J Clin Periodontol, 2001 Feb, 28(2), 128 - 36 Expression of matrix metalloproteinases in healthy and diseased human gingiva; Dahan M et al.; BACKGROUND, AIMS: The aim of our study was to investigate the patterns of several metalloproteinases (MMP-1, MMP-2 and MT1-MMP) mRNAs expression using a semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and to correlate them with clinical parameters and bacteriological diagnosis in healthy versus diseased human gingiva . METHODS: To identify the cell origin of MMP production, in situ hybridization (ISH) was also performed for the MMPs on the same samples . 17 gingival biopsies were collected (13 affected by advanced periodontitis and 4 healthy used as controls) and plaque index, gingival index, pocket depth and bleeding on probing were measured . Subgingival microbial samples were also collected to be analysed by a DNA probe technique . The biopsies were processed both for RT-PCR and ISH . We also investigated a model for bacterial induced MMP expression in human gingival fibroblasts (HGF) infected by Eikenella corrodens . RESULTS: We found an expression of the mRNA encoding MMP-1 only in diseased gingiva but at low levels relative to beta-actin (mean+/-SD: diseased versus healthy: 0.013+/-0.024 versus 0) . Although the frequencies and levels of mRNA encoding for MMP-2 or MT1-MMP are not significantly different between each group (mean+/-SD: 0.329+/-0.344 versus 0.137+/-0.219 for MMP-2; 0.485+/-0.374 versus 0.466+/-0.296 for MT1-MMP), using ISH, we observed an expression of both mRNAs in fibroblasts of pathological specimens at sites that histologically showed signs of chronic inflammation and connective tissue remodelling . In vitro infection of HGF by Eikenella corrodens stimulated 3-fold the production of the mRNA encoding MMP-2 while other mRNAs remained unchanged . CONCLUSION: Our results did not reveal significant differences in the expression of mRNAs encoding for the MMPs between healthy and periodontitis-affected patients, reflecting the great heterogeneity in the periodontal status of individuals . However, they indicate that gingival fibroblasts are an active source of MMP-2 production in response to a periopathogen. Clin Microbiol Infect, 2000 Mar, 6(3), 131 - 6 Bordetella holmesii isolated from a patient with sickle cell anemia: analysis and comparison with other Bordetella holmesii isolates; Njamkepo E et al.; OBJECTIVES: To analyze a Bordetella holmesii isolate from a patient with sickle cell anemia and to compare it with other B . holmesii strains and isolates and with strains of B . pertussis and B . bronchiseptica, two well-characterized species of the Bordetella genus . METHODS: The bacteriological characteristics and proteins produced by the B . holmesii isolate and the reference strain (ATCC 51541) were analyzed and compared with those of B . pertussis and B . bronchiseptica using sera from patients infected with B . pertussis, B . bronchiseptica or B . holmesii . RESULTS: The bacteriological characteristics of the B . holmesii isolate studied here were similar to those of the B . holmesii reference strain and other isolates . Some of the proteins produced by B . holmesii isolates were similar to those produced by B . pertussis and B . bronchiseptica, but none of these proteins was similar to the toxins and adhesins involved in the pathogenicity of B . pertussis and B . bronchiseptica . The phenotypic diversity of the proteins produced by B . holmesii isolates and the reference strain was striking . CONCLUSIONS: Our results suggest that either, the expression of B . holmesii proteins is regulated as in B . pertussis and B . bronchiseptica, with the B . holmesii strain exhibiting different phases, or the proteins produced in B . holmesii are different. Vet Microbiol, 2001 Jan 26, 78(2), 101 - 9 Paratuberculosis in sheep: its possible role in the epidemiology of paratuberculosis in cattle; Muskens J et al.; A total of 50 sheep originating from 15 Dutch farms with a known paratuberculosis infection in their cattle herd, but with no history of paratuberculosis infection in their sheep flock, were examined for infection with Mycobacterium avium subsp . paratuberculosis (Map) . The sheep had been grazing on the same pastures as the cattle or on pastures fertilised with manure from these cows . The sheep were screened for paratuberculosis by serum biochemistry, serology and intradermal skin tests . At necropsy they were examined macroscopically, microscopically and bacteriologically for paratuberculosis.From 10 sheep, originating from eight flocks, Map could be isolated from various tissues but not from the intestinal contents, after an incubation period of 2.5-4 months . Six of these culture-positive sheep had no macroscopic signs of paratuberculosis at necropsy . Seven sheep were Map culture negative but showed macroscopic and microscopic lesions consistent with a paratuberculosis infection . Results of serology and skin tests did not correlate with the results of bacteriological culture . Serum concentrations of calcium, albumin and total protein of the infected, suspected and negative sheep were not different . These results indicate that a substantial number of the sheep examined were infected with Map . Even though this bacterium was not isolated from their faeces, the possibility that these sheep could have been shedding Map with their faeces below detection level or at a later stage of the disease cannot be eliminated . Map infected sheep should, therefore, be considered as a possible factor in the epidemiology of with Map infected cattle herds in The Netherlands . At necropsy bacteriological culture of Map should be performed on a routine basis to improve the diagnosis of paratuberculosis in sheep. Crit Care Med, 2000 Mar, 28(3), 665 - 71 Safety, efficacy, and cost-effectiveness of mechanical ventilation with humidifying filters changed every 48 hours: a prospective, randomized study; Markowicz P et al.; OBJECTIVE: To determine whether three hydrophobic and hygroscopic heat and moisture exchangers (HMEs) retain their heating and humidifying properties (assessed by psychrometric measurements of absolute humidity, relative humidity, and tracheal temperature) for 48 hrs without any drop in their bacteriologic efficiency . DESIGN: Prospective randomized clinical trial . PATIENTS: Sixty-one consecutive unselected mechanically ventilated intensive care unit patients . INTERVENTIONS: Patients were randomly allocated to one of the three HMEs studied (Hygrobac-Dar from Mallinckrodt, n = 21; Humid-Vent from Gibeck, n = 20; and Clear-Thermal from Intersurgical, n = 20) . MEASUREMENTS AND MAIN RESULTS: Hygrometric parameters were measured by psychrometry after 3, 24, and 48 hrs of use . Peak airway pressure was recorded every 6 hrs and averaged over 24 hrs . Bacterial colonization of both patients and circuits was studied . Patients in all three groups were similar in terms of age, indications for, and overall duration of mechanical ventilation . Tracheal tube occlusion never occurred . Hygrometric data included 371 measurements whereas bacteriologic data included >700 samples and cultures . The Hygrobac-Dar HMEs gave a significantly higher absolute humidity whatever the time of measurement (3, 24, or 48 hrs) than the other two HMEs (p < .001) . The Clear-Thermal HMEs gave the poorest hygrometric parameters (p < .01); five of them were replaced prematurely (24 hrs) because the absolute humidity was <25 mg H2O/L . This did not occur for the other HMEs . Mean peak airway pressures were identical in the three groups . The bacterial colonizations of both patient and circuit were similar (and negligible for circuits) for all three groups . CONCLUSION: Some HMEs may be used safely for 48 hrs without change . However, this does not pertain to every brand of HME . Objective in vivo evaluation of their humidifying performances is decisive before extending their duration of use. Rev Med Chil, 1999 Aug, 127(8), 891 - 3 {Helicobacter pylori . The bacteriological revolution}; Valenzuela J; The finding of II pylori in the gastric mucosa has changed the understanding of the pathogenesis of common diseases of the stomach and duodenum . The bacteria causes acute and chronic gastritis and is the precursor of peptic ulcers, gastric lymphoma and gastric cancer . The most common test used to diagnose the infection is the urease test on a gastric biopsy but an endoscopy must be performed to obtain the biopsy . Determination of serum levels of IgG appears the most suitable test to perform in large population studies . Patients with peptic ulcers, gastric lymphoma and early gastric cancer should be treated . Combinations of antibiotics such as amoxicillin, chlarithromycin and a proton pump inhibitor have yielded the best results in irradicating H pylori . Unfortunately this therapy is expensive and new combinations should be explored . Vaccination should be the treatment of choice for prevention and irradication in countries like Chile with high infection rate . Preliminary results are encouraging. Ann Fr Anesth Reanim, 2000 Jan, 19(1), 47 - 53 {Surveillance of nosocomial infections related to anesthesia . A multicenter study}; Hajjar J et al.; OBJECTIVES: To determine incidence rate, main characteristics and risk factors of nosocomial infections associated with anesthesia (NIAA) . STUDY DESIGN: Prospective, descriptive multicentre survey . PATIENTS: All patients aged more than 15 years and undergoing surgery (except cardio-thoracic, ENT or ambulatory surgery) under general or regional anaesthesia . METHODS: Voluntary participation of surgical units from public or private hospitals . Use of pre-established definitions of infections and a 72 hours postanesthetic follow-up . Anaesthesia and operation related risk factors collected . End point based on occurrence, or not, of clinical infection . Record, control, treatment and analysis of the data by Epi Info--5.0 software . Statistics used: Fischer's exact test, Mantel-Haenszel test, Anova method, Kruskall-Wallis test . RESULTS: Among 7,300 patients belonging to 13 hospitals, 25 developed an infection (nine vascular catheter related infections, 12 respiratory tract infections, two infections of the eye and two of the mouth) . Only two infections have been bacteriologically documented . The overall incidence of NIAA was 3.4 per 1,000 patients . It was significantly higher after an anaesthetic of more than 2 hours and after transfusion . CONCLUSIONS: This first prospective survey of NIAA confirmed that nosocomial infections are a real problem in the practice of anaesthesia and the necessity to use preventive measures . A survey with a larger sample size would allow to specify the respective part of the various risk factors and to develop a risk index. Int J Syst Evol Microbiol, 2000 Nov, 50 Pt 6, 2229 - 30 Change of the names Haloanaerobiales, Haloanaerobiaceae and Haloanaerobium to Halanaerobiales, Halanaerobiaceae and Halanaerobium, respectively, and further nomenclatural changes within the order Halanaerobiales; Oren A; A formal proposal is made to rename the order Haloanaerobiales as Halanaerobiales, the family Haloanaerobiaceae as Halanaerobiaceae, the genera Haloanaerobium and Haloanaerobacter as Halanaerobium and Halanaerobacter, respectively, and to change the specific epithets of Halanaerobium acetoethylicum, Halanaerobacter lacunaris, Halocella cellulolytica and Halanaerobium chitinovorans to acetethylicum, lacunarum, cellulosilytica and chitinivorans, respectively . These changes are required in view of Rule 61, Appendix 9, of the Bacteriological Code. Dtsch Tierarztl Wochenschr, 2000 Dec, 107(12), 486 - 9 {Investigations on Brachyspira--diagnostic and therapeutic strategies in swine dysentery}; Waldmann KH et al.; The infectious agent of swine dysentery, Brachyspira (Br.) hyodysenteriae, seems to be widespread in German pig herds . Due to different reasons the eradication is increasingly difficult . Not only the success of therapeutic procedures but also the possibilities of diagnostics are unsatisfactory . Although only the bacteriological investigation of faeces or intestinal probes by culture techniques allows the typing of Brachyspira strains and the testing of drug resistance, however, the rate of false negative results is relatively high . In comparison with the cultural method an easy, prompt and cheap immunofluorescent test (IFT) resulted in a good sensitivity (90%) . The higher rate of negative results by culture techniques can not be attributed to a lower specificity of the IFT, but to an insufficient transport of samples to the laboratory . The IFT therefore has to be considered as a valuable supplement to the cultural diagnostic of Br . hyodysenteriae . It is absolutely necessary to establish strategies in eradication of swine dysentery which result in pig breeding herds free of Br . hyodysenteriae . Only weaner pigs which are reliable free of this germ guarantee a fattening period sufficiently free of swine dysentery . The principles of different measures in effective eradication are described. Oral Microbiol Immunol, 2000 Feb, 15(1), 19 - 26 Gingival crevicular fluid inflammatory mediators and bacteriology of gingivitis in nonhuman primates related to susceptibility to periodontitis; Ebersole JL et al.; The hypothesis to be tested was that the microbiota and resulting local host inflammatory response characteristics in oral conditions of high levels of chronic gingival inflammation increases susceptibility to progressing periodontitis . This study used cynomolgus monkeys, Macaca fascicularis (nonhuman primates), with high and low levels of long-standing gingival inflammation to define the profiles of gingival crevicular fluid mediators, cytokines and immunoglobulins; describe the subgingival