Microbial

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 the purulent-septic complications occurrence.

Pediatrics, 1999 Aug, 104(2 Pt 1), 216 - 21
Natural outcome of Helicobacter pylori infection in asymptomatic children: a two-year follow-up study; Ganga-Zandzou PS et al.; BACKGROUND AND OBJECTIVES: It is known that Helicobacter pylori can be acquired in early childhood . There is not enough data to know whether or not infected children should be treated . A better knowledge of the natural outcome and implications of H pylori infection may provide evidence that eradication therapy is beneficial in childhood . This prospective study looks at clinical symptoms, endoscopic, microbial, and histologic changes during a 2-year period in infected asymptomatic children . It is hoped that some prognostic indicators will be found that select out the children that later need therapy . PATIENTS AND METHODS: During epidemiologic study of the prevalence of H pylori infection, 18 children aged 7 +/- 4 years (mean +/- 1 SD) were discovered to have H pylori infection and enrolled in the 2-year follow-up study . These patients had received no eradication therapy because they were asymptomatic . The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years . Gastric mucosal samples were analyzed for bacteriologic and histologic changes . Various factors were initially recorded: individual factors included sex, age, and housing conditions; microbial factors included bacterial load and the presence of the CagA gene . Inflammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which was described using the Sydney classification . Typing polymerase chain reaction-restriction fragment length polymorphism was performed to check the persistence of the same strain of H pylori in each patient . RESULTS: All of the children were still infected after 2 years with the same strain as in the initial assessment with the exception of 1 child whose infection cleared spontaneously . The density of antral and fundal mucosal colonization with H pylori also remained stable . There were progressive inflammatory changes in this cohort, particularly between the first and second year (histologic score, 3.5 +/- 1.3 vs 5 +/- 1) . Active antral gastritis occurred in 3 out of 14 and 1 out of 8 children during the first and second year, respectively . Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period . Increases in the histologic score were found particularly in male children, and children colonized by cagA- strains of H pylori during the follow-up . The frequency of nodular gastritis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years . CONCLUSION: These findings demonstrate a deterioration in the histologic features of the gastric mucosa of infected children despite stable H pylori colonization and the absence of symptoms.

Ann Fr Anesth Reanim, 1999 May, 18(5), 499 - 502
{Laryngoscope . Evaluation of a device for preventing blade contamination}; Bazin JE et al.; OBJECTIVE: To evaluate the efficacy and the difficulty of use of a disposable sheath which prevents the contamination of blades . STUDY DESIGN: Prospective bacteriological, virological and clinical evaluation . MATERIAL: A translucid cover sheath, made of polyethylene enclosing the blade of the laryngoscope, and delivered in clean, non-sterile packaging (Prolam, Peters) . METHOD: 1) A control of sterility performed by setting-up a culture derived from the solution used for rinsing the device before its use . 2) An in vitro study of the effectiveness of preventing contamination of the blades by a polio virus/RT-PCR technique . 3) Clinical evaluation: after 200 orotracheal intubations by 12 anaesthesiologists and 15 nurse anaesthetists, a questionnaire on the ease of use was completed . RESULTS: The bacteriological study of the sheats before use showed an acceptable level of contamination . The sheath was an effective barrier against poliovirus, even after 12 h of immersion . Clinically, the sheath was easily adapted over the blade of the laryngoscope in 98% of the cases . Insertion in the mouth was considered as easy in 94% of the patients . The visualization was good or excellent in 83% of the cases and in 16% of the patients, the users experienced difficulties to intubate . CONCLUSION: The laryngoscope blade sheath is simple and easy to use, efficient and not expensive.

Biosci Biotechnol Biochem, 1999 Jun, 63(6), 969 - 72
Structural diversity of membrane lipids in members of Halobacteriaceae; Kamekura M et al.; This minireview gives an updated and consolidated summary of taxonomic classification correlated with membrane phospholipid, glycolipid, and core lipid structural diversity within the family Halobacteriaceae . We also point out that the recently reported diversity in the membrane core lipid structure of a putative strain of Halobacterium (Halobacterium halobium strain IAM 13167) (Morita et al., Biosci . Biotechnol . Biochem., 62, 596-598, 1998) is not correct since the strain used by the authors has for some time been recognized not to be a member of the genus Halobacterium but a member of halobacteria group 2 (Grant and Larsen, Bergey's Manual of Systematic Bacteriology, Vol.3, pp . 2216-2233, 1989), which has recently been designated as a new genus, Natrinema (McGenity et al., Int . J . Syst . Bacteriol . 48, 1187-1196, 1998).

Antonie Van Leeuwenhoek, 1999 Apr, 75(3), 165 - 9
Christiaan Eijkman . First bacteriologist at Utrecht University, Nobel laureate for his work on vitamins; Verhoef J et al.; One century ago, Christiaan Eijkman was appointed Professor of Bacteriology at the Utrecht University, The Netherlands . Despite his appointment to teach bacteriology, Christiaan Eijkman made his main contribution to medical science not in bacteriology but in nutrition . He discovered that Beri-Beri was not an infection but a nutritient deficiency (later called vitamin-deficiency) and was awarded the Nobel Prize for Medicine in 1929 for these observations . These landmark studies were made in the former Dutch East Indies . Interestingly, the results of his studies were presented in the Dutch language, in the medical journal of the Dutch East Indies . As a professor of Bacteriology, his work was the beginning of an important school in biochemistry in The Netherlands.

New Microbiol, 1999 Jul, 22(3), 219 - 25
Bacteriological and clinical follow-up of periodontal pockets during a topically applied 1% metronidazole-gel therapy in patients with adult periodontitis; Piccolomini R et al.; The aim of this study was to evaluate the clinical and bacteriological effects of the intrasulcular application of a 1% metronidazole-gel (repeated administrations outdistanced of 7 days weeks long) currently employed in dermatological practice, to observe if a lower concentration of the chemotherapic agent could be equally effective as the 25% formulation in improving the periodontal condition of nine patients with adult periodontitis . The results showed that this regimen can modify, at a statistically significant level, the clinical (Pocket Probing Depth, Gingival Bleeding Index and Plaque Index) and bacteriological (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Veillonella parvula) parameters associated with adult periodontitis . The results are similar to those obtainable with a 25% Metronidazole-gel administered two times outdistanced by 7 days.

Indian J Pathol Microbiol, 1999 Jan, 42(1), 31 - 5
Platelet auto-antibodies in septicaemic patients; Ghosh TK et al.; Thrombocytopenia associated with acute Septicaemia has been reported which may be due to Disseminated Intravasscular Coagulation (DIC), but has also been reported even without any evidence of it . An immunological cause has been suggested to explain this observation . The present study involved the investigation of 50 patients with clinical and bacteriological evidence of Septicaemia . By Direct Platelet Suspension Immunofluorescence Test (PSIFT) antiplatelet antibodies were detected in 54% patients with septicaemia and 67.5% with those having thrombocytopenia . The septicaemic patients were treated with antibiotics (mean 14 days) . After successful treatment, i.e., when there was no bacteriological evidence of septicaemia, there was in increase in the platelet count (> 150 x 10(9)/L) with a corresponding fall in "PSIFT" positivity in 17 cases (P < 0.001) . Hence an immunological process is considered to play a significant role in the pathogenesis of thrombocytopenia in these patients with septicaemia.

Ann Urol (Paris), 1999, 33(3), 230 - 6
{Temporary retrograde and anterograde ureteral catheterization}; Scarpa RM et al.; This article examines the technical modalities or ureteral catheterization . The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise . After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation . The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.

Am J Vet Res, 1999 Jul, 60(7), 905 - 8
Biosafety and antibody responses of adult bison bulls after vaccination with Brucella abortus strain RB51; Olsen SC et al.; OBJECTIVE: To evaluate clearance, antibody responses, potential shedding, and histologic lesions in reproductive tissues of adult bison bulls after vaccination with Brucella abortus strain RB51 . ANIMALS: 61 two- and 3-year-old bison bulls . PROCEDURE: 12 bison bulls were vaccinated s.c . with B abortus strain RB51, 3 were inoculated s.c . with 0.15 M NaCl, and antibody responses were evaluated . Various specimens were obtained to evaluate bacterial shedding . Four vaccinates and 1 control were necropsied 10, 20, and 30 weeks after vaccination . In a separate experiment, bison bulls were vaccinated s.c . with 0.15 M NaCl, or by hand or ballistically with strain RB51 . Antibody responses were monitored 6 weeks after vaccination and during necropsy 13 weeks after vaccination . Tissue specimens obtained during necropsy from both studies were evaluated bacteriologically and histologically . RESULTS: Strain RB51 was recovered at various times from semen of 3 of 12 vaccinated bison bulls in experiment 1 . During necropsy, strain RB51 was recovered 10 and 20, but not 30, weeks after vaccination . In experiment 2, strain RB51 was recovered from lymphoid tissues of hand- and ballistic-vaccinated bison bulls during necropsy . In both experiments, microscopic lesions in testes, epididymis, and seminal vesicles were minimal and did not differ between strain RB51-vaccinated and saline-inoculated bison bulls . CONCLUSIONS AND CLINICAL RELEVANCE: Strain RB51 does not induce relevant inflammatory lesions in reproductive tissues of adult bison bulls . Shedding of strain RB51 in semen may be transient in some bison bulls; however, the importance of this observation is unknown.

Diagn Cytopathol, 1999 Jul, 21(1), 4 - 6
Pap smear follow-up of possible role of mucopurulent exudate as a prognosticator of a negative pregnancy outcome; Bedrossian UK et al.; Our objective was to study a cohort of women by various means to detect sexually transmitted diseases (STD) and to correlate the presence of mucopurulent exudate (PEX) on Papanicolaou (Pap) smears with pregnancy outcome . Bacteriologic cultures taken from swabs for chlamydia and gonorrhea were correlated with Gen-Probe results . Smears were examined for trichomonas, yeast, HPV, obscuring mucopurulent exudate, and squamous intraepithelial abnormalities . There was no positive correlation between STD and negative pregnancy outcome . Mucopurulent exudate on Pap smears was very high in this population . Continuing study of this population of women is needed to see if larger cohorts will demonstrate any positive correlations between PEX and pregnancy outcome . Placing women with obscuring mucopurulent exudate in a "high-risk" category for complications may prevent adverse side effects to the birth product . The Pap smear works as well as the Gram stain for detection of bacterial vaginosis and cervicitis . Eliminating the Gram stain from routine pelvic exam results in cost savings.

Equine Vet J, 1999 May, 31(3), 197 - 202
Comparison of bacteriology and cytology of tracheal fluid samples collected by percutaneous transtracheal aspiration or via an endoscope using a plugged, guarded catheter; Christley RM et al.; Cytological and bacteriological results from tracheal fluid samples obtained endoscopically using a telescoping, plugged catheter (TPC) were compared with results from samples collected by percutaneous transtracheal aspiration (PTA) . The TPC technique and PTA were performed in random order on 9 healthy Standardbred geldings . Three weeks later the procedures were performed on the same horses in the reverse order . The presence of oropharyngeal contamination was determined by quantitative bacteriology and quantification of squamous epithelial cells (SEC)/ml sample . The relative numbers of macrophages, haemosiderophages, giant cells, neutrophils, lymphocytes and eosinophils did not differ between techniques . The number of SEC/ml was greater in samples with more colony forming units/ml indicating that quantification of SEC provides evidence of the probable degree of oropharyngeal contamination . Fifteen out of the 18 TPC samples were free of contamination, indicating that the TPC can provide adequate samples for bacteriology . The results also indicate that tracheoscopy sometimes results in oropharyngeal contamination of the trachea, but that this does not affect the results of the TPC sample.

Laryngoscope, 1999 Jul, 109(7 Pt 1), 1068 - 73
Experimental nasal intubation: a study of changes in nasoantral mucosa and bacterial flora; Westergren V et al.; OBJECTIVES: To investigate the local effects in a nasal cavity and its adjacent sinuses of long-term detention of an endonasal tube, with special attention to inflammatory pathology and microbiology . STUDY DESIGN: Experimental rabbit study . METHODS: Four groups of 4 rabbits, in all 16, were unilaterally nasally intubated and evaluated macroscopically, histopathologically, and bacteriologically after 1, 2, 4, and 8 weeks, respectively . RESULTS: At first, in the 1- and 2-week groups to the 4-week group, histopathology, such as degeneration of olfactory mucosa, squamous cell metaplasia, and polyp formations, was observed together with frequent opportunistic bacterial findings in the nasal cavity . Later, in the 4- and 8-week groups, inflammatory mucosal changes, such as septal increase of connective tissue, goblet cell hyperplasia, and epithelial invaginations, were found in the nasal cavity containing a tube . A concomitant increase was found of commensal bacteria adjacent to the tube and the similar bacterial findings in the ipsilateral maxillary sinuses . However, there were no signs of inflammatory reactions in the sinuses . CONCLUSIONS: Our investigation points to the tube as the cause of local goblet cell hyperplasia with an increased mucus production, and as a food source for the commensals with a marked increase of the amount of bacteria . The positive bacterial cultures from the maxillary sinuses might be considered to be colonization . However, because of the possibility of contamination, improved sampling techniques are required, as are further studies.

Rev Clin Esp, 1999 May, 199(5), 275 - 9
{The cost effectiveness of the study of the familial contacts of tuberculosis patients coinfected with the human immunodeficiency virus}; Garcia Ordonez MA et al.; The investigation of contacts of patients with tuberculosis is a highly cost-effective measure to detect new cases of disease and infected individuals; nevertheless, its efficacy has not been contrasted with persons living with patients with tuberculosis (TB) coinfected with HIV . A total of 152 family contacts were studied corresponding to 84 HIV-positive tuberculosis patients . As a control group, 516 persons living with HIV-negative TB patients were included . Contacts were classified according to the bacteriologic status of the index case (IC): group I, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens; group II, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens, and group III, contacts of pulmonary and/or extrapulmonary TB patients with negative bacterioscopy and culture . Among IC coinfected with HIV there was a higher percentage of extrapulmonary clinical forms and therefore a lower proportion of bacillary forms, which accounted for a lower rate of infection among contacts of HIV-positive patients than among contacts of HIV-negative patients (20.4% vs 48.8%; OR: 3.7; 95% CI: 2.4-5.9) . After controlling for bacteriologic status of the IC, differences remained when bacillary (group I) of HIV-coinfected patients were compared with those of patients not coinfected with HIV (35.9% vs 52.3%; OR: 2.1%; 95% CI: 1.2-5.9) . Overall, 28 new TB cases were detected (4.2% of the total of studied persons living with TB patients) with no differences among contacts of both groups . The lower rate of infections among persons living with HIV-positive patients might be due not only to a lower number of pulmonary forms in HIV-coinfected IC and therefore less bacillary forms but also to a lower degree of crowding and a higher protection against exposure to their contacts.

J Hosp Infect, 1999 Apr, 41(4), 301 - 11
Detecting legionellosis by unselected culture of respiratory tract secretions and developing links to hospital water strains; Kohler JR et al.; For a 13-month period, all respiratory tract secretions submitted for routine bacteriology from a large hospital complex were cultured for legionella, irrespective of clinical diagnosis and laboratory requests . Ten cases of legionellosis were detected in this manner, three of which met a strict epidemiological definition of hospital-acquired . Therefore, the 16 warm-water systems of the hospitals, spread out over two locations, were examined for the presence of legionella . Legionella pneumophila was found in 15 warm water systems, with a distinct pattern of serogroups between the two locations . Legionella of the same serogroups as those isolated from patients were present in each hospital water supply . The isolates were further typed by monoclonal antibodies and by genomic macrorestriction analysis . Similarity between clinical and environmental isolates was found in seven cases . In these cases, acquisition from the hospital water supply appears very likely . The strains of the remaining three patients did not match those in hospital water, suggesting that community-acquired legionellosis was occurring as well . This study suggests that routinely culturing respiratory tract secretions of pneumonia patients for legionella can help diagnose unsuspected cases of legionellosis . Typing legionella strains beyond the serogroup level with tools such as macrorestriction analysis is useful to define sources of infection, which can then be targeted for control measures.

Am J Rhinol, 1999 May-Jun, 13(3), 229 - 33
Distilled water nasal provocation in hyperreactive patients; Baudoin T et al.; Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals . The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data . A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry . Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study . After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response . In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy . Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation . In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased . The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation . Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.

Dig Dis Sci, 1999 Jun, 44(6), 1173 - 6
Use of chopsticks for eating and Helicobacter pylori infection; Leung WK et al.; Epidemiological data suggests that ethnic groups using chopsticks for eating have a higher prevalence of H . pylori infection . This study investigated the carriage of H . pylori in chopsticks after eating . Used chopsticks and saliva were collected from asymptomatic individuals whose H . pylori status was determined by {13C}urea breath test and serology . Both the saliva specimens and chopsticks were cultured and processed by polymerase chain reaction (PCR) for the detection of H . pylori . Furthermore, chopsticks used by hospital staff in the cafeteria were pooled for the detection of H . pylori by bacteriologic culture and PCR . Sixty-nine volunteers were recruited in the first study and 45 (65%) were diagnosed to have H . pylori infection . While all cultures were negative, H . pylori was detected by PCR in the saliva from 15 (33%) infected subjects and in the chopsticks from one (2%) . Among the 12 sets of pooled chopstick-washing studied, H . pylori was detected by PCR in two sets . This study showed that H . pylori was rarely detected in chopsticks after eating and hence, the risk of contracting this infection via the use of chopsticks is low.

J Hosp Infect, 1999 Jun, 42(2), 113 - 7
Routine disinfection of patients' environmental surfaces . Myth or reality?
Dharan S, Mourouga P, Copin P, Bessmer G, Tschanz B, Pittet D.
We have evaluated the need for daily disinfection of environmental surfaces not contaminated by biological fluids, in patient areas of a medical unit with two wings {North (N) and South (S)} at the University Hospitals of Geneva, Switzerland . Weekly bacteriological monitoring of surfaces was carried out at random (N = 1356 samples) . In the S wing (control), we used detergent/disinfectant for daily cleaning of the floors and furniture . In the N wing we began by using a detergent for floors and furniture; after four weeks the results suggested changing to a rotation of detergent, dust attracting disposable dry mops and disinfectant . During this period the furniture was cleaned with an active oxygen-based compound . The average differences in contamination before and after cleaning floors were (mean reduction in bacterial counts and 95% confidence intervals; CI95): disposable mops: 92.7 cfu/24 cm2 (CI95; 74-112), active oxygen based compound 111.1 (90-133), and quaternary ammonium compound -0.6 (-27-26) . Use of detergent alone was associated with a significant increase in bacterial colony counts: on average by 103.6 cfu (CI95 73-134) . The quaternary ammonium compound was inadequate for disinfecting bathrooms and toilets but the active oxygen based compound was satisfactory . For furniture, there was a significant reduction in bacterial counts with both the methods using disinfectants . As the detergent was contaminated, by using it alone for cleaning, we were actually seeding surfaces with bacteria . A total of 1117 patients was studied and we observed no change in the incidence of nosocomial infections during the four months of the trial . In conclusion, uncontrolled routine disinfection of environmental surfaces does not necessarily make it safe for the patient and could seed the environment with potential pathogens.

Pneumoftiziologia, 1998 Jul-Sep, 47(3), 177 - 80
{The clinico-epidemiological aspects of tuberculosis occurring in medical personnel in pneumophthisiology units in Bucharest (1992-1996)}; Ibraim E et al.; The authors studied 38 TB cases diagnosed between 1992 and 1996 among the 1092 employees (medical and nonmedical) of the pneumophthisiology departments in Bucharest (hospitals and ambulatory units) . Most cases had pulmonary involvement (76.3%), 85.7% were bacteriologically tested for bK . Among them, 66.7% were confirmed . The therapeutic results evaluated after 1 year, showed just 1 failure . The medium annual risk of tuberculosis at the PF personnel is corresponding to an incidence of 700/100,000 (6.36 times higher than TB incidence in general population) . This conclusions calls for emergency measures for protecting and compensating this personnel.

Medinfo, 1998, 9 Pt 2, 952 - 6
Hospital information system: reusability, designing, modelling, recommendations for implementing; Huet B; The aims of this paper are to precise some essential conditions for building reuse models for hospital information systems (HIS) and to present an application for hospital clinical laboratories . Reusability is a general trend in software, however reuse can involve a more or less part of design, classes, programs; consequently, a project involving reusability must be precisely defined . In the introduction it is seen trends in software, the stakes of reuse models for HIS and the special use case constituted with a HIS . The main three parts of this paper are: 1) Designing a reuse model (which objects are common to several information systems?) 2) A reuse model for hospital clinical laboratories (a genspec object model is presented for all laboratories: biochemistry, bacteriology, parasitology, pharmacology, ...) 3) Recommendations for generating plug-compatible software components (a reuse model can be implemented as a framework, concrete factors that increase reusability are presented) . In conclusion reusability is a subtle exercise of which project must be previously and carefully defined.

J Am Vet Med Assoc, 1999 Jun 15, 214(12), 1813 - 6, 1791-2
Laparoscopically assisted resection of umbilical structures in foals; Fischer AT Jr; A technique for laparoscopically assisted resection of umbilical structures in foals was developed . Eleven foals ranging from 8 to 42 days old underwent this procedure . Results of bacteriologic culture of umbilical structures were positive in 7 foals . Mean duration of anesthesia was 99 minutes, of which the initial 20 to 25 minutes were typically devoted to positioning and preparation of the foal for surgery . Major complications did not develop in any foal . Minor complications, such as slippage of the endoscopic ligating clip or laceration of the bladder during dissection, were dealt with successfully during the procedure . Potential benefits of use of laparoscopy (i.e., decreased postoperative morbidity, smaller incisions, and increased intraoperative access to structures) must be carefully weighed against the risks of increased duration of anesthesia . However, anesthetic-related complications were not observed in any foal.

J Am Vet Med Assoc, 1999 Jun 15, 214(12), 1817 - 23
Use of mammary gland and colostral characteristics for prediction of colostral IgG1 concentration and intramammary infection in Holstein cows; Maunsell FP et al.; OBJECTIVE: To determine whether mammary gland or colostral characteristics at calving could be used to predict colostral immunoglobulin G1 (IgG1) concentration or intramammary infection (IMI) and whether leakage of colostrum affects IgG1 concentration . DESIGN: Prospective study . ANIMALS: 113 multiparous Holstein cows . PROCEDURE: Cows were examined within 3 hours of calving, and mammary gland and colostral characteristics, colostral volume, somatic cell count, and concentrations of IgG1, fat, and protein were determined . Bacteriologic culture of mammary secretions was performed approximately 14 and 7 days before calving and at calving . Associations of gland and colostral characteristics with colostral IgG1 concentration, colostral volume, and IMI were examined . RESULTS: Thick or thin colostrum had higher IgG1 concentration than colostrum of intermediate viscosity . Colostrum from mammary glands that were firm had low IgG1 concentration . Colostral IgG1 concentration was weakly correlated with volume . Intramammary infection was likely to be detected if colostrum contained clots or blood or if the California Mastitis Test (CMT) score was > or = 2 . Somatic cell count was higher for glands with IMI than for uninfected glands, and CMT score was correlated with cell count . CLINICAL IMPLICATIONS: Mammary gland and colostral characteristics were of little value in predicting IgG1 concentration . Our findings do not support recommendations that first milking colostrum that is thin (watery) or that is from cows producing large volumes not be fed to dairy calves . Colostral characteristics, particularly CMT score, were of value for predicting IMI.

Med J Aust, 1999 May 17, 170(10), 482 - 5
Disseminated tuberculosis: still a diagnostic challenge; Paull AE et al.; Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in Australia, familiarity with its manifestations has dwindled . We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties . Surprisingly, immunosuppressive therapy need not cause rapid deterioration . Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas . In the absence of confirmatory results, a prompt therapeutic trial may be life-saving.

Zhonghua Wai Ke Za Zhi, 1997 Mar, 35(3), 138 - 9
{Early diagnosis of pancreatic infection by CT-guided needle-aspiration}; Sun J et al.; 35 CT-guided percutaneous needle-aspirations with bacteriological sampling were performed in 21 patients suspected of pancreatic infection out of 122 patients with severe acute pancreatitis . Thirteen patients were found by smear and staining culture to have pancreatic infection, and diagnosis was confirmed by surgery . The pathogens found were E coli, pseudomonas and fungi . All pancreatic infections were in grade D or E according to the grading system of Balthazar . Seven of 8 patients with sterile aspirates were cured by nonsurgical therapy . We conclude that CT-guided aspiration is a safe, accurate method for identifying infection of the pancreas at the early stage of severe acute pancreatitis.

Zhonghua Jie He He Hu Xi Za Zhi, 1997 Oct, 20(5), 301 - 4
{Evaluation of different methods of detection and diagnosis for infectious pulmonary tuberculosis}; Shi H et al.; OBJECTIVE: To evaluate the compare the efficiency and benefit of fluoroscopy and direct sputum examination . METHOD: The suspected persons with pulmonary tuberculosis symptoms were enrolled to be examined with fluoroscopy, chest radiography, sputum smear and culture . RESULT: The diagnostic procedure used by World Bank-loaned Tuberculosis Control Project in China is based on fluoroscopy screening . The miss-detection rates of smear positive, culture positive and bacteriological positive pulmonary tuberculosis were 10.5%, 28.3% and 28.2% respectively . Its accuracy of diagnosis was lower than that of direct sputum smear examination and the cost was higher . CONCLUSION: Direct sputum smear examination seems to be the best diagnostic method for infectious pulmonary tuberculosis and suitable for application in rural areas.

Zhonghua Jie He He Hu Xi Za Zhi, 1997 Dec, 20(6), 358 - 60
{Efficacy of unfixed continuation phase short-course chemotherapy}; Xiao C et al.; OBJECTIVE: To evaluate the efficacy of the short-course chemotherapy shorter than six months . METHOD: The 2SHRZ/xHR regimen was used in 290 smear positive new untreated tuberculosis patients . The duration of continuation phase was not fixed, just in accordance with the speed of sputum negative conversion . The treatment was continued until sputum negative conversion mantained for three consecutive months . RESULT: Two hundred eighty-three out of 290 patients were cured . The sputum negative conversion rate at the end of the sixth month was 98.3% . The duration of treatment was 4.7 months on the average . The rate of two-year follow-up was 94.3%, and the rate of bacteriological relapse during two-year follow-up was 1.9% . CONCLUSION: The results showed that the length of the six-month short-course chemotherapy could be shortened, and its recent and long-term efficacy was found satisfactory.

