Int J Tuberc Lung Dis, 2002 Nov, 6(11), 952 - 8 Treatment of isoniazid-resistant tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide for 6 months; Nolan CM et al.; SETTING: In 1992 the Seattle-King County Department of Public Health Tuberculosis Clinic began to treat patients with isoniazid-resistant tuberculosis with a regimen of isoniazid, rifampin, pyrazinamide, and ethambutol daily for 6 months . OBJECTIVE: To conduct a review of clinical and bacteriological outcomes of treatment for patients who received the four-drug, 6-month regimen for isoniazid-resistant tuberculosis . DESIGN: A retrospective review of medical records of TB cases meeting the study criteria, a Mycobacterium tuberculosis isolate resistant to isoniazid, and intent to treat with a 6-month course of isoniazid, rifampin, pyrazinamide, and ethambutol . RESULTS: Through December 1999, 44 consecutive patients with isoniazid-resistant, rifampin-susceptible tuberculosis were started on the four-drug, 6-month daily regimen . Among 42 patients followed until completion of therapy, three required changes in the regimen due to side effects . There was one case of drug-induced hepatotoxicity . Among 39 patients with pulmonary involvement, 37 converted sputum cultures from positive to negative within 2 months of starting treatment . There were no treatment failures . On passive follow-up of at least 2 years on all patients, two patients relapsed . The single patient with bacteriological relapse did not develop further drug resistance . CONCLUSION: The regimen of isoniazid, rifampin, pyrazinamide, and ethambutol given daily for 6 months produced successful outcomes when used in a public health tuberculosis clinic as routine therapy for isoniazid-resistant tuberculosis. Dis Colon Rectum, 2002 Dec, 45(12), 1665 - 71 Bacterial translocation in patients with Crohn's disease undergoing surgery; Takesue Y et al.; PURPOSE: Much evidence, derived from experimental studies, suggests that bacterial translocation indeed occurs, yet its clinical significance is still a matter of controversy in humans . The aims of this study were to determine the prevalence of bacterial translocation in patients with Crohn's disease undergoing laparotomy and to identify any association with postoperative septic complications or systemic inflammatory response syndrome . METHODS: Mesenteric lymph node and peripheral blood samples from 42 patients with Crohn's disease undergoing laparotomy were collected for bacteriologic assessments . RESULTS: Bacterial translocation to mesenteric lymph node was identified in 20 patients (48 percent) . The most common organism was (27 percent) . Blood cultures were positive in 2 of 20 patients in whom translocation to lymph node was identified . Bacterial translocation was associated with a greater than two-fold increase in the incidence of postoperative septic complications (35 14 percent), but this difference was not significant . In the analysis of the occurrence of systemic inflammatory response syndrome, a significantly higher incidence continued until the third postoperative day in patients with those without bacterial translocation . In a logistic regression analysis, bacterial translocation had a significant effect on the occurrence of systemic inflammatory response syndrome, even though septic complications were taken into account . CONCLUSIONS: Bacterial translocation to mesenteric lymph node predisposed patients with Crohn's disease undergoing laparotomy to systemic inflammatory response syndrome. J Orthop Surg (Hong Kong), 2000 Dec, 8(2), 1 - 5 Bacterial load in tissues and its predictive value for infection in open fractures; Sen RK et al.; The role of quantitative bacteriology is considered controversial for the prediction of infection in open fractures . A study was done in 20 patients with open fractures . Post debridement pieces of skin, muscle and periosteal tissue were obtained for quantitative bacterial counts . Among a total of 50 samples from all of the tissues, 29 showed positive bacterial counts (16 of 20 skin, 11 of 20 muscle and 2 of 10 periosteum samples) . By quantitative estimation, the bacterial load was >10(5) per gram in 10 skin and 3 muscle tissue samples . Infection developed in 9 of the 20 cases within one month, and eight of these patients had contamination of >10(5) per gram in 8 of the skin but only 3 muscle samples . It was concluded that with tissue specific bacterial load estimation, prediction of subsequent infection can be made if skin tissue contains >10(5) per gram, or if muscle tissue carries any level of bacterial presence. J Med Microbiol, 2002 Dec, 51(12), 1041 - 9 Isolation from a sheep of an attaching and effacing Escherichia coli O115:H- with a novel combination of virulence factors; Cookson AL et al.; Attaching and effacing (AE) lesions were observed in the caecum, proximal colon and rectum of one of four lambs experimentally inoculated at 6 weeks of age with Escherichia coli O157:H7 . However, the attached bacteria did not immunostain with O157-specific antiserum . Subsequent bacteriological analysis of samples from this animal yielded two E . coli O115:H(-) strains, one from the colon (CO) and one from the rectum (RC), and those bacteria forming the AE lesions were shown to be of the O115 serogroup by immunostaining . The O115:H(-)isolates formed microcolonies and attaching and effacing lesions, as demonstrated by the fluorescence actin staining test, on HEp-2 tissue culture cells . Both isolates were confirmed by PCR to encode the epsilon (epsilon) subtype of intimin . Supernates of both O115:H(-) isolates induced cytopathic effects on Vero cell monolayers, and PCR analysis verified that both isolates encoded EAST1, CNF1 and CNF2 toxins but not Shiga-like toxins . Both isolates harboured similar sized plasmids but PCR analysis indicated that only one of the O115:H(-) isolates (CO) possessed the plasmid-associated virulence determinants ehxA and etpD . Neither strain possessed the espP, katP or bfpA plasmid-associated virulence determinants . These E . coli O115:H(-) strains exhibited a novel combination of virulence determinants and are the first isolates found to possess both CNF1 and CNF2. Tuberculosis (Edinb), 2002, 82(4-5), 161 - 5 Milk containing Mycobacterium bovis as a source of infection for white-tailed deer fawns (Odocoileus virginianus); Palmer MV et al.; SETTING: White-tailed deer represent the first wildlife reservoir of Mycobacterium bovis in the United States . The behavior of does with nursing fawns provides several potential mechanisms for disease transmission . Little information exists concerning transmission between doe and fawn, specifically transmammary transmission . OBJECTIVE: Determine if fawns can become infected by ingestion of milk replacer containing M . bovis, thus simulating transmission from doe to fawn through contaminated milk.DESIGN: Seventeen, 21-day-old white-tailed deer fawns were inoculated orally with 2 x 10(8) CFU (high dose, n=5), 2.5 x 10(5) to 2.5 x 10(6) CFU (medium dose, n=5), and 1 x 10(4) CFU (low dose, n=5) of M . bovis in milk replacer . Dosages were divided equally and fed daily over a 5-day period . Positive control fawns (n=2) received 1 x 10(5) CFU of M . bovis instilled in the tonsillar crypts . Fawns were euthanized and examined 35-115 days after inoculation and various tissues collected for bacteriologic and microscopic analysis . RESULTS: All fawns in the tonsillar, high oral and medium oral dose groups developed generalized tuberculosis involving numerous organs and tissues by 35-84 days after inoculation . Three of five fawns in the low-dose oral group had tuberculous lesions in the mandibular lymph node, and one of five had lesions in the medial retropharyngeal lymph node when examined 115 days after inoculation . CONCLUSION: White-tailed deer fawns can become infected through oral exposure to M . bovis . Therefore, the potential exists for fawns to acquire M . bovis while nursing tuberculous does. Vet Dermatol, 2002 Dec, 13(6), 315 - 22 Macroscopic, cytological and bacteriological evaluation of anal sac content in normal dogs and in dogs with selected dermatological diseases; Pappalardo E et al.; Macroscopic and cytological aspects of anal sac content were evaluated in 40 normal dogs and 10 dogs each with pyoderma, Malassezia dermatitis associated with atopic dermatitis and uncomplicated atopic dermatitis . Bacteria isolated from anal sacs were compared with those from abdominal skin and hair in 20 normal dogs and 10 dogs with pyoderma . There was no difference between the groups in anal sac dimension, or in the colour, consistency or presence of granules in their content . Extracellular bacteria were found in higher numbers in diseased animals, whereas intracellular bacteria were observed in 40% of dogs with pyoderma and in only 2.5% of normal dogs . Malassezia spp . were present in 15.7% of dogs, with no difference between groups . Neutrophils were observed in 12.5% of normal dogs, 30% of dogs with Malassezia dermatitis with underlying atopic dermatitis and in 70 and 80% of dogs with pyoderma and uncomplicated atopic dermatitis, respectively . Seven bacterial species were isolated from anal sacs, with no difference between normal dogs and dogs with pyoderma . In five normal animals and in four dogs with pyoderma the same bacterial strains were isolated from anal sacs and from abdominal skin and hair. Proc AMIA Symp . 2002;:270-4. Informatics tools to monitor progress and outcomes of patients with drug resistant tuberculosis in Peru; Fraser HS et al.; Multi-drug resistant tuberculosis (MDR-TB) is an important and growing problem in many developing countries . New strategies have been developed to combat the disease but require complex treatment regimens and close monitoring of patients' bacteriology results . We describe a web-based medical record system deployed in Peru to support the management of MDR-TB . Web-based analyses have been developed to track drug sensitivity test results, patterns of sputum smear and culture results and time to conversion from positive to negative cultures . Individual and aggregate drug requirements can also be monitored in real time . Multiple analyses can be linked together and data can be graphed or downloaded to spreadsheets . Over 1200 patients are currently in the system . We argue that such a web-based clinical and epidemiological management system is an important component for successful implementation of complex health interventions in resource poor areas. Arch Inst Pasteur Madagascar, 2000, 66(1-2), 13 - 7 {Extrathoracic forms of tuberculosis in Mahajanga hospitals (Madagascar)}; Ravolamanana Ralisata L et al.; Pathological samples issued from patients suspected of extrapulmonary tuberculosis were examined in Laboratories of Mycobacteria and of Histopathology at the Androva Hospital in the University Hospital Centre of Mahajanga . A retrospective study was carried out from 1989 to 1993 . During this period, 64 cases of extrapulmonary tuberculosis were recorded . Samples came from Androva Hospital, from Lutherian Hospital of Antanimalandy and from the Medical Centre of Mahabibo . The sex-ratio was of 1.28/1, mean age was 28 years old (extreme ages: 1-78 years old) . The diagnosis was confirmed by bacteriological and/or histopathological examinations . Ganglial tuberculosis were the most frequent (53.1%), then digestive tract tuberculosis (20.2%) and anal fistula tuberculosis (14%) . In front of chronic lesions, biopsies must be performed to obtain confirmation of diagnosis. J Chemother, 2002 Oct, 14(5), 508 - 17 Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d . with cefuroxime 500 mg b.i.d . in the treatment of chronic and acute exacerbation of chronic sinusitis in adults; Namyslowski G et al.; The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d . for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d . for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis . Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%) . In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%) . However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group . A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea . Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime) . AMX/CA 875/125 mg b.i.d . for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d . for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate. J Gynecol Obstet Biol Reprod (Paris), 2002 Nov, 31(7 Suppl), 5S52 - 6 {Markers of infection and inflammation in the amniotic fluid: therapeutic contribution of amniocentesis}; Le Bouar G et al.; A part of preterm labor with intact membranes seems to be related to amniotic infection or local inflammatory process . In these cases, amniotic fluid is collected by amniocentesis for bacteriological studies: amniotic cultures are positive in 10% and polymerase chain reaction (PCR) in 40-50% . Interleukin 6 (IL6) concentrations are elevated in cases with amniotic infection and in some cases with negative cultures . IL6 amniotic concentrations are predictive of premature delivery and neonatal morbidity . Matrix metalloproteinases (MMP) are endogenous enzymes implicated in membrane weakening . Amniotic concentrations of these enzymes seem to be predictive of premature delivery and neonatal prognosis . Furthermore, at the time of genetic amniocentesis, IL6 and MMP concentrations are markers for preterm delivery . In the second half of gestation, amniocentesis is a safe procedure complicated in less than 1% of cases, although specific evaluation in cases of premature labor is missing . Nevertheless, as long as there is no evidence of any benefit in this procedure, there is no indication for amniocentesis in premature labor with intact membranes in general practice. Biomed Tech (Berl), 2002, 47 Suppl 1 Pt 1, 476 - 8 Glycosaminoglycans--all round talents in coating technology; Hildebrandt P; The use of glycosaminoglycans for coating of medical implants had it's beginning in heparin coating of coronary stents and catheters to improve their haemocompatibility . Until now glycosaminoglycans proved as very potent in a variety of medical applications . Glycosaminoglycans not only show anticoagulant properties, also their crystal growth inhibiting effects in urology, inhibition of bacterial adherence and influence on the proliferation behaviour of human cells could be demonstrated . Beside an overview over the development of glycosaminoglycan coatings so far, recent outcomes of a bacteriological and a cell proliferation study with coated surfaces are presented. Dtsch Tierarztl Wochenschr, 2002 Oct, 109(10), 442 - 3 Streptomyces sp., a cause of fistulous withers in donkeys; Elzein S et al.; Four of 10 donkeys, which showed lesions simulating fistulous withers, were examined clinically with the aim to cultivate and identify the causal agent . Aspiated purulent materials were subjected to bacteriological examination . The causal organisms were recovered in Tryptic Soya agar medium when incubated aerobically at 37 degrees C for up to 5 days . These organisms were found to be actinomycetes-like, Gam positive with stable branching filaments and to form heavy aerial hyphae on colony surface . The isolated organisms ere tentatively identified as Streptomyces sp . on the basis of morphological and cultural characteristics . The initial sequences analysis of the 16S rDNA gene conformed that one of the isolates (SD551) falls within the phylogenetic clade, which encompasses the genus Streptomyces . Studies are underway to further describe the disease and its causal agent . The report represents a good evidence to incriminate Streptomyces in the aetiology of the fistulous withers. Hautarzt, 2002 Dec, 53(12), 822 - 5 {In memory of the 160(th) birthday and the 80(th) anniversary of the death of Heinrich Irenäus Quincke, as well as of his description of angioedema 120 years ago}; Goring HD; In the year 2002 we celebrate the 160(th) birthday and the 80(th) anniversary of the death of Heinrich Irenaus Quincke, former head of the department of internal medicine at the University of Kiel from 1878 to 1908 . Moreover we remember the description of the angioedema by Quincke in the "Monatsheften fur Praktische Dermatologie" 120 years ago . Because his name is so tightly linked with angioedema, Quincke's other discoveries and achievements are scarcely recalled today . Some of his other accomplishments include the invention of the lumbar puncture, the initiation of the term siderosis, the study of the resorption of inorganic iron to treat iron-deficiency anemia and his early contributions to pulmonary surgery . Quincke was the first to describe the causative organism of animal favus, which today is known as Trichophyton quinckeanum . Quincke suspected a syphilitic infection as the cause of aortic aneurysms and recommended antisyphilitic therapy . In the beginning of his career in Kiel, Quincke gave lectures not only in internal medicine but also in dermatology and venerology, pediatrics, bacteriology and public health, until chairs were established for these disciplines . Quincke was for four terms Dean of the medical faculty and in 1900 Rector of the University of Kiel. Dent Traumatol, 2002 Aug, 18(4), 196 - 205 Consequences of crown fractures with pulpal exposure: histopathological evaluation in dogs; Harran-Ponce E et al.; When a crown fracture involving pulpal exposure is produced, the therapeutic treatment to be applied depends to a great extent on the general histopathological condition of the exposed pulp . Hence, the objective of this study was to evaluate histopathological and bacteriological changes occurring in dental tissue and periradicular tissue of crown-fractured teeth with pulpal exposure . Twenty-four anterior teeth (central and lateral incisors) from the maxillary teeth of four young, adult Mongrel dogs were used . At 48 and 72 h after performing the crown fractures, the animals were sacrificed and the results evaluated . Both observation periods revealed the existence of an area of superficial inflammation with the formation of hyperplastic tissue towards the external surface . Intense neutrophilic infiltrate was observed below it . Mean depth of inflammation was greater at 48 h (4633.33 microm) than at 72 h (3933.33 microm), perhaps coinciding with the bigger pulp chamber opening (x1332.14 microm at 48 h vs . x479.52 microm at 72 h) . Upon approaching the cervical portion, the inflammation became less . Bacterial contamination was constant in all the cases evaluated, worsening the histopathological findings with exposure time . This study demonstrates that when a crown fracture with pulpal exposure is produced, the success in treating it depends partly on how quickly therapeutic treatment is administered. Gesundheitswesen, 2002 Nov, 64(11), 614 - 22 {"Health is a Crossroad"--Nature and society, individual and community, in safeguarding public health}; Paul N et al.; Any person actively engaged in the sphere of Public Health who refers to "molecular medicine" is bound to arouse suspicion . Nevertheless, neither Public Health nor public health protection or the health sciences in general can afford to ignore medicine and biology . This fundamental fact is explored in a historical and subsequently in an anthropological context . The connections between molecular medicine and public health are discussed at length . Accordingly, health on an individual as well as on a social level is essentially bound to the knowledge of genetically determined dispositions . We may expect that this molecular-genetic reality will become as "true" in future as the hygienic-bacteriological reality has become "true" today . The medicalisation of all human realities will be continued by their "molecularisation" . It is important to fundamentally understand the actual effects of this transformation, which is the subject of a wider public discussion . This is the only way to rationally estimate both the opportunities offered by molecular medicine and the involved risks . It is essential for a debate of this kind within public health care institutions that the public health movement addresses the current developments of molecular medicine in a critical but constructive manner . "Nature", and with it the medicine and biology of public health, is an essential aspect of protecting public health . This is the only way to clarify the sphere of activity of public health protection in general, to appreciate its dynamics and to develop adequate measures: "Health is a crossroad" according to Julio Frenk: "It is where biological and social factors, the individual and the community, and social economic policy all converge". Kekkaku, 2002 Oct, 77(10), 647 - 58 {Preventive therapy in middle-aged and elderly persons selected from the population-based screening by mass miniature radiography--methodological aspect and adverse reactions}; Ohmori M et al.; The notification rate of tuberculosis in Japan was 31.0 per 100,000 in 2000 . The rate was especially high among the elderly population, reaching 85.5 per 100,000 among those over 65 years of age . We conducted a study of preventive therapy in middle-aged and elderly persons selected from the population-based screening by the mass miniature radiography . The eligible criteria were 50-79 years of age, fibrous lesion which were compatible with healed tuberculosis and showed no change for at least one year, no previous treatment for tuberculosis, normal liver function tests, and no serious disease at the time of study . The eligible criteria for liver function tests in this study was less than 50 IU/L of AST and ALT value, and less than 1.5 mg/dl of T-bil level . A total of 13,219 people underwent TB screening in 4 cities in 1997 and 2 cities in 1998 . Among them, 440 persons fulfilled the above criteria based on the screening records and chest X-ray films . The municipal offices sent letters to 418 people, except 22 whose addresses were unknown, to obtain permission to use their addresses and results of screening in our study . Permission was obtained from 137 persons and we sent them invitation letters for cost-free physical checkup service . Ninety-five persons visited us, and we offered them physical checkup and explained about our study . After obtaining the informed consent, we performed chest X-ray and sputum examination for 3 consecutive days . Finally 29 people were enrolled in the study . They were divided into 4 groups by sex and age, and were randomly assigned to one of two treatment groups . One group took 300 mg of INH per day for 6 months and the other group was only followed up by chest X-ray . Fourteen out of 29 persons began to take INH and received monthly liver function test . All the subjects were scheduled to follow by medical checkup every 6 months for 5 years . The proportion of taking INH tablets was estimated to range from 94% to 100%, based on the calendar for record of taking medication and the number of remaining tablets each month . Six (42.9%) of 14 persons reported adverse reactions . Two of 6 persons complained some of diarrhea, vomiting and gastrointestinal disturbance within 2 weeks, and discontinued taking INH, although none of them showed abnormal liver function tests . Two of 6 persons who reported some kinds of symptoms and 2 of 8 persons who did not complain of any symptoms showed abnormal liver function tests . The abnormal liver function tests had developed from 2 months after the beginning of INH taking in most of the persons and the abnormality improved after the completion of 6-month treatment . We have followed them for a maximum duration of 2.5 years, and 3 cases dropped out from the study . These defaulted cases had completed 6 months of INH . One person (69 y.o . male) was diagnosed as active TB by his chest X-ray film at the 6th month medical checkup, although it was not confirmed bacteriologically . One person (62 y.o . female) had the mastectomy for breast cancer 7 months before the entry to this study and relapsed at the 8th month after the entry . One person (73 y.o . female) was diagnosed as lung cancer at the medical checkup on 2.5 years . Besides them, 4 persons were suspected of worsening the abnormal shadows on chest X-ray films; one was from the INH group and three were from the follow-up group . However none of them was diagnosed clinically and bacteriologically as active tuberculosis. Nippon Rinsho, 2002 Nov, 60(11), 2210 - 5 {Neonatal bacterial infection}; Sato Y; In our NICU, 70 patients with sepsis were examined and analyzed by birth weight, onset day, causative pathogens, clinical symptoms and clinical examination values . Our study result showed the relationship between the birth weight and bacteriological infection rate: the lower birth weight was, the greater infection rate was . For low birth weight newborns, their onset were relatively late as horizontal transmission . For 50% of matured infants, they showed clinical symptom by 6 days after the birth . E . coli or/and S . agalactiae were identified from 57% patients of vertical transmission, and S . aureus and E . cloacae were the major pathogens of horizontal transmission . Low birth weight newborns did not show typical clinical symptoms and examination values . To prevent nosocomial infection, it is important to culture for monitoring and management of skin in addition to taking standard precaution. Pancreatology, 2002, 2(6), 565 - 73 IAP Guidelines for the Surgical Management of Acute Pancreatitis; Uhl W et al.; During 2002 the International Association of Pancreatology developed evidenced-based guidelines on the surgical management of acute pancreatitis . There were 11 guidelines, 10 of which were recommendations grade B and one (the second) grade A . (1) Mild acute pancreatitis is not an indication for pancreatic surgery . (2) The use of prophylactic broad-spectrum antibiotics reduces infection rates in computed tomography-proven necrotizing pancreatitis but may not improve survival . (3) Fine-needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome . (4) Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention including surgery and radiological drainage . (5) Patients with sterile pancreatic necrosis (with negative fine-needle aspiration for bacteriology) should be managed conservatively and only undergo intervention in selected cases . (6) Early surgery within 14 days after onset of the disease is not recommended in patients with necrotizing pancreatitis unless there are specific indications . (7) Surgical and other forms of interventional management should favor an organ-preserving approach, which involves debridement or necrosectomy combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate . (8) Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis . (9) In mild gallstone-associated acute pancreatitis, cholecystectomy should be performed as soon as the patient has recovered and ideally during the same hospital admission . (10) In severe gallstone-associated acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery . (11) Endoscopic sphincterotomy is an alternative to cholecystectomy in those who are not fit to undergo surgery in order to lower the risk of recurrence of gallstone-associated acute pancreatitis . There is however a theoretical risk of introducing infection into sterile pancreatic necrosis . These guidelines should now form the basis for audit studies in order to determine the quality of patient care delivery . Int J Antimicrob Agents, 2002 Nov, 20(5), 333 - 8 Impact of an antibiotic policy on antibiotic use in a paediatric department . Individual based follow-up shows that antibiotics were chosen according to diagnoses and bacterial findings; Berild D et al.; Guidelines and clinical Cupertino for rational antibiotic use were implemented in a Norwegian paediatric department in 