microbiota; and evaluate their susceptibility to ligature-induced periodontitis . Sixteen nonhuman primates were stratified into two groups (HI, LO) based upon Bleeding Index as a measure of the natural level of inflammation (HI = 1.26 +/- 0.45; LO = 0.22 +/- 0.16) . The host mediator levels, subgingival microbiota, and clinical characteristics of the LO and HI groups were compared after 30 days of oral hygiene, during a 30 day experimental gingivitis (7, 14, and 30 days), and during periodontitis (30, 60, and 90 days) . The results demonstrated that nonhuman primates with high levels of long-standing gingival inflammation when compared to those nonhuman primates with low inflammation show: 1) different inflammatory mediator profiles in gingival crevicular fluid (particularly for immunoglobulin A (IgA) and IgG levels), 2) a different quantitative and qualitative subgingival microbiota; and 3) a similar progression of periodontitis . Thus, while variations in host inflammatory responses to local factors exist in the nonhuman primates, an extensive subgingival challenge (such as ligation) may negate these individual differences. Oral Microbiol Immunol, 2000 Feb, 15(1), 1 - 9 Taxonomy and virulence of oral spirochetes; Chan EC et al.; All oral spirochetes are classified in the genus Treponema . This genus is in the family Spirochaetaceae as in Bergey's manual of systematic bacteriology . Other generic members of the family include Spirochaeta, Cristispira and Borrelia . This conventional classification is in accord with phylogenetic analysis of the spirochetes based on 16S rRNA cataloguing . The oral spirochetes fall naturally within the grouping of Treponema . Only four species of Treponema have been cultivated and maintained reliably: Treponema denticola, Treponema pectinovorum, Treponema socranskii and Treponema vincentii . These species have valid names according to the rules of nomenclature except for Treponema vincentii, which only has had effective publication . The virulence factors of the oral spirochetes updated in this mini-review have been discussed within the following broad confines: adherence, cytotoxic effects, iron sequestration and locomotion . T . denticola has been shown to attach to human gingival fibroblasts, basement membrane proteins, as well as other substrates by specific attachment mechanisms . The binding of the spirochete to human gingival fibroblasts resulted in cytotoxicity and cell death due to enzymes and other proteins . Binding of the spirochete to erythrocytes was accompanied by agglutination and lysis . Hemolysis releases hemin, which is sequestered by an outer membrane sheath receptor protein of the spirochete . The ability to locomote through viscous environments enables spirochetes to migrate within gingival crevicular fluid and to penetrate sulcular epithelial linings and gingival connective tissue . The virulence factors of the oral spirochetes proven in vitro underscore the important role they play in the periodontal disease process . This role has been evaluated in vivo by use of a murine model. J Antimicrob Chemother, 2001 Jan, 47(1), 67 - 76 Randomized, double-blind, double-dummy study comparing the efficacy and safety of amoxycillin 1 g bd with amoxycillin 500 mg tds in the treatment of acute exacerbations of chronic bronchitis; Georgopoulos A et al.; This randomized, multicentre, double-blind, double-dummy study compared the efficacy and safety of amoxycillin 1 g bd with amoxycillin 500 mg tds in 395 patients with a clinical diagnosis of acute exacerbation of chronic bronchitis (AECB) . Patients were treated for 10 days and were assessed during therapy (days 3-5), after the end of therapy (days 12-15) and at follow up (days 28-35) . In the intention-to-treat (ITT) population, clinical success rates at the end of therapy were 86.6% (162/187 patients) and 85.6% (161/188 patients) in the bd and tds group, respectively . In the per-protocol (PP) subgroup, the success rates were 89.1% (156/175) and 92.6% (150/162), respectively . The clinical recurrence rates at follow up were, in the ITT and PP populations, respectively, 14.2% (20/141) and 13.4% (18/134) in the bd group, and 12.6% (18/143) and 13.7% (18/131) in the tds group . The 95% confidence intervals (CI) confirmed the clinical equivalence of the two dosage regimens in the ITT and PP populations . Two hundred and nineteen patients from the clinically evaluable ITT population had at least one pathogen isolated at baseline and were evaluable for bacteriological efficacy . Bacteriological success at the end of therapy was obtained in 76.2% (83/109) of patients in the bd group, and 73.7% (81/110) of patients in the tds group (95% CI: -9 to 14%) . The most frequently reported drug-related adverse events in the safety evaluable patients were gastrointestinal symptoms, which occurred in 11.2% (22/197) in the bd group and 11.6% (23/198) in the tds group . Amoxycillin 1 g bd is clinically and bacteriologically as effective as amoxycillin 500 mg tds in the treatment of AECB, and the two dosage regimens show a similar safety profile. Rev Chir Orthop Reparatrice Appar Mot, 2000 Dec, 86(8), 794 - 800 {Alpha-1-antitrypsin in early infections after hip prosthesis surgery}; Gomez Navalon LA et al.; PURPOSE OF THE STUDY: The aim of this work was to determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and alpha-1-antitrypsin (A1AT) levels are correlated significantly with early postoperative infectious complications after hip prosthetic surgery . MATERIALS AND METHODS: This prospective study was conducted on 100 total hip replacements performed between 1994 and 1995 . ESR, CRP and A1AT were obtained before surgery then at 1, 2 and 6 weeks after surgery . RESULTS: Seven bacteriologically proven cases of infection were reported . Infection was considered to be superficial if it did not extend deeper than the muscles fascia . There was a strong statistical correlation between A1AT level and infection for all postoperative times (p<0.0001) . A1AT was highly sensitive (87.5 p . 100) and specific (85.8 p . 100) for infection compared with ESR (sensibility 70 p . 100 and specificity 65.9 p . 100) and CRP (sensitivity 63.6 p . 100 and specificity 80.1 p . 100) . DISCUSSION AND CONCLUSION: In our hands, A1AT can be a most useful diagnostic tool for infection after prosthesis hip surgery . Although not totally specific, it is highly sensitive for infection compared with other tools such as ESR and CRP more frequently used . These findings suggest an avenue of research on the role of A1AT in infectious complications after prosthetic joint surgery. Neurol India, 2000 Dec, 48(4), 370 - 3 Infected Ewing's sarcoma of spine; Kumar R et al.; An unusual case of extradural, intraspinal Ewing's sarcoma with significant extraspinal extension is reported . In view of associated constitutional symptoms, suggestive signs, leucocytosis, elevated ESR and operative findings, the initial diagnosis of Pott's spine was entertained . The lesion however turned out to be infected Ewing's sarcoma on histopathology and bacteriological examination. Mol Microbiol, 2001 Jan, 39(2), 330 - 40 Platelet activation by a relapsing fever spirochaete results in enhanced bacterium-platelet interaction via integrin alphaIIbbeta3 activation; Alugupalli KR et al.; Borrelia hermsii, a spirochaete responsible for relapsing fever in humans, grows to high density in the bloodstream and causes thrombocytopenia . We show here that B . hermsii binds to human platelets . Extended culture in bacteriological medium resulted in both diminished infectivity in vivo and diminished platelet binding in vitro . Platelet binding was promoted by the platelet integrin alphaIIbbeta3: the bacterium bound to purified integrin alphaIIbbeta3, and bacterial binding to platelets was diminished by alphaIIbbeta3 antagonists or by a genetic defect in this integrin . Integrin alphaIIbbeta3 undergoes a conformational change upon platelet activation, and bacteria bound more efficiently to activated rather than resting platelets . Nevertheless, B . hermsii bound at detectable levels to preparations of resting platelets . The bacterium did not recognize a point mutant of alphaIIbbeta3 that cannot acquire an active conformation . Rather, B . hermsii was capable of triggering platelet and integrin alphaIIbbeta3 activation, as indicated by the expression of the platelet activation marker P-selectin and integrin alphaIIbbeta3 in its active conformation . The degree of platelet activation varied depending upon bacterial strain and growth conditions . Prostacyclin I2, an inhibitor of platelet activation, diminished bacterial attachment, indicating that activation enhanced bacterial binding . Thus, B . hermsii signals the host cell to activate a critical receptor for the bacterium, thereby promoting high-level bacterial attachment. Trans R Soc Trop Med Hyg, 2000 Sep-Oct, 94(5), 563 - 8 Double-blind placebo-controlled trial of Mycobacterium vaccae immunotherapy for tuberculosis in KwaZulu, South Africa, 1991-97; Mayo RE et al.; To investigate Mycobacterium vaccae immunotherapy in the treatment of human tuberculosis and to assess longer-term outcomes following treatment for tuberculosis patients, a double-blind placebo-controlled Phase-2 clinical trial was set up in the Mseleni and Manguzi health wards in north-eastern KwaZulu, South Africa . In 1991-93, 204 patients admitted with clinical tuberculosis to the 2 hospitals were allocated to receive single intradermal doses of 0.1 mL M . vaccae NCTC 11659 or 0.1 mL tetanus toxoid alongside standard 6-months chemotherapy with rifampicin, isoniazid, pyrazinamide and ethambutol . The main outcome measures were sputum bacteriology culture conversion to negativity, clinical assessment, weight gain, erythrocyte sedimentation rate and chest radiography . Patients were followed-up after 4 years to determine their health status . M . vaccae cases gained weight more quickly during the first 8 weeks compared with 'placebo' patients . Regression analysis found a synergistic relationship between BCG positive scar status and M . vaccae-induced weight gain . No further difference was found between treatment groups . The bacterial conversion rate to negativity at 2 months was much lower than expected (44.8% active, 38.8% placebo) . Mortality was considerably higher than expected after treatment (7.1% each group) and after 4 years (25.8% active, 21.0% placebo; death from tuberculosis 14.5% and 16.1%, respectively) . Immune sensitization to environmental mycobacteria may explain the geographical variability of M . vaccae efficacy, as occurs with BCG vaccination and occurred with Koch's tuberculins of the late 19th century . Multiple doses of M . vaccae may be more effective . Further work is required to link the ability of M . vaccae to modulate protective cytokine profiles to favourable outcome in clinical studies . The high mortality found in this study suggests urgent reviews of chemotherapy and monitoring of patients are necessary in KwaZulu. Chirurg, 2000 Nov, 71(11), 1385 - 91 {Therapy of bacterial knee joint infection by radical synovectomy and implantation of a cemented stabilized knee joint endoprosthesis}; Siegel A et al.; INTRODUCTION: The report presents an alternative to the treatment of joint destruction in cases of knee joint empyema by resection or arthrodesis: implantation of a stabilised knee prosthesis using antibiotic-loaded bone cement for fixation . METHOD: From 1985 to 1997 a total of 33 knees in 32 patients (21 female, 12 male) were treated for knee empyema by radical synovectomy and implantation of a stabilised knee prosthesis fixed in position with antibiotic-loaded bone cement . The antibiotics were chosen according to the antibiogram of the pathogen . In all these cases the infections had not responded to previous treatment . The criterion for success was the elimination of infection . The follow-up period ranged from 2 to 15 years . RESULTS: Of 33 infected knees 31 (93.9%) were followed up . In 22 cases (71.0%) the infection was eliminated by primary surgery . In five cases (16.1%) further exchange operations were necessary to eliminate the infection . In four cases (12.9%) preservation of the joint was not possible . CONCLUSION: Uncontrolled infection in cases of knee empyema and destruction of the joint can be treated by radical synovectomy and implantation of a stabilised knee prosthesis using antibiotic-loaded bone cement for fixation . The success rate corresponds to the results of one-stage exchange arthroplasty to treat periprosthetic infection of knee prostheses . This therapy should be performed only in specialised centres which have the facilities and personnel essential for accurate bacteriological diagnosis and recommendation. Indian J Pediatr, 2000 Feb, 67(2 Suppl), S34 - 40 Management of non-pulmonary forms of tuberculosis: review of TRC studies over two decades; Balasubramanian R et al.; Tuberculosis Research Centre, Chennai has been conducting randomized controlled clinical trials in both adults and children (n = 1015) in various non-pulmonary forms of tuberculosis, for the last two decades . This communication discusses the salient findings of these studies . The important finding is that short course chemotherapeutic regimens have been proven to be highly effective in tuberculosis of spine, superficial tuberculous lymphadenitis, abdominal tuberculosis, brain tuberculoma and Pott's paraplegia . However, in tuberculous meningitis, the outcome appears to be directly related to the stage of the disease on admission . The intermittent regimens have been found to be as effective as daily regimens . The other important aspects highlighted are the need to obtain bacteriological/histo-pathological confirmation by resorting to relevant