Clin Sci (Lond), 1992 Mar, 82(3), 277 - 82 Exposure of rat colonic mucosa to human semen in vivo induces mucosal cytolysis, abolishes fluid absorption and raises paracellular permeability; Mendizabal MV et al.; 1 . The effects of human semen on rat descending colon fluid absorption, permeability to 3H-labelled polyethylene glycol 4000 and the histological appearance of the mucosa were examined . Also, the semen was fractioned by centrifugation into plasma and sperm fractions and the effects of these fractions on rat colonic function were examined . The effects of trypsin and bacterial collagenase, mimetics of acrosin and seminal collagenase activity, were examined in order to investigate which component of human semen alters colonic permeability . 2 . Contact between human semen and rat descending colonic mucosa for 3 h decreased fluid absorption from 52.0 +/- 2.9 microliters h-1 cm-2 (control) to 10.7 +/- 3.4 microliters h-1 cm-2 (P less than or equal to 0.001), increased the permeability to polyethylene glycol 4000 from 0.099 +/- 0.006 cm/h (control) to 0.31 +/- 0.04 cm/h (P less than or equal to 0.001) and caused cytolysis of the surface mucosa . 3 . Spermatozoa inside the colonic lumen were destroyed within 1 h with release of acrosomal contents; this raised the activity of the acrosomal proteolytic enzyme acrosin by 40-fold (P less than or equal to 0.005) and of seminal plasma metalloproteinase (collagenase) by about twofold (mean activity 1623 +/- 240 units/ml of luminal fluid) . 4 . The changes in colonic permeability induced by seminal plasma were similar to those induced by similar activities of clostridial collagenase . 5 . We conclude that seminal collagenase is present in sufficient amounts to cause acute damage to the colonic mucosa, and that this could be a factor in facilitating viral transmission across the colonic wall. Artery, 1992, 19(2), 112 - 23 Type I collagen fibril formation by human vascular endothelial cells in culture; Yamamoto K et al.; The formation of type I collagen fibrils by vascular human endothelial cells in culture was demonstrated by the indirect immunofluorescence method . The fibrillar structure was formed on the cell surface on the third day after subcultivation and had grown like a knitting ball of 0-3 microns in diameter and 0-200 microns in length on the seventh day . The fibril formation was stimulated by the addition of basic fibroblast growth factor, but completely blocked by the presence of beta-aminopropionitrile . The fibrils were eliminated by the treatment with clostridial collagenase or with 0.5% Triton X-100 . The pathophysiological significance of type I collagen fibril formation by vascular endothelial cells in vascular diseases is also discussed. Zentralbl Chir, 1992, 117(9), 509 - 14 {Is penicillin G the drug of choice in gas gangrene? Results of a prospective documentation of clinical, microbiological and animal experiment data}; Erttmann M et al.; Between 1978 and 1990 98 patients with gas gangrene were treated in the departments of general surgery and traumatology of the University of Kiel . The microbiological results of tissue samples and results of animal infectious experiments were correlated to the clinical outcome . It could be shown, that gas gangrene due to C.perfringens alone had a higher mortality than gas gangrene due to polymicrobial infection . In trauma patients, however, the rate of amputations was lower in cases of clostridial monoinfections (25%), than in patients with mixed infections (48%) . The results of animal experiments with guinea pigs which were infected by patients' infectious material showed a correlation to the clinical outcome . This correlation could not bee shown using isolated and cultured clostridia . Therefore and because of the quantity of mixed infections it is necessary to use broad spectrum antibiotics for treatment in cases of gas gangrene and for perioperative antibiotic prophylaxis . Penicillin-G alone can not more be recommended for this purpose. Chirurgia (Bucur), 1992, 41(1), 1 - 9 {The timely diagnosis of postoperative clostridial infection}; Radulescu D et al.; Authors report a case of clostridial myonecrosis postcholecystectomy . The causes of the occurrence of this severe, frequently lethal complication are reviewed, as well as the difficulties of an early diagnosis, the only factor able to save the patient . The curative treatment of the detected infection requires the initiation of a series of local and general measures and a permanent cooperation between the surgeon, the specialist in resuscitation and the infectionist. Arch Med Res, 1992, 23(2), 31 - 3 Primary structures of alcohol and aldehyde dehydrogenase genes of Entamoeba histolytica; Samuelson J et al.; Ethanol is the major metabolic product of glucose fermentation by the protozoan parasite E . histolytica under the anaerobic conditions found in the lumen of the colon . With the goal of finding new targets for anti-amebic drugs, the E . histolytica NADP(+)-dependent alcohol dehydrogenase gene (EhADH1; EC 1.1.1.2) and an aldehyde dehydrogenase gene (EhALDH1; EC 1.3.2) were cloned . The EhADH1 alcohol dehydrogenase gene encoded -39 kDa protein with 62 and 60% amino acid identities, respectively, with NADP(+)-dependent alcohol dehydrogenases of anaerobic bacteria Thermoanaerobium brockii and Clostridia beijerinckii . In contrast, EhADH1 showed a 15% amino acid identity with the closest human alcohol dehydrogenase . An EhADH1-glutathione-S-transferase fusion protein showed the expected NADP(+)-dependent alcohol dehydrogenase and NADPH-dependent acetaldehyde reductase activities . The enzymatic activities of the EhADH1 fusion protein were inhibited by pyrazole and 4-methyl pyrazole . The E . histolytica aldehyde dehydrogenase EhALDH1 gene encoded a 60 kDa protein, which showed a 36% amino acid identity over a 451 amino acid overlap with the human stomach aldehyde dehydrogenase (ALDH3). J Vasc Surg, 1992 Jan, 15(1), 205 - 13 Enzymatic harvesting of adult human saphenous vein endothelial cells: use of a chemically defined combination of two purified enzymes to attain viable cell yields equal to those attained by crude bacterial collagenase preparations; Suggs W et al.; Seeding vascular prostheses with enzymatically harvested endothelial cells can create endothelial linings that improve small-caliber prosthetic patency . But crude bacterial collagenases used for endothelial harvest contain cytotoxic nonspecific proteases and clostridial cell wall debris which might limit their clinical usefulness . We therefore compared the endothelial cell harvest efficiency of crude bacterial collagenase with that of purified bacterial collagenase alone, purified trypsin alone, and combinations of purified bacterial collagenase and trypsin using concentrations of pure collagenase equal in collagenolytic activity to the crude bacterial collagenase material . The efficiency of harvest from human saphenous vein segments was measured by a microtiter well-growth curve assay of the number of living endothelial cells capable of attachment to fibronectin and subsequent growth obtained per unit area of saphenous vein lumen . Whereas pure collagenase and purified trypsin alone both harvested less than 5% of the baseline endothelial cell density on the veins, a combination of purified collagenase and 0.01% w/v purified trypsin was found to harvest 22% +/- 10% (SD) (n = 8 veins) of the approximately 1.3 x 10(5) endothelial cells/cm2 available on normal saphenous veins . This figure was not statistically different from the harvest efficiency of 19% +/- 10% (N = 4 veins) (p greater than 0.05) obtained by use of 0.1% w/v crude collagenase alone . This result suggests that endothelial harvesting can be done with a defined mixture of pure enzymes which would be clinically preferable to presently used crude extracts of clostridial cultures as a standardized preparation for graft seeding. Vet Res Commun, 1992, 16(6), 415 - 24 Causes of lamb morbidity and mortality in the Ethiopian highlands; Bekele T et al.; A study was conducted to investigate causes of lamb morbidity and mortality on farms and on-station at Debre Berhan