Ann Acad Med Singapore, 1999 Jan, 28(1), 141 - 6
Gut barrier dysfunction in experimental acute pancreatitis; Andersson R et al.; Bacterial infections, frequently caused by bacteria of enteric origin, are often seen during the progression of severe acute pancreatitis, concomitant with the potential development of multiple organ dysfunction . In the present paper, the complex mechanisms of gut barrier dysfunction and gut origin sepsis in acute pancreatitis are discussed . The individual parts of the gut barrier, e.g . the immunological, bacteriological and morphological (mucus, epithelium, endothelium and interstitium) components, seem to interact and depend on each other . Pancreatitis-induced hypovolaemia due to endothelial barrier leakage and gut arteriovenous shunting causes intestinal ischaemia and reperfusion injury with concomitant gut barrier dysfunction . Gut endothelial barrier dysfunction probably plays a central role . Potential molecular mechanisms could, among others, be associated with alterations in intracellular signal transduction, intercellular signalling and expression of adhesion molecules on endothelial cells . The mechanisms underlying gut barrier dysfunction in acute pancreatitis are thus complex and still not fully elucidated . Knowledge about the regulating events will probably allow future pharmacological therapy for prevention and treatment of the severe complications of acute pancreatitis, including gut barrier dysfunction.

Eur J Cardiothorac Surg, 1999 Apr, 15(4), 465 - 8
The possibilities of greater omentum usage in thoracic surgery; Levashev YN et al.; OBJECTIVE: To illustrate the wider role of an omental pedicle flap in surgical treatment for diverse thoracic organ disorders we have, retrospectively, reviewed our experience over the last 8 years . METHODS: We used the greater omental pedicle flap in 68 patients . Bronchial stump omentopexy was performed in 35 patients with a high risk of impaired bronchial healing after right pneumonectomy as a preventive method and in two patients with an acute bronchial fistula . In 13 patients after circular tracheal or carinal resections and in four after esophago-respiratory disjoints of fistulas we applied anastomoses or circular omentopexy of the fistula zone . The omental coverage was performed in four patients with chronic empyema, in seven patients after extensive chest wall resection and in two patients with post-sternotomy mediastinites . In one patient with idiopathic fibrosing mediastinitis, one-stage allotransplantation of tracheal thoracic segment was conducted and greater omentum (GO) was used to wrap the allograft . RESULTS: Three patients developed major complications . The first, bronchial fistula after bronchial stump omentoplasty . In two patients circular wide tracheal resection (11-12 rings) was complicated by a tracheal divergence of anastomoses . These complications were cured in a conservative way since a displaced omental flap substituted the tracheal wall and, therefore, the trachea remained hermetically sealed . In other cases, the perfect adhesive properties of the omental tissue promoted perfect adhesive properties promoted prevention of incompetence and inflammatory complications . Immunological and bacteriological examinations showed that pediculated omental flap is a lymphocyte source and promotes a decrease in bacterial quantity and activity . CONCLUSION: We think the series demonstrates the value of the omental method, which offers excellent therapeutic results following an easy surgical procedure . This method extends indications for surgical treatment and decreases the postoperative complications.

Can J Vet Res, 1999 Apr, 63(2), 101 - 6
Identification of Mycobacterium bovis in bovine clinical samples by PCR species-specific primers; Romero RE et al.; Tuberculosis, caused by Mycobacterium bovis is emerging as the most important disease affecting cattle . Furthermore, it results in a major public health problem when transmitted to humans . Due to its difficult and non-specific diagnosis, M . bovis has been declared to be one of the etiologic agents causing significant economic loss in the cattle industry . Our group evaluated a more rapid and specific method, based on a new polymerase chain reaction species-specific primers, which amplifies a 470-base pair fragment of the M . bovis genome . A total of 275 milk-producing cows were studied by intradermal tuberculin test (ITT) which gave 184 positive and 91 negative cases . From them, 50 animals were taken from a cattle ranch free of tuberculosis . Three different samples were collected from each animal (blood, nasal mucus, and milk) . Positive results were obtained from 26 animals by PCR (11.4%), 1 by bacteriological culturing (0.4%) and 1 by bacilloscopy (0.4%) . This finding suggests, as in previous reports, that ITT, normally used for bovine tuberculosis detection, has the inconvenience of having a broad range of specificity and sensitivity, and the PCR technique is a more specific and sensitive test to detect infection associated with M . bovis . Therefore, we propose this PCR assay as a useful tool in the epidemiological characterization of infected animals in areas considered to be at high risk of transmission.

Eur Respir J, 1999 Apr, 13(4), 900 - 3
Prospective multicentre study on the evaluation of antituberculosis treatment results in Italy: comparison of the culture- versus the smear-based methods . National AIPO Tuberculosis Study Group; Migliori GB et al.; Cohort analysis of treatment outcomes is the most informative technique to evaluate the tuberculosis (TB) control programme . The aim of the study was to assess treatment outcomes comparing the smear- versus the culture-based methods, using data on TB patients treated under programme conditions in Italy . This was a prospective monitoring study based on the standardized collection of forms from a representative sample of Italian TB Units . The forms, with individual data, were reviewed and analysed on a quarterly basis according to the principles of cohort analysis, using both the smear- and culture-based methods . The complete bacteriological profile of patients was analysed at diagnosis and at completion of treatment . Nine hundred and ninety-two TB cases were notified . Among 681 pulmonary cases, 368 cases were culture-confirmed at diagnosis (333 new and 35 retreatment cases, 293 being sputum smear positive, 79.6%) . At the end of treatment, out of the 333 new culture-confirmed cases, 136 (40.8%) were defined "cured" using the culture-based method and 108 (32.4%) using the smear-based method (p<0.05, chi2 test) . The culture-based method is the recommended tool to evaluate pulmonary tuberculosis treatment results . Culture allows a more precise definition of a "cured" patient in both sputum smear positive and negative tuberculosis cases.

Hand Clin, 1999 May, 15(2), 245 - 8, viii
High-pressure injection injuries to the hand; Schnall SB et al.; High-pressure injection injuries of the hand can lead to devastating outcomes . Amputation rates as high as 48% have been reported . The authors review the history of high-pressure injection injuries, with attention to the materials injected, the clinical presentation of these injuries, emergency room and subsequent definitive surgical management of these injuries, the bacteriology and recommendations for antibiotic use in these injuries, and postoperative management.

Vet Rec, 1999 Apr 24, 144(17), 466 - 70
Infection of gnotobiotic calves with Escherichia coli o157:h7 strain A84; Woodward MJ et al.; Six colostrum-deprived, hysterotomy-derived calves were maintained under sterile conditions and fed a milk replacer diet . At five days of age, five of the calves were dosed orally with 10(9) cfu of Escherichia coli O157:H7 strain A84 . They were killed after, one, two, six, 12 and 24 days, and samples were taken for bacteriological and pathological examination . The sixth uninfected control calf was killed at seven days of age and matched samples were taken for pathological comparison . The animals remained normal throughout the observation period . Bacteriological data indicated a heavy bacterial load of strain A84 throughout the gastrointestinal tract but the bacterium was not found in liver, kidney or muscle . No evidence of 'attaching and effacing' lesions in the small or large intestine was found although there was a mild inflammatory response in the intestinal tract, consisting mainly of infiltrating eosinophils.

Microbiol Mol Biol Rev, 1999 Jun, 63(2), 263 - 4
A bit of history; Ingraham JL et al.; Reviews of scientific literature began to appear in the 17th century . Journals dedicated to them soon followed, leading eventually to this one, which emerged in the 1930s as Bacteriological Reviews; it adapted to the many changes in our fluid discipline, evolving into the present, much broader Microbiology and Molecular Biology Reviews.

Kansenshogaku Zasshi, 1999 Apr, 73(4), 291 - 7
{Combination effect of fosfomycin otic solution and norfloxacin against chronic otitis media}; Uno Y; Studies on a combination therapy of fosfomycin (FOM) and norfloxacin (NFLX) against chronic otitis media were performed, and the following results were obtained . 1 . The fractional inhibitory concentration index (FIC index) < or = 0.5 between FOM and NFLX showed 66.7% (4/6) against S . aureus isolated from chronic otitis media and 80.5% (4/5) against P . aeruginosa . 2 . Clinical effects was excellent in 2 cases (18.2%), good in 6 cases (54.5%) and poor in 3 cases (27.3%) . 3 . Bacteriologically 9 strains out of 11 patients were eradicated after the combination treatment; 5/6 in S . aureus and 4/5 in P . aeruginosa . 4 . No adverse effect and abnormal laboratory findings were observed in this study . It is suggested that the combination of FOM otic solution and NFLX is useful for the treatment of chronic otitis media.

Kekkaku, 1999 Apr, 74(4), 365 - 75
{The current situation and treatment of childhood tuberculosis}; Takamatsu I; We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997 . The diagnosis criteria for establishing TB were history of direct contact with TB patients, tuberculin skin test reactivity, positive bacteriology and radiographic findings compatible with TB . There were 192 males and 202 females (age range 1 month to 18 years of age, mean 6.3 years of age) . Fifty-four percent of the cases were under 5 years of age . Primary pulmonary TB was presented in 200, post primary pulmonary TB in 97, pleural effusion in 53, endbronchial TB in 4, TB meningitis (TBM) in 28, miliary TB in 28 and other extra-pulmonary TB in 31 . A history of contact with the patients was obtained in 72.8% of cases . Two hundred and thirty (58.4%) had received BCG, 134 (34%) no BCG, 30 (7.6%) were unclear . Especially, under 5 years of age, only 29 (13.6%) had received BCG . TBM is not disappeared in Japan and there were 28 cases with TBM . Fifteen patients out of them recovered completely, 8 patients recovered with severe neurological sequelae which included mental retardation, motor weakness, seizures and hydrocephalus and 5 patients died . Twenty-six had no BCG . Particularly in 1990s, we had experienced 4 dead TBM cases, 1 multi-drug resistant (MDR) TBM case and 1 TBM case due to nosocomial infection . Children with TBM should received 12-month regimen using initial daily treatment with isoniazid, rifampin, pyrazinamide, and streptmycin, followed by isoniazid and rifampin administered daily . Pulmonary TB in children is successfully treated with 6-month standard chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months . In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR TB are most important in Japan.

Pneumonol Alergol Pol, 1998, 66(7-8), 396 - 403
{Deaths from tuberculosis among permanent residents of Toruń in the years 1990-1993}; Sipak M et al.; The aim of this was to verify the cases of death from tuberculosis (TB) in Torun province in the years 1990-1993 . The data of the official register of death were compared, with the hospital records and with the autopsy reports . Tuberculosis was accepted as the cause of death in all patients treated for sputum positive tuberculosis and also in those in whom pathological proof of tuberculosis existed . In addition tuberculosis was accepted as the cause of death in patients in whom no bacteriological examination was done, but who were tuberculosis contacts and who had the radiological picture of the lung compatible with tuberculosis . Those patients were admitted to the hospital in terminal state and the permission for autopsy was refused . Tuberculosis was excluded as the cause of death in those who were treated for tuberculosis but were considered cured and also in those in whom a proof of other severe disease existed . 72 cases of tuberculosis death were officially registered in the above-mentioned time . In 23 of those 72 causes tuberculosis was excluded . On the other hand 26 patients who died of tuberculosis were officially registered as death from other causes . After verification we have found that 75 patients died of tuberculosis . Thus the real number of death from tuberculosis was similar to the registered one although the errors in registered deaths from tuberculosis are in two directions.

Int J Tuberc Lung Dis, 1999 May, 3(5), 421 - 5
Clinical utility of a commercial ligase chain reaction kit for the diagnosis of smear-negative pulmonary tuberculosis; Kwiatkowska S et al.; SETTING: In paucibacillary forms of smear-negative tuberculosis it is very difficult to establish a correct and rapid diagnosis, as several weeks are usually required to obtain positive results from culture . In the last few years new rapid techniques based on molecular biology for the detection of Mycobacterium tuberculosis have been introduced . OBJECTIVE: The aim of this study was to evaluate the utility of the ligase chain reaction method (LCx, Abbott) for the diagnosis of smear-negative pulmonary tuberculosis . DESIGN: Thirty smear-negative patients with radiographic changes and clinical signs consistent with TB participated in the study . Sputum and bronchial aspirate were assessed according to traditional methods on Lowenstein-Jensen medium, and bronchoalveolar lavage (BAL) was assessed by the LCx test and the Bactec 460 system . Another 30 patients with non-tuberculous infections were included in the study as controls . RESULTS: Of the 30 patients suspected of tuberculosis, 19 had active disease on clinical, bacteriological and radiographic grounds, nine inactive tuberculosis and two had lung cancer . Bacteriological confirmation was obtained in 12 of the 19 (63.2%) patients with active tuberculosis . The sensitivity of sputum culture was 42.1% and bronchial aspirate culture 47.4% . BAL fluid revealed positive results in 57.9% using both LCx and Bactec . The results of the LCx assay can be obtained in 5 hours as opposed to several weeks using other methods . CONCLUSION: The LCx test may be useful in the diagnosis of smear-negative pulmonary tuberculosis and may be recommended in these clinical situations.

Tierarztl Prax Ausg G Grosstiere Nutztiere, 1999 Apr, 27(2), 114 - 21
{Effectiveness and disposition of the newly developed cephalosporin cefquinome in puerperal septicemia and toxemia in gilts}; Heinritzi K et al.; Epizootiological, clinical, bacteriological and haematological studies were carried out to assess the effectiveness of the recently developed cephalosporin preparation Cefquinome in the treatment of the puerperal septicaemia and toxaemia syndrome . Cefquinome was administered at three different doses (1, 2 and 4 mg/kg BW) to 188 sows with feverish puerperal illness . Amoxicillin (7 mg/kg BW) was used as a control drug . In 41% of cases endometritis was a monoinfection whereas in 70% of mammary infections mixed infections were diagnosed . Results showed that for therapy of puerperal septicaemia and toxaemia Cefquinome at doses of 2 mg/kg BW and 4 mg/kg BW is clearly more effective than the control drug Amoxicillin and Cefquinome at its lowest dose of 1 mg/kg BW.

Tierarztl Prax Ausg G Grosstiere Nutztiere, 1999 Apr, 27(2), 99 - 106
{Cell count and differential cell count in goat milk--variability and influencing factors}; Fahr RD et al.; In a total of 413 dairy goats of different breeds from five herds (milk performance 550-1000 kg) somatic cell counts and cell types were investigated in fore milk samples from udder halves, in composed udder and bulk milk samples . Cytoplasmatic particles in the milk were not counted . Three herds were investigated monthly during two years . At every sampling a clinical examination of the mammary gland (fore milk, teats, gland tissue, lymphatic nodes of the udders) and a bacteriological examination of the milk samples were carried out . In all herds the clinical health status of the udders was good . Independent of the sample type the mean SCC was about 1000 x 10(3)/ml with a wide range between several millions and < 100,000/ml . A seasonal influence on the monthly minima and maxima of the bulk milk SCC was evident, the lower SCC being recorded mainly during April to October . Increasing lactation numbers and months are connected with increasing SCC . Goats with high milk SCC at the begin of the lactation tended to maintain their high SCC levels as the lactation progressed . Limit values for SCC in goat milk should take into account the influence of the kidding season of the herds upon the dynamics of the bulk milk SCC . Polymorphonuclear leukocytes were the main cell type in goat milk (around 40%), their number tended to increase as total SCC increased, in particular in samples with cell counts above one million . Likewise, the differences between SCC in the milk of corresponding udder halves increased significantly as one of the halves showed more than one million somatic cells . Defining limit values for SCC in goat milk this should be taken into account.

Tierarztl Prax Ausg G Grosstiere Nutztiere, 1999 Apr, 27(2), 92 - 8
{Physical examination and palpation findings of mammary glands and indications of udder health in goat milk}; Schulz J et al.; In dairy goats there is less evidence for relationships between udder form traits, results of physical udder examinations and mastitis indicators in the milk than in dairy cows . In 413 goats (predominantly Weisse Deutsche Edelziege and Bunte Deutsche Edelziege) from five herds (free from C.A.E.) repeated investigations of 2537 udder halves and fore milk samples were carried out in order to compare udder traits with findings in the milk . Less than 20% positive bacteriological findings and a low incidence of clinical mastitis testified a good clinical udder health status of the herds . Small teat-floor distances, loose hanging of the udders and bottle-shaped teats, findings which tended to become more frequent as lactation and lactation numbers progressed, indurative alterations of the mammary tissues and the teats tended to be connected with higher milk cell counts (> 1 million/microliter), more polymorphonuclear milk cells (> 40%), higher electrical milk conductivity (> 6.8 mS/cm) and lower milk lactose content (< 4.6%) . A similar effect had a bad state of foot trimming . It is proposed to include the studied udder traits into herd health programs and breeding schemes for goats.

J Clin Microbiol, 1999 Jun, 37(6), 2104 - 5
Primary Shewanella alga septicemia in a patient on hemodialysis; Iwata M et al.; We report the first Japanese case of primary septicemia with Shewanella alga and also describe the bacteriological characteristics of and results of antibiotic susceptibility tests of the isolate . S . alga was repeatedly isolated, at times simultaneously with Escherichia coli, from the blood of a 64-year-old female undergoing hemodialysis . The isolated organism was determined to be S . alga based on recently published identification criteria, such as hemolysis on sheep blood agar, no acid production from carbohydrates, and growth on agar containing 6 . 5% NaCl . Results of antibiotic susceptibility tests demonstrated that the isolate was sensitive to levofloxacin and cefpirome (MICs, </=0.063) but resistant to cefazolin, ceftizoxime, and imipenem (MICs, >128, 64, and 8 microg/ml, respectively) . Although the role of S . alga as a human pathogen has not been fully determined, accumulating data suggest that this organism may be a potential pathogen, especially in compromised hosts.

Plast Reconstr Surg, 1999 May, 103(6), 1561 - 6
Prophylactic antibiotics in plastic and reconstructive surgery; Baran CN et al.; There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection . This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates . A total of 1400 patients were classified into four groups based on their diagnosis . During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously . Wound infection rates were observed in the postoperative period . Age, sex, and operative site of the patients with the same diagnosis were comparable in each group . The white blood cell count and the body temperature reading of each patient were recorded postoperatively . Wounds were observed daily in the postoperative period and graded according to a predetermined scale . Bacteriologic specimens were obtained from patients who had wound infections . According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery . At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.

Orv Hetil, 1999 Apr 11, 140(15), 811 - 4
{Liver changes in HIV/AIDS}; Telegdy L et al.; Loss of cellular immunity accompanying the progressive HIV/AIDS disease, results in altered clinical picture and outcome of traditional infections as well as severe and often lethal illness caused by facultative pathogens . Unusual infections may call the attention to the underlining HIV disease . Liver disease appears in the great majority of HIV/AIDS patients . The authors review the viral, bacterial, fungal and protozoal infections involving the liver in AIDS . Liver biopsy has a diagnostic value beside the serology and bacteriology and may give therapeutic consequences.

Zhonghua Liu Xing Bing Xue Za Zhi, 1998 Aug, 19(4), 200 - 4
{Investigation of an Legionnaires' disease outbreak associated with contaminated air-conditioning}; Ma X et al.; An outbreak of upper respiratory infection (influenza-like syndrome) took place among the staff members of a large office building in Beijing, June, 1997 . To understand the cause of the outbreak, with a case-control study with serological antibodies detection against serogroup 1 to 14 of Legionnaires' disease bacteria (LDB) and bacteriological test and culture on samples collected from the air-conditioning system of the office building was performed . The findings showed that the attack rates of tonsillitis and upper respiratory infection were 61.86% and 34.62% respectively . The relation was statistically significant between the symptoms of fever and tonsillitis in the cases (chi 2 = 77.88, P < 0.01) . The positive rates of LDB antibodies on serogroups 9, 10, 12, 14 were 45.94% in the cases of upper respiratory infection and 3/15, 6/17, 0/15, 1/16 respectively in the four controls groups . Condensied water samples from an air-conditioning system showed that Legionella Pneumophila was positive . Evidence showed that it was an outbreak resulting from LDB serogroup 9 and 12, accompanied by upper respiratory infection related to air-conditioning system contaminated by LDB . This was the first report Lp infection associated with an air-conditioning system in China.

New Microbiol, 1999 Apr, 22(2), 139 - 50
Variability of some microbial parameters in relation to the hydrological features of the water column in the Eolian Basin (Southern Tyrrhenian Sea); Giuliano L et al.; During the EOCUMM '94 cruise, 15 stations located in the Eolian Islands area (Southern Tyrrhenian Sea) were sampled to analyse the distributions of the total bacterioplankton densities and the heterotrophic viable bacteria counts on Marine Agar 2216 . According to the TS (temperature-salinity) diagrams, obtained by processing the CTD (conductivity-temperature-depth) vertical profiles, the sampled stations were grouped in "hydrological clusters" . The bacteriological variables, together with the chlorophyll a and the particulate organic carbon measures obtained during the same cruise were used to compare the stations of the same and different clusters . The results indicated that variabilities of the analysed microbial parameters were not obviously related to the hydrographic features of the sampling stations . This work is an attempt to verify the possibility of using microbial parameters to characterize the structure of the water column.

Crit Care Med, 1999 Apr, 27(4), 756 - 63
Pentoxifylline improves bacterial clearance during hemorrhage and endotoxemia; Heller S et al.; OBJECTIVE: The aim of this study was to investigate whether the methylxanthine-derivative pentoxifylline (PTX) affects bacterial clearance of the organism in states of hemorrhage and endotoxemia . DESIGN: Prospective, randomized, controlled trial . SETTING: Experimental laboratory in a university hospital . SUBJECTS: Fifty-four female chinchilla rabbits . INTERVENTIONS: To quantify the clearance process, defined numbers (10(7) CFO) of Escherichia coli bacteria were injected intravenously into anesthetized rabbits, 60 mins after induction of hemorrhage (n = 9 + 3) or infusion of endotoxin (lipopolysaccharide {LPS}; 40 microg/kg/hr; n = 9 + 3) and after saline infusion (control; n = 9), respectively . Hemorrhage was induced by bleeding, standardized by defined reduction of mean arterial pressure (30% of baseline value) . To evaluate the potential effects of PTX on bacterial elimination and killing, in states of hemorrhage and endotoxemia, blood clearance of E . coli and colonization of different organs were investigated after pretreatment with PTX (30 mg/kg) as a bolus injection followed by continuous infusion of PTX (50 mg/kg/hr) in hemorrhagic (n = 9) and endotoxemic rabbits (n = 9) . Three additional experiments were performed to evaluate the effects attributable to PTX itself . MEASUREMENTS AND MAIN RESULTS: Parameters monitored were rates of bacterial and LPS elimination from the blood, arterial blood pressure, blood gases, and serum lactate concentrations . Additionally, flow cytometric analysis of respiratory burst activity was performed . Three hours after bacterial injection, the animals were killed, and tissue samples of liver, kidney, spleen, and lung were collected for bacteriologic examinations . Compared with the controls, hemorrhage and endotoxemia resulted in a significantly prolonged elimination of injected E . coli from the blood . The delayed blood clearance was associated with a significantly (p < .01) higher bacterial colonization of all organs, which was most pronounced in the lung . Pretreatment with PTX slightly enhanced blood clearance of E . coli as well as of LPS, and significantly reduced (p < .05) the colonization of lung and kidney after hemorrhage and endotoxemia . Furthermore, PTX suppressed polymorphonuclear neutrophil respiratory burst activity . CONCLUSIONS: Hemorrhage and endotoxemia induce impaired bacterial clearance from blood and tissue . Treatment with PTX may reduce the risk of bacterial infections by attenuating bacterial colonization of organs in states of hemorrhage and endotoxemia.

Schweiz Med Wochenschr, 1999 Apr 10, 129(14), 547 - 55
{Pulmonary abscesses and bronchiectasis}; Ris HB et al.; Both primary and secondary pulmonary abscesses are increasingly observed in thoracic surgery units . Primary pulmonary abscesses are related to necrotising pneumonia or aspiration due to alcoholism, drug abuse, dysphagia or gastrointestinal reflux disease . Secondary poststenotic abscesses are related to bronchial obstruction (endobronchial tumour or foreign body aspiration) or to superinfection of pulmonary neoplasia or infarction pneumonia . Bronchoscopy is mandatory if a pulmonary abscess is suspected, to exclude endobronchial obstruction and obtain bacteriological examination by bronchial lavage or transbronchial fine needle aspiration . Transthoracic fine needle aspiration may be helpful for bacteriological examination, since germs found in sputum do not necessarily correlate with those found in the abscess . Pulmonary abscesses are primarily treated by administration of appropriate antibiotics with a remission rate of 80% . In the presence of complications of the abscess or if conservative management fails, percutaneous transthoracic drainage or surgical resection may be indicated . Bronchiectasis is also increasingly seen, especially in refugees and immigrants . The disease is characterised by chronic dilatation of bronchi with paroxysmal cough, mucopurulent secretion and recurrent pulmonary infections . Bronchiectasis is most commonly caused by recurrent bronchial infections during childhood or behind bronchial obstruction . Congenital bronchiectasis is very rare . Viral and bacterial pulmonary infections during childhood are by far the most common causes of bronchiectasis, leading to destruction of the mucociliary apparatus and the cartilage of the segmental bronchi . Bronchiectasis should be treated by an appropriate antibiotic regimen . Resection should only be considered in situations where a conservative regimen fails . Segmentectomy of all involved segments is the surgical treatment of choice in situations with well-localised bronchiectasis and results in long-lasting remission in over 80% of those patients . Patients with bilateral bronchiectasis may be considered for bilateral surgical resection if diffuse and congenital disease has been ruled out.

Klin Lab Diagn, 1999 Mar, (3), 41 - 3
{Principles of assessing quality of activities of clinico-diagnostic laboratories under conditions of market economy}; Potashova AM et al.; A model of final results (MFR) is developed for assessing the quality of work at clinical diagnostic laboratories (CDL), including biochemical, serological, and bacteriological . The model is based on efficiency and deficiency indices (EI and DI, respectively) . The coefficient of efficiency (CE) is determined by the ratio of EI score minus DI score to the sum of reference values . The proposed MFR is developed at laboratory center of municipal hospital No . 4 and has been used for 5 years . This model helps the head of a laboratory to assess objectively the activities of a CDL every month and promotes monetary stimulation of work with consideration for its results.

Radiology, 1999 May, 211(2), 459 - 65
Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow; Lee SK et al.; PURPOSE: To find any differential magnetic resonance (MR) imaging findings between septic arthritis and transient synovitis in pediatric patients . MATERIALS AND METHODS: The MR imaging findings in nine pediatric patients with septic arthritis and 14 with transient synovitis were retrospectively studied . The diagnoses were made by means of joint aspiration with bacteriologic study, arthrotomy, and clinical evaluation . MR imaging findings were analyzed with emphasis on the grade of joint effusion and alterations in signal intensity in the soft tissue and bone marrow of the affected hip joint . RESULTS: Signal intensity alterations in bone marrow (i.e., low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted spin-echo images and high signal intensity on fat-suppressed T2-weighted fast spin-echo images) were seen in eight of nine patients with septic arthritis . These signal intensity alterations consisted of mild juxtaarticular changes in six patients without osteomyelitis and extensive changes in the femoral head and neck in two patients with coexistent osteomyelitis . Signal intensity alterations in bone marrow were not seen in the 14 patients with transient synovitis . CONCLUSION: Signal intensity alterations in the bone marrow of the affected hip joint are useful in the differentiation of septic arthritis from transient synovitis.