diagnostic procedures, value of Mantoux as a diagnostic tool and role of surgery. Ann Vasc Surg, 2000 Nov, 14(6), 602 - 7 Use of cryopreserved arterial homografts for management of infected prosthetic grafts: a multicentric study; Verhelst R et al.; The objective of this study was to evaluate the effectiveness of cryopreserved arterial homografts for management of prosthetic graft infection . Between October 1992 and July 1998, 90 patients (84 men) with a mean age of 64 years from six different hospitals were treated for prosthesis infection by in situ replacement using a cryopreserved arterial homograft (CAH) . In 43 patients (47%), the primary procedure had been performed at a nonparticipating center . Prosthetic graft infection occurred early (i.e., within 1 month after the primary procedure) in 15 cases and late in 75 cases . In the late group, the mean interval between the primary procedure and CAH replacement was 34 months (range, 3 to 330 months) . In 41 patients, infection was located in the aortic region, including 17 presenting with enteroprosthetic fistula (EPF) . In 49 patients, infection was confined to the femoral, popliteal, or subclavian region . Bacteriologic cultures were positive for one or more germs in 75 patients and negative in 15 . The surgical procedure consisted of complete or partial removal of the infected prosthetic graft, debridement, and in situ reconstruction using one or more CAH . Our results showed that management of prosthetic graft infection, a grave complication, using a CAH is a promising technique, especially for patients in stable condition prior to reconstruction. Indian J Pathol Microbiol, 1999 Oct, 42(4), 463 - 9 Clinical, bacteriologic and histopathologic studies on induced leptospirosis in stray dog pups; Saravanan R et al.; Eighteen 8-12 days old stray dog (canis familiaris mongrel) pups of either sex; 6 pups each in test groups and control group were infected with lepotspiral serovars autumnalis and canicola . The experimental animals, clinical, bacteriologic and histopathologic kinetics were observed . Both the serovars had evoked typical clinical manifestations . Leptospiraemia could be demonstratedin between the post inoculation (PI) days 1 & 5 . Leptospiruria commensed in between the PI days 5 & 7 and lasted throughout the study period . Histopathologic study did not reveal any marked pathologic changes except hydropic changes in the liver of both the test groups. Salud Publica Mex, 2000 Sep-Oct, 42(5), 397 - 406 {Bacteriological quality of human drinking water in high-margination zones in Chiapas}; Sanchez-Perez HJ et al.; OBJECTIVE: To analyze the bacteriological quality of drinking water (BQDW) and its association with diarrhoea and intestinal parasites in children 1 to 14 years old, in areas of high levels of poverty in Chiapas, Mexico . MATERIAL AND METHODS: From March to September 1998, drinking water was collected from a random sample of 99 households in the Border Region of Chiapas, Mexico; data on diarrhoeal disease (in the past 15 days) were collected and stool testing for intestinal parasites was performed in children 1 to 14 years old (n = 322) . The BQDW was determined by the filtration membrane technique . Intestinal parasitic infections were determined by the Faust Method . The chi 2 statistic was used to analyse factors associated with BQDW . RESULTS: Only 31% of the water samples were adequate for human consumption . The BQDW and the presence of diarrhoea (informed by the mothers of the children) showed no association . Children living in households with inadequate BQDW had a higher prevalence of Entamoeba histolytica and a greater tendency to have intestinal parasites . CONCLUSIONS: It is necessary to develop programs that improve BQDW and to develop education efforts aimed at increasing the use of boiled water and the adequate management and care of community water storage sites. J Chir (Paris), 2000 Dec, 137(6), 349 - 54 {Surgical management of community-acquired peritonitis in children . Analysis of a survey}; Becmeur F et al.; The purpose of this work was to determine current practices of pediatric surgeons in the management of community peritonitis, excepting antibiotic use and resuscitation car . A questionnaire was sent to 63 French pediatric surgeons in France . Forty-six answers concerning appendicular peritonitis were analyzed . Laparoscopy was a good indication for 40 surgeons . A sample for bacteriological examination was never ordered . Conditions for washing and drainage were detailed . Treatment to prevent postoperative pain was used by all. J Microbiol Methods, 2001 Jan, 43(3), 153 - 64 Status of methods for assessing bacterial cell surface charge properties based on zeta potential measurements; Wilson WW et al.; Surface interfacial physiology is particularly important to unicellular organisms with regard to maintenance of optimal cell function . Bacterial cell surfaces possess net negative electrostatic charge by virtue of ionized phosphoryl and carboxylate substituents on outer cell envelope macromolecules which are exposed to the extracellular environment . The degree of peripheral electronegativity influences overall cell surface polarity and can be assessed on the basis of zeta potential which is most often determined by estimating the electrophoretic mobility of cells in an electric field . The purpose of this review is to provide bacteriologists with assistance as they seek to better understand available instrumentation and fundamental principles concerning the estimation of zeta potential as it relates to bacterial surface physiology. Eur J Clin Microbiol Infect Dis, 2000 Oct, 19(10), 787 - 9 Evaluation of a Helicobacter pylori stool antigen test for the diagnosis and follow-up of infections in children; Husson MO et al.; The aim of this study was to evaluate the performance of a newly developed enzyme immunoassay kit (HpSA) for detecting Helicobacter pylori antigens in the stool of children . This study was comprised of 58 children referred to various endoscopy units for evaluation of gastrointestinal symptoms and upper gastroduodenal endoscopy and 11 children for post-therapy follow-up . In the first group, 23 children were diagnosed as positive for Helicobacter pylori using bacteriological and/or histological methods . Stool antigens were detected in 20 of these positive patients, for a sensitivity of 86.9% and a negative predictive value of 91.9% . Since only one false-positive reaction was observed with the HpSA kit, the specificity was 97.1% and the positive predictive value 95.2% . Results obtained for post-therapy follow-up were also promising . The HpSA assays were negative for the eight children whose infections were eradicated after therapy, and a positive result was obtained for two of three patients who had a persistent infection. Eur J Vasc Endovasc Surg, 2000 Nov, 20(5), 413 - 8 The prevention and treatment of vascular graft infection with a Triclosan (Irgasan)-bonded Dacron graft: an experimental study in the pig; Hernandez-Richter T et al.; Objectives: to evaluate the role of Triclosan (Irgasan(R)) in the prevention of prosthetic graft infection . Material and methods: fifty-one pigs were assigned randomly to six groups . Group I (graft) and II (graft and Triclosan) were control groups . Groups III (graft) and IV (grafts and Triclosan) were contaminated with 2 x 10(7)CFU/ml S . aureus . Groups V (graft) and VI (graft and Triclosan) were intraoperatively contaminated with 2 x 10(7)CFU/ml S . aureus and reoperated on after 7 days . Remaining animals were sacrificed on day 28 . The end point of the investigation was vascular graft infection, defined as the bacteriological and/or histological proof of infection . Results in both control groups no vascular graft infections were detected in Groups I and II . All of the group III animals presented but none of the group IV developed a graft infection (p <0.02) . All of the group V animals presented and 10 of 12 animals developed a graft infection . Conclusion: in this animal model Triclosan bonding appears effective in preventing prosthetic graft infection . However, the in situ replacement of Triclosan-protected grafts was not successful in the treatment of graft infection . Surg Today, 2000, 30(11), 1049 - 52 Rapid progression of intrahepatic cholangiocarcinoma after drainage of large cystic lesions: report of a case; Kaneko T et al.; We report herein a case of cholangiocarcinoma with large cystic lesions . Computed tomography (CT) demonstrated large cysts in segment IV and the paracaval portion of the caudate lobe, and a solid tumor in the anterior segment of the right lobe of the liver which was contiguous to the cyst in the paracaval portion of the caudate lobe . The large cysts were diagnostically misleading and a liver abscess was suspected . Thus, percutaneous transhepatic drainage of the cyst was performed . The fluid in the cyst was negative bacteriologically, but malignant cells were detected . A CT scan done 2 weeks after drainage of the cyst showed progression of the solid tumor with intrahepatic metastasis and replacement of the cystic lesions by the solid tumor . Following percutaneous transhepatic portal embolization, a right hepatic trisegmentectomy with caudate lobectomy was performed . Pathological examination confirmed cholangiocellular carcinoma . These results indicate that drainage of the cystic lesion induced the tumor progression in the liver . Therefore, the possibility of cholangiocarcinoma with a large cystic lesion should be borne in mind when considering the differential diagnosis of a cystic lesion in the liver, and appropriate surgical therapy should be carefully selected. Arch Pediatr, 2000 Nov, 7(11), 1197 - 200 {Meningitis and interferon-alpha in the cereprospinal fluid . What diagnostic and therapeutic approach? A case report}; Mbuila C et al.; BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis . The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult . The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude . CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever . The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia . The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative . The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams . The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis . CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification. Kekkaku, 2000 Oct, 75(10), 583 - 8 {Comparison of chest CT findings between suspected and definite cases of primary pulmonary M . avium complex infection}; Harada S et al.; It is very difficult to treat pulmonary infection with MAC, because we have few effective drugs against this organism . In this situation, an early diagnosis and treatment are very important to manage this disease . We evaluated chest CT scans of the primary pulmonary MAC infection which had no underlying lung diseases and no immunocompromised diseases such as HIV infection . We defined suspected cases of pulmonary MAC infection as cases in which abnormal features of chest CT scans were recognized but frequency of detection of organisms of MAC did not fulfil the diagnostic criteria for atypical mycobacteriosis according to Japanese Mycobacteriosis Research Group of the National Chest Hospitals . CT scans of suspected cases were compared with the definite cases . Results obtained were as follows: 1 . In classification by CT scans of primary pulmonary MAC infection, the proportion of localized type and diffuse type was the same both in suspected and definite cases . In localized type, more tuberculosis-like pattern was seen in definite cases . 2 . In suspected cases, characteristic features of CT scans of primary pulmonary MAC infection were recognized in the same frequency as in definite cases . 