1994 . From 1994 to 1998 the use of antibiotics and expenditures was reduced by 50% . There was an 80% decrease in the use of cloxacillin, a 74% decrease of aminoglycosides and a 59% decrease of cephalosporins . The use of penicillin V and G increased by 14% and ampicillins by 8% . Eight point prevalence studies showed that on average 23% (range 21-38%) of the patients were treated with antibiotics . Penicillins were used in 44% of courses, aminoglycosides in 35% of courses and cephalosporins in 9% of courses . Treatment was mostly adjusted to bacteriological findings . Compliance with guidelines was >90% . Guidelines for rational antibiotic policy and multidisciplinary co-operation lead to reduction in the use and expenses of antibiotics in a paediatric department. Neth J Med, 2002 Aug, 60(7), 281 - 4 Contact tracing using DNA fingerprinting in an asylum seeker with pulmonary tuberculosis; van Loenhout-Rooyacke JH et al.; BACKGROUND: The diagnosis of tuberculosis in asylum seekers is followed by contact tracing, which is routinely performed by the Municipal Health Service (MHS) . We investigated cases of tuberculosis whose symptoms became apparent after closure of regular contact tracing . METHODS: Analysis of data from the DNA Fingerprinting Surveillance Project on all Mycobacterium tuberculosis isolates and contact tracing instances . RESULTS: Four additional cases of tuberculosis were detected, caused by bacteria of identical DNA fingerprints . No further contacts with a bacteriologically confirmed form of tuberculosis were found around these four new patients . CONCLUSION: DNA fingerprinting contributed to tracing instances of late manifestations of tuberculosis transmission. Chest, 2002 Nov, 122(5), 1604 - 8 Should bronchoscopy be performed in the evaluation of suspected pediatric pulmonary tuberculosis? Bibi H, Mosheyev A, Shoseyov D, Feigenbaum D, Kurzbart E, Weiller Z. BACKGROUND: Pulmonary tuberculosis (PTB) infection in children is difficult to diagnose . OBJECTIVE: To evaluate the effectiveness of fiberoptic bronchoscopy in the diagnosis of PTB . METHODS: Four hundred twenty-two children underwent bronchoscopic evaluation . The study population was composed of 80 children (study group) who were suspected of having PTB and 342 children with chronic cough or recurrent/persistent pneumonia (control group) . Videotape reviews of each bronchoscopy were correlated with the results of smears and cultures . RESULTS: The majority of children in the study group (54 of 80 children) were new immigrants from Ethiopia, while most of the control group (323 of 342 children) were born in Israel . Among patients in the control group, physical anomalies such as laryngotracheomalacia were more common among children in the control group (105 of 342 children) compared with those in the study group (5 of 80 children; p < 0.03) . In the study group, external compression of the right main bronchus, usually at the entrance, was more common (32 of 80 children) compared with the control group (6 of 342 children; p < 0.001) . Cultures from BAL fluid revealed Mycobacterium tuberculosis in 3 of the 80 children from the study group compared with 2 children from the control group (p < 0.08) . The children with positive cultures from the control group had external compression of the right main bronchus that had been documented by bronchoscopy . CONCLUSION: Bronchoscopy in children with suspected PTB has a low yield and does not significantly aid bacteriologic confirmation . External compression at the entrance to the right main bronchus is suggestive of PTB infection. Am J Gastroenterol, 2002 Nov, 97(11), 2768 - 75 Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis; Fritscher-Ravens A et al.; OBJECTIVES: The clinical value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic lesions is uncertain in patients with normal parenchyma and chronic pancreatitis . The aim of this study was to analyze the diagnostic yield and influence of EUS-FNA on the clinical management of patients with pancreatic lesions, in the presence (CP) or absence (NP) of chronic pancreatitis . METHODS: A total of 207 consecutive patients with NP (n = 133) and CP (n = 74) were examined using linear array echo endoscopes for the procedure and 22-gauge needles . RESULTS: Adequate specimens were obtained from 200 lesions . A correct final diagnosis was established at histology (n = 108), bacteriology (n = 9), and clinical follow-up (n = 83) . Cytology gave 17 false-negative EUS-FNA results (overall sensitivity: 85%) . In patients with NP, 60 solid adenocarcinomas were detected, 32 other malignancies, and 38 benign lesions, with 11 false-negative results (sensitivity: 89%) . In patients with CP, only seven of 13 malignancies (all solid adenocarcinomas) were identified using FNA (sensitivity: 54%) . Overall, malignancy was identified in 116 patients, 32 of whom (27%) had lesions other than primary solid adenocarcinomas . Management was altered in 25 of these patients, which changed the surgical approach in 21% . EUS-FNA influenced the therapeutic approach in 44% of the total patient group . CONCLUSIONS: EUS-FNA was especially useful in patients with a focal pancreatic lesion with normal parenchyma . Its sensitivity in patients with CP was unacceptably low, and resection of the tumor using standard surgical techniques was still usually required to confirm the correct diagnosis . Diagnostic EUS-FNA influenced clinical management in nearly half of patients. Presse Med, 2002 Oct 12, 31(33), 1546 - 50 {Correct and incorrect usage of antibiotics . Prevalence study in Franche-Comté}; Floret N et al.; OBJECTIVE: To report the results observed regarding the prescription of antibiotics according to various indications in the Franche-Comte area: curative for a community infection, curative for a nosocomial infection and prophylactic . METHOD: A total of 6,038 patients hospitalized in 32 hospital centers of the Franche-comte area were surveyed . RESULTS: Among the 1,016 (16.8% of the total) patients receiving anti-infection products, 47.7% received anti-infection agents for the treatment of a community infection, 25.9% for a nosocomial infection and 26.4% for prophylaxis . Multiple antibiotherapy was more frequent for the treatment of community infections than for nosocomial infections {p = 0.067, Relative Risk = 1.11, (confidence interval: 95%: 1.00-1.24)} . Sixty percent of the prescriptions of 3rd generation cephalosporines were within the community framework . This class of antibiotics was widely prescribed for the treatment of E . coli infections, multi-sensitive to antibiotics, not only before but after bacteriological documentation . Among the 83 patients treated with fluoroquinolone for a nosocomial infection, 47 (56.6%) were treated with monotherapy . Regarding prophylaxis, 3rd generation cephalosporine and fluoroquinolone, which are not indicated for this, were widely used, in contradiction with the recommendations of the Societe Francaise d'Anesthesie et de Reanimation (French Society of Anesthesia and Reanimation) . CONCLUSION: This survey, despite the limits related to the prevalence method, shows the high frequency of antibiotic prescriptions that do not conform to the recommendations of the ANDEM (French agency for the assessment of medical practice) and the scientific societies. Water Res, 2002 Nov, 36(18), 4655 - 8 Delayed incubation as an alternative method to sample storage for enumeration of E . coli and culturable bacteria in water; Guardabassi L et al.; The effects of sample storage on enumeration of Escherichia coli in marine bathing water and culturable bacteria in drinking water were evaluated . Results showed that overnight storage at 0-5 degrees C significantly reduced the counts of E . coli in bathing water (p = 0.0001) with a mean reduction of 25% . A similar effect of sample storage was observed for the enumeration of culturable bacteria in drinking water at 22 +/- 2 degrees C for 66 +/- 4 h (p = 0.0074; mean reduction = 25%) or at 36 +/- 2 degrees C for 44 +/- 4h (p = 0.0353; mean reduction = 6%) . The use of a delayed incubation method, i.e . overnight storage at 0-5 degrees C of inoculated agar plates prior to incubation, did not significantly affect the counts of culturable bacteria when plates were incubated at 22 + 2 degrees C for 66 +/- 4 h, whereas it resulted in a significant increase of the bacterial numbers when plates were incubated at 36 +/- 2 degrees C for 44 +/- 4 h (p = 0.0002; mean increase = 32%) . Based on these results, it is suggested to avoid the use of overnight or longer sample storage for the enumeration of E . coli in bathing water samples, as well as for the enumeration of culturable bacteria in drinking water . The delayed incubation method appears to be a reliable procedure for the enumeration of culturable bacteria and could represent a valid alternative to sample storage in order to overcome problems associated with the performance of bacteriological counts during weekends or statutory holidays . However, a multi-laboratory study is needed to evaluate the reproducibility of the delayed incubation method for the enumeration of culturable bacteria and its possible use for the enumeration of E . coli by membrane filtration. J Am Vet Med Assoc, 2002 Mar 1, 220(5), 656 - 9 Prevalence of Mycobacterium bovis infection in cervids on privately owned ranches; Kaneene JB et al.; OBJECTIVE: To determine prevalence of tuberculosis caused by infection with Mycobacterium bovis in cervids on privately owned ranches in northeastern lower Michigan . DESIGN: Epidemiologic survey . ANIMALS: Cervids on 96 privately owned ranches . PROCEDURES: A combination of slaughter and skin tuberculin testing was used to collect data . Infection with M . bovis was confirmed by use of standard necropsy and bacteriologic culture techniques . RESULTS: Cervids with tuberculosis were detected on 1 of the 96 ranches . The apparent prevalence of tuberculosis in cervids from the 96 ranches was 1.1 cases/100 cervids (21 cases/1,867 cervids tested) . For the ranch with infected cervids, prevalence of infection with M . bovis was 12.1 cases/100 cervids (21 cases/174 cervids tested) . No obvious gross lesions were seen in 8 of 21 white-tailed deer and 1 coyote with culture-confirmed M . bovis infection . CONCLUSIONS AND CLINICAL RELEVANCE: The lack of visible lesions in a substantial proportion of infected animals should be taken into consideration in studies involving detection and prevalence of tuberculosis. Khirurgiia (Mosk), 2002, (2), 41 - 3 {Use of gas flow with nitrogen oxide (NO-therapy) in combined treatment of purulent wounds}; Lipatov KV et al.; NO-therapy was used in 40 patients with purulent wounds of soft tissues . Bacteriological, cytological and morphological examinations demonstrated acceleration of wound process compared with control group (40 patients without NO-therapy) . Laser doppler flowmetry demonstrated significant improvement of microcirculation in wound zone during NO-therapy . This method shortens by 3-5 days the time of preparation of wound surface for surgical closure. J Indian Med Assoc, 2002 Jun, 100(6), 398 - 9 Evaluation of sparfloxacin eye drop in the management of conjunctival and corneal infection; Vyas U et al.; Sparfloxacin 03% eye drop was evaluated in consecutive culture proven cases of conjunctivitis and corneal infection . Sparfloxacin 03% eye drop was found to provide 100% cure rate clInIcally as well as bacteriologically . This can be due to better ocular penetration and higher therapeutic index of sparfloxacin 03% eye drops . Sparfloxacin seems to be a better antibiotic for topical application for themanagement of external ocular Infections like conjunctivitis, keratitis and corneal ulcers. J Indian Med Assoc, 2002 Jun, 100(6), 376, 378 - 9 Pulmonary tuberculosis and diabetes mellitus--a study; Ezung T et al.; One hundred diabetes mellitus patients attending the diabetic clinic and those admitted in the medical wards of the Regional Institute of Medical Sciences, Imphal, were selected randomly to study the prevalence of pulmonary tuberculosis with the age-and the sexwise distribution in diabetes mellitus patients . The diagnosis of diabetes mellitus was established from the dinical symptoms and the estimation of blood sugar levels whereas pulmonary tuberculosis was diagnosed from clinical, radiological and bacteriological examinations . The majority of the patients were above the age of 40 years, the mean age was 55.4 years (SD +/- 13.5) . The prevalence of pulmonary tuberculosis in diabeties was 27% by radiological diagnosis and 6% by sputum positivity . Out of the 27 patients with radiological findings 11 had minimal lesions, 7 had moderate lesions and 9 patients were found to have far advanced lesions; cavitation was found in 3 patients, fibrosis in 4, homogeneous opacities in 6, heterogeneous opacities in 10, pleural effusion in 3 and consolidation and Fibrosis in only one patient . Mean duration of diabetes mellitus was 7.6 years (SD +/- 6.24) . Duration of diabetes mellitus did not correlate well with the prevalence of pulmonary tuberculosis . No correlation could be found with the history of contact with tuberculosis. Blood, 2003 May 1, 101(9), 3501 - 8 Epub 2002 Oct 24. Generation and genetic modification of dendritic cells derived from mouse embryonic stem cells; Senju S et al.; We developed a method to generate dendritic cells (DCs) from mouse embryonic stem (ES) cells . We cultured ES cells for 10 days on feeder cell layers of OP9, in the presence of granulocyte-macrophage colony-stimulating factor in the latter 5 days . The resultant ES cell-derived cells were transferred to bacteriologic Petri dishes without feeder cells and further cultured . In about 7 days, irregularly shaped floating cells with protrusions appeared and these expressed major histocompatibility complex class II, CD11c, CD80, and CD86, with the