Nephrologie, 1999, 20(2), 81 - 6
{Severe renal forms of leptospirosis . Apropos of 6 cases seen in 15 years at one center}; Schillinger F et al.; We report on six cases of leptospirosis observed in fifteen years in our department of nephrology . The contamination is two times from professional origin and four times linked to water leisures, during hot season, from june to september for the majority . Two serotypes are found: L . icterohaemorragiae characterized by marked jaundice, and L . patoc with anicteric form . Acute renal failure, five times oliguro-anuric, necessitates in the six cases hemodialysis (two to six sessions) . Meningitis is found in four patients, associated in one case to an encephalitis and a polyradiculoneuritis . In one case, there were interstitial pulmonary lesions, in one another, a myocarditis with conduction disorders, responsible of the only death of this series, and finally, in three cases, a gastrointestinal hemorrhage . Bacteriological diagnosis seems little profitable and microagglutination remains the reference technique, helped by the IgM detecting through ELISA, looking forward to the evaluation of PCR (Polymerase Chain Reaction).

Infect Immun, 1999 May, 67(5), 2110 - 6
Role of polymorphonuclear neutrophils in a murine model of Chlamydia psittaci-induced abortion; Buendia AJ et al.; To assess the role of polymorphonuclear neutrophils (PMNs) in Chlamydia psittaci infection in a pregnant mouse model, pregnant and nonpregnant Swiss OF1 mice were depleted of PMNs by treatment with the RB6-8C5 monoclonal antibody before intraperitoneal infection with C . psittaci serotype 1 . Nondepleted mice served as infection controls . Depleted mice aborted earlier and had a much higher mortality rate than nondepleted mice . Bacteriological analysis showed that the number of chlamydiae isolated from the spleens of depleted mice at 5 and 7 days postinfection was 100 times greater than that isolated from nondepleted mice . Histopathological analysis of the placentas of depleted mice showed widespread necrosis of the uteroplacental units, with weak immunoreaction to chlamydial antigen, while the placentas of nondepleted mice showed substantial neutrophil infiltration but no large areas of necrosis, with moderate to strong immunoreaction to chlamydial antigen . The livers of depleted mice showed numerous chlamydial inclusions in the hepatocytes, delayed microgranuloma formation, and in the pregnant animals extensive coagulative periportal necrosis . The livers of nondepleted mice displayed multiple small foci of PMNs and mononuclear cells with microgranuloma formation . Among this group of mice, the pregnant animals always had more hepatic damage than nonpregnant animals . Our results suggest that PMNs play an essential role in the response to C . psittaci primary infection, preventing the uncontrolled multiplication of chlamydiae in the liver and spleen.

J Antimicrob Chemother, 1999 Mar, 43 Suppl A, 117 - 28
Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy . Ciprofloxacin Study Group; Krumpe PE et al.; Five hundred and forty patients with severe infection were enrolled in a multicentre, prospective, randomized, non-blinded study to compare the efficacy and safety of i.v . ciprofloxacin with i.v . standard therapy . Five hundred and thirty-one patients received at least one dose of study drug for pneumonia (310), septicaemia (112) or skin and skin structure infection (109) . Intravenous ciprofloxacin (400 mg, every 8 h) or i.v . ciprofloxacin (400 mg, every 8 h) plus a beta-lactam were compared with a standard monotherapy (beta-lactam) or combination (aminoglycoside plus a beta-lactam) therapy . Patients were treated parenterally for a minimum of 2 or 3 days, then at the discretion of the investigator could be switched to oral therapy (ciprofloxacin 750 mg, every 12 h or a standard oral therapy) . Patients were randomized in the ratio of 2:1 for the ciprofloxacin and standard therapy treatment groups and stratified to monotherapy if the APACHE II score was < or = 20 or to combination therapy if the APACHE II score was 21-29 . Three hundred and ninety-five (74%) patients were valid for the efficacy analysis: these comprised 242 pneumonia (167 ciprofloxacin and 75 standard therapy), 70 septicaemia (47 ciprofloxacin and 23 standard therapy), and 83 skin infections (56 ciprofloxacin and 27 standard) . The primary efficacy variable was clinical response and the secondary efficacy assessment was bacteriological response at the end of therapy (2 or 3 days after treatment) . The mean duration of therapy for patients receiving only i.v . monotherapy or combination therapy was shorter (9-10 days) than for patients receiving sequential i.v./p.o . therapy (14-17 days) . At the end of therapy, overall clinical resolution/improvement (success) for monotherapy was 138/166 (83%) for the ciprofloxacin group, compared with 74/87 (85%) for standard-treated patients (95% CI = -11.5% to 7.6%), and for combination therapy the response was 43/51 (84%) for the ciprofloxacin group and 14/20 (70%) for standard-treated patients (95% CI = -6.3% to 34.9%) . For pneumonia, the most frequent infection treated, clinical success rates following monotherapy were 85% for ciprofloxacin and 83% for standard-treated patients and 83% for ciprofloxacin compared with 69% for standard-treated patients in the combination therapy group . Bacteriological eradication/presumed eradication following monotherapy was 85/102 (83%) for ciprofloxacin and 31/46 (67%) for standard-treated patients (95% CI = 1.6% to 30.3%), and that for combination therapy was 29/36 (81%) for ciprofloxacin and 7/10 (70%) for standard-treated patients (95% CI = -18.3% to 39.5%) . Drug-related adverse events, primarily diarrhoea and nausea, were reported in 22% of ciprofloxacin-treated patients and 20% of standard-treated patients . In summary, ciprofloxacin administered alone or in combination was found to be effective in treating a wide range of severe infections.

Arch Pediatr, 1998, 5 Suppl 1, 33s - 36s
{Penicillin-resistant pneumococcal pneumonia (serotype p14), and coinfection with respiratory syncytial virus and Mycoplasma}; Bremont F et al.; A 3-year old child was admitted for a pneumococcal pneumonia with pleural effusion, initially treated with amoxicillin and clavulanic acid . Clinical deterioration suggested a resistance to conventional antibiotics which was confirmed by bacteriological investigation . A co-infection with respiratory syncitial virus and Mycoplasma pneumoniae was associated . Under adapted antibiotherapy, the clinical course improved.

Arch Pediatr, 1998 Feb, 5(2), 159 - 62
{Multifocal invasive Kingella kingae infection}; Sarda H et al.; CASE REPORT: A 2-year-old child, non immunodeficient, presented with septicemia due to Kingella kingae successively complicated by meningitis, arthritis of one knee and endocarditis . Outcome was favourable after a long and adjusted antibiotherapy, involving in particular for the endocarditis ceftriaxone (100 mg/kg/d) and amikacin (20 mg/kg/d) during 3 weeks, then amoxicillin per os (200 mg/kg/d) during 3 weeks . CONCLUSIONS: Bacteriologic characteristics of the bacteria, the culture of which requires medium base with additional nutrient are reviewed . The tropism of Kingella kingae is essentially osteoarticular and cardiac as shown by the cases reported in the literature . Its susceptibility to antibiotics explains the frequent favourable outcome.

Wiad Lek, 1998, 51(11-12), 513 - 7
{Sclerotherapy of single non-parasitic liver cyst}; Wysocki A et al.; Single, non-parasitic liver cysts, usually asymptomatic, accidental finding during ultrasound examination require treatment only if they attain larger diameter and upper right quadrant symptoms could not be explained by other pathology . Treatment options include surgical enucleation, open or laparoscopic unroofing or percutaneous emptying usually associated with injection of sclerotising agent . From May 1995 to June 1997 10 patients with single, symptomatic, non-parasitic cysts of the liver were treated at the 2nd Department of General Surgery, Collegium Medicum of Jagiellonian University . Ultrasound and gastroscopy excluded other pathology of upper GI tract that might be responsible for the symptoms . Under ultrasound guidance samples of cysts content were collected for cytology, bilirubin concentration and bacteriology . Injection of the contrast medium revealed no contact of the cyst's cavity with the biliary tree . 5 patients were excluded from the protocol due to leakage of contrast in to fee peritoneal cavity . Other 5 were submitted to sclerotherapy by injection of 95% ethanol after introduction of fine drain into the cyst's cavity under ultrasound guidance; in two patients procedure was performed once, in two twice and in one tree times . In 4 patients complete or nearly complete resolution of symptoms was achieved, in one with big cyst treatment failed . We observed no complication . Owing to satisfying results we may conclude that this minimally invasive method might be attempted before more aggressive treatment would be employed.

Heart, 1999 Jan, 81(1), 82 - 7
Pacemaker lead infection: echocardiographic features, management, and outcome; Victor F et al.; OBJECTIVE: To compare transthoracic and transoesophageal echocardiography (TTE, TOE) in patients with permanent pacemaker lead infection and to evaluate the safety of medical extraction in cases of large vegetations . METHODS: TTE and TOE were performed in 23 patients with definite pacemaker lead infection . Seventeen patients without previous infection served as a TOE reference for non-infected leads . RESULTS: TTE was positive in seven cases (30%) whereas with TOE three different types of vegetations attached to the leads were visualised in 21 of the 23 cases (91%) . Of the 20 patients with vegetations and lead culture, 17 (85%) had bacteriologically active infection . Left sided valvar endocarditis was diagnosed in two patients . In the control group, strands were visualised by TOE in five patients, and vegetations in none . Medical extraction of vegetations >/= 10 mm was performed in 12 patients and was successful in nine (75%) without clinical pulmonary embolism . After 31.2 (19.1) months of follow up (mean (SD)), all patients except one were cured of infection; three died from other causes . CONCLUSIONS: Combined with bacteriological data, vegetations seen on TOE strongly suggest pacemaker lead infection . Normal TTE examinations do not exclude this diagnosis because of its poor sensitivity . Medical extraction of even large vegetations appeared to be safe.

South Med J, 1999 Apr, 92(4), 375 - 9
Tuberculosis management practices in Kentucky: comparison with national guidelines; Evans ME et al.; BACKGROUND: We assessed the quality of tuberculosis management practices in a predominantly rural state . METHODS: Medical records of persons reported to the Centers for Disease Control and Prevention (CDC) with the diagnosis of tuberculosis were audited; management practices were compared with guidelines from the American Thoracic Society (ATS) and CDC . RESULTS: We reviewed 207 records from 24 health districts in Kentucky . These records represented 30% of the cases reported to the CDC during the 17-month study . Tuberculosis was diagnosed by culture in 66% of patients; 12 different antibiotic regimens for antibiotic sensitive bacteria were prescribed; human immunodeficiency virus testing was documented in only 39%; monitoring for drug toxicity and bacteriologic cure was appropriate in < 65%; directly observed therapy was used in only 38%, and only 23% of close contacts were reevaluated at 12 weeks . CONCLUSIONS: Tuberculosis management practices in Kentucky fall short of ATS/CDC guidelines . Continuing quality-improvement efforts are warranted.

Am J Nephrol, 1999, 19(2), 346 - 9
A note on the early history of renal transplantation: Emerich (Imre) Ullmann; Nagy J; In January 1902 at the Vienna Medical Society Meeting, the surgeon Emerich Ullmann reported the first case of renal autotransplantation performed in the neck of a dog . In the same year, he presented the first xenotransplantation of the kidney (a goat with a dog's kidney) . These publications immediately had a great impact on the medical word . After his failed attempt to transplant a pig's kidney into a young uraemic woman he stopped his research in this field in order to devote himself to other lines of surgical research . However, his idea survived him, because, nowadays, nearly 100 years later, pigs appear to be the most suitable donors for human renal xenotransplantation . Ullmann was born in Pecs, Hungary, on February 23, 1861 . After a distinguished undergraduate career in 1878 his father (being also a medical doctor) sent him to study medicine at the world-famous Vienna Medical School . He graduated in 1884 and was immediately invited to the Surgical Department where Billroth worked . Next year, because of his interest in bacteriology he visited Pasteur in Paris and successfully volunteered to serve as a healthy subject to prove the effectiveness of Pasteur's antisera against rabies . Although Ullmann did not succeed in doing a human transplantation he gave birth to the era of the organ transplantation, stimulated vascular surgery and the development of transplantation immunology.

Auris Nasus Larynx, 1999 Apr, 26(2), 165 - 8
Simple clinical system for the prediction of recurrence of nasal polypi; Mostafa BE et al.; OBJECTIVE: A trial to determine a simple way to predict recurrence of nasal polypi to determine the need for long term medical therapy . METHODS: Retrospective clinical analysis of the records of 100 patients with nasal polypi and studying various parameters including radiological, intra-operative and bacteriological data . RESULTS: Among the various parameters studied, maxillary antral involvement, and positive bacterial cultures seemed the most predictive criteria of recurrence . Patients without polypoid involvement of the maxillary sinus and/or with negative cultures were less likely to have early recurrence of their disease . CONCLUSION: Using simple clinical criteria, two patient populations could be defined . One in which recurrence is inevitable requiring continuous local steroid therapy after surgery and another group requiring occasional local treatment after an initial short course of local steroid spray.

Diagn Mol Pathol, 1998 Dec, 7(6), 310 - 6
Multiplex polymerase chain reaction for rapid detection of atypical mycobacteria and Mycobacterium tuberculosis complex; Klemen H et al.; A three-step polymerase chain reaction (PCR) method was developed for the detection and typing of mycobacterial DNA in clinical samples and fixed tissue specimens . The first step was to rule out or prove the presence of DNA of Mycobacterium tuberculosis complex . An amplified fragment from the insertion sequence (IS) 6110 was used for this purpose . Patients negative for IS 6110 were evaluated for a fragment of the 65 kDa-antigen, present in all mycobacteria . In positive patients, a multiplex PCR was performed for M . gordonae, M . avium, M . kansasii, M . fortuitum, and M . malmoense, combined in one PCR run . As another control, to prove mycobacterial DNA, PCR was used for the gene coding for the 16S ribosomal RNA also found in all mycobacteria . Appropriate negative controls were included . Different clinical samples were compared for an efficient amplification of these different mycobacterial DNA fragments . Different mycobacteria can be identified within one day in either unfixed cytologic and bacteriologic samples, or formalin-fixed paraffin-embedded tissue samples . Therefore, this method is a quick, cost efficient, and reliable tool to identify mycobacteria other than the tuberculosis complex.

Ann Fr Anesth Reanim, 1999 Feb, 18(2), 186 - 95
{Phare study . Comparative study of combined cefepime-amikacin versus ceftazidime combined with amikacin in the treatment of nosocomial pneumonias in ventilated patients . Multicenter group study}; Beaucaire G et al.; OBJECTIVE: To compare the associations of cefepime (2 g x 2/day) + amikacin (7.5 mg.kg-1 x 2/day) (= cefe-ami) and ceftazidime (2 g x 3/day) + amikacin (7.5 mg.kg-1 x 2/day) (= cefta-ami) in patients under mechanical ventilation suffering from a nosocomial pneumonia . STUDY DESIGN: Multi-centre, open, comparative, randomised study . PATIENTS: The study included 275 ICU patients enrolled either in the cefe-ami group (n = 141) or in the cefta-ami group (n = 134) . METHODS: All cases were reviewed in a blinded fashion by the steering committee . RESULTS: Microbiology laboratory tests were positive in 74% of patients of the cefe-ami group and in 63% of the cefta-ami group respectively; 319 presumed causative strains of bacteria were isolated . The mean duration of treatment was 12 days for cefepime, 11 days for ceftazidime and 8 days for amikacin . In intention to treat, the clinical recovery rate was 48.2% in the cefe-ami group and 44.8% in the cefta-ami group respectively . In the population with a documented pneumonia, the clinical recovery was significantly better in the cefe-ami group (53.3%), than in the cefta-ami group (39.3%) (P = 0.05) . In per protocol analysis, these rates reached 67.7% in the cefe-ami group and 68.2% in the cefta-ami group respectively . In the bacteriologically documented cases the eradication rates were 86.5% and 89.3% respectively . CONCLUSION: The efficacy rates of cefe-ami and cefta-ami combinations were similar in ICU patients under mechanical ventilation with a nosocomial pneumonia . However the cefe-ami association was significantly more efficient in the population with a bacteriologically documented pneumonia.

Dig Surg, 1999, 16(2), 125 - 9
Specific prognostic factors for secondary pancreatic infection in severe acute pancreatitis; Armengol-Carrasco M et al.; BACKGROUND/AIMS: The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis . METHODS: Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI . RESULTS: Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis . A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection . CONCLUSION: The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.

Vet Immunol Immunopathol, 1999 Mar 1, 67(4), 373 - 84
Effect of antibiotic induced bacterial clearance in the udder on L-selectin shedding of blood neutrophils in cows with Escherichia coli mastitis; Monfardini E et al.; Bacterial clearance, L-selectin adhesion receptor expression and neutrophil recruitment during experimentally induced Escherichia coli mastitis were investigated . Acute mastitis was induced by injection of 10(4) cfu E . coli into both left quarters of 12 clinically healthy lactating cows, 2-6 weeks after parturition . Half the cows were treated intravenously 10 h after infection, and subcutaneously 30 h after infection with enrofloxacin . In both groups, bacterial count, milk serum albumin, milk somatic cell count, circulating leukocyte count and L-selectin expression on neutrophils were determined . Both groups responded to challenge with udder inflammation and fever . Treatment with enrofloxacin affected the elimination rate of bacteria at hours +14, +18, +24, +48, and +72 after challenge, but not the bacteriological cure rate (five out of six for treated and three out of six for nontreated cows) . The drop in L-selectin expression found following challenge did not differ between groups throughout the study . No effect of treatment was found on SCC . Based on these findings, it may be concluded that when treatment is administered 10 h after infection, the number of bacteria in milk is not correlated with L-selectin expression on circulating PMN during experimentally induced E . coli mastitis . The initial bacterial load probably dictates the extent of the decrease in L-selectin expression and milk somatic cells.

AIDS, 1999 Apr 1, 13(5), 575 - 82
Predictors of survival and eradication of Mycobacterium avium complex bacteremia (MAC) in AIDS patients in the Canadian randomized MAC treatment trial . Canadian HIV Trials Network Protocol 010 Study Group; Singer J et al.; OBJECTIVE: To assess the importance of baseline characteristics including medical history, indicators of current disease status, therapeutic drug use, in vitro drug susceptibility, immune status and mycobacterial load on bacteriologic response and survival in HIV-positive patients with Mycobacterium avium complex (MAC) bacteremia . DESIGN: An observational substudy of an open-label randomized controlled trial of two alternative therapeutic regimens for MAC . SETTING: Twenty-four hospital-based HIV clinics in 16 Canadian cities . MAIN OUTCOME MEASURES: The main outcome measures were survival and bacteriologic response, defined by consecutive negative blood cultures for MAC at least 2 weeks apart within 16 weeks of study entry . RESULTS: Prior AIDS diagnosis, low Karnofsky score, active unstable AIDS-related conditions, absence of antiretroviral therapy and absence of Pneumocystis carinii pneumonia prophylaxis were associated with shorter survival by univariate regression using the proportional hazards model . On multivariate analysis, antiretroviral therapy was not an independent predictor of mortality, and previous rifabutin prophylaxis was independently associated with poor survival outcomes, a result consistent across study treatment . Using a logistic regression model, baseline quantitative mycobacterial load {relative odds of clearing, 1.97 for a decrease of 1 log10 colony forming count; 95% confidence interval (CI), 1.36-2.87; P < 0.001} and Karnofsky score were the only statistically significant univariate predictors of clearance, although previous prophylaxis with rifabutin was also a significant predictor in a multivariate model (relative odds of clearing, 0.39; 95% CI, 0.17-0.88; P < 0.05) . CONCLUSIONS: This study indicates that although the level of MAC bacteremia is an important predictor of clearance, it is not associated with survival.

Neurosurgery, 1999 Apr, 44(4), 748 - 53; discussion 753-4
Cranial extradural empyema in the era of computed tomography: a review of 82 cases; Nathoo N et al.; OBJECTIVE: Intracranial suppurative disorders (abscesses and empyemas) continue to be common neurosurgical emergencies in South Africa . Cranial extradural empyema (EDE) occurs less frequently than its subdural counterpart but remains a potentially devastating disease process . We present our 15-year experience with this condition in the era of computed tomography . METHODS: Of the 4623 patients with intracranial sepsis who were admitted to the neurosurgical unit at Wentworth Hospital (Durban, South Africa) during a 15-year period (1983-1997), 76 patients with EDEs were identified . An additional six patients who were identified from our outpatient records were treated nonsurgically . Analyses were performed with respect to clinical, radiological, bacteriological, surgical, and outcome data . All information for this study was obtained from the computerized databank for the unit . Statistical analyses of the related pre- and postoperative clinical data were performed . RESULTS: The 76 patients with EDEs accounted for 1.6% of the total number of patients admitted for treatment of intracranial sepsis during the study period . Thirteen patients (15.8%) had infratentorial pus collections . Male patients predominated by a ratio of 2:1, and 66 patients were between the ages of 6 and 20 years (mean age, 16.56+/-9.87 yr) . The origins of the sepsis were paranasal sinusitis for 53 patients (64.6%), mastoiditis for 16 patients, trauma for 5 patients, dental caries for 1 patient, and miscellaneous causes for 7 patients . The most common clinical presenting features were fever, neck stiffness, and periorbital edema . Surgery was performed in the form of burrholes for 21 patients, small craniectomies for 39 patients, and craniotomies for 5 patients . The additional five patients, while having drainage of their infected paranasal sinuses, had simultaneous drainage of their extradural pus collections by the ear, nose, and throat surgeon . The majority of patients (81 patients) experienced good outcomes (Glasgow Outcome Scale scores of 4 or 5) . A single patient died after surgery (mortality rate, 1.22%) . CONCLUSION: EDEs occur less frequently than subdural empyemas and are associated with better prognoses . Surgical drainage (burrholes), simultaneous eradication of the source of sepsis, and high-dose intravenous antibiotic therapy remain the mainstays of treatment . Selective nonsurgical management of small EDEs is possible, provided the source of sepsis is surgically eradicated . It is our opinion that EDE is a disease that should be managed without morbidity or death.

Probl Tuberk, 1999, (1), 4 - 8
{DOTS strategy and its application in Russia}; Khomenko AG; Leading principles of DOTS strategy for Russia are outlined . It has been introduced in Russia since 1994 in Ivanovo, Tomsk Regions, Mary El Republic . New territories (Leningrad and Arkhangelsk Regions) have recently joined the project . Methods of detecting bacillary patients, scheme of chemotherapy for different tuberculosis patients and of bacteriological and x-ray follow-up control are presented . Positive aspects of the program are analyzed as well as causes of its insufficient benefit under conditions of Russian Federation.

Int J Epidemiol, 1999 Feb, 28(1), 113 - 6
Capture-recapture method for estimating misclassification errors: application to the measurement of vaccine efficacy in randomized controlled trials; Simondon F et al.; BACKGROUND: The measure of efficacy is optimally performed by randomized controlled trials . However, low specificity of the judgement criteria is known to bias toward lower estimation, while low sensitivity increases the required sample size . A common technique for ensuring good specificity without a drop in sensitivity is to use several diagnostic tests in parallel, with each of them being specific . This approach is similar to the more general situation of case-counting from multiple data sources, and this paper explores the application of the capture-recapture method for the analysis of the estimates of efficacy . METHOD: An illustration of this application is derived from a study on the efficacy of pertussis vaccines where the outcome was based on > or =21 days of cough confirmed by at least one of three criteria performed independently for each subject: bacteriology, serology, or epidemiological link . Log-linear methods were applied to these data considered as three sources of information . RESULTS: The best model considered the three simple effects and an interaction term between bacteriology and epidemiological linkage . Among the 801 children experiencing > or =21 days of cough, it was estimated that 93 cases were missed, leading to a corrected total of 413 confirmed cases . The relative vaccine efficacy estimated from the same model was 1.50 (95% confidence interval: 1.24-1.82), similar to the crude estimate of 1.59 and confirming better protection afforded by one of the two vaccines . CONCLUSION: This method allows supporting analysis to interpret primary estimates of vaccine efficacy.

Arch Pediatr, 1999 Mar, 6(3), 290 - 2
{Visceral leishmaniasis and malnutrition: a case report}; Hida M et al.; BACKGROUND: Visceral leishmaniasis occurring in malnourished subjects can have an uncommon course, which explains difficulties in its diagnosis . CASE REPORT: A 22-month-old infant was admitted because of malnutrition and prolonged fever . The bacteriological investigation was negative . When his nutritional status improved, he developed a splenomegaly . The medullogram confirmed the diagnosis of visceral leishmaniasis . The course was then favorable with treatment by pentavalent antimonial . CONCLUSION: Malnutrition constitutes a risk factor of opportunist parasitic disease such as leishmaniasis . Its diagnosis can be very difficult.

Lupus, 1999, 8(2), 164 - 7
Primary subcutaneous nocardial infection in a SLE patient; Balbir-Gurman A et al.; A patient with systemic lupus erythematosus (SLE) developed primary subcutaneous nocardiosis during steroid and cyclophosphamide therapy for diffuse proliferative glomerulonephritis . In spite of local process the patient manifested signs of general deterioration mimicking SLE exacerbation . The diagnosis was made by bacteriologic examination of the material obtained by CT guided aspiration . Surgical drainage and systemic treatment with trimethoprim/sulphamethoxazole (TMT/SMZ) 960 mg twice/d led to a clinical recovery and enabled the continuation of the steroid and cytotoxic regimen.

Rev Chir Orthop Reparatrice Appar Mot, 1998 Nov, 84(8), 685 - 8
{Simple puncture versus trocar puncture biopsy for the bacterial diagnostic evaluation of osteoarticular infections . A prospective study of 54 cases}; Piriou P et al.; PURPOSE OF THE STUDY: We have performed a prospective study in 54 patients with suspected osteoarticular deep infection . The purpose of the study was to compare notch needle-biopsy versus simple punction in term of bacteriological efficiency . MATERIAL AND METHODS: Among 54 patients (32 males, 22 females), 16 cases of deep infections were proven . There was 29 hips, 17 knees, 6 ankles, 2 elbows and 1 shoulder . Each patient was investigated with simple punction and notch needle-biopsy . Diagnostic value of both methods were evaluated by comparison with results of surgical prelevement which was the gold standard for evaluating both tests . The study was made using usual diagnostic test criteria: sensitivity, specificity, positive predictive value, negative predictive value and also likelihood ratio method . RESULTS: Sensibility for the simple punction was 31.25 per cent and sensibility for notch needle-biopsy was 69 per cent . Specificity for simple punction was 97 per cent but for notch needle-biopsy it was 100 per cent . Positive predictive value was respectively 83.33 per cent for simple punction and 100 per cent for notch needle-biopsy . Negative predictive value was 0.71 per cent for simple punction and 0.31 per cent for notch needle-biopsy . Likelihood ratios for simple punction was 11.87 and likelihood ratios for notch needle-biopsy was infinite . DISCUSSION: Sensibility for notch needle-biopsy of 69 per cent is two time superior to sensibility of simple punction . Notch needle-biopsy had no false positive . It is a completely specific test . Methodology was valuable because all patients who had negative result of non invasive test had no preoperative antibiotherapy, and underwent surgery for bacteriological diagnostic only . CONCLUSION: Notch needle-biopsy is always superior to simple punction . This study leads us to modify our practice . From now on we will never use again simple punction but we will only perform notch needle-biopsy which diagnostical efficiency is superior.

