . Treated CF patients showed favorable clinical outcomes, as opposed to untreated patients . We propose a modified definition for diagnosis and hence treatment of NTM pulmonary infection in CF patients.

Curr Treat Options Gastroenterol, 2003 Oct, 6(5), 359 - 367
Surgical Treatment of Acute Pancreatitis; Werner J et al.; Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit . Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis . Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice . Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome . Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery . Patients with sterile pancreatic necrosis should be managed conservatively . Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis . The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate . Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials . Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

Infect Control Hosp Epidemiol, 2003 Aug, 24(8), 613 - 7
A Chryseobacterium meningosepticum outbreak in a neonatal ward; Gungor S et al.; OBJECTIVE: To report epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak . DESIGN: Outbreak investigation . SETTING: A neonatal intensive care unit (NICU) of a referral teaching hospital . METHODS: During 2 weeks in September 2001, four neonates in the NICU developed sepsis and underwent laboratory investigation . Multiple samples were obtained for cultures from endotracheal tubes, mechanical ventilators and humidifier boxes, infant incubators, parenteral and antiseptic solutions, feeding bottles, sinks, faucets, doors, and healthcare workers . RESULTS: C . meningosepticum was isolated from the blood cultures of four patients . The first isolate was identified 5 days after the death of the index case . Although all isolates were ciprofloxacin susceptible in vitro, the remaining three patients did not respond to ciprofloxacin therapy given for 6 or 7 days . Therapy was switched to vancomycin and rifainpin and all three patients survived, with one having a complication (hydrocephalus) . Environmental surveillance revealed C . meningosepticum in the stock lipid solution as the source of the epidemic . The outbreak was controlled after discontinuation of intravenous lipid solution, restriction of further neonatal admissions, and thorough disinfection of the unit and its equipment . CONCLUSION: Early identification of an epidemic and its source is important in avoiding morbidity and mortality . A contaminated lipid stock bottle was the source of this outbreak associated with multiple cases and one death.

Vet Microbiol, 2003 Sep 24, 95(4), 229 - 37
Evaluation of a newly developed real-time PCR for the detection of Taylorella equigenitalis and discrimination from T . asinigenitalis; Premanandh J et al.; A 'culture-LightCycler PCR' assay has been developed for the detection of Taylorella equigenitalis, the causative agent of contagious equine metritis (CEM) in horses . The primers and hybridisation probes were derived from the 16S rDNA sequence . Their specificity was determined in two closely related organisms and six commensal bacteria of the genital tract . The assay was specific for T . equigenitalis and discriminates T . asinigenitalis isolates . It also avoids misidentifications of morphologically and phenotypically similar organisms . The sensitivity was evaluated in comparison to a standard bacteriological culture method . It detected T . equigenitalis in 10 of 52 samples that had not been identified bacteriologically . The results indicated that the assay had a greater sensitivity . This is the first real-time PCR for the detection of T . equigenitalis and avoids PCR carry-over contamination . The 'culture-LightCycler PCR' assay is specific, sensitive and reproducible, and can be used effectively for the detection of T . equigenitalis infections.

Leg Med (Tokyo), 2003 Mar, 5 Suppl 1, S233 - 6
Fatal outcome of varicella in children; Kernbach-Wighton G et al.; Varicella or chicken-pox are one of the most frequent diseases in childhood . Severe or even lethal complications are rare (in about 0.03 per thousand ) . Our paper presents two cases of varicella infections leading to sudden deaths (3- and 7-year-old children) . In one of these cases, the paediatrician in charge was accused of an impaired medical treatment . Both of the children showed multiple typical efflorescences in different stages . Furthermore were observed affections of the respiratory tracts and serious involvements of the hearts, the lungs, and the livers . In one case an immunological identification could be made of an acute varicella infection . Based on autoptical, histological, bacteriological, virological, and neuropathological findings is given an analysis of such uncommon and severe courses of chicken-pox in children being identified as haemorrhagic form and massive abscess-forming varicella pneumonia.

Tunis Med, 2003 May, 81(5), 329 - 33
{Male gonococcal urethritis in the region of Sfax (1996-2000)}; Znazen A et al.; The sexually transmitted infections pose a real public health problem, mainly in developing countries . In Tunisia, the epidemiological state is not precise . The objective of our study was to determine the sociological, epidemiological and bacteriological characteristics of gonococcal urethritis in the area of Sfax . The study was performed on all patients attending at the CNSS of Sfax for urethritis for 5 years, from 1996 to 2000 . A urethral swab was carried out for each patient with a classic bacteriological exam . 256 cases were collected . The mean age was 29.7 years . 74.3% were workers . The direct exam was positive in 51.2% of cases and the culture enabled us to isolate 72 strains, of which 15.5% were productive of beta-lactamase and 23.9% were resistant to tetracyclin . There was no resistance to pristinamycin, ofloxacin nor spectinomycin.

Nihon Kokyuki Gakkai Zasshi, 2003 Jul, 41(7), 457 - 62
{A case of Farmer's lung accompaign with caseous granuloma, monitored with serum KL-6 and SP-D}; Samukawa T et al.; A 65-year-old man was admitted to our hospital with a productive cough, fever, and dyspnea; his chest radiographs revealed diffuse nodular and ground-glass opacities . He had worked on a farm for 11 years . Six months earlier, he had presented with similar symptoms at another hospital, and was admitted with suspected atypical pneumonia . After treatment with antibiotics, his condition improved and he was discharged . Examination on admission to our hospital revealed markedly elevated serum KL-6 levels . Histological findings from specimens obtained by video-assisted thoracic surgical lung biopsy showed caseating and non-caseating epitheloid cell granuloma, lymphocyte infiltration, and alveolitis . Bacteriological tests for mycobacteria and fungi were all negative . Farmer's lung was diagnosed in accordance with the criteria for hypersensitive pneumonia . It is generally accepted that the distinguishing histological finding for Farmer's lung disease is non-caseating epitheloid cell granuloma, but in this case, caseous granuloma was also present.

Am J Clin Pathol, 2003 Aug, 120(2), 256 - 64
Bacteriologic characterization of 36 strains of Roseomonas species and proposal of Roseomonas mucosa sp nov and Roseomonas gilardii subsp rosea subsp nov; Han XY et al.; We used a polyphasic approach (sequencing analysis of the 16S ribosomal RNA gene and phenotypic analyses) to characterize 36 strains of Roseomonas species isolated from blood . Five strains, represented by strain MDA5176 (M.D . Anderson Cancer Center), were identified as Roseomonas gilardii . One strain belonged to Roseomonas genomospecies 4 . The 22 strains represented by strain MDA5527 showed significant differences genotypically and phenotypically with R gilardii and other Roseomonas species and represented a new Roseomonas species; Roseomonas mucosa sp nov was proposed to denote its prominent mucoid, almost runny colonies . Eight strains, represented by strain MDA5605, had minor differences with R gilardii and displayed obvious pink to red colonies; Roseomonas gilardii subsp rosea subsp nov was proposed . For subspecies differentiation, R gilardii was proposed to be R gilardii subsp gilardii subsp nov . Unique patterns of biochemical reactions were established for these Roseomonas species, which may assist routine identification of these organisms . All 36 strains and 2 American Type Culture Collection strains were susceptible to amikacin and ciprofloxacin but resistant to cefepime and ceftazidime . They also were frequently susceptible to imipenem and ticarcillin-clavulanate but far less susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin . R mucosa strains were most resistant, whereas R gilardii subsp gilardii strains were most susceptible.

Shock, 2003 Sep, 20(3), 251 - 6
Orally inoculated Escherichia coli strains colonize the gut and increase bacterial translocation after stress in rats; Nettelbladt CG et al.; Coliforms are the members of the indigenous gut flora that most often translocate to mesenteric lymph nodes . Very few strains of Escherichia coli found in cecal contents of rats are able to translocate . The present study investigated the role of the composition of the gut flora for the occurrence of bacterial translocation . Two strains of E . coli (KI-C1 and KI-C2), previously shown to translocate in rats subjected to stress, were given by oral inoculation to rats lacking these strains . A biochemical fingerprinting method was used to identify bacteria in cecal contents, on cecal epithelium, and in mesenteric lymph nodes . In a challenge study, the inoculated E . coli strains were shown to colonize the rats and persist for up to 75 days in cecum . Subsequently, one group was starved for 24 h and a second group was subjected to experimental hemorrhage and then starved for 24 h before sampling for bacteriological analyses from blood, cecum, and mesenteric lymph nodes . Two parallel groups of rats served as controls and were not inoculated but otherwise received the same treatment before sampling . In the inoculated group, starved for 24 h, seven out of 11 rats showed translocation, whereas in the noninoculated group one of 11 rats showed translocation (P < 0.05) . In groups subjected to hemorrhage and then starved for 24 h, 15/22 rats in the inoculated and 5/20 rats in the noninoculated group showed translocation (P < 0.01) . These findings show that orally inoculated KI-C1 and KI-C2 strains can colonize the gut and can substantially increase bacterial translocation in rats subjected to mild and severe stress . The composition of the gut flora seems to be an underestimated factor in the pathophysiology of bacterial translocation.

J Comp Pathol, 2003 Aug-Oct, 129(2-3), 100 - 10
Mycoplasma bovis-associated suppurative otitis media and pneumonia in bull calves; Maeda T et al.; Outbreaks of Mycoplasma bovis-associated otitis media and pneumonia occurred on four beef cattle farms in Hokkaido, Japan between 2000 and 2001 . The morbidity and mortality were estimated at 8-40 and 30-100%, respectively . Eight calves with bilateral ear droop and exudative otitis media were examined bacteriologically and histopathologically . M . bovis was isolated post mortem from nasal swabs and from the ears, lungs, lymph nodes (cranial and pulmonary), brain and heart of all calves . At necropsy, suppurative exudates were observed in the tympanic bullae of all cases . Numerous abscesses were also found in the petrous portion of the temporal bone and lungs in seven cases . Histopathologically, the exudates within the tympanic bullae consisted of a mixture of neutrophils, necrotic cell debris and fibrin, and the tympanic mucosa was thickened with neutrophil and macrophage infiltration and proliferation of fibrous connective tissue . Pulmonary lesions included extensive foci of coagulative necrosis surrounded by numerous neutrophils . Hepatocytes or renal tubular epithelial cells were enlarged with hyaline cytoplasmic inclusions in four calves . Immunohistochemical labelling confirmed the presence of M . bovis antigen in the cytoplasm of the inflammatory cells in the middle ear, temporal bone and lungs, and was also demonstrated within the cytoplasmic inclusions of the hepatocytes and renal tubular epithelial cells . Ultrastructurally, mycoplasma-like organisms, 200-500 microm in diameter, were found within not only hepatocytes and renal tubular epithelia but also within axons of the facial nerves . The present results show that M . bovis spreads to multiple organs and is capable of invading various kinds of host cell . The intracellular localization may be favourable for evading host immune responses.

Rheumatol Int, 2004 Jan, 24(1), 9 - 13 Epub 2003 Aug 14.
Diagnosing tuberculous spondylitis: patients with back pain referred to a rheumatology outpatient department; Kotevoglu N et al.; The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations, slow development of radiographic abnormalities, and nonspecific constitutional symptoms . This lack of specific symptoms causes delays in diagnosis . Magnetic resonance imaging demonstrates osteitis, intraosseous abscesses, paravertebral and epidural soft tissue extensions and abscesses, discitis, multilevel involvement of spinal cord or nerve root compression, and scoliosis . We present six patients with tuberculous spondylitis referred to our outpatient department with back pain resistant to medical therapy . All of them were women aged from 25 to 58 years (mean 44.6) . The diagnosis of tuberculous spondylitis was based on clinical presentation, radiographic and/or MRI evidence of focal destructive vertebral lesions (with paravertebral mass), and positive bacteriological findings of Mycobacterium tuberculosis . The combined antituberculous chemotherapy consisted of 1.0 g/day streptomycin for 1 month, 25 mg/kg ethambutol or 25 mg/kg pyrazinamide, 600 mg/day rifampicin, and 300 mg/day isoniazid . The duration of therapy was 12 months . All the patients recovered without any sequelae . The mean follow-up period was 28 months (range 12-48) . Magnetic resonance imaging is considered the main imaging modality for patients with suspected tuberculous spondylitis; it must be included in differential diagnosis of back pain and, if it is diagnosed in early stages, antituberculous chemotherapy enables satisfactory outcome.

J Heart Valve Dis, 2003 Jul, 12(4), 530 - 4
Antineutrophil cytoplasmic autoantibody-negative antiproteinase 3 syndrome presenting as vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture; Stollberger C et al.; Antiproteinase 3 antibodies (antiPR3) are assumed to be subtypes of antineutrophil cytoplasmic autoantibodies (ANCA), with a high specificity for active Wegener's granulomatosis and microscopic polyangiitis . Thus, antiPR3 positivity in ELISA, together with negativity in indirect immunofluorescence (IIF) is a rare finding . A 56-year-old man with Dupuytren's contracture and polyneuropathy was admitted for leukocytoclastic vasculitis . Echocardiography, performed because of fever and dyspnea, detected aortic valve endocarditis . Because of severe aortic insufficiency the valve was replaced . Blood cultures and bacteriologic investigations of the explanted valve were negative . AntiPR3 were elevated (123-163 U/ml; normal <6 U/ml), together with negativity in IIF . This case shows that antiPR3 elevation with negative ANCA may be associated with vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture . A causal relationship between the clinical presentation and antiPR3 elevation is likely . In order not to miss such cases of vasculitis, combined screening by IIF and ELISA is recommended in selected cases.

Lin Chuang Er Bi Yan Hou Ke Za Zhi, 2003 May, 17(5), 291 - 3
{Bacteriologic examination in experimental maxillary sinusitis of rabbits}; Liu F et al.; OBJECTIVE: To investigate how to induce experimental maxillary sinusitis so as to explore its bacteriologic changes . METHOD: Forty New Zealand white rabbits were divided into six groups according to different methods to create experimental sinusitis . The purulent discharge of sinus and bacteria culture is investigated in different times . RESULT: The positive rate of bacteria culture are 0%(control group), 20%(sham-operation group), 84.6% (ostia-block group), 10%(bacteria inoculation group) and 100%(ostia-block plus bacteria inoculation group) . The cultivate bacteria are mainly inoculate ones when sinusitis induced shorter than 2 weeks . If maxillary sinusitis induced more than 3 weeks, the cultivate bacteria are mainly opportunistic pathogens of rabbits . CONCLUSION: Experimental maxillary sinusitis can be successfully induced by bacteria inoculation with an ostium closed . The cultivate rate of opportunistic bacteria is related to the process of sinusitis.

Hong Kong Med J, 2003 Aug, 9(4), 263 - 8
Prevalence and predictors of default from tuberculosis treatment in Hong Kong; Chan-Yeung M et al.; OBJECTIVE: To determine the prevalence and risk factors of default from tuberculosis treatment in Hong Kong . DESIGN: Retrospective study . SETTING: Data were obtained from programme forms completed by physicians in the Hong Kong Government Tuberculosis and Chest Service and from medical records from Hong Kong chest clinics . PATIENTS: In all, 5917 patients registered for antituberculous drug therapy in 1996; medical records of 5757 patients were reviewed . MAIN OUTCOME MEASURES: Patients who defaulted treatment were defined as those who had failed to collect medication for more than 2 consecutive months after the date of the last attendance during the course of treatment . Demographic and clinical characteristics, including history, treatment, and outcome, were compared between defaulters and non-defaulters, both among the whole group and among those with pulmonary disease . RESULTS: There were 442 (8%) patients who defaulted from treatment . Forty-five percent of those who defaulted did so in the first 2 months of treatment . Key risk factors associated with non-compliance were a history of default, male sex, and a history of concomitant liver disease or lung cancer . Among patients with pulmonary tuberculosis (381 defaulters and 1537 non-defaulters), multiple drug resistance was also associated with default from treatment . Among defaulters with pulmonary disease, 39% were still bacteriologically positive at the time of default . CONCLUSION: Default from treatment may be partially responsible for the persistent high rates of tuberculosis in Hong Kong in the past decade . Health professionals should ensure that all barriers to treatment be removed and that incentives be used to encourage treatment compliance.

Kisaengchunghak Chapchi, 1982 Dec, 20(2), 93 - 99
Studies On Intestinal Trematodes In Korea: V . A Human Case Infected By Fibricola Seoulensis (Trematoda: Diplostomatidae); Seo BS et al.; A 25-year old Korean male was admitted to Seoul National University Hospital on July 5, 1982 because of fever, epigastric discomfort and diarrhea . Laboratory examination revealed moderate eosinophilia, and large operculated helminth eggs in stool repeatedly . Other laboratory test resulted in normal range and bacteriological cultures were nefative . Under the impression of intestinal fluke infection, bithionol treatment with magnesium purgation was tried . From the diarrheal stool after treatment, a total of 79 small adult trematodes was collected, and identified as Fibricola seoulensis . The patient had eaten raw viscera of 2 snakes 9 days before admission in a rural village in Korea . It was assumed that this is the first record that described human infection by an adult diplostomatid fluke.

Hist Cienc Saude Manguinhos, 2003 Jan-Apr, 10(1), 85 - 111
{On the abominable profession of being a vampire: Emílio Goeldi and Mosquitos in Pará (1905)}; Sanjad N; In the fields of public health and entomology, the turn of the 20th century was marked by an emphasis on insects as transmitters of disease . Physicians, bacteriologists and zoologists perseverently tried to understand the etiology of diseases like malaria and yellow fever and make an inventory of the species of insects associated with disease, studying their scientific and biological classification and establishing procedures to control epidemics . The Swiss zoologist Emilio Goeldi (1859-1917), who was then director of the Museum of Natural History and Ethnography of Para, in Belem, was an active participant in this scientific network and wrote a number of papers on mosquitos in the Amazon . His ideas and contributions to zoology and medical entomology are the focus of this paper.

Hist Cienc Saude Manguinhos, 2003 Jan-Apr, 10(1), 13 - 83
{Adolpho Lutz: a biographical sketch}; Benchimol JL; This article portrays the family origins and life story of Adolpho Lutz (1855-1940) up to his transfer to the Instituto Oswaldo Cruz in 1908 . His life history is used as a motif for an analysis of the institution of pasteurian and tropical medicine in Brazil . His university and postgraduate study in German-speaking Europe are examined, as are his activities as a clinician and researcher on subjects related to helminthology, parasitology, veterinary medicine and bacteriology in the interior of Sao Paulo state; his stay at the Molokai leprosarium in Hawaii; and the medical controversies in which he participated as head of the Bacteriological Institute of Sao Paulo, especially those on cholera, dysenteries, typhoid fever, malaria and yellow fever.

J Am Coll Surg, 2003 Aug, 197(2), 206 - 11
Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center; Byrne MF et al.; BACKGROUND: Standard treatment for acute cholecystitis is cholecystectomy, but some patients are at high risk for immediate surgery . Percutaneous cholecystostomy might be the procedure of choice in this group . We reviewed the experience of percutaneous cholecystostomy in a large tertiary center population . STUDY DESIGN: We performed a retrospective analysis of patients who underwent percutaneous cholecystostomy, and recorded indications for cholecystostomy, duration of tube placement, clinical outcome, death within 30 days of procedure, complications, bacteriology of aspirated bile, gallbladder contents, and performance of interval cholecystectomy . RESULTS: Forty-five patients (mean age 63 years) had cholecystostomy tubes placed from July 1999 to March 2002 . All had confirmed or presumed acute cholecystitis . Mean duration of tube insertion was 54.3 days . Thirty-six patients improved clinically within 5 days . Nine patients died within 30 days; only one death was directly related to gallbladder sepsis . Nine patients subsequently had laparoscopic cholecystectomy, eight had open cholecystectomy, and two had cholecystoenterostomy . Cholecystectomy was planned in another five patients . Cholecystostomy tubes leaked in two patients, blocked in four, and dislodged in one . One patient developed a hemoperitoneum . Bile aspirated at cholecystostomy was culture positive in 12 patients, negative in 16, and not sent or recorded in 17 . Twenty-two patients had gallstones, 10 had sludge, 9 had both, and 4 had neither . CONCLUSIONS: In experienced hands, percutaneous cholecystostomy is easy to perform, with low complication and high success rates . It is the procedure of choice in patients with acute cholecystitis unfit for emergency surgery . Patients often improve clinically, so that cholecystectomy can be done electively.

An Sist Sanit Navar, 1999 May-Aug, 22(2), 177 - 87
{Evaluation of the Program for the Prevention and Control of Tuberculosis during the period January 1993 - June 1996}; Andueza J et al.; In 1992 a Technical Commission was formed in Navarra with the participation of different specialists who drew up the Program of Vigilance and Control of Tuberculosis . We present the results of the evaluation of this program for the period from January 1993 to June 1996 . In the 3.5 years of the study, 419 cases of tuberculosis were found, 317 belonging to respiratory forms and 102 to extra-respiratory forms . The annual rate of incidence of total tuberculosis, 22.8 cases per 100,000 inhabitants observed in Navarra, is the lowest of those registered at the level of the Autonomous Communities according to the TIR study of the SEPAR (acronym for Spanish Society of Pneumology and Thoracic Surgery) in 1996, and the second lowest, after Castilla-La Mancha, according to the multicentric study of the National Centre of Epidemiology . In Navarra the highest rates of incidence are produced in those over 65 years of age, following the pattern observed in the more developed countries . 13.9% of the patients with respiratory tuberculosis showed co-infection by HIV, and besides more than 90% of these were users of intravenous drugs . The percentage of immigrants, prisoners and the destitute observed in the Navarra series is lower than that found in areas such as Madrid, Barcelona or Zaragoza . 91% of the cases of respiratory tuberculosis showed bacteriological confirmation and 98% of the cases were diagnosed and treated in specialised care . Outstanding were the high follow-up of the cases until discharge and the high percentage of cures achieved, some 85.4%.

Thorax, 2003 Aug, 58(8), 680 - 5
Resolution of bronchial inflammation is related to bacterial eradication following treatment of exacerbations of chronic bronchitis; White AJ et al.; BACKGROUND: Recent studies of the role of bacteria in chronic bronchitis have shown that bacterial colonisation is associated with enhanced inflammation and that purulent acute exacerbations of chronic bronchitis (AECB) are associated with bacteria and characterised by increased inflammation . Changes in bronchial inflammation in response to the success or failure of bacterial eradication following AECB were therefore studied . METHODS: Bacterial quantitative culture and sputum markers of inflammation (myeloperoxidase (MPO), neutrophil elastase, leukotriene B4 (LTB4), sol:serum albumin ratio, and secretory leukoprotease inhibitor) were measured in patients presenting with culture positive purulent AECB and repeated 10 days and 2 months later . 41 patients provided sputum sufficient for both bacteriology and assessment of inflammation at baseline and day 10, and 46 provided sufficient sample for bacteriology, 40 of which could also be analysed for inflammation at 2 months (when clinically stable) . RESULTS: At day 10, 17 of the 41 patient samples had a positive bacterial culture . In the stable state, 18 of the 46 samples had a positive culture, but with a significantly lower bacterial load than at presentation . Although there was no difference between the groups at presentation, the concentration of MPO was lower (p<0.05) in those in whom bacteria were eradicated by day 10 than in those with persisting bacteria . The LTB4 concentration was similarly lower (p<0.001) in those in whom bacteria were eradicated than in those with persistent bacteria . In the stable clinical state the concentrations of both MPO and LTB4 were lower in those in whom bacteria were eradicated than in patients with persisting bacteria . CONCLUSION: Resolution of bronchial inflammation following AECB is related to bacterial eradication . Those in whom bacteria continue to be cultured in their sputum have partial resolution of inflammation which may reflect continued stimulation by the reduced bacterial load.

Cornea, 2003 Aug, 22(6), 569 - 72
How long can donor sclera be safely stored?
Romanchuk KG, Nair P, Grahn B.
PURPOSE: To determine whether after prolonged storage of sclera in glycerin, there is any bacteriologic contamination that will reactivate, whether reconstituted sclera retains its tensile strength, and whether sclera retains its microstructural integrity . METHODS: Sixty-six scleral shells stored in glycerin for 9 to 19 years, as well as 11 controls stored for 6 months to 4 years, were studied by cutting a small wedge of tissue from the anterior margin of each and directly inoculating into thioglycolate broth, cutting an equatorial ring and determining its break strength using a tensiometer, and cutting a small piece from the remaining posterior portion and examining by scanning electron microscopy . RESULTS: After such prolonged storage, bacteriologic contamination was not detected, tensile strength generally increased with increasing duration of storage, and ultrastructural integrity was maintained on scanning electron microscopy . CONCLUSIONS: This study suggests that storage of scleral shells can be safely prolonged; we hope this can facilitate an increased supply of donated sclera to patients and surgeons.

Trends Microbiol, 2003 Jul, 11(7), 318 - 21
Gene-sequence-based criteria for species definition in bacteriology: the Bartonella paradigm; La Scola B et al.; The definition of new species is currently based on polyphasic classification that includes both determination of phenotypic characteristics and DNA-DNA homology . However, none of these techniques is convenient for the rapid characterization of fastidious or non-culturable bacteria . Using sequences available in the GenBank database, we compared the similarities of gene fragments among the currently recognized Bartonella species . This comparison led to both the definition of similarity values that discriminated Bartonella at the species level and assessment of the relative discriminatory power of each gene examined . In this perspective, rpoB and gltA were found to be the most potent.

J Int Med Res, 2003 May-Jun, 31(3), 157 - 69
Oral telithromycin 800 mg once daily for 5 days versus cefuroxime axetil 500 mg twice daily for 10 days in adults with acute exacerbations of chronic bronchitis; Zervos MJ et al.; The efficacy and safety of a 5-day regimen of 800 mg telithromycin once daily was compared with a standard 10-day regimen of 500 mg cefuroxime axetil twice daily in a multicentre, randomized, double-blind, parallel-group trial involving 376 patients with acute exacerbations of chronic bronchitis (AECB) . In clinically evaluable patients (n = 282), post-therapy clinical cure rates were 86.4% with telithromycin and 83.1% with cefuroxime axetil . In bacteriologically evaluable patients (n = 53), eradication or presumed eradication of the pathogen was achieved in 76.0% and 78.6% of telithromycin and cefuroxime axetil patients, respectively . Adverse events were mostly mild; the most common were diarrhoea (12.8% versus 11.8%) and nausea (8.9% versus 3.2%) in telithromycin and cefuroxime axetil patients, respectively . The 5-day regimen of 800 mg telithromycin once daily was similar in efficacy and equally well tolerated as a 10-day regimen of 500 mg cefuroxime axetil twice daily in adults with AECB.

Clin Ther, 2003 May, 25(5), 1453 - 68
Randomized, open-label, parallel-group, multicenter study of the efficacy and tolerability of IV gatifloxacin with the option for oral stepdown gatifloxacin versus IV ceftriaxone (with or without erythromycin or clarithromycin) with the option for oral stepdown clarithromycin for treatment of patients with mild to moderate community-acquired pneumonia requiring hospitalization; Correa JC et al.; BACKGROUND: Empiric therapy for community-acquired pneumonia (CAP) requires the use of antibiotics with activity against a broad spectrum of respiratory pathogens and suitable pharmacokinetic properties to simplify IV-to-oral step-down therapy switches . OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of IV gatifloxacin with the option for oral stepdown gatifloxacin with a standard regimen of IV ceftriaxone (with or without erythromycin or clarithromycin) with the option for oral stepdown clarithromycin in patients with mild to moderate CAP requiring hospitalization . METHODS: In a randomized, open-label, parallel-group, multicenter study, adults with CAP received 7 to 14 days of treatment with either IV gatifloxacin 400 mg QD with the stepdown option or IV ceftriaxone 1 or 2 g QD (with or without erythromycin 0.5 or 1 g QID or clarithromycin 500 mg BID) with the stepdown option . RESULTS: One hundred seventy adults with CAP were included in the study . IV gatifloxacin was stepped down to oral gatifloxacin in 90.6% (7785) of patients; IV ceftriaxone was stepped down to oral clarithromycin in 87.1% (7485) of patients . Among clinically evaluable patients (n = 153), cure rates at 1 to 3 days after treatment were 97.4% in the gatifloxacin group (7476) and 90.9% in the ceftriaxone group (7077), with a 95% CI for the difference (-3.7% to 19.1%) indicating statistical equivalence . In patients in whom pathogens were isolated from pretreatment sputum cultures, bacteriologic eradication rates were 100.0% (2929) and 90.9% (3033), respectively . Both regimens were well tolerated; treatment-related adverse events occurred in 27.1% (2385) and 21.2% (1885) of patients, respectively . CONCLUSIONS: In the population studied, treatment with IV gatifloxacin with an option for oral stepdown gatifloxacin was as effective for achieving clinical cure as IV ceftriaxone (with or without concomitant IV erythromycin or clarithromycin) with an option for oral stepdown clarithromycin . Both regimens were well tolerated.

Am J Vet Res, 2003 Jul, 64(7), 845 - 54
Effects of pico-tesla electromagnetic field treatment on wound healing in rats; Trostel CT et al.; OBJECTIVE: To evaluate the effects of a pico-tesla electromagnetic field (PTEF) on healing of sutured and open skin wounds and clinicopathologic variables in rats . ANIMALS: 64 male Fischer-344 rats . PROCEDURE: An incision made in the dorsal aspect of the neck was sutured (n = 32) or left open to heal (32) . In each group, 16 rats were not PTEF-treated (controls) . Wound treatment consisted of exposure to a PTEF once daily . Rats in each group were euthanatized at days 2, 4, 7, and 14 . Wounds were evaluated via tensiometry (sutured wounds), digital planimetry (open wounds), laser Doppler perfusion imaging, bacteriologic culture, and histologic examination . Blood samples were collected from all rats for analysis . RESULTS: At day 14, sutured wounds in PTEF-treated rats were stronger (ultimate stress) and tougher (strain energy) than were sutured wounds in control rats . Open wounds in PTEF-treated rats contracted more quickly at days 2 and 4 than did those in control rats . Compared with control wounds, histologic changes (indicative of improved healing) in sutured and open wounds in PTEF-treated rats were detected as early as day 4 . Laser Doppler perfusion measurements, results of CBCs, serum biochemical analyses, and bacteriologic cultures were not different between groups . CONCLUSIONS AND CLINICAL RELEVANCE: Exposure to the PTEF caused no adverse effects on clinicopathologic, histologic, or bacteriologic variables tested in this study . It appears that PTEF is a safe form of adjuvant treatment for wounds and improves strength of sutured wounds and speeds contraction of open wounds.