during 1989 and 1990 . It showed pneumonia (bacterial and/or verminous), starvation-mismothering exposure (SME) complex, gastrointestinal parasites, enteritis, abomasal impaction and physical injuries to be important health constraints on productivity . Neonatal mortalities were 51.5% and 46.3% on farms and on-station respectively and occurred owing to management problems such as SME, abomasal impaction and physical injuries . On the farms the lamb birth weight was 2.56 +/- 0.25 kg and was significantly (p < 0.05) affected by the dam's age, lambing weight, litter size, sex of lamb and year of lambing, but not by the season of lambing . Birth weight significantly (p < 0.05) influenced lamb mortality . Lambs with a low birth weight tended to die from SME . Morbidities and mortalities due to infectious causes increased in older lambs, suggesting that infections were acquired with age when resistance was lowered owing to inadequate nutrition and poor management . Heavy loss of lambs could be overcome by such health management interventions as foster mothering, warming lambs during the cold season and vaccination with polyvalent vaccines against pasteurellosis, clostridial infection and Dictyocaulus filaria. Klin Khir, 1992, (9-10), 47 - 9 {Changes in the microflora of the suppurative cavities resulting from the treatment of acute bacterial destruction of the lungs}; Krotov NF et al.; The results of complex bacteriologic examination of 62 patients with acute bacterial destruction of the lungs during the process of treatment were analysed . The complex of investigations included the express methods (bacterioscopy, studies in the ultraviolet light, chromatography-mass spectrometry), inoculation under aerobic and anaerobic conditions . A role of anaerobic non-clostridial infection in the development of acute pulmonary destruction, polymicrobial character of microflora are shown . It was established that complex conservative therapy with inclusion of the methods for drainage of the cavities of destruction, prolonged intraarterial infusion, aimed antibacterial therapy permitted to achieve rapid suppression of microflora, its anaerobic component in particular . In chronization of the disease, the gram-negative aerobic flora is playing the leading part in its pathogenesis. J Biol Chem, 1991 Nov 25, 266(33), 22147 - 53 Glycine reductase protein C . Properties and characterization of its role in the reductive cleavage of Se-carboxymethyl-selenoprotein A; Stadtman TC et al.; The clostridial glycine reductase complex catalyzes the reductive deamination of glycine in an energy-conserving process that results in the esterification of orthophosphate . The complex consists of three protein components: selenoprotein A; protein B, a carbonyl group protein; and protein C, a sulfhydryl protein . The protein C component also catalyzes the arsenate-dependent decomposition of acetyl phosphate . Reaction of protein C with iodoacetate inhibits its ability to decompose acetyl phosphate, but this inactivation of the enzyme by alkylation is prevented in the presence of the substrate indicating the formation of an unreactive enzyme-bound acetylthiol ester . The Se-carboxy-methylselenocysteine residue of the selenoprotein A component of glycine reductase was generated by selective alkylation of the ionized selenol group at pH 6 with {14C}bromoacetate . Using this pure alkylated selenoprotein A as substrate, it was shown that protein C catalyzes the conversion of the {14C}carboxymethyl group, in selenoether linkage to protein A, to {14C}acetate in the presence of arsenate, dithiothreitol, and Mg2+ . A procedure using hydrophobic chromatographic matrices was developed for the large scale isolation of protein C, and a number of the properties of the enzyme were determined. J Infect, 1991 Nov, 23(3), 293 - 5 Successful antibiotic therapy of clostridial septic arthritis in a patient with bilateral total hip prostheses; Kibbler CC et al.; We report a case of clostridial bacteraemia with infection of a prosthetic hip joint . The patient was successfully treated with IV benzyl penicillin and fucidin followed by oral amoxycillin and probenecid, without surgical intervention . She had no recurrence of her infection in the 19 months before her death . This is believed to be the first reported case of clostridial infection affecting a prosthetic joint. Vet Rec, 1991 Sep 7, 129(10), 216 - 9 Treatment and control of an outbreak of fat cow syndrome in a large dairy herd; Andrews AH et al.; An outbreak of fat cow syndrome occurred in a herd of 300 Friesian and Friesian/Holstein dairy cows calving predominantly between January and May . The herd came in off grass in good condition despite a long and hot summer . The dry cows received a diet of grass silage, brewing waste and minerals until the end of December, but the grass silage was butyric and was partially replaced by maize silage . By January 23, 16 of 70 calving cows (23 per cent) had appeared to suffer milk fever . Subsequent blood tests revealed that the cows may have been ketotic, and clinical and post mortem examination showed that they were probably suffering from fat cow syndrome . The freshly calved sick cows were treated with glucose, and corticosteroids were injected every second day into those which remained ill . The cattle had received a high energy diet, but the cows still to calve were placed on a diet of low metabolisable energy (77 MJ/cow) but adequate levels of undegradable protein . The problem was associated with a possible clostridial infection in two cows and with reduced fertility. Am J Surg, 1991 Sep, 162(3), 247 - 50 General surgical problems requiring operation in postoperative vascular surgery patients; Franko E et al.; Surgical intervention after vascular surgery usually occurs as a result of bleeding or thrombosis, whereas general surgical problems requiring operation after vascular surgery are unusual . The purpose of this study was to review the results of operations for general surgical problems done soon after major vascular surgery . From January 1985 to December 1989, 1,236 major vascular procedures were performed, and 15 patients developed significant postoperative general surgical problems including perforated duodenal ulcer (2), perforated diverticular disease (2), evisceration and dehiscence (2), liver infarct (1), gangrenous cholecystitis (2), clostridial myonecrosis (1), pseudomembranous colitis (1), and small bowel obstruction (4) . The overall mortality was very high (47%), and the chance of dying was significantly higher (p less than 0.05) if the initial vascular procedure was an emergency (100% mortality) . All the patients who died (n = 7) succumbed to sepsis . There was a long delay in diagnosis in all groups; however, the delay did not correlate with mortality . Although this is a study of a small group of patients with a very heterogenous group of complications, several observations can be made: (1) a general surgical problem after vascular surgery carries a very high mortality; (2) general surgical complications in postoperative vascular patients in whom the initial procedure was an emergency are very poorly tolerated and almost uniformly lethal; and (3) these elderly patients have multiple medical problems and seem unlikely to tolerate any septic insult. J Cardiovasc Surg (Torino), 1991 Jul-Aug, 32(4), 472 - 4 Clostridial mycotic aneurysm of the suprarenal abdominal aorta; Skipper D et al.; Clostridial mycotic aneurysms are unusual . We therefore record a fatal case of a ruptured clostridial mycotic aneurysm of the suprarenal aorta which developed several weeks after the resection of a segment of gangrenous small bowel. Am Surg, 1991 Jun, 57(6), 388 - 93 Clostridial bacteremia: implications for the surgeon; de Virgilio C et al.; Clostridial bacteremia is rare and has a variable presentation from asymptomatic to septic shock with disseminated intravascular coagulation (DIC), red cell hemolysis, and rapid death . In order to delineate the predisposing and prognostic factors in these patients, the authors reviewed 47 cases of clostridial bacteremia presenting over a seven year period at a major