Pediatrics . 1999 Apr;103(4):e53.
Neonatal necrotizing fasciitis: a report of three cases and review of the literature; Hsieh WS et al.; OBJECTIVE: Necrotizing fasciitis (NF) is a predominantly adult disorder, with bacterial infection of the soft tissue . In children, it is relatively rare and has a fulminant course with a high mortality rate . In the neonate, most cases of NF are attributable to secondary infection of omphalitis, balanitis, mammitis, postoperative complications, and fetal monitoring . The objective of this communication is to report 3 cases of neonatal NF and provide a literature review of this disorder . RESULTS: This review yielded 66 cases of neonatal NF . Only 3 cases were premature . There was no sex predilection and the condition rarely recurred . Several underlying conditions were identified that might have contributed to the development of neonatal NF . These included omphalitis in 47, mammitis in 5, balanitis in 4, fetal scalp monitoring in 2, necrotizing enterocolitis, immunodeficiency, bullous impetigo, and maternal mastitis in 1 patient each . The most common site of the initial involvement was the abdominal wall (n = 53), followed by the thorax (n = 7), back (n = 2), scalp (n = 2), and extremity (n = 2) . The initial skin presentation ranged from minimal rash to erythema, edema, induration or cellulitis . The lesions subsequently spread rapidly . The overlying skin might later develop a violaceous discoloration, peau d'orange appearance, bullae, or necrosis . Crepitus was uncommon . Fever and tachycardia were frequent but not uniformly present . The leukocyte count of the peripheral blood was usually elevated with a shift to the left . Thrombocytopenia was noted in half of the cases . Hypocalcemia was rarely reported . Of the 53 wound cultures available for bacteriologic evaluation, 39 were polymicrobial, 13 were monomicrobial, and 1 was sterile . Blood culture was positive in only 20 cases (50%) . Treatment modalities included the use of antibiotics, supportive care, surgical debridement, and drainage of the affected fascial planes . Two of the 6 cases who received hyperbaric oxygen therapy died . The overall mortality rate was 59% (39/66) . In 12 cases, skin grafting was required because of poor granulation formation or large postoperative skin defects among the survivors . CONCLUSION: Neonatal NF is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia . It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity . The wound cultures are predominantly polymicrobial and the location of initial involvement depends on the underlying etiologic factor . High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management in the newborn infant with NF.

Acta Paediatr, 1999 Feb, 88(2), 166 - 8
Helicobacter pylori gastritis in children: efficacy of 2 weeks of treatment with clarithromycin, amoxicillin and omeprazole; Tiren U et al.; Thirty-eight children with Helicobacter pylori gastritis diagnosed by histopathology, and/or bacteriological culture were treated with omeprazole, amoxicillin and clarithromycin . Follow-up endoscopy was performed in 34 children . Outcome was measured by negative histology and culture for H . pylori . Six patients were excluded . Of the 32 remaining children eradication was achieved in 75% (95% confidence interval 60-90%).

Pol Merkuriusz Lek, 1998 Dec, 5(30), 328 - 9
{Clinical analysis of pneumonia treated at the hospital}; Gaik A et al.; 104 cases of pneumonia, treated in Department of Pulmonary Diseases of Military Medical Academy in the years 1995-1997, were analysed . Patients were divided into two groups . In the first group were 58 patients which had acute symptoms of pneumonia and the treatment was started in our department without any treatment before . In the second group were 45 patients which had acute symptoms two or three weeks before admission to hospital . In this period these patients received one or more antibiotics . The bacteriological findings and the periods of the treatment were analysed in these both groups.

Pol Merkuriusz Lek, 1998 Dec, 5(30), 325 - 7
{Difficulties in diagnosis of specific pneumonia: clinical and pathomorphological confrontation}; Lewek S et al.; Caseous pneumonia is one of acute kinds of tuberculosis . Difficulties in diagnosing of caseous pneumonia were described in this paper . Material contained 40 patients /28 men and 12 women/ mean age 53 +/- 16 years/ which died in The Hospital of Lung Diseases in Lodz . In this patients diagnosed caseous pneumonia . Analyse obtained many clinical parameters /age, sex, hospitalisation, period, investigation and medical, examination, results of bacteriological and radiological finding and autopsy diagnoses . Authors thought that the need of bacteriological examination and X-Ray examination in diagnosis of caseous pneumonia . Confrontation of clinical and pathomorphological diagnosis are very important.

Clin Orthop, 1999 Mar, (360), 66 - 70
Culture results in open wound treatment with muscle transfer for tibial osteomyelitis; Patzakis MJ et al.; Fifty-three patients who underwent a two-staged protocol of debridement and muscle flap coverage for chronic osteomyelitis of the tibia between 1991 and 1996 were evaluated . All patients underwent a thorough debridement of all nonviable tissue and bone at initial debridement . Multiple cultures were taken, including aerobic, anaerobic and fungal cultures from the pus, soft tissue, bone curettings and bone . All patients were treated with open wound management and dressing changes . Between 2 to 7 days, median 4 days, all patients underwent a second debridement with a complete set of identical cultures, and immediate soft tissue muscle transfer . There were 42 free vascularized and 11 local tissue transfers . The 53 patients were classified according to the Cierny-Mader classification for chronic osteomyelitis . Twenty-four patients had Stage IVA osteomyelitis, 10 patients had Stage IIIA osteomyelitis, nine patients had Stage IIIB osteomyelitis, eight patients had Stage IVB osteomyelitis, one patient had Stage IA osteomyelitis, and one patient had Stage IIB osteomyelitis . All 53 patients had positive cultures at the time of their initial debridement, and 14 of 53 (26%) had a positive culture at the time of the second debridement . Based on the results, it seems from a bacteriologic stand-point that the second debridement allows for the opportunity for redebridement and wound sterilization of organisms that still may be present.

Rev Pneumol Clin, 1998 Dec, 54(6), 399 - 403
{Metropolitan pneumologists and exotic diseases}; L'Her P et al.; Due to the increasingly widespread development of international exchanges, physicians, particularly pneumologists, working in metropolitan France may encounter patients with respiratory signs who have travelled or lived in tropical zones . In such cases, history taking, physical examination, imaging, bacteriological and parasitological explorations, pathology and immunology are all precious tools for diagnosis . All possible tropical diseases should be entertained, taking into account the geographical setting and the patient's lifestyle . The pneumologist must not forget that these exotic tropical diseases remain uncommon compared with cosmopolitan causes of lung disease: bacterial infections, tuberculosis, cancer.

Cell Motil Cytoskeleton, 1999, 42(3), 218 - 29
Perturbation of the actin cytoskeleton induces PAI-1 gene expression in cultured epithelial cells independent of substrate anchorage; Providence KM et al.; Perturbation of cellular architecture with agents that alter cytoskeletal organization provides a means to assess the relationship between cell shape and gene expression . Induced transcription of the plasminogen activator inhibitor type-1 (PAI-1) gene in serum-free cultures of normal rat kidney (NRK-52E) cells following disruption of actin microfilament structures with cytochalasin D (CD) provides a simple model to probe mechanisms underlying shape-related expression control . Transition from the typical flat epithelial cell shape to an "arborized" phenotype was a concomitant of the PAI-1 inductive response . Stimulated expression occurred rapidly (i.e., within 2 h of CD addition), involved increases in both PAI-1 mRNA abundance and de novo protein synthesis, and was dependent upon the concentration of CD used . A series of culture conditions were designed (e.g., use of bacteriological surfaces, poly-HEMA coated surfaces, maintenance in suspension on agarose) to discriminate cell shape from adhesive influences on CD-stimulated PAI-1 expression . Cytoskeletal disruption, and not simply changes in cell shape, was a critical aspect of CD-mediated PAI-1 expression in NRK cells cultured under serum-free conditions; induced expression was independent of substrate anchorage . Low concentrations of CD (1-2 microM) failed to cause cell arborization or increase either relative PAI-1 mRNA/protein abundance levels suggesting, however, that cell rounding may be a necessary but not sufficient aspect in CD-mediated PAI-1 induction . Transfection of PAI-1 promoter-CAT reporter constructs into NRK cells followed by stimulation with CD or serum additionally indicated that CD-induced PAI-1 expression did not utilize the same functional complement of serum-responsive promoter sequences, thus, further defining differences in the growth factor- and cytoskeletal-mediated pathways of PAI-1 gene regulation.

Med Tr Prom Ekol, 1999, (2), 17 - 20
{Clinical morphological aspects of chronic gastroduodenitis in patients with vibration disease}; Liubchenko PN et al.; The article covers data of endoscopy, histologic and bacteriologic study of gastric lavage in 55 vibration disease patients (random select) . Duodenal peptic ulcer was found in 1 patient, gastric polyp--in 1 patient, erosive gastroduodenitis in 14 (25.45%) patients, chronic gastroduodenitis without destruction of mucosa--in 39 (70.91%) patients . Contamination with Helicobacter pylori appeared in 97% of cases, being significant and subject to therapy only in 35.29% of patients.

Ann Dermatol Venereol, 1999 Jan, 126(1), 29 - 31
{Eosinophilic pustulosis in an infant accompanied by immune deficit}; Rybojad M et al.; BACKGROUND: Eosinophilic is a skin eruption which occurs in the first years of life, progressing by pruriginous flare-ups with amicrobial papulopustulae on a hairless scalp . Eosinophil infiltration of the skin is variable (follicular or perifollicular dermal infiltration) . In adults, eosinophilic pustulosis is often associated with immune deficiency, but this association has not been reported in children . We report two cases . CASE REPORTS: Two boys had a pruriginous papulopustular eruption involving the scalp and the trunk which had progressed with periods of exacerbation since birth . Search for bacteriological or mycological involvement was negative . Histology showed folliculitis with major polynuclear eosinophil infiltration . Both children had a past history of repeated skin and extracutaneous infections strongly suggesting an immune deficit . Buckly syndrome was suspected in the second case . DISCUSSION: Juvenile eosinophilic pustulosis belongs to the spectrum of childhood eosinophilic dermatoses . The presence of eosinophil infiltration in the skin demonstrates localized or systemic immune dysfunction . A hematology and immunology work-up is needed in case of associated skin or deep infections.

Schweiz Arch Tierheilkd, 1999, 141(3), 99 - 102
{The situation concerning antibiotic resistance from the viewpoint of the bacteriologist}; Nicolet J et al.; Already fifty years ago, when antibiotics were introduced, their effectiveness was challenged by certain bacteria which had the ability to resist the bacteriocidal effect of the antibiotics . Development of such resistance is due to selection pressure that results from the use of antibiotics in therapy, particularly in human medicine . In Switzerland, the veterinary public health aspect of this problem has become of current interest . The ban on the use of growth promoters has triggered the need for an update of the statistical information on the phenomena of resistance and the setting up of a surveillance system of antibioresistance in animals and in products of animal origin.

Int J Tuberc Lung Dis, 1999 Jan, 3(1), 68 - 73
Mycobacterium kansasii infection in a Paris suburb: comparison of disease presentation and outcome according to human immunodeficiency virus status . Groupe dEtude Des Mycobactéries de la Seine-Saint-Denis; Lortholary O et al.; SETTING: Department of Seine-Saint-Denis, France . OBJECTIVE: To compare the presentation and outcome of Mycobacterium kansasii infections according to human immunodeficiency virus (HIV) status . DESIGN: Retrospective analysis of all the medical charts of adults meeting the diagnostic criteria of the American Thoracic Society for M . kansasii infection between 1991 and 1995 . RESULTS: Between 1991 and 1995, 35 cases (23 HIV-{6%} and 12 HIV+ {34%}) were found, giving an annual incidence of 0.5/100000 . The following particularities were common to both groups: 1) frequency and prominence of respiratory and general symptoms, 2) rarity of clinically apparent extra-thoracic involvement, 3) bacteriological confirmation mostly obtained with respiratory tract specimens, 4) favourable bacteriological outcome, and 5) low mortality attributable to the mycobacterial infection . The most striking differences concerned chest radiography: HIV- patients had apical cavitated and nodular lesions, while HIV+ patients exhibited a variety of other patterns, including alveolar infiltrates, miliary lesions and/or thoracic lymphadenopathy . CONCLUSION: Apart from pulmonary radiographic differences, presentation and short-term outcome of M . kansasii infections were similar in HIV+ and HIV-patients.

Int J Tuberc Lung Dis, 1999 Jan, 3(1), 42 - 6
Replacement of streptomycin by ethambutol in the intensive phase of tuberculosis treatment: no effect on compliance; Rabarijaona L et al.; SETTING: Seven tuberculosis clinics in the National Tuberculosis Programme of Madagascar . OBJECTIVE: To compare the treatment efficacy and tolerance of regimens including either streptomycin or ethambutol for patient compliance during initial treatment of smear-positive tuberculosis . DESIGN: The 1023 patients included in the study were randomly divided into two treatment groups-one to receive streptomycin (S), isoniazid (H), rifampicin (R) and pyrazinamide (Z) (SHRZ), and the other to receive EHRZ, where streptomycin was replaced by ethambutol (E) . During the 2-month intensive phase, drug delivery was completely supervised . The same 6-month continuation regimen was then given in both groups . Follow-up consisted of a clinical and bacteriological examination at the end of the second, fifth and eighth months . RESULTS: There was no significant difference between the two regimens as regards compliance with treatment, the number of patients lost or who died, or for bacteriological response during the intensive phase . EHRZ was better tolerated . During the continuation phase, the results of the two groups remained comparable, but treatment failures occurred earlier in the patients who had received streptomycin . CONCLUSION: Patient compliance was not better with streptomycin . The ethambutol-containing regimen was as efficient as the other, and better tolerated . There is no argument for preferring streptomycin in the intensive phase of treatment of smear-positive tuberculosis.

Presse Med, 1999 Feb 27, 28(8), 435 - 9, 433
{Tropheryma whippelii, an emerging intracellular pathogen causing Whipple disease}; Drancourt M; CLINICAL DIAGNOSIS: Whipple's disease is a diffuse disease with a wide variety of clinical manifestations . Differential diagnoses include chronic enteritis, chronic joint disease, chronic meningoencephalitis and prolonged fever with weight loss, chronic uveitis and endocarditis with negative blood culture . MOLECULAR DIAGNOSIS: Histologically the characteristic lesions contain PAS-positive inclusions . PCR of RNAr gene 16S in fresh tissue identifies Tropheryma whippelii and confirms bacteriological diagnosis . AN EMERGING PATHOGEN: Tropheryma whippelii is a recently identified pathogen highly difficult to culture . Since its discovery, it has been a model of emerging pathogens . Clinical observation, microscope studies, molecular and cellular biology, and bacteriology have all contributed to its recent isolation which should lead to the development of indirect diagnostic techniques {abstract corrected}

Clin Pharmacokinet, 1999 Feb, 36(2), 89 - 98
Once daily aminoglycoside therapy . Is it less toxic than multiple daily doses and how should it be monitored?
Barclay ML, Kirkpatrick CM, Begg EJ.
After 50 years of clinical experience with the aminoglycoside agents, there is continuing debate over the most appropriate administration regimen for these drugs . In recent years, once daily administration has been used increasingly, in the hope of both improving efficacy and reducing toxicity . At least 30 controlled clinical trials have compared once versus conventional multiple daily administration . Efficacy was assessed in some, but not all, studies using clinical and/or bacteriological cure . Toxicity was generally determined using rather nonsensitive end-points such as measurement of serum creatinine for nephrotoxicity and clinically detectable hearing loss for ototoxicity . The results of individual clinical trials and subsequent meta-analyses have been variable . However, 5 of 9 meta-analyses found clinical efficacy to be significantly better with once daily administration, and in 3 of the 9 there were significantly less nephrotoxicity with once daily administration . The results were not significant for ototoxicity in any of the meta-analyses . There is debate about how therapeutic drug monitoring should be performed, and whether it is still required with once daily administration . Previous experience with the aminoglycosides, especially in patients with impaired drug clearance caused by renal impairment, suggests that monitoring is still prudent . Results from the once daily administration trials appear to support this . Various methods of monitoring and dose adjustment have been proposed . The most common is to measure a 24-hour trough concentration and to adjust the dose to maintain the trough concentration below a value of 2, 1 or 0.5 mg/L . However, this method allows for greater total aminoglycoside exposure than has been permitted with conventional dosages, increasing the likelihood of toxicity in patients with impaired aminoglycoside clearance . Other methods measure drug concentrations at a time-point or points within the dose interval (when the concentration is still measurable), and adjust the dose according to concentration-time curve nomograms or to a target area under the concentration-time curve . This allows the use of higher doses in those with high drug clearance . Furthermore, in patients with impaired clearance, drug exposure is limited to the same extent as, or less than, that with conventional multiple daily administration . To date no controlled trials have compared methods of dose-individualisation . In summary, in addition to a slight overall improvement in efficacy, once daily administration has resulted in a small reduction in nephrotoxicity . In the studies using more sensitive measures of toxicity, the differences in toxicity were greater, strengthening the case for once daily administration . Therapeutic drug monitoring is probably required with once daily administration . Methods which use mid-dosage interval concentrations to gauge drug exposure would seem to be preferable over trough concentration measurement.

Int J Tuberc Lung Dis, 1999 Feb, 3(2), 126 - 32
Assessment of a combined preparation of isoniazid, rifampicin and pyrazinamide (Rifater) in the initial phase of chemotherapy in three 6-month regimens for smear-positive pulmonary tuberculosis: a five-year follow-up report; Teo SK; SETTING: Singapore Tuberculosis Service . OBJECTIVE: To assess the acceptability, efficacy and relapse rate of a combined formulation of three drugs--isoniazid, rifampicin and pyrazinamide (Rifater)--given in the initial phase of chemotherapy in three 6-month regimens (2SHRZ/4H3R3, 1SHRZ/5H3R3 and 2HRZ/4H3R3) under direct observation for all patients . DESIGN: A randomised, controlled, unblinded study comparing a group of patients treated with Rifater and another given the three component drugs as separate formulations . RESULTS: The 310 patients admitted to the study were divided into two groups of 155 patients . The frequency of side effects was similar in both groups . Of 271 patients with drug-sensitive strains who had completed treatment without interruption, sputum cultures converted in all patients . At the end of 5 years, there were 15 relapses: three (2.2%) in the separate drugs group and 12 (9.3%) in the Rifater group . Exclusion of two cases in the Rifater group, one with silicotuberculosis and another with no bacteriological confirmation of diagnosis, gave a relapse rate of 7.9% (P = 0.03 for the comparison of relapse rates in the two groups) . CONCLUSION: A combined formulation of three drugs given daily in the initial phase of 6-month short-course therapy, followed by intermittent treatment with isoniazid and rifampicin given three times a week under direct observation for all patients, appears to be less effective than treatment with the component drugs given as separate formulations.

Acta Otorrinolaringol Esp, 1999 Jan-Feb, 50(1), 72 - 4
{Lingual abscess with atypical clinical presentation}; Ballesteros Garcia AI et al.; Lingual abscesses have become extremely rare since the discovery of antibiotics, with only about 200 cases reported in the last 160 years . Diagnosis on the basis of clinical symptoms alone is quite difficult . Imaging studies are essential for the diagnosis of lingual abscesses and for their differentiation from related pathologies with similar clinical symptoms . We report a case of lingual abscess with otherwise unremarkable clinical findings that was diagnosed by CT scan . The etiology, pathophysiology, bacteriology, diagnosis, and treatment of these uncommon infections is discussed.

Clin Ther, 1999 Jan, 21(1), 103 - 17
Sparfloxacin versus clarithromycin in the treatment of community-acquired pneumonia; Ramirez J et al.; Community-acquired pneumonia remains a significant health concern despite the availability of effective antibiotics . This randomized, double-masked, double-dummy, multicenter comparative trial was undertaken to compare the efficacy and safety of sparfloxacin with those of clarithromycin in the treatment of community-acquired pneumonia . In 54 centers throughout the United States, 342 patients aged > or = 18 years with community-acquired pneumonia were enrolled in this trial . A total of 167 patients, 98 males and 69 females with a mean age of 51.0 years (range, 18-87), received a 400-mg loading dose of sparfloxacin on the first day, followed by 200 mg once daily for a total of 10 days . A total of 175 patients, 85 males and 90 females with a mean age of 51.3 years (range, 18-91), received clarithromycin 250 mg twice daily for 10 days . In the intent-to-treat population, 133 (79.6%) patients in the sparfloxacin group and 145 (82.9%) in the clarithromycin group were cured or improved (the 95% confidence interval {CI} for the differences in success rate between sparfloxacin and clarithromycin was -11.5% to 5.1%) . Success rates for the per-protocol patients were 88.7% (133/150) in the sparfloxacin group and 88.9% (144/162) in the clarithromycin groups (95% CI, -7.2% to 6.8%) . There were no significant differences in success rate between treatment groups based on age > or = 65 years . The overall bacteriologic response rates in the bacteriologically assessable population were 97.0% (64/66 isolates) in the sparfloxacin group and 91.4% (74/81 isolates) in the clarithromycin group . Recurrence occurred in 6.0% of per-protocol patients in the sparfloxacin group and 6.3% of patients in the clarithromycin group . The overall frequency of adverse events was 56.3% in the sparfloxacin group and 65.1% in the clarithromycin group . Gastrointestinal disturbances were the most common adverse event in both groups . Abnormal taste related to study drug was reported by 17 patients (9.7%) treated with clarithromycin, versus 3 patients (1.8%) treated with sparfloxacin (P = 0.002) . Photosensitivity reactions were reported in 10 patients (6.0%) treated with sparfloxacin, versus 1 patient (0.6%) treated with clarithromycin (P = 0.002) . QT-interval prolongation was documented in 4 patients (2.4%) in the sparfloxacin group and no patients in the clarithromycin group . Thus sparfloxacin was as well tolerated and as effective as clarithromycin in the treatment of community-acquired pneumonia.

Arch Surg, 1999 Mar, 134(3), 316 - 20; discussion 321
Reoperation for severe pancreatitis: a 10-year experience in a tertiary care center; Paye F et al.; OBJECTIVES: To analyze the specific problems encountered in treating patients previously operated on for necrotizing pancreatitis and to determine the benefit of such a complex and demanding procedure . DESIGN AND SETTING: Review of a case series in an academic tertiary care referral center . PATIENTS: Forty-four consecutive patients referred and reoperated on in 10 years . INTERVENTIONS: Reiterative laparotomy with complete debridement of all necrotic sites, followed by Mikulicz packing . Mikulicz packs were replaced by removable drains allowing both local prolonged lavage and open drainage of large solid necrotic debris . Enteral nutrition was performed through a feeding jejunostomy . Associated gastrointestinal tract lesions were simultaneously treated . MAIN OUTCOME MEASURES: Operative findings, bacteriological status of necrosis, in-hospital mortality, length of hospitalization, and surgical complications and their management . RESULTS: Necrosis was infected in 36 (82%) of the 44 cases and associated gastrointestinal tract lesions were found in 20 (45%) of these patients . Mortality was 23%, and was significantly (P = .03) related to the preoperative clinical status . Surgical complications occurred in 31 (70%) of the 44 patients necessitating surgical treatment in 18 (41%) of these patients . Mean (+/- SD) stay in the intensive care unit was 66+/-8 days for survivors . CONCLUSION: This complex and demanding surgical procedure is worthwhile, yielding mortality rates comparable to those observed in de novo severe necrotizing pancreatitis.

Schweiz Med Wochenschr, 1999 Jan 30, 129(4), 120 - 30
{Pseudomonas pneumonia--an important differential pulmonary infiltration diagnosis in AIDS}; Kaufmann P et al.; Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients . Up to now, H . influenzae and S . pneumoniae have been described as the most important germs . Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P . aeruginosa . All patients were in HIV stage C3; 3F, 12M; median age 34 (24-54) years; median CD4 count 10 (0-130) microliters . Except for 3 nosocomial pneumonias, all others were community-acquired . Only 3 patients had neutropenia < 1000/microliter; 7 were intravenous drug abusers . Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax . 4 patients showed bilateral infiltrates that could not be differentiated from those of P . carinii pneumonia . Our diagnosis was based on quantitative cultures of broncho-alveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases) . 8 patients died of pseudomonas pneumonia within 1-3 months despite therapy . 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4-15) months of the underlying illness . In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically . We conclude that in HIV-infected patients pneumonia caused by P . aeruginosa is a significant and severe pulmonary complication.

J Invest Surg, 1999 Jan-Feb, 12(1), 25 - 9
Should colon-penetrating small missiles be removed? An experimental study of retrocolic wound tracks; Edwards DP et al.; Small-fragment injury to the colon may occur in approximately 5% of battlefield casualties . The surgical management aims to reduce the risk of retrocolic infection and provide optimal conditions for colonic wound healing . This study aimed to quantify the risk of retrocolic infection . Steel fragments were fired through exteriorized porcine colon and caught in 20% gelatin . The fragments, and resultant tracks, were extracted and subjected to quantitative bacteriological examination to determine the extent of contamination . The median bacterial count for complete tracks was 1.2 x 10(4) CFU/g (interquartile range 1.8 x 10(3) to 2.7 x 10(4)) . Counts were highest in the initial 1 cm of the track and reduced along its length . This study does not support wound track excision or missile fragment removal in cases of retrocolic trauma following penetrating colonic injury . Either or both procedures will increase local trauma and are likely to prejudice colonic wound repair.

Vestn Otorinolaringol, 1998, (6), 11 - 2
{Use of gaseous ozone and ozonized solutions in the treatment of chronic suppurative otitis media}; Ovchinnikov IuM et al.; Ozone as gas and ozonized solutions were employed as treatment modalities in 28 patients with acute and chronic inflammatory diseases of the middle ear . Basing on otoscopy, bacteriological tests of the discharge from the middle ear cavity, number of washings before disappearance of the purulent discharge the conclusion was made that cure of patients on ozone therapy occurs 3-5 days earlier than in ozone-untreated patients . Ozone therapy is a beneficial adjuvant in combined treatment of otitis media.

Am J Public Health, 1999 Mar, 89(3), 399 - 407
Skirting the issue: women and international health in historical perspective; Birn AE; Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health . This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s . These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles . Women's health and social advocacy movements in Mexico and the United States partially shaped this interest . Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor . The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women.