Matrix Biol, 2003 May, 22(3), 241 - 9
Selective adhesion of osteoblastic cells to different integrin ligands induces osteopontin gene expression; Carvalho RS et al.; Skeletal homeostasis is partly regulated by the mechanical environment and specific signals generated by a cell's adhesion to the matrix . Previous studies demonstrated that osteopontin (OPN) expression is stimulated in response to both cellular adhesion and mechanical stimulation . The present studies examine if specific integrin ligands mediate osteoblast selective adhesion and whether opn mRNA expression is induced in response to these same ligands . Embryonic chicken calvaria osteoblastic cells were plated on bacteriological dishes coated with fibronectin (FN), collagen type I (Col1), denatured collagen/gelatin (G), OPN, vitronectin (VN), laminin (LN) or albumin (BSA) . Osteoblastic cells were shown to selectively adhere to FN, Col1, G and LN, yet not to VN, OPN or BSA . Opn mRNA expression was induced by adhesion to Col1, FN, LN and G, but neither OPN nor VN induced this expression . Examination of the activation of the protein kinases A and C second signaling systems showed that only adhesion to FN induced protein kinase A and protein kinase C (PKC) activity while adherence to Col1 induced PKC . Evaluation of the intracellular distribution of focal adhesion kinase (FAK) and p-tyrosine within cells after adherence to FN, VN or BSA demonstrated that adherence to FN stimulated FAK translocation from the nucleus to the cytoplasm and high levels of p-tyrosine localization at the cell surface . However, cell adherence to VN or BSA did not show these morphological changes . These data illustrate that osteoblast selective adhesion is mediated by specific integrin ligands, and induction of intracellular second signal kinase activity is related to the nature of the ligand.

Riv Biol, 2003 Jan-Apr, 96(1), 137 - 44
Insect bacteria and hazelnut pests' biocontrol: the state of the art in Turkey; Yaman M; Turkey is first among all hazelnut producing countries . However, it lags far behind them in terms of amount harvested per unit area . A main reason for this is that hazelnut has many agricultural pests that can not be effectively controlled . Chemical pesticides utilized to control these pests have hazardous effects on the environment . Increasing problems with resistance of these pests to most commonly used synthetic insecticides have spurred the search for alternative pest management strategies that would reduce reliance on synthetic insecticides . Biological control of hazelnut pests is an alternative control method to chemical pesticides . It is very important ecologically because of production of honey, milk and fish in the surrounding areas of hazelnut fields in Turkey . Several promising bacteriological studies have been made to find some biological control agents against these pests in Turkey . This paper presents a review of the current status of bacteriological studies on biological control of hazelnut pests in Turkey.

J Perinatol, 2003 Jul-Aug, 23(5), 404 - 8
Impact of race and ethnicity on the outcome of preterm infants below 32 weeks gestation; Petrova A et al.; OBJECTIVES: To determine the impact of race/ethnicity on mortality and morbidity such as intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD) and bacteriologically confirmed sepsis, assisted ventilation, surfactant administration, intrauterine growth retardation (IUGR), and patent ductus arteriosus (PDA) among very prematurely delivered infants . STUDY DESIGN: Retrospective study of a cohort of 1006 preterm neonates with gestational age ranging from 22 to 32 weeks discharged from the Neonatal Intensive Care Unit (NICU) between 1998 and 2001 . Subgroup analysis according to gestational age (GA) (22 to 24, 25 to 28, and 29 to 32 weeks) and plurality (singleton and multiple) was performed using the chi(2) test and an analysis of variance . RESULTS: Of the 1006 infants, 54.3% were white, 21.7% black, 13.7% Hispanic, and 10.3% were classified as Other . Multiple births among white infants were approximately twice that in (42.4%) black infants (22.1%), and was also significantly higher than in the Hispanic (28.3%) and other race/ethnic groups (25.2%) . Overall, a higher proportion of black infants were born with a GA <or=28 weeks (n=115, 55.3%) than white (n=201, 37.1%) and Hispanic (n=53, 38.4%), p<0.05 . Therefore, black neonates had a lower GA (27.9+/-2.9 weeks) and birth weight (1170+/-463 g) as compared to white (p<0.0002) and Hispanic infants (p<0.0001) . There was no significant impact of race/ethnicity on the mean gestational age in any of the gestational age categories . Infant mortality and morbidity in each gestational age category by race/ethnicity were comparable . The multiple birth black infants were seen to have a lower gestational age and birth weight as compared to singleton black as well as to white, Hispanic and other race/ethnic groups . However, this did not influence morbidity and mortality in multiple birth black neonates . The result of this study showed that the level of prematurity and not plurality predominantly influences the rate of infant mortality and morbidity in each race/ethnic category . CONCLUSIONS: The reduction in gestational age and birth weight in black neonates is not associated with an increased risk of infant mortality and morbidity . In general, the outcomes of black singleton and multiple pregnancies were comparable with those of white, Hispanic and other race/ethnic groups.

Int J Clin Pract, 2003 Jun, 57(5), 377 - 84
Efficacy and tolerability of once-daily oral therapy with telithromycin compared with trovafloxacin for the treatment of community-acquired pneumonia in adults; Pullman J et al.; A randomised, double-blind study of adults with community-acquired pneumonia (CAP) resulted in clinical cure rates of 90.0% for telithromycin and 94.2% for trovafloxacin . Bacteriological eradication rates were also comparable for both treatments . All high-risk patients (i.e . > or = 65 years old {n=25}, Pneumonia Severity Index score > or = 111 {n=16}, pneumococcal bacteraemia {n=4}) were clinically cured . In infections caused by Mycoplasma pneumoniae and Chlamydophila (Chlamydia) pneumoniae, clinical cure rates were 93.3% (14/15) for telithromycin and 100% (16/16) for trovafloxacin . Possibly drug-related, treatment-emergent adverse events (TEAEs) were considered mild and occurred in 47.2% of telithromycin and 33.0% of trovafloxacin patients . The most frequently reported, possibly drug-related, TEAEs were diarrhoea and nausea for telithromycin and diarrhoea and headache for trovafloxacin . Serious TEAEs occurred in 1.9% of telithromycin and 1.8% of trovafloxacin subjects and were considered not drug related . No deaths occurred during the study . Telithromycin and trovafloxacin were safe and comparable in efficacy in these patients with CAP.

Rev Chir Orthop Reparatrice Appar Mot, 2003 Apr, 89(2), 163 - 6
{Total hip replacement prosthesis infected by Mycobacterium tuberculous}; Boeri C et al.; We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection . Revision total hip arthroplasty (THA) was performed in one patient . The prosthesis was left in situ in the second patient due to lack of sufficient bone stock . Medical treatment was given . The diagnosis was established on direct examination of bacteriological samples and culture on specific media . Polymerase chain reaction identified the Mycobacterium tuberculosis complex . Non-specific granulomas were observed on the histology sections . For us, management of overt tuberculosis involving a THA depends on the quality of the fixation . If the prosthesis remains stable, medical treatment can be sufficient . If the prosthesis loosens, definitive ablation must be considered with possible revision THA later . Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient . Minimal duration of anti-tuberulosis treatment is six months.

Rev Chir Orthop Reparatrice Appar Mot, 2003 May, 89(3), 250 - 6
{Acute bone and joint infections in children: how much attention should be paid to persistent fever during intravenous antibiotic therapy?}; Ceroni D et al.; PURPOSE OF THE STUDY: Bone and joint infections are challenging therapeutic situations requiring rapid antibiotic therapy as soon as bacteriology specimens have been obtained . Laboratory tests (C reactive protein, erythrocyte sedimentation rate, white cell count) and clinical findings are used to assess therapeutic efficacy . Most of the clinical signs however, particularly in children or after a surgical procedure, are not explicit enough to allow proper assessment of the clinical course under antibiotic therapy . Body temperature is the only parameter currently used in routine practice . But the measurement of body temperature is not always reliable and variations observed during treatment should not always be attributed to treatment failure . The purpose of this work was to assess the significance of changes in body temperature observed in children given effective intravenous antibiotic treatment for bone and joint infections . MATERIAL AND METHODS: We reviewed retrospectively the files of 60 children treated in our unit for acute bone and joint infections . The patients had acute hematogeneous osteomyelitis (n=27), septic arthritis (n=25), and infectious osteoarthritis (n=8) . A bacterial strain was identified on cultures of blood, joint fluid, or metaphysis puncture samples in all cases . Blood test results (C-reactive protein, erythrocyte sedimentation rate, white cell count) were recorded during treatment . Body temperature was recorded three times a day until normalization then daily until discharge . We searched for correlations between variations in the temperature curve observed during treatment and blood test results . RESULTS: Ninety percent of the children had fever at admission (mean 39.1 degrees C) . Among the six children without fever, the temperature rose in 5 during the first 48 hours of hospitalization . Even when the treatment was effective, apyrexia was achieved slowly, on the average after 8 days of antibiotic treatment . We also observed that the peak temperature occurred during the first 5 days of antibiotic treatment considered effective . C-reactive protein level normalized within a satisfactory time (10.5 days), reflecting the efficacy of the antibiotics . DISCUSSION: The efficacy of antibiotic treatment must always be verified in patients with acute bone and joint infections . Generally, biological parameters are used to monitor efficacy . Currently, C-reactive protein appears to be the most reliable parameter to assess efficacy, its rapid decline reflecting clinical cure . Erythrocyte sedimentation rate and white cell counts are poor surveillance parameters . Finally, body temperature is not a specific surveillance parameter and persistent fever during treatment does not necessarily signify ineffective antibiotic treatment . In light of this fact, body temperature should always be compared with C-reactive protein level to draw any conclusion concerning therapeutic failure.

Rev Chir Orthop Reparatrice Appar Mot, 2003 Jun, 89(4), 297 - 303
{Re-infection with a different strain after prosthesis revision for bacterial infection: 13 cases}; Lortat-Jacob A et al.; PURPOSE OF THE STUDY: Treatment of an infected arthroplasty is always a delicate task . Multidisciplinary management involving surgeons, clinicians, bacteriologists, and the patient may be long and not always successful . Rare re-infections caused by a bacterial strain different from the initial strain may be a cause of failure . We analyzed cases of re-infection with a different strain in search of an explanation . MATERIAL AND METHODS: We reviewed 13 cases of re-infection in 12 patients with 7 hip and 5 knee arthroplasties . The causal germ had been clearly identified by the bacteriology laboratory during the first infection . The antibiotic regimens were confirmed by the medical team . All patients underwent surgery in our unit . At the time of the second infection, the implant had been removed, had been left in place, or had been changed . We recorded the new strains isolated and studied their antibiotic susceptibility profile . Treatment protocols and biological and functional results were analyzed . RESULTS: A mean 27 months after the re-infection, clinical and biological success had been achieved in 7 cases . The failures more frequently corresponded to cases where the first infection was caused by an aggressive germ and where the second germ was found during reimplantation . DISCUSSION: Theoretically a change in the causal germ could be explained by an insufficient initial biological analysis with an unrecognized or masked germ, by peroperative contamination subsequent to the difficulties observed in these hospitalized patients, and finally by secondary contamination . We recall the criteria of secondary infection (free interval, distant infectious focus, time sequence), measures taken to prevent peroperative infections, and conditions for optimal bacteriological sampling . If no resistance emerges after the first antibiotic treatment, there could nevertheless be a selection of conditions enabling growth of germs infrequently encountered . We stress that re-infection should not be considered necessarily as a failure of initial management but can, in certain cases, be considered as a de novo infection, and treated as such.

Ann Dermatol Venereol, 2003 Apr, 130(4), 443 - 6
{Acneiform eruptions induced by cetuximab}; Walon L et al.; INTRODUCTION: Many drugs may induce acneiform eruptions: vitamine B12, corticosteroids, androgens, lithium, tuberculostatics, halogens, some antidepressants, anticonvulsives and immunosuppressors . Many cases of acneiform eruptions can be observed following treatment with cetuximab, a drug used for solid cancers at advanced stages in experimental protocols . CASE REPORTS: Case 1 . A 56 year-old woman, suffering from a colorectal cancer, developed a sudden acneiform eruption after 6 cures of cetuximab, at a one-week interval . She was treated with bisoprolol hemifumarate, sodium levothyroxin, cyproterone acetate and estradiol valerate . Clinical examination revealed inflammatory and follicular papulopustules localized on the face and upper chest . Comedos were absent . Itching sensations were discrete . Histopathological examination of a papulopustule revealed a folliculitis with polymorphonuclear neutrophils . PAS staining did not reveal the presence of bacteria or yeasts . Bacterial and fungal cultures were negative . Lesions faded in approximately 2 weeks following minocycline treatment (100 mg/day) . Case 2 . A 65 year-old man, treated by cetuximab for a colorectal adenocarcinoma, suddenly developped follicular inflammatory papulopustules on the face, trunk and extensor surfaces of both arms, after 3 weeks of treatment . Itching was discrete . Comedos were absent . Histopathology revealed the presence of a folliculitis with polymorphonuclear neutrophils . Bacteriology and mycology were negative . Lesions were partly controlled by administration of minocycline (100 mg/day) but worsened again in the days following each cure of cetuximab . DISCUSSION: Cetuximab is a monoclonal antibody binding to the epidermal-growth-factor-receptor . It is used in the treatment of solid cancers at advanced stages . Both case reports share some similarities: the development of follicular inflammatory papulopustules distributed on the face and trunk typical, of acneiform drug eruptions . Itching is discrete . Comedos are absent . Quick onset of lesions is the rule . Cetuximab can be added to the list of drugs responsible for acneiform eruption.

J Clin Microbiol, 2003 Jul, 41(7), 3438 - 40
Shiga toxin-producing Escherichia coli-associated kidney failure in a 40-year-old patient and late diagnosis by novel bacteriologic and toxin detection methods; Teel LD et al.; Infection with Shiga toxin-producing Escherichia coli (STEC) is the most common cause of kidney failure in children . High morbidity is also associated with infections in the elderly . We describe STEC-associated kidney failure in a 40-year-old patient, including the methods used to identify STEC a month after disease onset.

Int J Antimicrob Agents, 2003 Jul, 22(1), 7 - 13
Determination of the real standard distribution of susceptible strains in zone histograms; Kronvall G; The procedure for NRI, a method for normalised resistance interpretation, is presented . By means of its promising autocalibration system the method generates zone breakpoints for resistance in zone diameter histograms for bacterial species-antibiotic combinations . These breakpoints give a normalised interpretation of resistance which is independent of disc test standard chosen, disc potency, medium used, inoculum size, etc . of the individual laboratory as long as the performance shows good reproducibility and precision . The method should be further tested as a tool for setting "bacteriological breakpoints" or "epidemiological breakpoints", for calculating resistance rates for comparative purposes, e.g . in antibiotic resistance surveillance, and for quality control of the disc diffusion test.

J Indian Med Assoc . 2003 Feb;101(2):104, 106, 108.
Damodar river pollution and health hazards; Banerjee K et al.; Damodar river is one of the most polluted rivers in this country . Chemical pollution and bacteriological pollution, both are high--leading to rising trend in different industrial health hazards in the Damodar basin.

Emerg Med J, 2003 Jul, 20(4), 347 - 8
How do blood cultures sent from a paediatric accident and emergency department influence subsequent clinical management?
Leonard P, Beattie TF.
OBJECTIVES: To determine the clinical impact of positive results from blood cultures sent from a busy paediatric accident and emergency department . METHODS: All children who attended the department over a seven month period and had blood culture investigations were identified . Case notes of patients who had any growth on blood culture were reviewed to determine whether the organism was felt to be pathogenic and how the result affected clinical management . RESULTS: 1159 children had blood cultures sent, 26 of these grew an organism that was felt to be pathogenic . However, only five significantly influenced clinical management . CONCLUSIONS: Blood cultures sent from an accident and emergency department rarely influence clinical management . A more focused approach to bacteriological investigation is recommended.

Theriogenology, 2003 Sep 1, 60(4), 607 - 16
The effect of semen extender, seminal plasma and raw semen on uterine and ovarian blood flow in mares; Bollwein H et al.; Transrectal color Doppler sonography was used to evaluate the effect of intrauterine infusion of skim milk semen extender, seminal plasma and raw semen on the endometrium and blood flow in the uterine and ovarian arteries in mares . Six Trotter mares (mean age: 12 years) were examined during estrus in three cycles . Each mare received an intrauterine infusion of 20 ml of skim milk semen extender, seminal plasma or raw semen during estrus in one of three cycles . Blood flow measurements in both uterine and ovarian arteries and the determination of intrauterine fluid via sonography were performed before each infusion and 1, 3, 6, 12, and 24 h after infusion . Forty-eight hours later, the intrauterine infusion and measurements were repeated using the same time intervals . Changes in blood flow were detected using transrectal color Doppler sonography and were evaluated using the mean time-averaged maximum velocity (TAMV) of the blood flow . Cytological and bacteriological examination of uterine swabs performed 48 h after the second infusion revealed less inflammation and bacterial growth in mares infused with skim milk semen extender than in those infused with seminal plasma or raw semen . There was an increase in intrauterine fluid as early as 1 h after infusion of any of the substances . The infusion of skim milk semen extender had no effect on uterine blood flow . Within 1 h after infusion of seminal plasma or raw semen, there was an increase in the TAMV values of both uterine arteries (P<0.05) . In contrast, ovarian blood flow increased only in the artery ipsilateral to the preovulatory follicle and only after the infusion of raw semen (P<0.05) . In conclusion, the changes in uterine perfusion observed after intrauterine infusion may be associated with endometrial inflammation and vasodilatory components in the seminal plasma, whereas the changes seen in ovarian blood flow are possibly attributable to the interaction between sperm and oviduct.

Rev Panam Salud Publica, 2003 May, 13(5), 294 - 302
{The use of chest X-rays for surveillance of bacterial pneumonias in children in Latin America}; Lagos R et al.; The Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) is promoting epidemiological surveillance of bacterial pneumonias in children in Latin America in order to generate scientific evidence to support future decisions concerning using vaccines to control such pneumonias in the countries of the Region of the Americas . The diagnosis of these diseases rarely includes bacteriological documentation of the causative agent . Therefore, studies of this type that are carried out around the world accept radiological images of alveolar consolidation as a confirmatory criterion for a presumptively bacterial pneumonia . This piece examines the theoretical rationale and requirements for using thorax radiology as an instrument for epidemiological surveillance of bacterial pneumonias . The piece also summarizes the activities carried out during 2 years of joint efforts between the Center for Vaccine Development (Centro para Vacunas en Desarrollo) of Chile and PAHO's Division of Vaccines and Immunization . During those 2 years, the two groups encouraged the epidemiological study of bacterial pneumonias in Latin American children, using internationally accepted criteria and definitions as well as tools and practical solutions adapted to the reality of the Region of the America . The activities carried out so far show both the need for and the feasibility of standardizing the interpretation of chest radiographs so that they can be used in epidemiological studies.

Pediatr Crit Care Med, 2003 Jul, 4(3), 279 - 83
Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong; Chiu WK et al.; OBJECTIVE: To report the clinical, laboratory, and radiologic features of children with severe acute respiratory syndrome (SARS) and to examine the difference between the younger and older age groups . DESIGN: Retrospective descriptive cohort study . SETTING: A regional hospital in Hong Kong . PATIENTS: Children younger than 18 yrs with SARS . RESULTS: Twenty-one children were included, with a mean age of 10.7 +/- 5.1 yrs . Children with SARS presented with fever, nonproductive cough, malaise, chills, headache, myalgia, and loss of appetite . Examination of the chest showed minimal auscultatory findings . Common laboratory findings included lymphopenia, thrombocytopenia, and mild elevations of activated partial thromboplastin time, alanine transaminase, lactic dehydrogenase, and creatine phosphokinase . Bacteriologic and virologic studies were all negative for common pathogens . Unilateral focal opacity was the commonest finding in chest radiography . High-resolution computerized tomography of the thorax was an early diagnostic tool if the chest radiograph was negative . The clinical course was less severe in comparison with adult patients . However, adolescents (age, > or =12 yrs) resembled adults in their clinical features . When compared with the younger age group, the adolescents had significantly higher temperatures, more constitutional upset, and a greater need for steroid treatment . Children younger than 12 yrs seemed less ill but had more coughing . On the whole, the outcome was favorable . CONCLUSION: Severe acute respiratory syndrome affects children, but the course is less severe . Nevertheless, the disease could have a significant psychosocial impact on children because of the potential seriousness of the disease in their adult family members.

Expert Opin Investig Drugs, 2003 Jul, 12(7), 1165 - 77
Therapeutic potential of the new quinolones in the treatment of lower respiratory tract infections; Blasi F et al.; The impact of respiratory infections on public health is increasing and lower respiratory tract infections are a major cause of morbidity and mortality . We are also facing a worldwide burst of antibiotic bacterial resistance . The new fluoroquinolones have an excellent spectrum covering the most important respiratory pathogens, including atypical and 'typical' pathogens . Pharmacokinetic and dynamic properties of the new fluoroquinolones have a significant impact on their clinical and bacteriological efficacy . They cause a concentration-dependent killing with a sustained postantibiotic effect . Fluoroquinolones combine exceptional efficacy with cost-effectiveness . Not surprisingly, different guidelines have inserted these agents among the drugs of choice in the empirical therapy of community-acquired pneumonia . This review discusses the more recent data on bacteriological and clinical activity and critically analyses the risks of a potential overuse of this valuable new class of drugs.

J Am Vet Med Assoc, 2003 Jun 15, 222(12), 1713 - 6, 1706
Pneumoperitoneum secondary to a perforated gastric ulcer in a cat; Lykken JD et al.; A 7-year-old domestic cat was examined because of a history of weight loss, intermittent diarrhea, and anorexia of 6 months' duration . Results of physical examination were normal except for marked abdominal tension . Results of a CBC and serum biochemistry profile were unremarkable . Severe pneumoperitoneum was noted radiographically, and abdominocentesis yielded 640 mL of air . Abdominal distension recurred 1 day after abdominocentesis . Exploratory laparotomy was performed 3 days after recurrence of abdominal distension and revealed a gastric perforation along the greater curvature of the stomach with omental and pancreatic adhesions at the site of perforation . Mild local peritoneal inflammation was also noted . A partial gastrectomy was performed to resect the lesion, and histologic examination confirmed a severe perforating ulcer . The gastric wall adjacent to the ulcer was histologically normal . Aerobic and anaerobic bacteriologic cultures of abdominal swab specimens were negative for bacterial growth . The cat was discharged 4 days after surgery and clinically normal at suture removal.

Acta Otorrinolaringol Esp, 2003 Mar, 54(3), 195 - 201
{Sinusitis in immunocompromised patients . A multicenter study}; Bernal Sprekelsen M et al.; This paper evaluates different aspects of sinusitis in patients with a decreased immunological system, such as its prevalence and clinical evolution, its peculiar bacteriology and the altered response to treatment, and the prognosis, especially in patients with AIDS . There seems to be an increased prevalence of sinusitis in these patients, with a relationship between their immunological status and the severity and aggressiveness of the sinusitis . Bacteriological studies reveal the pressure of more aggressive species, such as P . aeruginosa, and specific sinusitis are more frequent, which may explain why the treatment with common antibiotics often remains uneffective . The simultaneous therapy of concomitant infections leads to a higher resistance towards common drugs . A standard treatment is therefore needed . The results of three studies, retrospective and prospective, on HIV-infected patients reveal a high incidence of acute sinusitis with aggressive bacteria.

Zhonghua Liu Xing Bing Xue Za Zhi, 2003 May, 24(5), 385 - 8
{Identification of Mycobacterium tuberculosis and rifampin-resistant strains by gene-chips}; He M et al.; OBJECTIVE: To evaluate the gene-chip detecting rifaman-resistance Mycobacterium tuberculosis applied in TB diagnosis and drug-resistant detection . METHODS: Mycobacterium tuberculosis and rifaman-resistant strains among 35 rifaman-resistance isolated strains and 102 sputa specimens from TB patients, 27 sputa specimens from other patients were examined the gene-chips . Results obtained were compared with sputum examination, bacteriological culture and standard drug susceptibility test of Mycobacterium tuberculosis . RESULTS: Thirty-five rifaman-resistance strains were detected by gene-chips and 33 were identified as rifaman-resistance strains and the concordance with the traditional drug susceptibility test of Mycobacterium tuberculosis was 94.29% . Twenty-seven sputa specimens from other patients were examined Mycobacterium tuberculosis by the gene-chips, 2 were positive, the detection specialty was 92.59% . Using three methods detecting Mycobacterium tuberculosis among 102 sputa specimens the positive rate respectively was, sputum examination 35.29% (36/102), bacteriological culture 28.43% (29/102), gene-chip 77.45% (79/102) . Among 102 sputa specimens only 29 examined Mycobacterium tuberculosis by the traditional drug susceptibility test and 8 were rifaman-resistant strains . While using gene-chip, there were 20 among 102 sputa specimens identified as rifaman-resistance strains . Among total 55 rifaman-resistance strains detected by the gene-chips, the most frequent mutations were those associated with codon 531 (23 of 55; 41.8%), 526 (15 of 55; 27.27%) and 516 (9 of 55; 16.36%) . CONCLUSION: Results showed that this was a rapid, simple and highly specific method when using gene-chip to detect Mycobacterium tuberculosis and rifaman-resistant strains.

J Neurol Neurosurg Psychiatry, 2003 Jul, 74(7), 929 - 32
Early diagnosis of external ventricular drainage infection: results of a prospective study; Pfisterer W et al.; OBJECTIVES: The aim of this study was to evaluate the influence of total drainage time on the risk of catheter infection, and the predictive value of standard laboratory examinations for the diagnosis of bacteriologically recorded cerebrospinal fluid (CSF) infection during external ventricular drainage . METHODS: During a three year period, all patients of the neurosurgical intensive care unit (ICU), who received an external ventricular drain, were prospectivly studied . Daily CSF samples were obtained and examined for cell count, glucose and protein content . Bacteriological cultures were taken three times a week, and serum sepsis parameters were determined . RESULTS: 130 patients received a total of 186 external ventricular drains . The ventricular catheters were in place from one to 25 days (mean 7.1 days) . In 1343 days of drainage, the authors recorded 41 positive bacteriological cultures in 21 patients between the first and the 22nd drainage day (mean 6.4) . No significant correlation was found between drainage time and positive CSF culture . The only parameter that significantly correlated with the occurrence of a positive CSF culture was the CSF cell count (unpaired t test, p<0.05) . CONCLUSIONS: Drainage time is not a significant risk factor for catheter infection . Increasing CSF cell count should lead to the suspicion of bacteriological drainage contamination . Other standard laboratory parameters, such as peripheral leucocyte count, CSF glucose, CSF protein, or serum sepsis parameters, are not reliable predictors for incipient ventricular catheter infection.

Di Yi Jun Yi Da Xue Xue Bao, 2003 Jun, 23(6), 598 - 601
{Quantitative study of bacteriological infections in dogs undergoing gunshot wound in seawater}; Bu HJ et al.; OBJECTIVE: To investigate the changes in bacterial proliferation and the time of infection occurrence in dogs wounded by gunshot in seawater . METHOD: Fourteen canine models of gunshot wound in seawater were established, with another 2 dogs receiving the wound without seawater immersion serving as control . Gross observation and quantitative bacterial analysis were performed at 0, 6, 12 and 24 h after the injury respectively, and two dynamic models for the bacterial growth were set up on the basis of statistical analysis of the results . RESULTS: Bacterial quantity in both of the two groups tended to increase with time, but at each time point after the injury, the seawater group had higher bacterial count than the other group . Within 6 h after the injury, the bacterial count reached the critical point for clinical infection in seawater group . The two bacterial growth dynamics models were (1) Y=9.12 x 10(3+0.247X) and (2) Y=1.35 x 10(3+0.227X) for the seawater group and land group respectively, with the variant X representing time after gunshot injury, and Y the bacterial count per gram tissue . Using the dynamic models, we found that to reach the same bacteria count, the land group needed 4 h more than the seawater group(4.2 h) . CONCLUSIONS: Bacterial proliferation is accelerated in the wounds in seawater to result in earlier infection onset with more severity, suggesting that early debridement within 4 h after the injury, complete washing of the wound and early administration of the antibiotics are necessary for the wound management.

Enferm Infecc Microbiol Clin, 2003 Jun-Jul, 21(6), 281 - 6
{Study investigating infection in contacts of tuberculosis patients in a semi-urban area}; Alseda M et al.; INTRODUCTION: The most important factors for establishing priorities in studies of contacts are the bacteriological status of the patient and the degree of exposure of contact persons to the index case . The aim of the present study was to analyze the results of tuberculosis contact tracing and the relationship between these results and the bacteriological situation of the index case and the proximity of exposure . METHODS: We studied the contacts of tuberculosis cases examined in the Center for Tuberculosis Control and Prevention of Lleida (a city in the autonomous region of Catalonia, Spain) over the period 1991-1997 . The Mantoux test with 2 TU of PPD-RT23 was used to identify infected persons . Diagnosis of tuberculosis disease was made on evidence from the clinical situation, chest radiography and bacteriological status . Associations between infection or disease in the contact, and the bacteriological status of the index case and proximity of exposure, were analyzed . The chi-square test was used for statistical analyses; significance was set at a p value of, 0.05 . The odds ratio was calculated as a measure of association . RESULTS: The prevalence of tuberculosis infection among the contacts was 44% (763/1733) . Tuberculin conversion was observed in 7.8% of contacts, and 31 new cases of tuberculosis were detected (1.8%) . The percentages of tuberculosis infection, tuberculin conversion and case detection were higher among persons exposed to sputum smear-positive patients and among those in close contact with the index case . Contact infection was more highly associated with the bacteriological status of the index case and degree of proximity of exposure when the analysis was restricted to contacts less than 15 years old . Case detection was 4% among close contacts living with a sputum smear-positive patient . CONCLUSIONS: Investigation into tuberculosis contacts offered a high yield of detection of infected contact persons and new tuberculosis cases, even among contacts of culture-negative pulmonary tuberculosis patients and contacts of extrapulmonary tuberculosis patients.

Braz J Infect Dis, 2003 Feb, 7(1), 62 - 8 Epub 2003 Dec 02.
An open label, multicenter, non-comparative study of the efficacy and safety of oral gatifloxacin in the treatment of community-acquired pneumonia: a Brazilian study in five centers; Nicodemo AC; We made an open label, multicenter, non-comparative study to assess the efficacy and safety of oral gatifloxacin, 400 mg PO given once-daily during 7 to 14 days for the treatment of adult outpatients with community-acquired pneumonia at five Brazilian medical facilities . Among the 86 subjects available for clinical evaluation, 84 (98%) were cured . The bacteriological eradication and presumed eradication rate was 98% (52/53) among the 44 (51%) patients who were bacteriologically evaluated . Drug-related adverse events were reported by 27% of the patients, diarrhea being the most frequent, occurring in 12% of patients . Adverse events were considered mild (89%) or moderate (11%) . We conclude that a 7-14 day course of gatifloxacin, 400 mg PO given once daily is safe and effective for the treatment of community-acquired pneumonia . The drug had a favorable safety profile and a good clinical and bacteriological efficacy.