capacity to stimulate primary mixed lymphocyte reaction (MLR) and to process and present protein antigen to T cells . We designated them ES-DCs (ES cell-derived dendritic cells), and the functions of ES-DCs were comparable with those of DCs generated from bone marrow cells . Upon transfer to new dishes and stimulation with interleukin-4 plus tumor necrosis factor alpha, combined with anti-CD40 monoclonal antibody or lipopolysaccharide, ES-DCs completely became mature DCs, characterized by a typical morphology and higher capacity to stimulate MLR . Using an expression vector containing the internal ribosomal entry site-puromycin N-acetyltransferase gene or a Cre-lox-mediated exchangeable gene-trap system, we could efficiently generate ES cell transfectants expressing the products of introduced genes after their differentiation to DCs . ES-DCs expressing invariant chain fused to a pigeon cytochrome C epitope presented the epitope efficiently in the context of E(k) . We primed ovalbumin (OVA)-specific cytotoxic T lymphocytes in vivo by injecting mice with ES-DCs expressing OVA, thus demonstrating immunization with ES-DCs genetically engineered to express antigenic protein . The methods may be applicable to immunomodulation therapy and gene-trap investigations of DCs. No Shinkei Geka, 2002 Oct, 30(10), 1075 - 80 {The efficacy of prophylactic administration of SBT/ABPC for postoperative infection in neurosurgical operations}; Idomari K et al.; We investigated prospectively the efficacy of sulbactam sodium/ampicillin sodium (SBT/ABPC), which is a combination drug of ampicillin and beta-lactamase inhibitor, as a preventive drug against postoperative infection in the field of neurological surgery . One hundred and six patients were given SBT/ABPC as follows: Before anesthetic induction at surgery, 1.5 g of SBT/ABPC was administrated by intravenous drip infusion, and further doses were continued at 12-hour intervals for 5 to 7 days . We assessed postoperative infection, type of surgery, duration of operation, and amount of hemorrhage . Search for related side effects and bacteriological examinations of the nasal cavity and throat before and after treatment were performed . The result was that postoperative infection was found in none of the patients . Adverse reactions due to SBT/ABPC such as apparent skin symptoms or gastrointestinal symptoms were not observed . Considering infections highly resistant to MRSA, SBT/ABPC would be effective to prevent postoperative infection in neurosurgical operations and could be used safely. Thorax, 2002 Nov, 57(11), 964 - 6 Tobacco smoking and pulmonary tuberculosis; Kolappan C et al.; BACKGROUND: The prevalence of tuberculosis in adult men in India is 2-4 times higher than in women . Tobacco smoking is prevalent almost exclusively among men, so it is possible that tobacco smoking may be a risk factor for developing pulmonary tuberculosis . A nested case control study was carried out to study the association between tobacco smoking and pulmonary tuberculosis . METHODS: A tuberculosis disease survey was carried out in two Panchayat unions in the Tiruvallur district of Tamil Nadu in India . Eighty five men aged 20-50 years with bacteriological tuberculosis (smear and/or culture positive) were selected as cases and 459 age matched men without tuberculosis were selected randomly as controls . Information on smoking status, type of tobacco smoked, quantity of tobacco smoked, and duration of tobacco smoking was collected from cases and controls using a questionnaire . RESULTS: The estimated crude odds ratio (OR) of the association between tobacco smoking and bacillary tuberculosis was 2.48 (95% confidence interval (CI) 1.42 to 4.37), p<0.001.The age adjusted OR (Mantel-Hanszel estimate) was 2.24.(95% CI 1.27 to 3.94), p<0.05 . The ORs for mild (1-10 cigarettes/day), moderate (11-20/day), and heavy (>20/day) smokers were 1.75, 3.17, and 3.68, respectively (p<0.0001 test for linear trend) . The ORs for smokers with <10 years, 11-20 years, and >20 years of smoking were 1.72, 2.45, and 3.23, respectively (p<0.0001 test for linear trend) . CONCLUSION: There is a positive association between tobacco smoking and pulmonary (bacillary) tuberculosis (OR 2.5) . The association also shows a strong dose-response relationship. Adv Perit Dial, 2002, 18, 158 - 60 Keeping the catheter exit site clean by sealing with a dressing film in patients under continuous ambulatory peritoneal dialysis; Tanaka S et al.; In patients on continuous ambulatory peritoneal dialysis (CAPD), exit-site care is troublesome . We developed a new method for exit-site care, using a dressing film . We investigated the possibility of keeping the exit site clean for up to 6 weeks, using seven protocols: Control group (n = 24)--the exit site was cleaned with a povidone iodine solution daily and a gauze dressing was applied . Group A (n = 120)--the exit site was cleaned with a povidone iodine solution once weekly, was covered with a small piece of gauze, and was completely sealed using a dressing film . Group B (n = 181)--as with Group A, except once every 2 weeks . Group C (n = 64)--as with Group A, except once every 3 weeks . And so on: Group D (n = 45)--once every 4 weeks . Group E (n = 8)--once every 5 weeks . Group F (n = 2)--once every 6 weeks . At each session, we examined the small gauze bacteriologically . In groups A-F, the patients were asked to bathe every day and not to do anything about the exit site for 1-6 weeks, as applicable . In the control group, the rate of positive bacterial culture was 87.5% . In the other groups, the rates were group A, 15%; group B, 6.6%; group C, 6.3%; group D, 2.2%; and groups E and F, 0% . In the film-method groups, the rates of positive bacterial culture were significantly low . We thought that the film method kept the exit site clean. Vestn Otorinolaringol, 2002, (4), 36 - 8 {Efficient antibiotic therapy in radical surgery on the maxillary sinus}; Kriukov AI et al.; The study assessed efficiency of local antibiotic therapy with mupirocin and amoxicillin/clavulanate in 28 patients radically operated on the maxillary sinus (MS) . Early after the operation, MS tamponing with a latex tampon was made . The tampon was filled with mupirocin for patients of group 1 . In patients of group 2 and controls the tampon was sterile but in group 2 after the tampon removal postoperative maxillary washing was made with amoxicillin/clavulanate solution . The results of the study demonstrated high efficiency of local administration of mupirocin and amoxicillin/clavulanate and validity of bacteriological examination in planning antibiotic therapy early after surgery. Rev Chir Orthop Reparatrice Appar Mot, 2002 Sep, 88(5), 467 - 74 {Total hip arthroplasty and femoral head osteonecrosis in renal transplant recipients}; Stromboni M et al.; PURPOSE OF THE STUDY: Osteonecrosis of the femoral head is reported in a very variable proportion of renal transplant recipients . When these patients require total hip arthroplasty (THA), immunosuppression and poor bone quality increase the risk of aseptic loosening and infection . In the literature, functional outcome has been satisfactory although rates of early and late complications have varied greatly . The purpose of our work was to determine the long-term outcome in a series of renal graft recipients who underwent THA for osteonecrosis of the femoral head.MATERIAL AND METHODS: Forty-eight THA were implanted for aseptic osteonecrosis of the femoral head (Ficat grade III and IV) in 32 renal transplant recipients between 1974 and 1995 (21 men and 11 women) . Mean age was 30 years at transplantation and 39 years at THA surgery . Thirty patients had been on hemodialysis for a mean 1 year prior to transplantation . Joint disease concerned 2 or more joints in 23 of the 32 patients . Fifteen hips had a surgical history: 8 drillings and 3 head arthroplasties . The THA was implanted under general anesthesia via the posterolateral approach . All implants were fixed with a gentamycin cement . A cephalosporin was used for the antibiotic prophylaxis in 20 cases and a cephalosporin/vancomycin combination in 24 . Functional outcome was assessed with the Postel-Merle-d'Aubigne (PMA) score . Functional gain was {(PMAreview-PMApreop)/PMApreop} . General or local complications were recorded at last follow-up . The complete or incomplete nature of lucent lines seen on the last follow-up x-rays and their evolution were also recorded . Reasons for second procedures were noted.RESULTS: Early complications were: phlebitis (n=1), hematoma (n=7), dislocation (n=1), deep infection (n=2) . At last follow-up (mean=5 years 7 months), four patients (6 THA) had died and six (7 THA) were lost to follow-up . Preoperatively, function was scored fair or poor in 91% of the patients . At last follow-up function was scored good, very good, or excellent in 75% . Mean functional gain was 38% . A second operation was necessary for seven THA due to aseptic loosening (mean delay 9 years 10 months), for five others for septic loosening (mean delay 6 years 8 months), and finally for two for instability (one early and the other after more than 2 years) . In all, 29% of the THA were reoperated . Two deaths were related to late THA infection . Active lucent lines were observed in 11% of the THA (excepting patients reperated for loosening) . DISCUSSION: The functional gain provided by THA in renal transplant recipients with aseptic osteonecrosis of the femoral head is clearly established . Implant survival remains a problem . The rate of early local complications was high in our series, mainly related to hematoma formation and infection . The infections observed were particularly severe requiring early comprehensive management at onset of clinical signs . For patients with suspected deep infection, we propose an aspiration biopsy of the joint to obtain a bacteriological sample . CONCLUSION: THA enables good functional outcome for renal transplant recipients suffering from osteonecrosis of the femoral head, but at the cost of a high risk of early and long-term complications not always reported in the literature. Hepatogastroenterology, 2002 Nov-Dec, 49(48), 1567 - 70 Effect of acute portal hypertension on gut mucosa; Hashimoto N et al.; BACKGROUND/AIMS: Patients with cirrhosis are predisposed to develop spontaneous bacteremias and peritonitis, mainly by enteric bacteria . Portal hypertension, by producing congestion and edema of the bowel wall, could increase the passage of bacteria from the intestinal lumen to regional lymph nodes to the systemic circulation or to both, a process termed bacterial translocation . The aim of this study was to investigate bacterial translocation, brush border enzyme activity and intestinal permeability of experimental acute portal hypertension . METHODOLOGY: Twenty-six male Wistar rats were used for all experiments . Rats were studied two days after the induction of portal hypertension (n = 13) . Control animals were also studied two days after sham operation (n = 13) . Samples of mesenteric lymph nodes for standard bacteriological cultures and a fragment of ileum for histological examination and mucosal contents of protein, Alp were obtained . Moreover, we evaluated the intestinal permeability by using the phenolsulfonphthalein test . RESULTS: Two days after surgery, a significantly greater properties of rats with acute portal hypertension (12 of 13, 92%) had positive mesenteric lymph node cultures compared with control group: sham operated (2 of 13, 15%) . A significant increase in disappearance of phenol red from the luminal solution was observed in rats with acute portal hypertension . Brush border enzyme of Alp was also significantly decreased in acute portal hypertension, compared with in sham operated controls . CONCLUSIONS: The results of our study suggested that acute portal hypertension may be a major factor in the development of spontaneous infections in cirrhosis. C R Biol, 2002 Aug, 325(8), 901 - 6; discussion 911-5 {Bacteriological risks: detection and tracing}; Grimont PA; Advances in molecular taxonomy of bacteria have generated many tools allowing identification of any bacteria, whether culturable or not . In addition to taxonomic identification, growing knowledge on pathogenicity mechanisms allows the detection of bacteria with given virulence genes . The problem is in asking the proper questions so that the most appropriate tools can be chosen . Some rapid identification tools (gene amplification, in situ hybridisation) require a starting hypothesis . Other tools (rrs gene amplification and sequencing) can be used without prior hypothesis, but take longer . To face the bioterrorist threat, particular attention should be given to laboratory and strain dispatch (within- and between-laboratory) organisation. Lancet, 2002 Oct 5, 360(9339), 1050 - 5 Mycobacterium vaccae (SRL172) immunotherapy as an adjunct to standard antituberculosis treatment in HIV-infected adults with pulmonary tuberculosis: a randomised placebo-controlled trial; Mwinga A et al.; BACKGROUND: Mortality rates of HIV-infected patients treated for tuberculosis remain high . This study aimed to assess the effect on mortality of immunotherapy with single-dose SRL172 added to standard antituberculosis chemotherapy in such patients . METHODS: The double-blind trial enrolled 1229 patients aged 18-60 years, who had never received antiretroviral treatment and who presented with newly diagnosed, sputum-smear-positive pulmonary tuberculosis to referral centres in Lusaka, Zambia, and Karonga, Malawi . Both HIV-positive and HIV-negative patients were enrolled, to avoid stigmatisation . Participants were randomly assigned a single injection of SRL172 or matching placebo within 2 weeks of starting 8 months of antituberculosis chemotherapy and followed up for at least 12 months . The primary endpoint was time to death in the HIV-infected population . Analyses were based on 760 HIV-positive patients after exclusion of 84 patients with errors in storage of the injection, no bacteriological confirmation, or no HIV result . FINDINGS: Of 760 HIV-infected patients, 374 received SRL172 and 386 received placebo . SRL172 did not cause any serious adverse events . The follow-up rate was 88% at 12 months in both groups . Of the HIV-positive patients, 109 (19.5 per 100 person-years) of 372 assigned SRL172 and 107 (19.3 per 100 person-years) of 386 assigned placebo died . In the Cox's regression analysis, stratified by centre, the hazard ratio of deaths (SRL172/placebo) was 1.03 (95% CI 0.79-1.35) . There was no evidence of benefit to the group assigned SRL172 . INTERPRETATION: Immunotherapy with single-dose SRL172 as an adjunct to standard antituberculosis treatment in HIV-positive adults with pulmonary tuberculosis had no significant effect on survival or bacteriological outcome, though the treatment was safe and well tolerated. Jpn J Thorac Cardiovasc Surg, 2002 Sep, 50(9), 391 - 4 Spontaneous parathyroid adenoma hemorrhage; Shundo Y et al.; We report a case of spontaneous parathyroid adenoma hemorrhage . A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess . No evidence was found, either, in bacteriological culture of sputum and pleural effusion . After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma . Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause. Adv Ren Replace Ther, 2002 Oct, 9(4), 282 - 9 The Acute Dialysis Quality Initiative--part VII: fluid composition and management in CRRT; Schetz M et al.; Fluid composition and management are important parts of continuous renal replacement therapy (CRRT) . Most commercially available CRRT solutions are able to reestablish electrolyte homeostasis provided some phosphate supplementation is given . Supraphysiologic glucose concentrations should be avoided . Predilution fluid replacement allows higher ultrafiltration rates and can be considered as an adjunct to the anticoagulation regimen . Lactate is an effective buffer in most CRRT patients . Bicarbonate is preferred in patients with lactic acidosis and/or liver failure . When citrate is used as anticoagulant, frequent monitoring of pH is required . The clinical consequences of CRRT-induced decreases of body temperature are not clear . Substitution fluid should be sterile, but the bacteriologic requirements for CRRT dialysate are less clear . There is no consensus on the optimal parameters to monitor fluid management . Integrated balancing systems have theoretical advantages over adaptive use of intravenous fluid pumps . Although there is evidence that volume overload is associated with adverse outcome, there is no evidence that fluid removal per se improves outcome in critically ill patients with or without acute renal failure . Klin Khir, 2002 Sep, (8), 42 - 3 {Amoxiklav in the treatment of acute paraproctitis}; Kondratenko PG et al.; In 38 patients with an acute paraproctitis a new generation antibiotic Amoxiclave, owing broad spectrum of activity, was applied . While observing the wound clearance and healing process, together with clinical parameters, the results of bacteriological investigation were controlled . High efficacy of the preparation was observed as well as expediency of its application in the purulent wound surgery, for an acute paraproctitis in particular. Pancreatology, 2002, 2(5), 449 - 55 The gut origin of bacterial pancreatic infection during acute experimental pancreatitis in rats; Samel S et al.; BACKGROUND: Infections are frequent complications and determine clinical course and outcome in severe pancreatitis . A novel animal model was used to assess minimal transit time of bacterial translocation (BT) across the gut mucosa in vivo using green fluorescent protein-transfected Escherichia coli and intravital video microscopy . METHODS: Three hours after induction of acute pancreatitis by i.p . injection of 40 microg/kg cerulein, 0.5 ml of a suspension of green fluorescent protein-transfected E . coli were injected into the lumen of a small bowel reservoir formed by ligature in anesthetized Wistar rats . Translocation of E . coli was assessed by intravital microscopy . Animals were sacrificed 5 h after induction of pancreatitis . RESULTS: BT across the mucosa and into the muscularis propria took a mean +/- SD of 36.4 +/- 8 min and 80.9 +/- 9.5 min, respectively, in sham animals . Pancreatitis resulted in a significantly shorter minimal transit time across the mucosa (16.4 +/- 4.9 min, p = 0.007) and into the muscularis propria (47.7 +/- 2.5 min, p = 0.001) . E . coli were detected on frozen cross-sections and on bacteriological examination of pancreatic tissue in animals with acute pancreatitis but not in controls . Discussion: Intravital microscopy of fluorescent bacteria is a new approach towards studying BT in vivo . Minimal transit time of BT serves as a novel functional aspect of mucosal barrier function during acute pancreatitis . The observation of fluorescent bacteria translocating from the small bowel lumen into the pancreas provides substantial experimental proof for the gut-origin-hypothesis of infectious complications in pancreatitis . J AOAC Int, 2002 Sep-Oct, 85(5), 1037 - 44 Assurance enzyme immunoassay eight hour method for detection of enterohemorrhagic Escherichia coli O157:H7 in raw and cooked beef (modification of AOAC Official Method 996.10): collaborative study; Feldsine PT et al.; AOAC Official Method 996.10, Assurance Enzyme Immunoassay (EIA) for Escherichia coli O157:H7 (EHEC), was modified to incorporate a new enrichment protocol using BioControl EHEC8 medium for testing raw and cooked beef . Foods were tested by EIA and the U.S . Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) enrichment conditions and the FDA Bacteriological Analytical Manual (BAM) isolation and confirmation techniques . A total of 14 collaborators participated . Raw and cooked ground beef were inoculated with E . coli O157:H7 at 2 different levels: a high level where predominantly positive results were expected, and a low level where fractional recovery was anticipated . Collaborators tested 378 test portions and controls by both the 8 h EIA and the USDA/FSIS enrichment methods, for a total of 756 test portions . Of the 378 paired test portions, 75 were positive and 212 were negative by both methods . Thirteen test portions were presumptively positive by EIA and could not be confirmed culturally; 30 were negative by EIA, but confirmed positive by culture; and 65 were negative by the culture method, but confirmed positive by the EIA method . There was no statistical difference between results obtained with the Assurance EIA for EHEC 8 h method and the culture method for raw ground beef . The Assurance EIA had a significantly higher recovery for cooked beef. J AOAC Int, 2002 Sep-Oct, 85(5), 1029 - 36 Visual immunoprecipitate assay eight hour method for detection of enterohemorrhagic Escherichia coli O157:H7 in raw and cooked beef (modification of AOAC Official Method 996.09): collaborative study; Feldsine PT et al.; AOAC Official Method 996.09, Visual Immunoprecipitate Assay (VIP) for Escherichia coli O157:H7, was modified to incorporate a new enrichment protocol using BioControl EHEC8 medium for testing raw and cooked beef . Foods were tested by VIP assay and the U.S . Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) enrichment procedure and the FDA Bacteriological Analytical Manual (BAM) isolation and confirmation techniques . A total of 15 collaborators participated . Raw and cooked ground beef were inoculated with E . coli O157:H7 at 2 different levels: a high level, where predominantly positive results were expected, and a low level where fractional recovery was anticipated . Collaborators tested 396 test portions and controls by both methods, for a total of 792 test portions . Of the 396 paired test portions, 75 were positive and 230 were negative by both the VIP and culture methods . Eleven test portions were presumptively positive by VIP and could not be confirmed culturally; 32 were negative by VIP, but confirmed positive by culture; and 65 were negative by the culture method, but confirmed positive by the VIP method . There was no statistical difference between results obtained with the VIP for EHEC 8 h method and the culture method except for cooked beef, where the VIP had significantly higher recovery for one inoculation level. Scand J Infect Dis, 2002, 34(9), 648 - 53 Incidence and clinical significance of non-tuberculous mycobacteria isolated from clinical specimens during a 2-y nationwide survey; Thomsen VO et al.; A 2-y nationwide survey of patients in Denmark with non-tuberculous mycobacteria (NTM) cultures was undertaken . Patients were identified by means of records held at the International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Denmark . The objectives were to identify isolated NTM to species level, to describe the incidence of the various species and to evaluate the clinical significance of pulmonary NTM isolates other than M . avium complex (MAC) and M . gordonae . Identification was performed by means of hybridization or sequencing of 16S rDNA . The clinical significance of pulmonary NTM isolates was evaluated by means of questionnaires concerning patients (was sent to the clinicians!) patients who had NTM isolated for the first time using bacteriologic, radiographic and clinical criteria . A total of 1110 specimens (2.1%) from 525 patients grew NTM . After MAC (n = 198) and M . gordonae (n = 168), most patients had M . abscessus (n = 21), M . malmoense (n = 20) and M . xenopi (n = 17) isolated . Of the pulmonary patients, 50.6% met bacteriologic criteria, 75.3% radiographic criteria and 53.4% clinical criteria for significant infection . Almost half of the pulmonary patients met all the criteria for significant NTM infection that could be evaluated . Clinically significant infection was associated with underlying disease in most patients. Ann Biol Clin (Paris), 2002 Sep-Oct, 60(5), 513 - 23 {RNA isolation and purification methods}; Bastard JP et al.; Recent advances in human, bacterial and viral genome projects and the development of quantitative real-time reverse transcription-polymerase chain reaction methods offer the possibility of analysing a large number of gene transcripts . These molecular developments represent an important advancein the field of genetics, cancer, virology, bacteriology and hematology . A limiting step remains the isolation of high quality mRNA purified from biological samples . This review describes the different methods used to isolate mRNA from biological samples and to verify RNA integrity and gives precise details about RNA storage conditions. Ugeskr Laeger, 2002 Sep 2, 164(36), 4177 - 81 {Acute hematogenous osteomyelitis and purulent arthritis in childhood . A 10-year study from the county of Copenhagen with a follow-up}; Christiansen P et al.; INTRODUCTION: The proper treatment of patients with acute haematogenous osteomyelitis and acute suppurative arthritis is still controversial . Based on a previous study, a treatment regimen was recommended . We now report on the clinical, bacteriological, and radiological aspects of the diseases, with special attention to possible changes in the natural history of the diseases and the long-term prognosis . MATERIAL AND METHODS: A total of 69 children with acute haematogenous osteomyelitis and 48 with septic arthritis admitted in the period 1977-1987 were entered in a retrospective review . Epidemiological and bacteriological data were analysed and compared to those of an earlier study (1965-1974), confined to the same geographical area . Long-term outcome was assessed by a questionnaire and clinical-radiographic follow-up . RESULTS/CONCLUSIONS: A significant increase in the admission rate for both disorders was seen . The long-term outcome was favourable, with major sequelae found in only three patients (3%) and minor sequelae in two patients (2%) . The benign long-term outcome may well be related to quick admittance to hospitals and long-lasting, appropriate antibiotic treatment. Int J Syst Evol Microbiol, 2002 Sep, 52(Pt 5), 1831 - 5 Halomicrobium mukohataei gen . nov., comb . nov., and emended description of Halomicrobium mukohataei; Oren A et al.; Haloarcula mukohataei, previously isolated from soils of salt flats in Argentina, was originally placed in the genus Haloarcula on the basis of 16S rRNA gene sequence comparison . However, its morphology and polar lipid composition differs from that of the other Haloarcula species . In addition, its phylogenetic distance from other Haloarcula species is rather large, and the 16S rDNA sequence does not contain many of the signature bases characteristic of the genus . Transfer of the species to a new genus was therefore recommended by the International Committee on Systematic Bacteriology Subcommittee on the taxonomy of Halobacteriaceae . A full description of the isolate, proposed as a member of a new genus, Halomicrobium, as Halomicrobium mukohataei comb . nov., is presented . The type strain is strain arg-2T (= JCM 9738T = DSM 12286T = ATCC 700874T = NCIMB 13541T). Radiology, 2002 Oct, 225(1), 205 - 9 Utility of polymerase chain reaction for detecting Mycobacterium tuberculosis in specimens from percutaneous transthoracic needle aspiration; Kang EY et al.; PURPOSE: To determine the clinical utility of polymerase chain reaction (PCR) for detecting Mycobacterium tuberculosis in specimens from percutaneous transthoracic needle aspiration (PTNA) . MATERIALS AND METHODS: PCR for M tuberculosis detection in specimens from PTNA was performed prospectively in addition to cytologic and histologic analyses in 45 patients . On computed tomographic (CT) scans, tuberculosis (TB) versus malignant neoplasm or other infection was diagnosed in 28 patients; possible malignancy was diagnosed in 