Vet Rec, 1999 Feb 6, 144(6), 139 - 42
Tonsillar lesions in cattle naturally infected with Mycobacterium bovis; Cassidy JP et al.; The upper respiratory tract surfaces, the palatine and pharyngeal tonsils and associated lymph nodes of 32 tuberculin reactor cattle were examined pathologically and bacteriologically . Tuberculous lesions were observed histologically in the palatine tonsils of five animals and in both the palatine and pharyngeal tonsils of a sixth . Mycobacterium bovis was cultured from the tonsils of four of these animals and from the palatine or pharyngeal tonsils of a further eight cattle in which no lesions were observed . The upper respiratory tract surfaces of 10 animals were M bovis-positive.

N Z Med J, 1999 Jan 22, 112(1080), 7 - 9
Mycobacterial cervical adenitis in Auckland: diagnosis by fine needle aspirate; Harrison AC et al.; AIMS: To evaluate the role of fine needle aspiration (FNA) in the diagnosis of tuberculous and non-tuberculous mycobacterial cervical adenitis in Auckland, and to examine the demography of these conditions . METHOD: We reviewed the medical records of cases of mycobacterial adenitis in the Auckland region between 1991-1994 . Cases were identified by cross-checking the reference mycobacteriology laboratory records, all hospital cytology reports from cases who had an FNA taken from the neck region and hospital discharge diagnosis databases . RESULTS: Twenty-two cases of M tuberculosis adenitis, and 13 of M avium adenitis were identified . No FNAs were smear positive for mycobacteria . The FNA from 6/18 (33%) cases of M tuberculosis adenitis and from 4/6 (66%) M avium adenitis cases were culture positive . Bacteriological confirmation was obtained (by various methods) in 72% of tuberculous and in 100% of M avium adenitis cases . The clinical picture was different for the two organisms: tuberculous adenitis occurred mainly in caucasian adults, while M avium adenitis cases were predominantly caucasian children . None of the confirmed cases of tuberculous adenitis demonstrated drug resistance to standard anti-tuberculous agents . CONCLUSIONS: (1) Clinicians should more consistently include mycobacterial tests when investigating neck lumps . (2) FNA is not a reliable diagnostic test for mycobacterial cervical adenitis in New Zealand . Here, FNA should only be regarded as a screening test for mycobacterial adenitis . If anti-tuberculous treatment is required before it is known whether FNA has provided a positive culture, excision biopsy should first be performed to identify the mycobacterium and its susceptibility pattern.

Zhonghua Jie He He Hu Xi Za Zhi, 1997 Jun, 20(3), 164 - 6
{Long-term efficacy of full course intermittent short-course chemotherapy on new smear positive tuberculosis patients}
{Laboratory diagnosis of tuberculous peritonitis}
Gan H, Ouyang Q, Bu H.

Department of Internal Medicine, First Affiliated Hospital, West China University of Medical Sciences, ChengduOBJECTIVE: To evaluate the diagnostic value of polymerase chain reaction (PCR) assay in combination with Southern hybridization technique and enzyme-linked immunosorbent assay (ELISA) in tuberculous peritonitis . METHODS: Fourty-two tuberculous ascites were detected for M . tuberculosis by PCR technique in combination with Southern hybridization, in which nuclear acid probe was digoxigenin-labeled, and the result was compared with conventional bacteriological methods and ELISA . IS6110, a specific insert sequence of M . tuberculosis, was used as primer . The specificity of PCR products was confirmed by hybridization and digestion with Sal I restrictive endonuclerase, and the sensitivity of hybridization was compared with gel electrophoresis . RESULTS: The sensitivities were 69% by PCR, 71% by ELISA, 9% by culture and 0 by acid fast staining respectively . Hybridization was found more sensitive than gel electrophoresis . CONCLUSIONS: Both PCR technique and ELISA are valuable in diagnosis of tuberculous peritonitis, and the former is more specific than the latter . PCR technique in combination with Southern hybridization can improve both the sensitivity and the specificity of dectection.

Zhonghua Jie He He Hu Xi Za Zhi, 1997 Aug, 20(4), 234 - 6
{Analysis of causes of drug resistance and therapeutic effects on 27 multi-drug resistant pulmonary tuberculosis patients}; Ye Z et al.; OBJECTIVE: To analyse the causes of multi-drug resistant tuberculosis (MDR-TB) and to evaluate the effects of chemotherapy with ofloxacin and other antituberculosis drugs . METHOD: 27 cases with MDR-TB were treated with the regimen of 3KPTHOX/PTHOX . Changes of sputum convesion, X-ray manifestations and side effects after the treatment were also evaluated . RESULTS: 67% of the MDR-TB patients were due to irregular treatment, and 18% were caused by improper treatment . The sputum culture conversion rate at end of treatment was 89% . The bacteriological relapse rate of converted cases during 2 year follow-up was 8% . CONCLUSIONS: MDR-TB might be prevented by a combination of health education and rational use of short-course chemotherapy . Ofloxacin and other second-line anti-tuberculosis drugs are effective and were tolerated in treating patients with MDR-TB.

Br J Neurosurg, 1998 Aug, 12(4), 325 - 8
The management of brain abscess in a developing country: are the results any different?
Joshi SM, Devkota UP.
A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented . Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years . Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection . The diagnosis was made with enhanced computed tomography (CT) in all the cases . Positive bacteriology was found in only nine cases . The treatment consisted of 6 weeks of intensive intravenous antibiotics and emergency surgical drainage of the abscess . Five out of the total cases died (13.5%) . These patients were all in an extremely poor condition at the time of presentation . All the survivors made a good recovery . With timely CT diagnosis, surgical drainage and antibiotics, good results can be achieved even in a developing country.

Neurosurgery, 1999 Mar, 44(3), 529 - 35; discussion 535-6
Intracranial subdural empyemas in the era of computed tomography: a review of 699 cases; Nathoo N et al.; OBJECTIVE: Intracranial empyemas are the most common form of intracranial suppuration seen in our unit and, despite modern antibiotic therapy and advanced neurosurgical and imaging facilities, these pus collections remain a formidable challenge, often resulting in significant morbidity and death . We present an analysis of our 15-year experience with this condition in the era of computed tomography . METHODS: A retrospective analysis of 4623 patients admitted with intracranial sepsis during a 15-year period (1983-1997) identified 699 patients with intracranial subdural empyemas . The inpatient notes for these patients were analyzed with respect to clinical, radiological, bacteriological, surgical, and outcome data . Statistical analyses were performed . RESULTS: The 699 intracranial subdural empyemas accounted for 15% of all admissions for intracranial sepsis during the study period . Young male patients in the second or third decade of life were most commonly affected (62%), and the mean age was 14.65+/-12.2 years . Almost all patients (96%) underwent surgery . Eighty-two percent of patients experienced good outcomes (Glasgow Outcome Scale scores of 4 or 5) . A morbidity rate of 25.9% (including postoperative seizures) was noted, and 85 patients died (mortality rate, 12.2%) . CONCLUSION: Intracranial subdural empyema, which is a neurosurgical emergency, is rapidly fatal if not recognized early and managed promptly . Early surgical drainage, simultaneous eradication of the primary source of sepsis, and intravenous administration of high doses of appropriate antibiotic agents represent the mainstays of treatment.

Folia Microbiol (Praha), 1998, 43(6), 583 - 8
The 1997 list . Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology (an informational note); Frederiksen W et al.; A list of names published or validated in 1997 is presented . We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

J Neurosurg, 1999 Mar, 90(3), 559 - 62
Late complications of Silastic duraplasty: low-virulence infections . Case report; Ekseth K et al.; The authors describe three patients with expanding hemorrhagic mass lesions who presented 13 to 18 years after undergoing Silastic duraplasty . In all patients, results of bacteriological cultures of the masses obtained intraoperatively were positive, revealing low-virulence bacteria . Two of the patients were treated with antibiotic drugs and made a good recovery . The third did not receive antibiotic medications initially and later developed an epidural empyema that necessitated reoperation, but subsequently made a complete recovery . Vascularized neomembranes are generally agreed to be causes of the expanding masses, but the possibility that patients could be harboring chronic infections must be considered . Thus, on removal of duraplasty materials a complete bacteriological culture should be obtained, and if it is positive the proper antibiotic therapy should be administered . Furthermore, the creation of a registry of patients who have received implants is advocated to facilitate tracking of implanted material in case of complications.

Probl Tuberk, 1998, (6), 26 - 9
{Late results of multistage polysegmental lung resection for tuberculosis at many sites}; Repin IuM et al.; The late outcomes of surgical treatment of 124 patients operated on for pulmonary tuberculosis at many sites were analyzed . Surgery was made in the anatomic variant of typical polysegmental resections involving 3 to 7 bronchopulmonary segments in combination with a number of additional elements . The stable cure rates were 77.7, 71.2, and 64.3% at 3-, 5- and 10-year follow-ups, respectively . The maximum relapse rates at 2- and 3-year follow-up were 9.5 and 9.2%, respectively with variations in some subgroups according to the type of resection, the clinical forms of tuberculosis, the bacteriological activity of the process by surgery and the drug resistance of Mycobacteria . The cumulative adjusted survival rates in the same periods were 92.1, 85.1, and 70%, respectively, with the maximum mortality rate (6.8%) at 3-year follow-up, they being ranged under the influence of the above risk factors . No systematic controlled preventive chemotherapy regimens are a cause of relapses and death in the late periods of follow-ups.

Korean J Intern Med, 1999 Jan, 14(1), 95 - 8
Hyperimmunoglobulin E-recurrent infection syndrome in a patient with juvenile dermatomyositis; Min JK et al.; A 13-year-old girl presented with multiple skin abscesses . She was diagnosed as having juvenile dermatomyositis (DM) at the age of 7 years . She had suffered from recurrent skin infections, atypical pruritic dermatitis and pneumonia since the age of 8 years . Bacteriologic and fungal cultures for skin abscesses and oral mucosa were positive S . aureus and C . albicans, respectively . Chemotactic defect in peripheral blood neutrophils was observed . The level of serum IgE was markedly elevated, and anti-S.aureus specific IgE was found . A diagnosis of hyperimmunoglobulin E-recurrent infection syndrome (HIE) was made and she was successfully treated with surgical drainage and antibiotics . To our knowledge, this is the first case report of HIE in a patient with juvenile dermatomyositis.

APMIS, 1998 Dec, 106(12), 1204 - 9
The 1997 list . Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology . An informational note; Frederiksen W et al.; A list of names published or validated in 1997 is presented . We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999 Feb, 87(2), 227 - 32
Outcomes of periradicular surgery in cases with apical pathosis and untreated canals; Danin J et al.; OBJECTIVE: Surgical management is intended to eliminate or block infection originating in the root canals . The root end is customarily sealed to prevent pathogenic products remaining in the root canal from reaching the periradicular tissues . The purpose of this study was to evaluate the microbiologic and radiographic outcomes of surgical treatment of periradicular pathosis associated with teeth with necrotic pulps . STUDY DESIGN: One tooth from each of 10 patients was root-end resected and root-end filled without prior root canal treatment . One year postoperatively, the outcomes were assessed radiographically and the root canals were sampled for bacteria . RESULTS: Radiographic examination showed complete or incomplete (scar tissue) healing in 5 teeth and uncertain healing in the other 5 teeth . Bacteriologic samples from the root canals were positive in 9 of the 10 cases . CONCLUSIONS: In teeth with necrotic pulps, treatment of periradicular pathosis by surgery and root-end filling may show radiographic evidence of satisfactory healing 1 year postoperatively . However, viable bacteria may persist in the canals, constituting a potential risk factor for recurrence of periradicular pathosis.

Contact Dermatitis, 1999 Feb, 40(2), 77 - 83
An epidemic of occupational contact dermatitis from an immersion oil for microscopy in laboratory personnel; Le Coz CJ et al.; Since November 1997, 14 successive cases of occupational contact dermatitis were observed in 13 laboratory technicians and 1 physician, working in a genetics laboratory in Leuven (Belgium) in 3 laboratories of bacteriology in Strasbourg, Montbeliard and Angers, and in the laboratory of hematology in Bordeaux (France) . The dermatitis, located on the hands, forearms and face, relapsed after each exposure to an immersion oil for microscopy . Patch tests performed in 10 patients were positive to epoxy resin (ER) in the European standard series (10/10 patients) and to newly formulated Leica immersion oil (7/7), 1 patient testing negatively with the former oil . A breakdown performed in 2 patients with the oil's ingredients confirmed sensitization to liquid modified ER components, contained at >80% concentration in the oil . The presence of DGEBA was demonstrated by HPLC analysis at a +/-30% rate . Although the safety data sheet indicated a revision of the formula, nobody was alerted to the risk of sensitization and the need for skin protection . ERs, as a source of occupational allergy, can provoke epidemics of contact dermatitis in industry . This report of epidemic contact dermatitis from ERs, used for their optical properties in an immersion oil for microscopy, emphasizes the need for perpetual vigilance in occupational medicine and the usefulness of multicentre contacts in dermato-allergology.

Vet J, 1999 Jan, 157(1), 61 - 7
The efficacy of the skin delayed-type hypersensitivity using a Brucellin prepared from a mucoid strain of Brucella abortus to detect brucellosis; Bercovich Z et al.; Eight-hundred-and-ninety-six cattle belonging to herds officially designated Brucella-free, and 190 cattle belonging to infected herds were tested with the skin delayed-type hypersensitivity (SDTH) test, using brucellin (273) prepared from a mucoid strain of Brucella abortus . An increase in skinfold thickness > or = 2 mm was considered a positive SDTH test . The serum agglutination test, complement fixation test and bacteriological examination were used to confirm SDTH test results . Results show that 6 of the 896 uninfected cattle tested positive in the SDTH test, indicating a 99.3% specificity . Of the 44 cattle that tested serologically or bacteriologically positive, 33 tested positive in the SDTH test, indicating a 75% sensitivity . The value of the SDTH test was demonstrated by its ability to detect infection earlier than serological tests, and by confirming infection in cattle with ambiguous serological test results . An increase in skinfold thickness > or = 1 mm in cattle in suspected herds should not be ignored, as it may indicate specific sensitization . We recommend the use of the SDTH test in combination with serological tests for early diagnosis of brucellosis in cattle.

Tidsskr Nor Laegeforen, 1999 Jan 10, 119(1), 30 - 3
{Tuberculosis in Bergen 1996}; Nordtvedt S et al.; In 1996, 30 patients with tuberculosis were reported from Haukeland University Hospital to the Norwegian Tuberculosis Registry . Culturing proved 63% with mycobacterium tuberculosis (M . tuberculosis) . 13 of the patients, eight adults and five children, all natives, were identified as close relatives or friends (cluster) . M . tuberculosis with identical restriction fragment length polymorphism pattern (RFLP) were found in all the adults, indicating that they carried the same bacteria strain . We have compared the clinical findings, bacteriology and treatment among the adults in the cluster with other patients with pulmonary tuberculosis identified the same year at the Department of Thoracic Medicine at Haukeland University Hospital . The patients in the cluster were young adults without any previous chest X-ray changes . The other natives with tuberculosis were older, two showing chest X-ray changes indicating former tuberculosis . No difference was seen in sex, BCG status, tuberculin sensitivity, symptoms, physical findings or chest X-ray between the two groups . In the cluster, four patients proved sputum smear positive, as compared to four in the other group . Spread of infection and new cases of M . tuberculosis with identical RFLP were found only in the cluster . Since RFLP analyses of M . tuberculosis started in Norway in 1993, this cluster in Bergen is the largest cluster observed with identical RFLP pattern.

Gesnerus, 1998, 55(3-4), 249 - 69
{Solving the mystery of cellular inclusions . A contribution to the history of virology}; Diosi P; In the middle of the 19th century cell inclusions were observed with increasing frequency in more and more diseases and were closely scrutinized by researchers working in different fields . Because of their distinct viewpoints, however, the various authors came inevitably to different conclusions . The morphologists interpreted the inclusions as artefacts or degenerative changes, the etiologists, on the other hand, took them for pathogenic protozoa, for cellular lesions inflicted by invisible agents or, conversely--for aggregated products of the cellular defense . Various morphological, parasitological and bacteriological methods have been used to clear up the pros and cons of these hypotheses . It was the rapid progress realized in virology at the middle of the 20th century that finally brought to light their real significance.

Abdom Imaging, 1999 Mar-Apr, 24(2), 163 - 4
Hepatic abscess following transhepatic drainage of subphrenic abscess; Yu A et al.; A case of an hepatic abscess that developed after percutaneous transhepatic drainage of a subphrenic abscess is presented . The location of the abscess immediately along the tract of the drainage catheter and the similar organisms recovered from bacteriologic culture suggest that the abscess was related to direct contamination along the tract of the drainage catheter . The potential for abscess formation within the liver should be considered in the choice of access route for percutaneous drainage of retroabdominal abscesses . It may be preferable to avoid transhepatic drainage in patients in whom it is anticipated that the catheter drainage will require considerable length of time.

J Med Microbiol, 1999 Feb, 48(2), 113 - 6
Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology; Frederiksen W et al.; A list of names of bacteria published or validated in 1997 is presented . Comments are made of the tendency to base names of new taxa on a single bacterial strain and the consequences for reliable descriptions that this tendency implies.

Verh K Acad Geneeskd Belg, 1998, 60(5), 387 - 440
{Ronald Ross: a century of the transfer of malaria by mosquitoes}; Janssens PG; Ronald Ross is a brilliant and polyvalent mind . When orientated towards medicine he took the training amateurishly and ended up with a limited qualification . After 2 years as a ship doctor, he attended the compulsory complementary training in order to be admissible in the IMS, the garrison life left him with plenty of time to engage in his hobby's: painting for a short while, writing, poetry and mathematics . By the end of his first term he questioned the sense of his medical activities and decided, with a view to his career, to acquire a Public Health diploma and some complementary bacteriology . During his second term the malaria problem drew his attention . As he was unable to detect the parasite of Laveran in the blood of patients with malarial fevers he concluded that the parasite had been some lucky microscopic finding without any value and turned this parasite into ridicule . During his leave in 1894 he met Manson, who showed him the technique to put the parasite in evidence and convinced him to search for its vector which, to his opinion, should be a mosquito . Ross decided to follow this lead . With his minimal parasitological knowledge and an entomological background limited to the external appearance of mosquitoes he endeavoured to establish the life cycle of the malarial parasites . Notwithstanding some service bounded transfers, he followed the fate of the filaments of the crescents and discovered the parasite on the stomachwall of dapled-winged mosquitoes . During his special mission in Calcutta and in the absence of suitable malaria infections in man he shifted to bird proteosoma (now P . relictum) with a grey mosquito (culex) as vector . He demonstrated the complete life-cycle ending in the salivary glands of the mosquitoes and succeeded in transmitting this infection by mosquito-bites in healthy birds . This climax in his research was crowned by the attribution in 1902 of the Nobel Prize for Medicine . In the mean time he resigned from the IMS and was appointed as "Lecturer on Tropical Diseases" at the Liverpool School . He reoriented his activities to the prevention of malaria by control of the vector in its aquatic larval stage, which he tried out and promoted during his journeys to the West African Coast and other countries . His current were variegated but without salient details . Through the survey of the parasite index and the assessment of the spleen rate in children he founded the malariometry as a epidemiological tool, focussed attention on the relation of malaria and the community and on the complexity of the transmission dynamics . By handing in his resignation at the Liverpool School and moving to London he hampered further his scientific productivity . The tardy foundation of the Ross Institute did not stimulate a new impetus . He suffered a stroke which left him partially crippled an he died in his Institute.

Klin Khir, 1998, (7), 22 - 3
{The treatment of an acute thrombophlebitis of subcutaneous veins of the foot: an current surgical problem}; Orishchak DT; The results of treatment of 1225 patients with an acute subcutaneous foot veins thrombophlebitis were analysed . Morphological changes of the vein wall were studied up, bacteriological investigation of the thrombosed veins was conducted.

J Infect Dis, 1999 Feb, 179 Suppl 1, S120 - 6
Ebola virus outbreak among wild chimpanzees living in a rain forest of Côte d'Ivoire; Formenty P et al.; An outbreak of Ebola in nature is described for the first time . During a few weeks in November 1994, approximately 25% of 43 members of a wild chimpanzee community disappeared or were found dead in the Tai National Park, Cote d'Ivoire . A retrospective cohort study was done on the chimpanzee community . Laboratory procedures included histology, immunohistochemistry, bacteriology, and serology . Ebola-specific immunohistochemical staining was positive for autopsy tissue sections from 1 chimpanzee . Demographic, epidemiologic, and ecologic investigations were compatible with a point-source epidemic . Contact activities associated with a case (e.g., touching dead bodies or grooming) did not constitute significant risk factors, whereas consumption of meat did . The relative risk of meat consumption was 5.2 (95% confidence interval, 1.3-21.1) . A similar outbreak occurred in November 1992 among the same community . A high mortality rate among apes tends to indicate that they are not the reservoir for the disease causing the illness . These points will have to be investigated by additional studies.

Dtsch Med Wochenschr, 1999 Jan 22, 124(3), 45 - 8
{Focal mycobacterial lymphadenitis after starting highly active antiretroviral therapy}; Schwietert M et al.; HISTORY AND FINDINGS: A 30-year-old man with a known HIV infection for 7 years presented for treatment with antiretroviral drugs . He was known to have had herpes zoster, oral hairy leukoplakia and recurrent Candida stomatitis, but was otherwise without symptoms . INVESTIGATIONS: The CD4 lymphocyte count was 19 cells/mm3 and there were 41,000 HIV-RNA copies/ml . DIAGNOSIS, TREATMENT AND COURSE: The HIV infection was in CDC stage B3, indicating the need for combined antiretroviral treatment . A week after starting stavudine, saquinavir and ritonavir he had to be admitted because of nausea and vomiting, colicky abdominal pain, diarrhea, fever up to 39 degrees C and a rise of C-reactive protein to 207 mg/dl . Bacteriological examination of feces and biopsy of an enlarged retroperitoneal lymph node revealed atypical mycobacteria . Antituberculosis treatment was started . The CD4 cell count rose to 56/mm3 and the viral count fell to 11,000/ml . Each time after initiating a different antiviral regimen the symptoms recurred . CONCLUSIONS: This case illustrates an atypical manifestation of on opportunistic infection: during combined antiviral treatment the CD4 cell count rose and thus precipitated an heretofore subclinical mycobacterial infection with focal lymphadenitis . If, on starting antiretroviral treatment at a late HIV stage, new symptoms develop within 1-3 weeks, one should consider drug-induced side effects or the onset of an opportunistic infection that has become manifest as the result of an improved immunological state.

Am J Otolaryngol, 1999 Jan-Feb, 20(1), 7 - 11
Azithromycin versus amoxicillin/clavulanate in the treatment of acute sinusitis; Klapan I et al.; PURPOSE: To compare the efficacy and tolerability of a 3-day course of azithromycin with a 10-day course of amoxicillin/clavulanic acid in the treatment of acute sinusitis in adults . PATIENTS AND METHODS: One hundred adult patients with acute sinusitis were included in an open, randomized study . Clinical diagnosis of sinusitis was confirmed by nasal endoscopy, sinus radiography, and (when possible) by culture of sinus aspirate . Patients were randomized to receive azithromycin (500 mg once daily for 3 days) or amoxicillin/clavulanate (625 mg every 8 hours for 10 days) . RESULTS: A significantly faster resolution of signs and symptoms of sinusitis was observed in the azithromycin-treated patients . By the end of therapy (days 10-12), 95% of the patients in the azithromycin group and 74% in the amoxicillin/clavulanate group were cured . The remaining patients' conditions were improved . By the follow-up visit, cure was achieved in 98% of the azithromycin-treated patients, and 91% of the amoxicillin/clavulanate-treated patients . Treatment failure was observed in three patients from the amoxicillin/clavulanate group, and relapse occurred in one patient from each group . Bacteriologic eradication was achieved in 23 of 23 and 21 of 24 patients treated with azithromycin and amoxicillin/clavulanate, respectively . Both drugs were well tolerated . Two patients (4%) from the azithromycin group and five patients (10%) from the amoxicillin/clavulanate group reported mild gastrointestinal disturbances . CONCLUSIONS: In adults with acute sinusitis, a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid . A significantly simpler dosage regimen and faster clinical effect were the advantages of azithromycin.

Arch Orthop Trauma Surg, 1998, 118(3), 156 - 8
Bone allograft contamination in multiorgan and tissue donors; Segur JM et al.; Multiorgan and tissue donors offer a larger quantity and high quality of bone allograft that cannot be obtained from living donors . The risk of bone contamination must be borne in mind if secondary sterilization is not performed . The bacteriological cultures of 270 bone segments obtained from 53 multiorgan or tissue donors were analysed to study the relationship between previous organ and tissue procurements and bone retrieval contamination . We concluded that no significant differences in bacterial contamination percentage were found for each type of previous organ and tissue procurement, nor in the number of teams per donor.

Lepr Rev, 1998 Dec, 69(4), 376 - 81
beta 2-Glycoprotein I-dependence of anticardiolipin antibodies in multibacillary leprosy patients; Fiallo P et al.; This study was undertaken to investigate the influence of beta 2-glycoprotein I (GPI) on anticardiolipin antibody (aCL) titration in leprosy . The study group consisted of 140 sera from patients with multibacillary leprosy (46 borderline, 94 lepromatous) . The group included newly diagnosed, previously untreated patients, patients under treatment and patients released from treatment . GPI addition enhanced significantly the aCL titres in sera from lepromatous leprosy but not in those from borderline leprosy . Moreover, when the patients were classified according to their bacteriological status, aCL titres were found to be significantly higher in skin smear positive patients compared to bacteriologically negative patients . Thus, the present study demonstrates that aCL in multibacillary leprosy patients are mainly of the GPI-dependent type and emphasizes the importance of GPI addition for aCL titration in leprosy.

Gac Med Mex, 1998 Nov-Dec, 134(6), 651 - 9
{Diagnostic usefulness of bronchoalveolar lavage in nosocomial pneumonia associated with mechanical ventilation in patients undergoing antibiotic treatment}; Vazquez-Garcia JC et al.; We evaluated the diagnostic utility of the colony forming units (CFU) count in bronchoalveolar lavage (BAL) cultures from patients with nosocomial pneumonia associated with mechanical ventilation (PAMV) and treatment with systemic antibiotics . Cultures with greater than 10(4) CFU/ml were considered positive, while the absence of cultures was considered negative . Cultures with < or = 10(3) CFU/ml were classified as contaminated . The gold standard was defined by clinical, bacteriological, and histological criteria . We studied 12 patients suspected of having PAMV, and six controls who had no evidence of pneumonia or infection of any kind . Positive cultures were found in all patients suspected of having PAVM, while all controls had negative cultures . One patient was eliminated because we were unable to corroborate the final diagnosis . Using the gold standard, nine patients had PAVM, and eight did not have PAVM . The sensitivity of the test was 100%, and the specificity was 75%, while the positive predictive value was 88%, and the negative predictive value 100% . We conclude that the CFU count in BAL cultures is a useful method for the diagnosis of PAMV in patients treated with systemic antibiotics.