J Dairy Res, 2003 May, 70(2), 139 - 48
Evaluation of diagnostic procedures for subclinical mastitis in meat-producing sheep; Clements AC et al.; Samples of foremilk were collected from 261 clinically normal glands of 150 ewes, and tested using the California mastitis test (CMT) . Further samples were collected from 195 of these glands for determination of automated somatic cell counts (SCC), and from 60 of these glands for bacteriological assessment . The sensitivity and specificity of CMT for detecting samples with SCC above different threshold levels and for CMT and SCC in determining bacteriological status were evaluated using two-graph receiver operating characteristics (TG-ROC) . Milk samples were obtained subsequently from ten CMT positive, and five CMT negative first- and second-lactation ewes . Samples were cultured using a variety of media, incubation temperatures and atmospheric conditions, immediately after collection, and 1 week after storage at 4 degrees C and -21 degrees C . Results suggested that CMT is best used as a diagnostic test for ovine subclinical mastitis (SCM) with a cut-off of 3 (distinct gel formation), and that automated SCC thresholds of > 1200 x 10(3) cells/ml are appropriate, especially where low prevalences are expected (e.g . < 5%) . Additionally, this study showed that routine bacteriological methods were appropriate for isolation of most species of pathogen responsible for ovine SCM, but storage of samples prior to culture, either at 4 degrees C or -21 degrees C, was detrimental to the isolation of several of these organisms.

J Crit Care, 2003 Jun, 18(2), 107 - 13
A study of once-daily amikacin with low peak target concentrations in intensive care unit patients: pharmacokinetics and associated outcomes; Bacopoulou F et al.; PURPOSE: The aim of this study was to assess the pharmacokinetics of individualized amikacin single-dosage regimens targeting low peak serum concentrations in a population of intensive care unit (ICU) patients, and to describe the outcomes associated with this dosing strategy . MATERIALS AND METHODS: In this prospective, noncomparative, pharmacokinetic study, 36 ICU patients with adequate renal function were treated with amikacin (intravenous infusion), in combination with other antibiotics, for hospital-acquired infections . The initial doses of amikacin were calculated based on individual creatinine clearance values whereas subsequent doses were calculated by using the amikacin pharmacokinetic parameters estimated from the serum concentration-time data of each individual patient (samples were drawn postinfusion, 1 h, 3 h, 6 h, and 10 h after the onset of the infusion and just before the next dose on days 2, 4, and 7 of therapy) . RESULTS: Results showed moderate only interpatient and lack of intrapatient (except for the volume of distribution) variability in amikacin pharmacokinetic parameters . There were no significant differences between achieved and target peak levels . Clinical response was noted in 94% and bacteriologic response was noted in 86% of patients . Nephrotoxicity did not occur during or after treatment . CONCLUSIONS: Amikacin dosage individualization with low peak target concentrations was successful for the 36 ICU patients . This dosing strategy was not associated with nephrotoxicity, but conclusions on clinical efficacy cannot be drawn from this limited study .

Int J Tuberc Lung Dis, 2003 Jun, 7(6), 580 - 6
Evaluation of the polymerase chain reaction in the diagnosis of miliary tuberculosis in bone marrow smear; Escobedo-Jaimes L et al.; OBJECTIVE: Miliary tuberculosis (MTB) is difficult to diagnose . When prompt diagnosis is necessary, the polymerase chain reaction (PCR) to detect mycobacterial DNA may be valuable . SETTING: Tuberculosis clinic in an academic tertiary-level hospital in Mexico . DESIGN: Bone marrow (BM) aspiration samples from 30 consecutive clinically suspected MTB patients and 58 non-tuberculosis hematologic patients were evaluated by in-house PCR using a fragment of the insertion sequence IS6110; results were compared with those obtained by acid-fast-stained smears, culture in Lowenstein-Jensen medium, histology, and serology . RESULTS: Tuberculosis diagnosis was confirmed in all MTB suspects, 28 by microscopy and culture in pulmonary or extra-pulmonary samples other than BM, and two by clinical and radiologic improvement after antituberculosis treatment . In fresh BM specimens, in-house PCR was positive in 21/30 (70%) suspects, contrasting with only one positive (3.3%) in staining and culture, and four with compatible histologic findings (13.3%) . BM samples from the control group showed negative results in bacteriologic and histologic studies, except in nine who had positive PCR results . These nine control cases had malignant processes . CONCLUSION: PCR in aspirates of BM is a useful diagnostic assay in cases of MTB, mainly when bacteriological results are negative.

Hist Sci Med, 2003 Jan-Mar, 37(1), 95 - 103
{The new terms of "infectious diseases": the birth of the clinical bacteriology and infectious pathology in France}; Contrepois A; The terms of "infectious diseases" appeared for the first time in Charles Bouchard's classification at the beginning of the twentieth century . Louis Pasteur's role was significant in the birth of a new pathology but the common physicians had to assume the conception of a new branch of medicine . Alain Contrepois describes the moving of French medicine from 1870 to 1914, outside the German bacteriology whose knowledge remained misunderstood owing to the political circumstances.

Eur Respir J Suppl, 2003 Jun, 41, 46s - 53s
COPD exacerbations: definitions and classifications; Burge S et al.; Chronic obstructive pulmonary disease (COPD) is defined independently of exacerbations, which are largely a feature of moderate-to-severe disease . This article is the result of a workshop that tried to define exacerbations of COPD for use in clinical, pharmacological and epidemiological studies . The conclusions represent the consensus of those present . This review describes definitions, ascertainment, severity assessments, duration and frequency, using varying sources of data including direct patient interview, healthcare databases and symptom diaries kept by patients in studies . The best general definition of a COPD exacerbation is the following: an exacerbation of COPD is a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations that is acute in onset and may warrant additional treatment in a patient with underlying COPD . A more specific definition for studies where a bacteriological cause of exacerbation is being studied is included, as well as simpler definitions for retrospective identification from database sources . Prospective diary card assessments are best recorded as changes from an agreed baseline, rather than absolute symptom severities . Diary cards identify many unreported exacerbations, which on average have similar severities to reported exacerbations . A scale for exacerbation severity is proposed that incorporates in- and outpatient assessments . Exacerbation duration, which also relates to severity, is defined from diary card reports . Healthcare utilisation is not an adequate substitute for severity, depending on many unrelated social and comorbidity factors . It is an outcome in its own right.

J Clin Microbiol, 2003 Jun, 41(6), 2706 - 8
Molecular and conventional epidemiology of tuberculosis in Hong Kong: a population-based prospective study; Chan-Yeung M et al.; A prospective population-based molecular and conventional epidemiological study of 65.4% of bacteriologically confirmed cases of tuberculosis was carried out on the island of Hong Kong from May 1999 to Oct 2000 by the IS6110-based restriction fragment length polymorphism technique . Eleven of the isolates had five or fewer bands; 24.5% of the remaining 691 isolates belonged to clusters . The estimated proportion of recently transmitted disease was 15 to 20%.

J Nucl Med, 2003 Jun, 44(6), 920 - 6
Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases; Sarda L et al.; Ciprofloxacin labeled with (99m)Tc specifically binds to various bacteria . Thus, it potentially constitutes a specific marker allowing discrimination between septic arthritis/osteomyelitis and aseptic osteoarticular diseases . The aim of this prospective study was to evaluate such properties in patients with skeletal diseases . METHODS: We prospectively investigated 2 groups of patients: patients with suspected osteoarticular infections (G1, n = 16) and a control group of patients with a presentation of osteoarticular diseases and no sign suggestive of infection (G2, n = 11) . All had clinical, biologic, and radiologic evaluations and had 1-, 4-, and 24-h images from (99m)Tc-ciprofloxacin scintigraphy (370 MBq) before planned biopsy or surgery . For 23 patients, the scintigraphic results were compared with histologic and bacteriologic analyses of biopsy tissue samples; for 4 patients, the scintigraphic results were compared with the findings from 23 +/- 5 mo of follow-up . RESULTS: In G1, (99m)Tc-ciprofloxacin findings were true-positive in all 11 infected sites, true-negative in 2 cases, and false-positive in 3 . In G2, (99m)Tc-ciprofloxacin was true-negative in 4 cases and false-positive in 7 . Neither the location of (99m)Tc-ciprofloxacin activity nor its intensity or kinetics between 1, 4, and 24 h allowed discrimination between infection and aseptic diseases (sterile loosened joint replacement, pseudoarthrosis, or arthrosis) . Sensitivity, specificity, and accuracy were 100%, 37.5%, and 63% . CONCLUSION: (99m)Tc-Ciprofloxacin scintigraphy showed good sensitivity and a high negative predictive value for the detection of bone and joint infection, but it did not discriminate between infected and aseptic osteoarticular diseases in symptomatic patients referred for surgery.

Vet Res, 2003 May-Jun, 34(3), 297 - 305
Evaluation of a modified Rose Bengal test and an indirect enzyme-linked immunosorbent assay for the diagnosis of Brucella melitensis infection in sheep; Ferreira AC et al.; A modified Rose Bengal test (mRB) and an indirect ELISA (iELISA) with Protein G as the conjugate, were evaluated for the diagnosis of Brucella melitensis infection in unvaccinated sheep with a known bacteriological status, and their diagnostic efficacy was compared with that of the standard Rose Bengal (RB) and Complement Fixation (CF) tests used in the current eradication campaign in EU countries . All tests showed 100% specificity when testing the sera from 212 Brucella-free sheep . When testing the sera from 219 Brucella melitensis culture-positive sheep, both the mRB and iELISA tests were more sensitive (98.6% and 96.8%, respectively) than the RB and CF tests (95.0% and 92.7%, respectively) . These results were similar when testing the sera from 181 animals belonging to infected flocks but found bacteriologically negative, suggesting that the mRB or iELISA tests could advantageously replace the current RB procedure used as the screening test.

Dig Surg, 2003, 20(4), 296 - 9; discussion 300 Epub 2003 Jun 05.
Are some cases of infected pancreatic necrosis treatable without intervention?
Ramesh H, Prakash K, Lekha V, Jacob G, Venugopal A.
BACKGROUND: Infected pancreatic necrosis is considered an absolute indication for interventional management such as percutaneous drainage or surgery . The presence of retroperitoneal air is a sign of anaerobic sepsis . METHOD: A retrospective review of case records of patients presenting with severe acute pancreatitis and pancreatic necrosis was performed to identify cases in whom conservative treatment was followed by a satisfactory outcome . RESULTS: Four patients were identified over a 3-year period who had pancreatic necrosis and retroperitoneal air; they were treated with antibiotics and intensive care, and they improved without any interventional treatment . CONCLUSIONS: Some patients with infected pancreatic necrosis are treatable medically . The clinical status of the patients may well be a more important factor governing the choice of the treatment approach than bacteriological findings of infection alone .

Best Pract Res Clin Rheumatol, 2003 Apr, 17(2), 209 - 18
Infection and arthritis . Infection of prosthetic joints; Lidgren L et al.; Infection of prosthetic joints is one of the most devastating complications following replacement surgery . The size of the problem, the diagnostic puzzle, bacteriological findings and treatment modalities are highlighted.

Zhonghua Jie He He Hu Xi Za Zhi, 2003 Feb, 26(2), 74 - 6
{Follow-up observation on relapse of smear negative pulmonary tuberculosis after short-course chemotherapy}; Xu WG et al.; OBJECTIVES: To evaluate the efficacy of the tuberculosis (TB) control project supported by WPRO/WHO in Jiangsu province, China, and to analyze the factors associated with relapse . METHODS: All registered patients with smear positive pulmonary tuberculosis which were diagnosed and cured in the project, were examined for bacteriological relapse after 2 to 3 years . The relationships among relapse rate, bacterial load and the time of sputum negative conversion were analyzed by historical cohort study . RESULTS: Fifty seven cases of 1,730 patients who were followed for 2 - 3 years were found smear positive, the relapse rate being 3.29% . The relapse rates in patients whose sputum became negative within two months, within three months and beyond three months after the start of therapy were 2.1%, 5.3% and 8.8% (P < 0.01), respectively . CONCLUSIONS: The long-term result of the TB control project in Jiangsu was good . The relapse rates in patients whose sputum converted negative within three months and beyond three months after the start of therapy were significantly higher than that in patients whose sputum converted negative within two months.

Vet Microbiol, 2003 Jul 1, 94(2), 105 - 20
Use of a macrophage cell line for rapid detection of Mycobacterium bovis in diagnostic samples; Ritelli M et al.; Mycobacterium bovis isolation on bacteriological media from suspected cases of bovine tuberculosis (TB) demands laborious and time-consuming procedures . Even polymerase chain reaction (PCR) and radiometric analyses are secondary procedures and not alternatives to bacteriological procedures . Therefore, there is a need to develop new techniques aimed at rapid M . bovis detection in diagnostic samples . The human macrophage cell line THP-1 was thus investigated in experiments of M . bovis propagation and isolation from reference lymph node suspensions . THP-1 cells were shown to support a high-titered propagation within 48h of minute amounts of both M . bovis BCG and fully pathogenic M . bovis strain 503 . A semi-nested PCR for TB-complex-specific insertion sequence IS6110 revealed M . bovis infection in THP-1 cells . The same was true of a flow cytometry (FC) assay for expression of M . bovis chaperonin 10 in infected cells . The reduced time for isolation and identification of M . bovis (48-72h) and the consistency of the test results make the use of macrophage cell cultures attractive and cost-effective for veterinary laboratories involved in TB surveillance.

J Vet Intern Med, 2003 May-Jun, 17(3), 298 - 303
Percutaneous ultrasound-guided cholecystocentesis in healthy cats; Savary-Bataille KC et al.; Percutaneous ultrasound-guided cholecystocentesis (PUC) is a minimally invasive technique for bile collection that is used successfully in human patients with cholecystitis . Its use in veterinary medicine for evaluation of hepatobiliary disorders has been limited because of the perceived unacceptable risk of bile peritonitis . An experimental study was conducted to evaluate the safety and efficacy of PUC, to collect data on bile cytology and bacteriologic culture, and to attempt to isolate Helicobacter spp . from the bile of healthy cats . In fasted and sedated cats, PUC was performed with a 22-gauge 1.5-in . (3.81 cm) needle with an attached 12-mL syringe via a right-sided transhepatic approach (n = 1) or into the fundus of the gallbladder (n = 11) via a right ventral abdominal approach . An attempt was made to completely empty the gallbladder . A small amount of abdominal effusion, consistent with bile or blood, was seen ultrasonographically immediately after aspiration in the 1st cat . Ultrasonographic complications with the 2nd technique were not observed in the remaining 11 cats . Decreased appetite and evidence of mild abdominal pain were detected in 4 cats within 2 days after PUC . The mean neutrophil count increased 2 days after PUC (P < .01) but remained within the reference range . The bile was acellular in 11 of 12 cats, and aerobic, anaerobic, and Helicobacter spp . cultures yielded no growth in 12 of 12 cats . There were no remarkable gross or histologic lesions of abdominal organs at the postmortem examination (8 cats) performed 7-8 days after the procedure . PUC appears to be a safe and technically simple procedure . Further studies are warranted to determine the use and safety of PUC in cats with hepatobiliary diseases.

Gastroenterol Clin Biol, 2003 Apr, 27(4), 416 - 9
{Endoscopic and pathological aspect of small bowel and colonic involvement in Whipple's disease: a case report}; Le Lan C et al.; We describe a case of Whipple's disease confirmed by clinical, histological, bacteriological and molecular criteria . The duodenal involvement was associated with the presence of an endoscopic and histological enterocolitis . Final diagnosis of small bowel and colonic involvement by Whipple's disease was confirmed by histology and molecular biology . We review the literature on extra duodenal involvement . We underline the fact that enterocolitis in Whipple's disease is non-specific . We also discuss the other causes of intestinal mucosal infiltration by macrophages.

Microbes Infect, 2003 May, 5(6), 553 - 60
Louis Pasteur (1822-1895); Bordenave G; In Louis Pasteur's scientific career it is striking to note the exponential character of the research he introduced in all the fields he opened up . He offered fabulous opportunities to stereochemistry . He is acknowledged as one of the founders of microbiology . He established the possibility of anaerobic life . He pointed the way to epidemiology, public health, and the bacteriologic fight . He struggled against the idea of spontaneous generation of life . He irrevocably substantiated the microbial theory of infectious diseases . He demonstrated that bacterial virulence could be attenuated, he evidenced immunity and generalised the vaccination principle . He also was an incomparable experimenter.

Can Vet J, 2003 May, 44(5), 413 - 5
Evaluation of the California mastitis test to detect an intramammary infection with a major pathogen in early lactation dairy cows; Dingwell RT et al.; The purpose of this study was to evaluate the usefulness of the California mastitis test (CMT) to detect an intramammary infection caused by a major mastitis pathogen in early lactation cows . The gold standard used for comparison was bacteriological culture of single milk samples . The sensitivity (82.4%) and specificity (80.6%) of a positive CMT were highest on the 4th day of lactation.

Rev Inst Med Trop Sao Paulo, 2003 Mar-Apr, 45(2), 103 - 5 Epub 2003 May 14.
A retrospective evaluation of a score system adopted by the Ministry of Health, Brazil in the diagnosis of pulmonary tuberculosis in childhood: a case control study; Sant'Anna CC et al.; Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministerio da Saude - MS), to diagnose pulmonary tuberculosis (PTB) in childhood . This system is independent of bacteriological or histopathological data to define a very likely (> or = 40 points), possible (30-35 points) or unlikely (< or = 25 points) diagnosis of tuberculosis . Records of hospitalized non-infected HIV children at the Instituto de Puericultura e Pediatria Martagao Gesteira of Federal University of Rio de Janeiro (IPPMG-UFRJ), were reviewed . Patients were adjusted for age and divided in two different groups: 45 subjects in the case group (culture-positive) {mean of age = 10.64 mo; SD 9.66}; and 96 in the control group (culture-negative and clinic criteria that dismissed the disease) {mean of age = 11.79 mo.; SD 11.31} . Among the variables analyzed, the radiological status had the greater impact into the diagnosis (OR = 25.39), followed by exposure to adult with tuberculosis (OR = 10.67), tuberculin skin test >10mm (OR = 8.23) . The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9% and specificity of 86.5%.

Srp Arh Celok Lek, 2002 Nov-Dec, 130(11-12), 409 - 11
{Pyometra as a result of placement of an intrauterine device for 40 years and chronic endometritis}; Todorovic N et al.; Pyometra is the accumulation of pus in the uterine cavity, thus stretching its walls and thinning and enlarging the uterus . This change is characteristic of the senium period of life, when the uterus is atrophic with a stenotic cervical canal . It most frequently occurs as a result of secondary infection of the cancerogenic tissue of the uterus and additional stenosation and clogging up of cervical canal by a malignant process . Apart from carcinomas of the body and uterus cervix, pyometra less often can occur in other illnesses such as senile endometritis and senile colpitis . As pyometra most frequently occurs in uterine carcinomas, in detection of this state, we must think of malignancy and direct our examination to this direction . In this paper we present a patient in whom pyometra developed because she carried an intrauterine device for forty years that resulted in chronic endometritis . The main symptoms for which the patient was admitted to hospital were abdominal pain and intensive suppurative vaginal excretion a month after removal of intrauterine device . The diagnosis of pyometra was made by gynaecological and ultrasound examinations, and also on the basis of gynaecological and ultrasound examinations one month after chronic endometritis was confirmed . On the basis of this finding we suspected that chronic endometritis was caused by this state . By cytological, PAP and histopathological examinations of samples obtained by explorative curettage and biopsy of the uterine cervix, malignant changes were eliminated a possible cause . By laboratory analysis and bacteriological examination of the uterine cavity and vaginal excretion, inflammatory changes of the uterine mocous membrane were confirmed as a cause of the pyometra . This conditions was due to carrying the intrauterine device for more decades . The therapy consisted of dilatation of the cervical canal and evacuation of accumulated suppurative contents and irrigation of uterine cavity with 3% solution of hydrogen peroxide and Povidon . Also wide spectrum antibiotics and uterotonics were given . Such treatment contributed to a fast and effectious recovery.

Clin Ther, 2003 Feb, 25(2), 542 - 57
A comparison of 5-day courses of dirithromycin and azithromycin in the treatment of acute exacerbations of chronic obstructive pulmonary disease; Castaldo RS et al.; BACKGROUND: Short-term use of antibiotics has become a common component of the management of acute exacerbations of chronic bronchitis (AECB), particularly in complex cases with productive cough or purulent phlegm . The macrolide antibiotics, particularly second-generation agents such as dirithromycin and azithromycin, are among the antibiotic classes frequently recommended and used to treat upper and lower respiratory infections, including AECB . OBJECTIVE: This study compared the clinical efficacy and tolerability of 5-day courses of dirithromycin and azithromycin given once daily for the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) . METHODS: This randomized, investigator-blinded, parallel-group clinical trial was conducted at 5 centers in the United States . Eligible patients were adult (age >35 years) smokers or ex-smokers (smoking history of at least 10 pack-years) with chronic bronchitis and an acute exacerbation, defined by the occurrence of increased dyspnea and/or productive cough and feverishness within 48 hours of enrollment . Before randomization, an attempt was made to obtain a sputum specimen from each patient for Gram's staining and culture . Patients were randomized to receive dirithromycin 500 mg QD for 5 days or azithromycin 500 mg QD on day 1 and 250 mg QD on days 2 to 5 . Clinical efficacy was assessed separately by patients and physicians at early (days 7-10) and late (days 25-35) posttreatment visits . RESULTS: Eighty-six patients (48 women, 38 men; mean age, 55 years) with a mean smoking history of 31 pack-years were included in the intent-to-treat analysis . Forty-six (54%) patients were randomized to dirithromycin and 40 (47%) patients to azithromycin . Clinical efficacy was reported in a high proportion of patients in both treatment groups, both at the early posttreatment visit (84.8% dirithromycin, 75.7% azithromycin; difference dirithromycin - azithromycin, 9.1%; 95% CI, -8.2 to 26.4) and the late posttreatment visit (95.5% and 86.5%, respectively; difference dirithromycin - azithromycin, 9.0%; 95% CI, -3.7 to 21.6) . A similar proportion of patients required a second course of antibiotics over the study period (20.5% dirithromycin, 27.0% azithromycin; difference dirithromycin - azithromycin, -6.6%; 95% CI, -25.2 to 12.1) . Only 42 (48.8%) patients were able to produce a sputum sample before receiving study treatment, and of these, only 20 (47.6%) demonstrated a preponderance of neutrophils on Gram's staining . Both treatments were well tolerated . CONCLUSIONS: The results of this study suggest comparable clinical efficacy between 5-day courses of once-daily dirithromycin and azithromycin in acute exacerbations of COPD . There were insufficient data to permit meaningful comparison of the bacteriologic efficacy of these macrolide antibiotics.

Dis Aquat Organ, 2003 Mar 31, 54(2), 105 - 17
Experimental mycobacteriosis in striped bass Morone saxatilis; Gauthier DT et al.; Striped bass Morone saxatilis were infected intraperitoneally with approximately 10(5) Mycobacterium marinum, M . shottsii sp . nov., or M . gordonae . Infected fish were maintained in a flow-through freshwater system at 18 to 21 degrees C, and were examined histologically and bacteriologically at 2, 4, 6, 8, 17, 26, 36 and 45 wk post-infection (p.i.) . M . marinum caused acute peritonitis, followed by extensive granuloma development in the mesenteries, spleen and anterior kidney . Granulomas in these tissues underwent a temporal progression of distinct morphological stages, culminating in well-circumscribed lesions surrounded by normal or healing tissue . Mycobacteria were cultured in high numbers from splenic tissue at all times p.i . Standard Ziehl-Neelsen staining, however, did not demonstrate acid-fast rods in most early inflammatory foci and granulomas . Large numbers of acid-fast rods were present in granulomas beginning at 8 wk p.i . Between 26 and 45 wk p.i., reactivation of disease was observed in some fish, with disintegration of granulomas, renewed inflammation, and elevated splenic bacterial densities approaching 10(9) colony-forming units g(-1) . Infection with M . shottsii or M . gordonae did not produce severe pathology . Mild peritonitis was followed by granuloma formation in the mesenteries, but, with 1 exception, granulomas were not observed in the spleen or anterior kidney . M . shottsii and M . gordonae both established persistent infections in the spleen, but were present at densities at least 2 orders of magnitude less than M . marinum at all time points observed . Granulomas in the mesenteries of M . shottsii- and M . gordonae-infected fish resolved over time, and no reactivation of disease was observed.

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi, 2003 Mar, 20(1), 132 - 4
{Refit of simple plasma generator}; Zhang Y et al.; A simple plasma generator was refitted on the basis of usual ion sputter in biological labs, and uniformity of plasma intensity was verified . Bacteriological dishes were used as an example of material surface modification . The results showed that bacteriological dishes were switched from hydrophobic to hydrophilic after plasma treatment, and they obtained the ability to support cells adhesion and spreading . This demonstrated that the refitted ion sputter can be used as an effective plasma generator for biomaterial surface engineering.

Probl Tuberk, 2003, (3), 33 - 5
{Acutely progressive pulmonary tuberculosis: morphological and bacteriological features}; Surkova LK et al.; The data of autopsies (n = 431) and morphological (n = 52) and bacteriological (n = 47) studies of the operating material obtained from the lungs of patients with tuberculosis during 1980-1989 and 1990-1999 were analyzed at the Research Institute of Pulmonology and Phthisiology, Republic of Belarus . The analysis revealed an increase in the incidence of acutely progressive forms of pulmonary tuberculosis . Autoptic data indicated that in 83.7% of cases, acute progressive tuberculosis was associated with the development of caseous pneumonia as an independent tuberculous process (31.7%) and as a phase of ensuing development of other forms (52.0%) . The distinctive morphological features of today's caseous pneumonia were as follows: a great extent of lesion, an unrestrained progression of a process, a predominance of an alterative-and-exudative component of tuberculous inflammation, a rapid decay and suppuration of caseous masses, no differentiation of caseous and pneumonic foci, and suppressed cellular reactions of tissue immunity . The morphological and bacteriological studies of the operating lung material from patients with pulmonary tuberculosis suggested that there was a predominance of a progressive disseminating process at the moment of surgery.

J Dairy Sci, 2003 Apr, 86(4), 1240 - 9
Role of dietary copper in enhancing resistance to Escherichia coli mastitis; Scaletti RW et al.; The role of dietary copper in enhancing resistance to Escherichia coli mastitis was investigated in first-lactation heifers . Twenty-three primigravid Holstein heifers were maintained on a basal (6.5 ppm copper; -Cu) diet or a diet supplemented (20 ppm) with copper sulfate (+Cu) beginning 60 d prepartum through 42 d of lactation . Liver biopsies and blood samples were taken for liver and blood minerals and plasma ceruloplasmin . Milk samples were taken weekly postpartum for bacteriology . The overall mean liver Cu concentration was about threefold higher, and the overall mean plasma Cu concentration was greater in the +Cu group than the -Cu group . At 34 d of lactation, one pathogen-free quarter per animal was infused with 22 cfu of Escherichia coli strain 727 . Plasma Cu was greater at -24, 0, 18, 24, 36, 96, 192, and 240 h relative to infusion for +Cu animals . Plasma Zn concentration was higher at 24 h for the +Cu group . Milk bacterial count (log10 cfu/ml) was lower at 12, 18, and 48 h for the +Cu group . Somatic cell count (log10/ml) was lower at 18 h in +Cu animals . Clinical score at 24 h was lower for +Cu cows, while at 144 h, clinical score was lower for -Cu cows . Rectal temperature was lower at 18 h for the +Cu group . Plasma ceruloplasmin and Fe, dry matter intake and milk production did not differ . Copper supplementation reduced the clinical response during experimental E . coli mastitis, but duration was unchanged.

J Dairy Sci, 2003 Apr, 86(4), 1221 - 32
Potential for improving description of bovine udder health status by combined analysis of milk parameters; Sloth KH et al.; The objective of this study was to assess the potential of a stepwise multivariate procedure to quantify cow-level udder health based on eight milk parameters: milk yield, protein percentage, fat percentage, lactose percentage, citrate percentage, somatic cell count (SCC), and two electrical conductivity parameters . The data were collected in one research herd and included 821 cow-level observations . In addition to milk parameters, disease recordings and bacteriology on quarter milk samples every eighth week throughout lactation were included . A multivariate mixed model was applied to the milk parameters in a healthy subset to adjust for the following systematic factors: total mixed ration (TMR) energy density, breed-line combination, parity, stage of lactation, and season . The proportion of variance accounted for by the mixed model ranged from 0.14 to 0.82 depending on milk parameter . The adjustments estimated in the healthy subset were applied to the whole dataset, including observations pertaining to nonhealthy cows . Combined description of the adjusted variation in the milk parameters was performed with a principal component analysis . The first principal component (Prin1) described 30% of the adjusted variation and was interpreted as being the main consequences of mastitis . Finally, cluster analysis based on Prin1 separated the observations into nine clusters, which were strongly associated with udder health in terms of increasing clinical and subclinical mastitis with increasing level of Prin1 . It was concluded that a multivariate approach to assess udder health from milk parameters has the potential to substantially improve description of udder health.

J Vet Med Sci, 2003 Apr, 65(4), 479 - 84
Immune responses of immunocompetent and immunocompromised mice experimentally infected with Bartonella henselae; Kabeya H et al.; The aim of this study is to understand host immune responses in immunocompetent and immunocompromised mice against Bartonella henselae infection . BALB/c and nude (BALB/c nu/nu) mice were inoculated intraperitoneally with 10(8) colony forming units of B . henselae (Houston-1 strain) . Blood, brain, liver, spleen, kidney and bone marrow samples were collected 0, 3, 7, 14, 21 and 28 days after infection and submitted to bacteriological, serological and genetical examinations . B . henselae was isolated only from the liver 3 days after infection . DNA of the inoculums was detected by polymerase chain reaction from blood, liver, and spleen samples collected from BALB/c and blood from nude mice 3 and 7 days after infection . No bacterial DNA was detected from both BALB/c and nude mice thereafter during 4 weeks observation periods . These results indicate that the T-cell may not participate in the effective elimination of the organisms from mice . In addition, western blot analysis revealed that the antigens of 27.3- and 31.5-kDa reacted with IgM antibodies from the blood of BALB/c and nude mice after 3 days of infection, suggesting that these antigens were recognized by thymus-independent mechanism . Furthermore the antigens were detected from the culture-supernatants of B . henselae, indicating that these antigens were secreted from the organisms.