metropolitan teaching hospital . Predisposing factors included locally decreased oxidation reduction potential (Eh) in 43 per cent (including atherosclerosis, diabetes, and radiation therapy), systemic immunosuppression in 53 per cent (including alcohol abuse, chemotherapy, steroids, and malignancy), and a site of epithelial barrier disruption . The sites of clostridial invasion included: gastrointestinal tract (GI) (n = 22), pulmonary (n = 7), cutaneous (n = 7), undetermined (n = 7), and female genital tract (n = 4) . Seven patients were found to have malignancy . Seventy-nine per cent of the blood culture isolates were histotoxic species (Clostridia perfringens and C . septicum) . The overall mortality was 47 per cent . Significant differences between survivors and deaths included DIC, new onset renal failure, severe atherosclerotic disease, and age (P less than .05) . The authors conclude that clostridial bacteremia is uncommon but highly lethal and may occur when decreased tissue Eh, systemic immunosuppression, and an epithelial barrier disruption are present . Poor outcome appears to be a reflection of advanced age, underlying illness, and presence of a histotoxic species. Wei Sheng Wu Xue Bao, 1991 Jun, 31(3), 221 - 6 {Study on ursodeoxycholic acid biotransformation by three strains of clostridia}; Huang A et al.; Using the improved TLC procedure, we measured the conversion rates of ursodeoxycholic acid(UDCA) from chenodeoxycholic acid (CDCA) by 3 strains of clostridia--C . perfringens HS-10, C . butyricum DL-20 and LQ-29 isolated . The orthogonal test was used to determine the optical conditions of biotransformation for HS-10 . It was found that the conversion rate of UDCA by HS-10 was over 80% during 6-48 h in RCM medium containing 0.2 mmol/L CDCA . The UDCA conversion rates were still over 70% when the CDCA concentrations were as high as 0.8-1.0 mmol/L . In addition, the WW-BCP (Waste water from bean curd production) without any supplemental nutrients was preliminarily proved to be a potential inexpensive conversion medium. Biochemistry, 1991 Apr 23, 30(16), 4090 - 7 Mechanism of action of clostridial glycine reductase: isolation and characterization of a covalent acetyl enzyme intermediate; Arkowitz RA et al.; Clostridial glycine reductase consists of proteins A, B, and C and catalyzes the reaction glycine + Pi + 2e(-)----acetyl phosphate + NH4+ . Evidence was previously obtained that is consistent with the involvement of an acyl enzyme intermediate in this reaction . We now demonstrate that protein C catalyzes exchange of {32P}Pi into acetyl phosphate, providing additional support for an acetyl enzyme intermediate on protein C . Furthermore, we have isolated acetyl protein C and shown that it is qualitatively catalytically competent . Acetyl protein C can be obtained through the forward reaction from protein C and Se-(carboxymethyl)selenocysteine-protein A, which is generated by the reaction of glycine with proteins A and B {Arkowitz, R . A., & Abeles, R . H . (1990) J . Am . Chem . Soc . 112, 870-872} . Acetyl protein C can also be generated through the reverse reaction by the addition of acetyl phosphate to protein C . Both procedures lead to the same acetyl enzyme . The acetyl enzyme reacts with Pi to give acetyl phosphate . When {14C}acetyl protein C is denaturated with TCA and redissolved with urea, radioactivity remained associated with the protein . At pH 11.5 radioactivity was released with t1/2 = 57 min, comparable to the hydrolysis rate of thioesters . Exposure of 4 N neutralized NH2OH resulted in the complete release of radioactivity . Treatment with KBH4 removes all the radioactivity associated with protein C, resulting in the formation of {14C}ethanol . We conclude that a thiol group on protein C is acetylated . Proteins A and C together catalyze the exchange of tritium atoms from {3H}H2O into acetyl phosphate.(ABSTRACT TRUNCATED AT 250 WORDS) Voen Med Zh, 1991 Apr, (4), 38 - 43 {The etiological diagnosis of nonclostridial anaerobic organic infection of the hepatobiliary system in military medical institutions}; Nechaev EA et al.; The results of B-bile bacterial examinations of patients who had undergone operations on biliary tract for acute or chronic cholecystitis in the military medical institutions of the USSR and the USA were retrospectively compared . Distinctive and similar features were revealed . The leading role of bacteroids, anaerobic found bacteria and clostridia was ascertained during the studies of etiological structure of anaerobic biliary infection . As for nonclostridial anaerobic infection of biliary tract, the polymicrobiotic process of aerobic and anaerobic associations is more typical . The centralization of bacteriological examinations in specialized "anaerobic" laboratory may improve the efficiency of microbiological diagnostics of nonclostridial anaerobic infection. Appl Environ Microbiol, 1991 Feb, 57(2), 573 - 8 Gut microflora of vervet and samango monkeys in relation to diet; Bruorton MR et al.; The microflora in the gastrointestinal tracts of wild vervet and samango monkeys (Cercopithecus aethiops and C . mitis, respectively) were studied, using fermentation acid analysis, electron microscopy, and culturing methods . The diets of the two species of monkey differ considerably, with that of the samango including a greater proportion of cellulose-rich leaf material, and this is reflected in the microflora . Volatile fatty acid measurements along the gut of both species showed that these end products of bacterial metabolism were concentrated in the cecum and colon . Electron microscopy indicated that morphologically similar bacteria were present in the cecum and colon of both species, but the samango possessed a distinct stomach microflora . Bacteria in the lumina of the four main regions of the gut of the monkeys (stomach, small intestine, cecum, and colon) were plated on a number of anaerobic media (Mann, Rogosa, and Sharp; clostridial basal; and complex media) . The cecum and colon were found to contain higher numbers of microbes per gram (wet weight) of gut content than the stomach and small intestine . Microbial isolates were able to catabolize carboxymethyl cellulose and other polymers . This may aid the monkeys, particularly samangos, in the digestion of fibrous dietary components such as leaves. Immun Infekt, 1991 Feb, 19(1), 18 - 21 {ADP ribosylation of actin--a cytotoxic principle of bacterial toxins}; Just I et al.; The ADP-ribosylation of actin is the pathobiochemical mechanism by which various clostridial toxins affect the eukaryotic target cell . The toxins are binary in structure and consist of a binding component and an enzyme component with ADP-ribosyltransferase activity . Probably endocytosis-mediated the binding component transfers the clostridial ADP-ribosyltransferase into the target cell, whereupon G-actin but not F-actin is ADP-ribosylated . The ADP-ribosylated actin is incapable of polymerization but binds to the barbed ends of actin filaments to inhibit polymerization of non-modified actin . Thereby the ADP-ribosylation of actin destroys the cellular architecture of the microfilament network . The ADP-ribosylating toxins are novel tools to study the physiological functions of actin. Res Microbiol, 1991 Jan, 142(1), 87 - 93 Improved egg-yolk agar plate medium for the detection of clostridial phospholipase C activity; Gubash SM; A new modification of the egg-yolk agar plate medium, an egg-yolk triple-salt medium, is described . The medium incorporates a tryptic soy agar base, yeast extract, D-glucose CaCl2, MgCl2 and ZnSO4 . Only in egg-yolk triple-salt medium did all tested phospholipase-C-producing clostridia form a lecitho-vitellin precipitate after overnight incubation; 95.5% formed a high-density precipitate in the new medium as opposed to 6.1%, 6.6%, 10.6% and 20.2% of the isolates not forming a visible precipitate in liver-veal, Lombard-Dowell, McClung and Toabe modified, and "viande-levure" egg-yolk media, respectively, after the same incubation time. Padiatr Grenzgeb, 1991, 30(3), 193 - 203 {Gas gangrene in childhood--a review}; Roloff D; Although gas gangrene in childhood