Am Surg, 1999 Feb, 65(2), 99 - 104
Ticarcillin/clavulanate versus imipenem/cilistatin for the treatment of infections associated with gangrenous and perforated appendicitis; Allo MD et al.; The objective of this study was to compare ticarcillin/clavulanate given at 3.1 g every 6 hours with imipenem/cilistatin given at 500 mg every 6 hours for the treatment of infections associated with gangrenous or perforated appendicitis . One hundred thirty-seven patients were found to have gangrenous or perforated appendicitis and received the study medication for 3 to 5 days in a double-blinded, randomized manner . Clinical success was similar for the two treatment groups, 96.9 and 95.9 per cent in the ticarcillin/clavulanate and imipenem/cilistatin groups, respectively (P=0.99; 95% confidence interval for the difference was -5.6% to 7.6%) . Bacteriologic success at the end of therapy was similar in the two groups, 100 and 98.4 per cent in the ticarcillin/clavulanate and imipenem/ cilistatin groups, respectively (P=0.99; 95% confidence interval for the difference was -1.8% to 4.7%) . The occurrence of adverse events related to treatment was similar for the two groups (P=0.31) and led to study withdrawal for four patients (one with ticarcillin/clavulanate and three with imipenem/ cilistatin) . Ticarcillin/clavulanate given at 3.1 g every 6 hours is as effective and as safe as imipenem/ cilistatin given at 500 mg every 6 hours for treatment of gangrenous or perforated appendicitis.

Chest, 1999 Jan, 115(1), 26 - 30
Tuberculous pleural effusion in children; Merino JM et al.; STUDY OBJECTIVES: To describe the age distribution, clinical, laboratory, radiographic, and bacteriologic findings of pediatric patients with tuberculous pleural effusion . DESIGN: A retrospective study . PATIENTS AND METHODS: We have identified all cases of primary pulmonary tuberculosis in children < 18 years, reported to the health department . We have collected information from medical records regarding demographics, clinical findings, bacteriologic results, and evolution . Chest radiographs obtained at the time of initial evaluation were reviewed independently by two groups of radiologists who were blind to the clinical and epidemiologic data . RESULTS: Between January 1983 and December 1996, 175 children < 18 years were diagnosed as having primary pulmonary tuberculosis . Among them, 39 patients (22.1%) showed pleural effusion on chest radiograph . The mean age of patients with tuberculous pleural effusion was significantly higher (13.52+/-0.5 years vs 6.97+/-0.42 years) . The sensitivity of the tuberculin test is 97.4% for an induration > or = 5 mm . Pleural fluid analysis shows a lymphocytic exudative effusion . Chest radiograph review showed unilateral pleural effusion in all cases . Pleural effusion was the sole radiographic manifestation in 41% of cases . Parenchymal disease is associated in 23 cases (59%) . Bacteriologic confirmation of tuberculosis was achieved in 22 cases (56.4%) . Cultures of pleural fluid and biopsy material both yielded Mycobacterium tuberculosis in 15 of 34 (44.1%) and 12 of 18 (66.6%), respectively, for samples under study . Pleural biopsy specimens showed granulomatous inflammation in 18 of 23 cases (78.3%) . Antituberculous therapy for 6 to 9 months was effective in all cases . Transient side effects occurred in 1 of 39 patients (2.9%) . CONCLUSIONS: Pleural effusion accounts for 22.1% of cases of pediatric pulmonary tuberculosis . Parenchymal consolidation is the most common associated radiographic finding . Bacteriologic confirmation was achieved in 56.4% of cases . A short course of chemotherapy is effective.

Ann Cardiol Angeiol (Paris), 1998 Dec, 47(10), 735 - 8
{Infectious endocarditis, did it change?}; Habib G et al.; Although the incidence and prognosis of infectious endocarditis have remained relatively stable for many years, this disease has recently undergone major modifications of its aetiological and bacteriological profiles, and has benefited from progress in echocardiographic techniques . New diagnostic criteria have been proposed and considerable therapeutic progress has been accomplished, in both medical (antibiotic therapy) and surgical (conservative surgery, homografts) modalities.

J Gynecol Obstet Biol Reprod (Paris), 1998 Nov, 27(7), 665 - 75
{Management of premature rupture of membranes in a monofetal pregnancy before 28 weeks gestation}; Marret H et al.; To establish appropriate management of premature rupture of the membranes before 28 weeks, we examined maternal and fetal risks in pregnancies complicated by this rare problem (1-7/1000) . Three main factors were identified in such circumstances: prematurity, infection and oligohydramnios . Prematurity is inevitable and depends on three factors: gestational age at rupture of the membranes which is an independent predictor of poor prognosis before 22 weeks; gestational age at delivery as neonates born before 26 weeks gestation have an overall perinatal survival < 50%, and latency period between preterm rupture of the membranes and delivery which ranged from 1 to 161 days with a mean 7.8 days . Infection is the second factor with a high incidence (> 30%) of chorioamnionitis . The third factor is skeletal deformations and pulmonary hypoplasia predicted by severe and prolonged (> 14 days) oligohydramnios . Only about 40% of such women will take home a live baby . Successful outcome can be achieved in about 60% of these survivors . Termination of pregnancy is warranted at 22 weeks gestation or less and may be proposed . Beyond 22 weeks gestation, management is based on a wait-and-see attitude with ultrasonographic and bacteriological surveillance . After 25 weeks gestation, management becomes more active with use of antibiotics, tocolytics and steroids which can help prolong the latency period and improve fetal outcome . Ongoing counselling and psychological support are essential in the management of this morbid complication of pregnancy.

Ann Med Interne (Paris), 1998 Nov, 149(7), 464 - 6
Pericardial tamponade as the first manifestation of dermatopolymyositis; Chraibi S et al.; Pericardial involvement in polymyositis and dermatomyositis (PM/DM) is rare, usually asymptomatic and exceptionally part of the initial presentation . We describe a 37-year-old patient hospitalized for overt acute pericarditis, revealing dermatomyositis, which to our knowledge has not been previously reported . Pericardial puncture relieved the patient . The pericardial fluid was citrine yellow, exsudative, and mainly contained lymphocytes . Search for LE cells and anti-DNA antibodies was negative, whereas the antinuclear antibodies and the rheumatoid factor were present in the pericardial fluid . A biopsy of the pericardium showed a non-specific chronic inflammatory state and the search for an etiology was negative . There was no sign of tuberculosis, systemic lupus, nor neoplasia . Moreover bacteriological cultures and HIV serology were negative . After pericardiostomy associated with corticosteroid therapy at the dose of 1 mg/kg/day, outcome was good with a resolution of the pericarditis confirmed at one-year follow-up . Since pericardial tamponade, even though rare, may be fatal in a patient with dermatomyositis, we emphasize that a two dimensional echocardiographic study should be performed in all patient presenting with dermatopolymyositis.

Vojnosanit Pregl, 1998 Sep-Oct, 55(5), 559 - 63
{Recurrent abscessing pneumonia caused by Nocardia}; Sikimic S et al.; In female patient, 19 years old, disease occurred when she was 5 . Thoracotomy with atypical resection of lung part was performed for the abscess in right lobe . Nocardia was bacteriologically confirmed . In the next 3 years, she was treated for pneumonia several times . When she was 19, abscess-forming pneumonia that recurrently occurred after the antibiotic therapy cease was established in right lobe . Nocardia was isolated by bronchoscopically taken aspirate, bacteriologically stained by Gramm, Ziehl-Neelsen and Kinyon and cultivated on several bacteriological and mycological media . She has been treated by antibiotic combination (sulfamethoxazole + trimethoprim and amoxicillin + clavulanic acid and minocycline) for 10 months . Subjective discomforts disappeared after the therapy, biohumoral findings were normal, and smaller pleuropulmonary adhesions on the right side could have been radiologically observed.

J Clin Laser Med Surg, 1998 Oct, 16(5), 263 - 7
Histological changes induced by CO2 laser microprobe specially designed for root canal sterilization: in vivo study; Kesler G et al.; OBJECTIVE: Until now, no suitable delivery fiber has existed for CO2 laser endodontic radiation in the apical region, where it is most difficult to eliminate the pulp tissue using conventional methods . To overcome this problem, we have designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal and thus favorably increasing the thermal effects . METHODS: A CO2 laser microprobe coupled onto a special hand piece was attached to the delivery fiber of a Sharplan 15-F CO2 laser . The study was conducted on 30 vital maxillary or mandibulary, central, lateral, or premolar teeth destined for extraction due to periodontal problems . Twenty were experimentally treated with pulsed CO2 laser delivered by this newly developed fiber after conventional root canal preparation . Temperature measured at three points on the root surface during laser treatment did not exceed 38 degrees C . Ten teeth represented the control group, in which only root canal preparation was performed in the conventional method . RESULTS: Histological examination of the laser-treated teeth showed coagulation necrosis and vacuolization of the remaining pulp tissue in the root canal periphery . Primary and secondary dentin appeared normal in all cases treated with 15-F CO2 laser . Gram stain and bacteriologic examination revealed complete sterilization . These results demonstrate the unique capabilities of this special microprobe in sterilization of the root canal, with no thermal damage to the surrounding tissue . CONCLUSIONS: The combination of classical root canal preparation with CO2 laser irradiation using this special microprobe before closing the canal can drastically change the quality of root canal fillings.

Nihon Kokyuki Gakkai Zasshi, 1998 Oct, 36(10), 886 - 90
{Severe Legionella micdadei pneumonia effectively treated with hemofiltration therapy}; Matsubara S et al.; A 42-year-old man was admitted because of fever, productive cough, and progressive dyspnea . Chest x-ray films and computed tomographic scans disclosed dense consolidation in the left and right lung fields . No pathogenic agent was found despite extensive bacteriological examinations . Based on serological findings, the patient was given a diagnosis of acute pneumonia caused by Legionella micdadei . It has been reported that Legionnaire's disease is easily complicated by fatal systemic illnesses such as disseminated intravascular coagulation (DIC) and multiple organ failure . In fact, the patient suffered from severe hypotension and DIC on admission . Treatments against systemic complications were started together with intravenous administration of antibiotics including erythromycin . Continuous intravenous cathecolamin, however, failed to alleviate the patient's shock . We therefore applied endotoxin eliminating therapy using a polymyxin-B-column (PMX) and continuous hemofiltration (CHF) . The patient recovered from critical shock immediately after the start of PMX, which together with CHF, alleviated his systemic complications . Although the factors responsible for fatal systemic complications in Legionnare's disease are not well-documented, our findings suggested that some substances removable by PMX and CHF play an important role in pathogenesis.

Rev Med Interne, 1998 Dec, 19(12), 917 - 20
{Disseminated tuberculosis in non-immunocompromised host: three case reports}; Charfi MR et al.; INTRODUCTION: Disseminated tuberculosis, i.e., tuberculosis involving lung, liver, spleen, bone marrow and lymph nodes is rare (2.8%), particularly when immunocompromised diathesis is lacking . EXEGESIS: We report three cases of disseminated tuberculosis confirmed by bacteriology or histology, which occurred in non-immunocompromised patients . Disease evolution under antituberculous treatment was favorable in two cases and fatal in the third one . CONCLUSION: Disseminated tuberculosis must be suspected when miliary pulmonary lesions are associated with hematologic abnormalities, even in non-immunocompromised host . Early treatment is mandatory to avoid fatal outcome.

Arch Pediatr, 1998 Dec, 5(12), 1378 - 82
{Medical examination of sexually abused children and adolescents}; Rey C et al.; Medical examination of sexually-abused children or adolescents aims: 1) to identify clinical evidence of genital or extragenital lesions, 2) to diagnose sexually-transmitted infections or pregnancy, 3) to evaluate the needs for medical care, psychological support, and social investigation . The amount of laboratory evidence depends on the history . Laboratory investigations usually include tests for sperm, bacteriological cultures from all sites, testing for HIV, HCV and HBV antibodies, and the detection of pregnancy . Careful writing of a descriptive medical certificate is an important part of the medical intervention.

Nippon Rinsho, 1998 Dec, 56(12), 3181 - 4
{Pulmonary tuberculosis in the elderly}; Saito T et al.; Clinical problems of pulmonary tuberculosis in the elderly patients were discussed . As for diagnosing tests, chest X ray sometimes shows atypical findings in patients with pre-existing pulmonary diseases (i.e . pulmonary emphysema, interstitial pneumonia and etc) . It is most important to get bacteriologic evidence from suspected patients of pulmonary tuberculosis . Elderly patients have co-existing diseases except pulmonary tuberculosis . Controlling co-existing diseases is essential for treatment of pulmonary tuberculosis in the elderly patients . Treatment with standard chemotherapy leads to good result even in the elderly . However, we have to investigate the mechanism of rush cases, who dies in a few months in spite of adequate chemotherapy.

Nippon Rinsho, 1998 Dec, 56(12), 3162 - 6
{Differential diagnosis of pulmonary tuberculosis}; Morishita M et al.; Differential diagnosis of pulmonary tuberculosis is discussed . Chest X-ray findings of pulmonary tuberculosis may be greatly varied, because tuberculosis may cause three different lesions: an exudative lesion, a proliferative lesion, and a fibrotic lesion, and because it may invade all the structure . Thus, the differential diagnosis of pulmonary tuberculosis includes very many diseases . The most important differential diagnosis of nodule is tuberculoma and lung cancer . The clue of the diagnosis is the feature of the nodule and surrounding structure, such as pleural indentation, or knotching . There is, however, the limitation of the diagnosis by imaging: some tuberculoma may show the identical feature with the pulmonary adenocarcinoma . It is important to gather the pathological or bacteriological evidences by means of suitable procedures.

Nippon Rinsho, 1998 Dec, 56(12), 3153 - 6
{Tuberculosis in the field of gynecology}; Mizuno K; Recently few cases as to female genital tuberculosis were reported, therefore it is considered that the incidence of the female genital tuberculosis was decreased . However it is important to make a right diagnosis of tuberculosis, because the tuberculosis in the female sexual organs is one of the factors of female sterility . The diagnosis is needed to examine bacteriologically or pathologically . The diagnosed genital tract or pelvic tuberculosis was treated by anti-tuberculosis chemotherapy firthtly and by surgical procedures in case of necessity.

Nippon Rinsho, 1998 Dec, 56(12), 3073 - 6
{Role of endoscopy for the diagnosis of tuberculosis}; Ozawa S et al.; The usefulness of bronchoscopy in diagnosis of pulmonary tuberculosis (PT) has been demonstrated with many workers after 1980's . The indication for bronchoscopy is in patients suspected of having active PT with negative sputum smear and polymerase chain reaction (PCR) . The combination of bronchial aspiration, brushing, bronchoalveolar lavage, biopsy and postbronchoscopy sputum give a high yield of early diagnosis, ranging from 40-70% of cases . Furthermore, early diagnostic rate improves by these procedure adding PCR in 85% . The bacteriologic study of pleural effusion in diagnosis of tuberculous pleurisy has shown positive results in less than 30 percent of cases . Although the diagnostic rate improves in 60 percent by blind needle biopsy, the diagnostic accuracy is much greater when the thoracoscopy is used, because the pathologist is provided with multiple, selected biopsy . So not only surgeon but also physician should learn thoracoscopy for the diagnosis of pleural effusion.

Nippon Rinsho, 1998 Dec, 56(12), 3001 - 7
{Bacteriology of mycobacteria: taxonomic and morphological characteristics}; Tomioka H; Bacteriological characteristics of organisms belonging to Genus Mycobacterium which involves more than 60 species are described . Mycobacterial organisms can be divided into the following groups having differential characteristics, on the basis of the results of biological, biochemical, and genetic investigations, including lipid analysis, DNA probe test, and comparative 16S ribosomal RNA sequencing . First, Mycobacterium tuberculosis complex (M . tuberculosis, M . bovis, M . africanum, etc.) . Second, cultivable but slowly growing nontuberculous mycobacteria, including photochromogens (Runyon Group I) such as M . kansasii, M . marinum, M . simiae, M . intermedium, and M . asiaticum, scotochromogens (Runyon Group II) such as M . scrofulaceum, M . szulgai, M . injectum, M . lentiflavum, and M . gordonae, nonphotochromogenens (Runyon Group III) such as M . avium, M . intracellulare, M . xenopi, M . malmoense, M . genavense, M . celatum, and M . gastri . Third, cultivable rapidly growing nontuberculous mycobacteria (Runyon Group IV) including M . fortuitum, M . chenolae, M . abscessus, M . phlei, and M . smegmatis . Fourth, noncultivable mycobacteria including M . leprae . About 30 species of Mycobacterium cause pulmonary, dermal, lymphatic, and disseminated infections in human beings . This paper mainly deals with the taxonomic, morphological, and other biological characteristics of these mycobacterial organisms.

Gastroenterol Clin Biol, 1998 Nov, 22(11), 855 - 7
{Helicobacter pylori infections in children in the tropical zone . Endoscopic and histological aspects}; Ilboudo D et al.; AIMS: To assess the endoscopic and histological aspects of Helicobacter pylori (H . pylori) infection in children in a prospective study . PATIENTS AND METHODS: One hundred and four children (6 months-15 years old), with digestive symptoms admitted to the Pediatric Department of the National Hospital of Ouagadougou between February Ist and October 31 1996, underwent upper digestive endoscopy with fundic and antral biopsies for histological and bacteriological analysis . RESULTS: Endoscopy was normal in 80 cases (77%) . No lesion was specific of H . pylori infection . Nodular gastritis was observed in 3% of the cases only . Duodenal ulcers were seen in 3 children (3%) . 83% of the children had chronic antral gastritis, associates with H . pylori in 95% of the cases . The lesions were follicular gastritis (45%), mild atrophic gastritis (38.5%) and lymphocytic gastritis (1%) . Follicular gastritis was more pronounced in the antrum than in the fundus . CONCLUSION: The high prevalence of early H . pylori infection and chronic gastritis in children contrasts with the rarity of gastric cancer in black Africa . Protective factors or peculiar strains should be searched for.

Pediatr Surg Int, 1998 Dec, 14(3), 204 - 7
T-cryptantigen (TCA) activation in surgical neonates: a hidden problem; Grant HW et al.; The Thomsen-Friedenreich cryptantigen (TCA) is located on the surface of all red cells, but is concealed by a layer of neuraminic acid . When bacteria that produce neuraminidase disrupt this coating, the TCA can be exposed and activated . If blood products containing antibody to the TCA are subsequently administered, haemolysis can result . While the relationship between TCA and necrotising enterocolitis (NEC) is well described, the incidence of TCA activation in other forms of sepsis in surgical neonates is not known . In a prospective study, 117 patients admitted to the Surgical Neonatal Nursery were examined for evidence of TCA activation . Of the 117 babies, 69 were clinically non-septic and only 1 had weak TCA activation (1.4%) . Forty-eight were clinically or bacteriologically septic; 8 of these demonstrated TCA activation (17%), 3 of whom died . Forty of the septic group showed no evidence of TCA activation although 27 grew organisms on culture; 17 in this group died . Two of the TCA-activated babies received unwashed red cells, and both haemolysed; 4 TCA-activated babies received washed red cells and none haemolysed . Although 1 of the well babies in this study demonstrated TCA activation, we would not recommend routine TCA testing on clinically well babies . We would, however, recommend routine testing in all clinically septic infants, as 17% showed signs of TCA activation in this study . We would also suggest the adoption of a selective transfusion policy in TCA-activated patients to avoid the risk of haemolysis . This may help to reduce unnecessary morbidity and mortality in a high-risk group of neonates.

Vet Immunol Immunopathol, 1998 Dec 11, 66(3-4), 343 - 58
A study of immunological responses of sheep clinically-affected with paratuberculosis (Johne's disease) . The relationship of blood, mesenteric lymph node and intestinal lymphocyte responses to gross and microscopic pathology; Burrells C et al.; Nineteen adult sheep diagnosed as having clinical paratuberculosis (Johne's disease) and 16 unaffected controls were examined in this study . Animals were tested for the presence of circulating antibodies of Mycobacterium avium ssp . paratuberculosis (M . a . paratuberculosis) and lymphocytes derived from the blood, mesenteric lymph nodes and intestines were examined for cell-mediated immune (CMI) responses to Johnin pure protein derivative (Johnin-PPD: J-PPD) . Bacteriological examinations were carried out on faeces and tissues and any mycobacterial isolates identified as M . a . paratuberculosis (IS900+) or M . avium ssp . silvaticum (M . a . silvaticum) (IS901+) by polymerase chain reaction (PCR) . Full necropsy and histopathological studies were performed and diseased animals were categorised on the basis of having a lepromatous or tuberculoid form of intestinal pathology . Unaffected control sheep were generally antibody-negative and demonstrated varying CMI responses to J-PPD . Clinically-affected animals were almost always antibody-positive with variable CMI responses . A correlation was observed between the histological lesion type in the intestine and the cellular immune response . Tuberculoid-type lesions were associated with strong CMI responses in lymphocytes derived from the peripheral blood, mesenteric lymph node and intestine, whereas lepromatous-type lesions were associated with weak CMI responses in all tissues examined.

Avian Dis, 1998 Oct-Dec, 42(4), 829 - 31
Isolation of avian serotype 3 paramyxoviruses from imported caged birds in Israel; Shihmanter E et al.; Ten avian serotype 3 paramyxoviruses were isolated for the first time in Israel from passerine and psittacine imported caged birds . The birds were submitted for investigation of an illness characterized by nonspecific signs of weakness, anorexia, vomiting, and sneezing . In addition, only the parakeets developed specific neurologic signs . In bacteriologic and pathologic investigation, cachexia and diarrhea were observed in both groups of birds . In psittacines, considerable alterations were observed in lungs, liver, and spleen . Some nonviral pathogens were occasionally isolated . The isolates appeared to belong to serotype 3b avian paramyxovirus (APMV), the prototype strain of which is APMV-3b/parakeet/Netherlands/449/75 . The isolation of APMV-3 viruses from imported caged birds may represent a way of introduction of these viruses into the country.

Gastrointest Endosc, 1999 Jan, 49(1), 32 - 8
Endoscopic urease sensor system for detecting Helicobacter pylori on gastric mucosa; Sato T et al.; BACKGROUND: It is now accepted that the curing of Helicobacter pylori infection will result in healing of chronic active gastritis and will change the natural history of gastroduodenal ulcer disease . Both endoscopic observation and evaluation of H . pylori status of the stomach are necessary for diagnosis and treatment of such patients . We carried out a clinical evaluation of an endoscopic tube type urease sensor system for the detection of H . pylori on the gastric mucosa . The differential output of two pH-sensitive field effect transistors at the tip of the endoscopic tube reflects the pH change in a urea solution depending on the existence of urease . METHODS: In vitro experiments and clinical evaluation of the system were performed . Fifty-one patients who were suspected to have a gastroduodenal disorder were examined for H . pylori infection with this system, using the combination of histologic and bacteriologic examinations and rapid urease test as the references . RESULTS: Clinical sensitivity and specificity of this system were 26 of 28 (92.9%) and 22 of 23 (95.7%), respectively . A measurement at 1 site is completed in about 1 minute . Repetition of the procedure provides multi-site measurements . CONCLUSIONS: The present system makes possible quick on-site detection of H . pylori under endoscopic observation, with satisfactory sensitivity and specificity.

J Nucl Med, 1998 Dec, 39(12), 2145 - 52
Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis; Guhlmann A et al.; The aim of this study was to assess the usefulness of PET with 2-18F-fluoro-2-deoxy-D-glucose (FDG), as compared to immunoscintigraphy (IS) with 99mTc-labeled monoclonal antigranulocyte antibodies (AGAbs), in the detection of chronic osteomyelitis . METHODS: Fifty-one patients suspected of having chronic osteomyelitis in the peripheral (n = 36) or central (n = 15) skeleton were evaluated prospectively with static FDG PET imaging and combined 99mTc-AGAb/99mTc-methylene diphosphonate (MDP) bone scanning within 5 days . FDG PET and IS were evaluated in a blinded and independent manner by visual interpretation, which was graded on a five-point scale of two observers' confident diagnosis of osteomyelitis . Receiver operating characteristic (ROC) curve analysis was performed for both imaging modalities . The final diagnosis was established by means of bacteriologic culture of surgical specimens and histopathologic analysis (n = 31) or by biopsy and clinical follow-up over 2 yr (n = 20) . RESULTS: Of 51 patients, 28 had osteomyelitis and 23 did not . According to the unanimous evaluation of both readers, FDG PET correctly identified 27 of the 28 positives and 22 of the 23 negatives (IS identified 15 of 28 positives and 17 of 23 negatives, respectively) . The area under the ROC curve was 0.97/0.97 (reader 1/reader 2) for FDG PET and 0.87/0.90 for IS, with a high degree of interobserver concordance (K-values were 0.96 for FDG PET and 0.91 for IS) . In the central skeleton, the ROC curve area was 0.98/1.00 for FDG PET and 0.71/0.77 for IS (p<0.05) . On the basis of ROC analysis, the overall accuracies of FDG PET and IS in the detection of chronic osteomyelitis were 96%/96% and 82%/ 88%, respectively . With regard to the optimal threshold values, sensitivity and specificity were 100%/97% and 95%/95% with FDG PET, compared to 86%/92% and 77%/82% with IS, respectively . CONCLUSION: In the peripheral skeleton, both FDG PET and combined 99mTc-AGAb/99mTc-MDP scanning are appropriate imaging modalities to diagnose chronic osteomyelitis . FDG PET additionally allows reliable differentiation between osteomyelitis and infection of the surrounding soft tissue . In the central skeleton within active bone marrow, FDG PET is highly accurate and superior to AGAb imaging in the diagnosis of chronic osteomyelitis, which frequently presents as a nonspecific photopenic lesion at scintigraphy with labeled white blood cells.

Nippon Igaku Hoshasen Gakkai Zasshi, 1998 Nov, 58(13), 745 - 50
{Usefulness of CT-guided aspiration biopsy in combination with rapid cytology for diagnosis of benign pulmonary lesions}; Kodama F et al.; PURPOSE: To evaluate the diagnostic accuracy of computed tomography (CT)-guided aspiration biopsy in combination with rapid cytology for benign pulmonary lesions . MATERIALS AND METHODS: We performed percutaneous aspiration biopsy under CT guidance in combination with a rapid cytologic examination in 91 patients with pulmonary lesions . A 21-gauge modified Menghini needle coaxially placed through an 18-gauge needle was used in this procedure . Thirty-one lesions that were confirmed as a benign pulmonary lesion histologically, serologically, bacteriologically and/or clinically were evaluated in this study . RESULTS: In 28(90.3%) of 31 lesions, sufficient material for cytologic diagnosis was obtained from the aspiration biopsy . Specific benign diagnosis for benign disease was obtained in 13 lesions (41.9%), while nonspecific diagnosis for benign disease was obtained in 15 lesions (48.4%) . The overall accuracy of the rapid cytological examination was 90.3% . Pneumothorax developed in 17 patients (54.8%), with 7 patients (22.6%) requiring chest tube drainage . Only one patient complained of mild hemoptysis, which subsided with hemostatic agents . CONCLUSION: Percutaneous aspiration biopsy combined with a rapid cytologic diagnosis provides a high degree of accuracy in the diagnosis of benign pulmonary lesions.