Microb Pathog, 2003 May, 34(5), 239 - 48
Experimental tularemia in mice challenged by aerosol or intradermally with virulent strains of Francisella tularensis: bacteriologic and histopathologic studies; Conlan JW et al.; BALB/c and C57BL/6 mice were challenged by aerosol or intradermally with low doses ( approximately 10-20 colony forming units) of virulent type A and type B strains of the facultative intracellular pathogen, Francisella tularensis, and the course of infection was monitored . Both mouse strains were equally susceptible to infection, but type A strains reached lethal numbers a few days earlier than type B strains regardless of challenge route . BALB/c mice showed overt signs of infection for several days, whereas C57BL/6 mice remained asymptomatic until a few hours before death . Histological changes were extensive and severe in the liver and spleen, but much more limited in the lungs, even in mice challenged by aerosol . Thus, it appears that regardless of the route of infection, systemic rather than pulmonary infection was the likely cause of death following low dose challenge with virulent F . tularensis.

Ann Otol Rhinol Laryngol, 2003 Apr, 112(4), 342 - 7
Is secretory otitis media a single disease entity?
Sade J, Russo E, Fuchs C, Cohen D.
The outcome of 809 children who had middle ear effusion (MEE) was correlated with their age and medical history and the bacteriologic and cytologic findings of the MEE . Three groups emerged . Group A (n = 384) had a medical history of relatively recent acute otitis media (AOM) with a peak prevalence of 2.6 years of age, and its MEE was hypercellular (mostly polymorphonuclear leukocytes) with a 24% rate of positive bacteriologic culture . In contrast, the peak prevalence of group B (n = 280) was approximately 5 years of age . Its MEE followed no otologic medical history and was bacteriologically sterile with relatively few cells (mostly lymphocytes typical of viral infections) . Group AB (n = 145) resembled group B except that they had a history of AOM some years before hearing loss onset . Altogether, the clinical features of group A are statistically distinguishable from those of groups B and AB in most respects . These findings explain the bimodal peak prevalence distribution that was found in many available epidemiological studies of secretory otitis media (SOM) and that was also seen in our data . It appears that SOM should neither be termed nor treated as an otitis media, but as a sequela of either bacterial AOM (group A) or of insidious, asymptomatic, probably viral otitis media (groups B and AB) . Our data do not support antibiotic treatment for SOM (otitis media with effusion)--especially not in chronic cases.

Med Trop (Mars), 2002, 62(6), 623 - 6
{Tuberculosis and HIV in Bangui, Central African Republic: strong prevalence and management difficulties}; Breton G et al.; The increasing incidence of tuberculosis in relation with the HIV-AIDS epidemic poses a major public health problem in sub-Saharan Africa . The purpose of this retrospective study was to analyze the prevalence of HIV-1 infection, clinical presentation, and bacteriological findings in patients treated for tuberculosis in a hospital department in Bangui, Central African Republic between January 1996 and December 1998 . Among the 1142 patients who benefited for HIV serology, HIV-1 prevalence of was 82% (IC95%: 79-85%) . Most patients (92%), had not undergone HIV serology before hospitalization . Mean age was 34 years . Sex ratio F/M was 1.21 . Diagnosis of tuberculosis was based mainly on clinical and radiological data . Positive sputum smears were available for only 52% of the patients . The most frequent site of tuberculosis was the lungs with no significant difference between the HIV-positive and HIV-negative groups (83% versus 79% respectively) . Sputum-smear examination was positive in 42% of the patients with no significant difference between the HIV-positive and HIV-negative groups (43% versus 37%) . Upon admission patients usually presented advanced disease, with 11% dying within a week after hospitalization . There was a steep increase in the prevalence of HIV in tuberculosis-infected patients in Banqui, from 32% in 1988 to 62% in 1994 . In spite of the existence of a National Tuberculosis Control Program, diagnostic facilities remain limited and diagnosis of tuberculosis and HIV-infection is often delayed . Outpatient care must be improved.

Yonsei Med J, 2003 Apr 30, 44(2), 259 - 64
The effects of increased intra-abdominal pressure on bacterial translocation; Polat C et al.; In this study, we investigated the effect of different values of intra-abdominal pressure on bacterial translocation . Twenty-four Wistar-Albino rats were divided into four groups . The animals belonging to the Control group were not subjected to any increased intra-abdominal pressure . In groups I, II and III, an intra-abdominal pressure of 14, 20, and 25 mmHg, respectively, was established by carbon dioxide pneumoperitoneum for a period of 60 minutes . Four hours after the pneumoperitoneum, all animals were sacrificed to evaluate the degree of bacterial translocation at this time . Liver, spleen and mesenteric lymph nodes were excised under sterile conditions . Bacterial growth was assessed using standard bacteriological techniques and compared statistically . The Kruskal-Wallis and Mann-Whitney U tests were used for the statistical analysis . Different amounts of bacterial growth were found in all of the animals subjected to increased intra-abdominal pressure, except for the controls . Bacterial translocation was detected at an intra-abdominal pressure of 14 mmHg but this finding was not statistically significant (p > 0.05) . There was a significant increase in bacterial growth in animals subjected to an intra- abdominal pressure of 20 mmHg or above (p < 0.001) . As a result, we found that bacterial translocation started when the intra-abdominal pressure reached a level of 14 mmHg . Patients should be closely monitored for septic complication risks following laparoscopic procedures in which the intra-abdominal pressure exceeds 20 mmHg.

J Am Vet Med Assoc, 2003 May 1, 222(9), 1252 - 6
Evaluation of cattle for experimental infection with and transmission of Brucella suis biovar 4; Forbes LB et al.; OBJECTIVE: To determine whether cattle can become persistently infected with Brucella suis biovar 4, whether the organism can be transmitted vertically or horizontally, and whether tests for bovine brucellosis are diagnostic . DESIGN: Observational study . ANIMALS: 24 pregnant cows and their calves and 6 bulls . PROCEDURE: Cows and bulls were housed separately in groups of 6 with each group consisting of 3 cattle experimentally infected with B suis biovar 4 and 3 naive animals . Cattle were observed for clinical signs daily; blood samples were collected weekly . Clotted blood from each sample was submitted for bacterial culture . Serum was tested with an indirect ELISA and the standard tube agglutination test (STAT), buffered plate agglutination test, brucellosis card test (BCT), and complemen't fixation test (CFT) . Tissues collected at necropsy were submitted for bacterial culture and histologic examination . RESULTS: All 15 inoculated cattle seroconverted on 2 or more serologic tests, and bacteria were isolated from 4 inoculated cows at necropsy . There was no bacteriologic evidence of vertical or horizontal transmission, and none of the cattle developed clinical abnormalities or gross or histologic lesions . Results of the indirect ELISA were positive for all inoculated cattle . The other tests gave variable results; the CFT, STAT, and BCT yielded negative results for at least 1 of the 4 cattle from which the organism was isolated . CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cattle-to-cattle transmission of B suis biovar 4 is unlikely . Serologic tests for bovine brucellosis should be used cautiously when attempting to identify cattle with rangiferine brucellosis, as they do not discriminate between the 2 diseases and vary in their ability to detect exposed cattle.

J AOAC Int, 2003 Mar-Apr, 86(2), 296 - 313
Enumeration of total yeasts and molds in foods by the SimPlate Yeast and Mold-Color Indicator method and conventional culture methods: collaborative study; Feldsine PT et al.; The relative effectiveness of the SimPlate Yeast and Mold-Color Indicator method (Y&M-CI) was compared to the U.S . Food and Drug Administration's (FDA) Bacteriological Analytical Manual (BAM) method and the proposed International Organization for Standardization (ISO) method, ISO/CD 21527, for enumerating yeasts and molds in foods . Test portions were prepared and incubated according to the conditions stated in both the BAM and ISO methods . Six food types were analyzed: frozen corn dogs, nut meats, frozen fruits, cake mix, cereal, and fresh cheese . Nut meats, frozen fruits, and fresh cheese were naturally contaminated . All other foods were artificially contaminated with either a yeast or mold . Seventeen laboratories throughout North America and Europe participated in the study . Three method comparisons were conducted . In general, there was <0.3 mean log count difference in recovery between the SimPlate method and the 2 corresponding reference methods . Moreover, mean log counts between the 2 reference methods were also very similar . The repeatability (Sr) and reproducibility (SR) standard deviations were comparable between the 3 method comparisons . These results indicate that the BAM method and the SimPlate method are equivalent for enumerating yeast and mold populations in foods . Similarly, the SimPlate method is comparable to the proposed ISO method when test portions are prepared and incubated as defined in the proposed ISO method.

Curr Pain Headache Rep, 2003 Jun, 7(3), 224 - 8
Pseudomigraine with lymphocytic pleocytosis; Pascual J et al.; Pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis is a self-limited syndrome of unknown origin characterized by headache accompanied by transient neurologic symptoms and cerebrospinal fluid lymphocytosis . Patients with this condition are between 15 and 40 years of age . The syndrome is more frequent in men . The clinical picture encompasses one to 12 episodes of changing variable neurologic deficits accompanied by moderate to severe headache and occasional fever . These headaches are described as predominantly throbbing and bilateral with a variable duration (mean, 19 hours) . The average duration of the transient neurologic deficit is 5 hours . Sensory (78% episodes), aphasic (66%), and motor (56%) disturbances are the most common . Migraine-like visual symptoms are relatively rare (18% episodes) . Patients are asymptomatic between episodes and after the symptomatic period (duration > 3 months) . Lymphocytic pleocytosis (10 to 760 cells mm(3)) and increased cerebrospinal fluid protein are found with negative bacteriologic, viral, fungal, and immunologic studies . Brain computed tomography and magnetic resonance imaging are normal, but an electroencephalogram frequently shows focal slowing over the symptomatic brain area . Single photon emission computed tomography reveals transient focal areas of decreased uptake consistent with the clinical symptoms . It is possible that pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis could result from an activation of the immune system secondary to a recent viral infection, which would produce antibodies against neuronal or vascular antigens . This autoimmune attack may induce an aseptic leptomeningeal vasculitis, accounting for the headache and the transient symptoms likely through a spreading depression-like mechanism.

Ter Arkh, 2003, 75(3), 32 - 6
{Errors in diagnosing pulmonary tuberculosis in general hospitals and results of treating the disease}; Chelnokova OG et al.; AIM: To specify diagnostic approaches to rapidly progressive destructive pulmonary tuberculosis (RPDPT) in general hospitals and effects of the time of the diagnosis on treatment results . MATERIALS AND METHODS: History, diagnostic techniques and treatment of 162 patients with RPDPT (98 cases with cheesy pneumonia, 37 cases with rapidly progressive infiltrative tuberculosis, 27 cases with rapidly progressive disseminated tuberculosis) were studied . RESULTS: The diagnosis of tuberculosis was verified for 7 days in 56% patients, in 33% of them the diagnosis took more than 14 days . Tuberculosis was hidden under the mask of inflammatory pulmonary diseases in 60% patients, concomitant pathology--in 19% . Masks were also due to severe intoxication, multiorgan insufficiency, complications, tuberculosis of other organs . RPDPT was diagnosed primarily by x-ray examination, bacteriological test for M . tuberculosis was used in 14% . Lethal outcomes in the group of patients diagnosed for 14 days and longer occurred 2.6 times more frequently than in those diagnosed within 7 days . CONCLUSION: The analysis of the diagnostic errors resulted in design of the scheme of the diagnosis of RPDPT including cheesy pneumonia intended for use in general practice with account for possible "masks" of the disease . Basic criteria of the diagnosis are stepwise development of the disease and infiltrative-alterative changes on x-ray picture . Phthisiological alertness of general practitioners in relation to RPDPT must direct the physicians to active detection of M . tuberculosis in the sputum and close cooperation with phthisiologist in complicated diagnostic cases.

Zh Mikrobiol Epidemiol Immunobiol, 2001 Nov-Dec, (6 Suppl), 114 - 8
{Results of the bacteriological work of the specialized epidemic brigade of the Stavropol Research Institute for Plaque Control}; Briukhanov AF et al.; The experience of use of efforts and resources by the bacteriological section of the specialized antiepidemic brigade of the Stavropol Research Institute for Plague Control in the Chechen Republic during the period of 1999-2000 under the conditions of the emergency situation, formed as the consequence of carrying out the antiterrorist operation, is summarized . The work load falling of the bacteriological section in different shifts, the structure of bacteriological investigations, as well as some problems arising in the process of work, were analyzed . The experience showed the necessity of the complete accommodation of the bacteriological laboratory in specialized motor-vehicle modules having all necessary equipment for investigation works, disinfection, sterilization . The brigade sent to its mission should be given concrete tasks with a view to ensure the adequate supply of the bacteriological section with diagnostic preparations, materials and equipment.

Zh Mikrobiol Epidemiol Immunobiol, 2001 Nov-Dec, (6 Suppl), 112 - 4
{Working experience of the analytical group of the specialized epidemic brigade}; Mezentsev VM et al.; The working experience of the analytical group as the section of the specialized antiepidemic brigade for the organization and realization of antiepidemic measures, made under the conditions of the antiterrorist operation in the Chechen Republic in the year 2000, is generalized . The necessity for equipping the specialized brigade with a modern computer with peripherals and the necessary specialized computer programs, as well as with modem and fax-telephone facilities, is shown . The necessity of equipping this brigade with the electronic variant of the information and legal data base (references on methods, sanitary norms and other normative documents on sanitation, hygiene, epidemiology, bacteriology and the organization of health service) is indicated.

Zh Mikrobiol Epidemiol Immunobiol, 2001 Nov-Dec, (6 Suppl), 37 - 41
{On the sanitary-hygienic state of the drinking water supply facility and the organization of the sanitary and bacteriological control of the water supply of the population of Grozny in recent years}; Onishchenko GG et al.; Information on the state of water supply in Grozny in the time of peace, during the armed conflict of 1994-1996 and at the period of the antiterrorist operation in the year 2000 is presented . In the year 2000 the centralized water supply of the population proved to be completely paralyzed . The quality of water brought to the city and water from the sources of decentralized water supply considerably deviated from the norm by its bacteriological characteristics . The control of the quality of drinking water supplied to the population was carried out only by the bacteriological laboratory of the specialized antiepidemic brigade.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Jul-Aug, (4 Suppl), 43 - 7
{Persistence of pneumotrophic infective agents in acute bronchopulmonary diseases in children}; Lykova EA et al.; 175 children with acute bronchopulmonary pathology were examined for the presence of the pneumotropic infective agents by serological and bacteriological methods . In most children microbial associations with the prevalence of mycoplasmas, pneumocycts and, to a lesser extent, chlamydiae were detected . The considerable activation of cytomegalovirus (CMV) infection in children with pneumonia and bronchitis was noted . Taking into account the results of the examination and the clinico-anamnestic data, the character of infections could be established: chlamydial and CMV infections were mainly persisting; pneumococcal infection was mainly acute, hemophilic and pneumocyst infections were mixed . The clinical picture of acute pneumonia cases had characteristic features determined by the supposed etiological agent, but this picture could change under the influence of pneumotropic infective agents.

Eur J Surg Oncol, 2003 May, 29(4), 327 - 30
Delayed breast cellulitis following breast conserving operation; Zippel D et al.; A complication of breast conservation, which has been increasingly reported in the literature, is 'delayed cellulitis' in the treated breast . This is to be distinguished from wound infection in the breast following lumpectomy . This study reports 16 cases diagnosed with delayed cellulitis following breast conserving surgery, unresponsive to antibiotic therapy . Diagnostic criteria included: pain, erythema and edema in the operated breast . Symptoms appeared up to 10 months after surgery and time to resolution was seven and a half months . No patients had positive cytology and bacteriology tests were negative . Thirteen patients were observed, and three patients were treated with antibiotics with no apparent immediate effect . The appearance of breast cellulitis after surgery poses a problematic diagnostic and management dilemma . It is important to distinguish between this entity and infection, or inflammatory carcinoma . The picture may be attributed to impairment or occlusion of the lymphatic circulation in the breast . This seems to be a newly defined complication with an incidence of 3-5%.

Acta Paediatr, 2003, 92(2), 221 - 7
Role of cytokines (interleukin-1beta, 6, 8, tumour necrosis factor-alpha, and soluble receptor of interleukin-2) and C-reactive protein in the diagnosis of neonatal sepsis; Santana Reyes C et al.; AIM: To investigate whether the serum levels of interleukin-1beta, 6, 8, tumour necrosis factor-alpha and the soluble receptor of IL-2 are useful in the diagnosis of neonatal sepsis, and whether their diagnostic power is increased when in combination with classical markers such as C-reactive protein and white blood cell count . METHODS: Blood samples were collected at admission from 40 neonates with suspected infection . Patients were included in different groups according to the bacteriological and laboratory results: Group I consisted of 20 newborns with positive blood cultures and other biological tests suggestive of infection . Group II included 20 neonates with negative blood cultures and biological tests not suggestive of infection . The control group included 20 healthy neonates with no clinical or biological data of infection . RESULTS: Mean values of C-reactive protein were significantly higher in Group I . No differences were found between the groups for white blood cell count, with the exception of the presence of leucocytosis in Group II . Levels of interleukin-1beta, 6, 8, tumour necrosis factor-alpha, soluble receptor of interleukin-2, and C-reactive protein were significantly higher in infected neonates than in the control groups . Detection sensitivity and specificity were 80 and 92% for C-reactive protein, 60 and 87% for interleukin-1beta, 61 and 80% for interleukin-6, 62 and 96% for interleukin-8, 54 and 92% for tumour necrosis factor-alpha and 63 and 94% for soluble receptor of interleukin-2 . The discriminant analysis showed that the best combination for sepsis diagnosis was C-reactive protein + interleukin-8 + soluble receptor of interleukin-2, with a sensitivity of 85% and a specificity of 97.1% . CONCLUSION: Our study suggests that no individual test can on its own identify infected neonates, and that although the combination of C-reactive protein, interleukin-8 and the soluble receptor of interleukin-2 exhibits a high specificity, its sensitivity is limited.

Pneumonol Alergol Pol, 2002, 70(9-10), 504 - 8
{Diagnostic difficulties in tuberculosis meningoencephalitis}; Piekarska A et al.; Tuberculous meningoencephalitis (TBM) is a rarely diagnosed form of tuberculosis . It is characterised with high mortality . Only rapidly started treatment allows to patient's survival . However, bacteriologic prove of the diagnosis is achieved only in 40% of cases . It was hoped that introduction of PCR to clinical practice, would allow rapid and unquestionable diagnosis . We present case of male with lymphocytic bacterial meningoencephalitis in whom tuberculous etiology was suspected . The diagnosis was abandoned when negative results of PCR was obtained . As cessation of treatment led to dramatic worsening of patients state, the antituberculosis therapy was restarted . After 2 months of therapy, complete clinical remission was achieved . Nevertheless, computed tomography of brain revealed clinically asymptomatic hydrocephalus . Presented case shows that the treatment is effective, it should not be ended even in case of negative results of PCR test.

Indian J Lepr, 2002 Apr-Jun, 74(2), 115 - 28
Reactions in borderline leprosy; Ramu G et al.; This is a retrospective study of 276 patients consisting of 157 active and 119 reactive patients of borderline leprosy . They were followed up for 10 years after sulphone monotherapy . The presenting symptoms were carefully examined from the records and systematically presented . Frequency of reactions was least in BT cases and most in BL cases . Risk factors of reaction appear to be the type of leprosy, multiplicity of lesions, high BI and, possibly, psychological stress . Biopsy of skin lesions was performed in all cases initially, and at the subsidence of the disease . Histological findings closely correlated with clinical classification . While all the cases showed clinical subsidence, histological subsidence was found in 200 (73%) cases, and the condition was static in 36 cases (13%) . Immunological upgrading was seen in 110%, while 4% showed downgrading . Bacteriological status and lepromin reaction of active and reactive cases were compared . All these factors need to be taken into consideration for instituting prompt and proper treatment.

Chir Narzadow Ruchu Ortop Pol, 2002, 67(6), 605 - 11
{The effect of organism environment on bacteriostatic and mechanical properties of Palacos R cement mixed with antibiotic}; Toborek J et al.; The results of bacteriological tests of Palacos R cement with antibiotic directly after its obtaining and 3 and 6 months after implantation in rabbit organism have been presented in this work . The results of tests of mechanical characteristics of cement with and without antibiotic samples after being kept in physiological saline for 3 to 6 weeks have also been presented . Bacteriological tests prove that antibiotic (III generation cephalosporin) added to surgical cement retain its bacteriostatic properties . When tested on rabbits cement plus antibiotic retains its bacteriostatic properties only in the initial period . Kep of the Palacos R cement with and without III generation cephalosporin in physiological saline insignificantly decreased the strength properties as compared to respective values of dry cement strength and did not lead to any loss of its visco-elasticity.

Ann Biol Clin (Paris), 2003 Mar-Apr, 61(2), 219 - 22
{Nocardia otitidiscaviarum, cutaneous infection in a patient receiving long-term corticosteroid treatment}; Dekeyser S et al.; A 62-year-old man, under long-term corticosteroid therapy for pigeon breeder's disease, was admitted to endocrinology disease department for cutaneous abscess on back, limbs and scalp . Culture of various bacteriological samples (cutaneous abscess, blood culture) isolated Nocardia otitidiscaviarum . The patient was treated by trimethoprime-sulfametoxazole during several weeks with abscess disappearance . Our laboratory quickly identificatied a bacteria belonging to the Nocardia genus, with simple technique, later confirmed by a specialized laboratory (Pr . Boiron Claude Bernard University Lyon I) with identification of Nocardia otitidiscaviarum . The proof of pulmonary nocardiosis could not be established despite the existente of several risk factors . Prognosis is poor for immunocompromised patients, but the secondary cutaneous dissemination phase presented a favourable evolution under antibiotic therapy.

Acta Otolaryngol, 2003 Jan, 123(2), 310 - 3
Effect of endosinusal treatment on cellular markers in mild and moderate asthmatics; Kalogjera L et al.; OBJECTIVE: To determine the efficacy of topical endosinusal treatment in terms of reduction in activation of inflammatory cells and asthma/rhinosinusitis symptoms in patients with asthma and chronic rhinosinusitis (CRS) . MATERIAL AND METHODS: Eighteen mild-to-moderate asthmatics with CRS were subjected to antral sinoscopy and endosinusal treatment with 2 mg of dexamethasone and 40 mg of gentamicin per maxillary sinus for 7 days . Sinus lavage and serum samples were taken before and after the treatment and bacteriological swabs from the sinuses were taken at the time of inclusion in the study . Subjective scores for CRS symptoms and forced expiratory volume in 1 s (FEV1) were tested at inclusion and after 30 days . Levels of eosinophil cationic protein (ECP), tryptase and myeloperoxidase (MPO) were analyzed in serum and sinus fluid before and after the treatment . RESULTS: ECP and tryptase levels were significantly reduced in both serum and sinus fluid, but serum MPO did not show significant changes after the treatment . MPO in sinus lavage was reduced only in moderate asthmatics . Subjective scores for CRS and FEV1 were significantly improved for the whole group . ECP, usually used as a parameter for asthma staging, was mostly affected at the systemic level, whilst tryptase was more markedly reduced at the local level . CONCLUSION: The topical endosinusal treatment used in this clinical study significantly reduced activation of eosinophils and mastocytes, improved FEV1 and reduced symptoms of CRS in mild-to-moderate asthmatics.

Medicina (Kaunas), 2003, 39(3), 225 - 31
{Tuberculous pneumonia in children}; Steponaviciene D et al.; Tuberculosis (TB) is one of the most common infectious diseases worldwide . Data from WHO show that one third of the world population is estimated to be infected with Mycobacterium Tuberculosis (TM) . TB remains an important problem for adults and children in Lithuania as number of new diagnosed children's TB cases vary between 16.7-21.8 per 100 000 population . The aim of this article is to present the TB pneumonia in childhood: peculiarities of clinical forms, symptoms, diagnostics, treatment and results . The diagnosis of TB in children more often is made on epidemiological data, supposed by clinical symptoms, tuberculin skin test and chest radiography results, rather than bacteriological data . Clinical symptoms of TB pneumonia are mostly similar to atypical pneumonia, caused by Mycoplasma pneumoniae and Chlamydia pneumoniae . We discussed similarities and differences between atypical and TB pneumonia, based on 10-year data of our patient ill with atypical and TB pneumonia, (123 - 63.7%) and (69 - 36.3%) respectively . Chemotherapy of TB is directed towards the eradication of TM . The main principle of TB chemotherapy is regular, directly controlled and long-term usage of several antituberculous drugs . The child, ill with TB, is totally cured, when he has no clinical symptoms or laboratory findings specific for TB and is able to return to his normal social life . Two clinical cases of children ill with TB pneumonia are discussed as well . We hope that this article and two clinical cases would remind pediatricians and family doctors to be aware of still possible TB in childhood.

Respir Med, 2003 Apr, 97(4), 439 - 44
Pulmonary disease caused by Mycobacterium xenopi in HIV-negative patients: five year follow-up of patients receiving standardised treatment; Jenkins PA et al.; The literature concerning the management of pulmonary disease caused by Mycobacterium xenopi is scanty and consists of retrospective reports, mostly of small series of patients . Our aim was to document the clinical features and response to treatment of this rare but challenging disease . Patients were treated in a randomised, multi-centre trial with either rifampicin plus ethambutol or rifampicin, ethambutol and isoniazid . Clinical, bacteriological and radiological progress was monitored at set intervals for 5 years . As no differences emerged between the two groups, the results have been combined to provide this prospective survey . Forty-two patients were studied . Mean age was 65 years, three-quarters were male and two-thirds had other lung disease(s) . Sputum was positive on direct smear in 62% . Cavitation was present in 81%, mostly large cavities, and disease was extensive in 38% . Despite good clinical response and little toxicity the death rate was high (69%), but less than 10% died primarily because of the M . xenopi disease . The failure of treatment/relapse rate was 12% . Only 11 (26%) were known to be alive at 5 years of whom seven (17%) were known to be cured . There was no correlation between failure of treatment/relapse and in vitro resistance . Better methods of susceptibility testing and more effective regimens are needed, but it is also evident that improved management of concomitant diseases and better general health will play a major part in increasing survival.

Minerva Chir, 2003 Feb, 58(1), 77 - 82, 82-5
Mycobacterium infection directly observed in a surgical outpatient centre; Cherubini M et al.; BACKGROUND: This study aims to check the presence and the role of the Mycobacterium tuberculosis infection, in an Ambulatory and Day Surgery Out-Patient Centre . METHODS: Two periods of activity in this Centre are evaluated corresponding separately to the years 1989-1993 and 1994-1998 and the total number of patients, coming for examination, ambulatory or day surgery, hospitalization, postoperative follow-up, is considered, in order to identify the number of cases and the clinical signs of this disease . All cases were examined by the same team and the checks were completed, in the selected cases in which it was advisable, with radiological, bacteriological, bioptical, radiometrical exams and with the Elisa test (after informed consent) . RESULTS: In the first period 1989-1993, 21,220 patients were examined and no case of tubercular infection was observed . In 1994-1998, 24,347 patients were examined and 4 cases of tubercular infection detected, which represent 0.016% of the patients attending the service . The clinical cases are as follows . Case 1: right sub-mammary lump, diameter 7 x 5 cm, smooth, oval, firm . Case 2: right breast swelling, diameter 5 cm, not sore, with deep attachments . The mammography and ultrasound scan indicate: the opacity is compatible with mali moris breast lesion . Case 3: coloured, immigrant, who presents back swelling, diameter 8 cm, with fluctuation . CT of the chest indicates opacity near left latissimus dorsi muscle, diameter 10 cm, without bronchopleural connections . Case 4: bleeding neoplastic ulcer of the wrist . At physical exam a right subclavear amphoric breath sound is noticed, corresponding at chest X-ray to an opacity including cavitation . In the 4 cases no lymph node in the regional effusion areas is detected . In the 4 cases surgical therapy is integrated with antituberculous chemotherapy till 6 months after operation . CONCLUSIONS: Mycobacterium tuberculosis infection has been increasing in the second group of years considered, as it is observed in European industrialized countries and North America . This increase corresponds to 0.016% in 24,374 patients examined in the period 1994-98 . This infection must not be connected with the classic sites and traditional primary and post-primary symptons, but must be considered and identified in a surgical hospital out-patient centre, in unusual sites, sometimes masquerading as a false positive carcinoma, in patients with predisposition, because of old age, race, immunodepression (also if HIV negatives), resistance to treatment, previous tuberculous infection . In the cases identified deep diagnostic definition, the surgical treatment and a prolonged antituberculous chemotherapy are necessary.

Rev Panam Salud Publica, 2002 Dec, 12(6), 375 - 83
{Epidemiology and inequality: notes on theory and history}; da Silva JB et al.; In this paper we present a historical analysis of the concept of inequality, and we also discuss how inequality has been viewed within the field of health . Natural and social inequalities are discussed, along with the concept of equity, theoretical explanations for inequality, and stratification in modern societies . Finally, we focus on the relationships between epidemiology and studies on social inequalities in health since epidemiology was established as a discipline, during the so-called bacteriological era, and at the present time, when there is a growing interest in social inequalities in health.

Lijec Vjesn, 2002 Nov-Dec, 124(11-12), 380 - 9
{100 years of continuous preventive medicine in the area of Rijeka}; Bakasun V et al.; The Hungarian Ministry of Agriculture established a chemical investigation service named . The Hungarian Royal Experimental Chemical Service of the City of Rijeka . According to the information found in the city's archive, as well as to the news published in the daily newspaper of that time "La Bilancia", the Service started its activity on April 8th, 1900 . The Service was in fact the first organized institution of public health within this region and the current Institute of Public Health is its direct heir . At the end of the World War I, the city of Rijeka was incorporated to the Kingdom of Italy in 1924, while the territory of Susak came under the Kingdom of Yugoslavia . The Chemical Investigation Service, though changing different names, continued its activity . As the Provincial Laboratory for Hygiene and Prophylaxis, the institution carried on its activity from 1927 until the end of World War II in 1945 . As the consequence of the frontier erected on the river banks of Rjecina, the Susak area remained without a single medical institution . The first organized institution of public health in this area was the Bacteriological Service in Kraljevica, established in 1923 . The Health Care Center Susak was founded in February 1926 and moved in a new building located in Kumicica St . No 6 . Subsequent to Italian occupation of Susak in 1941, the major parts of the Health Care Center moved to Crikvenica, continuing its activity within the district of Susak that came under the Independent State of Croatia (NDH) . The smaller part of the Center that remained in Susak ceased its activity in 1942 . After the liberation in May 1945, the Health Care Center came back to Susak . Due to the fact that the most of experts left the town by the end of war, the activity of the Laboratory in Rijeka was reduced in that period . In 1946 the organization structure had already been changed with Sanitary Epidemiological Service (SES) founded in Susak, and the Municipal SES established in Rijeka . Both institutions were on January 1st united into the regional Hygienic Institute in Rijeka . The Hygienic Institute and the Health Care Center Rijeka (founded in 1953) were unified into the Institute of Public Health on July 1st 1960 . A huge improvement in preventive medical service was obtained by moving into a new building of the Institute in nowdays location in Kresimirova St . No 52a.