is not mentioned in the paediatric literature, paediatric surgery textbooks included, this toxic wound infection also occurs in children . Prognosis totally depends on the early detection of the disease . Having checked over 2000 relevant literature sources, in which 110 cases of gas gangrene are mentioned, of which 24 are described in detail, this paper points to constellations paving the way for developing or favouring the infection . In aetiologic respect accidents range first, but also in children postoperative clostridial myonecrosis and those resulting from intramuscular injections are possible, but rare . On the basis of case reports the initial symptoms are stressed . In the foreground local (heavy pains, odematous swelling, "dirty" exudate, dyschromia, foetor) and general (tachycardia, rapidly deteriorating condition, shock, icterus) signs are dealt with, which occur after a latent period ranging between some few and 72 (up to 96) hours . Only through quick diagnosis and sufficient immediate therapy it will be possible to improve the prognosis and, in particular, reduce letality . A later publication in this journal will explain that also in children gas gangrene does not belong to those diseases which seldom occur. Anaesthesiol Reanim, 1991, 16(1), 49 - 58 {Prerequisites for the transfer of patients with gas gangrene to a specialized facility}; Roloff D; According to the cases reported in the GDR as well as in the FRG, 1-2 persons contract a gas gangrene infection per week . The lethality is alarmingly high . In the GDR more than two thirds of the patients die . Among the numerous factors influencing the prognosis time is a very important one . Through early detection, adequate immediate therapy and subsequent prompt transfer to a treatment centre with facilities for hyperbaric oxygenation, the chances of survival can be improved considerably . Some experiences with the transfer of 275 patients under the tentative diagnosis "gas gangrene" are described, together with the preparation and actual transfer to a specialized centre . For the detection of the disease the clinical symptoms are of greatest importance . The histological findings confirm the diagnosis, bacterioscopy also provides early results . To start treatment early, one cannot wait for the result of the microbiological detection of clostridia which is virtually necessary for exact diagnosis . The initiated treatment (rigorous surgical removal of the gas gangrene focus, antibacterial and intensive therapeutic measures) has to be continued without interruption during transport with a rescue helicopter, aircraft or emergency ambulance . Medical care of the severely ill patient has to be provided throughout transportation . The practical measures are briefly described . The possibility for consultations should be used more frequently. Microbios, 1991, 66(266), 7 - 20 Purification, characterization and antimicrobial properties of an antibiotic (wassumycin) from Streptomyces species 215; Singh S et al.; A yellow amorphous compound, wassumycin, was isolated from an unidentified strain of Streptomyces . Wassumycin inhibited the growth of several species of human and animal pathogenic bacteria especially Clostridia . Wassumycin also inhibited the growth of HeLa cells, and showed good antitumour activity against experimental mouse tumours such as L1210, P388 leukaemias, and B16 melanoma . On the basis of the chemical and antimicrobial properties, the antibiotic appeared similar to the chromomycins and olivomycins, but its ultraviolet, infrared, and proton magnetic resonance spectra differed from theirs significantly. Sov Med, 1991, (10), 30 - 3 {Characteristics of the clinical course and surgical tactics in odontogenic suppurative mediastinitis}; Abakumov MM et al.; Odontogenic purulent mediastinitis arising with higher frequency in young males after mandibular periodontitis, is characterized by a rapid progression of intoxication and respiratory disorders . To achieve an immediate effect and avoid tracheostomy ameliorating the prognosis, it is necessary to perform early and adequate drainage of the purulent foci . The above form of mediastinitis should be preferably managed by bilateral transcervical drainage of the anterior and posterior mediastinum with addition of antibacterial therapy against ++non-clostridial anaerobic microflora as well as of passive and active immunization. Probl Tuberk, 1991, (11), 58 - 63 {Effects of non-clostridial anaerobic infection on the course of chronic pulmonary tuberculosis in experimental animals}; El'shanskaia MP et al.; Influence of non-clostridial anaerobic infection on the course of chronic pulmonary tuberculosis caused by intrapleural administration of BCG used in a vaseline-lanolin mixture was studied experimentally on guinea pigs . Administration of Bacteroides fragilis in the presence of a mild tuberculous inflammation aggravates the course of a specific process promoting pleural empyema development, increase in the size of pulmonary granuloma, extension of pathologic changes into the parenchymatous organs and aggravation of a nonspecific inflammatory reaction . Animals with mixed infection exhibited a longer duration and higher level of M . tuberculosis and B . fragilis excretion than those having a mono-infection . The findings suggest M . tuberculosis and B . fragilis synergism. Klin Khir, 1991, (9), 18 - 20 {The role of bacteriologic study of the bile in the surgical treatment of patients with cholangitis}; Andriushenko VP et al.; Bacteriologic study of the intraductal bile was performed in 123 patients operated on for cholangitis: chronic relapsing--in 47, acute--in 59, septic--in 17 . Aerobic microflora was revealed in 59%, anaerobic non-clostridial--in 12%, mixed--in 27% of cases . After operation, the reduction in bacteriobilia was noted . The microflora revealed was resistant to antibacterial preparations . The possibility to use the techniques of gas-liquid chromatography and pH-metry of bile in instant diagnosis of cholangitis is shown. Lab Delo, 1991, (9), 69 - 70 {Gas chromatographic analysis of the metabolic products of anaerobic bacteria . 2 . Clostridia}; Tararin PA et al.; Qualitative and quantitative characteristics of clostridial metabolites (short-chain carbonic acids and alcohols) were analyzed in associations of these bacteria with facultative anaerobes . Various bacterial groups were found to vary as regarded the composition and quantitative ratio of the major bacterial metabolites . These data may become the criteria for the indication of pathogenic clostridia in mixed cultures after anaerobic passages for 24-48 h at 37 degrees in a medium with 1% glucose. Clin Neurol Neurosurg, 1991, 93(2), 149 - 50 Sciatic neuritis as initial symptom of spontaneous clostridial myonecrosis; Hoefnagels WA et al.; A 21-year-old woman is reported with aplastic anaemia, who presented with pain in the leg . Rapid loss of sciatic nerve function followed . MRI showed irregular streaks of low intensity in the muscles of the pelvic region . A diagnosis of sciatic neuritis as initial symptom of clostridial myonecrosis was made. Br J Clin Pract . 