Zentralbl Bakteriol, 1998 Nov, 288(3), 309 - 17
The 1997 list . Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology . An informational note; Frederiksen W et al.; A list of names published or validated in 1997 is presented . We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

Rev Sci Tech, 1998 Dec, 17(3), 699 - 712
A review of leptospirosis in farm animals in Portugal; Rocha T; This paper presents a review of Leptospira infection in farm animals in Portugal which is based mainly on serological results obtained in the National Veterinary Research Laboratory between January 1987 and December 1993 . Serum samples were tested by the microscopic agglutination test, at a minimum dilution of 1:100 . Positive titres were obtained in 15.3% of the 9,543 bovine samples examined . Sejroe, Pomona, Hebdomadis, Tarassovi and Icterohaemorrhagiae were the principal serogroups which reacted in the tests . A total of 3,195 pigs were tested, of which 20.2% showed positive reactions . The main serogroups which reacted were Australis, Pomona, Cynopteri, Icterohaemorrhagiae and Autumnalis . Field observations on outbreaks of leptospirosis in pigs, along with data obtained from an experimental infection with serovar mozdok in pregnant gilts suggest that this serovar, rather than serovar pomona, may be causing Pomona group infections in pigs . Serum samples from 5,298 sheep were tested and 3.3% gave positive results . The predominant serogroups involved were Canicola, Pomona, Cynopteri, Sejroe and Icterohaemorrhagiae . From the 1,631 goats examined serologically, 5.0% gave positive results, mainly to serogroups Grippotyphosa, Canicola, Pomona, Icterohaemorrhagiae and Pyrogenes . Only 83 serum samples from horses were obtained, of which 43.4% showed positive titres . Serogroups Australis, Autumnalis, Cynopteri and Pyrogenes were those most commonly found . Serological evidence of leptospirosis in farm animals is widespread in Portugal, particularly in cattle and pigs . Leptospirosis in horses needs to be studied further . In an attempt to provide a general view on the occurrence of leptospirosis in these animal species in Portugal, the present results are compared with results obtained in previous studies and are complemented with both previous and recent bacteriological findings.

Rev Sci Tech, 1998 Dec, 17(3), 654 - 9
Sensitivity and specificity of serological and bacteriological tests for contagious bovine pleuropneumonia; Bellini S et al.; In 1990 an outbreak of contagious bovine pleuropneumonia (CBPP) occurred in Italy . Subsequent surveillance for CBPP was based on random sampling in bovine herds, serological controls on all animals moved from the herd of origin and controls on slaughtered animals . Official tests employed were the complement fixation test (CFT) and bacteriological isolation and typing . A total of 33,856 serum samples collected from herds in CBPP-free regions were used to define CFT specificity, while samples from 595 animals from infected herds were employed to define the sensitivity . Ninety-nine animals from three infected herds were used to estimate the sensitivity of the isolation technique . Results showed the specificity of CFT (threshold +1:10) to be 98% and sensitivity to be 63.79% . The sensitivity of the test did not change significantly, regardless of whether the lesions were caused by acute or chronic infection . The sensitivity of the isolation technique was 54.1%.

Int J Tuberc Lung Dis, 1998 Nov, 2(11), 904 - 8
Pulmonary tuberculosis in the adult in a low prevalence area: is the radiological presentation changing?
Van den Brande P, Dockx S, Valck B, Demedts M.
SETTING: Pulmonary division of a university hospital in Belgium, an area with a relatively low tuberculosis incidence (14.9 per 100 000 population in 1993) . OBJECTIVE: To evaluate whether 'unusual' radiographic presentations of pulmonary tuberculosis (PTB) have increased in recent years, especially in elderly and non-indigenous patients . DESIGN: Retrospective study of chest X-rays of 219 patients aged over 18 years with bacteriologically proven PTB in the period 1981-1990, including 92 elderly (> or =65 years) and 17 non-indigenous patients . 'Unusual' presentations consisted of solitary pleural effusion, isolated hilar or mediastinal lymphadenopathies, normal chest X-ray, lower lung field TB, nodular lesions, diffuse infiltrations and atelectasis . RESULTS: There was an increase in 'unusual' presentations, from 24% in 1981-1985 to 35% in 1986-1990, yet this was not statistically significant (P = 0.08) . This increase tended to be more pronounced in the elderly age group, i.e., from 24% to 42% compared to 23% to 31% in the younger age group . The proportion of elderly patients in the group with 'unusual' findings was 44% in 1981-1985 and 48% in 1986-1990 . In the non-indigenous group, the percentage of 'unusual' findings did not change between the two periods (40% versus 41%) . The proportion of non-indigenous patients in the group with 'unusual' findings increased from 7% in 1981-1985 to 13% in 1986-1990; however, this difference was not significant . CONCLUSIONS: In an area with low TB incidence, adult PTB still presents with the classical pattern of reactivation disease . Although not statistically significant, there is a trend towards a relative increase in the frequency of unusual presentations in recent years, which is most pronounced in the elderly and in non-indigenous adults.

Rev Clin Esp, 1998 Oct, 198(10), 641 - 6
{Study of costs associated with catheter-related bacteremia}; Moris de la Tassa J et al.; BACKGROUND: Nosocomial infection (NI) is associated with an increase in resource consumption . The estimation of extra costs attributable to NI in a group of patients with catheter-related bacteremia (CRB) was the objective of the present study . METHODS: A matched case-control, study was conducted in a cohort population . Individual matching was accomplished departing from the diagnosis related group (DRG) to which the case patient episode was ascribed and later searching in the hospital discharge data base using the following parameters: DRG, sex, age, admission date, department, comparison of hospital stays, main diagnosis, co-morbidity, number of secondary diagnoses and procedures . Matching was obtained for 22 cases (68.7%), upon which the cost estimations were performed . RESULTS: The mean hospital stay length for cases was 26.5 days (median: 24.5) and for controls 14.5 days (median: 13.5), p = 0.0002 . The excess stay attributable to CRB was 11.5 days . The use of diagnostic resources was significantly higher for bacteriological tests and complete blood counts . The consumption of antibiotics and fluid therapy was higher in infected patients . Eighty-nine percent of 536,736 pesetas, the total excess of the estimated cost per episode, corresponded to the increase in hospital stay length . Seven patients (32%) were responsible for 64% of the total of extra costs . CONCLUSIONS: The method employed proved useful for estimating the costs associated with NI . The prolongation of hospital stay is responsible for most of the associated cost.

Salud Publica Mex, 1998 Sep-Oct, 40(5), 421 - 9
{Efficacy and efficiency of antitubercular treatment in health jurisdictions of Morelos}; Garcia-Garcia ML et al.; OBJECTIVE: To evaluate the efficacy and efficiency of tuberculosis treatment administered by the Secretaria de Salud (SSA) in the sanitary jurisdictions of Cuernavaca and Cuautla, Morelos, for the 1992-1996 period by retrospectively reviewing tuberculosis treatment control cards . MATERIAL AND METHODS: Official Norm for Tuberculosis Prevention and Control in Primary Care Units outcome definitions were used . Data was collected on standardized forms and analyzed with SAS and Epi Info programs; 149 primary care units and 4 hospitals in the study area were visited . RESULTS: There were found 288 patients cards, of which 260 were new cases . These patients received 311 treatments of which 85% were directly observed . Reviewed cards represented 60% of SSA notified cases for this period . There were analyzed 246 treatments of which 32% were bacteriological cures, 26% probable cures, 18% dropouts, 1% failures and 3% deaths . In 20% of treatments the outcome was unknown . Cure rate was better in new cases (61%) than in retreatments (38%), p < 0.01 . Efficacy of treatment was 71% and efficiency 58% . Patients receiving retreatment abandoned it more frequently (32%) than new cases (16%), p < 0.01 . A statistically significant association was found between abandoned treatment and being retreated (OR = 3.3, CI 95% 1.3-8.5, p = 0.01) or belonging to a lower socioeconomic level (OR = 2.3, CI 95% 1.0-4.9, p = 0.04) . In the 34 retreatment programs, 22 were initiated after abandonment, failure or relapse . CONCLUSIONS: Proportion of cure rate (58%) compares unfavorably with WHO recommendations (85%) . Implications of a high dropout rate and probability of circulation of resistant strains of M tuberculosis are discussed . Creative strategies to reinforce patient compliance which take into account the patient and not only the health services, extension of cultures to known M . tuberculosis drug resistance and evaluation of modifications to drug regimens are proposed . Review of treatment control cards is a useful tool for program evaluation.

J Gastrointest Surg, 1997 Jan, 1(1), 40 - 47
Glutamine Stabilizes Intestinal Permeability and Reduces Pancreatic Infection in Acute Experimental Pancreatitis; Foitzik T et al.; Intestinal barrier failure and subsequent translocation of bacteria from the gut play a decisive role in the development of systemic infections in severe acute pancreatitis . Glutamine (GLN) has been shown to stabilize gut barrier function and to reduce bacterial translocation in various experimental settings . The aim of this study was to evaluate whether GLN reduces gut permeability and bacterial infection in a model of acute necrotizing pancreatitis . Acute necrotizing pancreatitis was induced in 50 rats under sterile conditions by intraductal infusion of glycodeoxycholic acid and intravenous infusion of cerulein . Six hours after the induction of pancreatitis, animals were randomly assigned to one of two groups: standard total parental nutrition (TPN) or TPN combined with GLN (0.5 g/kg-1/day-1) . After 96 hours, the animals were killed . The pancreas was prepared for bacteriologic examination, and the ascending colon was mounted in a Ussing chamber for determination of transmucosal resistance and mannitol flux as indicators of intestinal permeability . Transmucosal resistance was 31% higher in the animals treated with GLN- supplemented TPN compared to the animals given standard TPN . Mannitol flux through the epithelium was decreased by 40% . The prevalence of pancreatic infections was 33% in animals given GLN-enriched TPN as compared to 86% in animals receiving standard TPN ( P < 0.05) . Adding GLN to standard TPN not only reduces the permeability of the colon but decreases pancreatic infections in acute necrotizing pancreatitis in the rat . This confirms previous reports that GLN decreases bacterial translocation by stabilizing the intestinal mucosal barrier . The present findings provide the first evidence suggesting that stabilizing the intestinal barrier can reduce the prevalence of pancreatic infection in acute pancreatitis and that GLN may be useful in preventing septic complications in clinical pancreatitis.

J Indian Med Assoc, 1998 Aug, 96(8), 239 - 40, 244
A retrospective study of infections in neutropenic patients; Madiajagane R; This is a retrospective non-randomised study of 37 episodes of infections in neutropenic patients (grades III and IV myelosuppression) . The commonest presentation of infection in these patients was fever which was followed by diarrhoea . Infection was documented bacteriologically in 22.6% of episodes and blood culture was positive in 5.5% of episodes only . More than half episodes (56.8%) received quinolone and aminoglycoside combination, 24.3% 3rd generation cephalosporin and aminoglycoside combination and 18.9% combination of quinolone and cephalosporin in cross over . These combinations of antibiotics were successful in 90.5% with quinolone arm, 44.4% with cephalosporin arm and 71.4% in cross over arm . This difference in success was statistically significant and is independent of grade of neutropenia.

Antibiot Khimioter, 1998, 43(10), 27 - 31
{Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns}; Krutikov MG et al.; The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described . The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease . The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.

Ann Chir Gynaecol, 1998, 87(3), 183 - 9
Surgical treatment of acute pancreatitis; Beger HG et al.; The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedematous and necrotizing pancreatitis . Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data . Persisting or progressive systemic or local organ complications occurring despite ICU-treatment are indicators for surgical management . Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, surgical acute abdomen and persisting or progressing ileus should be treated surgically . The surgical technique is based on careful necrosectomy or debridement in combination with continuous or repeated surgical evacuation of necrotic tissue, bacteria and biologically active compounds . Necrosectomy and postoperative continuous local lavage resulted in a hospital mortality of 17% in necrotizing pancreatitis, conservative management of necrotizing pancreatitis in a hospital mortality of 6.3% . In 1442 patients treated in a 14-year period the overall hospital mortality was 4.4%.

Schweiz Med Wochenschr, 1998 Oct 17, 128(42), 1598 - 601
{Establishing an umbilical cord blood bank for unrelated allogenic stem cell transplantation}; Tichelli A et al.; We report the establishment of a cord-blood bank in a routine hematological laboratory . Cord-blood collection was performed with placenta in utero by a trained team and immediately sent to the cord-blood bank . There, 6.8 ml cord-blood was used for analysis of nucleated cell counts, counts of CD34-positive cells, CFU's, complete HLA-typing, ABO and Rhesus blood groups, bacteriologic cultures and serology for HIV 1 and 2, HbsAg, HVC, CMV, syphilis and toxoplasmosis . The cord-blood collection was frozen and conserved at -192 degrees C . From each cord-blood vials of DNA, viable cells and plasma were cryopreserved . Between June 1997 and April 1998, 54 cord-bloods were collected . 40 of them were cryo-preserved, and 14 discarded because of low cell counts . The median volume was 109 ml with 1.4 x 10(9) nucleated cells . The in vitro capacity of proliferation of the cord-blood correlated well with the absolute counts of CD34-positive cells (r = 0.93), moderately with the relative counts of CD34 (r = 0.68) as well as the nucleated cells (r = 0.70), poorly with the volume (r = 0.44) . Three of the 40 (7.5%) cord-blood products contained a bacterial contamination . This study shows that a cord-blood bank can be organised in a routine hematological laboratory, which is familiar with transplantation products . However, the procedure is time consuming, expensive and requires a highly qualified team and specialised technical equipment.

Am J Gastroenterol, 1998 Nov, 93(11), 2285 - 7
Isolated jejunal Crohn's disease in a young adult presenting as fever of unknown origin; Lonardo A et al.; A 27-yr-old man was referred for fever, weight loss, fatigue, and occasional mild epimesogastric pain without diarrhea or vomiting . Laboratory tests were suggestive of an active inflammatory disease but serological, bacteriological, viral searches, markers of autoimmunity, and neoplasia were all negative . The following were also negative: ultrasonography; conventional x-rays; CT scans; esophagogastroduodenoscopy, pancolonoscopy with ileoscopy; cytohistology including duodenum and ileocolon . Empiric antibiotic regimens failed to control the temperature . Small bowel enema disclosed multiple proximal jejunal strictures . Jejunoscopy revealed erythema, friability, linear ulcerations, stenosis, and dilation in the proximal jejunum . Multiple directed biopsies showed inflammatory changes devoid of any specific features . The patient received steroid treatment and his temperature normalized . Six months later, he was readmitted on account of intestinal subocclusion that was managed conservatively . A few days later urgent laparotomy was performed with peritoneal lavage, repair of double perforated proximal jejunal ulcers, and stricturoplasty . Surgical jejunal biopsy confirmed the results of enteroscopic biopsies . The patient is presently without fever, in the absence of steroid treatment . There have been no reports of cryptogenic fever due to isolated jejunal Crohn's disease in the recent literature . Our patient's clinical picture resembled disease as seen in older children and adolescents, in whom it is a difficult diagnosis owing to the absence of diarrhea . In adults with Crohn's disease isolated jejunal involvement represents approximately 1% of cases . A thorough small bowel investigation is warranted in young adults with cryptogenic fever and low serum protein levels, even in the absence of major gastrointestinal complaints.

Arch Surg, 1998 Nov, 133(11), 1247 - 50
Ciprofloxacin as a therapeutic modality in pediatric burn wound infections: efficacious or contraindicated?
Heggers JP, Villarreal C, Edgar P, Wolf S, Klein GL, John SD, Desai M, Herndon DN.
BACKGROUND: Food and Drug Administration regulations state that ciprofloxacin hydrochloride may cause arthropathies . For this reason, such therapy is contraindicated in the pediatric population . However, several studies in children with cystic fibrosis have found the drug to be efficacious . Our hypothesis was that ciprofloxacin treatment is justified in the case of multiresistant organisms in burn populations . DESIGN: During a 4-year period (January 1, 1993, to December 31, 1997) we treated 56 of our pediatric burn patients with ciprofloxacin when cultures proved resistant to other antibiotics . The burn area was 65% of the total body surface area . The average patient age was 8.4 years . Of the 56 patients who received ciprofloxacin, 50 received the recommended dose . Biopsy specimens were assessed for quantitative bacteriology and antibiotic sensitivity . Radiologic review was conducted to examine for arthropathy . RESULTS: All patients showed unequivocal reduction in quantitative bacterial counts, and susceptibility to ciprofloxacin remained stable without the development of resistance . Of the 56 patients treated, 42 had a major reduction in their quantitative wound biopsies from 10(6) to less than 100 colonies per gram of tissue, while the remaining 14 were observed to have a 2- to 3-log decrease . No arthropathy was detected in any of the 56 patients receiving ciprofloxacin . Review of the patients' charts showed no documented adverse events associated with the use of ciprofloxacin . All patients survived their thermal injury and the complications associated with it without any untoward problems or complications of arthropathy . CONCLUSION: On the basis of these data, ciprofloxacin therapy in the treatment of immunosuppressed pediatric burn patients is efficacious and does not cause arthropathy.

Zentralbl Veterinarmed B, 1998 Oct, 45(8), 495 - 505
The effect of vaccination against Mycoplasma hypopneumoniae in pig herds with a continuous production system; Maes D et al.; An inactivated Mycoplasma hyopneumoniae vaccine was evaluated in five pig herds clinically infected with enzootic pneumonia and practising a continuous production system in the growing/finishing unit . In each herd, a vaccinated and control group of approximately 47 pigs each were individually monitored from birth until slaughter . Vaccinated pigs received the first dose at about 1 week of age and the second approximately 3 weeks later . During all production stages, an equal number of vaccinated and control pigs was present in the same pen . Both groups were compared with respect to zootechnical parameters (major variables) and by means of serological, pathological, and bacteriological parameters (ancillary variables) . Daily weight gain was improved by 14 gr/day during the period from 8 days of age until slaughter (P = 0.0486) and by 25 gr/day during the growing/finishing period (P = 0.0067) . Mortality rate, and the costs for curative medication were not significantly improved by vaccination . The results of the ancillary variables are presented and discussed.

J Infect, 1998 Jul, 37(1), 71 - 3
Actinomyces pyogenes septic arthritis in a diabetic farmer; Lynch M et al.; We report a case of septic arthritis and osteomyelitis of the left ankle due to Actinomyces pyogenes in a diabetic farmer . Few confirmed human cases of A . pyogenes infection have been reported, partly because of inadequate identification of this bacterium . Bacteriological characteristics of the organism, which resembles Arcanobacterium haemolyticum, are described with a review of previous case reports.

J Infect, 1998 Mar, 36(2), 197 - 201
Evaluation of a Brucella enzyme immunoassay test (ELISA) in comparison with bacteriological culture and agglutination; Gad El-Rab MO et al.; An ELISA test for IgG and IgM antibrucella antibodies was found to be effective in diagnosis of human brucellosis . Assays for IgG and IgM in 30 culture-positive cases gave significant ELISA values . By the standard agglutination test, 10% of these cases gave readings less than 1:160 . These are considered insignificant, taking 1:160 as the accepted cut-off value . Moreover, in an extra 135 samples from suspected brucella cases, where only serology was requested (77.6% of all cases), 7.4% were found to have IgM brucella antibodies by ELISA . In all of these, the corresponding agglutination titres were less than 1:80 and hence reported as insignificant . We report the detection of IgG and IgM antibodies in samples from patients with both acute and chronic disease . In few patients with acute disease, only IgM was detected . These findings are discussed in comparison with earlier studies . Finally, the ELISA test, in addition to measuring antibody classes directly, also detects incomplete antibodies . By this, it can efficiently replace the 2 mercaptoethanol test (2ME) and the Coomb's antihuman-globulin test . This saves considerable laboratory cost and time.

Am J Surg, 1998 Oct, 176(4), 331 - 4
Does large-bowel enema reduce septic complications in acute pancreatitis?
Sahin M, Yol S, Ciftci E, Baykan M, Ozer S, Akoz M, Yilmaz O, Kuru C.
BACKGROUND: The source of septic complications in acute pancreatitis was unknown until recent years . The pathogenesis of bacterial translocation from the gut has been accepted as the main source of pancreatic or peripancreatic infection . This study was designed to investigate the role of large bowel enema during acute pancreatitis in preventing bacterial translocation . MATERIALS AND METHODS: Twenty-four Spraque-Dawley rats were used in this study . The rats were divided into two groups . Group I animals received biliopancreatic duct ligation plus colon cleansing by rectal enemas; group II animals received only biliopancreatic duct ligation . Rectal enemas were applied to the first group of animals three times, at 6, 24, and 48 hours after the operation using 10 cc sodium hydrogen phosphate solutions . All animals were sacrificed 72 hours later, and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures via a midline laparatomy . Blood and cecum cultures were also prepared . RESULTS: Positive mesenteric lymph node cultures were found in all 12 animals in group II but in only 3 of 11 animals of group I (P <0.05) . Distant organ cultures were positive in 9 of group II, but the only infected distant organ culture found in group I was the positive liver culture (P <0.05) . CONCLUSION: As a result of this study, we believe that large bowel enema can reduce the frequency of septic complications in acute pancreatitis by reducing bacterial translocation.

Eur Respir J, 1998 Oct, 12(4), 820 - 4
Systemic markers of inflammation in stable bronchiectasis; Wilson CB et al.; Patients with bronchiectasis have an active local and systemic inflammatory response during infective exacerbations . Systemic markers of inflammation were investigated during a stable phase of their illness, because continued inflammation could affect their general health and be involved in disease progression . The relationship between levels of various systemic markers of inflammation and extent of disease on computed tomographic scan, lung function, sputum bacteriology and health related quality of life (HRQoL) was investigated in 87 noncystic fibrosis bronchiectasis patients . Several markers were elevated and correlated with the extent of disease and poor lung function . The total white cell count, neutrophil count and erythrocyte sedimentation rate correlated with both disease measures . Sputum bacteriology did not correlate with inflammation markers and patients with positive and negative cultures were similar . C-reactive protein and total white cell count correlated with some components of a disease-specific HRQoL questionnaire . In conclusion, patients with bronchiectasis in a stable phase have raised systemic markers of inflammation . Some markers, particularly the neutrophil count, correlate with disease severity . This result is in keeping with the hypothesis that the level of inflammation determines disease progression and health status.

Arch Inst Cardiol Mex, 1998 Jul-Aug, 68(4), 333 - 6
{Endocarditis due to an alga of the genus Prototheca sp . A saprophyte of water and of tree sap?}; Buendia A et al.; We report a case of a preterm neonate with very low birth weight (775 grs), He stayed 77 days in a neonatal care unit due to respiratory distress syndrome, with respiratory support for 27 days, and complications in gastrointestinal and nervous systems . In a structural normal heart, he developed infective endocarditis that was treated with good bacteriologic results . An echocardiogram showed the persistence of a mass in the right atrium, the mass was a thrombus and it was resected . Histopathological analysis and cultures of the thrombus reported Prototheca sp . that is an algae . The patient received medical treatment with amphothericin B with satisfactory clinical evolution . He is doing well 6 months later . This is the first report of literature of an algae causing endocarditis.

Arch Inst Cardiol Mex, 1998 Jul-Aug, 68(4), 309 - 14
{Mitral and/or aortic infectious endocarditis . The correlation between transesophageal echocardiography, surgery and pathological anatomy}; Espinola Zavaleta N et al.; The aim of this study was to correlate the findings obtained by transesophageal echocardiography (TEE) with those obtained during surgery and histopathologic studies in patients with mitral and/or aortic infective endocarditis . Twenty eight patients were studied . In all of them clinical history, bacteriological study and TEE . In 15 cases a positive blood culture was found and in 13 the blood culture was negative . The TEE demonstrate infective aortic vegetations in 12 cases, in mitral valve in 11 and in five in both valves . The endocarditis-associated complications were found in 53% of cases and the incidence of embolic events was of 25% . TEE findings related with the presence of vegetations were confirmed in the studies of pathologic anatomy in 92.8% and at surgery in 89.2% . These data suggest that the TEE leads to a significant improvement in the diagnosis and prognosis of mitral and/or aortic infective endocarditis, because it has a high correlation with the studies of pathologic anatomy and surgery.