3 . In pulmonary tuberculosis-like type, definite cases showed more cavitary lesions than suspected cases . These results showed that a careful long term follow-up of suspected cases with frequent bacteriological tests of sputum and chest CT scannings was important for early diagnosis of primary pulmonary MAC infection. Presse Med, 2000 Nov 4, 29(33), 1807 - 12 {Good clinical practice in using antibiotics in the hospital . Current status in 207 public and private hospitals in 1999}; Gindre I et al.; OBJECTIVES: The purpose of this study was to map activities developed in hospitals to monitor antibiotic usage and evaluate implementation of French guidelines for good clinical practice on use of antibiotics in the hospital setting . METHODS: A questionnaire was mailed to the head of the pharmacy of 300 French hospitals . The questionnaire targeted methods developed to monitor antibiotic usage (antibiotic committees, local recommendations, types of prescription and dispensing, surveillance, information and evaluation activities) . RESULTS: The response rate was 69% (207 answers) . A local committee supervised antibiotic usage in 49% of the hospitals (nosocomial, drug or antibiotic committees) . Local recommendations existed in 120 hospitals (59%) and 42% of the hospitals had a validation process before dispensing drug in accordance with the recommendations . Antibiotic prescription was nominal in 65% of the hospitals and specific monitoring was carried out in 42% of them . Antibiotic consumption was monitored in 80% of the hospitals and resistance was monitored in 53% . Twelve percent of the hospitals used an electronic network to share information on prescription and bacteriological results . Regular internal training existed in 20% of the hospitals and evaluation methods (medical audits, impact measures) in 14% . DISCUSSION: Careful monitoring of antibiotics is implemented in most hospitals . Strict application of guidelines, definition and implementation of indicators, and evaluation methods must be improved . Implementation of better hospital monitoring of antibiotics requires: i) a local consensus to limit the antibiotics available and guidelines to adapt to local infections; ii) dissemination of guidelines and training for prescribers; iii) implementation of a dispensing system to check the validity of prescriptions according to local guidelines; iv) implementation of indicators to monitor bacterial resistance and the volume of antibiotics used. Ugeskr Laeger, 2000 Nov 13, 162(46), 6254 - 5 {Tuberculosis in immigrants}; Viskum K; Three cases of tuberculosis in immigrants are described here . The manifestations of tuberculosis in this group are often different from those seen in Danes--in casu tuberculosis of the lymph nodes, skin, bone, and intestines . Diagnosis is difficult, as Danish doctors are not familiar with the clinical picture . Language problems are common and often necessitate the presence of an interpreter . Immigrants tend to move around without notifying the responsible doctor and the resources needed to find them may not be readily available . These factors may cause a considerable delay--from months to years--in the diagnosis and treatment . Doctors examining immigrants from Africa and Asia should be aware of tuberculosis as a possible cause of disease . Secretion and biopsies from fistulae, chronic ulcerations, lymph nodes, and abscesses should always be cultured for Mycobacterium tuberculosis . The Mantoux reaction can be misleadingly negative in patients suffering from severe tuberculosis . Identification of Mycobacterium tuberculosis is not necessary for treatment--that decision is made on the clinical picture . On the other hand material for a bacteriological diagnosis should always be obtained, because of possible resistance problems. Ann R Coll Surg Engl, 2000 Nov, 82(6), 408 - 10 A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy; Harling R et al.; Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given, as demonstrated in previous studies . Antibiotic treatment may be unnecessary and, therefore, undesirable, so we compared two forms of prophylaxis: a cephalosporin antibiotic and bag extraction of the dissected gallbladder . A total of 76 patients undergoing laparoscopic cholecystectomy were randomised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag . Complicated cases were excluded . There was a total of 6 wound infections (7.9%), 3 in each of the study groups . All these were associated with skin commensals . There were no other septic complications . Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals . A total of 10 potential pathogens were isolated, 9 of which were found in the group receiving antibiotics . We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon, but clearly not entirely prevented by antibiotic or mechanical prophylaxis . Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy . Further study is warranted. Crit Care Med, 2000 Nov, 28(11), 3705 - 9 Bacterial translocation and tumor necrosis factor-alpha gene expression in experimental hemorrhagic shock; Tani T et al.; OBJECTIVE: To investigate whether bacterial translocation is the causative mechanism underlying cytokine production during hemorrhagic shock . DESIGN: Prospective, randomized, unblinded animal study . SETTING: Surgical research laboratories of Shiga University of Medical Science . SUBJECTS: Male Sprague-Dawley rats . INTERVENTIONS: The rats were randomly divided into three groups . Each animal was anesthetized with pentobarbital, given a continuous infusion of 0.9% saline, and monitored for blood pressure . The normoxic and sham shock groups breathed room air, whereas the hyperoxic shock group was administered 100% oxygen . Except in the sham shock group, blood was withdrawn to induce a hemorrhagic shock state, then the shed blood was reinfused . Sixty minutes after the induction of hemorrhagic shock, arterial blood cultures were performed in all three groups . The animals were then killed, and their mesenteric lymph nodes (MLNs) were harvested for bacterial culture . The terminal ileum, liver, spleen, kidney, lung, and MLNs were also collected for histologic study by in situ hybridization . MEASUREMENTS AND MAIN RESULTS: In the bacteriologic study, the prevalence of bacterial translocation was 0% (0/11) in the hyperoxic shock group, 55% (6/11) in the normoxic shock group, and 0% (0/9) in the sham shock group . In the in situ hybridization study, tumor necrosis factor-alpha gene expression was detected only in the ileal tissue, MLNs, and spleens of the normoxic shock group . Blood cultures were sterile in all three groups . CONCLUSIONS: Bacterial translocation occurred in MLNs within 1 hr of hemorrhage . Hemorrhagic shock causes tumor necrosis factor-alpha gene expression as well as bacterial translocation in MLNs, but not in the liver, in this model . Bacterial translocation was prevented by hyperoxia early in the course of hemorrhagic shock . Hyperoxia also prevented tumor necrosis factor-alpha gene expression along the bacterial invasion route. Dtsch Med Wochenschr, 2000 Oct 20, 125(42), 1260 - 2 {Multilocular fixed drug reaction simulating intertrigo in a diabetic patient}; Brabek E et al.; HISTORY AND CLINICAL FINDINGS: A 57-year-old man with diabetes and hypertension was treated with amoxycillin, clarithromycin and pantoprazole for a gastric ulcer positive for Helicobacter pylori . On the second treatment day he developed inguinal pruritus with erythema . He presented at out-patient clinic on the 5th day suspected of having Candida intertrigo . He had bright red, relatively well-circumscribed erythema, most marked at the edges, mainly over the inguinal region and the inside of the thigh . There were no other symptoms . INVESTIGATIONS AND DIAGNOSIS: Bacteriological and mycological tests of the affected skin were unremarkable . Immunological tests showed a normal total IgE but were negative in the CAP-FEIA test for penicilloyl G, penicilloyl V, amoxycilloyl and ampicilloyl . An epifocal epicutaneous test with amoxycillin and ampicillin (5% each in vaseline and doritin) gave a +2 positive reaction and confirmed a suspected fixed drug reaction . TREATMENT AND COURSE: After amoxycillin had been discontinued and local class III steroids had been administered (mometasone furoate, Ecural) for one week the cutaneous changes disappeared without complication, except for slight hyperpigmentation . H . pylori eradication was continued without further complications using clarithromycin, metronidazole and pantoprazole . The patient was issued with an "allergic to penicillin" card . CONCLUSION: Intertriginous changes during antibiotic treatment may not be due to Candida intertrigo, which is fairly common, but to a prognostically much more important drug reaction. Eur Radiol, 2000, 10(11), 1815 - 23 Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis; Ledermann HP et al.; The aim of this study was to evaluate pitfalls and technical limitations of MR imaging in diagnosing relapse of chronic posttraumatic osteomyelitis of the lower extremities . Retrospective analysis of MR examinations in 15 patients (17 body areas) with suspected relapse of chronic posttraumatic osteomyelitis (at least 1.5 years duration/mean number of surgical procedures per patient: 5.8) . The MRI findings were compared with postoperative bacteriology (n = 11) and clinical follow-up (n = 4) . Five patients had additional CT examination . Magnetic resonance imaging identified all infected areas correctly, but five uninfected regions were diagnosed false positive due to postoperative scarring/oedema in bone defects (n = 4) and soft tissue (n = 1) . Specificity of MRI in diagnosing active bone infection was 63% and sensitivity 100% . Additional CT was preoperatively necessary in 5 patients (33%) to further examine osteomyelitic and reparative bone remodeling . Metal artefacts were present in 11 patients, rendering complete evaluation impossible (n = 2) or considerably more difficult (n = 4) . Scarring/oedema in postoperative bone defects occurs up to 13 months postoperatively and represents a major pitfall leading to low specificity . Definitive evaluation of suspected fistula, bony fragments and mineralization by MRI may be limited in this special patient group and requires additional CT in one third of patients . Metal artefacts occur in most patients and may impair or even prevent correct film evaluation in 23 and 11%, respectively. Curr Infect Dis Rep, 2000 Apr, 2(2), 130 - 140 Complications of Acute Otitis Media and Sinusitis; Cohen JT et al.; Otitis media and sinusitis are clinically identifiable infections of the middle ear and sinuses . Both conditions should be regarded as dynamic processes with a clinical spectrum, which may extend from a self-limiting condition to a prolonged and sometimes complicated disease . With the advent of antibiotics, the natural course of these diseases has changed significantly . Severe complications once characterized by high mortality and morbidity have become rare . This has led to a generation of general practitioners, otolaryngologists, and pediatricians trained in an atmosphere of complacency in the treatment of otitis media and sinusitis . However, several recent publications report an increasing incidence of serious complications associated with otitis and sinusitis, probably due to rising antibiotic resistance . A high index of suspicion, based on clinical grounds, is therefore warranted . The ultimate goal in the approach of these conditions is pharmacotherapeutic management, resorting to surgery for the restoration of function rather than for the eradication of the infectious disease . As new information becomes available on the etiology, pathogenesis, and bacteriology of these conditions, new strategies are being used to improve treatment and to prevent complications . These measures should include a more appropriate choice of antibiotics, the determination of the role of adjuvant therapy and surgical procedures, and the development of new vaccines. J Int Med Res, 2000, 28 Suppl 1, 25A - 36A Short courses of antibiotic in acute otitis media and sinusitis infections; Pichicero M; Poor compliance with standard antibiotic regimens of 7 - 10 days' duration used in the treatment of acute upper respiratory tract infections contributes significantly to treatment failure . Patients fail to complete the recommended course of treatment, stopping once symptoms have resolved, which is typically within 2 - 5 days . Accumulating evidence from a large number of prospective clinical studies suggests that shortened courses of treatment may be as, or more, effective than conventional regimens of longer duration . As an example, a study comparing 5 days of cefuroxime axetil therapy with either 10 days of cefuroxime axetil or amoxycillin/clavulanate showed no differences in rates of clinical cure, bacteriological eradication and recurrence in paediatric patients with either acute otitis media or sinusitis . Shortened-course therapy with agents such as cefuroxime axetil has the potential to improve patient compliance and so reduce the rate of clinical failure and the emergence of resistant strains . Other potential benefits include fewer side-effects, improved patient satisfaction and lower treatment costs. J Int Med Res, 2000, 28 Suppl 1, 13A - 24A Short-course antibiotic therapy for infections with a single causative pathogen; Adam D; Studies evaluating short-course therapy have focused on prevalent infections with demonstrable aetiology . Metaanalyses of clinical trials demonstrate that uncomplicated acute otitis media in children can be successfully treated with a 5-day course of cefuroxime axetil . In the treatment of tonsillopharyngitis, 4 - 5-day courses of oral cephalosporins compared favourably with the standard 10-day penicillin V regimen . The clinical cure rate and the bacteriological eradication rate were both significantly higher for cephalosporins than for penicillin V . Bacteriological failure rates for cephalosporins were about half those for penicillin . In studies on acute bacterial exacerbations of chronic bronchitis, no difference in the clinical cure rates or relapse rates was found between short-course therapy using cephalosporins and standard courses . The short courses had the advantage of improved gastrointestinal tolerance compared with longer durations of treatment . The results suggest that new short-course dosing regimens are viable and may be favourable in terms of increased tolerability, reduction in healthcare costs, enhanced patient compliance and the control of the development of antibiotic resistance. Artif Organs, 2000 Oct, 24(10), 826 - 9 Membranes for endotoxin removal from dialysate: considerations on feasibility of commercial ceramic membranes; Bender H et al.; As the quality of water in dialysis fluid varies considerably, dialysate is often contaminated by large amounts of bacteria and endotoxins . Membrane properties and operating pressures are acknowledged to give high-flux dialysis with bicarbonate the bacteriological potential to favor passage of endotoxin fragments from the dialysate into the blood stream . Therefore, a sterile dialysate will have to become a standard . Ultrafiltration across hydrophobic synthetic membranes was shown to remove endotoxins (and their fragments) from dialysis water by the combined effect of filtration and adsorption . However, each module can be used for a limited time only . Ceramic membranes may represent an alternative to polymeric membranes for endotoxin removal . In this article, we tested the capacity of different commercial ceramic membranes with nominal molecular weight cut-off down to 1,000 to retain endotoxins from Ps . aeruginosa . The tested membranes