Am J Respir Crit Care Med, 2003 Apr 15, 167(8), 1090 - 5 Epub 2003 Jan 24.
Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease; Wilkinson TM et al.; Chronic obstructive pulmonary disease (COPD) is characterized by an accelerated decline in lung function and progressive airway inflammation . Bacteria have been isolated from the lower airway of stable COPD patients, and airway inflammation has been related to bacterial load and type . The relationship between bacterial colonization, airway inflammation, and lung function decline remains uncertain . We studied 30 patients with COPD, mean (SD) FEV1 0.947 (0.329), 34.8% (13.6%) predicted, for 12 months . Sputum collected at recruitment and the end of the study was analyzed for cytokines and for quantitative bacteriology . The decline in FEV1 was 57.6 (137.6) ml year-1 . Bacterial growth was identified in all subjects, with an initial count of 107.47(0.91) cfu ml-1 rising to 107.93(0.81) cfu ml-1 at the end of the study (p = 0.019) . FEV1 decline was related to this increase in airway bacterial load (r = 0.59, p = 0.001) . FEV1 decline was greater in subjects who exhibited a change in the colonizing bacterial type compared with those with persistence of a single bacterial species over the study period (p = 0.017) . Higher sputum interleukin (IL-8) was associated with greater declines in FEV1 (p = 0.03) . Rising airway bacterial load and species changes are associated with greater airway inflammation and accelerated decline in FEV1 . Bacterial colonization in COPD is an important factor in disease progression.

Clin Infect Dis, 2003 Apr 15, 36(Suppl 3), S123 - 7
Forum report: issues in the evaluation of diagnostic tests, use of historical controls, and merits of the current multicenter collaborative groups; Bennett JE et al.; This forum report contains conclusions about 3 different issues relevant to conducting clinical trials in deep mycoses . (1) Trials of diagnostic tests for deep mycoses must define the population appropriate for testing and the clinical question being asked . The unanswered question for the serum Aspergillus galactomannan assay is whether knowledge of results can change use of empirical therapy to treat febrile patients at high risk of invasive aspergillosis . (2) Use of historical controls is suboptimal but offers a pragmatic solution for studying rare mycoses; use of contemporaneous controls, matched for critical variables and evaluated by a blinded data review committee using detailed criteria, appears optimal . (3) Established groups of independent investigators, such as the European Organization for Research on Treatment of Cancer's Invasive Fungal Infections Group and National Institute of Allergy and Infectious Diseases's Bacteriology and Mycology Study Group, provide a pool of experienced investigators, defined operating rules, impartiality, and specialized expertise . Considering the enormous investment required for adequately powered efficacy trials of antifungal agents and the importance of these trials to guide clinical practice, use of collaborative groups outweighs the extra administrative time that is sometimes required.

J Med Assoc Thai, 2003 Jan, 86(1), 52 - 60
Nontuberculous mycobacterial skin infections: clinical and bacteriological studies; Mahaisavariya P et al.; OBJECTIVE: Nontuberculous mycobacterial (NTM) skin infections were analysed in terms of clinical manifestation in different species to provide clues for the clinical diagnosis and sensitivity patterns of these species were studied for planning appropriate therapy . DESIGN: A retrospective study was performed in 123 suspected cases of NTM infections from January 1994 to December 2000 . NTM infection was documented by culture result of the infected tissue obtained by skin biopsy . Drug susceptibility test was done as requested . RESULT: Rapid growers (M . fortuitum-chelonae) were found in 26 cases (65%) and M . marinum was responsible for 12 cases (30%) and caused only localized skin lesions on arms or legs as indurated plaque, Disseminated skin infections manifested as multiple abscesses were found in 2 cases caused by M . avium in an HIV-infected male patient and mixed infection of M . szulgai and M . terrae in an immunocompetent female patient after a dental procedure . Both sexes were affected equally in overall number but male predominated in M . marinum infection and females predominated in rapid growers . All ages can be affected but most cases were middle aged . Scrofuloderma-like cervical lymphadenitis and cutaneous abscesses were the common manifestation of rapid grower infections . Hyperkeratotic verrucous plaques (tuberculosis verrucosa cutis-like) and sporotrichoid lesions were the common manifestations of M . marinum infection . M . marinum is sensitive to minocyclin, clarithromycin, amikacin, rifampicin and ethambutol and a good clinical response was obtained with doxycyclin 100 mg orally twice a day for 3 months . Clarithromycin and amikacin showed in vitro activity against the same strain of M . fortuitum but most strains of rapid growers resisted antituberculous drugs and also various antibiotics . CONCLUSION: Clinical manifestations can be used as clues for diagnosis . Medical therapy is recommended for M . marinum infection and surgical treatment is recommended for rapid growers.

Schweiz Arch Tierheilkd, 2002 Sep, 144(9), 483 - 92
{Abortion in small ruminants in Switzerland: investigations during two lambing seasons (1996-1998) with special regard to chlamydial abortions}; Chanton-Greutmann H et al.; Abortion cases of 144 goats und 86 sheep were investigated etiologically during 2 lambing seasons (1996/1997, 1997/1998) . Macroscopic inspection of fetus and placenta was completed by histopathology and bacteriological isolation of agents . In addition, immunohistologically the following antigens were labeled in formalin-fixed and paraffin-embedded tissue sections: Toxoplasma gondii, Neospora caninum, Chlamydophila abortus (formerly Chlamydia psittaci serovar 1) and Border Disease Virus . From farms with abortions caused by Chlamydophila abortus specific data were recorded . In 75% of abortion cases in sheep and in 59% of cases in goats an etiologic diagnosis could be substantiated . Chlamydophila abortus is the most commonly involved agent in the etiology of caprine and ovine abortion (sheep 39%, goats 23%), followed by Toxoplasma gondii (sheep 19%, goats 15%) and Coxiella burnetti (sheep 1%, goats 10%) . All other agents are of minor importance . An infectious cause of abortion based on histopathologic findings without isolation of agents was observed in sheep (10%) and goats (21%) . Malformation occurred in sheep (2%) and goats (3%) and lesions suggestive for Vitamin E/Selenium deficiency were seen in goats only (2%).

Can J Gastroenterol, 2003 Mar, 17(3), 187 - 90
Renal impairment after spontaneous bacterial peritonitis: incidence and prognosis; Perdomo Coral G et al.; BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is an important complication in cirrhotic patients . The aim of the present study was to assess the incidence, predictive factors and prognosis for renal impairment (RI) after SBP in cirrhotic patients from southern Brazil . METHODS: Of the 1030 hospitalizations evaluated, 114 episodes of SBP were diagnosed in 94 patients (mean age 49 years; 76.59% men) . SBP diagnosis was established when the ascitic fluid polymorphonuclear cell count was equal to or greater than 250 cells/mm3 . Five cases were excluded . The variables assessed as possible predictors of steady or progressive RI were blood urea nitrogen and creatinine levels before the diagnosis of SBP; type of infection, antibiotic prophylaxis, first episode or recurrent SBP, presence of gastrointestinal bleeding and hepatic encephalopathy during hospitalization, SBP resolution, Child-Pugh classification, levels of blood pressure, ascitic fluid and blood polymorphonuclear cell count, bacteriological data (positive and negative ascitic fluid culture), albumin, bilirubin, sodium and prothrombin time at the moment of diagnosis . RESULTS: The incidence of SBP was 11.07% . In 61 (55.96%) episodes, SBP was associated with RI (transient in 57.37%; steady in 19.67%; and progressive in 22.95%) . The mortality rate associated with progressive RI was 100%; 58.33% with steady RI; and 2.85% with transient RI . The mortality rate in patients with or without RI was 36.07% and 6.25%, respectively (P<0.001) . The level of creatinine (greater than or equal to 1.3mg/dL) before the diagnosis of SBP and the rate of infection resolution were the only predictors of RI in the multivariate analysis . CONCLUSIONS: RI after SBP is a common complication, and indicates a poor prognosis for this infection . High levels of creatinine before infection and the rate of infection resolution are independent predictors of RI.

Mol Microbiol, 2003 Apr, 48(2), 305 - 21
The Legionella pneumophila LidA protein: a translocated substrate of the Dot/Icm system associated with maintenance of bacterial integrity; Conover GM et al.; Legionella pneumophila establishes a replication vacuole within phagocytes that requires the bacterial Dot/Icm apparatus for its formation . This apparatus is predicted to translocate effectors into host cells . We hypothesized that some translocated proteins also function to maintain the integrity of the Dot/Icm translocator . Mutations that destroy this function are predicted to result in a Dot/Icm complex that poisons the bacterium, resulting in reduced viability . To identify such mutants, strains were isolated (called lid-) that showed reduced viability on bacteriological medium in the presence of an intact Dot/Icm apparatus, but which had high viability in the absence of the translocator . Several such mutants were analysed in detail to identify candidate strains that may have lost the ability to synthesize a translocated substrate of Dot/Icm . Two such strains had mutations in the lidA gene . The LidA protein exhibits properties expected for a translocated substrate of Dot/Icm that is important for maintenance of bacterial cell integrity: it associates with the phagosomal surface, promotes replication vacuole formation, and is important for both efficient intracellular growth and high viability on bacteriological media after introduction of a plasmid that allows high level expression of the dotA gene.

Indian Heart J, 2002 Nov-Dec, 54(6), 681 - 6
Ten-year experience with the arterial switch operation; Sharma R et al.; BACKGROUND: Arterial level repair is considered the most appropriate procedure for transposition of the great arteries . This report describes our experience with the arterial switch operation over the past decade . METHODS AND RESULTS: From January 1991 to January 2001, a total of 299 patients underwent an arterial switch operation for transposition of the great arteries or double-outlet right ventricle . Group I (n=169, 56.5%) comprised patients with transposition of the great arteries in whom the ventricular septum was essentially intact . Group II patients (n=130, 43.5%) had transposition of the great arteries with an additional significant ventricular septal defect or had double-outlet right ventricle with a subpulmonic ventricular septal defect . Of the total, 245 (82%) were males and 54 (18%) were females . In group I, the ages ranged from 2 days to 18 years (median 19 days) and weight ranged from 1.7 to 68 kg (median 2.5 kg) . In group II, the ages ranged from 4 days to 4 years (median 90 days) and weight ranged from 2.5 to 17 kg (median 4 kg) . Fifteen percent of the patients (25/169) in group I and 30% of the patients (39/130) in group II had features of bacteriologic infection . Arterial switch operation was performed on standard lines . In group I, 141 patients (83.4%) had a primary arterial switch operation while 28 (16.6%) underwent a rapid two-stage repair . Twenty-three patients required concomitant relief of associated anatomic left ventricular outflow tract obstruction . Operative mortality was 8.8% (15/169) in group I and 33% (44/130) in group II with an overall mortality of 19% (59/299) . The major causes of operative mortality included pulmonary arterial hypertensive crisis (n=21), sepsis and related complications (n=16), and left ventricular failure (n=8) . Coexisting arch anomalies, longer cross-clamp time, late presentation, and preoperative bacteriologic infections were incremental risk factors . Follow-up ranged from 1 to 10 years and was 87% complete . On follow-up, 91% of the patients were asymptomatic and off all medications . There were 3 late deaths and 5 patients required reoperation . CONCLUSIONS: Excellent long-term results are obtained in operative survivors following the arterial switch operation . However . operative mortality remains a concern in our set-up.

Br J Surg, 2003 Apr, 90(4), 407 - 20
Management of severe acute pancreatitis; Yousaf M et al.; BACKGROUND: Acute pancreatitis is still associated with significant morbidity and mortality . Current management guidelines are sometimes equivocal, particularly in relation to the surgical treatment of severe disease . This review assesses available investigative and treatment strategies to allow the development of a formalized management approach . METHODS: A literature review of diagnosis, staging and management of acute pancreatitis was performed . RESULTS AND CONCLUSION: Recent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis . Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years . This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed . A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis .

Int J Antimicrob Agents, 2003 Apr, 21(4), 350 - 3
Treatment of typhoid fever in children with a flexible-duration of ceftriaxone, compared with 14-day treatment with chloramphenicol; Tatli MM et al.; Although the efficacy of ceftriaxone in typhoid fever is well documented, the precise duration of ceftriaxone therapy in children with typhoid fever is not established and varies from 3 to 14 days in the literature . In a prospective, randomized study ceftriaxone was compared with chloramphenicol for treatment of 72 children who had bacteriologically confirmed typhoid fever . Ceftriaxone was given at a dose of 75 mg/kg per day (maximally 2 g/day) intravenously, in two doses until defervescence and continued 5 days after that time . Chloramphenicol was given at a dose of 75 mg/kg per day (maximally 2 g/day) in four doses for 14 days . Mean defervescence time was in 5.4 days in the ceftriaxone group and 4.2 days in the chloramphenicol group (P=0.04) . Clinical cure without complications was achieved in all patients in both groups . No patient relapsed in the ceftriaxone group, and four patients relapsed in the chloramphenicol group (P=0.048) . The overall results of this study suggest that a flexible-duration of ceftriaxone therapy given until defervescence time, followed by an additional 5 days of therapy is a reasonable alternative to conventional 14-day chloramphenicol treatment in children with typhoid fever.

Int J Antimicrob Agents, 2003 Apr, 21(4), 308 - 12
Evaluation of antibiotic use in a hospital with an antibiotic restriction policy; Erbay A et al.; The study was designed to evaluate rational antibiotic use in relation to diagnosis and bacteriological findings . All hospitalized patients who received antibiotics were evaluated by a cross-sectional study . Of the 713 patients hospitalized, 281 (39.4%) patients received 377 antibiotics . Among 30 different antibiotics the most frequently requested were first generation cephalosporins (19.9%), ampicillin-sulbactam (19.1%) and aminoglycosides (11.7%) . Antibiotic use was appropriate in 64.2% of antibiotic requests . In analysis of appropriate use, a request after an infectious diseases consultation was a frequent reason (OR=14, P<0.001, CI=0.02-0.24) . Antibiotics requested in conjunction with susceptibility results were found to be more appropriate than those ordered empirically (OR=4.5, P=0.017, CI=0.06-0.76) . Inappropriate antibiotic use was significantly higher among unrestricted antibiotics than restricted ones (P<0.001) . Irrational antibiotic use was high for unrestricted antibiotics . Additional interventions such as postgraduate training programmes and elaboration of local guidelines could be beneficial.

Lepr Rev, 2003 Mar, 74(1), 18 - 30
Comparison of PCR mediated amplification of DNA and the classical methods for detection of Mycobacterium leprae in different types of clinical samples in leprosy patients and contacts; Torres P et al.; Traditional staining and microscopic examination techniques for the detection of Mycobacterium leprae, DNA amplification by polymerase chain reaction (PCR) of a 531-bp fragment of the M . leprae specific gene encoding the 36-kDa antigen, and serodiagnosis with M . leprae specific antigens (PGL-1 and D-BSA) were compared on different clinical specimens (serum samples, slit-skin smears, biopsies and swabs) from 60 leprosy patients attending the Sanatorium of Fontilles . Patients were divided into groups; (i) 20 multibacillary patients (MB) with positive bacteriological index (BI) by conventional methods and on WHO multidrug therapy (MDT); (ii) 30 MB patients with negative BI and completed minimum 2 years treatment MDT; (iii) 10 paucibacillary (PB) patients who had completed 6 months MDT at least 8 years ago . Control groups included four non-leprosy patients for PCR methods and 40 health control patients and 10 tuberculosis patients for serological methods . In the multibacillary BI positive group, there was a good correlation between all methods . All tests were negative in the paucibacillary group, although only a few patients were tested and all had been treated many years ago . One must be cautious concerning the diagnostic potential of these techniques in this type of leprosy . We also studied different combinations of leprosy diagnosis methods to determine the potential risk in a leprosy contact individuals group . The prevalence of antibodies to M . leprae antigens in serum was measured, together with the presence of M . leprae DNA in the nose and lepromin status in a group of 43 contacts of leprosy patients (12 household and 31 occupational) to evaluate the maintenance of infection reservoirs and transmission of the disease . Only two individuals were found to form a potential high risk group.

Hong Kong Med J, 2003 Apr, 9(2), 83 - 90
Tuberculosis in Hong Kong-patient characteristics and treatment outcome; Tam CM et al.; OBJECTIVES: To identify the general characteristics of patients with tuberculosis, and to evaluate their treatment outcomes . DESIGN: Retrospective study . SETTING: Tuberculosis and Chest Service, Department of Health, Hong Kong . SUBJECTS AND METHODS: All patients with tuberculosis registered for treatment from 1 January 1996 to 31 December 1996 were included in the study . Information was extracted from their medical records at treatment commencement and at 12 and 24 months after treatment was instigated . Data gathered included demographic data, past treatment, site of disease, case category, treatment regimen, bacteriological status, and treatment outcome . RESULTS: There were 5757 patients for analysis . Approximately one third of patients were aged 60 years or older, and 69.1% were male . Pulmonary disease alone occurred in 77.7% of patients, while both pulmonary and extrapulmonary diseases occurred in 8.6% . New patients comprised 84.6% of cases, and 16.3% had concomitant illnesses . There was excess risk of disease among patients who were male, elderly, or who had silicosis . Only 0.1% of patients were co-infected with human immunodeficiency virus infection . Among the 5757 cases evaluated, 1324 (23.0%) were new patients with a positive sputum smear, 299 (5.2%) were patients who were retreated with a positive sputum smear, and 4134 (71.8%) were new or retreatment patients with a negative sputum smear . The overall treatment completion rates at 12 and 24 months were 80.4% and 84.8%, respectively . Males and patients aged 60 years or older had lower treatment completion rates . Non-adherence, transfer to other services, and mortality among the elderly were key factors influencing treatment outcomes . Co-morbidity was associated with better case-holding, and this more than compensated for its effect on prolongation of treatment and mortality . CONCLUSIONS: There was an excess risk of tuberculosis among male and elderly patients, who also had a less favourable outcome . Active screening of clearly identified risk groups may be appropriate but requires the completion of more in-depth studies and careful cost-effectiveness analyses . Further efforts with respect to case-holding are indicated to address treatment defaulting and transfer rates.

Dtsch Tierarztl Wochenschr, 2003 Feb, 110(2), 59 - 64
{The clinical effectiveness of a post milking teat disinfection method with a foaming iodophor teat dip}; Falkenberg U et al.; The effect of postmilking teat dipping with a foaming iodophor agent on incidence of intramammary infections (IMI), incidence of clinical mastitis, somatic cell count and the characteristics of udder tissue and teat was investigated in a positively controlled field study . Two groups of animals were compared . Teats were dipped with a foaming iodophor in the treatment group (TG, 122 animals) while teats in the control group (CG, 121 animals) were dipped with a conventional iodophor teat dip with the same iodine content . A bacteriological examination of quarter milk samples divided the study period in two parts . The incidence of new IMI did not differ between the groups (1st part of trial: TG vs . CG: 6.84% vs . 9.16%, 2nd part of trial: 7.78% vs . 7.82%) . There were no differences between the treatment groups regarding incidence of clinical mastitis . We detected 0.64 clinical cases per 100 days in the treatment group vs . 0.50 in the control group . The development of SCC was comparable in both groups . Teat skin and teat duct conditions showed variation during the study period . Clinical efficacy of postmilking teat disinfection with a foaming iodophor was comparable to the treatment with a conventional iodophor product.

Hist Philos Life Sci, 2002, 24(1), 3 - 36
'Like all that lives': biology, medicine and bacteria in the age of Pasteur and Koch; Mendelsohn JA; This essay draws a new picture of the science of bacteria in its 'golden age', circa 1880-1900: the organization of its knowledge and practice, its germ theory of disease, the difference between its two major research traditions, and, above all, its place in life science in this period that bristled with theories and debates over inheritance, variation, selection, evolution and that witnessed the transition from natural history to laboratory biology . Pasteur and Koch's science acquired this biological dimension not despite being outside academic biology, nor despite the limitations of its applied, medical matrix, but rather because of that framework . The very practices of vaccine development constituted, at the same time, a new biological model of bacterial species and variation, which aligned them with other living things . Finally, the new picture reveals unsuspected continuity to later microbiology and molecular biology . In illuminating the self-perceptions of these sciences in relation to the past, it situates and opens a critical perspective on writings by bacteriologists such as Ludwik Fleck, Francois Jacob and Rene Dubos, which have widely informed how we understand science.

Eur Respir J, 2003 Mar, 21(3), 478 - 82
Pulmonary disease caused by M . malmoense in HIV negative patients: 5-yr follow-up of patients receiving standardised treatment; Tuberculosis transmission patterns in a high-incidence area: a spatial analysis; Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, Western Cape, South AfricaSETTING: In the Cape Town suburbs of Ravensmead and Uitsig, tuberculosis has reached epidemic levels, with notifications of 1340/100,000 in 1996 . These suburbs are characterised by overcrowding, high unemployment and poverty . It is traditionally believed that tuberculosis transmission takes place mainly in households after close contact with an infectious person . Studies have recently linked tuberculosis transmission to locations outside the household, and have associated these places with a particular high-risk lifestyle . Anthropological studies in some suburbs of Cape Town, in which a very high number of local drinking places (shebeens) were identified (17 per km2), have suggested that social drinking is part of such a lifestyle . OBJECTIVE: To investigate various risk factors and places of transmission of tuberculosis using a geographical information system (GIS) . RESULTS AND CONCLUSION: The 1128 bacteriologically-proven cases of tuberculosis studied over the period 1993-1998 were investigated using spatial epidemiological techniques of exploratory disease mapping . Point pattern analysis and spatial statistics indicated clustering of cases in the areas of high incidence . Significant associations of tuberculosis notifications were found with unemployment, overcrowding and number of shebeens per enumerator sub-district . High tuberculosis notifications with unemployment and its associated poverty emerged as the strongest association.

Int J Tuberc Lung Dis, 2003 Mar, 7(3), 258 - 65
Are community surveys to detect tuberculosis in high prevalence areas useful? Results of a comparative study from Tiruvallur District, South India; Santha T et al.; BACKGROUND: In Tiruvallur District, South India, tuberculosis cases are detected at health facilities (HF) as part of a DOTS programme, and by screening adults through community survey (CS) as part of ongoing epidemiological research . OBJECTIVE: To compare socio-demographic, clinical and bacteriological characteristics and treatment outcomes of all patients detected at HF with those of all patients detected by CS during a 12-month period . RESULTS: Of 32,663 adults surveyed, 100 had smear-positive and 116 had smear-negative tuberculosis; of 65 smear-positive patients who began treatment, 44 were cured . Compared to HF patients, CS patients were significantly more likely to be older (AOR = 1.9), male (AOR = 2.7), non-literate (AOR = 1.7), and living in poor quality housing (AOR = 2.0), and were less likely to have cough >3 weeks (AOR = 3.4) or smear-positive tuberculosis (AOR = 4.2) . Of 61 new smear-positive CS patients, 40 reported chest symptoms; of these, 32 (80%) had already consulted a health-care provider, but remained undiagnosed . CONCLUSIONS: The community survey was of little value in tuberculosis case detection even in this high-prevalence setting . Patients identified by the survey were less symptomatic and less infectious, and less than half were cured . Diagnostic services should be made more accessible to the elderly, the non-literate and men.

Int J Tuberc Lung Dis, 2003 Mar, 7(3), 243 - 7
Physicians' approach to the diagnosis and treatment of tuberculosis in Afyon, Turkey; Cirit M et al.; OBJECTIVE: To evaluate physicians' approaches to the diagnosis and treatment of tuberculosis in Afyon, Turkey . MATERIAL AND METHODS: A questionnaire on tuberculosis was filled out by 208 physicians (46 specialists and 162 general practitioners) . RESULTS: Bacteriology was the preferred method of diagnosis among 75% (n = 156) of the physicians . For treatment of newly diagnosed tuberculosis, 64.4% prescribed a three-drug and 30.8% a four-drug combination . The combination most often selected was HRE (36.5%) . Preferred treatment durations were 9 (38.5%) and 6 (34.6%) months . For patients with treatment failure, 20.2% of the physicians would add a new drug to the existing regimen, while 65.4% would refer the patient to a specialised tuberculosis unit . For the treatment of childhood tuberculosis, 38.5% of the physicians thought a two-drug treatment was adequate . For tuberculosis during pregnancy, 9.7% of the physicians offered treatment after the pregnancy, while 11.5% offered treatment after abortion . CONCLUSION: The knowledge of the physicians about the diagnosis and treatment of tuberculosis was deemed insufficient . Additional educational resources for physicians may contribute to improvements in tuberculosis control.

Int J Tuberc Lung Dis, 2003 Mar, 7(3), 208 - 13
A systematic review of the adjunctive use of systemic corticosteroids for pulmonary tuberculosis; Smego RA et al.; OBJECTIVE: To determine the safety and benefit of adjunctive systemic corticosteroid therapy in the management of pulmonary tuberculosis . METHODS: A systematic review of 11 randomized, comparative clinical trials published from 1959 to 1999 involving the use of prednisone, prednisolone and/or adrenocorticotrophin (ACTH) in conjunction with standard anti-tuberculosis chemotherapy . A total of 1814 steroid-treated patients were analyzed, most of whom had moderate to severe disease and cavitation . Clinical, microbiologic and radiographic outcome measures included time to defervescence, weight gain, normalization of serum albumin level and erythrocyte sedimentation rate, length of hospitalization, rate and rapidity of sputum conversion and radiographic regression of pulmonary infiltrates and cavities . RESULTS: Corticosteroid therapy resulted in broad and significant clinical benefits in almost all of the studies reviewed . More rapid radiographic resolution of pulmonary infiltrates and, to a lesser extent, closure of cavities accompanied steroid use, especially in the first 4 months, but extended up to one year after initiation of treatment . Steroids did not have any appreciable effect on the speed or rate of sputum conversion . No detrimental side-effects attributed to steroid therapy or bacteriologic relapse were observed . CONCLUSION: The adjunctive use of systemic corticosteroid therapy can safely provide significant early and prolonged clinical and radiographic benefits in selected patients with advanced pulmonary tuberculosis.

Rev Med Interne, 2003 Mar, 24(3), 189 - 94
{Myopericarditis during Horton disease}; Teixeira A et al.; INTRODUCTION: Myopericarditis is an rare form of Horton disease . We report two new cases . METHOD: Two patients, more than 60-years-old, had developed global cardiac insufficiency with predominant left insufficiency, with physical alteration and biological inflammation . Echocardiography revealed a myopericarditis . Bacteriological explorations were all negative . In the two cases, temporal artery biopsy revealed giant cell arteritis . Treatment with oral corticosteroids improved biological and clinical symptoms . CONCLUSION: Myopericarditis is a rare form of Horton disease . Classical clinical presentation is rarely associated . Temporal artery biopsy is essential in confirming and proposing a specific therapy, in order to prevent cardiovascular ischemic complications.

Kekkaku, 2003 Jan, 78(1), 5 - 13
{The incidence rate of active pulmonary tuberculosis among adult population with fibrotic lesions}; Shimouchi A et al.; The incidence rate of "active" pulmonary tuberculosis (TB) cases with bacteriological confirmation or cavitary lesions on chest radiographs was studied among population screened with mass miniature radiography in Funai-Gun, Kyoto Prefecture from 1982 to 1993 . The results were as follows: Among population of 40 and over, prevalence rate of all fibrotic lesions on chest radiographs among male (8.3%) was twice as high as that of female (3.8%) . The rate of moderate or extensive fibrotic lesions among male (3.3%) was three times as high as that of female (1%) . The higher the age of the population, the higher the prevalence rate of radiological fibrotic lesions both in male and female . In male, in particular, prevalence rate of moderate or extensive fibrotic lesions started to rise after 40 years of age, became much higher after 70 years of age and reached 8.1% after 80 years of age . In female, however, it started to rise at 50s (0.3%) gradually and reached only 2.3% after 80 years of age . The incidence rate of "active" pulmonary TB among male of 40 years and over with moderate or extensive fibrotic lesions (4.2 per 1000 person-years) was 16 times as high as male of 40 years and over with normal chest X-ray finding (0.26 per 1000 person-years) . Similarly, the incidence rate of "active" pulmonary TB in female of 40 years and over with moderate or extensive fibrotic lesions was 24 times as high as among female with normal finding, and the difference was statistically significant (p < 0.001) . From the data obtained and bibliographical review, benefits of INH prophylaxis were discussed.

Am J Ophthalmol, 2003 Apr, 135(4), 447 - 51
Azithromycin vs doxycycline in the treatment of inclusion conjunctivitis; Katusic D et al.; PURPOSE: The aim of the study was to compare the efficacy and safety of azithromycin and doxycycline in the treatment of chlamydial conjunctivitis in adults . DESIGN: An open, randomized clinical trial . METHODS: Seventy-eight adult patients with incluson conjunctivitis were enrolled in this multicenter clinical study . Patients with chlamydial conjunctivitis as indicated by a positive direct fluorescent antibody (DFA) test or cell culture were randomized to receive a single 1-g dose of azithromycin or doxycycline, 100 mg twice daily for 10 days . A conjuctival swab for cell culture was obtained from all patients immediately before the treatment for subsequent confirmation of the presence of chlamydial infection in the central laboratory . Control examinations were performed 10 to 12 days and 4 to 6 weeks after the treatment initiation . Clinical and bacteriological responses to the treatment were evaluated at the last visit . The occurrence and frequency of adverse events were analyzed as well . RESULTS: Of 78 patients enrolled, 51 completed the study and were evaluated for efficacy . The main reasons for withdrawal were lack of confirmation of the presence of chlamydial infection by the central laboratory and failure to attend the follow-up visit . Eradication of C . trachomatis was achieved in 23 of 25 (92%) patients treated with azithromycin and in 25 of 26 (96%) patients treated with doxycycline . Clinical cure was observed in 15 (60%) and 18 (69%) patients treated with azithromycin and doxycycline, respectively . Both drugs were equally well tolerated . CONCLUSIONS: A single 1-g azithromycin therapy was as effective as standard 10-day treatment with doxycycline (100 mg twice daily) in the treatment of adult inclusion conjunctivitis.

Respir Med, 2003 Mar, 97(3), 242 - 9
Oral gemifloxacin once daily for 5 days compared with sequential therapy with i.v . ceftriaxone/oral cefuroxime (maximum of 10 days) in the treatment of hospitalized patients with acute exacerbations of chronic bronchitis; Wilson R et al.; In a randomized, open-label, controlled, multicentre study, the clinical and bacteriological efficacy, safety and tolerability of oral gemifloxacin (320 mg once daily, 5 days) was compared with sequential intravenous (i.v.) ceftriaxone (1 g once daily, maximum 3 days) followed by oral cefuroxime axetil (500 mg twice daily, maximum 7 days) in adult hospitalized patients with acute exacerbations of chronic bronchitis (AECB) (n = 274) . The clinical success rates at follow-up (21-28 days post-therapy) in the clinical per-protocol population (the primary endpoint) were 86.8% (105/121) for gemifloxacin vs . 81.3% (91/112) for ceftriaxone/cefuroxime (treatment difference = 5.5,95% CI -3.9,14.9) . The corresponding clinical results in the clinical intention-to-treat (ITT) population were 82.6% (114/138) vs . 72.1% (98/136), respectively (treatment difference = 10.5,95% CI 0.7, 20.4).Thus, gemifloxacin had significantly higher clinical success rates than ceftriaxone/cefuroxime.The median time to discharge was 9 days in the gemifloxacin group vs . 11 days in the ceftriaxone/cefuroxime group (P = 0.04, Wilcoxon test) . At follow-up, 120/138 (87.0%) gemifloxacin-treated patients had been discharged from hospital, compared with 111/136 (81.6%) ceftriaxone/cefuroxime-treated patients in the clinical ITT population . Both treatments were generally well tolerated and there was no significant difference between the treatment groups in the incidence or type of adverse events reported . A 5-day course of oral gemifloxacin was shown by this study to be at least equivalent to sequential i.v . ceftriaxone/cefuroxime axetil (for up to 10 days) in patients with AECB who require hospital treatment.