Biol Rev Camb Philos Soc, 1998 Aug, 73(3), 203 - 66
A revised six-kingdom system of life; Cavalier-Smith T; A revised six-kingdom system of life is presented, down to the level of infraphylum . As in my 1983 system Bacteria are treated as a single kingdom, and eukaryotes are divided into only five kingdoms: Protozoa, Animalia, Fungi, Plantae and Chromista . Intermediate high level categories (superkingdom, subkingdom, branch, infrakingdom, superphylum, subphylum and infraphylum) are extensively used to avoid splitting organisms into an excessive number of kingdoms and phyla (60 only being recognized) . The two 'zoological' kingdoms, Protozoa and Animalia, are subject to the International Code of Zoological Nomenclature, the kingdom Bacteria to the International Code of Bacteriological Nomenclature, and the three 'botanical' kingdoms (Plantae, Fungi, Chromista) to the International Code of Botanical Nomenclature . Circumscriptions of the kingdoms Bacteria and Plantae remain unchanged since Cavalier-Smith (1981) . The kingdom Fungi is expanded by adding Microsporidia, because of protein sequence evidence that these amitochondrial intracellular parasites are related to conventional Fungi, not Protozoa . Fungi are subdivided into four phyla and 20 classes; fungal classification at the rank of subclass and above is comprehensively revised . The kingdoms Protozoa and Animalia are modified in the light of molecular phylogenetic evidence that Myxozoa are actually Animalia, not Protozoa, and that mesozoans are related to bilaterian animals . Animalia are divided into four subkingdoms: Radiata (phyla Porifera, Cnidaria, Placozoa, Ctenophora), Myxozoa, Mesozoa and Bilateria (bilateral animals: all other phyla) . Several new higher level groupings are made in the animal kingdom including three new phyla: Acanthognatha (rotifers, acanthocephalans, gastrotrichs, gnathostomulids), Brachiozoa (brachiopods and phoronids) and Lobopoda (onychophorans and tardigrades), so only 23 animal phyla are recognized . Archezoa, here restricted to the phyla Metamonada and Trichozoa, are treated as a subkingdom within Protozoa, as in my 1983 six-kingdom system, not as a separate kingdom . The recently revised phylum Rhizopoda is modified further by adding more flagellates and removing some 'rhizopods' and is therefore renamed Cercozoa . The number of protozoan phyla is reduced by grouping Mycetozoa and Archamoebae (both now infraphyla) as a new subphylum Conosa within the phylum Amoebozoa alongside the subphylum Lobosa, which now includes both the traditional aerobic lobosean amoebae and Multicilia . Haplosporidia and the (formerly microsporidian) metchnikovellids are now both placed within the phylum Sporozoa . These changes make a total of only 13 currently recognized protozoan phyla, which are grouped into two subkingdoms: Archezoa and Neozoa the latter is modified in circumscription by adding the Discicristata, a new infrakingdom comprising the phyla Percolozoa and Euglenozoa) . These changes are discussed in relation to the principles of megasystematics, here defined as systematics that concentrates on the higher levels of classes, phyla, and kingdoms . These principles also make it desirable to rank Archaebacteria as an infrakingdom of the kingdom Bacteria, not as a separate kingdom . Archaebacteria are grouped with the infrakingdom Posibacteria to form a new subkingdom, Unibacteria, comprising all bacteria bounded by a single membrane . The bacterial subkingdom Negibacteria, with separate cytoplasmic and outer membranes, is subdivided into two infrakingdoms: Lipobacteria, which lack lipopolysaccharide and have only phospholipids in the outer membrane, and Glycobacteria, with lipopolysaccharides in the outer leaflet of the outer membrane and phospholipids in its inner leaflet . (ABSTRACT TRUNCATED)

Public Health, 1998 Sep, 112(5), 317 - 21
Water management practices in rural and urban homes: a case study from Bangladesh on ingestion of polluted water; Ahmed SA et al.; Although Bangladesh has achieved remarkable success in extending the availability of hand pumped and piped water, unsafe water is still ingested . This brief study attempted to assess water management practices in rural and urban homes in Bangladesh so as to establish the routes by which unsafe water is ingested, to examine methods of collection and storage, and determine why unsafe water sources are used when unsafe supplies are available . Forty-eight rural and forty-five urban slum households were studied . Observations, interviews and water quality investigations were conducted . The results show that the respondents were aware that hand pump/tap water is safe and took care to use these safe sources for drinking purposes . However, they continued to use surface water for non-drinking activities such as bathing, washing and rinsing their mouths . Reasons were given that it was a traditional practice to bathe in surface water and was more enjoyable . One of the reasons given for not using hand pumped water to wash clothing and food was that such groundwater caused staining . Bacteriological results from such ingested water showed the quality, especially in rural areas, to be poor . Results also showed the internal surfaces of the base of storage containers to be heavily contaminated with bacteria . This showed that water that was safe when it was first drawn would became contaminated during storage . This study had a limited scope; much further research is needed to find what determines and how water becomes contaminated in containers . These factors include how to reduce contamination of water, in particular the relationship between growth of bacteria in stored water and the material from which the container is made and how to improve the overall quality of water . On the management side, studies could be conducted as to how to improve people's understanding of the use of water for domestic purposes and its safe management.

Cancer, 1998 Nov 1, 83(9), 2015 - 22
Outcome and complications of epidural analgesia in patients with chronic cancer pain; Smitt PS et al.; BACKGROUND: Some cancer patients require invasive techniques for control of chronic cancer pain . Many patients have benefited from local administration of opioids and anesthetics through an epidural catheter . However, epidural abscess and meningitis are side effects of epidural catheters that have serious morbidity and mortality . METHODS: In a retrospective study, the charts of all patients who received an epidural catheter for the management of chronic cancer pain in a 3-year period (1993-1996) were reviewed . Patients with nervous system infections were identified and pertinent clinical, radiologic (magnetic resonance imaging), and bacteriologic data were analyzed . RESULTS: Ninety-one patients received 137 epidural catheters for a total of 4326 catheter days . All but four patients had died at the time of the final analysis . The median survival after placement of the first epidural catheter was 38 days (range, 1 day--> 1000 days) . Seventy-two patients received a percutaneous port whereas 19 patients were treated with an implanted subcutaneous port . Adequate pain relief was obtained in 76% of the 58 patients with nociceptive pain and in 73% of 33 patients with neuropathic pain . All neuropathic pain was associated with active tumor and could be classified as nociceptive nerve pain . Technical complications and superficial infections occurred in as many as 43% of patients . Deep infections occurred in 12 patients, 11 of whom had a spinal epidural abscess . CONCLUSIONS: Deep infection is a frequent complication of epidural analgesia and is associated with a high morbidity and mortality . Only cancer patients with a short life expectancy (< or =3 months) should be treated with epidural analgesia.

Semin Arthritis Rheum, 1998 Oct, 28(2), 114 - 23
Typhoid spine: somatic versus psychosomatic diagnosis in Osler's time; Benedek TG; OBJECTIVE: To review the history of typhoidal spondylitis as a paradigm of conflicts between medical and psychiatric diagnoses . METHODS: Because William Osler was the principal advocate for a psychogenic cause of this disease, all of his relevant writings are reviewed together with pertinent psychiatric concepts of the late 19th century, as well as the relevant bacteriologic and clinical research . RESULTS: Bacteriologic research had advanced sufficiently by 1903 that "typhoid spine" could be proved an osteomyelitis . Nevertheless, the belief that at least some cases were manifestations of a traumatic neurosis analogous to "railway spine" persisted, the trauma having been the acute typhoid infection . The last vestiges of this concept were represented by Osler's article of 1919 . CONCLUSIONS: Osler's 25 year struggle to understand typhoidal spondylitis is an example of the persistent tendency of physicians to attribute a psychologic cause to a syndrome, often pejoratively, because of the absence of a sufficient pathophysiologic explanation or reluctance to acknowledge a new concept.

Rev Pneumol Clin, 1998 Sep, 54(4), 207 - 9
{Congenital miliary tuberculosis . Apropos of a case}; Pham Duy L et al.; Congenital tuberculosis is an uncommon but probably underestimated disease . All cases occurring in developing countries are not published . Twenty-nine cases have been published in the English literature since 1980 . The diagnosis of congenital tuberculosis is different from post-natal tuberculosis and is based on recently defined criteria: bacteriologically proven tuberculosis in a new-born associated with at least one of the following: specific hepatic granulomatosis, tuberculosis infection of the placenta or maternal genital tract, exclusion of possible post-natal transmission . We report a case of congenital tuberculosis to be added to the 29 preceding cases meeting current diagnostic criteria.

Am J Rhinol, 1998 Sep-Oct, 12(5), 325 - 33
Endoscopic sinus surgery and postoperative intravenous aminoglycosides in the treatment of atrophic rhinitis; Jiang RS et al.; A total of 29 atrophic rhinitis patients were treated by endoscopic sinus surgery between 1990 and 1995 . After the surgery, a 7 to 10-day course of systematic aminoglycoside was administered . Two cases were excluded, due to later occurrence of nasal lymphoma in one patient and incompleteness of postoperative antibiotic therapy in the other . Among those included, atrophic rhinitis occurred in the absence of prior surgery in 24 patients, and the condition was secondary to a previous intranasal surgery in the other three patients . After a 1 to 6-year follow-up (mean: 63.4 months), seven patients were successfully managed without any characteristic symptom or sign of atrophic rhinitis . Another 18 patients felt improved . Only two patients did not have any improvement . The rate of improvement was 92.6% . Overall, one patient suffered from a left retrobulbar hematoma after operation . Exposed orbital fat was observed in the other patient . The orbital complication rate was therefore 7.4% . No other major complication occurred in this series . The bacteriologic, radiological, antroscopic, and pathologic findings are also included here . It is concluded that endoscopic sinus surgery in combination with adequate postoperative antibiotic therapy can significantly treat atrophic rhinitis.

Rev Cubana Med Trop, 1996, 48(3), 214 - 7
{Tuberculosis and HIV coinfection in Cuba}; Diaz Jidy M et al.; The first 28 Cuban HIV-seropositive patients with bacteriologically confirmed tuberculosis in the period of 21 months between July, 1993, and March, 1995, were presented . The clinical characterization and the therapeutic response of the multidrug regimen considered by the National Program for Tuberculosis Control are stressed . The most frequent clinical form of presentation was the pulmonary one with 89.3% No lesions were found in the chest X-ray of 8 patients . The response to the multidrug treatment was satisfactory, which together with a group of procedures performed prevented the propagation of this disease among the HIV-seropositive patients and the population in general.

Singapore Med J, 1998 Jun, 39(6), 260 - 2
Typhoid fever in children--a retrospective study of 54 cases from Malaysia; Yap YF et al.; BACKGROUND/AIM OF STUDY: Typhoid fever, which is endemic in Malaysia, affects all age groups and it has been stated that classical features described in textbooks were absent in children . The aim of this study was to find out whether this was true in the local setting and hence a retrospective study was undertaken . METHODS: Fifty-four paediatric patients satisfied the inclusion criteria and all were seen consecutively during the study period of 10 years . Patients' records were reviewed for demographic data such as age, sex, ethnicity, clinical features, therapy and results of laboratory tests . RESULTS: Fever was the most common presenting symptom and diarrhoea was more common than constipation . Isolation of S typhi from blood and/or stools was the most important diagnostic tool *85.2%) and of these 99% had significant Widal titres . Clinical and bacteriological relapse occurred in 5 children (3%) who were successfully treated with ceftriaxone . The absence of mortality and low level of complications indicates either a mild nature of the disease or to early recognition or prompt and appropriate therapy.

Parassitologia, 1997 Dec, 39(4), 325 - 30
Mortality associated with renal and intestinal coccidiosis in juvenile eiders in Iceland; Skirnisson K; The cause of unusual mortality observed in late June 1993 among hundreds of eider-ducklings (Somateria mollissima) originating from a colony of approximately 600 breeding eider ducks at Bildudalur, West-Iceland, was studied . The mortality occurred two weeks after a large-scale washing of gravel was initiated in a river-bed close to the colony . As a consequence marked environmental changes occurred in the area when a mud-layer gradually accumulated on the sea-bed around the colony . Necropsies, bacteriological, histoparasitological and pathological examinations were carried out on 14 ducklings . The ducklings were severely emaciated . Routine bacteriological tests performed were negative . Parasitological examinations revealed infection in some of the ducklings by an intestinal eimeriid of an unknown taxonomic status, and slight to moderate intestinal helminth infections . A prominent feature, observed in all ducklings, was greatly enlarged kidneys which were variegated with white or yellowish nodules . Kidney smears contained accumulations of urate crystals and huge numbers of the renal coccidian Eimeria somateriae . Acute renal failure, caused by E . somateriae, is assumed to be responsible for the death of the ducklings . The intestinal eimeriid, however, might also have contributed to some of the deaths as pathological examination of the intestines showed local destruction and necrosis of villi . Actually, the above mentioned environmental accident likely reduced markedly the availability of appropriate food and also reduced the hunting success of the ducklings in the area . Therefore, the ducklings in the fjord were presumably undernourished and in bad condition . It is suggested that the environmental accident promoted somehow the acute mortalities . A possible explanation is that the bad condition of the ducklings decreased the resistance to diseases like coccidiosis but other explanations should not be excluded.

Chemotherapy, 1998 Sep, 44 Suppl 1, 15 - 8
Comparison of 5-day and 10-day cefixime in the treatment of acute exacerbation of chronic bronchitis; Lorenz J; The focus of a multicenter trial conducted in Germany was to investigate whether a 5-day short course of cefixime 400 mg was equivalent to a 10-day standard therapy of cefixime 400 mg in the treatment of acute exacerbation of chronic bronchitis (AECB) . In the 167 patients who were evaluated, on day 11 following treatment with once-daily oral cefixime resulted in clinical success in 91 and 89% of cases in the 5-day and 10-day treatment groups, respectively . At days 6, 11 and 30 after treatment there was no statistically significant difference between the 2 dose groups (p < 0.01) . Bacteriological equivalence was also demonstrated . Gastrointestinal adverse events showed a tendency to occur less frequently in the 5-day group, but the difference was not significant . The results indicate that a short course therapy is equivalent in efficacy to the standard 10-day therapy in patients with AECB, and may thus offer cost advantages.

Int J Clin Pharmacol Ther, 1998 Oct, 36(10), 561 - 4
Prospective randomized study of once-daily versus twice-daily amikacin regimens in patients with systemic infections; Karachalios GN et al.; The efficacy and safety of amikacin administered once-daily versus twice-daily was evaluated in adult patients with systemic infections . Patients over 23 years of age with suspected or documented systemic infections were randomly divided into two groups: one group received amikacin intravenously 15 mg/kg once-daily, and the other group received amikacin 15 mg/kg divided into 2 doses . The efficacy of both dosage regimens was very good with a satisfactory clinical response in 90.2% and 89%, respectively . The bacteriological cure rate was 82.2% and 76%, respectively . There were no significant differences between the 2 regimens as far as what efficacy and safety are concerned . Nephrotoxicity appeared in 2 patients of the first group and 3 patients of the second, but did not lead to discontinuation of amikacin . No significant differences between the regimens with regard to hearing loss or prodromal signs of ototoxicity . We concluded that amikacin administered once-daily appears to be as effective and safe as the twice-daily dosing . However, the once-daily administration is more convenient and less costly.

Gac Sanit, 1998 Jul-Aug, 12(4), 182 - 9
{Genetics and epidemiology: possibilities of a common program from the perspective of the history of biology}; Moya F; The current convergence of molecular genetics and epidemiology on the analysis of chronic diseases have prompted the comparison of the roles of genetics and epidemiology with those maintained at the end of XIX century by the, then, emergent bacteriology and miasmatic theories of infectious diseases . In some cases, the analogy have been extended to the causal role of germ and mutation on infectious and chronic diseases respectively . An historical analysis of the construction of the theory of the gene in the early years of our century, reveals that this conception was one of the difficulties that the new science of genetics had to overcome to elaborate the current theory of heredity which, therefore, seems incompatible with such concepts . It points also to the historical concepts that, although already obsolete, are still reflected in a deterministic view of the gene and, on the other hand, cast some optimism about the possibility of constructing a common program for genetic and epidemiology.

Exp Clin Endocrinol Diabetes, 1998, 106(4), 346 - 52
Management and outcome of severe diabetic foot infections; Diamantopoulos EJ et al.; We evaluated the bacteriological and clinical efficacy of the combination of ciprofloxacin/clindamycin in severe diabetic foot infections and we tried to elucidate the relationship between the vascular status of the lower limbs and the outcome of these infections . Initial empirical antibiotic therapy with ciprofloxacin (300 mg/12 hrs IV) and clindamycin (600 mg/8 hrs IV) was administered in 84 hospitalized diabetics with severe lower limb infections . This treatment was continued only in cases with primary clinical improvement . The major endpoints of treatment were: cure, improvement and failure . Evaluation of the vascular status of the lower extremities was performed by high resolution imaging coloured ultrasonography, US-Doppler and TcPO2 measurements . Polymicrobial flora was found in 83% of the cases with an average 2.8 species per specimen . Osteomyelitis was detected in 58 % of the patients . After five days of IV administration of ciprofloxacin and clindamycin the response rate was 95.2% . After three weeks of therapy the clinical outcome was: cure 54.8%, improvement 23.8%, and failure 21.4% . The long term follow up (mean duration 16 months) revealed complete healing of the skin lesions in 63 patients (75%) . Unfavorable prognostic factors for these infections were: ankle systolic blood pressure <50 mmHg or toe systolic blood pressure < 30 mmHg and TcPO2 < 20 mmHg . The side effects of the combination of ciprofloxacin/clindamycin were mild and there were no cases of pseudomembranous enterocolitis . The combination of ciprofloxacin/clindamycin was found to provide an excellent empirical as well as definitive treatment of severe diabetic foot infections . The evaluation of the vascular status and the severity of ischaemia of the lower limbs has a strong predictive value in the outcome of these infections.

Med Trop (Mars), 1998, 58(2), 199 - 203
{The Center for Research on Meningitis and Schistosomiasis (CERMES), Naimey, Niger}; Chippaux JP; The Center for Research on Meningitis and Schistosomiasis (CERMES) was founded in 1977 and became fully operational in 1980 . Its mission is to provide support to the member states of its parent organization, the OCCGE . The CERMES is WHO collaborating centre for research and control of schistosomiasis and subregional reference laboratory for diagnosis of meningitis . In the field of meningitis, the CERMES carries out epidemiologic and bacteriologic studies and investigates new vaccination strategies . The CERMES is presently conducting clinical trials of several conjugated vaccines . In the field of schistosomiasis, the CERMES is studying mechanisms of transmission and performing experiments to evaluate immunogenicity and efficacy of the Sh28GST vaccine . The facilities of the CERMES include laboratories for bacteriologic and clinical testing, for experimental and clinical trials of vaccines, for studying the parasitological features and mode of transmission of schistosomiasis, for assessment of the results of epidemiological studies and prevention campaigns, and for processing geographic and remote sensing data . The CERMES is also called on for consultancy services and provides a full range of training courses in laboratory and management techniques for countries in the OCCGE.

Jpn J Thorac Cardiovasc Surg, 1998 Aug, 46(8), 772 - 6
{Pseudo-aneurysm of aortic arch and rupture into pericardium, a case report of successful surgical management}; Nonaka K et al.; This is a case report of 50 years old male suffering from pyrexia and epigastralgia 2 weeks prior to admission . On the 15th hospital day, he complained chest pain . Chest roentgenography revealed marked expansion of the mediastinum which was not existed upon admission . CT and MRI of the chest demonstrated a pseudoaneurysm of aortic arch at lesser curvature with extension into the pericardium . Exploration of the pericardium through median sternotomy disclosed fully filling with purulent effusion and blood clots . Following irrigation of the pericardial space and tube drainage, chest was closed . Repair of the aneurysm was postponded . Following continues irrigation of the pericardial space for 19 days, tube graft replacement of the aneurysm was performed under femorofemoral bypass and circuratory arrest through left thoracotomy . The aneurysmal space was filled with the omental pedicle to control infection . However, repeated bacteriological examination of the pericardium and aneurysm revealed no growth . Behcet disease was most suspected in report of the pathology.

Int J Tuberc Lung Dis, 1998 Oct, 2(10), 818 - 23
Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia; Liam CK et al.; SETTING: University Hospital, Kuala Lumpur, Malaysia . OBJECTIVE: To determine the incidence of hypercalcaemia in Malaysian patients with newly diagnosed tuberculosis (TB) before the commencement of antituberculosis treatment . DESIGN: A prospective study of consecutive patients with newly diagnosed bacteriologically and/or histologically proven tuberculosis in our institution from September 1994 to March 1996 . RESULTS: Of a total of 120 patients (67 males, 53 females), 68 had pulmonary TB, nine had pulmonary and pleural TB, 18 had pleural TB without chest radiograph evidence of lung involvement, 16 had various other forms of extra-pulmonary TB and nine had disseminated TB . The mean age of the patients was 44.3 (+/-18.0) years . The mean albumin-adjusted serum calcium concentration was 2.53 (+/-0.22) mmol/l . Hypercalcaemia was present in 27.5% of the patients, but only 12% of these patients showed symptoms of hypercalcaemia . The type of TB and, in the case of pulmonary TB, the radiographic extent of lung involvement, had no effect on the serum calcium level . CONCLUSION: Hypercalcaemia is not uncommon among Malaysian patients with newly diagnosed TB, but it is rarely symptomatic.

Arerugi, 1998 Jul, 47(7), 667 - 73
{Chlamydia pneumoniae infection in children with asthma exacerbation}; Kamesaki S et al.; Little is known about the significance of C . pneumoniae in wheezing state in children . In this study, a total of 33 children with exacerbation of bronchial asthma were serologically and bacteriologically analyzed to investigate whether C . pneumoniae infection is associated with wheezing in children with bronchial asthma . 1) Of the 33 patients 12 (39%) had an acute antibody rise against C . pneumoniae . C . pneumoniae was isolated from 8 patients (24%) by culture . Based on these findings, 15 cases (45%) were diagnosed as C . pneumoniae infection . 2) There were no significant difference in clinical signs, symptoms and laboratory studies between with and without C . pneumoniae infection . The high incidence of C . pneumoniae infection in children with exacerbation of bronchial asthma suggests its significance as a cause of wheezing . Although there was no specific symptom in C . pneumoniae infection, this infection should be suspected in wheezing children for diagnosis and proper treatment.

Lung, 1998, 176(6), 381 - 91
Mycobacterium avium-intracellulare pulmonary infection in patients without known predisposing lung disease; Kubo K et al.; We tried to characterize the clinical features and findings on chest high resolution computed tomography (HRCT) of patients with Mycobacterium avium-intracellulare (MAI) pulmonary infection without known predisposing lung disease and with no immunodeficiency . We also aimed to clarify the small airway and alveolar inflammation using bronchoalveolar lavage (BAL) from the affected regions . MAI infection was diagnosed in 53 patients from respiratory samples, including sputum and materials obtained using a fiberoptic bronchoscope . None had a predisposing lung disease or immunodeficiency, as assessed by medical history, routine laboratory data, and previously normal chest radiographs and/or CT scans . The mean age of the 53 patients was 60 +/- 11 years, and 48 were nonsmoking females . They had few respiratory symptoms, although 42% had chronic paranasal sinusitis . Chest HRCT findings showed centrilobular small nodules and ectasia of small bronchi and/or bronchioles located mainly in segment (S) 2, 3, 4, and 5 . S1, which is usually affected by pulmonary tuberculosis, was completely free of these opacities . The BAL study revealed that the predominant cells were activated T lymphocytes and neutrophils . The CD4+/CD8+ ratio increased significantly . Bacteriology was negative for other bacteria and fungi . Although our patients did not present with distinct respiratory symptoms, the regions affected by MAI showed a chronic inflammation of mainly neutrophils and activated T lymphocytes . The presence of chronic sinusitis may be merely coincidental . However, its high prevalence and the finding of bronchiectasis in chest HRCT raise the question of whether silent bronchiectasis may be a predisposition.

Pediatr Infect Dis J, 1998 Sep, 17(9), 776 - 82
Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome; Dagan R et al.; OBJECTIVE: To determine the relation between early bacteriologic eradication and clinical outcome of acute otitis media (AOM) in infants and young children treated with various antibiotics . STUDY DESIGN: The study group consisted of patients ages 3 to 24 months seen at the Pediatric Emergency Room with: (1) symptoms and physical findings consistent with AOM of < or = 7 days duration; (2) no spontaneous perforation or tympanostomy tubes; (3) positive initial middle ear fluid culture; and (4) a follow-up to at least Day 10+/-2 of the study with a second culture performed 72 to 96 h after initiation of antibiotic treatment . Any patient with a positive middle ear fluid culture 72 to 96 h after initiation of antibiotic treatment was considered to have bacteriologic failure . Otologic evaluation was done by an otolaryngologist unaware of the culture results and of the study drug allocation . A clinical score based on body temperature, report of irritability and ear tugging observed by the parents and the appearance and redness of the ear drum as observed by the otolaryngologist was also used for clinical evaluation . RESULTS: The study group consisted of 123 patients, of whom 57 (46%) had positive middle ear fluid 72 to 96 h after initiation of antibiotic treatment . Clinical failure was observed in 21 of 57 (37%) patients in whom bacteriologic eradication did not occur vs . only 2 of 66 (3%) patients with bacteriologic eradication after 3 to 4 days of treatment (P < 0.001) . Clinical score for both moderate and severe disease decreased significantly faster in those with bacteriologic eradication than in those in whom middle ear fluid was still culture-positive 72 to 96 h after initiation of treatment . CONCLUSION: Clinical failures in our population were associated with inability to eradicate the causative organisms of AOM from the middle ear fluid within 3 to 4 days after initiation of antibiotic therapy . Most patients (including those without bacteriologic eradication) improved after 3 to 4 days of treatment, but patients with sterile middle ear fluid felt better after 3 to 4 days of treatment than patients in whom middle ear fluid was still culture-positive.

Avian Dis, 1998 Jul-Sep, 42(3), 431 - 51
Molecular typing of avian Escherichia coli isolates by random amplification of polymorphic DNA; Maurer JJ et al.; Escherichia coli is a common inhabitant of the gastrointestinal tract of most animals . Like most pathogenic E . coli, avian isolates cannot be distinguished biochemically from the normal commensals inhabiting the gastrointestinal tract of birds . Using a molecular approach, we were able to identify genetic differences among avian E . coli isolates by restriction fragment length polymorphism (RFLP) and random amplification of polymorphic DNA (RAPD) by the polymerase chain reaction (PCR) . Several different RFLPs were observed among avian E . coli isolates using DNA probes for 16S ribosomal RNA genes (rrn) and insertion sequence elements (IS2) . We were also able to observe differences in DNA banding patterns generated by RAPD analysis . Similarities and differences among avian E . coli were discernible using RFLPs and RAPD analysis, whereas conventional bacteriological methods failed to differentiate these isolates . Based on RAPD patterns, avian E . coli appear to be genetically diverse . Of 16 different RAPD types (RT) encountered, 84% of E . coli fell into seven major RTs . One RT was present in clinical isolates but absent from the commensals isolated in this study . Many of these different E . coli RTs were not geographically restricted to northern Georgia but were also observed in other southern states in the United States . Resistance to various antibiotics was randomly associated with different E . coli RTs . Sarafloxacin resistance was present among different E . coli RTs, suggesting that antibiotic usage is not selecting for a clonal population in avian E . coli . RAPD provides a rapid and powerful tool to study the epidemiology of avian E . coli.

Orv Hetil, 1998 Sep 20, 139(38), 2235 - 40
{Complex treatment of infected necrotizing pancreatitis}; Farkas G et al.; Pancreatic necrosis associated with septic conditions is the leading cause of mortality in acute pancreatitis . Since 1986, 155 patients with infected pancreatic necrosis have been treated . The mean APACHE II score was 18.5 (range 11-32) . In all cases, the infected pancreatic necrosis was combined with retroperitoneal abscesses . The surgical treatment was performed on average 18.5 days (range 8-25 days) after the onset of acute pancreatitis . The operative management consisted of wide-ranging necrosectomy in the total affected area, combined with widespread lavage and suction drainage . In 69 of the 155 cases (45%), some other surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colon resection) was also performed . Following surgery supportive therapy was applied in all patients, which also consisted orf immunonutrition (glutamine and arginine supplementation) and modification of cytokine production by petoxyfillin and dexamethasone from 1992 . TNF and IL-6 serum levels were measured by ELISA and in vitro stimulation of leukocytes were induced by E . coli LPS . Following surgery, continuous lavage and suction drainage were applied for an average of 41.5 days (range 21-90 days), with an average of 9.5 (range 5-20) litres of saline per day . The bacteriologic findings revealed mainly enteral bacteria, but Candida infection was also frequently detected . The incidence of fungal infection was 20% . Thirty-two patients (21%) had to undergo reoperation . The cytokine production capacity (TNF and IL-6) was shown to correlate with the prognosis . As a consequence of pentoxifyllin and dexamethasone therapy, the TNF production generally dropped to the normal level . The overall hospital mortality was 6.4% (10 patients died) . In our experience, infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, long-standing lavage and suction drainage, together with supportive therapy consisting of immunonutrition and modification of cytokine production, combined with adequate antibiotic and antifungal medicationPublication Types:

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