11, but TB was considered clinically because of young patient age or presence of tuberculous lesions in other areas of the lungs . In six of these patients, TB was diagnosed, but bacteriologic results were negative . PTNA was performed with a 21-gauge needle by one chest radiologist by using CT (n = 25), ultrasonographic (n = 5), or fluoroscopic guidance (n = 15) . Final diagnoses were malignant neoplasm (n = 19), hamartoma (n = 1), TB (n = 17), and pneumonia (including actinomycosis and aspergillosis) (n = 8) . Sensitivity, specificity, and positive predictive values of PCR in PTNA specimens for diagnosis of TB were calculated . RESULTS: In 17 patients with TB, PCR results were positive in 11 and negative in six . PCR results were negative in all cases of malignant neoplasm, hamartoma, and pneumonia . Cytologic and histologic analysis of PTNA specimens resulted in a specific diagnosis of TB in two (12%) of 17 patients . By adding the PCR results, diagnosis of TB was established in 12 (71%) of 17 patients . Sensitivity, specificity, and positive and negative predictive values of PCR for diagnosis of TB in PTNA specimens were 65% (11 of 17), 100% (28 of 28), 100% (11 of 11), and 82% (28 of 34), respectively . CONCLUSION: PCR for detection of M tuberculosis in PTNA specimens is a useful adjuvant to cytologic and histologic analysis for diagnosis of TB. Child Trop, 1992, (196-197), 78 - 82 An Algerian experiment: short chemotherapy for tuberculosis; Anane T et al.; PIP: 427 Algerian children aged up to 15 years were treated at the Pediatric Clinic of the Beni-Messour University Hospital Centre, Algiers, between July 1979-January 1985 with a 6-month multi-drug course for tuberculosis (TB) . TB was diagnoses by clinical and x-ray findings in 56% and confirmed bacteriologically in the rest . Those with pulmonary, meningeal, osteoarticular, or renal TB received isoniazid and rifampicin daily for 6 months with streptomycin and pyrazinamide for the first 2 months . Those with primary TB, regional lymphadenitis, pleural, peritoneal, or other localized TB received the same drug regimen without initial streptomycin . 372 children completed the course, and, of these, all were cured, 99% definitely so . There were 3 relapses . Children who did not complete the drug treatment included 7 who died due to TB, 4 of them pulmonary and 3 meningeal; 1 who had drug toxicity; 17 who stopped treatment and were lost to follow-up; 30 who were lost to follow-up after completion of treatment and 5 who died of unrelated causes . The only adverse reactions were transient elevated liver transaminase in 4.6, and 1 case of jaundice in a child who received an accidental overdose . Besides its effectiveness, this short course treatment was considered beneficial because only 4% discontinued and were lost to follow-up, compared to 15% of a prior group given a 12-month treatment course . Vie Sante, 1990 Oct, (5), 30 - 2 {AIDS in Senegal}; Ndoye I; PIP: In Senegal, AIDS was 1st discovered in December 1986 going from 6 cases in 1987, to 181 in 1988, to 269 in 1989, and to 361 in June of 1990 . Senegal has the HIV-2 virus, which has a longer incubation period than the HIV-1 virus and its incidence is becoming a growing problem . Unlike most other countries in Africa, Senegal did not institute an AIDS program with the World Health Organization; but signed a contract with Harvard, Tours and Lomoges Universities to undertake research on AIDS, sexually transmitted diseases, prostitution, tuberculosis, infectious diseases, cancer, and diseases of internal medicine . The project established: 1) an epidemiological surveillance system with prostitutes, patients with STD's, tuberculosis, cancer, problems of internal medicine and pregnant women; and 2) a diagnostic referral center for West Africa with a bacteriology-virology laboratory in le Dantec Hospital . This hospital has trained most West African biologists and produced the 1st epidemiological studies in West Africa . In 1986, after receiving the 1st results of an epidemiological survey on prostitutes and the incidence of STD's, the government created The National Multidisciplinary Committee for the Prevention of AIDS which includes a National Component made-up of an epidemiological, clinical, information and ethical/judicial and research groups; Regional Committees, an Executive Committee and a Mixed Committee for Follow-Up and Coordination . The Roles played by each of these committees interface at a National level to safeguard the fight against AIDS and STDs in Senegal . Ann Natl Acad Med Sci, 1983 Jan-Mar, 19(1), 11 - 21 The case for B.C.G; Tripathy SP; PIP: A large BCG trial was undertaken by the Indian Council of Medical Research with the assistance of the World Health Organization and the US Public Health Service in Chingleput district in an effort to obtain reliable evidence of the efficacy of BCG in providing protection against tuberculosis and to investigate if there are differences between strains of BCG in their efficacy, if the vaccinating dose influenced the protective effect and whether nonspecific sensitivity interfered with the protective effect of BCG . A Leprosy Prevention Trial was superimposed on this study to determine if BCG provided protection against leprosy . The entire population of the Chingleput district -- about 360,000 persons -- was included in the trial . 2 BCG strains -- Danish and French -- were used to vaccinate randomly 2/3 of the population; the remaining 1/3 was administered a placebo injection . The vaccine was administered either in a normal dose of 0.1 mg or a lower dose of 0.01 mg, again by random allocation . The study design included an initial survey of prevalence of infection and disease and subsequent surveys at 2 1/2 year intervals to determine the incidence of tuberculosis in the vaccinated and control subjects . Approximately 270,000 subjects were vaccinated, of which about 1/3 were uninfected initially . These subjects formed the population for analysis of the protective effect of BCG . There were only 285 cases of tuberculosis within a 12-1/2 year period among 90,000 subjects, comprising about 1/5 of the expected incidence on the basis of a prevalence of 10.7 culture-positive cases/1000 subjects . There were at least as many cases of tuberculosis in each of the vaccinated groups -- 93 and 99 -- as in the placebo group -- 93, demonstrating that BCG vaccination either in a dose of 0.1 mg or 0.01 mg failed to protect against the development of bacteriologically positive pulmonary tuberculosis . Detailed analyses indicate that BCG most likely provided some protection . There was clear evidence of the presence of environmental mycobacteria, which caused sensitization and thus could detract from the possible beneficial effect from BCG by preempting BCG . Such an effect, even if it had occurred, could not account for the total absence of the protective effect of BCG . There was a 3% incidence of infection as assessed by tuberculin conversions among those subjects initially tuberculin-negative . The BCG protection provided at least 30% protection against leprosy in the vaccinated subjects . Contracept Deliv Syst, 1981 Apr, 2(1), 145 - 56 Histological responses of the endometrium to the IUD; De Brux J et al.; PIP: Histological studies of endometria after IUD use were conducted in 592 women (mean age, 32 years; range, 22 to 48 years) . Duration of IUD retention was not considered in these studies . Bacteriological studies were also performed in 108 cases after IUD removal by sterile technique . The following conditions were observed: 1) direct mechanical action of the IUD on the endometrium; 2) hormonal modification; 3) pregnancy modification; 4) vascular modification; and 5) inflammatory modification . The observed conditions suggest that IUD action on the endometrium resembles that of a foreign body inserted into a semiclosed cavity . The IUD is constantly in contact with the uterine cavity, the tubes, and the peritoneum . It appears to enhance various germ infections and this was attributed to increase in number of sexual partners (due to little fear of pregnancy) and less rigorous hygienic care . Hemorrhages in the form of menorrhagias or metrorrhagias were found to be one of the most frequent complications associated with IUD use, and one of the main reasons for termination of IUD use . Although the endometrium contains mucosa which triggers its defense mechanisms by means of lysozomes, the IUD induces mechanical vascular and hormonal reactions which affect endometrial resistance to infection . Contracept Deliv Syst, 1981 Apr, 2(1), 101 - 8 Infection and the IUD; Defoort P et al.; PIP: While certain complications of IUD use, such as perforation and pregnancy, are no doubt related to the infectious morbidity, IUD use accounts for only a moderate or even no increase of the PID rate . One problem hampering assessment and comparison of the magnitude of the risk involved is that little is known about the PID rate in the standard population . Furthermore, many findings related to the bacteriology of the IUD-containing uterine cavity and to the bacterial conductivity of tailless and tailed IUDs are contradictory, and claims of a very high PID risk in IUD-bearing nulliparas have not been unequivocally substantiated . Weaknesses inherent in case-control studies include difficult statistical interpretability coupled with an almost total disre.gard of technical aspects (e.g, patient selection, insertion technic, and IUD design) that may be of major prophylactic importance . It is imperative that the problem of IUD-related genital infection be further elucidated by prospective studies paying the necessary attention to these aspects . There is a body of literature and experience which suggests that, provided these risk factors are properly taken into account, the risk of IUD-related infection need not be significantly enhanced JAMA . 1973 Apr 23;224(4):537. Vacuum aspiration for second-trimester abortion not recommended; Nathanson BN; Question: Recently I observed the use of vaccuum aspiration in an attempt to induce abortion in a woman 16 weeks' pregnant, after dialation of the cervix to 14 mm under paracervical block anesthesia . Only amniotic fluid and a segment of the umbilical cord could be aspirated . The patient was returned to bed, and an oxytocin (Pitocin) infusion was begun . She aborted 24 hours later with no complications . Why is this procedure considered inferior to amniocentesis and saline solution instillation as a technique for inducing abortion? Answer: Transcervical rupture of the fetal membranes for the purpose of inducing second trimester abortion is unreliable as a method and is fraught with the most serious complication of intrauterine infection (Schwartz, R.H.: Septic abortion, Philadelphia, J.B . Lippincott, 1968, p . 17) . On the other hand, Roufa et al . (Clinical Obstetrics and Gynecology 14:119, 1971) report no failures of abortion and only 1 significant intrauterine infection in 229 patients aborted in the second trimester by the hypertonic, intraovular, saline solution instillation method . The cervicovaginal portion of the reproductive tract is bacteriologically a contaminated area teeming with a variety of organisms . White and Koontz (Obstetrics and Gynecology 32:402, 1968) cultured the cervices of 57 pregnant women in all trimesters of pregnancy, and a significant number of these women harbored pathogens . In general the skin is preferable to the cervicovaginal tract as a route of entry into the intraovular space . full text Nihon Kokyuki Gakkai Zasshi, 2002 Jun, 40(6), 520 - 4 {A case of infective endocarditis accompanied with pulmonary complications in a drug addict}; Yoshimoto A et al.; A 21-year-old man who had a history of intravenous drug addiction was admitted with complaints of high fever and a productive cough . Chest CT on admission showed multiple consolidations, and pneumonia was initially diagnosed and treated . Because echocardiography after admission showed vegetation, with no bacteriological findings, attached to the tricuspid valve, right-sided infective endocarditis was diagnosed . After antibiotic therapy was changed, his fever was reduced and the inflammatory findings were eliminated . In the western world, most cases of right-side infective endocarditis are caused by drug addicts, but in Japan, this disease is very rare . Right-side infective endocarditis in drug addicts causes a high rate of pulmonary complications, in particular, septic pulmonary embolism . Many drug addicts suffering from pulmonary complications may consult doctors, but if the latter are not well-informed about this disease, it may not be possible to give an accurate diagnosis or proper treatment. Di Yi Jun Yi Da Xue Xue Bao, 2002 Sep, 22(9), 830 - 2 {Application of BACTEC MGIT 960 system and molecular identification of mycobacteria in the diagnosis of spinal tuberculosis}; Zhou JS et al.; OBJECTIVE: To evaluate the clinical application of BACTEC MGIT 960 system and molecular identification of mycobacterium species in diagnosis of spinal tuberculosis . METHODS: Thirty-one specimens were obtained from patients with spinal tuberculosis, followed by culturing with BACTEC MGIT 960 system and in Lowenstein-Jensen (L-J) medium respectively . Mycobacterium species of the clinical isolates were identified with PCR amplification of IS986 and PCR-single-strand conformation polymorphism (PCR-SSCP) analysis of 16S rRNA, with the conventional identification approach serving as control . RESULTS: The positivity rates of mycobacterium culture with BACTEC MGIT 960 system and L-J medium were 83.87 % and 61.29 % respectively . The average detection time with BACTEC MGIT 960 were 11.3 d, 15.4 d shorter than that with the L-J medium (26.7 d) . The genetic identification of mycobacterium species was more rapid and accurate with consistent results with that from conventional method . CONCLUSION: BACTEC MGIT 960 system is preferable for detecting mycobacteria in spinal tuberculosis . The combined application of this instrument with genetic identification of mycobacteria is an effective strategy for the bacteriological diagnosis of tuberculosis. Health Millions, 1995 Jan-Feb, 21(1), 49 - 52 Tuberculosis control programme in rural area: experiences from the field; Sudarshan H et al.; PIP: According to the Indian National Tuberculosis Program (NTP), only 30% of tuberculosis (TB) patients receiving conventional treatment and 52% of those receiving short-course chemotherapy (SCC) complete the treatment . Incompletely cured patients return to the community, and each sputum-positive case can infect 10-14 people in the course of a year . Direct monitoring of chemotherapy is a must for success, especially if rifampicin is used after accurate diagnosis based on bacteriological examination . The National Leprosy Eradication Program, which has involved voluntary organizations, provides an example to be followed by NTP . This example was considered when the Karuna Trust, a voluntary organization, launched a TB control program on January 1, 1992, for Yelandur taluk, covering a population of 69,484 in 40 villages . A staff consisting of a medical officer, a supervisor, a smear technician, and paramedical workers had undergone training at the National TB Institute in Bangalore . Detection of cases was carried out by house-to-house visits, which could detect about 65% of cases . It was also found that TB treatment had been started without a sputum examination, sputum-positive cases had been on rifampicin, and data recording was incomplete . Up to October 1994, a total of 231 cases were registered and compliance was ensured by home visits . Private practitioners were carrying out harmful activities by not enforcing full patient compliance and thereby contributing to the increasing number of drug-resistant cases . In contrast, this program had a default of only 19.1% among sputum-positive cases, but even these can be recovered with an interaction with private practitioners . Treatment failure amounted to 10.1%, all having been on rifampicin . Retreatment requires more expensive second-line drugs . Drug collection will be decentralized for the convenience of patients; and an adequate supply of drugs was secured . Some suggestions were also made concerning adequate resources, integration of the program, monitoring, and involving nongovernmental organizations in implementation and evaluation . Imbonezamuryango, 1990 Apr, (17), 8 - 12 {Ten scenarios on the future of world population}; Niyibizi S; PIP: This work presents 10 hypotheses concerning possible catastrophes that might befall the world's population in the future . The perspective is pessimistic, but in most cases the hypotheses represent possibilities only . The 1st hypothesis is that demographic imbalances resulting from the excess of births over deaths will result in a total world population too large to be sustained by the earth's finite resources . A return of the great epidemic diseases of the past or the global warming that is already threatening are 2 other possible fates, along with cooling of the atmosphere and reglaciation . Atomic, bacteriologic, and chemical warfare represents a different sort of possibility . A collision of planets or of the numerous manmade satellites now circling the earth might have disastrous consequences, as might earthquakes or floods . The end of the world is foreseen in the Bible, although details are sparse . Finally, AIDS is viewed by many as divine punishment for the perversions of the human population and by others as a viral disease capable of decimating the world's population and returning once thriving areas to an uninhabited state . S Afr J Obstet Gynaecol, 1971 Sep 11, 9(2), 37 - 41 The parameters of septic abortion; Botes M; PIP: A retrospective analysis of 50 cases of septic incomplete abortion is made . In order to evaluate the spread of infection, septic abortions were grouped into 3 types . In Group 1 were cases with infection limited to the uterus alone . Group 2 included cases with extrauterine spread of infection to parametrium and/or adnexa, and Group 3 cases had pelvic or generalized peritonitis . The purpose of the study was 1) to correlate bacterial cultures with the clinical classification and with special reference to the offensive vaginal discharge; 2) to determine whether there is a dominant clinical parameter; and 3) to evaluate, after consideration of 1 and 2, whether endotoxic shock can be prevented by prophylactic treatment . The clinical picture, vaginal discharge, bacteriologic cultures of the cervix and uterine cavity and the histopathological picture of the uterine curettements were correlated . The mean temperature on admission was 98.9 degrees F in Group 1, 101 degrees F in Group 2, and 102.4 degrees F in Group 3 . Of the cases with a history of criminal intervention 9 percent were in Group 1; 57 percent in group 2, and 86 percent in Group 3 . In Group 1, 14 percent had offensive discharge, although 23 percent yielded positive cervical cultures and 9 percent positive uterine cultures . In Group 2, the discharge occurred in 57 percent, and positive cervical and uterine cultures were 43 percent and 33 percent respectively . The cases with peritonitis (Group 3) showed a very strong correlation: 71 percent offensive discharge with 86 percent cervical cultures and 71 percent positive uterine cultures . Analysis of the positive neutrophil responses showed that in Group 1 there was a 75 percent positive and a 25 percent negative response, in Group 2 there was a 40 percent positive and a 60 percent negative response, and in Group 3 there was a 30 percent positive and a 70 percent negative . It appeared that the more overwhelming the infection, the less was the response of the body against the infection . It is suggested that suspicion of criminal intervention might still be the only dominant clinical parameter to justify aggressive prophylactic treatment, if the patient would only give this information more freely . It is concluded that a septic abortion is any abortion where tenderness (indicating infection) can be elicited on bimanual examination . A classification of cases into the 3 groups is suggested . Group 2 and 3 cases should be evacuated vaginally without delay . Pneumonol Alergol Pol, 2002, 70(3-4), 155 - 66 {Tuberculosis in Poland 2000--at the turn of the century}; Szczuka I; The aim of this paper was to evaluate incidence, prevalence and mortality from TB in Poland in 2000 and to examine trends of TB incidence . Individual date on tuberculosis cases reported to National TB Register and data of prevalence and mortality from TB were analysed . The paper presents the epidemiological situation of TB in Poland in 2000 . The year of 2000 was the seventh consecutive year of decline at TB incidence after previous years (1991-1993) of increase . In 2000 there were 11,477 newly registered TB cases, of which 1428 were relapses . The incidence was 29.7 per 100,000 population, /26.0 were the new cases and 3.7 relapses/ . Relapses represented 12.4% of all registered cases . The incidence in 2000 was 5.7% lower than in 1999, but the rate of decline was smaller than in previous year--8.4% . Among the total number of newly registered cases there were 6518 cases--16.9 per 100,000--bacteriologically confirmed, of which 3.713 cases were sputum smear positive . The proportion of bacteriologically confirmed cases was 56.8% and of sputum smear positive--33.9% which is rather low, but similar to previous years . In view of sufficient network of laboratory services this low proportion of bacteriological confirmation of diagnosis may indicate low quality of bacteriological examinations . In 95.5% of cases the diagnosis was respiratory tuberculosis . Low proportion--4.5%--of extrarespiratory tuberculosis, which have continued for many years, may indicate inadequacies in diagnosis and registration of this form of disease . The incidence of tuberculosis increases with age, from 1.4 in children up to 62.4 among 65 and older . The proportion of cases in the age group 20-44 years is still high (34.7%) . The incidence in men (40.9) is two times higher than in women (19.1), and in rural population higher than in urban--30.5 and 29.2 respectively . The prevalence of tuberculosis at the end of 2000 was 38.5 (14,895 cases), of which 55.4% were bacteriologically confirmed cases (8252 cases) . In the latter group there were 232 cases bacteriologically positive for longer than one year, and 369 cases resistant to at least 1 drug . The proportion of resistant cases (3.9%) is similar to previous years and does not seem to influence the overall effectiveness of chemotherapy . There were 1.022 (1.024) deaths due to tuberculosis 995 (985)--respiratory tuberculosis and 27 (39) extrarespiratory tuberculosis) reported in 1999 i.e . (2.6) per 100,000 . Almost 43% of all deaths were in patients 65 year of age and older . Since many years the TB mortality is the order of 0.3% of total mortality . CONCLUSIONS: In recent years incidence of TB in Poland decreased . The incidence of tuberculosis in Poland was about 2 times higher than the average for E.U . countries, but lower than in other Eastern European countries . The distance between Poland and countries with lowest incidence in Europe is estimated at 25-30 years . Tuberculosis has been and will remain a major public health problem in Poland for many decades. J Hist Biol, 2002 Summer, 35(2), 221 - 50 Representation of the microcosm: the claim for objectivity in 19th century scientific microphotography; Breidbach O; Microphotography was one of the earliest applications of photography in science . The first monograph on tissue organization illustrated with microphotographs was published in 1845 . In the 1860s, a large number of introductions to scientific microphotography was published by anatomists . They argued that microphotography was a means of documenting the results of microscopic analysis, uncontaminated by subjectivity of the observer . In the early decades of the 19th century, before the general acceptance of cell theory, such a technique was of special importance, so no criteria were available to distinguish between important and superficial characters in the description of tissue microstructures . Microphotography was praised as the method of choice for documenting the scientific observations of microscopic material . Some of the microphotographic practices described in these early manuals, however, did not conform with the idea of a purely mechanical process of documentation . The authors of these manuals saw photography not as a technique which produced artifacts, but as a complete and reliable substitute for the original preparations . Thus, according to these authors, the artificial world of photography was seen as the actual representation of the microworld . Consequently, they tried to understand the microcosm by analyzing photographs instead of the microscopic preparation themselves . Such attitudes discredited the use of microphotography in the sciences . Consequently, the definitive breakthrough of scientific microphotography was delayed until the 1880s and was largely due to the efforts of Robert Koch, who made microphotography a central tool of bacteriology. J Obstet Gynaecol East Cent Africa, 1983 Mar, 2(1), 41 - 5 Contribution of endotoxic shock to gynaecological and maternal morbidity and mortality; Omu AE et al.; PIP: 60 cases of endotoxic shock in obstetrics and gynecology in a 7 year period, January 1974 to December 1980 in Nigeria are reviewed . The most common and causative conditions were septic abortion, puerperal sepsis and pyelonephritis in pregnancy . The commonest cultured organism was Eschericha Coli . There were 33 deaths, giving a mortality rate of 55%, which falls within the range reported in the literature . The mortality rate in the institution where this study was conducted has shown a downward trend . Early surgery is advocated in those cases with infected retained products of conception and pyoperitoneum, and more liberal use of steroids, hypertonic glucose solution and digoxin, especially in patients with cardiac decompensation . The patients of the sample met the following criteria: 1) the occurrence of hypotension with consistent reading of 80/50 mm Hg or less; 2) demonstrable evidence of infection as determined by fever, hematological and bacteriological studies; and 3) the presence of persistent tachycardia . Conditions related to pregnancy accounted for 50% of of all cases . A significant finding was that 14 out of 18 patients with induced abortion had it at 2 weeks before admission . A majority of the patients in this study had subnormal temperature . The presence of jaundice, pneumonia, persistent oliguria and hepatomegaly are ominous signs accompanied by high mortality . Pulmonary factors in shock are important in determining patient survival as well as lung functions afterwards . The mortality in endotoxic shock remains high despite widespread use of fluids, antibiotic and steroid therapy, indicating that eliminating bacteria and restoring blood pressure are not the only considerations in treating shock . Insufficient nutrition may contribute to cardiorespiratory deterioration in the acutely ill patient; important physiological variables are improved by administration of hypertonic glucose solution, which leads to increased clearance of E . Coli from the blood . Contracept Fertil Sex (Paris), 1977 Sep, 5(6), 515 - 20 {Laparoscopy and genital infection}; Vascular prosthetic graft infection: epidemiology et al.; Cattedra di Chirurgia Vascolare, Universita Vita e Salute, IRCCS H . San Raffaele, Milano, Italy . chiesa.roberto@hsr.it Vascular prosthetic graft infection remains a major surgical challenge . Prevention of risk factors and antibiotic