Vet Pathol, 1999 Nov, 36(6), 542 - 50 Bacterial isolation, immunological response, and histopathological lesions during the early subclinical phase of experimental infection of goat kids with Mycobacterium avium subsp . paratuberculosis; Sigurdardottir OG et al.; The diagnosis of Mycobacterium avium subsp . paratuberculosis infection is difficult, especially in the early stages of disease . This is due to the long incubation period, the variable lag phase associated with bacterial proliferation, and the multifocal distribution of slowly developing lesions . There are few previous studies of the early stages of experimental paratuberculosis in goats . In the present study, the ability of conventional diagnostic methods to detect M . a . paratuberculosis infection during the early stages of infection was assessed . Eight goat kids were experimentally infected with M . a . paratuberculosis and subjected to a series of immunological and bacteriological tests before being euthanatized at various times postinfection . At postmortem examination, the ages of the kids ranged from 1 1/2 to 12 months . Of the eight goats infected, three had histopathological evidence of paratuberculosis . Two of these goats were positive with bacteriology, but only one was also positive with all immunological tests . One animal had a positive immunological response, but infection could not be demonstrated by bacteriologic or histopathologic examination . Histopathologic lesions were found in the jejunum, in the ileum, and in one mesenteric lymph node, but only the mesenteric lymph nodes and one retropharyngeal lymph node gave positive results following bacteriologic culture . The disparity between the localization of histopathologic lesions and bacteriologic results emphasizes the need for exhaustive sampling to confirm a diagnosis during the early phase of an infection . It also highlights the need for a better understanding of the biology of M . a . paratuberculosis and its interaction with the immune system of the host. Am J Gastroenterol, 1999 Nov, 94(11), 3245 - 7 Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection; Ok UZ et al.; OBJECTIVE: Blastocystis hominis (B . hominis) is a common intestinal parasite that has long been considered nonpathogenic . Recently there have been many reports supporting a role for the organism as a potential pathogen . We performed a study to examine the pathogenicity of B . hominis and the effect of trimethoprim-sulfamethaxazole (TMP-SMX) on this organism . METHODS: Stool samples of patients, who came to the Department of Parasitology, Faculty of Medicine, Celal Bayar University, were examined by direct wet-mount, trichrome staining, formalin-ethyl acetate concentration, and Kinyoun acid fast techniques for intestinal parasites, and bacteriological stool cultures were performed . Fifty-three symptomatic patients (38 children and 15 adults) with two consequent stool samples positive for abundant B . hominis (five or more organisms per x400 field) and negative for other parasitic and bacterial pathogens were treated with TMP-SMX for 7 days, children 6 mg/kg TMP, 30 mg/kg SMX, and adults 320 mg TMP, 1600 mg SMX, daily . On the seventh day, at the end of treatment, stool samples of all patients were examined by same methods, and clinical symptoms were again evaluated . RESULTS: B . hominis was eradicated in 36 of 38 (94.7%) children, and 14 of 15 (93.3%) adults . Clinical symptoms disappeared in 39 (73.6%), decreased in 10 (18.9%), and no change was observed in one (1.9%) patient, whereas symptoms persisted in all three (5.7%) patients in whom B . hominis could not be eradicated . Mean number of stools per day was significantly decreased from 4.3 to 1.2 in the 33 children (p < 0.001), and decreased from 3.5 to 1.0 in the four adults (p = 0.06) with diarrhea . CONCLUSIONS: These results suggested that B . hominis may be pathogenic, especially when it is present in large numbers, and TMP-SMX is highly effective against this organism . Although there are some anecdotal reports, to our knowledge this is the first study examining the effect of TMP-SMX on B . hominis in humans. Proc AMIA Symp . 1999;:648-52. Student and faculty performance in clinical simulations with access to a searchable information resource; Abraham VA et al.; In this study we explore how students' use of an easily accessible and searchable database affects their performance in clinical simulations . We do this by comparing performance of students with and without database access and compare these to a sample of faculty members . The literature supports the fact that interactive information resources can augment a clinician's problem solving ability in small clinical vignettes . We have taken the INQUIRER bacteriological database, containing detailed information on 63 medically important bacteria in 33 structured fields, and incorporated it into a computer-based clinical simulation . Subjects worked through the case-based clinical simulations with some having access to the INQUIRER information resource . Performance metrics were based on correct determination of the etiologic agent in the simulation and crosstabulated with student access of the information resource; more specifically it was determined whether the student displayed the database record describing the etiologic agent . Chi-square tests show statistical significance for this relationship (chi 2 = 3.922; p = 0.048) . Results support the idea that students with database access in a clinical simulation environment can perform at a higher level than their counterparts who lack access to such information, reflecting favorably on the use of information resources in training environments. Cas Lek Cesk, 1999 Aug 2, 138(15), 460 - 4 {Tuberculosis in the Czech Republic in 1997}; Trnka L et al.; In the Czech Republic in 1997 1834 new cases of TB and relapses were notified, i.e . 17.8 patients per 100,000 population . This number comprised 1557 cases of TB of respiratory tract (15.1 patients per 100,000 population) . By bacteriological examination 952 new cases of respiratory TB were confirmed (9.2 per 100,000 population) whereby in 524 patients the sputum was direct smear positive . There were 277 (2.7/100,000) extrapulmonary forms . TB was were in 1997 the cause of death of 62 patients (0.6/100,000) . These numbers did not differ significantly from data recorded in 1990-1996 and we may conclude from them that the stagnating character of TB persists . Newly detected cases of pulmonary TB (affection of the pulmonary parenchyma only) were recorded in 1328 patients . The notifications made it possible to create a set of direct and indirect epidemiological indicators (age distribution, TB mortality) which made it possible to provide evidence that in this country the validity-notification did not change substantially in recent years. J Clin Microbiol, 1999 Dec, 37(12), 3844 - 50 Bacteriological and molecular analysis of rifampin-resistant Mycobacterium tuberculosis strains isolated in Australia; Yuen LK et al.; To develop a better understanding of the epidemiology and molecular biology of rifampin-resistant Mycobacterium tuberculosis strains in Australia, 50 clinical isolates (33 rifampin-resistant and 17 rifampin-sensitive strains) cultured between 1990 and 1997 were analyzed by a number of bacteriological and molecular techniques . Examination of the drug resistance profiles of the 33 rifampin-resistant isolates revealed that 91% were resistant to rifampin in combination with resistance to isoniazid, 88% were resistant to rifampin on first isolation, and 81% showed cross-resistance with rifabutin . On the basis of the demographic data provided for the patients infected with the rifampin-resistant strains, 90% of the patients were born overseas . Of these patients, 64% developed clinical symptoms within 5 years of residence in Australia . On a molecular level, analysis of the rpoB gene revealed that 97% of the rifampin-resistant isolates had missense mutations within a conserved region of the gene, and eight types of missense mutations were detected . Of the 31 rifampin-resistant isolates that were typed by restriction fragment length polymorphism (RFLP) analysis, 28 distinct patterns were obtained by RFLP analysis with IS6110, and three clusters of genetically related isolates were identified . All isolates within the clusters were from patients who were born overseas and who had the same country of origin . The results from this study provide an overview of the current situation of rifampin resistance in Australia and can serve as a basis for continued monitoring of drug-resistant M . tuberculosis strains isolated within the country. Kekkaku, 1999 Oct, 74(10), 741 - 6 {Factors for the onset of and the exacerbation of tuberculosis . 3 . Clinical factors for the development and the exacerbation of active tuberculosis . a . Children, young adult}; Takamatsu I; We reviewed the reports about the development and the exacerbation of active tuberculosis and performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997 . The factors for the development and the exacerbation of active tuberculosis were the bacteriological status of the source, the age of the person infected, the degree of tuberculin sensitivity, BCG non-vaccination, non-chemoprophylaxis, the medical condition that increases the risk for tuberculosis, the presence of other infection, poor nutrition. Burns, 1999 Nov, 25(7), 625 - 35 Effectiveness of human amnion preserved long-term in glycerol as a temporary biological dressing; Maral T et al.; Human amnion as a temporary biological wound dressing has remained a beneficial and cost-effective means of treating burns in developing countries . The aim of this study was to determine whether human amnion that has undergone long-term preservation in glycerol is an effective biological dressing compared to fresh amnion and glycerol-preserved human skin . Samples of human amnion and skin were preserved in sterile containers of 85% glycerol at 4 degrees C for over a year . Dorsal full-thickness or split-thickness skin wounds were produced in rats . The defects were divided into four areas, each of which was covered with preserved amnion, fresh amnion, preserved skin, or left uncovered as a control . The materials on the wounds were evaluated macroscopically and microscopically after 2, 4, 7, 10 and 14 days . The primary take or adherence of the grafts on full-thickness wounds was evaluated at 4 and 7 days, and material performance was scored based on several macroscopic and microscopic criteria . The bacteria levels reducing effect of the materials were examined by quantitative bacteriology in heavily infected full-thickness scald burn wounds of rats . Qualitative cultures confirmed that the storage conditions the materials were subjected to for over a year were aseptic and that the amnion and skin had maintained their characteristic properties . All materials were found effective on partial-thickness rat wounds as a cover under which re-epithelialization was completed by 7 days . The preserved skin performed better than either preserved or fresh amnion on full-thickness wounds but the performance of preserved amnion was comparable to that of fresh amnion . Glycerol-preserved amnion was found to be as effective as fresh amnion or skin in terms of decreasing bacterial levels in infected rat burn wounds . Amnion stored in glycerol is reliable and effective for a long period of time . Amnion banking could provide an unlimited quantity of biologic dressing for burn treatment at low cost, a factor that is particularly important in developing countries. Can Vet J, 1999 Nov, 40(11), 792 - 5 {Comparison of host water wash and trimming of pork carcasses for reducing the level of bacterial contamination}; Rheault N et al.; This study was carried out to evaluate the microbial contamination on pork carcasses after they had fallen on the floor in the cooler and also to evaluate the effectiveness of trimming and hot, high-pressure water washing (55 degrees C) . A bacteriological analysis was done on 2 groups of 40 carcasses before and after trimming or washing, along with a group of 10 control carcasses . Results showed that the bacterial total count was higher (P = 0.01) on carcasses after they had fallen, but, in this study, no significant difference (P = 0.76) was found for total coliform contamination . Also, no significant difference was observed between total count for aerobic bacteria, total coliforms, and Escherichia coli before and after decontamination, no matter which technique was used . Neither trimming nor washing carcasses showed, in this study, a significant difference (P = 0.37) in the reduction of the total aerobic bacterial count on the pork carcasses analyzed (P = 0.65). J Formos Med Assoc, 1999 Sep, 98(9), 599 - 605 Constrictive pericarditis in patients with tuberculous pericarditis; Chen KY et al.; Constrictive pericarditis is a complication of tuberculous pericarditis that necessitates surgical intervention . In this study, we sought to identify echocardiographic features that could predict the development of constrictive pericarditis from acute or subacute pericarditis . From January 1988 through May 1998, all patients with a discharge diagnosis of tuberculous pericarditis were enrolled in the study, and their clinical features, laboratory findings, sonographic images, treatments, and outcomes were analyzed . Tuberculous pericarditis was demonstrated on the basis of positive Mycobacterium tuberculosis cultures from pericardial fluid or tissue in 11 patients; pericardial biopsy specimens demonstrating caseating granulomas in seven; and bacteriologic or histologic evidence of active extra-pericardial tuberculosis in conjunction with major pericardial effusion in four . Seventeen patients had effusive tuberculous pericarditis and five had constrictive tuberculous pericarditis