did not generally produce dialysate meeting the Association for the Advancement of Medical Instrumentation standard . When using aluminum-containing membranes, we detected aluminum leaking into the dialysate that could possibly be transported into the blood stream. Ginekol Pol, 2000 Sep, 71(9), 1230 - 4 {Results of the activity of Jose Carreras Memorial Cord Blood Bank in Warsaw}; Machaj E et al.; Following the first successful cord blood transplantation in 1988, several hundreds of patients were treated using same protocol . The main limitation of the wide use of cord blood as a source of haematopoietic cells is the number of available units of this tissue . To make possible selection of HLA-matched cells for individual patient, several thousands of cord blood samples must be collected and stored in liquid nitrogen . The network of cooperating cord blood banks with join accessible database is necessary . In this paper the activity of Jose Carreras memorial Cord Blood Bank established in Warsaw was described . Since the middle of January the collection of cord blood units for clinical purposes was started . During first three months 80 samples of cord blood was collected . Collections were obtained from normal full-term deliveries after the third stage of labour . For the banking the collection over 60 ml or contain over 4 x 10(8) of mononuclear cells were qualified . Whole blood samples and plasma samples obtained following volume reduction were used for HLA and bacteriology tests . After volume reduction the number of nucleated cells (WBC), mononuclear cells (MNC) and hematopoietic cells (CD34+) were evaluated . After processing the cord blood samples were frozen using control freezer and were stored in liquid nitrogen storage tanks . According to results of cord blood transplantation hundred percent of banked samples are suitable for recipients weighing 10 kg and only 7 percent for these weighing 50 kg. Kyobu Geka, 2000 Nov, 53(12), 1058 - 61 {Successful treatment for descending necrotizing mediastinitis: a case report}; Ishida I et al.; A 21-year-old female was admitted to our hospital because of high fever, neck swelling, and dyspnea . She was diagnosed as descending necrotizing mediastinitis (DNM) extended from odontogenic infection . On the day of admission, she underwent cervical drainage . Next day, the CT scan showed an abscess below the tracheal bifurcation and bilateral pleural effusion . Mediastinal drainage was performed through a right thoracotomy, and a left thoracic tube was inserted . Anaerobic Peptostreptococcus was found with bacteriological culture . After the mediastinal drainage, bilateral thoracic irrigation was performed through the thoracic tubes . Left thoracic tube was removed on the 8th day and right one was removed on the 20th day after the thoracotomy . She was discharged on the 42nd day . DNM is relatively rare, but it is lethal disease with high mortality . Immediate and sufficient mediastinal drainage is indispensable for the disease. J Pediatr Surg, 2000 Nov, 35(11), 1600 - 5 Recipient FK506 pretreatment regimens in rat small bowel transplantation: allograft survival, function, and systemic infection; Guo WH et al.; PURPOSE: Successful small bowel transplantation requires effective immunosuppression that preserves intestinal function but avoids opportunistic infection . This study aims to evaluate FK506 as a single immunosuppressant in different pretreatment regimens in a rat high responder strain combination . METHODS: Lewis --> DA rat heterotopic small bowel transplantation was performed . Studied groups were (1) untreated control, n = 12; (2) FK-1, n = 8; (3) FK-3, n = 8 . FK506 (2 mg/kg/d, intramuscularly) was given to the recipients for 1 day (FK-1) and 3 days (FK-3) before small bowel transplantation, followed by 2 weeks of subtherapeutic treatment (0.3 mg/kg/d, intramuscularly) after small bowel transplantation . Syngeneic small bowel transplantation also was performed (n = 8) . FK blood levels, maltose absorption test, histology, and bacteriology were performed at different postoperative days . RESULTS: Allograft survival was prolonged significantly with FK pretreatment, being more so in FK-3 group (FK-1, 22.2 +/- 1.5 d; FK-3, 40.7 +/- 14.1 d; control, 6.6 +/- 0.8 d; P< .01) . In the first postoperative week, FK blood level was significantly higher in FK-3 group (19.8 +/- 1.5 ng/mL) than in FK-1 group (5.0 +/- 0.4 ng/mL; P < .05) . There was no evidence of systemic infection in either FK-treated group . For maltose absorption, control allograft was abnormal on day 7 correlating to severely damaged intestinal architecture . In contrast, FK-treated allografts showed well-protected intestinal structure and normal absorption on days 7 and 21 . CONCLUSION: High FK506 blood levels in the first postoperative week, achieved with FK pretreatment, prolonged intestinal allograft survival and preserved intestinal structure and function without allowing systemic infection. Przegl Epidemiol, 2000, 54(1-2), 9 - 24 {Tuberculosis in Poland and the world at the beginning of the third millennium}; Szczuka I; BACKGROUND: Tuberculosis has been a major public health problem in Poland for many decades . OBJECTIVE: The aim of this investigation was to evaluated incidence, prevalence and mortality from TB in Poland in 1998 and to examine trends of TB incidence . METHODS: Individual date on tuberculosis cases reported to National TB Register and date of prevalence and mortality from TB were analysed . RESULTS: The paper presents the epidemiological situation of TB in Poland in 1998 . The year of 1998 was the fifth consecutive year of decline at TB incidence after previous years (1991-1993) of increase . In 1998 there were 13,302 newly registered TB cases, of which 1,476 were relapses . The incidence was 34.4 per 100,000 population, (30.6 were the new cases and 3.8 relapses) . Relapses represented 11.1% of all new registered cases . The incidence in 1998 was 4.7% lower than in 1997, but the rate of decline was smaller than in previous year (9.3%) . Among the total number of newly registered cases there were 7,501 cases (19.4 per 100,000) bacteriologically confirmed, of which 4,090 cases were sputum smear positive . The proportion of bacteriologically culture positive cases was 56.4% and of sputum smear positive -30.7% 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 96.2% of cases the diagnosis was respiratory tuberculosis . Low proportion (3.8%) of non respiratory tuberculosis, which continuous for many years, may indicate inadequacies in diagnosis and registration of this form of disease . The incidence of tuberculosis increases with age, from 1.5 in children up to 67.3 among 65 and older . The proportion of cases in the age group 20-44 years is still high (38.1%) . The incidence in men (47.4) is two times higher than in women (22.1), and in rural population higher than in urban--35.6 and 33.7 respectively . The prevalence of tuberculosis at the end of 1998 was 39.5 (15,284 cases), of which 56.2% were bacteriologically confirmed cases (8,593 cases) . In the latter group there were 256 cases bacteriologically positive for longer than one year, and 541 cases resistant to at least 1 drug . The proportion of resistant cases (6.3%) is similar to previous years and does not seem to influence the overall effectiveness of chemotherapy . 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 is estimated at 25-30 years. J Ultrasound Med, 2000 Nov, 19(11), 743 - 9 Sonographic evaluation of cellulitis in children; Chao HC et al.; Within a 3 year period from July 1996 to July 1999, a total of 105 children with clinical diagnosis of cellulitis were evaluated by ultrasonography . Eighty-six children (age range, 17 days to 15 years) fulfilling the sonographic criteria for diagnosis of cellulitis were enrolled into the study . The sonographic features were used to correlate with clinical symptoms and their duration, the peripheral leukocyte count, and the serum C-reactive protein level . Pus aspiration for immediate microscopic and later bacteriologic studies was carried out under sonographic guidance . Ultrasonographic features of cellulitis included subcutaneous tissue thickening without distortion and pus (25 cases, 29%), distortion of subcutaneous tissue without pus accumulation (26 cases, 30%), distortion of subcutaneous tissue with pus accumulation (19 cases, 23%), and distortion of tissue with abscess formation (16 cases, 18%) . The presence of sonographic features of tissue distortion with or without pus accumulation, including abscess formation in children with cellulitis, correlated with a longer duration of symptoms (greater than 4 days), the presence of high-grade fever, higher peripheral leukocyte count, and higher serum C-reactive protein levels . Those patients who underwent sonographically guided aspiration or surgical intervention showed a shorter hospital stay and fever duration than those without such aspiration . Our results indicated that ultrasonography is of great value in managing cellulitis by providing information regarding the progression of inflammation . Sonographically guided aspiration of pus may be a treatment of choice, as it may decrease the need for operation. Nippon Hoigaku Zasshi, 2000 Aug, 54(2), 247 - 55 {A proposal of essentials for forensic pathological diagnosis of sudden infant death syndrome (SIDS)}; Takatsu A et al.; There are many sudden unexpected infant death cases which are easily diagnosed as sudden infant death syndrome (SIDS) both with or without autopsy in Japan . A SIDS diagnosis may provide a cover for accidental or criminal death . SIDS should not be a convenient diagnostic box that shelters the cases of unexpected infant death which lack the necessary antemortem information to make the correct diagnosis . The authors consider that SIDS should be diagnosed according to the direction of the international definition of SIDS, and propose the following essentials for a forensic pathological diagnosis . 1) A thorough autopsy should be performed based on precise autopsy protocol, including not only histological observation, but also, if necessary, toxicological, bacteriological, viral and/or biochemical examinations . 2) The forensic pathologist should be provided with pertinent information regarding antemortem health status, past clinical history, social circumstances, death scene investigation, etc . In order to collect more precise information, the authors recommend using a questionnaire such as the example in this report to record information from the deceased's guardians . 3) Suspicion of accidental death or infanticide should be completely ruled out . SIDS should be diagnosed only after these three essentials have been satisfied . When there is even a slight suspicion of accidental death or infanticide, or when the forensic pathologist can not obtain pertinent information about the deceased, the causes and classification of the death should be diagnosed as unspecified or undetermined . That is, the causes and classification of the death are undetermined as to whether it is a natural or unnatural death . Furthermore, several warning flags indicating a possible SIDS diagnosis were proposed: a case found dead in a supine position, the existence of a foreign body in the respiratory tract or mild infectious findings . The authors also emphasize the physician's responsibility to report a case found dead or dying of unnatural or clinically unexplained causes to the police . This is the crucial first step in getting an accurate diagnosis of SIDS. Antibiot Khimioter, 2000, 45(9), 13 - 9 {Spectrum of pneumotropic pathogens in pediatric patients with acute bronchitis and pneumonia}; Lykova EA et al.; One hundred eighty nine children with acute bronchopulmonary infectious pathological processes were examined bacteriologically and serologically for typical pneumotropic pathogens, 47 of them being as well examined for atypical organisms . Microbial associations mainly with Mycoplasma and Pneumocystis and to a lesser extent with Chlamydia were isolated from the majority of the children . Reactivation of the cytomegalovirus infection was observed in 25 per cent of the children . Pneumonia and bronchitis due to Mycoplasma pneumoniae either as a monoagent or in associations were mainly stated in children over 7 years of age . No significant changes between the indices of the infection due to a definite organism and the active progression of the infectious process of the same etiology were revealed, though in the cases of chlamydiosis the changes reached almost 10 per cent . In cases of acute bronchitis and pneumonia the chlamydial or cytomegalovirus infection could be assumed to be of the persisting nature, mainly acute in cases of pneumococcal infection, mixed in cases of hemophilic or pneumocystic infection, primary contamination with a tendency to prolonged in cases of mycoplasmic infection . The findings of the examination and the clinical and anamnestic data showed that the clinical picture of acute pneumonia had specific features associated with the supposed etiological agents, still it could change under the action of associations of pneumotropic pathogens. Pneumonol Alergol Pol, 1999, 67(11-12), 546 - 53 {Concentration of selected cytokines associated with monocytes/macrophages in serum of patients with different clinical stages of pulmonary tuberculosis}; Kwiatkowska S et al.; Monocytes/macrophages are the main effector cells as well as the essential elements in granuloma formation in tuberculosis . Serum concentration of some cytokines connected with monocytes/macrophages like IL-12, MCP-1, TNF-alpha i sTNFRI was assessed in patients with advanced bacteriologically confirmed pulmonary tuberculosis (I group) and in those with minimal tb