1990 Dec;44(12):752. Clostridial cholecystitis--the need for early recognition and treatment; Sagar PM et al.; There remains some controversy regarding the timing of cholecystectomy after an attack of acute cholecystitis . Opinions vary between early operation within two and seven days and delayed operation readmitting the patient eight to twelve weeks later . There is, however, a small group of patients who require prompt emergency cholecystectomy . This group includes patients presenting with cholecystitis complicated by gas-forming organisms where the plain abdominal gas-forming organisms where the plain abdominal radiograph can establish the diagnosis. Khirurgiia (Mosk), 1990 Oct, (10), 78 - 83 {Reconstructive and restorative operations in iatrogenic injuries of the extrahepatic bile ducts}; Kadoshchuk TA; The results of diagnosis and treatment of iatrogenic injuries of the extrahepatic biliary tract in 47 patients are analysed . The injury was detected during the operation only in 6 cases, in 41 cases it was revealed on the 1st-6th postoperative day . Intensive conservative therapy was applied in the preoperative period to correct the values of homeostasis and metabolism . Special attention was attached to antibacterial therapy aimed at suppression of ++non-clostridial anaerobic infection . Sixty-three surgical interventions were conducted on 47 patients; 47 of them were restorative or reconstructive, 15 were undertaken for emergency indications, one, for developed postoperative complication . One patient died . Particular importance was attached to adequate draining both in emergency and in reconstructive and restorative operations. Biochimie, 1990 Aug, 72(8), 555 - 74 Hydrophobic cluster analysis: procedures to derive structural and functional information from 2-D-representation of protein sequences; Lemesle-Varloot L et al.; Hydrophobic cluster analysis (HCA) {15} is a very efficient method to analyse and compare protein sequences . Despite its effectiveness, this method is not widely used because it relies in part on the experience and training of the user . In this article, detailed guidelines as to the use of HCA are presented and include discussions on: the definition of the hydrophobic clusters and their relationships with secondary and tertiary structures; the length of the clusters; the amino acid classification used for HCA; the HCA plot programs; and the working strategies . Various procedures for the analysis of a single sequence are presented: structural segmentation, structural domains and secondary structure evaluation . Like most sequence analysis methods, HCA is more efficient when several homologous sequences are compared . Procedures for the detection and alignment of distantly related proteins by HCA are described through several published examples along with 2 previously unreported cases: the beta-glucosidase from Ruminococcus albus is clearly related to the beta-glucosidases from Clostridum thermocellum and Hansenula anomala although they display a reverse organization of their constitutive domains; the alignment of the sequence of human GTPase activating protein with that of the Crk oncogene is presented . Finally, the pertinence of HCA in the identification of important residues for structure/function as well as in the preparation of homology modelling is discussed. J Periodontal Res, 1990 Jul, 25(4), 250 - 3 Accessible sialic acid content of oral epithelial cells from healthy and gingivitis subjects; Davis G et al.; The purpose of the present study was to determine if there were differences in the quantity of accessible sialic acid on superficial epithelial cells collected from different areas of the mouth, and from healthy subjects with good oral hygiene, as compared to subjects with gingivitis . Superficial epithelial cells were collected by gently scraping the tongue dorsum, hard palate, free gingiva and buccal epithelium . The cells were washed and treated with clostridial neuraminidase to release accessible sialic acid; this was quantitated using a fluorometric assay . Buccal cells released an average of 62.6 ng sialic acid per 10,000 cells, which was nearly 3-fold more than cells from the hard palate (24.1 ng), free gingiva (21.9 ng), or tongue (15.4 ng) . Buccal and free gingival cells collected from 5 healthy subjects had significantly higher levels of accessible sialic acid on their surface than cells collected from 5 subjects with gingivitis . These differences were significant at the p less than 0.001 and p less than 0.01 levels, respectively . The data obtained suggest that the oral hygiene status of an individual can influence the quantity of accessible sialic acid residues on oral epithelium; this would be expected to influence the attachment and colonization of bacteria which bind to sialic acid-containing receptors. Vet Immunol Immunopathol, 1990 Jun, 25(2), 167 - 75 Humoral immunity in the ewe . 3 . The influence of adjuvants and immunisation regimes on immune reactivity in the breeding ewe and her progeny; Reynolds GE et al.; Breeding ewes were immunised with clostridial vaccine using different inoculation schedules . Results, showing differences in the class of antibody produced, were heavily dependent on the vaccination regime used . Immunoglobulin M (IgM) levels were significantly lower in ewes given double doses of vaccine compared to ewes given a single inoculation or no treatment at all (P less than 0.01) . Neonatal lambs showed significant de novo IgM production with interference in this antibody production in the lambs of ewes vaccinated with the clostridial vaccine (P less than 0.05) . Immunoglobulin G1 (IgG1) levels were significantly increased in all lambs which had mothers vaccinated with the clostridial vaccine prior to or during pregnancy (P less than 0.025) . The greatest quantity of IgG1 was transferred to lambs when their mothers were given a double injection with primary inoculation prior to conception and booster prepartum (P less than 0.025) . No antigen specific immunoglobulin G2 (IgG2) was detected in the lambs . Ewes were also immunised with BSA and their isotype specific serum antibody response was compared with their respective lambs . There was no detectable anti-BSA IgM in the lambs of all groups of ewes though specific IgG1 antibodies could be readily detected in the lambs of hyperimmunised ewes . The efficiency of transfer was related directly to the ability of the adjuvant to maximise IgG1 production in the ewe . Although immunised ewes produced high levels of IgG2, this was not transferred passively to the lamb. J Clin Microbiol, 1990 Jun, 28(6), 1135 - 8 Accuracy and reproducibility of the MicroScan rapid anaerobe identification system with an automated reader; Stoakes L et al.; Rapid anaerobe identification (MicroScan) panels (4 h) were evaluated both visually and by the AutoScan-4, a computer-controlled microplate reader . The results of both reading methods were compared with identifications obtained by the conventional (Virginia Polytechnic Institute) method . In total, 237 anaerobes were tested . Correct identifications were obtained for 166 strains (70%) by visual reading and 157 strains (66.2%) by the AutoScan-4 . Supplementary tests resulted in 80.1 and 76.7% total correct identifications, respectively . Comparison of the two reading methods revealed complete agreement for 169 strains . Differences between the two reading methods were due to difficulties in reading specific reactions . This was especially true with the clostridial species . The performance of the MicroScan system in the identification of anaerobic bacteria appears comparable to that of other 4-h identification systems for anaerobes, but this system shows significant variance from the conventional system . Improvements in the trays and data base are required before the system can be recommended for routine use. Vestn Khir Im I I Grek, 1990 Jun, 144(6), 28 - 31 {Improving the clinico-microbiological diagnosis and treatment of non-clostridial anaerobic peritonitis}; Zimon IN et al.; On the basis of clinico-microbiological examinations the presence of anaerobic flora was found in 104 out of 198 patients with peritonitis . The authors propose using intra-aortal++ transfusions of oxygenated blood in complex therapy of anaerobic peritonitis. Khirurgiia (Mosk), 1990 Jun, (6), 33 - 8 {Characteristics of wound infection in long-term crush syndrome}; Fedorov VD et al.; Clinicobacteriological examination was carried out in 31 patients with the crush syndrome (CS) and extensive damage to the soft tissues in combination with bone fractures complicated by wound infection . Inadequate surgical treatment in the early periods after the trauma (complete closure of the wound, making small incisions of the involved skin and subcutaneous fat) is particularly hazardous in such cases because it leads to the development of severe wound infection . This disease is marked by a complex polymicrobial structure of the causative agents, massive dissemination of aerobic and opportunistic anaerobic bacteria in the purulent focus (10(7)-10(9) microbial bodies), and a high proportion (48.4%) of obligate anaerobic microflora . Wound