as the initial diagnosis . The echocardiographic findings of effusive pericarditis were classified as shaggy-type effusion (n = 8) and non-shaggy-type effusion (9) . Shaggy effusion was defined as the presence of multiple fibrin strands or a mass-like exudate coating the pericardium and bridging the pericardial effusion . Non-shaggy effusion was characterized by an anechoic pericardial space with or without a thickened pericardium, but no shaggy exudative coating . The mean duration between the onset of symptoms and diagnosis was longer in patients with shaggy-type effusion (39.6 +/- 8.7 vs 21.0 +/- 13.9 days, p < 0.05) . Prednisolone (20-30 mg/d) was used in addition to antituberculous chemotherapy in 11 of the 17 patients with effusive pericarditis . Two of 11 patients (18%) who received steroid therapy, and five of the six patients (83%) who did not, developed constrictive pericarditis in the following year . Therefore, we concluded that adjuvant therapy with steroids significantly decreased the risk of constrictive pericarditis in patients with non-shaggy, but not shaggy, effusion. Am J Respir Crit Care Med, 1999 Nov, 160(5 Pt 1), 1682 - 7 Predictors of outcome and long-term survival in patients with pleural infection; Davies CW et al.; In pleural infection, medical treatment failure (chest-tube drainage and antibiotics) requires surgery and increases mortality . It would be helpful to predict which patients will fail this approach . We examined clinical predictors in 85 consecutive patients with pleural infection receiving chest drainage and intrapleural fibrinolytics, and recorded age, length of history, antibiotic delay and choice, time to drainage, blood/pleural fluid (PF) bacteriology, PF pH, lactate dehydrogenase (LDH), glucose and appearance, effusion size, pleural thickness on computed tomographic (CT) scan, and survival from time of drainage . Failures (surgery/death) were compared with successes . There were 13 (15%) medical failures . PF purulence was more frequent in medical failures (10 of 13 versus 29 of 72 successes, p < 0.02 chi-square) . Absence of purulence was a useful predictor of success (positive predictive value {PPV} 93%) . Purulence was not useful in predicting medical failure (PPV 26%) . There was a trend for positive blood culture to predict failure (5 of 13 failures versus 11 of 72 successes, p = 0.05 chi-square), but no significant differences in other endpoints . Twelve (14%) patients died in follow-up, all with comorbidity within 400 d after drainage . Probability of survival at 4 yr was 86% . Of endpoints considered in this study, PF purulence was the only useful predictor of outcome with medical therapy in pleural infection . There is good long-term survival from pleural infection. Surg Neurol, 1999 Oct, 52(4), 404 - 10; discussion 411 Stereotactic surgery in the management of brain abscess; Barlas O et al.; BACKGROUND: Bacterial brain abscesses can be diagnosed and treated with stereotactic aspiration . METHODS: From 1991 to 1997 we have used computed tomography-guided stereotactic aspiration to diagnose and treat 21 patients with a total of 58 bacterial brain abscesses . The ages of the patients ranged from 4 to 72 years (median 25 years); 11 of these 21 patients had multiple abscesses . The number of abscesses per patient with multiple abscesses ranged from 2 to 9, all located deep in subcortical white matter . RESULTS: All patients underwent stereotactic surgical drainage and an 8-week intravenous antibiotic medical treatment . Of the 58 abscesses, 23 were aspirated . Of these 23 abscesses, 19 were radiologically stage III or IV and four were stage I or II . Pathological examination confirmed radiological staging in 19 patients (83%) . Except for the three patients who have mild residual hemiparesis and one patient recovering from ataxia, all patients had complete neurological recovery . CONCLUSIONS: Computed tomography-guided stereotaxy achieved all the objectives of management; namely, ascertaining the diagnosis, draining the content of the mass, and obtaining pus for accurate bacteriological diagnosis without morbidity . Stereotactic aspiration combined with an 8-week intravenous antibiotic regimen has yielded an effective therapeutic result in all of our abscesses, small or large, solitary or multiple, superficial or deep-seated . A high radiological-pathological correlation was also deduced from this study. Eur J Cardiothorac Surg, 1999 Sep, 16(3), 283 - 6 Videothoracoscopic debridement of the postpneumonectomy space in empyema; Hollaus PH et al.; OBJECTIVE: Simple irrigation has proven to be an efficient method to treat postpneumonectomy empyema provided that bronchopleural fistula is not present or successfully closed . However, with this treatment modality, infected material inside the thoracic cavity is not removed and this can be a potential source of empyema recurrence if the patient's immune system is compromised . The removal of the infected material should result in a lower recurrence rate . METHODS: As soon as diagnosis of postpneumonectomy empyema was established, a chest tube drainage was inserted . A concomitant bronchopleural fistula was evaluated bronchoscopically . If the fistula was smaller than 3 mm, bronchoscopic sealing with fibrin glue (Tissucol, Immuno, Vienna) was initiated . Fistulas closed surgically were excluded from this analysis . The thoracic cavity was cleared of infected material by videothoracoscopy and bacteriological samples were taken . Immediately after operation antibiotic irrigation according to culture sensitivity was started via a single chest tube drainage twice a day . After instillation of antibiotics the drain was kept clamped for 3 h . Culture samples were obtained twice a week . Empyema was considered eradicated, if three subsequent cultures showed no bacterial growth . After drain removal the patients were kept in hospital for another week and observed for clinical signs of infection; WBC and CRP were controlled . RESULTS: Nine patients (five men, four women) between 55 and 72 years (mean 61, SD 6), all initially operated on for malignancy, were successfully treated with this regimen . In three cases a concomitant bronchopleural fistula was successfully closed before videothoracoscopy . The interval between primary operation and empyema was between 7 and 436 days (mean 93, SD 141) . There was no postoperative mortality and no procedure related morbidity . Operating time ranged from 45 to 165 min (mean 92.7, SD 36.6), the suction volume (consisting of blood, debris and pus) was 300 to 1000 ml (mean 880, SD 600) . Duration of thoracic drainage was 12-38 days (mean 22, SD 9), duration of hospital stay after videothoracoscopy 21-46 days (mean 29, SD 9) . During the follow-up period of 204-1163 days (mean 645, SD 407) no recurrence of tumour or empyema was observed . CONCLUSIONS: Videothoracoscopic debridement of the postpneumonectomy space with postoperative antibiotic irrigation of the pleural space is an efficient method to treat postpneumonectomy empyema, provided that a concomitant bronchopleural fistula can be closed successfully . No early empyema or fistula recurrence were observed . However, late recurrence may occur many years after operation, therefore close follow-up is indicated. J Hosp Infect, 1999 Oct, 43(2), 149 - 54 A hospital outbreak of gastroenteritis possibly related to the contamination of tap water by a small round structured virus; Schvoerer E et al.; Small round structured viruses (SRSVs) are a major cause of gastroenteritis in institutions and sensitive new molecular techniques allow rapid diagnosis and the establishment of control measures . In January 1999, a 10 day-long outbreak of gastroenteritis in a re-education ward, was reported by a hospital hygiene department . A potential common source of contamination was tap water . The stools of six patients with gastroenteritis and seven tap water samples from the hospital ward, were tested for SRSV by reverse transcription and polymerase chain reaction (RT-PCR): three stools and four water samples, all bacteriologically negative, were SRSV-positive . Nucleotide sequencing of a fragment of the SRSV polymerase gene showed that the sequences of the positive samples (two patients and four water samples) were identical (genogroup II) . We cannot exclude interhuman transmission of SRSV together with viral soiling of some taps in the ward, but this hospital infection was more likely due to the transient contamination of the ward supply of drinking water with a SRSV strain. Med Arh, 1999, 53(3 Suppl 1), 11 - 2 Tuberculosis control and surveillance in changing health reform in the Czech Republic; Trnka L et al.; In the Czech Republic a centralized, governmentally budgeted and vertically structured health system has been reformed to a liberalized health system with fragmentation of organisation, responsibilities and funding after 1989 . Tuberculosis (TB) control and TB surveillance followed the general health system reform and implementation of liberalized health insurance system . In the liberalized health system the feasibility and accessibility of methods of TB control rather improved . In contrary to that TB surveillance in the liberalized system suffered bu absence of vertical mechanisms ensuring the completeness and validity of data collected in a centralised notification system (recording and reporting system) . The rate of control notification dropped up to 50% . TB surveillance was therefore supplemented in 1996 by vertically oriented mechanisms of the hygienic (public health) service . TB consultants were appointed at regional and mostly also on district level as part-time jobs of the hygienic service and entitled to supervise all notifications from the given region (district), particularly what regards completeness of bacteriological data . As a consequence complete and reliable reports on epidemiological situation are issued and an assessment of antituberculous chemotherapy of new TB cases is made by a regional cohort analysis starting 1st quarter 1998 . TB situation in the Czech republic is regarded as stable, being under control, with a decreasing trend of bacteriologically confirmed TB cases and increasing trend of bacteriologically not confirmed pulmonary TB . The TB is slowly shifting to high risk groups of population. Med Trop (Mars), 1999, 59(2), 181 - 92 {Epidemic typhus in Africa}; Ndihokubwayo JB et al.; Epidemic typhus is caused by a small strictly intracellular virus named Rickettsia prowazekii, a member of the Rickettsial family . It is transmitted to man by the body louse, Pediculus humanus . Although now rare in Western countries, exanthematic typhus remains common in the Southern hemisphere due to poverty, inadequate clothing hygiene, and poor socioeconomic conditions . In Africa, outbreaks have historically occurred in Burundi, Rwanda, southwest Ouganda, and Ethiopia . The largest outbreak of epidemic typhus since the World War II was reported in Burundi where ongoing civil war since October 1993 has forced 10 p . 100 of the population of Burundi to live in cold, promiscuity, and malnutrition of makeshift refugee camps . The purpose of this report based on our two-year experience working with this unfortunate population is to describe the characteristics of this disease in Africa where the epidemic form had become rare until recently . Indeed political unrest as well as numerous civil wars are now epidmiological factors favorizing outbreaks of epidemic typhus at any time . This overview also provides an opportunity to recall epidemiological, bacteriological, and clinical aspects of typhus as well as diagnosis and treatment of the disease in the context of Africa. J Comp Pathol, 1999 Nov, 121(4), 321 - 37 Lesions in cattle exposed to Mycobacterium bovis-inoculated calves; Cassidy JP et al.; Nine calves were housed for periods ranging from 24 to 117 days in close contact with cattle inoculated intranasally with Mycobacterium bovis . These "in-contact" calves were examined immunologically and bacteriologically during the period of exposure, and pathologically and immunocytochemically post mortem . Three became infected by day 14, as indicated by the detection of M . bovis in nasal mucus . In-vitro interferon-gamma production and lymphocyte proliferation were detected after stimulation of peripheral blood with M . bovis antigens in the majority of in-contact animals by day 28; this provided support for the role of immunological mechanisms in pathogenesis . Tuberculous lesions were found in the submandibular and bronchomediastinal lymph nodes and in the lungs of the in-contact calves; in distribution and appearance the lesions resembled those observed in naturally occurring disease . The distribution of M . bovis antigen and the numbers of mycobacteria within pulmonary lesions are reported . 