Water Sci Technol, 2003, 47(3), 131 - 6
Laboratory testing protocol to identify critical factors in bacterial compliance monitoring; Abbaszadegan M et al.; This research focused on providing guidelines for water utilities on the collection and handling of routine bacteriological samples and in developing scientifically-based approaches in selecting the most representative sampling locations . A laboratory-scale pilot distribution system was designed comprising two parallel loops, one using unlined cast-iron pipe and one using PVC pipe . Each loop contained six sampling ports, including (1) a distribution main dead end faucet, (2) one long (5.5 m; 18 feet) and (3) one short (0.3 m; 1 foot) household copper service line with threaded hose-bibb taps, (4) one hose-bibb with welded faucet, (5) one dedicated sampling port (modeled after a manufacturer's specifications) and (6) one laboratory-style (PVC) stop-cock sampling port . Residual chlorine concentrations were maintained at 0, 0.5, 1.5 and 2.0 mg/L stages during the course of the experiment . Bacterial samples were collected from the different sampling ports and assayed by membrane filtration and/or spread plate . Nutrient and R2A agars were used for heterotrophic plate counts (HPC), m-Endo agar for total coliform (TC) counts and Chromocult agar for injured bacterial analyses . Several methods of sample collection were tested using various combinations of flushing and tap disinfection, including "first flush" (no flushing, without tap disinfection), flushing only, tap disinfection only (using alcohol or hypochlorite solution) and flushing coupled with tap disinfection . The results indicated that the bacterial counts in samples drawn from dead ends were not significantly different from counts in samples from the other sample port configurations . First flush samples consistently produced the highest bacterial count results . Bacterial counts in samples from the long household copper service line were typically three orders of magnitude higher than in samples from the other sample ports . Thus, there is evidence that long copper household service connections may be unsuitable sample tap configurations for collecting samples intended to represent microbial quality in the distribution system.

Vet Rec, 2003 Mar 1, 152(9), 254 - 8
Abattoir-based survey of contagious bovine pleuropneumonia in cattle in Turkey; Cetinkaya B et al.; Blood samples collected from 945 cattle at four local abattoirs in Turkey were examined for contagious bovine pleuropneumonia (CBPP) by the complement fixation test (CFT) and competitive ELISA (cELISA) . In addition, the carcases of the animals were examined macroscopically at the abattoirs and 62 lung samples which had lesions suggestive of CBPP were collected for bacteriological culture . To identify suspicious isolates the PCR was used in addition to the routine biochemical tests . By the CFT, two of the 945 serum samples were seropositive, and by the cELISA, four of them were seropositive . In the bacteriological culture of the lungs, growth was observed in 18 (29 per cent) of the samples by the observation of turbidity in the broths . However, when these broths were inoculated into an agar base, growth was observed in only three (4.8 per cent) samples . These isolates were identified as Mycoplasma species on the basis of biochemical tests . In the PCR analysis of DNA extracted from the broths, none of the isolates was identified as Mycoplasma mycoides subspecies mycoides small colony or one of the members of the M mycoides cluster, but amplification was obtained in only eight (44.4 per cent) of 18 samples, using Mycoplasma-genus specific primers . These DNA samples were examined further with primers specific to 16S rRNA and were then sequenced and compared with the databanks; DNA homologies at different levels were observed in five samples, with Mycoplasma alkalescens, Mycoplasma canadense, Mycoplasma bovis and Mycoplasma bovigenitalium.

East Afr Med J, 2002 May, 79(5), 242 - 8
Laboratory methods for diagnosis and detection of drug resistant Mycobacterium tuberculosis complex with reference to developing countries: a review; Githui WA; OBJECTIVE: To outline principles, advantages and limitations of the currently available laboratory methods for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex . DATA SOURCE: Published series of peer reviewed journals and manuals written on laboratory methods that are currently used for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex were reviewed using the index medicus, pubmed and medline search . Conventional bacteriological microscopy and culture, BACTEC, and molecular-based techniques were included . Basic principles, advantages and limitations of the cited techniques have been highlighted . CONCLUSION: Conventional bacteriological microscopy and culture are usually used for diagnosis of tuberculosis (TB) particularly in developing countries . However, their limited sensitivity, specificity and delayed results make this provision inadequate . Despite the development of quicker and more sensitive novel diagnostic techniques, their complexity and high cost has limited their use in many poor-resource countries . Due to the rapidly growing TB problem in these countries, there is urgent need to assess promising alternative methodologies in settings with high disease prevalence.

J Formos Med Assoc, 2002 Dec, 101(12), 841 - 5
Screening for pulmonary tuberculosis among military conscripts in Taiwan; Chiang CY et al.; BACKGROUND AND PURPOSE: Military service is obligatory for young men who are medically fit in Taiwan . Each year, all 19-year-old men are notified to undergo a required health check to determine their eligibility for military service . This study determined the prevalence of pulmonary tuberculosis (TB) among military conscripts in 1997 and 1998 and evaluated the effect of the mass radiographic screening program for military conscripts on the reported TB case rate . METHODS: During the annual health check, all 19-year-old men in Taiwan undergo miniature (70 x 70 mm) chest roentgenography (CXR) . Those who have suspicious lesions on miniature films are notified to undergo follow-up CXR (14 x 14 inch) and sputum examinations . All these data for the period from 1997 to 1998 were analyzed to determine the prevalence of pulmonary TB . To evaluate the effect of the mass radiographic screening program among military conscripts on the reported TB case rates, annual data for newly diagnosed pulmonary TB in 1997 and 1998 were obtained from the National TB Register and analyzed by age and sex . RESULTS: A total of 305, 140 men eligible for military service underwent the required examination in 1997 and 1998 . Pulmonary TB was diagnosed in 237 (0.08%) of these men, and 21 (6.9/100,000) had positive bacteriologic findings . In 1997 and 1998, the annual reported TB case rates for males and females were similar in both children and young adults, except for an early peak among men aged 19 years . CONCLUSION: The screening program resulted in a significant increase in the reported TB case rate among males aged 19 years . However, a low bacteriologic confirmation rate implies the possibility of over-diagnosis with CXR . Mass radiographic screening at the health check for military conscripts is inefficient in detecting bacteriologically confirmed TB, an observation with implications for screening policy development by the national TB program.

Crit Care Med, 2003 Mar, 31(3), 823 - 9
Long-term mechanical ventilation with hygroscopic heat and moisture exchangers used for 48 hours: a prospective clinical, hygrometric, and bacteriologic study; Boyer A et al.; OBJECTIVE: To determine whether use of a hygroscopic heat and moisture exchanger (HME) for 48 hrs without change affects its efficiency and the level of bacterial colonization in long-term mechanically ventilated medical intensive care unit patients . DESIGN: Prospective, randomized clinical study evaluating two hygroscopic HMEs . SETTING: Medical intensive care unit at a university teaching hospital . PATIENTS: Long-term mechanically ventilated medical intensive care unit patients, including chronic obstructive pulmonary disease patients . INTERVENTIONS: Patients were randomly allocated to one of the two HMEs studied (Hygrolife and EdithFlex) and changed every 48 hrs . Devices in both groups could be changed if hygrometric measurements indicated insufficient humidity delivery . MEASUREMENTS AND MAIN RESULTS: Daily measurements of inspired gas temperature and relative and absolute humidity . In addition, cultures of tracheal aspirations and both patient and ventilator sides of the device were performed after 48 hrs of use . Ventilatory variables and clinical indicators of efficient humidification were also recorded . Prolonged use of both HMEs was safe and efficient (no tracheal tube occlusion occurred) . Mean duration of mechanical ventilation was 20 days . Both clinical indicators and hygrometric measurements showed that both devices performed well during 48 hrs . Absolute humidity with EdithFlex was significantly higher on day 0 and day 1 than with Hygrolife . Absolute humidity measured in chronic obstructive pulmonary disease patients was identical to that measured in the rest of the study population . Tracheal colonization and HME colonization were similar with both HMEs . Bacterial contamination of the ventilator side of both devices was markedly low . CONCLUSIONS: These two purely hygroscopic HMEs provided safe and efficient humidification during a 48-hr period of use in long-term mechanically ventilated medical intensive care unit patients, including chronic obstructive pulmonary disease patients . In addition, they maintained ventilatory circuits clean, despite the absence of filtering media . The cost of mechanical ventilation is consequently reduced.

Crit Care Med, 2003 Mar, 31(3), 676 - 82
Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome; Luna CM et al.; OBJECTIVES: To prospectively evaluate the performance of the Clinical Pulmonary Infection Score (CPIS) and its components to identify early in the hospital course of ventilator-associated pneumonia (VAP) which patients are responding to therapy . DESIGN: Prospective, multicenter, in a cohort of mechanically ventilated patients . SETTING: The intensive care unit of six hospitals located in the metropolitan area of Buenos Aires, Argentina . PATIENTS: Sixty-three patients, from a cohort of 472 mechanically ventilated patients hospitalized for >72 hrs, had clinical evidence of VAP and bacteriologic confirmation by bronchoalveolar lavage (BAL) or blood cultures . INTERVENTIONS: Bronchoscopy with BAL fluid culture and blood cultures after establishing a clinical diagnosis of VAP . All patients received antibiotics, 46 before bronchoscopy and 17 immediately after bronchoscopy . MEASUREMENTS AND RESULTS: CPIS was measured at 3 days before VAP (VAP-3); at the onset of VAP (VAP); and at 3 (VAP+3), 5 (VAP+5), and 7 (VAP+7) days after onset . CPIS rose from VAP-3 to VAP and then fell progressively in the population as a whole (p <.001), and the fall in CPIS was significant in 31 survivors, but not in 32 nonsurvivors . From the individual components of the CPIS, only the Pao /Fio ratio distinguished survivors from nonsurvivors, beginning at VAP+3 . When CPIS was <6 at 3 or 5 days after VAP onset, mortality was lower than in the remaining patients (p =.018) . These differences also related to the finding that those receiving adequate therapy had a slight fall in CPIS and a significant increase of Pao /Fio at VAP+3, whereas those getting inadequate therapy did not . CONCLUSIONS: Serial measurements of CPIS can define the clinical course of VAP resolution, identifying those with good outcome as early as day 3, and could possibly be of help to define strategies to shorten the duration of therapy.

Eur J Vasc Endovasc Surg, 2003 Mar, 25(3), 240 - 5
Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection; Daenens K et al.; OBJECTIVE: to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins . METHODS: forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied . Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan . The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins . After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan . RESULTS: there were four in-hospital deaths (8%) . One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%) . With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%) . There were no late amputations and only two late graft limb stenoses (4%) . We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91% . There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection . CONCLUSION:in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.

Tuberculosis (Edinb), 2002, 82(6), 275 - 82
Aerosol delivery of virulent Mycobacterium bovis to cattle; Palmer MV et al.; SETTING: Although animal models of aerosol inoculation of Mycobacterium tuberculosis and M . bovis have been reported using laboratory animals, a model of aerosol delivery of M . bovis to cattle has not been reported previously . OBJECTIVE: Develop and characterize a model of aerosol delivery of M . bovis to cattle, and compare the distribution of lesions in cattle infected with either of two different strains of M . bovis, one isolated from cattle (HC2005T), and the other isolated from white-tailed deer (1315) . DESIGN: Cattle (n=20, female and castrated males) aged 4 months, were infected with 1 x 10(3) (n=5) or 1 x 10(5) (n=5) colony-forming units (CFU) of M . bovis 1315 or 1 x 10(3) (n=5) or 1x10(5) (n=5) CFU of M . bovis HC2005T . Calves were infected using a commercially available aerosol delivery system . One hundred fifty-five days after infection, calves were euthanized, examined and tissues collected for microscopic analysis and bacteriologic culture . RESULTS: Nineteen of 20 calves developed tuberculosis . Typical tuberculous lesions were most pronounced in the lungs and tracheobronchial and mediastinal lymph nodes . CONCLUSION: The system described provides a reliable method of aerosol delivery of M . bovis to cattle . Lesion distribution suggests that the aerosolized inoculum was delivered deep into pulmonary alveoli and thus represents true aerosol exposure . Disease was more severe in groups receiving the highest dose of either inoculum strain; however, differences between strains were not seen . Published by Elsevier Science Ltd.

Antibiot Khimioter, 2002, 47(9), 18 - 21
{Evaluation of clarithromycin efficacy in the treatment of community-acquired pneumonia on the basis of the Binax NOW test results (a prospective open trial)}; Guchev IA et al.; The results of the treatment of community-acquired pneumonia with clarithromycin (500 mg bid for 6-8 days) at 172 patients (military recruits aged 18-25) are presented . Diagnosis, infection performance, treatment efficacy were evaluated by complex of data (X-ray, sputum analysis by bacteriological and cultural tests and immunochromatography test Binax NOW for pneumococcal antigen identification) . High efficacy of clarithromycin for the treatment of moderate and mild pneumonia (including pneumococcal pneumonia) was demonstrated . Side effects were registered at 6.2 per cent of patients (gastro-intestinal disorders at 5 patients) and 1 general urticaria at 1 patient whose treatment had to be changed).

Indian J Gastroenterol, 2003 Jan-Feb, 22(1), 7 - 10
Infected necrosis complicating acute pancreatitis: experience with 131 cases; Bhansali SK et al.; OBJECTIVE: Despite advances in its management, the mortality of infected pancreatic necrosis (IPN) remains high . We report our observations on complications and treatment of IPN . METHODS: We studied 131 patients with IPN seen over a 20-year period . Infection, suspected clinically, was proved by presence of extraluminal air on CT scan (23 cases), or by guided percutaneous aspiration of fluid or solid necrotic tissue, and bacteriological studies of the aspirate . Apart from organ support, vigorous nutritional support and appropriate antibiotic therapy were instituted . Evacuation of pus and surgical necrosectomy was done . Feeding jejunostomy was done in the majority of patients . RESULTS: Postoperative complications included multiple organ dysfunction syndrome (MODS; n=40, in addition to 65 with pre-operative MODS), pancreatic fistula (69), gastrointestinal fistula (24), and severe extra-intestinal bleeding (8 patients) . Pancreatic fistula developed in 30 of 63 patients who received octreotide and in 39 of 68 patients who did not (p=ns) . Forty-five patients died . Of 35 patients who underwent surgery within 15 days of the onset of acute necrotizing pancreatitis, 21 (60%) died; in comparison, of the 96 patients who underwent surgery more than 15 days after onset, 24 (25%) died (p<0.002) . Mortality was higher among those with serum albumin less than 2.5 g/dL than in those with albumin above 2.5 g/dL (20/36 versus 25/95; p=0.002), and in those with MODS (43/105) than in those without (2/26; p=0.001) . CONCLUSIONS: Complications of IPN include MODS (pre- or post-operative), gastrointestinal and pancreatic fistula, and extra-intestinal bleeding . Serum albumin below 2.5 g/dL, development of MODS and need for early surgery appear to be unfavorable features associated with higher mortality.

Ann Diagn Pathol, 2003 Feb, 7(1), 35 - 46
Prosthetic implant associated sarcomas: a case report emphasizing surface evaluation and spectroscopic trace metal analysis; Adams JE et al.; Advances with implantation of synthetic biomaterials in the setting of orthopedic surgery have clearly resulted in improvements in patient outcomes . However, all implants have been shown to have associated risks . For example, ionic and particulate debris from implants have been shown to engage in biological interactions with the native tissue, and have been associated with a wide range of metabolic, bacteriologic, immunologic, and oncogenic effects . The propensity of synthetic biomaterials to undergo degradation, producing an inflammatory reaction or other sequelae, has been well recognized . The use of porous implants, which allow for a greater interface area between native tissue and the prosthesis, may magnify the interaction between biologically active tissue and synthetic devices in some situations, giving rise to new and intriguing issues concerning biocorrosion and biocompatibility . In this article, we report the case of a high-grade conventional osteosarcoma occurring at the site of a modular porous-surfaced titanium and cobalt alloy total hip prosthesis 3 years after device implantation . Detailed spectroscopic trace metal analysis was performed and elevated levels of both vanadium and chromium, but not aluminum, nickel, or titanium were identified in the tumor .

Eur J Nucl Med Mol Imaging, 2003 May, 30(5), 705 - 15 Epub 2003 Mar 04.
The value of (18)FDG-PET for the detection of infected hip prosthesis; Vanquickenborne B et al.; We compared the accuracy of fluorine-18 labelled 2-fluoro-2-deoxy- d-glucose positron emission tomography ((18)FDG PET) with that of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (LS) in the detection of infected hip prosthesis . Seventeen patients with a hip prosthesis suspected for infection were prospectively included and underwent (99m)Tc-methylene diphosphonate bone scintigraphy (BS), LS and an (18)FDG-PET scan within a 2-week period . Seven volunteers with ten asymptomatic hip prostheses were used as a control group and underwent BS and an (18)FDG-PET scan . Bacteriology of samples obtained by surgery or by needle aspiration and/or clinical follow-up for up to 6 months were used as the gold standard . Planar images of BS and LS (4 and 24 h p.i.) were acquired, followed by single-photon emission tomography (SPET) LS images (after 4 h) . These images were scored as positive or negative by two experienced readers . The (18)FDG-PET scans of the patients were compared with the tracer distribution pattern in the asymptomatic control group and with BS . A phantom study was performed in order to identify artefacts . For this purpose, three different attenuation correction methods were tested . The combined analysis of the planar BS and LS resulted in a 75% sensitivity and a 78% specificity . The SPET LS images showed a better lesion contrast, resulting in an 88% sensitivity and a 100% specificity, while 24-h planar images were of no additional value . The analysis of PET images alone resulted in an 88% sensitivity and a 78% specificity . The combination of (18)FDG-PET and BS images resulted in an 88% sensitivity and a 67% specificity . Given the presence of small errors near the edge of the metal, which can induce significant artefacts in the corrected emission image, we decided to use the data without attenuation correction . In this preliminary study, (18)FDG-PET scans alone showed the same sensitivity as combined BS and LS, although the specificity was slightly lower.

Vaccine, 2003 Mar 28, 21(13-14), 1382 - 90
Smallpox vaccination techniques . 2 . Accessories and aftercare; Baxby D; The various accessories used for smallpox vaccination are surveyed . These included modified vaccination instruments and various other items which facilitated the procedure, containers for preservation and transport of vaccine, sterilising equipment, aids to interpretation and recording, and a variety of skin preparations and dressings . Three phases can be discerned in the development and use of such items and procedures . Initially, in the pre-bacteriological era, there was little need for accessory equipment apart from the means of preserving and transporting vaccine . Later, particularly by the end of the 19th century, the importance of aseptic and antiseptic procedures was realised, use was made of more traumatic vaccination techniques and glass capillaries became the standard method for preservation and transport . All this led to the increasing availability of a wide range of accessories, particularly of skin preparations and dressings . Finally, from about 1930, it was appreciated that skin preparation and dressings were often unnecessary, and could be counter-productive . So, although accessories for this were still available their use was very much reduced . In some respects the use of accessories during this last phase, based on scientific analysis was a return to the earliest, 'pre-scientific', era.

Pesqui Odontol Bras, 2002 Oct-Dec, 16(4), 313 - 8 Epub 2003 Feb 12.
Periodontopathogens in the saliva and subgingival dental plaque of a group of mothers; Rosa OP et al.; The aim of this study was to assess the periodontal condition and the presence of putative periodontal pathogens in 30 Brazilian mothers, aging 21-40 years (28.4 4.49 years), and in their children, aging 5-6 years, since mothers can be a source of pathogens and, thus, influence their children's bacteriological and clinical condition . Besides assessing the plaque index (PI), gingival index (GI) and pocket probing depth (PD), the survey analyzed four subgingival dental plaque samples from mothers and children, as well as a sample of stimulated saliva from mothers . Those samples were analyzed by means of the slot immunoblot (SIB) technique, in order to determine the presence of Actinobacillus actinomycetemcomitans (Aa), Prevotella nigrescens (Pn), Porphyromonas gingivalis (Pg) and Treponema denticola (Td) . The mean values and standard deviations of the evaluated clinical variables for mothers and children were, respectively: 1.86 0.67 and 1.64 0.68 for PI, and 1.24 0.67 and 0.82 0.37, for GI . Only for mothers, the total PD was 1.81 0.69 mm, and the PD of four sites was 4.03 1.40 mm . The Wilcoxon test revealed significant difference (p < 0.05) between mothers and their children only as to GI . The most prevalent bacteria in mothers were, in decreasing order: Aa, Pn, Pg and Td . The children presented patterns of oral hygiene and bacterial profiles similar to those of their mothers, in spite of the fact that most of them did not present enough subgingival plaque for testing . The comparison between mothers' subgingival dental plaque and saliva samples revealed statistically significant differences (p < 0.05) for all bacteria, with greater positivity and scores in the saliva, which demonstrates that it is an indicator of oral colonization and can work as a vehicle for the transmission of periodontopathogens from mothers to their children.

Rev Chir Orthop Reparatrice Appar Mot, 2003 Feb, 89(1), 71 - 4
{Digital tuberculous revealed by trauma}; Ben Brahim E et al.; Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors . Diagnosis must be confirmed by histology and/or bacteriology studies . We report the case of a 64-year-old diabetic woman who consulted for a painful tumefaction on her fourth finger of the left hand which had developed after minimal trauma . The x-ray of the hand visualized multiple bony defects involving the second phalanx of the fourth finger and a fracture . Pathology examination of a biopsy specimen revealed granulomatous osteitis with typical caseous necrosis . The clinical signs and radiographic images resolved after anti-tuberculosis treatment.

Ann Thorac Surg, 2003 Feb, 75(2), 382 - 7
Limited operation for severe multisegmental bilateral bronchiectasis; Mazieres J et al.; BACKGROUND: Some patients exhibiting severe multisegmental bilateral bronchiectasis are no longer improved with antibiotic treatment and drainage and, most of the time, operation is contraindicated . In our institution, limited operation has been offered to select patients for this indication . We report our data regarding the feasibility and utility of such a procedure . METHODS: We studied 16 patients who underwent surgical removal of nonlocalized disease between 1990 and 1999 . We report the mortality and morbidity rates of this surgical procedure and the clinical, bacteriological, and functional data for each patient . RESULTS: There was no mortality and the morbidity was low (18%, all with favorable outcome) . Symptoms such as hemoptysis, sputum production, or dyspnea were also improved . The recurring infections decreased in frequency in 8 patients and disappeared completely in 5 others . The bacteriological data assessment revealed disappearance of germs in 4 patients and persistence of chronic colonization in others . Postoperative spirometric data were not worsened and postoperative computed tomographic scans did not show progression of lesions not removed . CONCLUSIONS: These results suggest that, in properly selected patients, lasting symptomatic improvement can be achieved by resection . Limited operation may be indicated in nonlocalized bilateral bronchiectasis, provided that a target can be identified . This procedure is supported by physiopathologic arguments and is particularly relevant to patients with bronchiectasis with cystic and functionless territories.

Nippon Rinsho, 2003 Jan, 61(1), 153 - 9
{A new horizon of tuberculosis control and research}; Mori T; In the 1990s, tuberculosis (TB) came to be recognized as one of re-emerging diseases and as a serious health issue worldwide . This has brought about many innovations for TB control and care . These include a series of bacteriological examination methods based on the nucleic acid amplification, immunological diagnostics for TB infection or active disease . The completion of the whole genome analysis of Mycobacterium tuberculosis opened the way to the development of novel modalities for therapeutics, diagnostics and vaccines . For TB control, WHO developed the DOTS strategy as a standard TB treatment programme that has been being expanded globally, in both developed and developing nations . Japan's TB control programme is being revised drastically in order to meet the change in the TB epidemiology, aiming at realization of the DOTS concept adapted into the Japanese setting of patient care.

Am J Forensic Med Pathol, 2003 Mar, 24(1), 41 - 4
Fatal Waterhouse-Friderichsen syndrome due to Ewingella americana infection; Tsokos M; A fatal case of Waterhouse-Friderichsen syndrome resulting from infection in a previously healthy 74-year-old woman is reported . The patient died suddenly within 14 hours after presentation . The diagnosis of Waterhouse-Friderichsen syndrome as the cause of death was established post mortem based on autopsy findings, microscopic examination, measurement of serum procalcitonin concentration (113 ng/ml), and outcome of postmortem bacteriologic cultures that grew in heart and spleen blood samples . Since the introduction of as a new group in the family in 1983, more recent case studies have established its clinical significance and pathogenic potential to cause severe, life-threatening bacteremia and sepsis . is a rare pathogen that should be added to the list of unusual bacteria causing Waterhouse-Friderichsen syndrome.

Rev Prat, 2002 Dec 1, 52(19), 2127 - 32
{Extrathoracic tuberculosis}; Fain O; Incidence of extrathoracic tuberculosis has increased these last years . The average time to diagnosis is 3 months, owing to the poor specificity of some of its clinical signs, but also the failure to evoke these infections . Most common localizations are lymph nodes, bones and joints, genitourinary track and more rarely neuromeningeal or digestive systems . Diagnosis is based on bacteriological data (traditional culture, polymerase chain reaction) and histology . Computed tomography and magnetic resonance imaging are effective to detect the lesions at an early stage and appreciate their extent . Delayed diagnosis is responsible for mortality and sequelae of this affection for which treatment is effective, if it is correctly managed and followed.

Pneumologia, 2002 Jul-Sep, 51(3), 240 - 3
{Multiple, paravertebral Pott's abscesses}; Tabacu E et al.; The authors describe a case of vertebral tuberculosis with multiple localizations, high thoracical (T2-T6) and of the sacrum (S1-S4) at a young woman with nonspecific clinical symptoms and with CT examination suggestive of the diagnosis, where the diagnostical certainty was obtained by the bacteriological examination for bK of the pus (purulent liquid) extracted by CT guided fine needle biopsy performed in the posterior mediastinal tumor.

Pathologe, 2003 Feb, 24(1), 1 - 8 Epub 2003 Jan 21.
{Rudolf Virchow's influence on medicine after 100 years}; Dhom G; 100 years after Rudolf Virchow's death, we find it necessary to demonstrate the mark his work has left on present day medicine . Curt Froboese wrote 50 years ago: "To come to know Rudolf Virchow well, it is sufficient to read him" . Therefore the present collection of literal quotations from Virchow tries to show how valid many statements of Virchow still are . His definition of "health" precedes the well-known formulation of the World Health Organization . Virchow had a presentiment of molecular pathology, without defining this word, when he ascribed molecular forces to the cell and particularly to the cellular nucleus . As a terminologist he played a guiding role . His linguistic sense enabled him to prematurely find out "barbarisms" in medical terminology . At the same time, he also supported an international understanding . In particular the surgeons came to know through Virchow that malignant tumors are also primarily local events to be surgically treated preferably in the early stage . Therefore he requested a population-based statistical survey as developed by the cancer registries today . The legend that Virchow fought against bacteriology is not true . He did not stop in his efforts to differentiate between etiology, germs and the course of infection which presupposes knowledge of the respective cellular phenomena . Summing up it can be said that Virchow still plays an important role in our medical world.

East Mediterr Health J, 2001 Jan-Mar, 7(1-2), 26 - 30
Topical ciprofloxacin versus topical gentamicin for chronic otitis media; Nawasreh O et al.; We compared the therapeutic efficiency of ciprofloxacin hydrochloride and gentamicin sulfate in the treatment of chronic otitis media . A total of 88 patients aged 9-62 years with chronic suppurative media were randomly placed into two groups . In the first group, 48 patients (54.5%) received topical ciprofloxacin hydrochloride, while in the second group 40 patients (45.5%) received local gentamicin sulfate . Of the 48 patients who received ciprofloxacin hydrochloride, 42 (87.5%) were cured, while in 6 patients (12.5%) the treatment failed . In the gentamicin group, 12 (30%) of the patients were cured, while 28 patients showed no clinical or bacteriological improvement . Topical ciprofloxacin is safe and more efficacious and efficient than topical gentamicin in the treatment of acute exacerbation of chronic suppurative otitis media.

Bioessays, 2003 Mar, 25(3), 204 - 11
Nonculturable bacteria: programmed survival forms or cells at death's door?
Nystrom T.
Upon starvation and growth arrest, Escherichia coli cells gradually lose their ability to reproduce . These apparently sterile/nonculturable cells initially remain intact and metabolically active and the underlying molecular mechanism behind this sterility is something of an enigma in bacteriology . Three different models have been proposed to explain this phenomenon . The first theory suggests that starving cells become nonculturable due to cellular deterioration, are moribund, and show some of the same signs of senescence as aging organisms . The two other theories suggest that genetically programmed pathways, rather than stochastic deterioration, trigger nonculturability . One "program" theory suggests that nonculturability is the culmination of an adaptive pathway generating dormant survival forms, similar to spore formation in differentiating bacteria . The other "program" theory states that starved cells lose viability due to activation of genetic modules mediating programmed cell death . The different models will be reviewed and evaluated in light of recent data on the physiology and molecular biology of growth-arrested E . coli cells .

Lijec Vjesn, 2002 Sep, 124 Suppl 1, 20 - 3
{Helicobacter pylori--bacteriologic diagnosis and antibiotic sensitivity tests}; Plecko V et al.; Bacteriological diagnosis of Helicobacter pylori consists of culture from gastric biopsies, gastric juice, faeces and from specimens obtained from oral cavity, antigen stool assay and molecular diagnostic methods . In routine work culture is done from gastric biopsies . Other specimens are usually cultivated for research purposes . Culture constitutes the most specific way to establish the diagnosis of H . pylori infection . One of the major advantages of culture is that it allows sensitivity testing to drugs used in therapy . Culture also allows characterisation of H . pylori . Antigen stoll assay is a non-invasive diagnostic procedure, which should be evaluated . Molecular methods have confirmed their potential for epidemiological research and for the detection of resistant H . pylori, especially for macrolides . The clinical settings, local availability and economic considerations should guide use of bacteriological diagnostic methods.