therapy can reduced but not eradicate it . Management of infected vascular grafts depends on several factors, including the location of the infected prosthesis, the extent of infection, and the underlying micro-organism . Classic treatment consists of extra-anatomic bypass grafting . The disappointing results due to the high mortality and amputation rate have kindled interest in alternative approaches, such as in situ reconstruction with antibiotic-bonded prostheses, autogenous veins or arterial allografts . PURPOSE: We focused on the treatment of aortic graft infection by means of both fresh and cryopreserved arterial allograft . Here, the experience of the Italian Collaborative Vascular Homograft Group is reported . METHODS: Between March 1994 and December 2000 seventy-nine patients with aortic graft infection were treated . The results of 68 patients are analysed . Eleven patients were treated with fresh, and 57 with cryopreserved homograft . Emergency surgical procedures were performed in 12 patients (17%) . Aortoenteric fistula was diagnosed in 22 patients . The mean interval between the first procedure and the insertion of a homograft for patients with infected aortic graft was 3 years (range 1-15) . The mean duration of follow-up was 30 months (range 1-68) . Clinical and duplex scanning evaluation were routinely performed . Computer tomography (CT), magnetic resonance (MR), or arteriography were performed on the basis of duplex scanning results . RESULTS: The analysis was performed on 68 cases for which there were sufficient reliable data . Eleven deaths occurred during the early postoperative period (30 days), a mortality rate of 16% . There were also seventeen late deaths, a mortality rate of 25% . Eleven patients had graft occlusion; six cases were successfully treated with thrombectomy . In three cases leg amputation was necessary . The results of fresh and cryopreserved homografts were compared . No significant differences of early postoperative mortality, late mortality, homograft-related mortality, graft failure were observed . The presence of aortoenteric fistula is a negative predicting factor of perioperative early mortality, which causes a rapid decline in the survival curve . Thirty-six months after the surgery the actuarial survival of the patients was 57% and the actuarial patency of the allograft was 41% . CONCLUSION: No significant difference in terms of clinical outcome was observed when using fresh, rather than cryopreserved homografts . The only factor that significantly influenced the survival rate appeared to be the aorto-enteric fistula. Vet Microbiol, 2002 Oct 22, 89(2-3), 211 - 21 Genomic variations among Bartonella henselae isolates derived from naturally infected cats; Kabeya H et al.; The purpose of this study was to understand the mechanisms of persistent infection with Bartonella henselae in cats . Blood samples were collected from three naturally infected cats for 24 months . These cats were confirmed to be persistently infected with B . henselae by serological and bacteriological examination . Relapsing bacteremia was found in all three cats with intervals of 3-19 months . Following the peaks of bacteremia, increases of specific antibody titer were observed in these cats . To examine the genetic differences among the isolates derived from the first and following bacteremia, the genome DNA patterns of the restriction enzyme fragment length polymorphism (RFLP) of the isolates were examined by pulsed field gel electrophoresis . The isolates derived from the first bacteremia showed an identical RFLP pattern in each of the three cats . The isolates derived from the following peaks, however, showed 1-3 of different RFLP patterns in these cats . Furthermore, the isolates showing different RFLP patterns from those of the first bacteremia were also detected at the following bacteremic peaks in all three cats examined . The 16S ribosomal RNA (rRNA) gene type of all isolates was found to be 16S rRNA type I . The emergence of genetically distinct organisms at various peaks of bacteremia may contribute to the establishment of persistent infection in the naturally infected cats. Vet Microbiol, 2002 Oct 22, 89(2-3), 151 - 9 Transmission of Actinobacillus pleuropneumoniae in pigs under field-like conditions: emphasis on tonsillar colonisation and passively acquired colostral antibodies; Vigre H et al.; The objectives of this study were to elucidate at which age tonsillar colonisation by Actinobacillus pleuropneumoniae occurs in pigs and relate this occurrence to the presence of colostral antibodies to A . pleuropneumoniae . The infection patterns were studied in an isolated cohort of pigs, which consisted of the offspring from five sows originating from a conventional pig herd . The sows were transferred to isolated research facilities before farrowing . A . pleuropneumoniae was detected on the tonsils of all sows . After a nursing period of 3 weeks, the pigs were weaned and reared isolated from other pigs until slaughter . The pigs were examined repeatedly for the presence of A . pleuropneumoniae on the tonsils and for antibodies to A . pleuropneumoniae using bacteriological and serological techniques, respectively.A . pleuropneumoniae was detected in the tonsils of one pig as early as 11 days after birth, showing that A . pleuropneumoniae can be transmitted from sow to offspring during a 3-week nursing period . The cumulative proportion of pigs carrying A . pleuropneumoniae in their tonsils increased significantly between the age of 4-12 weeks . This age period corresponded to the age at which the proportion of pigs with detectable levels of colostral antibodies to the different serotypes of A . pleuropneumoniae was declining . Since these two events take place in the same age period, we expect a possible biological association between the level of the passive immunity and the degree of tonsillar colonisation . The median duration of tonsillar colonisation was estimated to approximately 7-8 weeks. Cas Lek Cesk, 2002 Jul 19, 141(14), 449 - 55 {Tuberculosis in the Czech Republic in the year 2000}; Trnka L et al.; BACKGROUND: Incidence of tuberculosis (TB) in the Czech Republic (CR) during the year 2000 was evaluated on the basis of newly detected cases as well the restriction of known TB sources by antituberculosis treatment . Data from compulsory reported TB cases in the TB register for the year 2000 were used as well as data from the analysis of treatment in cohorts of patients reported quarterly in 1999 and evaluated 12 months later . METHODS AND RESULTS: 1442 cases of new diseases and TB relapses were reported in 2000 (14.1/100,00) . 1244 cases (12.1/100,000) were TB of the respiratory system, 198 cases (2.0/100,000) belonged to the extra-respiratory TB . 61.9% of cases were bacteriologically verified TB of the respiratory system . In comparison with the year 1999, the number of TB cases was lower by 11.7%, respectively by 9.3% in TB of the respiratory system . The positive trend in TB incidence recorded in CR since 1998 has continued . From 1442 cases of the TB, 916 were males (63.5%) and 526 females (36.5%) . Majority of patients was older than 65 years . 143 (9.9%) of TB cases were patients born extra CR ("foreigners"), namely coming from Ukraine (41), Vietnam (16), and Romania (14) . 74 patients died of tuberculosis, mostly those older than 65 years . The youngest was the 24-year-old Ukrainian and a 38 year old homeless person, the citizen of CR . The highest incidence of TB was in West Bohemia, in Prague and in North Moravia; the lowest incidence was in South Moravia and in South Bohemia . TB was identified because of patient's troubles (68.0%), in the risk groups (13.3%), and by examination of contact persons (4.7%) . Other mycobacteriosis than TB was identified in 92 patients . The treatment was evaluated in 606 persons with the pulmonary TB, which was bacteriologically verified; analysis was done in cohorts of patients reported quarterly in 1999 . 70.1 to 77.5% of patients in individual cohorts were successfully treated, in 3 patients the treatment failed and 9 patients interrupted the treatment . Remaining 25% of patients either died before or during the treatment . The high mortality rate resulted from the high age and other diseases in some of the patients . CONCLUSIONS: WHO includes CR between countries with low TB incidence . Within the stabile population of CR the continuous decrease of TB incidence should continue, unless some unfavourable effects occur. Enferm Infecc Microbiol Clin, 2002 Aug-Sep, 20(7), 326 - 31 {Enhanced quality in a hospital microbiology laboratory: from automation to clinical advice}; Garcia-Irure JJ et al.; BACKGROUND: Quality policies focussed on the patient and applied to a hospital microbiology laboratory have led us to investigate clinicians' needs when requesting test results . The aim of this study was to analyze these requirements and to implement a plan to improve attention to the clinicians, considered as direct customers, particularly in the process of providing results . METHODS: Phase 1: To determine clinicians' needs, we studied the calls made to the Bacteriology Unit . Over a period of two weeks the information requested, the reasons for the call and the hospital Service calling were recorded . A descriptive analysis of this information was performed and the most frequent reasons for calling were identified . Phase 2: A quality improvement plan was designed to improve laboratory reporting of bacteriologic results . One month after its implementation, the results of this quality effort were assessed by analysis of calls to the Unit and use of a questionnaire to determine clinicians' satisfaction . RESULTS: Phase 1: among the total calls made, 43.8% asked for information on specimens being processed, 17.7% for information on specimens processed in other units, 16.1% demanded test results that had not been received within the expected time, and 22.4% were for other reasons . The hospital departments requesting information included 31% Infectious Diseases, 16% Internal Medicine, 13% Intensive Care Unit (ICU), and 40% others . Phase 2: within the quality plan, a microbiologist attended clinical sessions in the above mentioned departments in order to provide information on the specimens being processed, to discuss alternative diagnostic tests, and to comment on treatment prescribed to the patients . EVALUATION: Microbiologists attended two sessions per week during one month in the IM and ID Departments and ICU, and his/her participation was evaluated through analysis of calls and a satisfaction questionnaire . CONCLUSION: Automation of many laboratory tasks has allowed a reorientation of the activity of laboratory professionals toward satisfying the needs of the medical staff and improvements in the reporting process . The direct participation of laboratory professionals in discussions on patient care resulted in an enhancement of the overall quality of the health care provided to the patient. Southeast Asian J Trop Med Public Health, 2002 Jun, 33(2), 352 - 4 Clinical features of diphtheria in thai children: a historic perspective; Pancharoen C et al.; To study the clinical and laboratory features of childhood diphtheria, the cases of 381 children with clinical and bacteriological diagnoses of diphtheria who were treated at the Children's Hospital between 1976 and 1985 were reviewed . Of these, 191 were males and 190 were females . The mean age was 4.6 years . Approximately 75% of the patients had no history of immunization . Common manifestations of diphtheria included patch (100%), fever (92.4%), upper respiratory tract infection (91.6%), upper airway obstruction (42.3%), hoarseness (36.7%), and bull neck (11.3%) . The mean duration of fever prior to admission was 3.3 days with a range of 0-11 days . Patch sites included the tonsils (91.9%), the pharynx (55.9%), the larynx (27.8%) and others (24.4%) . Complications included upper airway obstruction (42.3%), cardiac complications (10.0%) and neurological complications (4.7%) . The mortality rate was 5.8% . There were significant associations between death and the presence of bull neck, laryngeal patch, airway obstruction and cardiac complications . Early recognition and prompt treatment will decrease complications and mortality in this group of patients. Kekkaku, 2002 Aug, 77(8), 547 - 54 {Relative relatedness of 11 mycobacteria species by microplate hybridization methods considering delta Tm}; Fukasawa Y; Intra-species variance within Mycobacterium xenopi, Mycobacterium gordonae or Mycobacterium szulgai has been reported in identification employing chemotaxonomic characteristics, 16 S rRNA gene sequences or relative relatedness (relative color index) of genomic DNA-DNA Hybridization . Genomic DNA-DNA reassociation at the constant temperature was found to be unreliable for classification of mycobacterial species . However, nonspecific DNA reassociation could be avoided by hybridization at 56 degrees C after 45 degrees C overnight, and this technique was named delta DDH method in the preceding paper . The present report shows relative relatedness (relative color index) of genomic DNA in delta DDH method among mycobacterial species . Relative relatedness was below 70% among BCG, M . kansasii, M . simiae, M . asiaticum, M . szulgai, M . gordonae, M . xenopi and M . nonchromogenicum . The results satisfied the criteria for bacterial classification, which was proposed by the International Committee for Systematic Bacteriology in 1987 . In regard to Mycobacterium avium complex, relative relatedness between M . avium and M . intracellulare were approximately 75% . It appeared that M . avium and M . intracellulare could be classified into one species . It has been recognized, moreover, that there are intermediate strains between M . avium and M . intracellulare . Previously, numerical classification raised a con