1999 Harcourt Publishers Ltd. Ann Pathol, 1999 Sep, 19(4), 294 - 8 {Aseptic abscesses in eight patients with cryptogenic inflammatory bowel disease}; Kemeny JL et al.; The aim of this study was to describe aseptic abscess related pathologic changes observed in eight patients with inflammatory bowel disease . Patients were 3 men and 5 women whose age ranged from 15 to 60 . Seven had Crohn's disease and one had ulcerative colitis . Diagnosis preceded abscess onset in two cases . Bacteriological investigations were performed in all cases and were negative . In all biopsy specimens, Hematoxylin and Eosin, PAS, Grocott, Whartin-Starry, Gram and Ziehl-Nielsen stains were negative . Histological changes were comparable and could be divided into early and older lesions . After discussion of the differential diagnoses, the hypothesis of a new clinico-pathological entity is suggested. J Dermatol, 1999 Sep, 26(9), 569 - 76 Macular lesions in leprosy: a clinical, bacteriological and histopathological study; Sarkar R et al.; Among 150 untreated patients of leprosy, 19 had only macular lesions; three were of the indeterminate type, and eight each were of the tuberculoid and the borderline types, according to the Indian Association of Leprologists (IAL, 1981) classification . The clinical, bacteriological, and histopathological parameters of these 19 patients were studied both before and after six months of WHO Multi Drug Therapy (MDT/1982) . A single macule was present in seven (36.84%) patients . In twelve (63.16%), two or more were seen . In eighteen (94.74%), one or more peripheral nerves were enlarged . The size of the macules varied from 5 to 15 cm, and there were no changes seen even after treatment . In most (94.74%) of the patients, the macules were hypopigmented . The surfaces were rough and dry in seven (36.84%) but smooth in the other twelve (63.16%) . The margins were well defined in the seven (36.84%) patients with single macules but ill defined in the other twelve (63.16%) . After six months of antileprosy treatment, the single macules showed some resolution . Slit skin smear examination was negative in all cases before and after treatment . Clinico-histopathological correlations were seen in only six (31.58%) patients; the clinical diagnoses were indeterminate and tuberculoid leprosy in three (15.79%) patients each . In the indeterminate group, the clinico-histopathological correlation was 100%; it was 37.50% in the tuberculoid group . There were no correlations between the clinical and histopathological parameters in thirteen (68.42%) cases . After six months of treatment, the histopathology became nonspecific in all patients . The lepromin test was positive in six (31.58%) patients; four were of the tuberculoid group and one each from the indeterminate and borderline leprosy groups . Hence, although macular lesions can be seen throughout the leprosy spectrum, it is difficult to correlate their clinical, bacteriological and histopathological parameters. Eur J Surg, 1999 Sep, 165(9), 897 - 902 Immune function of the upper splenic remnant supplied by short gastric vessels; Gurleyik E et al.; OBJECTIVE: To study the immune function of the upper third of the spleen supplied by short gastric vessels after two thirds partial splenectomy . DESIGN: Experimental study . SETTING: Teaching hospital, Turkey . MATERIAL: Sixty Wistar-albino rats, 20 in each group . INTERVENTIONS: Control = sham laparotomy; partial splenectomy = the upper third of the spleen supplied by short gastric vessels was preserved after two thirds partial splenectomy and dividing the main vascular supply; and total splenectomy . At the end of the sixth week postoperatively, antigenic stimulation was induced with an injection of pneumococcal suspension in 10 animals from each group . 0.5 ml of diluted Indian ink was injected into the aorta . MAIN OUTCOME MEASURES: Histological architecture of splenic tissue, and changes in the white pulp after antigenic stimulus . Bacteriological analysis with aerobic blood culture . Phagocytic activity as counted by Indian-ink-laden macrophages . The ability to produce antibodies as measured by serum IgM concentrations . RESULTS: Histological architecture of splenic tissue was normal . Germinal centres (p = 0.02), lymphoid follicles (p = 0.09), and their ratio (p = 0.0006) in the white pulp of the splenic remnant was significantly increased after antigenic stimulus compared with normal spleen . Significantly more animals without spleens developed bacteraemia (p = 0.02) . Phagocytic activity of the upper splenic remnant was 89% that of normal spleen . Serum IgM concentrations without antigenic stimulus were 144, 138.2 (p = 0.6), and 86.2 (p < 0.001) mg/L; and with antigenic stimulus 263, 201.7 (p < 0.0001), and 98.1 (p < 0.0001) mg/L in groups 1, 2, and 3, respectively . The increase in serum IgM concentrations as a response to antigen was significant in the control (p < 0.0001) and in the partial splenectomy group (p < 0.0001), but not in the splenectomy group (p = 0.1) . CONCLUSIONS: After reduction of its volume, the upper splenic remnant remained adequately supplied by the short gastric vessels . The upper part of the spleen preserved its normal histological architecture, had considerable phagocytic activity, possessed the ability to produce antibodies, and created a satisfactory immune response to antigenic stimulus . In rats, a considerable volume of functional and well perfused splenic tissue is preserved even after dividing the main vessels. Eur J Surg, 1999 Sep, 165(9), 875 - 84 Piperacillin/tazobactam compared with cefuroxime/ metronidazole in the treatment of intra-abdominal infections; Ohlin B et al.; OBJECTIVE: To assess the effect of piperacillin/tazobactam compared with cefuroxime/metronidazole in the treatment of patients with intra-abdominal infections . DESIGN: Randomised open study . SETTING: 16 Swedish and 6 Norwegian hospitals . SUBJECTS: 269 patients with intra-abdominal infections were randomised and treated with at least one dose of each study drug . 205 patients, 105 treated with piperacillin/tazobactam and 100 with cefuroxime, were clinically evaluable for follow up (had been given the full course of treatment) . INTERVENTION: Patients were given piperacillin 4g/tazobactam 0.5 g every 8 hours or cefuroxime 1.5 g every 8 hours plus metronidazole 1.5 g every 24 hours . Each patient was to be treated for a minimum of 3 days and not more than 10 days . MAIN OUTCOME MEASURES: Clinical evaluation of infection at the end of and 4-6 weeks after treatment . Evaluation of safety and tolerance to the drugs and bacteriological susceptibility to the treatment drugs . RESULTS: In the intention to treat analysis treatment was equally successful for piperacillin/ tazobactam (103/140, 74%) and the cefuroxime/metronidazole groups (90/129, 70%) (p = 0.6) . Corresponding figures for the clinically evaluable group were 102/105 (97%) and 94/100 (94%) for piperacillin/tazobactam and cefuroxime/metronidazole groups, respectively, at the end of treatment . At late follow up, 92/105 (88%) and 83/100 (83%) in the two groups, respectively, remained free of infection . The side effects of the treatment were mild and evenly distributed between the two groups . Most pathogens were susceptible to the drugs in both treatment groups . CONCLUSION: Both piperacillin/tazobactam and cefuroxime/metronidazole are well suited to the treatment of patients with intra-abdominal infections, and we found no significant difference between the two . The drugs were safe and well tolerated in the regimens used. Infect Immun, 1999 Nov, 67(11), 5676 - 82 Expression and characterization of the Mycobacterium tuberculosis serine/threonine protein kinase PknB; Av-Gay Y et al.; PknB is a member of the newly discovered eukaryotic-like protein serine/threonine kinase (PSTK) family of proteins . The pknB gene was cloned and expressed in Escherichia coli . The active recombinant protein was purified and shown to be reactive with antiphosphoserine antibodies, as well as with antibodies to the phosphorylated eukaryotic Ser/Thr kinases mitogen-activated protein kinase kinase 3 and 6, P38, and Creb . In vitro kinase assays demonstrated that PknB is a functional kinase that is autophosphorylated on serine/threonine residues and is also able to phosphorylate the peptide substrate myelin basic protein . Analysis of pknB expression in Mycobacterium tuberculosis indicates the presence of pknB mRNA in (i) organisms grown in vitro in bacteriological media, (ii) a murine macrophage in vitro infection model, and (iii) in vivo alveolar macrophages from a patient with tuberculosis. Microbiol Immunol, 1999, 43(7), 699 - 703 The characterization of Shiga toxin-non-producing Escherichia coli serotype O157:H7 isolated from carcasses of cattle at a slaughter house; Itoh Y et al.; A bacteriological investigation of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157:H7 was performed on 298 carcasses of cattle at slaughter houses between July 1996 and January 1997 in Gifu Prefecture, Japan . As a result, four Stx-non-producing Escherichia coli O157:H7 strains were isolated from two slaughtered carcasses of cattle . The purpose of this study was to examine the characterization of isolates . Isolates possessed the E . coli attaching and effacing gene (eaeA), and hemolysin gene (hlyA), and harbored 3.0-MDa and 60-MDa plasmids . The Xba I pulsed-field gel electrophoresis (PFGE) pattern showed three similar patterns . Consequently, a closely related genotype of Stx-non-producing E . coli O157:H7 may widely exist in cattle. Klin Oczna, 1999, 101(3), 179 - 83 {Pars plana vitrectomy in the treatment of endophthalmitis}; Kmera-Muszynska M et al.; PURPOSE: To assess the effectiveness of vitrectomy in the treatment of patients with endophthalmitis . MATERIAL AND METHODS: Ten patients with endophthalmitis were qualified for treatment with vitrectomy via pars plana of a cilliary body . Endophthalmitis was diagnosed as resulting from previous: ECCE + I in 3 patients, penetrating bulb injury in 3 patients, penetrating keratoplasty in 1 patient; 3 other patients suffered from endogenous endophthalmitis . In all patients prior to surgical procedure samples of the vitreous were collected for bacteriology and mycology tests . RESULTS: In 9 cases the surgery was followed by intravitreal administration of 1 or 2 antibiotics . In 1 case an antibiotic was added to the infusion solution . In all patients the following data were analyzed together with the result of a surgical procedure: cause of endophthalmitis, visual acquity directly before and after the procedure and over the follow-up period (from 6 months to 3 years), time delay between the onset of endophthalmitis and vitrectomy performed . CONCLUSION: Vitrectomy performed via pars plana of a cilliary body is an effective method of treatment in cases of endophthalmitis . In patients with endophthalmitis early performed vitrectomy, followed by adequate adjuvant pharmacotherapy determine the chances for good postoperative prognosis. Surg Endosc, 1999 Oct, 13(10), 1001 - 6 Effects of laparoscopic vs laparotomy treatment of E . coli peritonitis on hemodynamic responses in a porcine model; Palombo JD et al.; BACKGROUND: Laparoscopic surgery is being used now for increasingly diverse clinical applications, including diagnosis and treatment of appendicitis and bacterial peritonitis . However, some concerns and controversies exist regarding the effectiveness of laparoscopic irrigation of the abdominal cavity compared with that achieved during laparotomy . Of no less importance is concern that establishing a CO(2) pneumoperitoneum in patients with cardiopulmonary insufficiency or endotoxemic shock may compromise hemodynamic function . The objective of this randomized, controlled study was to determine the effects of laparoscopic versus laparotomy intervention on hemodynamic and outcome measurements using a porcine model of Escherichia coli peritonitis . METHODS: For this study, 24 specific pathogen-free Hanford pigs underwent surgical placement of carotid, Swan-Ganz, and peritoneal catheters . After a 24-h recovery period, one subset of pigs (n = 12) received a bolus infusion of 9 x 10(8) CFU/kg E . coli intraperitoneally (septic) and intravenous fluid resuscitation . The remaining 12 pigs were not challenged with E . coli (control) . Twenty-four hours later, all 24 pigs underwent either laparoscopic or open peritoneal irrigation with saline, then were reevaluated 48 h after surgical intervention . Standard cardiopulmonary, hematologic, and bacteriologic assessments were obtained both perioperatively and 48 h after surgical intervention . RESULTS: Pigs given E . coli exhibited significantly elevated heart rates and core temperatures and decreased O(2) saturation during the initial 6 h . Within 24 h, these pigs exhibited respiratory alkalosis, altered blood leukocyte profiles, and E . coli-infected peritoneal fluid . Random blood samples from the septic pigs tested negative for E . coli . Mean pulmonary artery and capillary wedge pressures were lower (p < 0.05) in septic than in control pigs before and after surgical intervention . Septic pigs that underwent laparoscopy had significantly lower (p < 0.05) arterial pH and higher arterial pCO(2) levels than septic pigs after laparotomy . Other cardiopulmonary responses were similar irrespective of the surgical modality used . One of six septic pigs from each surgical group still had E . coli growth in its peritoneal fluid 48 h after surgical intervention . CONCLUSION: Laparoscopic intervention demonstrated effectiveness equal to that of laparotomy for treating acute E . coli peritonitis in pigs without septic shock. Am J Gastroenterol, 1999 Oct, 94(10), 2881 - 4 Isolation of Helicobacter pylori from vomitus in children and its implication in gastro-oral transmission; Leung WK et al.; OBJECTIVE: The route of transmission of Helicobacter pylori (H . pylori) is unclear . Gastro-oral transmission via contaminated vomitus has been proposed as an important mode of transmitting H . pylori, especially in children . This pilot study attempted to isolate H . pylori from the vomitus of children . METHODS: Children presenting for evaluation with gastroenteritis-associated vomiting were studied . Fresh vomitus samples were collected for detection of H . pylori by bacteriological culture and polymerase chain reaction, (PCR) . A rapid, whole blood test was used to determine the H . pylori status of patients . RESULTS: A total of 18 children with mean age of 6 yr were studied; four had a positive serology test . Among these four children, H . pylori was isolated from vomitus by culture in one child and by PCR in two . An 18-month-old girl with negative serology had H . pylori detected in vomitus by PCR . Six months later, she had seroconversion confirmed, suggesting that she had an acute H . pylori infection on initial presentation . CONCLUSIONS: This is the first study reporting successful isolation of H . pylori from naturally produced vomitus . The result implies that transmission of H . pylori infection by vomitus, especially in children, is possible. Int J Dermatol, 1999 Sep, 38(9), 676 - 9 'Airborne' contact dermatitis due to Leica immersion oil; Geraut C et al.; BACKGROUND: Contact dermatitis has often been described in healthcare staff, resulting essentially from the use of natural rubber latex gloves, antiseptics, and especially aldehydes . This study reports an unusual cause of contact dermatitis in laboratory technicians . MATERIALS AND METHODS: Four patients working in the bacteriology departments of three different hospitals were seen for airborne contact dermatitis . All were patch tested for specific plastics and glues . RESULTS: For all patients, positive patch reactions were obtained with classic epoxy resins, such as diglycidylether of bisphenol, as well as with new types, such as diglycidylether of bisphenol F and an epoxyacrylate resin . CONCLUSIONS: Although phenols and ether handled by the laboratory technicians and an epoxy mastic applied during floor repair were initially suspected, an immersion oil used in light microscopy proved to be the real cause of the dermatitis . To our knowledge, these are the first reported cases due to this type of contact. Eur Respir J, 1999 Aug, 14(2), 339 - 46 Distinct sputum cytokine profiles in cystic fibrosis and other chronic inflammatory airway disease; Osika E et al.; The dominant role of inflammation in airways disease progression in cystic fibrosis (CF) is now well established and, based on recent findings, the possibility of an inappropriate inflammatory response in the lung of patients with CF has emerged . In order to characterize this response, the aim of the present work was to evaluate the levels of a number of pro- and anti-inflammatory cytokines in the sputum of CF children and to compare these levels to those observed in the sputum from non-CF children with diffuse bronchiectasis (DB) . Three groups of patients were investigated: a group of 25 CF children (mean age: 12.2 yrs), a group of 10 non-CF children with DB (mean age 11.5 yrs), and a group of five healthy young adults (mean age 24 yrs) . Elevated concentrations of pro-inflammatory cytokines, tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-8 were found in children with CF and in non-CF children with DB, with significantly higher concentrations of IL-1beta in CF children . Analysis of the natural anti-inflammatory cytokine IL-1 receptor antagonist (IL-1ra) and type II TNF soluble receptor (sTNFRII) concentrations showed distinct patterns, with elevated levels of both inhibitors in CF patients, whereas only sTNFRII was found to be increased in non-CF children with DB . IL-10 data indicated low concentrations in the CF group . In all CF children, the concentrations of IL-6 in the airways were extremely low, independent of the clinical, bacteriological or functional status . By contrast, significantly increased IL-6 levels were found in non-CF children with DB . These results document distinct cytokine profiles in cystic fibrosis patients and noncystic fibrosis patients . They also suggest that impairment of interleukin-6 expression may represent an important component of the excessive inflammatory response observed in cystic fibrosis. Spine, 1999 Sep 15, 24(18), 1909 - 12 Late-developing infection in instrumented idiopathic scoliosis; Clark CE et al.; STUDY DESIGN: This is a retrospective review of all patients requiring either Cotrel-Dubousset or Moss Miami rod removal . All initial spinal instrumentations were for adolescent idiopathic scoliosis from 1985 through 1994 . Twenty-two patients who underwent rod removal for late-developing infection constitute the study group . OBJECTIVES: To determine the bacteriology and treatment of patients with late-developing infection after posterior spinal instrumentation for scoliosis . SUMMARY OF BACKGROUND DATA: There have been conflicting reports regarding this entity, some reporting a high percentage of positive cultures and others a low yield . The latter have attributed the entity to fretting corrosion . Much literature describes late appearance of infection with large foreign bodies (implants) . Glycocalyx, a membrane that surrounds bacteria adjacent to surgical implants, results in poor antibiotic penetration, poor macrophage action, and difficulty in culturing bacteria . METHODS: One thousand two hundred forty-seven patients who underwent posterior instrumentation from 1985 through 1994 were reviewed . Those requiring implant removal were further studied . Those with late-developing infection (more than 1 year after the initial procedure) were further reviewed . Culture reports, presence of pseudarthrosis, and antibiotic regimen after implant removal were the primary parameters studied . RESULTS: Twenty-two patients (1.7%) experienced development of late infection a mean of 3.1 years after the initial procedure . In specimens from these patients cultured only 72 hours, only 1 of 10 was positive . Of those cultured for 7-10 days (the last 12) 11 were positive, usually for low-virulence skin organisms . After surgery, patients received antibiotics parenterally for 48 hours and orally for 7 days . All wounds were closed primarily . Four patients had pseudarthroses, two underwent revised procedures with titanium implants without signs of infection at more than 2 years' follow-up . CONCLUSIONS: Late-appearing infection with spinal instrumentation can be treated with device removal, primary skin closure, and short-term oral antibiotics . The infections affect soft tissue, not the bone. J Pediatr Orthop B, 1999 Oct, 8(4), 302 - 5 Epidemiologic, bacteriologic, and long-term follow-up data of children with acute hematogenous osteomyelitis and septic arthritis: a ten-year review; Christiansen P et al.; A total of 69 children with acute hematogenous osteomyelitis and 48 with septic arthritis admitted in the period 1978 through 1987 were included in a retrospective review . Epidemiologic and bacteriologic data were analyzed and compared with those of an earlier study (1965 through 1975), confined to the same geographic area . Long-term outcome was evaluated by a questionnaire and clinical and radiographic follow-up . A significant increase in the admission rate for both disorders was observed . The long-term outcome was favorable: major sequelae were found in three patients (3%), minor sequelae in two patients (2%) . The benign long-term outcome may well be related to rapid hospital admission and appropriate long-lasting antibiotic treatment. Vet Microbiol, 1999 Aug 31, 68(3-4), 301 - 6 Early in vivo interactions of Actinobacillus pleuropneumoniae with tonsils of pigs; Chiers K et al.; Twenty gnotobiotic piglets were inoculated with 5 x 10(8) colony forming units of an Actinobacillus pleuropneumoniae biotype 1-serotype 9 strain onto their tonsils . Five other piglets (controls) were inoculated with phosphate-buffered saline solution . Pigs were euthanized at 30 min, 90 min, 180 min, 6 h, 9 h, 12 h or 24 h after inoculation . At necropsy, samples were taken from the tonsils for bacteriological, histological, immuno-histochemical and electron microscopical examination . A . pleuropneumoniae was isolated from tonsils of all the infected pigs, but not from tonsils of the control pigs . Early after inoculation bacteria were mainly associated with the stratified squamous epithelium and detached epithelial cells . Vacuolization and desquamation of the epithelium was observed and many transmigrating neutrophils were present . At later times after inoculation, bacteria were found closely associated with the crypt-walls and with detached cells present in the crypts . A strong neutrophil migration was observed mainly in the deeper parts of the crypts . It is concluded that attachment of A . pleuropneumoniae to tonsillar epithelial cells probably constitutes a first step in establishing bacteria at this body site. Transplantation, 1999 Sep 15, 68(5), 672 - 7 Preserved vascular homograft for revascularization of pediatric liver transplant: a clinical, histological, and bacteriological study; Martinez JA et al.; BACKGROUND: Arterial or venous homografts are frequently implanted for vascular reconstruction in orthotopic liver transplantation (OLT) . When fresh vascular homografts (VH) from the same donor were not available, VH from another donor preserved at 4 degrees C in Terasaki (Ter) solution (modified lymphocyte culture medium) were used . METHODS: The clinical results after implantation of Ter-stored VH versus fresh VH in the revascularization of pediatric OLT were studied retrospectively . Short- and long-term follow-up of vascular patency was carried out by doppler ultrasonography in each case . A histological and bacteriological study of nonimplanted VH stored at 4 degrees C in saline (Sal), Ter and University of Wisconsin (UW) solutions for various time periods (days 0-28) was also undertaken . RESULTS: Between 1989 and 1996, 21 iliac arteries and 21 iliac veins preserved in Ter solution (mean preservation time: 8 days; range 1-26) and 100 fresh VH (68 arteries and 32 veins) (preservation time: 8 hr, range 4-21) were used in pediatric OLT . Thrombosis rates were 0 of 21 for stored arteries vs . 7 of 68 (10%) for fresh arteries (NS) and 3 of 21 (14%) for stored veins vs . 3 of 32 (9%) for fresh veins (NS) . Actuarial graft survival rates were similar in both groups . Histological analysis of stored, nonimplanted VH invariably showed endothelial destruction within 24-48 hr after procurement . The bacteriological study showed contamination rates of 14 of 25 (56%) for Sal-stored VH, 5 of 25 (20%) for UW, and 1 of 19 (5%) for Ter (Sal vs . UW and Sal vs . Ter: P<0.01; UW vs . Ter: NS) . CONCLUSIONS: Ter-preserved cadaveric VH could be safely used in OLT despite early destruction of endothelium. J Vet Pharmacol Ther, 1999 Aug, 22(4), 274 - 82 A multilocation clinical trial in lactating dairy cows affected with clinical mastitis to compare the efficacy of treatment with intramammary infusions of a lincomycin/neomycin combination with an ampicillin/cloxacillin combination; Deluyker HA et al.; A study was conducted to compare the efficacy in lactating dairy cows of intramammary infusions in quarters affected with clinical mastitis between a formulation containing 330 mg lincomycin and 100 mg neomycin in a 10-mL aqueous solution (LINCOCIN FORTE S, Pharmacia & Upjohn) and a formulation containing 75 mg ampicillin and 200 mg cloxacillin in an oil suspension (AMPICLOX, Pfizer Animal Health) . This study was designed as a multicentre clinical trial involving investigators in France, Germany and Belgium and carried out according to the European Commission guidelines on Good Clinical Practices . Cows in the herds were monitored for clinical mastitis . When evidence of clinical mastitis was detected in a single quarter, a pretherapy milk sample was collected from the affected quarter . After milk sampling, the cow was assigned to one of the two treatment groups at random and treated with an intramammary infusion of one syringe of either LINCOCIN FORTE S or AMPICLOX for three successive milkings in the mastitic quarter . At 4-5, 13-15 and 20-22 days after first infusion, the veterinarian returned to the farm to conduct a clinical examination and collect milk samples from the affected quarter . Milk samples were cultured for the presence of mastitis organisms and somatic cell count (SCC) was measured . Following a 10-month study period, 256 cases were enrolled in the study . A total of 232 and 189 cases were analysed for clinical cure and for clinical-plus-bacteriological cure, respectively . The proportions of cases cured clinically and cured clinically-plus-bacteriologically were compared between the two treatment groups . Somatic cell count differences between treatment groups were also tested . The clinical cure rate for LINCOCIN FORTE S (62.5%) was significantly better than for AMPICLOX (51.8%) (P = 0.035) . The clinical-plus-bacteriological cure rate was also significantly better for LINCOCIN FORTE S (38.1%) than for AMPICLOX (21.7%) (P = 0.005) . Among bacteriologically cured cases, the SCC declined in both treatment groups but the SCC was significantly higher for the AMPICLOX group than for the LINCOCIN FORTE S group (P = 0.036) . In conclusion, clinical cure rate, clinical-plus-bacteriological cure rate, and SCC level were significantly better with LINCOCIN FORTE S than for AMPICLOX. Cent Eur J Public Health, 1999 Aug, 7(3), 109 - 15 Present state of tuberculosis in the Czech Republic and in central European and Baltic countries; Kubin M et al.; The Central Europe forms a buffer zone between the countries of the European West reporting tuberculosis notification rates lower than 20 per 100,000, the cut-off set between low and high incidence areas, and the Eastern European countries including the republics of the former USSR, Russia and the Baltic States . The Czech Republic holds an intermediate place between these two territories with the total notification rate of tuberculosis cases 18.8, 9.7 bacteriologically verified and 5.7 positive in direct smear per 100,000 in 1996 . Data on drug resistance obtained from the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance were available from the Czech Republic, the only Central European country participating in the Project . The prevalence of resistant cases was here low: 2% primary and 13% acquired, and MDR cases were recorded in 1% of untreated and in 6% of repeatedly treated patients . The first microepidemic of MDR cases comprising 21 individuals was characterized by DNA fingerprinting . This outbreak pointed out the MDR tuberculosis as a new, extremely serious phenomenon in the epidemiology of tuberculosis . Corresponding data from Estonia and Latvia showed incomparably higher values in the drug resistance pattern: from 28 to 34% primary and 46 to 74% acquired resistance . MDR strains were reported in 9 to 14% of untreated and in 19 to 54% of repeatedly treated patients. Medicine (Baltimore), 1999 Sep, 78(5), 309 - 20 Spinal tuberculosis in adults . A study of 103 cases in a developed country, 1980-1994; Pertuiset E et al.; Spinal tuberculosis (TB) accounts for about 2% of all cases of TB . New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged . Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD) . We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD . The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients) . Sixty-eight percent of patients were foreign-born subjects from developing countries . None of our patients was HIV-positive . SPD accounted for 48% of cases and SPwD for 52% . Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions . Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups . Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases . Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77) . Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin . Median duration of antituberculous chemotherapy was 14 months . Surgical treatment was performed in 24% of patients . There were 2 TB-related deaths . Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries . The reasons for this remain to be elucidated. Anim Reprod Sci, 1999 Aug 16, 56(3-4), 259 - 77 The influence of exogenous steroid hormones on steroid receptors, uterine histological structure and the bacterial flora of the normal bitch; Dhaliwal GK et al.; Oestrogen (ER) and progesterone (PR) receptors have been shown to vary in both concentration and distribution during the oestrous cycle of the bitch, influenced by the normal changes in endogenous reproductive hormones . The influence of exogenous steroid hormones on steroid receptors and the histological structure of the uterus was studied in two groups of parous Beagle bitches . Group A (n = 6) were treated with progesterone (P4) in oil i.m . (3 mg/kg) in late metoestrus on the day that peripheral plasma P4 concentrations were first identified as <10 ng/ml, and subsequently once weekly on three other occasions . Group B (n = 6) were treated with a single i.m . injection of MPA (50 mg, 4.2-5.6 mg/kg) following the same protocol . Full-thickness uterine wall biopsies were obtained from the mid part of one horn 2-7 days after the last (fourth) injection of P4 or MPA . During the subsequent oestrus, when peripheral plasma P4 concentrations were between 8 and 10 ng/ml, each bitch in both groups (n = 12) received a single injection of oestradiol benzoate (ODB) in oil i.m . (7.5 mg, 0.63-0.84 mg/kg) . All bitches had an ovariohysterectomy 7 days later . Full-thickness uterine wall samples were obtained from the mid part of the intact horn and other parts of the uterus . Swabs were taken from the uterine lumen for bacteriological examination; all were sterile . Tissue samples were sectioned and examined for evidence of lesions, and stained for ER and PR receptors using an immunocytochemical method . The immunoreactivity was scored semiquantitatively, incorporating both the intensity and distribution of specific staining of the receptors using a simplified histoscore (H-score) . At the time of ovariohysterectomy, fluid had accumulated in the isolated section of the uterine horn distal to the point of biopsy; the volume was greater in the MPA-treated bitches . There was also evidence in some sections of histological changes in the endometrium . Variations in the expression of both ER and PR were seen between bitches, which may have been due to some not being in mid-metoestrus at the time of treatment . In general, ER scores were low after P4 and MPA treatment, but following ODB there was a significant (P<0.05) increase in ER expression in all parts of the endometrium . PR scores were zero in the glandular epithelium of all 12 bitches after P4, MPA and ODB treatment, whereas in the other parts of the endometrium they were generally moderate to high . Following treatment with ODB, PR generally increased in the three regions of the endometrium where PR were present . The study shows that ER and PR distribution and expression in the endometrium of bitches can be modified by P4, MPA and ODB, with evidence of individual variation. Ann Acad Med Singapore, 1999 Mar, 28(2), 178 - 82 Dissemination of respiratory secretions during tracheal tube suctioning in an intensive care unit; Ng KS et al.; Most intensive care patients require frequent tracheal toilet, a procedure usually performed by suctioning the tracheal tube . Such procedures often result in the production and dissemination of droplets . We measured the distance visible droplets disseminated during tracheal tube suctioning of patients in an adult surgical intensive care unit . Fifty consecutive suction procedures in 14 patients intubated with a cuffed tracheal tube were investigated . Visible droplets were scattered over a mean distance of 60 +/- 39 cm (range 25 to 168 cm) from the tracheal tube . Blood agar culture plates were placed at three fixed points from the tracheal tube to identify organisms resulting from environmental contamination (control plates) . This was repeated during suctioning procedures (study plates) to look into the occurrence of bacteriological cultures that differ from the control plates . Nine of the 14 patients had tracheal tube aspirate cultures done as part of their work-up for sepsis . In more than 30% of the suctioning procedures on these 9 patients, study plates grew bacteria that were similar to those present in their tracheal tube aspirates . In view of these observations, greater care should be taken to avoid contamination of the patient's immediate environment during tracheal tube suctioning and in the design of the intensive care unit. J Am Vet Med Assoc, 1999 Sep 15, 215(6), 826 - 8, 796 Actinobacillus lignieresii infection in two horses; Carmalt JL et al.; A 10-year-old pregnant Norwegian Fjord horse was examined for gross swelling of the muzzle of 2 years' duration . Examination of biopsy specimens revealed diffuse dermal fibrosis, micropustule formation, and vascular thrombosis; large numbers of Actinobacillus lignieresii were isolated in pure culture . Prolonged treatment with i.v . administration of sodium iodide and oral administration of trimethoprim-sulfamethoxazole caused regression of the swelling and did not induce abortion . A 5-month-old American Paint filly was examined for swelling in the udder region . Bacteriologic culture of purulent material obtained from the left teat revealed A lignieresii . Treatment with oral administration of rifampin and trimethoprim-sulfamethoxazole resulted in complete resolution of clinical signs . To the authors' knowledge, these findings represent the first report of mastitis and chronic nasal cellulitis caused by A lignieresii infection in horses. Rev Soc Bras Med Trop, 1999 Jul-Aug, 32(4), 405 - 11 {Endoparasite prevalence in truck farmers and in the vegetables of Feira do Produtor de Maringá, Paraná}; Guilherme AL et al.; Few studies have assessed the contamination of vegetables at Brazilian production sites . From April 1996 to December of 1997, the sanitary conditions of raw consumed vegetables sold in the Feira do Produtor de Maringa were investigated . We based the analyses on the contamination of vegetables, of the producers (stool samples and material under the fingernails) and of the water used for irrigation . It was observed that 16.6% of 144 samples of five different types of vegetables were contaminated with intestinal parasites . Forty three of 163 individuals (26%) were infected with one or more parasites . Only three of the 49 samples of material under the fingernails analyzed were positive for intestinal parasites . Analysis of samples of the water used for vegetable irrigation showed that the water did not satisfy bacteriological standards of potability . We conclude that in the investigated area the contamination of vegetables occurred during the production phase and that a sanitary education campaign directed at the producers is needed. Avian Dis, 1999 Jul-Sep, 43(3), 622 - 6 Isolation of ornithobacterium rhinotracheale from turkeys in Quebec, Canada; Joubert P et al.; In the spring of 1997, three large white hybrid turkey layer flocks of 52 wk of age experienced a severe respiratory condition . During the outbreak, the turkeys showed respiratory signs, an increased mortality rate, and an important drop in egg production . Macroscopic and histopathologic examinations were carried out on several carcasses, as well as bacteriologic analyses on different tissues . Colonies of Ornithobacterium rhinotracheale (OR) were detected after 24 hr of incubation, and the isolate appeared to be serotype A . The identification of the species was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins . Since 1993, several cases of OR infection have been diagnosed in the United States and more recently in Canada . Monitoring of this emerging infection is recommended. Int J Tuberc Lung Dis, 1999 Sep, 3(9), 786 - 90 Cause of death of patients on treatment for tuberculosis: a study in a rural South African hospital; Moorman J et al.; SETTING: Tintswalo Hospital, a rural district hospital in South Africa . OBJECTIVES: To assess the quality of data relating to deaths from tuberculosis; to determine the actual cause of death of patients who die whilst on tuberculosis treatment . DESIGN: A descriptive study of all patients who were treated for tuberculosis between January 1992 and June 1996, and who died during their course of treatment . A review of records, X-rays and death certificates of patients whose cause of death was recorded as tuberculosis . Verbal autopsies were done for patients who died at home . Deaths were classified into one of five categories: definitely, likely or possibly due to tuberculosis, unlikely or not due to tuberculosis, based on criteria such as bacteriological confirmation of tuberculosis and the presence of other illnesses . RESULTS: There were 927 cases of tuberculosis and 80 deaths recorded as due to tuberculosis . Valid criteria or detailed information were available for only 68 patients . Only 56% of deaths were confirmed or likely to be due to tuberculosis, and 12% of patients probably did not have tuberculosis at all . The remaining 32% had tuberculosis but died of other illnesses . CONCLUSIONS: The recorded tuberculosis mortality data were clearly inaccurate . There is a need to improve tuberculosis diagnosis, documentation on death certificates, and tracing of treatment interrupters in order to determine whether or not they have died. Am J Med Sci, 1999 Sep, 318(3), 171 - 80 History of medicine: the metamorphosis of scientific medicine in the ever-present past; Cruse JM; Hippocrates (460-370 BCE), the father of medicine, developed principles for medical diagnosis and treatment together with a code of ethics . When the first Ptolemy ruled Egypt, he created a great library of 700,000 rolls at Alexandria, which became a repository for the works of Socrates, Plato, Aristotle, Hippocrates, and all the writings of the known world, but it was destroyed by a great fire . Galen of Pergamum (129-216), who lived 500 years after Hippocrates, was well educated and studied anatomy, surgery, drugs and Hippocratic medicine . His ideas influenced medical thinking for the next 1500 years . The Arabic physician Ibn Sina (Avicenna) wrote a great medical work entitled Canon of Medicine . After the Dark Ages (500 to 1050), academic medicine was reestablished in Europe, especially at Salerno, Bologna, Padua, Paris, Montpellier, and Oxford . The greatest medical disaster of the Middle Ages was the Black Death . Other diseases of note were leprosy, smallpox, tuberculosis, typhus, measles, diarrhea, meningitis, and colic . As interest in human dissection increased, the study of anatomy became popular . With development of the printing press, medical knowledge became more widely disseminated and technical advances in science flourished . Advances in medicine occurred in concert with developments in technology . These included the microscope, the stethoscope, anesthetic agents, discoveries in bacteriology, a carbolic acid spray to reduce infection during surgery, the clinical thermometer, blood transfusions, electrocardiography, X-rays, and the sphygmomanometer . Johns Hopkins University was established at the end of the 19th century to train scientifically knowledgeable physicians . The first faculty included Welch, Osler, Halstead, Kelly, Mall, and Abel . Graduates of the new school carried scientific medicine to universities throughout America . More medical advances have been made during the 20th century than in all the other centuries combined . Advances in medical knowledge have resulted not only from developments in technology but from increased access to current information provided through libraries such as the National Library of Medicine in Bethesda, Maryland. J Invertebr Pathol, 1999 Sep, 74(2), 164 - 72 Gnotobiological study of infective juveniles and symbionts of Steinernema scapterisci: A model to clarify the concept of the natural occurrence of monoxenic associations in entomopathogenic nematodes; Bonifassi E et al.; Gnotobiology of Steinernema scapterisci and bacteriological study of its symbiont confirmed that this nematode harbors a symbiotic species of Xenorhabdus, as do other Steinermena species . Based on phenotypic and 16S rDNA data, this Xenorhabdus strain UY61 could be distinguished from other Xenorhabdus species . Bacteria reported previously as being associated with this nematode and belonging to several other genera were probably contaminating bacteria located in the intercuticular space of the infective juveniles (IJs) . These bacteria were detrimental to nematode reproduction in Galleria mellonella . Axenic S . scapterisci and its symbiont Xenorhabdus strain UY61 alone were not pathogenic to G . mellonella . The combination of both partners reestablished the pathogenicity of the complex toward G . mellonella . This combination also gave the best yields of IJs when produced in this insect and in vitro production on artificial diet . Eur J Cardiothorac Surg, 1999 Aug, 16(2), 181 - 6 Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle flap; Hollaus PH et al.; OBJECTIVES: The value of the pedicled intercostal muscle flap for the closure of postpneumonectomy bronchopleural fistulas was studied retrospectively . METHODS: Bronchopleural fistula was suspected in case of fever, cough, putrid or haemorrhagic expectoration, in combination with a rise of WBC and CRP . Fistula diagnosis was established bronchoscopically . Two patients underwent an initial trial of bronchoscopic sealing, the rest were reoperated immediately after fistula diagnosis . Immediately after operation antibiotic irrigation according to culture sensitivity was started via a single chest tube drainage twice a day . After instillation of antibiotics the drain was kept clamped for 3 h . Culture samples were obtained twice a week . Empyema was considered eradicated, if three subsequent cultures showed no bacterial growth . After drain removal the patients were kept in hospital for another week and observed for clinical signs of infection, WBC and CRP were controlled . Age, side, sex, histology, TNM-stage, duration of hospital stay after fistula diagnosis (days), duration of treatment (defined as the duration of chest tube drainage in days after operation), total hospital stay (including the initial hospital stay for primary resection and the hospital stay for fistula treatment in case of readmission), fistula size (mm), interval (days) between primary operation and fistula formation, and bacteriology were recorded . RESULTS: Eight patients (seven male) were treated . Age ranged from 46 to 70 years (mean 57.86) . Six fistulas were located on the right side . All patients had non small cell lung cancer . Interval ranged from 2 to 72 days (mean 26.9 days) . Fistula size ranged from 1 to 7 mm (mean 3.43) . Seven fistulas were successfully closed . Duration of treatment lasted from 15 to 28 days in those patients treated successfully (mean 17) . Hospital stay ranged from 15 to 31 days (mean 24.4) . In one patient the flap became necrotic, he was successfully treated with total thoracoplasty . One patient died on the 38th day after rethoracotomy due to aspiration pneumonia . At postmortem examination the bronchial stump was closed . CONCLUSION: The use of the pedicled intercostal muscular flap is an efficient method for the closure of bronchopleural fistula after pneumonectomy. Surg Today, 1999, 29(8), 701 - 6 The usefulness of conducting investigations on intra-abdominal bacterial contamination in digestive tract operations; Furukawa K et al.; A bacteriological study of 108 cases of gastrointestinal surgery was conducted by analyzing intra-abdominal bacterial contamination (IABC) and postoperative surgical site infections (SSI) . We utilized an anaerobic porter to detect intra-abdominal bacterial infection and transport bacteria to the laboratory . The positive IABC rate was 42.9% for gastric cancer surgery, 22.6% for biliary tract surgery, and 85.7% for colorectal cancer surgery . Most cases of SSI were IABC-positive, and isolated bacterial species from the SSI were similar to those from the IABC . In colorectal cancer surgery, a preoperative chemical intestinal preparation and the prophylactic use of antibiotics had a major influence on the sensitivity of bacteria isolated from the SSI . These data suggest that prophylactic antibiotics should be chosen from among those to which bacteria from the IABC are highly sensitive, and that therapeutic antibiotics should be chosen from among those to which bacteria isolated from the SSI are highly sensitive . Finally, the exploration of IABC enables us to predict the incidence of SSI. J Med Microbiol, 1999 Sep, 48(9), 789 - 99 Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen; Brooke CJ et al.; Erysipelothrix rhusiopathiae has been recognised as a cause of infection in animals and man since the late 1880s . It is the aetiological agent of swine erysipelas, and also causes economically important diseases in turkeys, chickens, ducks and emus, and other farmed animals such as sheep . The organism has the ability to persist for long periods in the environment and survive in marine locations . Infection in man is occupationally related, occurring principally as a result of contact with animals, their products or wastes . Human infection can take one of three forms: a mild cutaneous infection known as erysipeloid, a diffuse cutaneous form and a serious although rare systemic complication with septicaemia and endocarditis . While it has been suggested that the incidence of human infection could be declining because of technological advances in animal industries, infection still occurs in specific environments . Furthermore, infection by the organism may be under-diagnosed because of the resemblance it bears to other infections and the problems that may be encountered in isolation and identification . Diagnosis of erysipeloid can be difficult if not recognised clinically, as culture is lengthy and the organism resides deep in the skin . There have been recent advances in molecular approaches to diagnosis and in understanding of Erysipelothrix taxonomy and pathogenesis . Two PCR assays have been described for the diagnosis of swine erysipelas, one of which has been applied successfully to human samples . Treatment by oral and intramuscular penicillin is effective . However, containment and control procedures are far more effective ways to reduce infection in both man and animals. Scand J Infect Dis, 1999, 31(3), 229 - 34 C-reactive protein levels in HIV complicated by opportunistic infections and infections with common bacterial pathogens; Grutzmeier S et al.; In order to determine the pattern of C-reactive protein (CRP) concentrations in HIV-infected patients with various other infections, we conducted a prospective study (for the period 1990-91) of all HIV-seropositive patients hospitalized with fever and a retrospective study (for the period 1990-95) of all patients infected with Mycobacterium avium complex (MAC) and Pneumocystis carinii pneumonia (PCP) . Samples from blood, cerebrospinal fluid and sites with clinical signs of infection were obtained for bacteriological culture . Polymerase chain reaction (PCR) determination was performed for cytomegalovirus in blood and CSF . Patients with opportunistic infections had a significantly lower increase in CRP concentration than patients infected with common bacterial pathogens . Patients with PCP and mycobacterial infections had a distinct CRP response after the onset of therapy . Lack of CRP increase at diagnosis of MAC infection was associated with a shorter survival and normalization of CRP after MAC therapy with a significantly longer survival. Vestn Khir Im I I Grek, 1999, 158(3), 34 - 7 {Bronchoscopic methods in complex diagnosis and treatment of burned patients with inhalation injuries}; Shpakov IF et al.; Chromobronchoscopy was first used in treatment of 37 burned patients with inhalation injuries for better visual manifestation of the injuries of the tracheobronchial tree mucosa . The trachea and bronchi mucosa was irrigated with a viral stain--0.25% aqueous solution of methylene blue . The intensity of staining the mucosa in light blue colour showed the true limits and depth of the injury . Resulting from the clinico-endoscopic examinations supplemented with findings of chromobronchoscopy, cytological and bacteriological analyses, a working classification of inhalation injuries in burned people was developed which allowed the adequate methods of local treatment during fiber bronchoscopy to be worked out taking into account the degree of thermochemical injuries of the respiratory pathways . It resulted in 19.7% lower lethality of burned patients. Pneumonol Alergol Pol, 1999, 67(1-2), 28 - 37 {Humoral immune response against A60 antigen from tuberculosis expectoration and the clinical and radiologic state of patients with with pulmonary tuberculosis}; Sieminska A et al.; Serological tests available for diagnosis of tuberculosis can provide the valuable informations about host immune response to the mycobacterial infection . The aim of our study was to assess the correlation between clinical, radiological and bacteriological state of pulmonary tuberculosis patients and the serum concentration of IgG antibodies against A60 antigen of Mycobacterium bovis BCG . 110 active pulmonary tuberculosis patients--56 culture positive and 54 culture negative--were involved into the study . In all patients serum level of IgG ati-A60 antibodies was measured with the use of A60-ELISA test . We found that bacteriologically confirmed pulmonary tuberculosis is associated with higher serum level of anti-A60 antibodies . Our study also showed the significantly higher levels of anti-A60 IgG in patients with cavitary and more progressive forms of this disease . We conclude that the greater antigenic challenge in progressive forms of pulmonary tuberculosis stimulates more expressed antibody response. Chemotherapy, 1999 Sep-Oct, 45(5), 370 - 9 A comparative study of cefepime versus ceftazidime as empiric therapy of febrile episodes in neutropenic patients; Wang FD et al.; An open-label, randomized comparative study was conducted to evaluate the efficacy and safety of cefepime (2.0 g q . 8 h) and ceftazidime (2.0 g q . 8 h) in the empiric therapy of febrile neutropenic patients . A total of 45 eligible febrile episodes were randomized (1:1) to be treated with the study regimen . Nineteen febrile episodes treated with cefepime and 22 febrile episodes treated with ceftazidime were evaluable for efficacy . The two groups were comparable in terms of age, sex, height, weight, underlying neoplasm, number of pretherapy neutrophil, duration of neutropenia and types of infections . The overall therapeutic success rate of the cefepime group (53%) was comparable to the ceftazidime group (50%) . It did not differ significantly (95% confidence interval: -0.28 to 0 . 34, p = 0.85) . Eighty-eight percent of pathogens in each group were bacteriologically eradicated . The safety profile was similar in both groups . No patients in either group discontinued the therapy because of adverse events . None (0%) of the cefepime patients and 2 (9%) of the ceftazidime patients died of infection . The results of this study suggest that cefepime is an effective and safe agent in the empiric therapy of febrile episodes in neutropenic patients. BJU Int, 1999 Sep, 84(4), 461 - 3 The urodynamic profile of prostatodynia; Theodorou C et al.; OBJECTIVE: To evaluate urodynamically patients with prostatodynia, and thus define a specific urodynamic pattern that might add to the pathophysiology of the syndrome and possibly aid definitive treatment . PATIENTS AND METHODS: Forty-three patients (mean age 38.1 years, sd 9.25, range 24-59) with symptoms suggestive of chronic prostatitis, e.g . dysuria, frequency of micturition and a burning sensation in the perineum, were classified as having prostatodynia after excluding prostatic infection by standard bacteriological methods . Thereafter, the patients were evaluated urodynamically, including the measurement of free flow-rate, filling (water) cystometry, a pressure/flow study of micturition, with fluoroscopy and electromyography of the external urethral sphincter . RESULTS: Twenty-eight patients (65%) had a low maximum free flow rate (Qmax ), with a mean (sd) of 10.91 (1.26) mL/s . Of the 42 patients who underwent filling cystometry, 26 (62%) had a first sensation of filling, and 28 (67%) a first desire to void, at low volumes (<150 mL and <300 mL, respectively) . Of the 25 patients who underwent a pressure/flow study, 16 (64%) had an obstructive pattern of micturition, as defined by a low Qmax of 10.04 (1.38) mL/s and a high intravesical pressure at Qmax of 83.3 (5.3) cmH2O . The site of obstruction was at the level of the bladder neck, as confirmed by fluoroscopy . CONCLUSION: A significant proportion of these patients had a particular urodynamic pattern of functional infravesical obstruction at the level of the bladder neck and sensory disturbances. Clin Neurol Neurosurg, 1999 Jun, 101(2), 111 - 3 Metastatic adenocarcinoma masquerading as basal pontine tuberculoma; Mak W et al.; Tuberculous infection of the central nervous system is common in Hong Kong . A 39-year-old woman presented with isolated right sixth nerve palsy which was non-progressive for 10 months . Neuro-imaging revealed a right pontine lesion . Cerebrospinal fluid (CSF) examination showed lymphocytic meningitis with negative bacteriological and cytological studies . Empirical antituberculous drugs with initial corticosteroid resulted in improved CSF parameters . A diagnosis of cerebral tuberculoma complicated by meningitis was made . She subsequently deteriorated clinically and radiologically . Despite a number of clinical features which were atypical of leptomeningeal metastasis, adenosquamous carcinoma was found on biopsy . Her relatively indolent clinical course might be due to the initial corticosteroid treatment . This report illustrates the importance of early tissue diagnosis in uncertain cases of chronic lymphocytic meningitis. J Hosp Infect, 1999 Aug, 42(4), 287 - 93 Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination; Friberg B et al.; The relationship between surface contamination (cfus/m2/h) with particles carrying aerobic bacteria and corresponding air contamination rates (cfus/m3) was evaluated