changes, usually without clinical signs of the disease, and sputum smear-negative (II group) . We found that patients from group I had significantly higher concentration of IL-12 and sTNFRI and lower level of MCP-1 in comparison to group II . Significant difference between groups of patients with tuberculosis and the control group was found only while assessing serum concentration of TNFRI. Vestn Otorinolaringol, 2000, (5), 47 - 9 {Combined drug therapy in patients with chronic otitis media and mucositis}; Korviakov VS et al.; The data of the authors own studies using conservative therapy in patients with chronic otitis media (COM) and mucositis are presented . The efficiency of treatment of these patients is shown depending on the method of treatment (the highest efficiency being noted in the main group of patients in whom the altered middle ear mucosa was concurrently exposed to autoserum (AS) and magnetic laser therapy (MLT) . The efficiency of this or that conservative treatment was found to be related to the magnitude of altered middle ear mucosal changes: the more marked the signs of mucositis are, the more difficult it is to achieve a positive result . The results of treatment were assessed visually (under an operating microscope), bacteriologically, cytologically, and crystallographically . There was a correlation between the visual assessment of obtained treatment results and crystallographic findings . The high efficiency of the proposed treatment in patients with COM and mucositis is determined by the concurrent combined AS and MLT exposure of the entire thickness of the changed mucosa and by the stimulating action of MLT on AS . This conservative therapy can pretend to be the method of choice in treating patients with COM and mucositis. Yale J Biol Med, 1999 Sep-Oct, 72(5), 349 - 56 Alice C . Evans: breaking barriers; Colwell RR; Despite severe and persistent criticism of her research, Alice Evans persevered in her pioneering work on the bacterial contamination of milk, identifying the organism that caused undulant fever and demonstrating that drinking unpasteurized cow's milk could transmit the disease, undulant fever, to humans . The opprobrium that Alice Evans endured was unrelenting, even after her election as the first President of the Society of American Bacteriologists, (now the American Society for Microbiology), but she remained undeterred, a true heroine of American microbiology and a magnificent public health worker. Yale J Biol Med, 1999 Sep-Oct, 72(5), 341 - 7 Hans Zinsser: a tale of two cultures; Summers WC; Hans Zinsser, president of the Society of American Bacteriologists in 1926, was known as much for his literary and textbook writing as for his scientific contributions . He was a widely known scientist and person of letters . His early interests in poetry and other forms of literature were maintained and developed during his career as a microbiologist, and his most enduring legacy is based on his writing about microbiology for a general readership as well as his reflective and philosophical autobiography. Yale J Biol Med, 1999 Sep-Oct, 72(5), 329 - 39 Robert Earle Buchanan: an unappreciated scientist; Singleton R Jr; Robert Earle Buchanan (1883-1973), 19th President of the Society of American Bacteriologists (later American Society for Microbiology), was one of the more important 20th century microbiologists . He was a dominant force in creating the field of bacterial systematics and made significant contributions to microbial physiology . He also numbered a number of influential textbooks . A reasonable conclusion is that Buchanan was a major cultivator of modern microbiology . To justify that assertion, I have four major objectives in this essay: i) a brief biographical review of Buchanan's early life; ii) a brief review of his scientific contributions, many of which go beyond his recognized contributions to bacterial systematics; iii) Buchanan was an important academic administrator who created the microbiology program and fostered a strong graduate education program at Iowa State, iv)finally, I close the essay with a focus on Buchanan's "moral character." Yale J Biol Med, 1999 Sep-Oct, 72(5), 303 - 11 "The branches into which bacteriology is now ramifying" revisited; Bennett JW et al.; The American Society for Microbiology was originally founded in 1899 as the Society of American Bacteriologists . The transition from "bacteriology" to "microbiology" and from an emphasis on the identity of the membership (bacteriologists) to an emphasis on the discipline (microbiology) was a contentious one that occurred in several steps . This article reviews the history and events that accompanied this development. Arch Latinoam Nutr, 2000 Mar, 50(1), 87 - 90 {Nitrates and nitrites in homemade and industrial cheeses commercialized in the Southern region of Minas Gerais, Brazil}; Seraphim KR et al.; The evaluation of nitrate and nitrite in homemade and industrialized cheeses commercialized in the southern region of Minas Gerais State, was the aim of this work . In Brazil, the use of these additives is permitted at maximum levels of 50 mg/kg . The basis of the previously validated method is the quantitative reduction of nitrate to nitrite through cadmium column and spectrophotometric determination after nitrite diazotation with sulphanilic acid/alpha-naphtol reagent . From all samples analyzed, 38 (88.37%) showed neither a nitrate nor nitrite detectable content; 5 samples (11.63%) presented nitrate, 4 of them being above the tolerated level and only one (2.33%) showed detectable nitrite, however below the permissible limit . The majority of samples did not show nitrate or nitrite at detectable levels . However, though probably safe from a toxicological point of view, the results can implicate an increased risk of bacteriological contamination. Am J Surg, 2000 Aug, 180(2), 121 - 5 Whole gut washout ameliorates the progression of acute experimental pancreatitis; Yol S et al.; BACKGROUND: Septic complications are mainly responsible for deterioration of a patient with acute pancreatitis . Intestinal tract is accepted as the main source of pancreatic or peripancreatic infection . MATERIAL AND METHODS: Acute pancreatitis was induced in 40 Sprague-Dawley rats by ligation of the main biliopancreatic duct . Animals were divided into two groups . The first group of animals (n = 20) received high volume polyethylene glycol-3500 (GoLYTELY) for 6 hours through a silastic catheter introduced into the proximal part of the jejunum from a puncture gastrostomy during the initial laparotomy . The second group animals (n = 20) did not receive any treatment . Half of the animals from each group were sacrificed 72 hours later and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures . Cecum cultures were also prepared . Blood samples at 72 hours were obtained for the measurement of amylase, lactic dehydrogenase (LDH), lactic acid, alanine aminotransferase (ALT), glucose, calcium, arterial pH, base excess, partial oxygen pressure, bicarbonate, leucocyte count, and hematocrit levels . The pancreas was examined histopathologically . The remaining half of the animals from each group were allowed to survive until death . RESULTS: The levels of amylase, LDH, ALT, lactic acid, pH, pO(2), bicarbonate and base excess for the rats in group I were significantly lower when compared with the rats in group II (P<0.05) . Positive mesenteric lymph node cultures were detected in 30% of group I animals whereas they were positive in 90% of group II animals (P = 0.0198) . Distant organ cultures were positive in 8 animals (liver 5, spleen 2, pancreas 1) in group II, whereas only one positive distant organ culture (liver) was established in group I (P>0.05) . Histopathological scoring observed in the pancreas were less severe for the rats in group I when compared with the rats in group II (P = 0.012) . The rats in group I survived longer than the rats in group II (median survival 6.8 days versus 17.3 days, P<0.001) . CONCLUSIONS: Whole gut washout with high-volume polyethylene glycol in pancreatitis reduced the blood levels of enzymes and increased the survival . Whole gut washout for acute pancreatitis appears effective to ameliorate the prognostic factors in blood and this modality may be a promising treatment method in acute pancreatitis. Nucl Med Commun, 2000 Aug, 21(8), 747 - 53 Comparison of Tc-99m-labelled antileukocyte fragment Fab' and Tc-99m-HMPAO leukocyte scintigraphy in the diagnosis of bone and joint infections: a prospective study; Devillers A et al.; Between January and July 1998, we conducted a prospective study to compare Tc-99m-labelled antigranulocyte monoclonal antibody fragment Fab' (LEUKOSCAN) scintigraphy versus Tc-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO)-labelled leukocyte scintigraphy (HMPAO-LS) for the diagnosis of unselected patients with bone and joint infection . Twenty-three patients (16 men and 7 women; mean age, 67 years) with suspected bone infection were explored successively with bone scintigraphy, HMPAO-LS and LEUKOSCAN scintigraphy . Thirty-two foci were studied (diabetic foot = 11, prosthetic material = 8, joint disease = 4, others = diagnosed in 18 cases, eight on the basis of bacteriological and histological examination of surgical or puncture specimens, with or without radiographic signs, and 10 on the basis of clinical course and radiographic findings . Overall sensitivity, specificity and accuracy were 86%, 72% and 78%, respectively, for LEUKOSCAN scintigraphy (12 true positives (TP), 13 true negatives (TN), 5 false positives (FP), 2 false negatives (FN)), 93%, 100% and 96%, respectively, for HMPAO-LS (13TP, 18TN, 0FP, 1FN), and 100%, 17% and 53.3%, respectively, for bone scintigraphy . In this small series, LEUKOSCAN scintigraphy was found to be less specific for the diagnosis of osteomyelitis than HMPAO-LS . In addition, the interpretation of LEUKOSCAN scintigraphy is more difficult than HMPAO-LS for the diagnosis of bone infection in the diabetic foot, and would appear to be less discriminating for differentiating soft tissue infection from osteitis in the case of plantar perforating ulcers. Indian J Med Res, 2000 Aug, 112, 52 - 5 Leprosy affected beggars as a hidden source for transmission of leprosy; Rao PS et al.; BACKGROUND & OBJECTIVES: Despite the large scale implementation of multidrug therapy (MDT), the incidence rates of leprosy have not declined in several hyperendemic countries . Before searching for non-human reservoirs of leprosy it would be necessary to look for hidden human sources . This would include destitute leprosy affected persons who resort to begging and operate in congested areas . Hence this study was undertaken . METHODS: One major town and three semi-urban areas in Vellore district of Tamil Nadu and Chittoor town in Andhra Pradesh were purposefully selected for the study . All beggars in these towns were systematically identified and examined by allopathic doctors . Skin smears were examined for bacteriological index . RESULTS: Among the 193 beggars screened, 58 had leprosy . Of these 10 were smear positive . Several beggars, although living separately, were in touch with their relatives . Most beggars were pavement dwellers and regularly begged at places of worship, bus stands and shopping centres . INTERPRETATION & CONCLUSION: The fact that nearly 20 per cent of the leprosy affected beggars were skin smear positive highlights the need for regular screening and treatment of such beggars . Those positive should be actively treated and their close contacts frequently screened . This hidden reservoir should be completely eliminated. Int J Lepr Other Mycobact Dis, 2000 Jun, 68(2), 129 - 35 Trials of daily, long-term minocycline and rifampin or clarithromycin and rifampin in the treatment of borderline lepromatous and lepromatous leprosy; Rea TH; Daily, long-term treatment with minocycline 100 mg and rifampin 600 mg was initiated in 24 previously untreated borderline lepromatous (BL) and lepromatous (LL) patients for a total of 646 patient-months, averaging 26.9 months per patient . The same regimen was started in 12 BL and LL patients having a bacteriologic relapse for a total of 379 patient-months, averaging 32.5 months per patient, and in 12 patients judged to be at high risk for relapse for a total of 354 patient-months, averaging 29.5 months per patient . Daily, long-term treatment with clarithromycin 500 mg and rifampin 600 mg was initiated in 8 previously untreated BL and LL patients for a total of 174 patient-months, averaging 21.8 months per patient . The results in these 56 patients were compared to those obtained in 34 previously untreated BL and LL patients who were treated concurrently receiving daily, long-term dapsone 100 mg and rifampin 600 mg . No evidence of dangerous drug reactions or bone marrow, kidney or liver toxicity was seen in any of these five patient groups . Drug intolerance in 10 of the 90 patients studied necessitated discontinuing the chosen regimen, 4 from rifampin, 3 from dapsone, 2 from minocycline and 1 of undetermined attribution . The use of either minocycline or clarithromycin in conjunction with rifampin appears to pose no great risk when used long term. Am J Surg, 2000 Jul, 180(1), 65 - 72 Inflammatory consequences of the translocation of bacteria and endotoxin to mesenteric lymph nodes; Schoeffel U et al.; BACKGROUND: Translocation of intestinal bacteria to mesenteric lymph nodes (MLNs) has been documented in humans under a variety of circumstances, yet its clinical significance remains to be established . The aim of this study was to correlate detectable translocation to MLNs of bacteria and endotoxin with local and systemic signs of inflammation . METHODS: From each of 10 patients with carcinoma of