Z Gastroenterol, 2003 Feb, 41(2), 165 - 70
Procalcitonin is a valid marker of infection in decompensated cirrhosis; Connert S et al.; BACKGROUND/AIMS: Bacterial infections are life-threatening complications in cirrhosis and early diagnosis is mandatory . Procalcitonin, a 116 amino acid propeptide of calcitonin, is an early marker of infection . The aim was to evaluate prospectively procalcitonin in the diagnosis of bacterial infection in cirrhosis . 127 patients with liver cirrhosis were analysed and stratified into three groups according bacteriological and morphological findings; decompensated patients with (group I = 36) and without (group II = 64) infection, and 27 non-decompensated and non-infected (group III) . METHODS: Diagnosis of infection was made using standard criteria . Serum procalcitonin, tumour necrosis factor alpha, interleukin-6 and C-reactive protein were measured using commercially available methods . RESULTS: PCT serum levels were significantly different between group I (2.8 ng/ml {0.4 - 20.4}), group II (0.6 ng/ml {0.1 - 5.9}) and group III (0.4 ng/ml {0.1 - 1.2}), respectively . Levels above 0.58 ng/ml had a sensitivity of 92 % and specificity of 78 % for the diagnosis of infection and were associated with a 50 % mortality in the first two months . Interleukin-6, tumour necrosis factor alpha and C-reactive protein were less sensitive and specific for the diagnosis of infection . CONCLUSION: In decompensated cirrhosis procalcitonin serum levels provided the most sensitive and specific tool for the initial diagnosis of bacterial infection.

Vet Microbiol, 2003 May 2, 93(1), 53 - 61
Comparison of polymerase chain reaction and bacteriological culture for the diagnosis of sheep brucellosis using aborted fetus samples; Leyla G et al.; PCR assay has been shown to be a promising option for the diagnosis of brucellosis . However, few studies have been performed with field samples in order to evaluate the assay as a diagnostic tool . In this study, routine use of a species-specific PCR assay previously developed for the identification of Brucella cultures was assessed for the detection of Brucella DNA directly from the stomach contents of aborted sheep fetuses . The assay is based on the insertion sequence IS711 in the Brucella chromosome . In the study, during 3 successive lambing seasons (1998-1999, 1999-2000 and 2000-2001) 126 aborted fetus samples each from different flocks and locations were examined . Brucella strains were isolated from 39 (31%) of the samples and all of the strains were identified as Brucella melitensis by biochemical characteristics, agglutination with monospecific A and M sera and PCR . Thirty-seven of 39 B . melitensis isolates were biotyped as biotype 3, and 2 isolates as biotype 1 . From 38 of 39 culture positive fetal stomach contents B . melitensis-specific DNA was detected by PCR . PCR was found negative in all of the culture negative samples . Compared with culture, sensitivity and specificity of PCR were determined as 97.4 and 100%, respectively . The results indicate that this PCR procedure has a potential for use in routine diagnosis of sheep brucellosis .

Int J Tuberc Lung Dis, 2003 Feb, 7(2), 153 - 8
Tuberculosis in Nazilli District Prison, Turkey, 1997-2001; Kiter G et al.; SETTING: Nazilli District Prison, Turkey . OBJECTIVE: To evaluate the tuberculosis situation in a Turkish prison . DESIGN: Data obtained between 1997 and 2001 during the systematic annual tuberculosis screening programme undertaken in Nazilli District Prison were evaluated retrospectively . The screening programme consisted of yearly miniature chest radiography, and clinical and bacteriological evaluation of prisoners with abnormalities . Active tuberculosis cases among prisoners diagnosed passively at any time during the period were also studied . RESULTS: Over the 5-year period, 99.8% of the prisoners were screened . The mean point prevalence of tuberculosis in Nazilli District Prison was 341 per 100,000 prisoners . The total number of active tuberculosis cases was 13; five were symptomatic, of whom three were detected during screening . The remaining eight cases were determined only by screening . Treatment outcomes were treatment completion for six cases and cure for seven cases . CONCLUSION: Because tuberculosis prevalence is high among prisoners, it is necessary to continue screening for tuberculosis in prison in addition to passive case-finding activities . Treatment success is satisfactory in Nazilli District Prison . Screening of prison staff, contact examination and preventive approaches need further investigation.

Ther Umsch, 2002 Dec, 59(12), 629 - 40
{Obstetrics and gynecology--retrospect of 125 years in Basel}; Ludwig H; The development of the discipline Obstetrics and Gynecology is reflected by the medical history at the University of Basel . At the very beginning of academic obstetrics, the cantonal government realised the need of a more practical teaching completing the tradition of theoretical lecturing (1865) . Obstetrics was (and still is) a typical example for the turn from theoretical to hands-on-teaching in medicine . At the time, when the independent chair of obstetrics at the University of Basel was founded (1867, Bischoff {1841-1892}), the fight against puerperal fever was the most urgent aim . The battle against puerperal fever was ultimately won around the turn of the 19th to the 20th century (von Herff {1856-1916}) but not much earlier . Step by step the gynecology grew out of the classical surgery where it has been located previously . Surgically skilled obstetricians like Fehling {1847-1925} and Bumm {1868-1925} have enhanced that development . Clinical research started with better information about the lying-in patients (Fehling, Bumm, Labhardt) . Bacteriology in close connection with obstetrics was seen important (Bumm) . Some decades later, clinical laboratories (clinical chemistry) were founded accompanying the diagnostic approach to various disorders of pregnancy (Labhardt {1874-1949}) . Exfoliative cytology became mandatory since 1950 and this was the start to screening programs for early diagnosis of cervical cancer (Koller {1899-1985}) . The family planning exploded in the years from 1965 on as the pill has been available, replacing sterilisation-procedures (Labhardt) . Endocrinology of pregnancy and cycle needed new biochemical methods . The laboratories were installed . Responding to the demands of a growing discipline, the building was enlarged and adapted in three major steps: 1896 new "Frauenspital", 1928 first enlargement, 1956-1968 constructing of two more storeys, of new surgical theatres and an entire tract for routine and scientific laboratories filling now the area between Klingelberg-, Schanzen- and Spitalstrasse . The hospital harboured in its peak time (1968-1970) more than 300 beds . In 1959 the hospital staff took care of 5000 deliveries (Koller) . Fetal monitoring was introduced 1962, being the starting point for the development of "fetal medicine" in Basel . At that time, Otto Kaser {1899-1995} was chairman . He was appreciated as one of the most brilliant pelvic surgeons in Europe . Soon, the surgery for breast cancer was added to the classical gynecologic surgery . At the same time, ultrasound started to dramatically influence diagnostic procedures in pregnancy . In the eighties, in-vitro-fertilization and embryo-transfer improved the possibilities to overcome unwanted childlessness (Ludwig {*1929}) and supplemented endocrinology . The scientific spectre spread heavily to reproductive medicine since then, in particular to the molecular biology and research on stem-cells, which was introduced by the present chairman (Holzgreve {*1955}) . He has founded several research groups concentrating on the retrieval of floating fetal cells from cord and maternal blood, on other topics in fetal cell research, prenatal diagnosis and in ultrasound.

J Chemother, 2002 Dec, 14(6), 609 - 17
Carbapenems in the treatment of severe community-acquired pneumonia in hospitalized elderly patients: a comparative study against standard therapy; Romanelli G et al.; In this open, prospective, study were enrolled 204 hospitalized elderly patients with severe (88 males, 116 females, age range 70-94) . Patients were randomized to receive one of the following antibiotic treatment regimens: meropenem 500 mg i.v . t.i.d . (52); imipenem/cilastatin 500 mg i.v . t.i.d . (51), clarithromycin 500 mg + ceftriaxone 1 g i.v . b.i.d . (52), clarithromycin 500 mg + amikacin 250 mg i.v . b.i.d . (49) . In 99 cases causative germs were isolated (24 meropenem, 26 imipenem, 23 clarithromycin + ceftriaxone, 26 ceftriaxone + amikacin) . A satisfactory clinical, bacteriological response was achieved respectively in 86.5% 77% in meropenem; 86.3% 71% in imipenem/cilastatin; 69% 61% in ceftriaxone + clarithromycin and in 85.7% 77% in clarithromycin + amikacin . The mean total cost for each patient was $1,560; $1,620; $1,760 and $1,792 in meropenem, imipenem/cilastatin, clarithromycin + ceftriaxone and clarithromycin + amikacin respectively . This study shows that treatment with either meropenem or imipenem is as efficacious as conventional therapy in the treatment of community acquired pneumonia (CAP), and that meropenem is the most cost-effective.

J Chemother, 2002 Dec, 14(6), 597 - 608
Efficacy and safety of short course (5-day) moxifloxacin vs 7-day ceftriaxone in the treatment of acute exacerbations of chronic bronchitis (AECB); Grassi C et al.; The aim of this multicenter, open, randomized study was to compare the efficacy and tolerability of a 5-day treatment course with oral moxifloxacin (MXF) vs a 7-day course with i.m . ceftriaxone (CRO) in 476 patients with acute exacerbations of chronic bronchitis (AECB), and to conduct a cost minimization analysis of the two treatments from the perspectives of both the Italian National Health Service (INHS) and society . The study was conducted in Italy . Clinical success rates at test-of-cure in the 423 patients of the PP (Per Protocol) population (primary efficacy parameter) were 90.6% and 89.0% for MXF and CRO, respectively . Statistical non-inferiority of MXF vs CRO was confirmed . Similar results were found between study drugs on the secondary efficacy parameters, including success at end-of-treatment (95.3% for MXF vs 92.9% for CRO), success at test-of-cure in bacteriologically-positive patients (94.1% vs 90.7%) and eradication/presumed eradication rates (91.7% vs 93.3%) . ITT (Intention-to-Treat) analysis confirmed these data . There was a low incidence of adverse events (10.8% vs 9.1%) . During a 6-month follow-up period, relapse rates were lower for MXF vs CRO (23.3% vs 28.3%; p > .05) . Compared with CRO, MXF was associated with cost savings per patient ranging from Euro226.57 (INHS perspective) to Euro448.23 (societal perspective), with lower hospitalization rate the major variable contributing to reduced costs . MXF appears to be an ideal candidate for AECB treatment.

Clin Ther, 2002 Dec, 24(12), 2105 - 22
An open-label, randomized, multicenter, comparative study of the efficacy and safety of 7 days of treatment with clarithromycin extended-release tablets versus clarithromycin immediate-release tablets for the treatment of patients with acute bacterial exacerbation of chronic bronchitis; Weiss K et al.; OBJECTIVE: The aim of this study was to compare the efficacy and safety of clarithromycin extended-release (ER) tablets and immediate-release (IR) tablets . METHODS: This was a Phase III, open-label, randomized, multicenter, comparative study in ambulatory patients with a diagnosis of acute exacerbation of chronic bronchitis (AECB) . Eligible patients were randomized 1:1 to receive either 1 clarithromycin ER 500-mg tablet QD for 7 days or 1 clarithromycin IR 250-mg tablet BID for 7 days . Clinical and bacteriologic responses were assessed within 48 hours after the last dose of study drug and at a test-of-cure visit 21 +/- 2 days posttreatment . RESULTS: Of 233 patients randomized, 162 (86/117 {73.5%} in the ER group and 76/115 {66.1%} in the IR group) completed the study protocol . Compliance did not differ significantly between the treatment groups; however, significantly fewer patients in the ER group reported missing doses of study medication than in the IR group (7/118 {5.9%} vs 16/115 {13.9%}; P = 0.04) . The clinical cure rates for the clarithromycin ER and IR groups were 81.0% (68/84) and 82.1% (64/78) and the clinical success (clinical cure plus clinical improvement) rates were 94.0% {79/84} and 89.7% {70/78}, respectively . There were insufficient data for analysis of bacteriologic efficacy . However, bacteria were eradicated or presumed eradicated in 71.4% (10/14) and 79.2% (19/24) of patients in the ER and IR groups, respectively . The number of adverse events (AEs) considered to be possibly or probably related to study drug (23.4% {52/222} of patients receiving clarithromycin ER and 24.4% {43/176} of patients receiving clarithromycin IR) was similar between groups, as was the severity of these events (94.2% {49/52} in the ER group classified as mild or moderate vs 93.0% {40/43} in the IR group) . Overall, the most commonly reported AEs were diarrhea, nausea, abdominal pain, headache, and taste disturbance . CONCLUSION: Clarithromycin ER 500-mg tablets QD for 7 days were as effective and well tolerated as clarithromycin IR 250-mg tablets BID for 7 days in treating adults with AECB.

Scand J Infect Dis, 2002, 34(11), 811 - 4
Tuberculous meningitis in a country with a low incidence of tuberculosis: still a serious disease and a diagnostic challenge; Bidstrup C et al.; In order to assess the present epidemiology, clinical presentation and outcome of patients with tuberculous meningitis (Tm), a retrospective study was conducted including 20 Tm patients admitted to a referral department in Denmark between January 1988 and July 2000 . The findings were compared to those of a similar survey conducted 12 y earlier . A total of 65% of the patients came from countries with a high endemicity of tuberculosis, compared to only 26% in the previous survey . The overall mortality rate was 20%, with elderly patients with various pre-existing diseases being particularly affected . Neurological sequelae were seen in 50% of patients and seemed to be related to the duration of symptoms and treatment delay . The neurological state on admission and a rapid progression of symptoms seemed to be related to mortality . In 85% of the patients treatment was initiated without a definitive bacteriological diagnosis having been reached . The findings indicate that Tm is a rare but still serious disease, and one that is associated with high mortality and morbidity.

Curr Microbiol, 2003 Mar, 46(3), 199 - 204
Isolation and characterization of cyanobacteria from microbial mats of the Ebro Delta, Spain; Urmeneta J et al.; Isolation and identification of several strains of cyanobacteria from microbial mats of the Ebro Delta, Spain, are described . A series of tenfold dilutions was the first step of isolation . Self-isolation techniques, which use one or several physiological characteristics of a cyanobacterium, were applied in some cases to obtain enrichment cultures . Twelve filamentous strains were isolated and stored in axenic culture . As only a few cyanobacterial species can be frozen and revived without any cryoprotective agent, preservation of isolated strains was assayed with several cryoprotective solutions . Methanol and glycerol were not suitable as cryoprotective agents for most of the isolates . Dimethyl sulfoxide (DMSO) was apparently the best cryoprotector . A new method, which used a filter paper as a growing substratum that later could be directly stored at -80 degrees C, was successfully used . A morphological study of each strain under light and electron microscopy was made to classify them . All isolated strains belong to phylum BX, Class 1, subsection III of the Bergey's manual of systematic bacteriology, 2nd ed., vol . 1 . Most genera are included in the LPP group as Lyngbya aestuarii and Microcoleus chthonoplastes.

J Vet Intern Med, 2003 Jan-Feb, 17(1), 33 - 43
Comparison of direct and indirect tests for small intestinal bacterial overgrowth and antibiotic-responsive diarrhea in dogs; German AJ et al.; Controversy exists over the diagnosis of idiopathic small intestinal bacterial overgrowth (SIBO) in dogs and some clinicians use the term antibiotic-responsive diarrhea (ARD) in preference . However, whether such terms are interchangeable is not clear . To examine the relationship between duodenal bacterial numbers and a clinical response to antibiotics, SIBO and ARD were defined by nonoverlapping criteria . Quantitative duodenal juice bacteriology and indirect serum biochemical tests were used to assess small intestinal bacterial populations in 30 dogs with gastrointestinal disorders, including 9 with ARD . Serum total unconjugated bile acid (TUBA) concentrations were measured in all dogs, serum folate and cobalamin concentrations were measured in 29 of 30 dogs, and quantitative culture of duodenal juice was performed in 22 of 30 dogs . Serum TUBA concentrations also were measured in samples from 38 control dogs . Twenty of 22 affected (clinical) dogs in which quantitative bacteriology was performed were classified as having SIBO (>10(5) colony-forming units of total bacteria per milliliter of duodenal juice), but bacterial numbers did not differ significantly between dogs with ARD and dogs with other disorders . Increased folate (19/29), decreased cobalamin (16/ 29), or a combination (9/29) were common, but increased TUBA concentrations were documented in only 5 of 30 clinical dogs . Again, no significant differences were observed between dogs with ARD and those with other disorders, and a similar proportion (5/38) of controls had abnormally high TUBA concentrations . Finally, no significant differences were noted when duodenal bacteriology and TUBA concentrations were assessed before and during antibiotic therapy . These results question the utility of quantitative duodenal juice bacteriology and indirect biochemical marker tests for SIBO in the investigation of canine gastrointestinal disorders.

Lin Chuang Er Bi Yan Hou Ke Za Zhi, 1999 May, 13(5), 219 - 20
{Clinical and bacteriology observation on intraoperation usage of tarivid otic solution in treatment of chronic otitis media with cholesteatoma}; Gao Q et al.; OBJECTIVE: To determine the effect and safety of Tarivid (oflorxacin) otic solution used during the operation in treatment for chronic otitis media with cholesteatoma . METHOD: 42 patients were divided into two groups . In Tarivid group, 23 patients' operative cavities were soaked with 0.3% Tarivid, while other 19 patients' operative cavities in boric acid group were soaked with 4% boric acid during the open mastoidectomy with tympanoplasty . RESULT: The recovery rate was 82.6% and 50% respectively . There was significant difference between two groups (P < 0.05) . No side effect was observed . CONCLUSION: It shows that using Tarivid otic solution in the operation can improve the outcome of the operation and has high security.

Roum Arch Microbiol Immunol, 2001 Oct-Dec, 60(4), 323 - 7
Venous ulcer infection caused by Arcanobacterium haemolyticum; Panzaru C et al.; A . haemolyticum has been described as an unusual pathogen causing pharyngotonsillitis and extra pharyngeal infections like ulcerative lesions infection mainly in patients with underlying condition (peripheral vascular disease, diabetes, alcoholism) . A case of A . haemolyticum venous leg ulcer infection is reported in a 66 year-old diabetic male patient . Bacteriological diagnosis is based on conventional culture technique . But, due to its coryneform appearance and time growing, it is probably underreported.

J Gastroenterol, 2003, 38(1), 74 - 8
A case of primary esophageal tuberculosis diagnosed by identification of Mycobacteria in paraffin-embedded esophageal biopsy specimens by polymerase chain reaction; Fujiwara T et al.; We present a case of primary esophageal tuberculosis diagnosed by polymerase chain reaction (PCR) of paraffin-embedded esophageal biopsy specimens . A 42-year-old Japanese woman visited our clinic because of dysphagia . Radiologic and endoscopic examinations revealed a stenotic lesion with reddish mucosa and multiple ulcers in the middle esophagus . There was no associated lesion outside the esophagus . Histological and bacteriological studies of esophageal biopsy specimens and gastric aspirates did not give a definitive diagnosis . However, mycobacterial DNA was detected by PCR of paraffin-embedded esophageal biopsy specimens . She then was diagnosed as having primary esophageal tuberculosis . The esophageal mucosal lesion almost healed after 1 month of antituberculosis medication with residual annular stenosis which was resolved later by endoscopic balloon dilation.

Plast Reconstr Surg, 2003 Feb, 111(2), 781 - 8
Wound fluid bacterial levels exceed tissue bacterial counts in controlled porcine partial-thickness burn infections; Breuing K et al.; In the present study, an established controlled burn wound model was used to test the hypothesis that controlled surface contamination with is capable of generating a noninvasive method for the creation of a reproducible deep tissue burn wound infection . Using a liquid tight-wound chamber in Yorkshire pigs, partial-thickness burns were inoculated with saline-immersed for 24 hours . Noninoculated burns and unwounded skin immersed in normal saline served as controls . Bacterial cultures of wound fluid were performed daily, and tissue biopsies for bacteriological and histological evaluations were performed on days 1, 3, and 5 . was only recovered from -inoculated wounds (tissue and fluid), whereas all controls contained endogenous only . The number of colony-forming units per gram of wound tissue did not correlate with the bacterial counts found in the overlying wound fluid for any wounds . Fluid counts were consistently higher than tissue counts by two logs . -inoculated wounds showed three times deeper tissue destruction than control wounds . Obtaining consistently deep tissue colonization without cross-contamination among wounds, this study introduces a noninvasive model for controlled burn wound infection suitable for future investigations regarding the efficacy of topical antibiotic wound treatment in experimental burns.

Plast Reconstr Surg, 2003 Feb, 111(2), 744 - 50; discussion 751-2
Effects of burn wound excision on bacterial colonization and invasion; Barret JP et al.; Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period . Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still under debate . It was hypothesized that acute burn wound excision (in the first 24 hours after burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion . Twenty consecutive patients with thermal injuries were studied . Twelve patients underwent acute burn wound excision, and eight patients underwent conservative treatment and delayed excision . The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postburn day 6 . Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed . The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied . Patients admitted early exhibited bacterial counts of less than 10 bacteria per gram of tissue . Patients in this group did not experience infection or graft loss . Patients admitted late exhibited counts of more than 10 bacteria (p = 0.001, compared with early admission) . Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group) . Burn wound excision significantly decreased bacterial colonization for all patients (p < 0.001) . Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001) . It is concluded that burn wound excision significantly reduces bacterial colonization . Patients who undergo topical treatment and delayed burn wound excision exhibit greater bacterial colonization and increased rates of infection . Acute burn wound excision should be considered for all full-thickness burns.

Int J Pediatr Otorhinolaryngol, 2003 Jan, 67(1), 31 - 3
Acute mastoiditis caused by Moraxella catarrhalis; Leskinen K et al.; Acute mastoiditis is the most frequent intratemporal complication of otitis media . The bacteriology of acute otitis media is changing continuously and it differs markedly from the bacteriology of acute mastoiditis . Moraxella catarrhalis (M . catarrhalis) is the third most common bacteria found in acute otitis media, and in recent years its importance as an etiological factor of acute otitis media has markedly increased in certain geographic areas . However, there are no reports of acute mastoiditis caused solely by M . catarrhalis . This report describes a case of a 2-year-old girl with acute mastoiditis and M . catarrhalis in the bacterial culture of middle ear effusion.

Tidsskr Nor Laegeforen, 2002 Jun 30, 122(17), 1686 - 7
{Axel Holst and Theodor Frolich--pioneers in the combat of scurvy}; Norum KR et al.; Axel Holst (1860-1931), professor of hygiene and bacteriology at the University of Oslo and paediatrician Theodor Frolich (1870-1947) became interested in a disease termed "ship beriberi" which afflicted the crews of sailing ships, and which showed an uncanny likeness to scurvy . They suspected a nutritional deficiency, and established an animal model that allowed systematic study of factors that led to disease as well as the preventive value of different substances . The choice of the guinea pig as the experimental animal for these studies was one indeed fortuitous, as that species has been shown to be among the very few mammals incapable of endogenous synthesis of ascorbic acid . They found that the guinea pigs developed distinctly scurvy-like symptoms when fed a diet consisting of various types of grain either whole or baked into bread, and that these symptoms were prevented when the diet was supplemented with known antiscorbutics like fresh cabbage or lemon juice . Their findings were published in 1907 in the Journal of Hygiene, but caused scientific uproar since the concept of nutritional deficiencies was a novelty at the time . The crucial factor, Vitamin C, was discovered in 1930 by Albert Szent-Gyorgyi, for which he was rewarded the Nobel Prize . No prizes or proper recognition were awarded Holst and Frolich at the time . It took some 60 years before they due acclaim was given to them; the 1907 paper by Holst and Frolich is now considered the most important single contribution to elucidating the aetiology of scurvy.

Medicina (Kaunas), 2002, 38(12), 1207 - 11
{Variability and diagnosis of pulmonary tuberculosis}; Kaminskaite A; Five hundred-ninety new cases of tuberculosis were analyzed in Republic Santariskiu Tuberculosis and Lung Disease Hospital during 06 1997-06 2001 . Mean age of patients - 47+/-30 years . All cases were classified based on international tuberculosis classification: pulmonary tuberculosis (A15, A16) - 409 cases; tuberculosis pleurisy (A15.6, A16.5) - 169; miliary tuberculosis (A19) - 11; generalized tuberculous lymphadenitis (A18.5) - 1 . Pulmonary tuberculosis confirmed by sputum smear (A15.0) was prevalent in the structure of new tuberculosis cases (26.4%); pulmonary tuberculosis was confirmed by culture (A15.1) in 14.1%; by histology (A15.2) - in 10.3% . Unconfirmed pulmonary tuberculosis (A16) and tuberculous pleurisy (A16.5) amounted to 28.5% . Liver biopsy and positive sputum cultures for mycobacterias mostly confirmed tuberculosis diagnosis in miliary tuberculosis cases . From all tuberculous pleurisy cases in 65% the diagnosis was confirmed by bacteriology and/or histology.

Wei Sheng Wu Xue Bao, 2000 Oct, 40(5), 559 - 62
{Isolation and identification of a killing maggots bacterium}; Cai X; A notably killing maggots bacterium was isolated from natural dead maggots in the manure pits in the countryside of Yancheng . Its pathogenicity was confirmed by the law of KOCK . The results of preliminary bioassay show that the pathogen can infect the larvas of greenbottle flies and other larvas of flies in a certain extent, but can't infect animals and fowls . The G + C content of its DNA is 62.46% . The hybridization ratio of its DNA and the Pseudomonas pseudoalcaligenes' (AS1.1806) is 81.2% . According to Bergey's Manual of Systematic Bacteriology Ninth edition, the strain of the bacterium was primarily identified as Pseudomonas pseudoalcaligenes.

Int J Tuberc Lung Dis, 2002 Dec, 6(12), 1038 - 45
A critical review of diagnostic approaches used in the diagnosis of childhood tuberculosis; Hesseling AC et al.; SETTING: The diagnosis of tuberculosis (TB) in children is seldom confirmed, and is based mainly on clinical signs, symptoms and special investigations . Various attempts in the form of diagnostic approaches have been made to rationalise this diagnostic process . AIMS: To review and describe published diagnostic approaches aimed at diagnosing mainly intrathoracic tuberculosis in children in developing countries; to compare diagnostic approaches with each other and with bacteriologically confirmed TB; and to describe modifications to the diagnosis of TB in HIV-infected or malnourished children . METHODS: Literature review classified into 1) diagnostic approaches, 2) characteristics used in diagnostic approaches, and 3) studies done to validate diagnostic approaches . RESULTS: Sixteen systems were analysed . Comparison of systems is difficult because characteristic definitions and the ranking of characteristics are not standardised, few studies have been performed to validate these diagnostic approaches, and the gold standard of diagnosis is not practicable in most settings . The minority of systems are adapted for HIV-infected and malnourished patients . RECOMMENDATIONS: Characteristic definitions and ranking of characteristics should be standardised . Any new diagnostic approaches developed should be relevant to developing countries with limited resources, a high burden of tuberculosis, malnutrition and HIV/AIDS and a young population . Studies done to validate diagnostic approaches should be conducted scientifically.

Infect Immun, 2003 Feb, 71(2), 857 - 63
Protection of chickens against Escherichia coli infections by DNA containing CpG motifs; Gomis S et al.; Synthetic oligodeoxynucleotides (ODN) containing CpG motifs (CpG-ODN) have been shown to be effective immunoprotective agents in murine models for a variety of viral, intracellular bacterial, and protozoan infections . Until now, the use of CpG-ODN to protect against extracellular bacterial infections has not been reported . The objective of this study was to investigate the effect of CpG-ODN against cellulitis and colibacillosis in broiler chickens, using a well-established model . At 22 days of age, birds received CpG-ODN by either the subcutaneous or intramuscular route . Three days later, a virulent isolate of Escherichia coli was applied to a scratch site on the caudal abdominal skin . Birds were examined for 10 days after the E . coli challenge, and pathological and bacteriological assessments were conducted on all birds . The control group of birds receiving no CpG-ODN((2007)) had a survival rate of 15% . In contrast, groups that received CpG-ODN((2007)), by either subcutaneous or intramuscular injection, had significantly higher survival rates (P < 0.0001) . Furthermore, the size of the cellulitis lesion was significantly smaller in groups that received CpG-ODN((2007)) by the subcutaneous route (P < 0.01) . A dose of as little as 3.16 micro g of CpG-ODN((2007)), delivered 3 days prior to challenge by either the subcutaneous or intramuscular route, significantly protected birds against E . coli infection (P < 0.01) . This study demonstrates that CpG-ODN((2007)) has both local and systemic protective effects in broiler chickens . This is the first time that CpG-ODN((2007)) has been demonstrated to have an immunoprotective effect against an extracellular bacterial infection in any food animal species.

J Endod, 2003 Jan, 29(1), 12 - 4
Bacteriological evaluation of passive ultrasonic activation; Spoleti P et al.; The purpose of this study was to evaluate the influence of passive ultrasonic activation on root canal disinfection . Sixty human teeth (group A: upper incisors, group B: upper canines, and group C: distobuccal root of first upper molars) were selected and sterilized in an autoclave . A standardized inoculum was placed into the canals, and they were incubated for 72 h at 37 degrees C . Then, they were divided into subgroup 1, which received sterile saline (SS) as an irrigant, and subgroup 2, which received sterile saline with passive ultrasonic activation (SU) . The endodontic treatment was performed with a crown-down technique . Bacteriological identification of surviving colonies was carried out . Surviving colonies were higher when ultrasonics was not used (group A: SS: x 32.13, SU: x 13.53; group B: SS: x 53.70, SU: x 44.60; group C: SS: x 39.16, SU: x 29.40) . The homogeneity proportion tests to compare the results of both subgroups showed that the surviving proportions were higher (p = 0.01) when the ultrasonic activation was not used.

Medicina (B Aires), 2002, 62(6), 585 - 92
{Childhood tuberculosis and its diagnosis in Argentina}; Miceli IN et al.; TB notification rate in infants and children 0-4 years was 24.3/100,000 in Argentina, in 2000, for a global incidence of 31.8/100,000 . A 17% of all TB cases occurred in children (0-14 years), indicating a very active TB transmission . Usually TB is diagnosed when the disease is already advanced . Main criteria for the diagnosis are: a previous contact with an infectious TB patient, a positive PPD test result and clinical--radiological signs and symptoms . Bacteriology plays a limited role in diagnosis; gastric aspirate is the most often used specimen for bacteriological examination in children . Culture is performed on solid egg-media, but other more recently developed culture media systems are available in reference laboratories . Nucleic acid amplification assays are also used, but its systematic quality control is still lacking . Their results should be considered only as complementary . Strengthening of the laboratory network will contribute to increase diagnostic certainty of childhood TB, to improve reliability of cases reported, and to a better knowledge of the drug resistance profile . Early diagnosis of TB in children, by contacts investigation of infectious patients, followed by preventive chemotherapy or treatment when necessary, may revert the current epidemiological situation . TB meningitis in the 0-4 years group showed a significantly more pronounced decline than that of adults TB for the period 1980-2000, (only 10 meningitis cases were diagnosed in year 2000, 0.29/100,000), confirming the protection conferred by BCG vaccination when applied to newborns with a continuously high coverage.