in operating rooms (OR) equipped with ultra clean vertical or horizontal laminar airflow (LAF) . For the evaluation we collected data during strictly standardized sham operations using non-woven disposable or cotton clothing . Air contamination in the wound and instrument areas (Casella slit sampler) was related to the surface contamination rate (settle plates) in the same areas and in addition, on the patient chest . Typically, the mean surface counts were 20-70 cfus/m2/h and the air counts 1-2 cfus/m3 in disposable clothing experiments, whilst the use of cotton clothing resulted in higher counts of 100-200 cfus/m2/h (wound P > 0.05, patient P > 0.05, instruments P < 0.01) and 4 cfus/m3 (P < 0.02-0.001) . In the vertical LAF, taking both disposable and cotton clothing operations together, the surface and air contamination rates (surface/air ratio SAR) were highly correlated (P = 0.02-0.004) and the ratio varied between 18:1 and 50:1 with a mean for wound air of 36:1 . Using only disposable clothing in the vertical LAF, the number of significant correlations was reduced . With cotton clothing experiments in vertical LAF and in the horizontal LAF using disposable clothing, no significant correlation between surface and air contamination was found . The wide variation of SAR values and the inconsistent relationship between surface and air counts indicates that measurement of OR air contamination represents an unhelpful method for assessment of surgical site contamination in LAF units . We propose instead that colony counts on sedimentation plates is a clinically more relevant indicator of bacterial OR contamination in LAF units . In addition to the current bacteriological standard for ultra clean OR air of (< 10 cfus/m3) we suggest a corresponding standard for the surface contamination rate of < 350 cfus/m2/h. Bone Marrow Transplant, 1999 Aug, 24(4), 385 - 8 Red cell salvage and reinfusion in pediatric bone marrow donors; Kletzel M et al.; We evaluated the use of a semi-automated processing technique to salvage red blood cells from pediatric bone marrow donors to minimize the risk of severe anemia following bone marrow harvest and ABO incompatibility in the recipient . Sixty healthy, HLA-matched, pediatric donors of bone marrow hematopoietic cells with a median age 8.0 years (2-19) were studied . Thirteen of the donor-recipient pairs were ABO incompatible . There were 60 recipients with a median age of 8.6 years (2 months to 20.8 years) . Bone marrow was harvested under general anesthesia, filtered in the operating room and then transferred to the stem cell laboratory for processing . Samples were obtained for cell count, CD34+ quantification, colony assay, viability, and bacteriologic cultures before and after processing . The cells were processed in a semi-automated closed system (Stericel, Terumo) by density gradient separation with Ficoll-Hypaque and then washed . Two aliquots were obtained: one containing the mononuclear cell layer to be infused to the recipient and the other the washed red cells to be infused to the donor . The median volume harvested was 608 +/- 40.42 ml (278-1409), while the final volume infused was 174 +/- 10.75 ml (30.2-380) P < 0.0001, representing a decrease of 72% of the volume infused . The nucleated cell count harvested was 1.6 x 10(10) +/- 0.1 (0.56-3.2), while the count infused was 6.9 x 10(9) +/- 0.1 (0.12-5.4) P < 0.0001 . The median mononuclear cell count (MNC) per kg harvested was 0.67 x 10(8) +/- 0.05 (0.18-2.0) vs an infused cell number of 1.3 x 10(8) MNC/kg +/- 0.1 (0.6-33.6) P < 0 . 0001 . The CD34+ cells harvested were 2.8 x 10(6)/kg +/- 0.1 (0.25-10.2) vs an infused number of 6.0 x 10(6)/kg +/- 0.5 (0.84-31.0) P < 0.0001 . The viability before and after processing was 99% . Red cell salvage performed in a semi-automated closed system is safe and reduces the risk of post-bone marrow harvest anemia in pediatric donors, decreases the volume infused into the donor and enriches the mononuclear and CD34+ cell population, without affecting hematopoietic reconstitution. Int J Biometeorol, 1999 Jul, 43(1), 8 - 13 Changes in exercise and post-exercise core temperature under different clothing conditions; Kenny GP et al.; This study evaluates the effect of different levels of insulation on esophageal (Tes) and rectal (Tre) temperature responses during and following moderate exercise . Seven subjects completed three 18-min bouts of treadmill exercise (75% VO2max, 22 degrees C ambient temperature) followed by 30 min of recovery wearing either: (1) jogging shoes, T-shirt and shorts (athletic clothing); (2) single-knit commercial coveralls worn over the athletic clothing (coveralls); or (3) a Canadian Armed Forces nuclear, bacteriological and chemical warfare protective overgarment with hood, worn over the athletic clothing (NBCW overgarment) . Tes was similar at the start of exercise for each condition and baseline Tre was approximately 0.4 degree C higher than Tes . The hourly equivalent rate of increase in Tes during the final 5 min of exercise was 1.8 degrees C, 3.0 degrees C and 4.2 degrees C for athletic clothing, coveralls and NBCW overgarment respectively (P < 0.05) . End-exercise Tes was significantly different between conditions {37.7 degrees C (SEM 0.1 degree C), 38.2 degrees C (SEM 0.2 degree C and 38.5 degrees C (SEM 0.2 degree C) for athletic clothing, coveralls and NBCW overgarment respectively)} (P < 0.05) . No comparable difference in the rate of temperature increase for Tre was demonstrated, except that end-exercise Tre for the NBCW overgarment condition was significantly greater (0.5 degree C) than that for the athletic clothing condition . There was a drop in Tes during the initial minutes of recovery to sustained plateaus which were significantly (P < 0.05) elevated above pre-exercise resting values by 0.6 degree C, 0.8 degree C and 1.0 degree C, for athletic clothing, coveralls, and NBCW overgarment, respectively . Post-exercise Tre decreased very gradually from end-exercise values during the 30-min recovery . Only the NBCW overgarment condition Tre was significantly elevated (0.3 degree C) above the athletic clothing condition (P < 0.05) . In conclusion, Tes is far more sensitive in reflecting the heat stress of different levels of insulation during exercise and post-exercise than Tre . Physiological mechanisms are discussed as possible explanations for the differences in response. Int J Tuberc Lung Dis, 1999 Aug, 3(8), 722 - 31 Tuberculosis due to Mycobacterium bovis in the Australian population: DNA typing of isolates, 1970-1994; Cousins DV et al.; SETTING: Bacteriologically confirmed cases of Mycobacterium bovis in the Australian population . OBJECTIVE: To evaluate the DNA fingerprinting techniques commonly used for M . bovis on isolates from humans and determine whether they were useful for determining the origin of human infection . DESIGN: M . bovis strains isolated between 1970 and 1994 were obtained from five Australian Reference Laboratories . Four DNA fingerprinting techniques, comprising Southern hybridisation with three different probes (the insertion sequence {IS}6110, the polymorphic guanine-cytosine-rich sequence {PGRS} and the direct repeat {DR}) and a PCR-based method (spoligotyping) were used . RESULTS: The PGRS, DR and IS6110 RFLP methods identified 32, 22 and 14 different types respectively from the 45 isolates available . Spoligotyping identified 18 different types . When all methods were combined 41 different strains were identified . Clear differences were found between many isolates from Australian-born patients and those from patients born overseas . CONCLUSIONS: The PGRS RFLP method was the most effective method for typing the human strains, but a combination of methods is recommended for maximum sensitivity . Most Australian-born patients that had worked in the meat and livestock industries were infected with strains similar to those that are commonly found in Australian cattle, confirming the occupational risk in these industries . Patients born overseas were typically infected with strains genetically different from those of patients born in Australia . This suggests that patients born overseas identified with M . bovis were presenting with reactivation of infection acquired outside Australia. Int J Tuberc Lung Dis, 1999 Aug, 3(8), 715 - 21 Tuberculosis due to Mycobacterium bovis in the Australian population: cases recorded during 1970-1994; Cousins DV et al.; OBJECTIVE: To determine the contribution of Mycobacterium bovis to active tuberculosis in the Australian population during 1970-1994, and to collate and analyse demographic data from bacteriologically proven cases . DESIGN: Summary data for tuberculosis cases notified by Australian public health agencies during 1970-1985 and 1991-1994 were obtained from the database of notifiable diseases maintained by the Department of Health and Family Services . More detailed demographic data for cases confirmed by bacteriology during 1970-1994 were supplied by the Australian Mycobacterium Reference Laboratory Network . RESULTS: At least 236 cases of bovine tuberculosis (TB) occurred in the Australian population during 1970-1994 (mean 9.4 cases; range 3-22 cases annually) . The bovine strain has accounted for around 1% of Australian cases of TB during this period . Laboratory sources provided demographic data for 150 cases with positive bacteriology . For this group, the mean age was 54 years (range 22-86), and the male:female ratio was 2.4:1 . The majority of cases (74%) involved pulmonary disease . Australian-born persons accounted for 68% of the total cases and typically had histories of employment in meat and/or livestock industries . CONCLUSION: M . bovis was responsible for less than 1.5% of cases of TB in the Australian population during 1970-1994 . Most cases were apparently due to reactivation of infection acquired through occupational exposure . Thus, although virtual eradication of M . bovis from Australia's cattle herds has now reduced the risk of exposure, it can be expected that human cases of bovine TB will continue to be detected for years to come . The bovine strain should be considered as the possible agent of TB in foreign-born Australians. Rev Chir Orthop Reparatrice Appar Mot, 1999 Jul, 85(4), 337 - 48 {Revision of infected total hip prostheses by ablation reimplantation of an uncemented prosthesis . 57 case reports}; Lecuire F et al.; PURPOSE OF THE STUDY: 57 cases of infected total hip prosthesis treated by removal of the implant and implantation of unncemented prosthesis, were studied to evaluate functional and sepsis results . MATERIAL AND METHODS: 57 patients treated by reimplantation of an uncemented total hip prosthesis after removal of the infected prosthesis were observed . 16 patients underwent a single-stage exchange, 41 a two-stage reimplantation . 46 cases were analysed for infection findings (clinical, radiological and biological assessment) and only 34 cases for functional evaluation (PMA scale, Harris score) with a mean follow-up of 6.6 years . The antibiotic therapy was adapted to each patient but generally, the treatment was prolonged . RESULTS: At follow-up time (which might be too short in time), only 2 patients had a recurrence of infection . One had a single-stage exchange (reoperated by two stage exchange with a good final result at 6 years follow-up), the other a two-stage exchange . In both cases we found that postoperative antibiotic therapy was inadequate . Functional results were better with PMA scale (23 good results of 34) than with Harris score (14 excellent or good results only) . 5 patients were reoperated for mechanical implant failure . DISCUSSION: Since 1991, we adopted a standardized procedure to treat chronic infected total hip prosthesis including: routine preoperative aspiration of symptomatic prosthesis; removal of the implant and around debridement followed at a later date (6 weeks) by reimplantation using uncemented implants (hydroxyapatite coated implant) . Postoperative antibiotic therapy has to be massive (parenteral bitherapy for at least 21 days after each operative stage) and has to last 6 months after reimplantation . This procedure seems reliable and corroborate the validity of two-stage treatment . The using of uncemented implants allows a good bone reconstruction and does not seem to increase the risk of septic recurrence . CONCLUSION: It is quite difficult to find a hard and fast rule in infected prosthesis treatment, because many factors can influence results . The proposed procedure seems reliable, even if antibiotherapy is long and hard, but requires a strong collaboration between bacteriologist infectiologist and surgeon. Rev Chir Orthop Reparatrice Appar Mot, 1999 Jul, 85(4), 321 - 7 {C-reactive protein and transthyretin in early diagnosis of infection after open fractures of the lower limbs (a preliminary study)}; Jenny JY et al.; PURPOSE OF THE STUDY: The authors investigated the value of C-reactive protein (CRP) and transthyretin (TTR) in the early diagnosis of infection after open fractures of the lower limb in an open, prospective study . MATERIAL AND METHODS: Eighty patients were treated with acute debridement and bone fixation . Follow-up included clinical, radiological, bacteriological and biological assessment: white cell blood count (WBC), erythrocyte sedimentation rate (ESR), CRP and TTR . Diagnosis of infection was based on macroscopic presence of pus . RESULTS: Post-operative reference biological profiles were defined in 74 cases without infection . Reference profiles of WBC and ESR showed unreliable interindividual variations and could not be considered for the diagnosis of infection . Reference profiles of CRP and TTR showed a respective increase (for CRP) and decrease (for TTR) in the early post-operative course, with return to normal values after 12 days . In 6 infected patients, CRP concentrations were suddenly increased and TTR concentrations decreased at the time (3 cases) or even before (3 cases) clinical diagnosis of infection . These variations were mostly simultaneous . No unusual profile was found . The ratio of CRP/TTR concentrations experienced also a sudden increase in infected cases . DISCUSSION: Because of not specifical and unreliable variations in the post-operative outcome of non infected patients, WBC and ESR cannot be considered for the early diagnosis of infection . CRP and TTR concentrations with a respective cut-off value of 100 mg/L and 120 mg/L were found efficient for the early diagnosis of infection, and preceded clinical diagnosis in three of them . A CRP/TTR ratio over 60 p . 