the cecal region two MLNs were harvested prior to resection . The presence of bacteria and endotoxin in the lymphatic tissue and blood was determined by culture methods and DNA preparation (PCR) and by a Limulus assay, respectively . Inflammatory mediators were determined in plasma and in MLN homogenates . RESULTS: Viable bacteria were detected in MLNs of 7 patients and in 9 of 20 lymph nodes . PCR revealed traces of bacteria in 4 patients and in 6 of their MLNs . Combining both modalities, the translocation rate was 80% and 55% for patients and MLNs, respectively . There was no detectable bacteremia . Endotoxin was found in the plasma of 7 patients and in 9 MLNs from 5 patients . There was no correlation between culture findings and endotoxin concentrations . Moreover, bacteriological data did not correspond to local or systemic inflammation . The group of MLN with detectable endotoxin differed significantly from LPS-negative nodes with respect to interleukin-6, interleukin-10, and sCD14 . Systemic concentrations of endotoxin and inflammatory parameters did not correspond to levels within MLNs . CONCLUSION: Translocation to MLNs occurs in patients with cecal carcinoma . This, however, seems not to be of major clinical significance if no additional physiologic insults are encountered . Irrespective of the presence of bacteria, there are variations in inflammatory reactions between lymph nodes from one and the same patient, probably reflecting fluctuating response mechanisms to low-grade translocation. Chest, 2000 Oct, 118(4), 1158 - 71 Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline; Colice GL et al.; OBJECTIVE: A panel was convened by the Health and Science Policy Committee of the American College of Chest Physicians to develop a clinical practice guideline on the medical and surgical treatment of parapneumonic effusions (PPE) using evidence-based methods . OPTIONS AND OUTCOMES CONSIDERED: Based on consensus of clinical opinion, the expert panel developed an annotated table for evaluating the risk for poor outcome in patients with PPE . Estimates of the risk for poor outcome were based on the clinical judgment that, without adequate drainage of the pleural space, the patient with PPE would be likely to have any or all of the following: prolonged hospitalization, prolonged evidence of systemic toxicity, increased morbidity from any drainage procedure, increased risk for residual ventilatory impairment, increased risk for local spread of the inflammatory reaction, and increased mortality . Three variables, pleural space anatomy, pleural fluid bacteriology, and pleural fluid chemistry, were used in this annotated table to categorize patients into four separate risk levels for poor outcome: categories 1 (very low risk), 2 (low risk), 3 (moderate risk), and 4 (high risk) . The panel's consensus opinion supported drainage for patients with moderate (category 3) or high (category 4) risk for a poor outcome, but not for patients with very low (category 1) or low (category 2) risk for a poor outcome . The medical literature was reviewed to evaluate the effectiveness of medical and surgical management approaches for patients with PPE at moderate or high risk for poor outcome . The panel grouped PPE management approaches into six categories: no drainage performed, therapeutic thoracentesis, tube thoracostomy, fibrinolytics, video-assisted thoracoscopic surgery (VATS), and surgery (including thoracotoiny with or without decortication and rib resection) . The fibrinolytic approach required tube thoracostomy for administration of drug, and VATS included post-procedure tube thoracostomy . Surgery may have included concomitant lung resection and always included postoperative tube thoracostomy . All management approaches included appropriate treatment of the underlying pneumonia, including systemic antibiotics . Criteria for including articles in the panel review were adequate data provided for >/=20 adult patients with PPE to allow evaluation of at least one relevant outcome (death or need for a second intervention to manage the PPE); reasonable assurance provided that drainage was clinically appropriate (patients receiving drainage were either category 3 or category 4) and drainage procedure was adequately described; and original data were presented . The strength of panel recommendations on management of PPE was based on the following approach: level A, randomized, controlled trials with consistent results or individual randomized, controlled trial with narrow confidence interval (CI); level B, controlled cohort and case control series; level C, historically controlled series and case series; and level D, expert opinion without explicit critical appraisal or based on physiology, bench research, or "first principles." EVIDENCE: The literature review revealed 24 articles eligible for full review by the panel, 19 of which dealt with the primary management approach to PPE and 5 with a rescue approach after a previous approach had failed . Of the 19 involving the primary management approach to PPE, there were 3 randomized, controlled trials, 2 historically controlled series, and 14 case series . The number of patients included in the randomized controlled trials was small; methodologic weaknesses were found in the 19 articles describing the results of primary management approaches to PPE . The proportion and 95% CI of patients suffering each of the two relevant outcomes (death and need for a second intervention to manage the PPE) were calculated for the pooled data for each management approach from the 19 articles on the primary management approach . (ABST Cad Saude Publica, 2000 Jul-Sep, 16(3), 791 - 8 {Quality assessment of the public water supply in Nova Iguaçu, Rio de Janeiro}; d'Aguila PS et al.; This study proposes to develop methodologies for public water supply quality control by implementing evaluation and control mechanisms and enhancing environmental health surveillance decision-making . These objectives were based on data for waterborne diseases recorded at the Rio de Janeiro State Health Department . We selected the following neighborhoods: Posse (1st Township) and Caioaba (5th Township), with dissimilar situations, allowing us to produce a model of water supply coverage in the Municipality of Nova Iguacu, Rio de Janeiro State . The study underscored the poor quality of the water supply in the two townships, since 61% of the samples were positive on bacteriological examination, showing the undesirable effects of differential sanitation, especially in developing countries. Lupus, 2000, 9(8), 594 - 600 High prevalence of antiphospholipid antibodies in leprosy: evaluation of antigen reactivity; de Larranaga GF et al.; Antiphospholipid antibodies (aPL) have been reported not only in autoimmune disorders but also in various infectious diseases . Accumulating evidence indicates that beta2 glycoprotein I (beta2GPI) and prothrombin are the main proteins to which autoimmune aPL bind . The aim of this study was to evaluate the prevalence of different aPL in patients with leprosy . We included 51 outpatients (42 lepromatous and 9 borderline leprosy) without any clinical feature of the antiphospholipid syndrome (APS) . 35 had lupus anticoagulant and 31 had anticardiolipin antibodies (aCL) . Anti-beta2GPI antibodies were highly positive in 29/51 and anti- prothrombin antibodies (anti-II) were detected in 23/51 . Almost all aCL and anti-beta2GPI were of IgM isotype, while IgG isotype was more frequent among anti-II . No statistical difference was found when aPL were evaluated in patients grouped according to their bacteriological status . Furthermore, patients under treatment (n=33) had a similar frequency of positive aPL compared to patients in vigilance (n=14) . Assessing the specificity of antibody binding to CL and beta2GPI in ELISA by means of inhibition studies with cardiolipin-beta2GPI liposomes, leprosy and APS sera showed a similar behaviour . Comparable results were also found in both groups of patients when inhibition experiments with lysate of Mycobacterium leprae were carried out . In summary, leprosy-related aPL resemble those found in patients with APS but the immunoglobulin isotype is different, with IgM much more prevalent in leprosy patients. Rev Pneumol Clin, 2000 Sep, 56(4), 239 - 47 {Influence of nutritional status on development of nosocomial pneumonia in case of acute decompensation of chronic obstructive pulmonary diseases}; Bady E et al.; OBJECTIVE: The aim of this retrospective study was to assess the incidence of nutritional status on the development of nosocomial pneumonia in patients with chronic obstructive pulmonary disease (COPD) suffering an acute episode of respiratory failure requiring ventilatory assistance . PATIENTS AND METHODS: The study included 48 patients with COPD who were hospitalized in an intensive care unit for acute respiratory failure requiring ventilatory assistance . Nutritional status was assessed within 24 hours of admission to the intensive care unit . Body weight, tricipital skin fold, brachial muscle circumference, creatinuria-waist index, plasma levels of albumin, transferrin, transthyretin and retinol-binding protein, the Multitest and lymphocyte counts were recorded . The diagnosis of nosocomial pneumonia was based on recognized criteria: occurrence more than 48 hours after admission, Andrews' criteria for bacterial pneumonia and bacteriological proof . RESULTS: Nineteen of the 48 patients developed nosocomial pneumonia . The nutritional parameters at admission to intensive care were not significantly different between patients who developed nosocomial pneumonia and those who remained free of lung infection . The duration of ventilatory assistance and total stay in the intensive care unit were significantly longer in patients who developed nosocomial pneumonia . CONCLUSION: This study showed that in patients with COPD who undergo ventilatory assistance for acute decompensation, the development of nosocomial pneumonia was not correlated with nutritional status admission. Lik Sprava, 2000 Jul-Aug, (5), 88 - 94 {The characteristics of secondary pneumonia (the clinical, pathogenetic and bacteriological aspects)}; Asauliuk IK; The analysis of 857 medical histories of patients presenting with different bodily afflictions and traumata that had come to be complicated by secondary pneumonia (SP) and of more than 2700 protocols of pathoanatomic studies made in those deceased in 35 percent of whom there had been identified morphologic changes in the lungs that presented a clinical picture of SP suggest to us that there are reasons to believe that in many instances, SP diagnosis is made difficult because of a grave condition of the patient, especially during the terminal period or the period of administering treatments when the underlying trouble symptomatology come forth rather than manifestations of pneumonia . The information secured in the pathoanatomical investigations permitted finding out that the clinical diagnosis of SP had come to be in agreement with the pathoanatomical one only in 70 percent of cases, with hypodiagnosis having come to 30% . Practitioners in their everyday work, should entertain a possibility of SP development in somatic troubles, extensive surgical interventions, traumata, wounds/injuries, burns, intoxications, and septic conditions, and they are supposed to actively prevent any possibility of origination and development of pulmonary complications. Gastroenterol Clin North Am, 2000 Sep, 29(3), 633 - 48 Bacteriology and taxonomy of Helicobacter pylori; Windsor HM et al.; As the scientific community approaches the twentieth anniversary of the first isolation of H . pylori, it appears that despite the wealth of articles published in journals throughout the world every month, there are still many unanswered questions about the microbiology of this bacterium and others in the genus Helicobacter. Occup Environ Med, 2000 Nov, 57(11), 721 - 6 Evaluation of environmental bacterial contamination and procedures to control cross infection in a sample of Italian dental surgeries; Monarca S et al.; OBJECTIVES: To perform a pilot study on bacterial contamination in some dental surgeries (n=51) in a local health unit in Brescia (Lombardy Region, Italy) and to evaluate the procedures to control cross infection used by the personnel to reduce the risk of infection in dental practice . METHODS: A survey was carried out by interviewing 133 dental personnel with a questionnaire on the procedures used to control infection . The autoclaves, chemical baths (chemiclaves), and ovens present in the surgeries were tested for sterilisation efficiency with a spore test, and already packed and sterilised instruments were randomly sampled and tested for sterility . Microbial contamination of air, surface, and dental unit water samples were also studied . RESULTS: The dental personnel did not generally follow the principal procedures for infection control: 30% of personnel were not vaccinated against hepatitis B virus, infected instruments were often not decontaminated, periodic checks of autoclave efficiency were lacking, and the knowledge of disinfection mechanisms and procedures was incomplete . High bacteriological contamination of water at dental surgeries was often found and total bacteriological counts in air samples were high . Surface studies showed widespread bacterial contamination . CONCLUSIONS: On the basis of these results, an educational programme for the prevention of infective hazards has been prepared and carried out . The results of this pilot study will be used for planning a national survey. J Clin Nurs, 2000 Jan, 9(1), 95 - 102 Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration; Gould D et al.; Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits . Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks . A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness . An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits . The situation was less acute in a rural trust where a second audit was performed for comparative purposes . The motivation of clinical staff to improve hand hygiene precautions was high. Aust Vet J, 2000 Sep, 78(9), 608 - 11 An evaluation of a hand-held electrical resistance meter for the diagnosis of bovine subclinical mastitis in late lactation under Australian conditions; Seguya AG et al.; OBJECTIVE: To assess the ability of a hand-held device to differentiate between infected and noninfected bovine mammary glands according to the electrical resistance of milk, under Australian conditions . DESIGN: A cross-sectional study . PROCEDURE: Milk samples were collected from 236 quarters of 60 cows selected from a commercial dairy herd with a high prevalence of mastitis . The true infection status of these quarters was determined using bacteriology . Various methods were used in an attempt to relate the electrical resistance of milk from each quarter to the presence or absence of infection in that quarter . RESULTS: Although the electrical resistance of milk from infected quarters was generally lower than that of noninfected quarters, the overlap of readings between the two populations limited the ability of this device to indicate accurately whether a quarter was infected . The use of methods comparing the readings from each of the four quarters of a single cow did not allow the reliable detection of infected cows . CONCLUSION: Although this device may have some practical advantages in comparison with some other methods of diagnosing subclinical mastitis, the predictive value of the method was generally poor. J Microbiol Methods, 2000 Oct, 42(2), 121 - 7 Contrast-enhanced immunoelectron microscopy for Helicobacter pylori; Hong W et al.; Since a method of contrast enhancement for immunoelectron microscopy has not been available in bacteriology, the morphological localization of proteins of Helicobacter pylori is not well known . In this report, we established a method of contrast enhancement in immunoelectron microscopy in this organism . Immunostained ultrathin sections are stained with a mixture of alcian blue and osmium tetroxide prior to staining with uranyl acetate . This method of staining provided good contrast enhancement of the bacterial cell wall and membrane without any loss of immunolabeled gold particles on the ultrathin section. Z Rheumatol, 2000 Aug, 59(4), 233 - 9 {Possibilities and limits of conservative therapy of spondylitis and spondylodiscitis}; Flamme CH et al.; BACKGROUND AND AIM OF THE STUDY: For many years the treatment of spondylitis and spondylodiscitis has been discussed controversially . The aim of this study is to report on objective and subjective mid-term results of therapy of spondylitis and to present a differentiated concept of treatment . METHODS: Between 1988 and 1996, 58 patients were treated with spondylitis or spondylodiscitis . Nine of these patients had to be operated . A biopsy was taken in all of the cases . According to the antibiogram obtained by the biopsy, antibiotics were applied intravenously . The patients were immobilized by a plaster bed for at least 6 weeks and were then treated by a spinal orthosis for another 3 months . Patients were re-examined clinically and radiographically and by a questionnaire (including Roland-Morris score), after 8 years on average . RESULTS: Patients were diagnosed correctly 4 months after the begin of the disease . Spondylitis was predominantly localized in the lumbar spine . A positive bacteriological culture was derived from one third of the biopsies; none of them was a specific culture . C-reactive protein was revealed as appropriate for diagnosis and follow-up of spondylitis . In 84% of the patients a total or partial bony fusion was demonstrated radiographically . Questionnaire assessment revealed a significant decrease of the Roland-Morris score (17.8-7.4) and a significant relief of pain (8.9-2.5) . CONCLUSIONS: We recommend surgical treatment on patients with major vertebral body destruction, epidural abscess and progressive neurological impairment . These indications for operation can be prevented by a rapid diagnosis, so that spondylitis can be successfully treated by consequent immobilization in a plaster bed and appropriate antibiotics. Bull Soc Pathol Exot, 1999 Dec, 92(5 Pt 2), 408 - 10 {Medicine and medical science in 1898: insects and disease transmission}; Bynum WF; By the 1890's, some of the excitement had gone out of classic bacteriology . The germ theory of disease was widely accepted and the causative agents identified for many bacterial diseases . The nature of immunity preoccupied many scientists, but attention also shifted to the class of diseases which Patrick Manson called "tropical" . 1898 has claim to be the year in which tropical medicine came of age . It saw the work of Ross and Grassi on mosquito transmission of malaria, the research on the sexual nature of Plasmodium reproduction by Simond and MacCallum, the planning of the schools of tropical medicine in London and Liverpool, the opening of the Laboratory in Senegal, the first issue of the Journal of Tropical Medicine and the publication of Manson's classic textbook, Tropical Diseases . My talk will examine the state of biomedical knowledge a century ago, in a time of confident imperialism. Biotech Histochem, 2000 Jul, 75(4), 154 - 66 A brief history of the Biological Stain Commission: its founders, its mission and the first 75 years; Penney DP; The need for batch-to-batch consistency in available dyes and stains used for biological purposes posed a considerable problem for United States scientists following World War I . Prior to that time, most of the acceptable stains in this country were of German origin . In an attempt to standardize the performance of biological stains and dyes, the Society of American Bacteriologists in 1922 appointed Dr . Harold Conn to form the Committee on the Standardization of Biological Stains . To assist him, Dr . Conn recruited scientists from several major professional scientific societies . Mr . Rolland Will, a Rochester, NY, vendor of stains, was also instrumental in the Committee's success . This article traces the origin, mission and accomplishments of the product of that Committee, the Biological Stain Commission, through the past 75 years, and focuses on some of the major events that influenced and shaped its development. Khirurgiia (Mosk), 2000, (8), 38 - 41 {Basic principles of the treatment of chronic pelvic osteomyelitis}; Gostishchev VK et al.; The results of treatment in 177 patients with chronic osteomyelitis of the pelvis are reported . The diagnosis was clarified and the patients' general status was assessed by comprehensive examination (roentgenography, tomography, fistulography, scintigraphy, bacteriological, immunological, and laboratory studies) . A procedure of complex preoperative preparation, rational detoxication and immunocorrection, intraoperative blood loss replenishment (autohemotransfusion) and volemic disturbances correction was developed . This permits expansion of indications for surgery, whose basis is bone resection . Taking into account the localization of a pathologic process, the authors consider bone resection within the normal tissue limits to be a main component of surgical treatment of chronic pelvic osteomyelitis. Khirurgiia (Mosk), 2000, (8), 8 - 13 {Complex use of ultrasound in the diagnosis and treatment of surgical diseases of the lung and pleura}; Uspenskii LV et al.; Since 1980 the N.N . Burdenko Faculty Surgical clinic, I.M . Sechenov Moscow Medical Academy, has been using a combination of high- and low-frequency ultrasounds for the diagnosis and treatment of surgical diseases of lung and pleura in 156 patients for the diagnosis of pleuritis of various genesis, in 40 patients for transthoracic aspiration biopsy of lung tumors in the preoperative period, in 156 patients for pleural puncture and drainage, in 40 patients for the intraoperative differential diagnosis of peripheral lung tumors and for the inspection of hematogenic and lymphogenic metastatic areas, in 100 patients for intraoperative prophylaxis, and in 20 patients for the treatment of acute postoperative pleural empyema . Ultrasound was demonstrated to be of high informative value in diagnosing different pleuritis . Transthoracic aspiration biopsy was shown to have some advantages over standard methods: use of needle catheters for pleural puncture permits one to avoid serious complications (pneumothorax, bleeding, etc) . Ultrasound was used in intraoperative diagnosis of peripheral lung tumors for the first time . The use of low-frequency ultrasound for the intraoperative prevention of acute postoperative pleural empyemas promotes reliable sanitation of the pleural cavity, as confirmed by bacteriologic control data . Timely rethoracotomies with low-frequency ultrasound treatment of the pleura promote more rapid inflammation elimination in the pleural cavity and prevents irreversible complications. Auris Nasus Larynx, 2000 Oct, 27(4), 371 - 4 The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review; Sutbeyaz Y et al.; Tonsillar and laryngeal tuberculosis are rare diseases . We report a case with a tonsillar and laryngeal lesion . Histopathological and bacteriological examinations established the diagnosis of tonsillar and laryngeal tuberculosis associated with asymptomatic pulmonary focus. Indian Pediatr, 2000 Sep, 37(9), 947 - 51 Role of gastric lavage and broncho-alveolar lavage in the bacteriological diagnosis of childhood pulmonary tuberculosis; Singh M et al.; OBJECTIVE: To compare the mycobacteriological yield from gastric lavage (GL) and bronchoalveolar lavage (BAL), in children with pulmonary tuberculosis . METHODS: 58 consecutive children with chest radiograph suggestive of tuberculosis and positive Mantoux test or a positive history of family contact with a case of tuberculosis were prospectively subjected to gastric lavage on three consecutive mornings and broncho-alveolar lavage on the last day . The samples were subjected to bacteriological isolation . RESULTS: Samples from 10 (17.2%) children grew Mycobaterium tuberculosis from gastric lavage and 12 children had their BAL positive for this bacteria(p>0.05) . Overall mycobacterial isolation was possible in 20 patients (34.4%) as two children had grown Mycobacterim tuberculosis in GL as well as BAL . Addition of BAL to the diagnostic work up increased the mycobacteriological yield from 17.2% with gastric lavage alone to 34.4% when BAL was also performed (p=0.013) . CONCLUSION: There is no difference in mycobacterial isolation rates from gastric lavage and BAL when studied in isolation . However, when both GL and BAL are used; these procedures complement each other to double the diagnostic yield. Rev Med Interne, 2000 Aug, 21(8), 693 - 7 {Cutaneous nodules recurring in the legs ten years before the diagnosis of Wegener's granulomatosis}; Figarella I et al.; INTRODUCTION: Although cutaneous disorders preceding Wegener's granulomatosis are common, they usually are not isolated clinical features . We describe the case of a patient who presented Wegener's granulomatosis-related cutaneous disorders ten years before diagnosis, suggesting a protracted form of the disease . EXEGESIS: At first visit in 1987 a 44-year-old woman presented leg skin nodules since six months . Following biopsy clinical findings showed non-specific inflammation . Due to lung nodular lesions tuberculosis was diagnosed in 1993 . Though bacteriology did not confirm diagnosis, treatment was successful . After relapse in 1996, thoracotomy was performed and anatomic pathology findings uncovered Wegener's granulomatosis . The patient's history showed many flares of skin nodules since 1986 . This is only in 1997 that cutaneous pathologic findings showed the existence of Wegener's granulomatosis . CONCLUSION: The time to diagnosis after the occurrence of the first clinical signs is usually shorter than that observed . Superficial, protracted forms of the disease have been described . As in the present case, they raise diagnostic issues regarding the lack of specificity of anatomic pathology findings . This also suggests that Wegener's granulomatosis and infections might be related. Int J Tuberc Lung Dis, 2000 Sep, 4(9), 845 - 52 Three-year follow-up of patients with pulmonary tuberculosis in Guinea-Bissau, West Africa; Winqvist N et al.; SETTING: Raoul Follereau Hospital, Bissau, Guinea-Bissau . OBJECTIVE: To study the long-term outcome of patients with bacteriologically verified tuberculosis (TB), with or without human immunodeficiency virus (HIV) co-infection . DESIGN: Sputum samples were collected from all patients referred to the hospital with clinical symptoms of pulmonary tuberculosis . Direct microscopy and culture was performed at the Health Laboratory . Patients with a culture positive for Mycobacterium tuberculosis were followed for 3 years, and underlying factors were analysed regarding the outcome of treatment . A group of sex and age-matched HIV-negative individuals was used as controls . RESULTS: Of 206 bacteriologically verified pulmonary TB patients, 168 were followed up . Antibodies to HIV-2 were found in 33 patients (19.6%); eight patients (4.8%) had antibodies to HIV-1 or showed dual reactivity . Of 149 patients discharged to follow ambulatory treatment, the survival rate of HIV-2-positive patients was 42.3% (11/26) and for HIV-negative patients it was 81.9% (95/116) . The difference in survival between HIV-2-positive and HIV-negative patients was highly sig