infection in the CS takes a grave clinical course, but without profound microbiological study it is difficult to differentiate it into aerobic and anaerobic (clostridial and ++non-clostridial) forms . This is evidence of the need for emergency extended bacteriological diagnosis at all the stages of treatment . "Pure" aerobic infection was identified in half of the patients and mixed aerobic-anaerobic infection in the other half . The possibility of the involvement of asporogenic anaerobes is shown (35.5% of cases) . The high risk of the development of gas gangrene is detected (9.7%) and its is concluded that early prevention is necessary by adequate surgical intervention, adequate intensive antibacterial and detoxification therapy, including hyperbaric therapy . The efficacy of current antigangrene immunization agents must be evaluated. Vestn Otorinolaringol, 1990 May-Jun, (3), 22 - 5 {The role of non-clostridial anaerobic infections in the etiology, pathogenesis, clinical aspects and treatment of inflammatory diseases of the paranasal sinuses}; Mirazizov KD et al.; This paper presents the results of clinical and bacteriological examinations of 116 patients with suppurative rhinosinusitis . Bacteriological tests under anaerobic conditions revealed in 53% of the patients nonclostridium anaerobic bacteria that were highly resistant to most antibiotics and sensitive to metronidazole and its derivatives . A protocol of conservative therapy of suppurative rhinosinusitis was developed . The protocol included etiotrophic antianaerobic drugs (metronidazole and its derivatives) and oxygenation of paranasal sinuses . This therapeutic approach yielded positive effects in 92% of the patients. Berl Munch Tierarztl Wochenschr, 1990 May 1, 103(5), 167 - 72 {Bacteriological studies of the problem "Epidemic losses in hares and deer in habitats with high cultivation of 00-rapeseed"}; Bohnel H et al.; Within the scope of the research work for possible reasons of the so-called "wildlife mortality" more than 900 specimens of 440 animals (183 hares, 153 deer, 14 rabbits found dead, and 98 hares and 6 deer shot by hunters) were checked for the presence of Clostridia in inner organs . The results show that in 40.3% of the animals found dead but only in 13.3% of the hunted hares Clostridia were to be found . Out of the isolated Clostridia strains 24.4% could not be identified; potentially pathogenic species were found in 78.3% of isolates of hares, 81.7% of those of deer and in 9.2% of those of hunted hares . 23.9% of the isolates were C . perfringens . Considering the known epizootiology of clostridioses it can be concluded that clostridia certainly play a role in losses of wildlife, as well in hares as in deer . Triggering factors could lie in the kind of feed which is available for animals in modern agrarian landscape . During the critical period in autumn and winter there are mainly crop plants like rapeseed, wheat and barley only available for wildlife. Orthop Rev, 1990 Apr, 19(4), 333 - 41 Gas gangrene . A review; Present DA et al.; Gas gangrene continues to cause significant morbidity and mortality . This monograph reviews the entire spectrum of clostridial infection, including its etiology, pathophysiology, diagnosis, current recommended treatment, and prophylaxis . The early diagnosis of gas gangrene is paramount, as delay in aggressive combined treatment may result in death. J Pediatr Surg, 1990 Mar, 25(3), 346 - 8 Cyclic neutropenia with colonic perforation and nonhealing colocutaneous fistula; Langer JC et al.; Cyclic neutropenia is an hereditary disorder of white blood cells, characterized by profound neutropenic episodes approximately every three weeks . Septic complications are usually limited to cutaneous and oropharyngeal infections . A 4-year-old boy with known cyclic neutropenia was in shock with neutropenia, clostridial septicemia, and right lower quadrant peritonitis when he was admitted . At the time of laparotomy, inflammation of the cecum, with no gross perforation, was found; no resection or appendectomy was done . He subsequently developed a right lower quadrant abscess that was drained, resulting in a colocutaneous fistula . For the next 8 months his fistula persisted, with intermittent episodes of fever, increased fistula output, and abdominal pain during his neutropenic periods . Standard nonoperative approaches to healing the fistula failed (ie, elemental feeds, total parenteral nutrition, irrigations, antibiotics, and drains) . Attempts to medically abolish his neutropenic episodes using lithium, gammaglobulin, and steroids also failed . Ultimately, he underwent an ileocecal resection with primary anastamosis; the operation was done immediately following a neutropenic episode, in order to allow adequate healing of his anastamosis before his next period of neutropenia . Postoperative course was satisfactory, and he remains well after 8 months follow-up . This case, and several similar previously reported cases, illustrate that cyclic neutropenia may present with serious surgical complications . They also underlines the important role that neutrophils play in the healing of enteric fistulae. J Foot Surg, 1990 Mar-Apr, 29(2), 141 - 6 Nonclostridial gas gangrene; Weisenfeld LS et al.; Although nonclostridial gas gangrene is not an unusual occurrence, relatively few cases including the distal lower extremity have been reported . Due to the serious nature of some of these infections, it is important for physicians to familiarize themselves with these nonclostridial crepitant infections, which are often confused with clostridial myonecrosis . Etiology, evaluation, and treatment is described by the authors . Also, a case study is presented. Vestn Oftalmol, 1990 Mar-Apr, 106(2), 61 - 3 {Non-clostridial anaerobes as a cause of post-traumatic keratitis}; Volkov VV et al.; Up to present nonclostridial anaerobes in the opal cavity were not regarded as a cause of inflammatory ophthalmic diseases . The present case with injury to the cornea inflicted with a tooth fragment was extremely difficult to diagnose, and keratitis, induced by oral cavity anaerobes, difficult to cure . Only subtotal perforating keratoplasty stopped the process and prevented the death of the eye. Arch Biochem Biophys, 1990 Feb 1, 276(2), 317 - 21 Kinetic study of nucleophile specificity in dipeptide synthesis catalyzed by clostridiopeptidase B; Fortier G et al.; The kinetic parameters of Clostridiopeptidase B-catalyzed aminolysis of carbobenzoxyarginyl methyl ester leading to the formation of various dipeptides are investigated . The deacylation rates of the acylenzyme were evaluated by direct product analysis using high-performance liquid chromatography on a reversed-phase column . On the basis of the partitioning ratio and the first-order and second-order rate constants for the deacylation step, large differences in the nucleophile reactivities, which appear to be related to a S'1-P'1 interaction, were observed . The order of specificity was established as Leu much greater than Ser greater than Phe greater than Val greater than Ala = Gly much greater than Pro with second-order rate constants ranging from 578,614 M-1 s-1 for leucinamide to 5132 M-1 s-1 in the case of prolinamide . All of the amino acid amides had a nucleophilic strength at least 10 times higher than that of water during the deacylation step . The data reported here represent the first experimental evidence for the existence of a S'1 site engaged in the recognition of the amino acid side chain residue for this enzyme . The recognition site showed an increase in the affinity along with an increase in the hydrophobicity of the amino acid amide side chains. Clin Microbiol Rev, 1990 Jan, 3(1), 66 - 98 Toxigenic clostridia; Hatheway CL; Toxigenic clostridia belonging to 13 recognized species are discussed in this review . Each species or group of organisms is, in general, introduced by presenting the historical aspects of its discovery by early investigators of human and animal diseases . The diseases caused by each species or group are described and usually discussed in relation to the toxins involved in the pathology . Morphological and physiological characteristics of the organisms are described . Finally, the toxins produced by each organism are listed, with a presentation of their biological activities and physical and biochemical characteristics . The complete amino acid sequences for some are known, and some of the genes have been cloned . The term toxin is used loosely to include the various antigenic protein products of these organisms with biological and serological activities which have served as distinguishing characteristics for differentiation and classification . Some of these factors are not truly toxic and have no known role in pathogenicity . Some of the interesting factors common to more than one species or group are the following: neurotoxins, lethal toxins, lecithinases, oxygen-labile hemolysins, binary toxins, and ADP-ribosyltransferases . Problems in bacterial nomenclature and designation of biologically active factors are noted. Scand J Infect Dis, 1990, 22(2), 205 - 8 Influence of ciprofloxacin on the colonic microflora in young and elderly volunteers: no impact of the altered drug absorption; Ljungberg B et al.; The colonic microflora was studied before, on the fifth day of dosing, and 2 weeks after a 5-day oral course of ciprofloxacin 500 mg BID given to 7 young and 7 elderly, healthy volunteers . Considerable changes in the aerobic microflora were found, while the effects on the anaerobic bacteria were less pronounced . Despite larger absolute bioavailability of the first dose in the elderly (77 vs . 63%; p less than 0.05), the effect of ciprofloxacin on the microflora was similar in the two groups of volunteers . A higher number of clostridia were detected in faeces from elderly subjects before, during, and after the ciprofloxacin regimen. J Hyg Epidemiol Microbiol Immunol, 1990, 34(2), 191 - 8 Microbiological diagnosis of suppurative-inflammatory processes of the E . N . T . organs and the maxillo-mandibulo-facial region under suspicion of anaerobic non-clostridial infection; Mironov AYu et al.; The etiological role of non-sporulating anaerobic bacteria as causative agents of suppurative-inflammatory diseases (SID) of the maxillo-mandibulo-facial region and the E . N . T . organs as studied . Express diagnosis of anaerobic infection was carried out by means of gas-liquid chromatography . The species-specific composition of the microflora of the suppurative focus was investigated . It was established that only obligate anaerobes in monoculture or in association were isolated from patients with so-called "sterile" inoculations when strictly anaerobic bacteriological technique was used . The use of anaerobic bacteriological technique of investigation enlarged the spectrum of the microflora isolated from the suppurative focus from 5 to 26 species . Results of chromatographic and bacteriological examinations were compared; the main causes of obtaining false-positive and false-negative results of chromatography were analysed . Statistical processing using factor analysis has shown that the information power of chromatographic examination of the metabolites of anaerobic bacteria is higher in comparison with the main clinical-laboratory indices, but statistical processing using cluster analysis and correlation analysis has revealed that an index like metabolic activity reflects the degree of real participation of anaerobic microflora in the development of the pathological process, and can be used in the clinic for the evaluation of the degree of severity of the course of the SID and of the effectiveness of treatment. Instr Course Lect, 1990, 39, 491 - 3 Clostridial myonecrosis; Patzakis MJ; The best treatment for gas gangrene is prevention by following the principles of thorough debridement, immediate effective parenteral antibiotic therapy, and delayed closure of open fractures. Arch Orthop Trauma Surg, 1990, 109(2), 72 - 4 Antibiotic prophylaxis in lower-extremity amputations due to ischemia . A prospective, randomized trial of cephalothin versus methicillin; Thomsen S et al.; The efficiency of prophylactic antibiotic therapy in amputation surgery was studied in a prospective, randomized trial of a first-generation cephalosporin (cephalothin) compared with a narrow-spectrum beta-lactam stable penicillin (methicillin) . Eighty-eight patients received cephalothin 2 g X 4 on the day of operation, while 86 patients received methicillin 1 g X 4 . The patients were followed up for 21 days . Infected wounds occurred in 14.8% of the patients in the cephalothin group, compared with 14% in the methicillin group . The frequency of deep infections was 10.2% versus 4.7% (P = 0.1611) . The reamputation frequency was 18.2% in the cephalothin group compared with 12.8% in the methicillin group; the frequency of below-knee reamputation was 18.4% versus 7.7% (P = 0.1469) . No clostridial infections were found . The study did not demonstrate any significant difference between cephalothin and methicillin in the prophylaxis for lower-extremity amputations, although the latter drug tended to be the best choice. J Infect Dis, 1990 Jan, 161(1), 116 - 9 SA11 rotavirus is specifically inhibited by an acetylated sialic acid; Willoughby RE et al.; Bovine salivary mucin (BSM) inhibits rotavirus replication in vitro and in vivo . The inhibitory effect of BSM in vitro is abolished by Arthrobacter ureafaciens neuraminidase but not by Clostridia perfringens neuraminidase; it is abolished by mild base deacetylation but not by influenza C acetylesterase . The data suggest that SA11 rotavirus binds to a specific sialic acid structure on BSM different from the sialic acids recognized by other viruses. J Postgrad Med, 1990 Jan, 36(1), 13 - 5 Role of hyperbaric oxygen therapy in the rapid control of gas gangrene infection and its toxaemia; Trivedi DR et al.; Fifteen cases of proved gas gangrene infection were studied to assess the rapidity of control of infection and associated toxaemia, by hyperbaric oxygen therapy at 2 1/2 atmospheres pressure . Within 3-5 sittings, all the cases (100%) were found to become devoid of clostridial organisms as judged by smear and culture methods. Chirurgie, 1990, 116(4-5), 378 - 83; discussion 383-4 {Surgical indications of hyperbaric oxygen therapy}; Baranger B et al.; Beside clostridial myonecrosis surgical utilization of hyperbaric oxygen remain unprecise . After review of literature, analysis of their experience, the authors define: principles and effects of hyperbaric oxygen, his position with regard to surgical intervention, its surgical utilizations: unquestionable (non clostridial and clostridial gas gangrene), relative (aerobic cellulitis, diabetic arterial disease), preventive. J Pediatr, 1989 Dec, 115(6), 949 - 53 Transfusion of infants with activation of erythrocyte T antigen; Williams RA et al.; A protocol for transfusion of infants with erythrocyte T-antigen activation was evaluated for safety and effectiveness in a prospective, 3-year, sequential series of 1672 infants admitted for intensive care . Erythrocyte T antigens are activated by enzymes produced by clostridia or other bacteria in infants with sepsis, often in association with necrotizing enterocolitis . Transfusion of these infants with blood products containing plasma carries the risk of causing intravascular hemolysis . Our transfusion protocol included testing for T-antigen activation, restricting transfusion of patients with activated T antigens to washed erythrocytes or washed platelets whenever possible, and selecting donors with low-titer anti-T when plasma-containing blood products were required . In this series, 10 patients had T-antigen activation, including four with clostridial infections . Severe hemolysis occurred in one patient who received plasma before T-antigen activation developed . Of five patients who received low-titer anti-T plasma, mild hemolysis occurred in three and no hemolysis in two . Four patients who received no plasma-containing blood products experienced no hemolysis . Used cautiously, this protocol allows a full range of transfusion therapy to infants with T-antigen activation. Crit Care Nurse, 1989 Nov-Dec, 9(10), 30 - 8 Gas gangrene: certain