100, 8 days or more after initial surgery was found to be very specific (93 p . 100) and sensitive (100 p . 100) for the diagnosis of infection . CONCLUSION: Serial quantifications of CRP and TTR should be performed every four days during the follow-up of open fractures in order to early diagnose a post-operative infection . Comparison of both CRP and TTR could allow a higher accuracy, because of the possible lack of variation of one the two markers. Clin Infect Dis, 1999 May, 28(5), 1080 - 5 A randomized, placebo-controlled study of rifabutin added to a regimen of clarithromycin and ethambutol for treatment of disseminated infection with Mycobacterium avium complex; Gordin FM et al.; Current guidelines suggest that disseminated Mycobacterium avium complex (MAC) infection be treated with a macrolide plus ethambutol or rifabutin or both . From 1993 to 1996, 198 AIDS patients with MAC bacteremia participated in a prospective, placebo-controlled trial of clarithromycin (500 mg b.i.d.) plus ethambutol (1,200 mg/d), with or without rifabutin (300 mg/d) . At 16 weeks, 63% of patients in the rifabutin group and 61% in the placebo group (P = .81) had responded bacteriologically . Changes in clinical symptoms and time to survival were similar in both groups . Development of clarithromycin resistance during therapy was similar in the two groups; of patients who had a bacteriologic response, however, only 1 of 44 (2%) receiving rifabutin developed clarithromycin resistance, vs . 6 of 42 (14%) in the placebo group (P = .055) . Thus, rifabutin had no impact on bacteriologic response or survival but may protect against development of clarithromycin resistance in those who respond to therapy. Clin Infect Dis, 1999 Jun, 28(6), 1313 - 6 High sensitivity and specificity of serum procalcitonin levels in adults with bacterial meningitis; Viallon A et al.; It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis . To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department . Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients . The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF . Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis . Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis . On the other hand, a serum procalcitonin level >0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis . Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults. J Clin Pathol, 1999 Mar, 52(3), 193 - 7 Evaluation of three commercial detection systems for Mycobacterium tuberculosis where clinical diagnosis is difficult; Brown TJ et al.; AIMS: To assess the performance of three commercially available Mycobacterium tuberculosis detection systems employing nucleic acid amplification, when applied directly to respiratory and non-respiratory specimens from patients where the diagnosis of tuberculosis is difficult using clinical and traditional bacteriological methods . METHODS: 42 respiratory and 21 non-respiratory specimens were concentrated, examined with auramine staining, and cultured on Lowenstein-Jensen slopes . These specimens were also assayed using the Amplicor Mycobacterium tuberculosis test (AM) (Roche Diagnostic Systems), the Amplified Mycobacterium tuberculosis direct test (AMD) (Gen-Probe), and the LCx Mycobacterium tuberculosis assay (LMA) (Abbott Laboratories) . RESULTS: All three amplification systems used in this study gave specificities of 100% when used on respiratory specimens . When used on non-respiratory specimens, AM and LMA gave specificities of 100% and AMD 75% . With respiratory specimens the AM, AMD, and LMA systems gave sensitivities of 75%, 65.2%, and 79.2%, respectively . With non-respiratory specimens the sensitivities were 50%, 66.7%, and 60%, while with smear negative, culture positive specimens they were 33.3%, 66.7%, and 55.6% . Positive predictive values of 100% were seen with all specimens except non-respiratory specimens assayed using AMD where the value was 66.7% . CONCLUSIONS: The manufacturers of these systems recommend that they should only be used for the direct analysis of respiratory specimens, and the US Food and Drug Administration has approved them for use only with smear positive specimens . This study confirms that sensitivities are lower for non-respiratory and smear negative specimens, but positive predictive values are high . Provided they are interpreted with caution, positive results with these tests in respiratory and non-respiratory specimens are useful in tuberculous patients who are otherwise difficult to diagnose . Each amplification has advantages and disadvantages compared with the others. Postgrad Med J, 1999 Mar, 75(881), 133 - 40 Tuberculosis of the central nervous system; Garg RK; Tuberculous involvement of the brain and spinal cord are common neurological disorders in developing countries and have recently shown a resurgence in developed ones . Tuberculous meningitis is an important manifestation and is associated with high morbidity and mortality . Diagnosis is based on clinical features, cerebrospinal fluid changes, and imaging characteristics . Bacteriological confirmation is not possible in all cases as serological tests do not have sufficient sensitivity and specificity . The polymerase chain reaction shows promise for the future . Appropriate chemotherapeutic agents should be administered as early as possible, although there is no unanimity concerning chemotherapeutic regimens or optimal duration of treatment . The patient's clinical stage at presentation is the most important prognostic factor . The role of corticosteroids is controversial but they should be administered to all patients presenting in stage III . Surgical procedures are directed at management of the hydrocephalus . Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord . They do not usually require surgical intervention and respond well to antituberculous treatment, along with corticosteroids. Cent Afr J Med, 1999 Feb, 45(2), 45 - 7 Tuberculous orchitis co-existing with tuberculosis of the sternum--case report; Fadiran OA et al.; The sternum and testis are infrequent localisations for extra pulmonary tuberculosis . The initial response to a co-existing lesion, as this case depicted is, to implicate a malignant process of some sort . A high index of suspicion is needed to overcome this diagnostic riddle . Biopsy of the lesion and bacteriological work-up are essential ingredients of management. Indian J Chest Dis Allied Sci, 1999 Apr-Jun, 41(2), 89 - 100 Diagnosis of tuberculous pleural effusion; Aggarwal AN et al.; Tuberculosis is a common cause of pleural effusion in India . Diagnosis can be made in a majority of patients from the clinical features, pleural fluid examination (including cytology, biochemistry and bacteriology), and pleural biopsy . Adenosine deaminase estimation in pleural fluid is occasionally useful . Newer diagnostic techniques include lysozyme or interferon gamma estimation, immunodiagnostic methods and polymerase chain reaction . Although promising, they still need to be studied further before their routine use can be recommended. Eur Child Adolesc Psychiatry, 1999 Jun, 8(2), 117 - 25 Somatic correlates of functional enuresis; von Gontard A et al.; Functional enuresis is a heterogeneous group of syndromes with different aetiology and pathophysiology . The aim was to identify specific somatic correlates of enuresis non-invasively in child psychiatric patients after exclusion of neurologic and structural forms of incontinence . One hundred sixty-seven consecutive children, aged 5 to 10 years with day and/or night wetting were examined prospectively with: urinalysis and bacteriology; ultrasonography, including bladder wall thickness and residual volume; uroflowmetry and pelvic-floor-EMG; EEG; and a complete paediatric-neurologic examination . Day wetting children had a significantly higher rate of previous antibiotic prophylaxis, larger residual volume, thicker bladder walls; the uroflow curves were significantly less bell- and more staccato-shaped, the EMG less relaxed . Voiding postponers showed a tendency towards more uroflow anomalies than urge incontinent children . Primary and secondary enuretics did not differ on most parameters, but primary nocturnal enuretics with micturition problems had significantly less relaxed EMGs than monosymptomatic enuretics . Although day wetters had more pathological EEGs and neurological signs, these differences did not reach significance . The overall rate of urogenital anomalies was 10% . In conclusion, enuresis has a high rate functional somatic correlates with clinical and theoretical, classificatory implications. Clin Infect Dis, 1999 Jul, 29(1), 125 - 33 A prospective randomized trial of four three-drug regimens in the treatment of disseminated Mycobacterium avium complex disease in AIDS patients: excess mortality associated with high-dose clarithromycin . Terry Beirn Community Programs for Clinical Research on AIDS; Cohn DL et al.; The optimal regimen for treatment of Mycobacterium avium complex (MAC) disease has not been established . Eighty-five AIDS patients with disseminated MAC disease were randomized to receive a three-drug regimen of clarithromycin, rifabutin or clofazimine, and ethambutol . Two dosages of clarithromycin, 500 or 1,000 mg twice daily (b.i.d.), were compared . The Data and Safety Monitoring Board recommended discontinuation of the clarithromycin dosage comparison and continuation of the rifabutin vs . clofazimine comparison . After a mean follow-up of 4.5 months, 10 (22%) of 45 patients receiving clarithromycin at 500 mg b.i.d . had died (70 deaths per 100 person-years) compared with 17 (43%) of 40 patients receiving clarithromycin at 1,000 mg b.i.d . (158 deaths per 100 person-years) (relative risk, 2.43; 95% confidence interval, 1.11-5.34; P = .02) . After 10.4 months, 20 (49%) of 41 patients receiving rifabutin had died (81 deaths per 100 person-years) compared with 23 (52%) of 44 patients receiving clofazimine (94 deaths per 100 person-years) (relative risk, 1.20; 95% confidence interval, 0.65-2.19; P = .56) . Bacteriologic outcomes were similar among treatment groups . In treating MAC disease in AIDS patients, the maximum dose of clarithromycin should be 500 mg b.i.d. Ann Biol Clin (Paris), 1999 Jul-Aug, 57(4), 401 - 8 {Ocular bacterial infections : present and prospective methods of diagnosis}; Denis F et al.; Bacteriological samples and tests are essentiel for the diagnosis of superficial ocular infections and endophtalmitis . The direct examination and the traditional culture of the samples can be in the futur associated with new diagnostic approach using antigen detection (immunofluorescence, enzyme immunosorbent assays) and genome research by hybridation or better by amplification for Chlamydia and for the most frequent species responsible of endophtalmitis . An original genomic strategy of bacterial endophtalmitis diagnosis was developped. Radiology, 1999 Aug, 212(2), 390 - 4 Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage; Kim JK et al.; PURPOSE: To evaluate the effectiveness of simple percutaneous catheter drainage in the treatment of postoperative lymphocele . MATERIALS AND METHODS: Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy . All lymphoceles were diagnosed on the basis of biochemical and cytologic findings in aspirated fluid . The drainage catheter was removed when the amount of daily drainage was less than 10 mL per day and when the lymphocele was seen at imaging to have resolved . Follow-up US was performed at 1, 3, and 6 months after catheter removal . The results were classified as success, partial success, or failure . RESULTS: Lymphoceles ranged in size from 5 x 4 x 3 to 25 x 10 x 10 cm . Mean total drainage volume was 2,012 mL (range, 300-17,240 mL) . Fluid from 10 lymphoceles (43%) was positive at Gram staining and bacteriologic culture; fluid from 13 (57%) was sterile . Duration of catheter drainage was 3-49 days (mean, 22 days) . Twenty (87%) lymphoceles resolved completely; three (13%) recurred . Two recurrent lymphoceles were again treated with percutaneous catheter drainage; the third resolved spontaneously 5 months after catheter removal . Successful treatment was ultimately achieved in all patients . Postprocedural complications occurred in four patients . One had a secondary infection of lymphocele; one, catheter dislodgment; and two, skin infection at the site of catheter insertion . CONCLUSION: Percutaneous catheter drainage is safe and effective for treatment of symptomatic postoperative lymphoceles. Klin Khir, 1999, (5), 15 - 6 {The significance of dynamic ultrasound study in the choice of the treatment strategies of patients with pancreatic necrosis}; Radzikhovskii AP et al.; The results of examination and treatment of 18 patients with pancreonecrosis were analysed . If the liquoric formation was revealed in retroperitoneal space according to the ultrasonic investigation data obtained the puncture of it was performed with its content aspiration conduction and further bacteriological investigation of punctate . The diagnosin of wide, with lowered echogenicity, "nonhomogeneous" zones in retroperitoneal space trusted th