Paediatr Respir Rev, 2001 Jun, 2(2), 113 - 9
Non-pulmonary tuberculosis; Carrol ED et al.; Tuberculosis (TB) is a serious disease of global importance, with a rising incidence in the developed world in recent years . Tuberculous lymphadenitis, tuberculous meningitis, osteoarticular tuberculosis and miliary tuberculosis are some of the more well-recognised manifestations of non-pulmonary TB in childhood . The diagnosis of non-pulmonary TB poses a particular challenge for clinicians because of the protean ways in which the disease presents . The omission of tuberculosis from the differential diagnosis of patients with obscure illnesses and the relatively insensitive bacteriological methods for detecting Mycobacterium tuberculosis add to the complexity of the problem . A high index of suspicion is required in order to avoid delays in diagnosis which may influence treatment outcome . The advent of DNA amplification techniques such as the polymerase chain reaction may herald a promising new era in the prompt and accurate management of extrapulmonary tuberculosis.

Semin Arthritis Rheum, 2002 Dec, 32(3), 189 - 95
Sternoclavicular infectious arthritis in previously healthy adults; Bar-Natan M et al.; OBJECTIVE: To define characteristics of sternoclavicular infection (SCI) in previously healthy patients . METHODS: SCI in a previously healthy man is reported along with 4 similar cases found by surveying the hospital's database; 22 previously reported cases were culled from the literature and summarized . RESULTS: The frequency of SCI in healthy adults was 0.5% of all bone and joint infections admitted to the hospital . The clinical and bacteriologic features were similar to previous reports in nonselected SCI patients . Computerized tomography (CT) scan, arthrocenthesis, and biopsy were required for diagnosis . Complications included abscess formation, mediastinitis, and sepsis . The majority of patients were treated by surgical drainage and antibiotics . The final outcome was good, without mortality or long-term morbidity . CONCLUSIONS: Although SCI is a rare infection in healthy adults, it should be considered in the differential diagnosis of a painful sternoclavicular joint . Prompt diagnosis and appropriate treatment of SCI results in excellent outcome in most cases .

Biomaterials, 2003 Mar, 24(7), 1265 - 70
Calcium-deficient apatite: influence of granule size and consolidation mode on release and in vitro activity of vancomycin; Obadia L et al.; The use of dynamic compaction and isostatic compression to consolidate calcium phosphate powder loaded with a therapeutic agent avoids a sintering step that could destroy the drug . The present study applied these consolidation methods to vancomycin-loaded calcium-deficient apatite powder, using three granulometric fractions (40-80, 80-200 and 200-500 micrometer) . In vitro release profiles were determined via an original system derived from low-pressure liquid chromatography . The biological activity of vancomycin was measured by an in vitro standardized bacteriologic assay, which showed that the drug is completely active after association with calcium phosphate . Regardless of the consolidation method and granulometric fraction used, release profiles were not significantly different and therefore adaptable to injectable suspensions.

Curr Infect Dis Rep, 2003 Feb, 5(1), 9 - 15
The Role of Antibiotics in Acute Exacerbations of Chronic Obstructive Pulmonary Disease; Sethi S; Our understanding of the pathogenesis and consequences of acute exacerbations of chronic obstructive pulmonary disease (COPD) has increased considerably in the past decade . Several new lines of evidence support bacterial causation of about half the exacerbations . Contrary to previous data, recent studies with improved methodology have demonstrated that exacerbations do contribute to the loss of lung function in COPD . Another interesting new observation is that colonization by bacterial pathogens may not be innocuous, and in fact may lead to airway inflammation and contribute to pathogenesis of COPD . Evidence that bacteria cause exacerbations, that exacerbations contribute to loss of lung function, and that chronic colonization by bacteria may be harmful, has emphasized the potential importance of appropriate antibiotics in the treatment of exacerbations . An unfortunate paucity of data does not allow evidence-based recommendations to be made for optimal choice of antibiotics for exacerbations of COPD . Emerging data that antibiotics differ in unconventional measures of efficacy such as time to next exacerbation, improvement in health-related quality of life, and bacteriologic eradication will help us make concrete recommendations in the future.

Vestn Otorinolaringol, 2002, (5), 37 - 9
{Curiosine administration for management of wound process after middle ear operations in otitis media}; Perekhoda DL et al.; Curiosine solution was used in surgical treatment of 80 patients with chronic otitis media purulenta early after the intervention . Otoscopic, cytological and bacteriological examinations have demonstrated that the drug creates physiological conditions for activation, migration and division of cells participating in tissue regeneration, it promotes bacterial decontamination of the wound . Curiosine can be used after radical operations on the middle ear.

J Biomed Mater Res A, 2003 Feb 1, 64(2), 388 - 96
Bone formation on two-dimensional poly(DL-lactide-co-glycolide) (PLGA) films and three-dimensional PLGA tissue engineering scaffolds in vitro; Karp JM et al.; For some bone tissue engineering strategies, direct contact of newly synthesized bone with a scaffold is important for structural continuity and stability at the scaffold/bone interface . Thus, as the polymer degrades, the support function of the scaffold could be adopted by the developing bone structure . This study was designed to determine whether poly(DL-lactide-co-glycolide) with a comonomer ratio of 75:25 supports bone apposition in vitro . Osteogenic cells derived from rat bone marrow cells were cultured for 2 weeks on polymeric two-dimensional films and three-dimensional tissue engineering scaffolds . Bacteriological grade polystyrene and tissue culture polystyrene dishes served as negative and positive controls for interfacial bone deposition, respectively . The surfaces of the prepared substrates were characterized by X-ray photoelectron spectroscopy, dynamic water contact angle, scanning electron microscopy, and atomic force microscopy . After cell culture, the elaborated matrix was examined using scanning electron microscopy, transmission electron microscopy, and energy dispersive spectroscopy . The results show that poly(DL-lactide-co-glycolide) supports appositional bone growth on both two-dimensional films and three-dimensional scaffolds, including the formation of a mineralized cement line matrix . Furthermore, surface topographical features are not required for the adherence of the cement line matrix to the polymer .

J Vet Med Sci, 2002 Dec, 64(12), 1123 - 7
Diagnostic survey of bovine abortion in Korea: with special emphasis on Neospora caninum; Kim JH et al.; Causes of bovine abortion were surveyed in Korea within a designated period from the cases submitted to the Department of Veterinary Pathology, College of Veterinary Medicine, Seoul National University . One hundred and eighty aborted fetuses and maternal sera were evaluated by necropsy, histopathology, bacteriology, virology, PCR, and serologic tests . The causes of abortion were identified in 108 (60%) cases, of which 38 (21.1%) were due to the infection with Neospora caninum . None of the 38 cases showed any co-infection with either virus or bacteria . Viral and bacterial causes were diagnosed in 28 (15.5%) and 13 (7.2%) aborted fetuses, respectively . Non-infectious causes such as multiple pregnancy, maternal weakness or torsion of umbilical cord were observed in 22 (12.3%) cases . Results of the present study suggest that N . caninum is believed to be the leading cause of bovine abortion in Korea . Thus, more attention should be paid to this emerging disease in Korea . However, the causes of many aborted fetuses remain undiagnosed in this study . Therefore, this enigma should be clarified through further studies such as chromosomal analysis.

Cochrane Database Syst Rev . 2002;(4):CD001094.
Antibiotics for persistent nasal discharge (rhinosinusitis) in children; Morris P et al.; BACKGROUND: Nasal discharge (rhinosinusitis) is extremely common in children . It is the result of inflammation of the mucosa of the upper respiratory tract, and is usually due to either infection or allergy . OBJECTIVES: To determine the effectiveness of antibiotics versus placebo or standard therapy in treating children with persistent nasal discharge (rhinosinusitis) for at least 10 days . SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE, EMBASE, and the references of relevant articles were searched . Authors and pharmaceutical companies were contacted . Date of most recent searches: February 2002 . SELECTION CRITERIA: All randomised controlled trials that compared antibiotics versus placebo or standard therapy . Trials which included the use of other medications were included if all participants were allowed equal access to such medications or if the additional or alternative therapies were regarded as ineffective . Trials that only combined or compared antibiotics with surgery, or sinus puncture and lavage, were not included in the review . DATA COLLECTION AND ANALYSIS: Data were extracted by a single reviewer for the following eight outcomes: overall clinical failure (primary outcome), failure to cure, failure to improve, clinical improvement, time to resolution, complications, side-effects and bacteriologic failure . For the dichotomous outcome variables of each individual study, proportional and absolute risk reductions were calculated using a modified intention-to-treat analysis . The summary weighted risk ratio and 95% confidence interval (fixed effects model) were calculated using the inverse of the variance of each study result for weighting (Cochrane statistical package, REVMAN version 4.1) . MAIN RESULTS: A total of six studies involving 562 children compared antibiotics with placebo or standard therapy . Only the primary outcome (overall clinical failure) was reported in all studies . Around 40% of all randomised children did not have a clinical success documented when reviewed two to six weeks after randomisation . The control event rate varied from to 22 to 71% (mean 46%) . The risk ratio estimated using a fixed effects model was 0.75 (95% CI 0.61 to 0.92) . There was no evidence of statistical heterogeneity . Side effects occurred in 4 of 189 control group children (four studies) . More children treated with antibiotics had side effects (17 of 330), but this difference was not statistically significant (RR 1.75, 95% CI 0.63 to 4.82) . REVIEWER'S CONCLUSIONS: For children with persistent nasal discharge or older children with radiographically confirmed sinusitis, the available evidence suggests that antibiotics given for 10 days will reduce the probability of persistence in the short to medium-term . The benefits appear to be modest and around eight children must be treated in order to achieve one additional cure (NNT 8, 95% CI 5 to 29) . No long term benefits have been documented . These conclusions are based on a small number of small randomised controlled trials and may require revision as additional data become available.

Dent Clin North Am, 2003 Jan, 47(1), 115 - 25, x-xi
Preterm low birth weight and periodontal disease among African Americans; Dasanayake AP et al.; African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites . LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems . Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance . Pregnant women's poor periodontal healtlh is emerging as one such factor . Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries . This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis.

Dis Aquat Organ, 2002 Nov 7, 52(1), 87 - 91
Mycobacterial infection in farmed turbot Scophthalmus maximus; dos Santos NM et al.; Mycobacteriosis (piscine tuberculosis) has been reported to affect a wide range of freshwater and marine fish species; however, this is the first report describing mycobacterial infections in turbot Scophthalmus maximus . High numbers of granulomas were initially observed in the organs of moribund farmed turbot . Bacteriological analysis of organs with granulomas led to the isolation of Mycobacterium marinum . Further analysis, to determine the prevalence of the infection in the farm and to identify its source, showed the occurrence of a dual infection by M . marinum and M . chelonae . The presence of Nocardia sp . in some of the fish infected with mycobacteria was also detected . The presence of granulomas in internal organs of apparently healthy fish indicated a high prevalence of the disease, a conclusion that was supported by isolating mycobacteria from all fish with or without granulomas . The infection was probably responsible for the mortality observed (approximately 2% mo(-1)), as most of the recently dead fish presented high numbers of granulomas and isolation of mycobacteria was possible from all of the fish . The isolation of M . marinum from the inlet water suggested this as the most plausible source for the infection occurring in the farm.

Nippon Rinsho, 2002 Dec, 60(12), 2423 - 8
{Lung involvements of RA, diagnosis and treatment}; Tokuda H; Various pleuro-pulmonary abnormalities and conditions are known to complicate rheumatoid arthritis . Some of them are asymptomatic, tend to ameliorate spontaneously(ex . pleuritis and rheumatoid nodule), others may cause serious conditions and often fatal(ex . interstitial pneumonia and constrictive bronchiolitis) . Furthermore therapy-related lung complications and opportunistic infections may develop in RA patients . Clinicians must differentiate these conditions, using serological, physiologic, bacteriological, radiographic, and if necessary, invasive techniques including bronchoscopy and video-assisted thoracoscopic surgery . Therapy may vary according to the nature of these conditions . Appropriate anti-microbial agent must be given for infectious diseases . On the other hands immuno-suppressive therapy should be applied for interstitial pneumonia if the disease progress rapidly and threaten life . Anti-RA drugs should be withdrawn in case of drug-induced lung injury.

Indian J Pediatr, 2002 Nov, 69 Suppl 1, S11 - 9
Improving bacteriological diagnosis of tuberculosis; Wattal C; This review is to summarize recent developments in the field of mycobacteriology since the diagnosis of tuberculosis remains elusive in spite of our best efforts and great scientific advances . Progress has been made in further improving upon the age old, time tested traditional techniques like microscopy (Auramine-Rhodamine Fluorescent staining and peptide nucleic acids), culture and sensitivity techniques (solid, liquid, radiometric, and non-radiometric systems) that still remain as the gold standard for its diagnosis . Development of rapid methods {(high performance liquid chromatography, thin layer chromatography, RNA sequencing and polymerase chain reaction (PCR), nucleic acid sequence based amplification assay (NASBA), Transcription mediated assay (TMA) and Ligase chain reaction (LCR)} have paved the way for its rapid detection and treatment . It is interesting to see the role of molecular assays appearing more often in literature now . The molecular amplification systems (PCR, NASBA, TMA, LCR) besides identifying Mycobacterium tuberculosis (MTB) as well as non-tuberculous mycobacteria (NTM), directly from the sample can also identify Rifampin (rpoB gene)/Isoniazide (katG gene) resistant strain . Molecular assays have been found useful particularly in smear positive sputum with high sensitivity and specificity whereas variable sensitivity for sputum negative and extra pulmonary specimens has been observed . Representative specimen and its quality affect the performance of these assays . Emphasis should given to proper collection and transportation of the representative specimen for appropriate evaluation.

Clin Ther, 2002 Nov, 24(11), 1915 - 36
Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: a randomized, open-label, multicenter study of clinical efficacy and tolerability; Lode H et al.; OBJECTIVE: This study aimed to compare the efficacy and safety of oral gemifloxacin, an enhanced-affinity quinolone, with sequential therapy with IV ceftriaxone followed by oral cefuroxime (with or without a macrolide) in patients hospitalized for community-acquired pneumonia (CAP) . METHODS: A randomized, open-label, multicenter study comprised adults hospitalized with a clinical and radiologic diagnosis of CAP . Patients were randomized 1:1 to receive either (1) oral gemifloxacin 320 mg once daily (7-14 days); or (2) IV ceftriaxone 2 g once daily (1-7 days) followed by oral cefuroxime 500 mg twice daily (1-13 days) for a total of < or = 14 days . Patients receiving ceftriaxone/cefuroxime were allowed concomitant macrolide treatment . RESULTS: A total of 345 patients were randomized, of whom 341 received at least 1 dose of study medication (gemifloxacin, 169/172; ceftriaxone/cefuroxime, 172/173) . Clinical success rates in the clinically evaluable (CE) population at follow-up (day 21-28 post-therapy), the primary end point, were 92.2% (107/116) for gemifloxacin and 93.4% (113/121) for ceftriaxone/cefuroxime (treatment difference, -1.15; 95% CI, -7.73 to 5.43) . In patients in Fine risk classes IV and V, the clinical success rate was 87.0% (20/23) for gemifloxacin versus 83.3% (20/24) for ceftriaxone/cefuroxime . No difference in clinical response at follow-up was noted based on macrolide use . Bacteriologic success rates at follow-up in the bacteriologically evaluable (BE) population were 90.6% (58/64) for gemifloxacin and 87.3% (55/63) for ceftriaxone/cefuroxime (treatment difference 3.32; 95% CI, -7.57 to 14.21) . The clinical success rate in bacteremic patients at follow-up (BE population) was 100.0% . Both treatments were generally well tolerated . The frequency and types of adverse events were similar between the 2 groups . The most common treatment-related adverse events with gemifloxacin were diarrhea, liver-function adverse events, and rash; with ceftriaxone/cefuroxime, they were diarrhea, elevated hepatic-enzyme activity, and moniliasis . CONCLUSION: The clinical efficacy and tolerability of oral gemifloxacin 320 mg once daily were similar to those of IV ceftriaxone followed by oral cefuroxime (with or without a macrolide) in the treatment of adult patients hospitalized with moderate to severe CAP . Both treatments were effective in bacteremic patients and those at increased risk of mortality.

Rev Alerg Mex, 2002 Sep-Oct, 49(5), 157 - 62
{Relation between Helicobacter pylori and atopic diseases}; Lopez Perez G et al.; The rise in the incidence of atopic diseases in the last years is associated to a greater prevalence of viral and bacterial infections . The infections facilitate a chronic inflammatory process that is directly related to the sensibilization of mast cells which favors manifestations of allergic diseases . Within the proposed bacteriological agents as causes of is Helicobacter pylori . This work is a bibliographical revision and concludes that there is not evidence of the direct causal relation between infection by Helicobacter and allergic diseases; however, it can play an indirect role . Controlled and randomized studies are necessary to know accurately this relation because the eradication treatment could be a real alternative in these patients handling.

Khirurgiia (Mosk), 2002, (11), 27 - 31
{A comparative assessment of modern suture materials in stomach resection}; Korotkov NI et al.; Results of stomach resection by Bilrot-II in 30 experimental animals and 369 patients with gastric and duodenal ulcers were analyzed . Gastroenteroanastomoses were created with various sutures: capron, polysorb, titanium clips . Pneumopression, bacteriologic and morphologic examinations of anastomosis, fibroesophagogastroduodeno- and intestinoscopy, peripheral computed electrogastroenterography were used . It was revealed that mechanical suture with titanium clips was the best . Polysorb thread is inferior in tissue reaction to mechanical suture but superior to capron . Use of polysorb reduced rate of complications in immediate postoperative period 4 times . Taking into consideration high cost of suture devices it is reasonable to introduce polysorb in practice of abdominal surgery.

Anaesth Intensive Care, 2002 Dec, 30(6), 747 - 54
Reliability of procalcitonin as a severity marker in critically ill patients with inflammatory response; Tugrul S et al.; Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill . This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis . Eighty-five adult ICU patients were studied . Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n = 10), sepsis (n = 16), severe sepsis (n = 18) and septic shock (n = 41) . Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day . PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25 +/- 43.08 and 37.15 +/- 61.39 ng/ml) than patients with SIRS (0.73 +/- 1.37 ng/ml) (P < 0.05 for each comparison) . As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9 +/- 47.8 ng/ml), regardless of the degree of sepsis (P < 0.001) . PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response . Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP . We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.

ORL J Otorhinolaryngol Relat Spec, 2002 Nov-Dec, 64(6), 382 - 9
Meningitis following cochlear implantation: pathomechanisms, clinical symptoms, conservative and surgical treatments; Arnold W et al.; Pneumococcal otogenic meningitis is a rare postsurgical complication that can develop following stapedectomy or after cochlear implantation . The bacterial infection can be fatal in some instances . A recent increase in the incidence of otogenic meningitis among cochlear implant wearers is of concern . The majority of meningitis cases are associated with a 2-component electrode manufactured by one cochlear implant company . The device with the added 'positioner' component has been withdrawn from the market (FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater Risk for Meningitis, Updated: August 29, 2002, Not all cases have been subsequent to otitis media and symptoms have developed from less than 24 h up to a few years after implantation . The purpose of this paper is to review and discuss the pathogenesis, pathology/bacteriology and to elaborate on some clinical features of otogenic meningitis in implanted children and adults . Essential aspects of surgery, electrode design, and cochleostomy seal are discussed . Conclusions are drawn from the available data and recommendations are made for good practice in cochlear implantation and follow-up .

Acta Vet Hung, 2002, 50(4), 413 - 23
Association between endometritis and urocystitis in culled sows; Biksi I et al.; Slaughterhouse sampling and examination of urogenital tracts of 499 sows and gilts culled for reproductive reasons from 21 Hungarian herds were performed over a 6-year period . The aim was to estimate the prevalence of different urogenital tract lesions, and to provide sensitivity and specificity estimates for macroscopic and bacteriological examinations in the diagnosis of urocystitis and endometritis . Furthermore, the association between endometritis and urocystitis was assessed . The prevalence of main lesions of the urogenital tract was similar to that reported in other studies . The 'sensitivity' of macroscopic and bacteriological methods was determined statistically by taking histopathology as the 'Gold Standard' . As a result, the 'sensitivity' of macroscopic methods for the diagnosis of endometritis and urocystitis was < or = 18.1% and 47.9%, respectively, while the 'sensitivity' of bacteriology for the diagnosis of the same conditions was < or = 31.8% and 63.0%, respectively . The presumed positive association between urocystitis and endometritis was confirmed; it was not confounded by parity . Animals affected by urocystitis had a 3.5 times higher odds to simultaneously have endometritis than animals without urocystitis.

Ann Surg, 2003 Jan, 237(1), 101 - 9
Effects of interleukin-1alpha administration on intestinal ischemia and reperfusion injury, mucosal permeability, and bacterial translocation in burn and sepsis; Tadros T et al.; OBJECTIVE: To evaluate the effect of interleukin-1alpha (IL-1alpha) on the mesenteric circulation, intestinal mucosal integrity, and bacterial translocation in a burn/endotoxemia chronic porcine model . SUMMARY BACKGROUND DATA: Major burn and sepsis are associated with a high mortality, ischemia/reperfusion injury to the intestine, and an increased rate of bacterial translocation . Pathologic alterations of IL-1 synthesis, degradation, and binding to receptors have been reported . Manipulation of IL-1-mediated effects might be of therapeutic utility . METHODS: Twenty-one female pigs were instrumented with an ultrasonic flow probe on the superior mesenteric artery and a catheter into the superior mesenteric vein . After 5 days, all animals were anesthetized, and 14 received 40% total body surface area third-degree burn . IL-1alpha was administered intravenously at 1,000 ng/kg to seven pigs immediately after burn . Eighteen hours after burn, 100 microg/kg lipopolysaccharide (LPS) was administered intravenously . Systemic and splanchnic hemodynamics were measured and blood samples were drawn for blood gas analysis . Intestinal permeability was assessed every 6 hours by measuring the lactulose/mannitol (L/M) excretion ratio . At the end of the study (42 hours), tissue samples were harvested for bacteriologic cultures . RESULTS: Mesenteric blood flow was significantly decreased after burn and endotoxin . Administration of IL-1alpha significantly improved mesenteric blood flow postburn and post-LPS . Mesenteric oxygen supply and consumption showed a significant reduction after burn . In contrast, animals treated with IL-1alpha showed an increase in postburn mesenteric oxygen supply and consumption . LPS-induced mesenteric hypoxia was also ameliorated by IL-1alpha treatment . Intestinal permeability, as assessed by the L/M ratio, showed a 7- and 10-fold elevation after thermal injury and LPS, respectively . In contrast, IL-1alpha-treated animals showed an increase of only three- and fourfold in the L/M ratio, respectively . Bacterial translocation was significantly increased in the burn/endotoxin group . IL-1alpha significantly reduced the rates of bacterial translocation . CONCLUSIONS: IL-1alpha treatment attenuates mesenteric ischemia and reperfusion injury induced by thermal injury and endotoxemia by improving mesenteric blood flow and oxygenation . Subsequently, IL-1alpha reduces intestinal permeability and bacterial translocation after burn and sepsis.

Eur J Cardiothorac Surg, 2003 Jan, 23(1), 97 - 102
Prevalence of 90-days postoperative wound infections after cardiac surgery; Jonkers D et al.; OBJECTIVE: Postoperative wound infections generally cause considerable extra morbidity, mortality and costs . As nowadays length of hospitalization shortens, post-discharge surveillance is important to get reliable information on the prevalence of postoperative wound infections . In this study, the prevalences of sternal wound (SWI) and donor site infections (DSI) during hospitalization as well as, 30 and 90 days after cardiac surgery were studied paying special attention to the contribution of post-discharge surveillance . METHODS: A total of 1885 patients who underwent cardiac surgery were included in the study and were followed for the prevalence of SWI or DSI up to 90 days postoperatively . Infection data during hospitalization were collected using medical records, bacteriological results and systematic observations of infection control nurses . After discharge from the hospital, data were collected with the help of the out-patient clinic and the family physician . RESULTS: After cardiac surgery, SWI and DSI were diagnosed in 4.7 and 1.5% of patients during hospitalization, in 6.8 and 4.6% at 30 days postoperatively, and in 9.0 and 7.3% of patients at 90 days postoperatively . Of the 90-days postoperative infections rates almost half of SWI and 80% of DSI were diagnosed post-discharge, a result predominantly achieved by the active participation of the family physicians . CONCLUSIONS: After 30 and 90 days follow-up of patients after cardiac surgery, additional sternal wound and donor site infections were diagnosed compared with the in-hospital infection rate . Post-discharge surveillance is essential for a reliable assessment of surgical wound infections.

Semin Pediatr Infect Dis, 2002 Oct, 13(4), 257 - 62
Current laboratory diagnosis of Q fever; Scola BL; Q fever is a worldwide zoonosis caused by the strictly intracellular bacterium Coxiella burnetii . Among symptomatic patients (one-half of patients remain asymptomatic), acute Q fever most frequently manifests as a self-limited febrile illness, pneumonia, or hepatitis . Endocarditis is the predominant form of chronic Q fever . All the classical techniques of bacteriology may be used for diagnosis of C burnetii infection . Nonetheless, because of the risk of contamination, isolation must be performed in biosafety level 3 laboratories . Moreover, to date no diagnostic tests for detection by polymerase chain reaction or specific antibodies for immunochemistry are available commercially . Hence, Q fever is diagnosed in most cases by serology . The most reliable technique appears to be micro-immunofluorescence, which exhibits both good sensitivity and specificity . A wider use of this serology in cases of blood culture-negative endocarditis, atypical pneumonia, unexplained fever, and hepatitis should lead to an increase of diagnosed cases .

Vet Microbiol, 2003 Mar 20, 92(1-2), 65 - 72
Evaluation of a PCR test for the diagnosis of Brucella ovis infection in semen samples from rams; Manterola L et al.; The sensitivity and specificity of a PCR assay with primers derived from the insertion sequence IS6501 was compared with that of bacteriological culture and serological tests for the diagnosis of Brucella ovis infection in rams . No amplifications were detected with DNAs from the strains phylogenetically related to Brucella and from the seven bacterial species considered as the main etiologic agents of epididymitis in rams . In addition, the specificity of the PCR was 100% when testing semen samples from Brucella-free rams . The comparison of the semen culture and PCR results from 192 semen samples tested, showed a proportion of agreement of 0.91 between both tests . The PCR-based test described has sensitivity similar to that of semen culture and could be used as a complementary test for the direct diagnosis of Brucella ovis in semen samples of rams.

J Biomed Mater Res A, 2003 Jan 1, 64(1), 20 - 37
Correlating fibronectin adsorption with endothelial cell adhesion and signaling on polymer substrates; Koenig AL et al.; Fibronectin (Fn) adsorption was studied on different commercial polymer surface chemistries, including tissue culture polystyrene (TCPS), bacteriologic polystyrene (BPS), fluoropolymer Teflon AF, and poly-L-lactide (PLLA) . Antibody probes detected the availability of Fn's cell binding domain on adsorbed Fn in the competitive presence and absence of bovine serum albumin (BSA) . Domain availability was highest for Fn adsorbed on TCPS, especially in the presence of either serum albumin or dilute serum . Attachment and growth efficiencies for human umbilical venous endothelial cells (HUVECs) cultured on surfaces preadsorbed with Fn in serum and serum-free media correlated with antibody cell-binding domain availability: TCPS > BPS, Teflon AF > PLLA . Intracellular signaling from the GTPase, RhoA, was highest (RhoA:RhoGDI inhibitor ratio) in cells cultured on the Teflon AF surfaces, indicating that despite lower attached cell numbers on Teflon AF compared to TCPS, cell signaling remained activated after 24 h of growth . Up-regulated cellular Fn mRNA messages, assessed using RT-PCR techniques, supported HUVECs' producing the endogenous extracellular matrix (ECM) protein Fn in order to attach and survive on the suboptimal Teflon AF culture surfaces .

Vet Rec, 2002 Nov 23, 151(21), 629 - 35
Evaluation of a new immunocapture test for the diagnosis of ovine brucellosis caused by Brucella melitensis; Duran-Ferrer M et al.; A new immunocapture technique has been applied to the diagnosis of ovine brucellosis under experimental conditions . The tests were made on a serum bank derived from both young and adult ewes vaccinated conjunctivally with the Rev 1 strain at a dose of 10(8) to 10(9) colony-forming units . Adult ewes were infected experimentally two-and-a-half years after they had been vaccinated and the results were compared with an unvaccinated control group . The condition of each animal in terms of infection with Brucella melitensis was determined by clinical and bacteriological investigations . The development of the immune response was compared by the rose bengal test, the complement fixation test, the Coombs' test and the immunocapture technique for 180 days after the vaccination and for 410 days after the experimental infection, that is, the two following gestations . The results suggest that the new technique is more specific in animals vaccinated conjunctivally, regardless of their age when they were vaccinated . After the experimental infection, significantly (P < 0.05) fewer of the vaccinated sheep which were free of clinical signs and were not excreting B melitensis reacted positively to the test.

Arch Inst Pasteur Madagascar, 1999, 65(1-2), 82 - 5
{Evaluation of the management of tuberculosis in children in Madagascar . Results of a multicentric study}; Rasamoelisoa JM et al.; In Madagascar, tuberculosis remains an important cause of morbidity and letality with a Risk of Annual Tubercular Infection about 1% in 1996 in spite of a vaccination rate of 82.6% and tubercular drugs free of charge . In 1995, the National Tubercular Control Program detected 7,000 cases of pulmonary tuberculosis and expected more than 12,000 cases per year . This study was carried out in order to review the management and the treatment of the child tuberculosis in Madagascar . This retrospective study was conducted in four pediatric units of the General hospital of Befelatanana (A and B), Ambohimiandra Hospital and Regional Hospital Centre of Toliara for a twenty four months period from January 1997 to December 1998 . All the less than 15-year-old children medical files were consulted . 214 cases were suspected of tuberculosis . 133 of them were treated upon clinical presumption basis and/or radiological exams (33 bacteriological and/or histopathological exams were only realized) . 56% of the cases were vaccinated by BCG vaccine . Respiratory diseases with fever motive 46% of hospitalization . The majority of these children are living in poor conditions and 38% of them had malnutrition . Were found as clinical manifestations: 47% of pulmonary tuberculosis (among them 20% were smear-positive pulmonary tuberculosis), 12% had ganglionar tuberculosis, 10% peritoneal tuberculosis, 8% a tubercular meningitis, 5% a Pott-disease and 2% a miliary-disease . Mortality increases with suffocation . 18% of cases died, especially infants and in tubercular meningitis . The authors conclude that management and treatment of tuberculosis need an early diagnosis . But the diagnosis is difficult in front of non specific clinical manifestations in children and due to lack of means and national agreement which settle up diagnosis and therapy . A scoring system based upon clinical signs in agreement with complementary medical tests is desirablePublication Types:

Multicenter Study

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