diagnosis or certain death; Corry M et al.; Clostridia are organisms which, in the right environment, can cause a rapidly spreading, fulminant myonecrosis . Early diagnosis and a combined management program are clearly paramount to a successful outcome . Knowledge of this disease and ongoing meticulous assessment are the tools that a nurse must use when dealing with patients who have gas gangrene or are at high risk of developing it . In the face of radical disfigurements that may follow therapeutic measures, the potential transfer to a distant center for treatment, and a deteriorating prognosis, the nurse must remain alert to patient and family psychologic needs. Proc Natl Acad Sci U S A, 1989 Oct, 86(20), 7853 - 6 Clostridial glycine reductase: protein C, the acetyl group acceptor, catalyzes the arsenate-dependent decomposition of acetyl phosphate; Stadtman TC; The highly purified protein C component of clostridial glycine reductase is required in addition to seleno-protein A and protein B for the conversion of glycine to acetate and ammonia in the presence of arsenate . As shown by Arkowitz and Abeles {Arkowitz, R . A . & Abeles, R . H . (1989) Biochemistry 28, 4639-4644}, the products are ammonia and acetyl phosphate in the presence of phosphate . The protein C component alone catalyzes an arsenate-dependent decomposition of acetyl phosphate, showing that it serves as the acetyl group acceptor in the overall reaction . A thiol-reducing agent and Mg2+ are required for catalysis of the arsenolysis reaction by protein C . Alkylation or heating at 60 degrees C completely abolishes the ability of protein C to catalyze the arsenolysis reaction and to participate as an essential component in the overall glycine reductase reaction. South Med J, 1989 Oct, 82(10), 1272 - 4 Spontaneous clostridial myonecrosis in a man with drug-induced agranulocytosis; Slovick FT et al.; A middle-aged man had spontaneous clostridial myonecrosis during a period of neutropenia caused by drug-induced agranulocytosis . This complication in the absence of any prior cytotoxic chemotherapy or any evidence of an ileocecal neoplasm argues for the central role of neutropenia in the development of this rare syndrome . Survival of the patient was dependent upon prompt, aggressive medical and surgical management and the spontaneous recovery of the neutrophil count. J Dairy Sci, 1989 Oct, 72(10), 2565 - 72 Ammonia-treated alfalfa silage for lactating dairy cows; Kung L Jr et al.; Alfalfa was treated (3.3% of forage wet weight) with an aqua-NH3 (14% N) mix prior to ensiling in 2 consecutive yr . In the 1st yr, NH3-treated silage containing 30.5% DM was higher in pH, N, NH3N, acetic acid and butyric acid contents, and lower in amino acids, soluble carbohydrates, and lactic acid than two untreated silages having 32.8 and 47.5% DM . Milk composition and DM intake did not differ among treatments when these silages constituted 50% of the dietary DM and were fed to lactating cows . In situ and in vitro, but not in vivo, digestion of NDF was greater for NH3 silage . Dry matter content of NH3-treated silage in the 2nd yr was 36.1% and that of the two untreated silages was 37.8 and 54.9% . Silage N, NH3N, and acetic acid content were greater in treated silage . However, pH and butyric acid content were similar among treatments and lactic acid was greater for treated silage . Similar to findings in the 1st yr, milk production and DM intake were not different among treatments . Adding NH3 to alfalfa decreased proteolysis; however, when DM was low (30.5%), the buffering effect of NH3 apparently resulted in increased clostridial fermentation . This did not occur when silage DM was increased to 36.1%, presumably due to higher osmotic pressure . Ammonia addition enhanced fiber digestibility but had no effect on milk production. Antibiot Khimioter, 1989 Sep, 34(9), 707 - 11 {Empirical antibiotic therapy of wounds complicated by anaerobic non-clostridial infection}; Borisova OK et al.; Antibacterial activity of 14 drugs against clinical strains of asporogenic anaerobes causing wound infections in the soft tissues i . e . Bacteroides fragilis and Bacteroides melaninogenicus as well as anaerobic gram-positive++ cocci was assayed with the method of serial dilutions in agar . It was shown that among the investigated species B . fragilis had the most marked resistance since out of the 14 drugs only 8 were sufficiently active against it i.e . carbenicillin, levomycetin, lincomycin, dioxidine, metronidazole, thinidazole, nitrazole and erythromycin . The choice of drugs for treating infections caused by B . melaninogenicus and anaerobic grampositive cocci unlike those caused by B . fragilis offered no difficulty since practically++ all the investigated drugs were highly active against the causative agents . There was observed relationship between the frequency of asporogenic anaerobes and the wound genesis . The characteristic features of the species composition connected with localization of the suppurative foci were indicated . The detected specific antimicrobial profiles of the asporogenic anaerobes causing wound infections and the peculiarity of their participation in development of purulent infections of the soft tissues provided a differential approach to empirical antibacterial therapy prior to the pathogen bacteriological investigation and availability of the antibioticograms. Berl Munch Tierarztl Wochenschr, 1989 Sep 1, 102(9), 310 - 7 {The seasonal toxigenicity of different cultured plants for clostridia in relation to so-called wildlife mortality}; Bohnel H et al.; In the juice of plants which could be eaten by hares different amounts of toxins (haemolysin, lecithinase) could be found after the partly addition of a C . perfringens field strain and subsequent anaerobic incubation . Sterile filtrates showed a very pronounced toxigenicity . The presented results proof in tendency that oilseed-rape (00-rape seed), wheat, and barley as green plants can contribute in clostridial toxicosis in hares, whereas grass and beets are involved only partially, and clover is practically completely atoxigenic. Vestn Khir Im I I Grek, 1989 Aug, 144(8), 21 - 4 {Characteristics of the course of peritonitis in relation to the degree of perforation of the gastrointestinal tract}; Shurkalin BK et al.; An examination and treatment of 80 patients with general forms of peritonitis has shown that the course of the disease is greatly dependent on the character of the bacterial dissemination of the abdominal cavity . A microbiological examination has shown that in all the levels of perforation of the gastro-intestinal tract there are associations of various microorganisms . The most severe course of peritonitis is observed when caused by infection by colonic contents with prevailing anaerobic ++non-clostridial microflora in the exudate . The method of repeated revisions of the abdominal cavity should be used for these forms of peritonitis. Clin Orthop, 1989 Jul, (244), 254 - 7 Sepsis due to an infected pseudocyst of hemophilia . A case report; Ferenz CC et al.; A 42-year-old Factor-VIII-deficient hemophiliac developed an infected pseudocyst and subsequent clostridial sepsis . Wide surgical debridement and precise medical management provided for survival in this patient's case . The treatment of choice for this rarely encountered problem was radical excisional surgery along with antibiotics and replenishment of all necessary blood products. Khirurgiia (Mosk), 1989 Jun, (6), 68 - 71 {Diagnosis and treatment of suppurative processes caused by non-clostridial anaerobic microflora}; Ofanesian SS; One hundred and fifty patients suffering from various purulent diseases (60 persons) and postoperative purulent complications (90 persons) caused by nonclostridial anaerobes were examined . Nonclostridial anaerobic bacteria were isolated most frequently in acute mastitis, paraproctitis, and postinfectious abscesses among patients of the first group and after appendectomy and resection of the large intestine among those of the second group . The character of the wound discharge, the location of the focus of infection, the tendency of the purulent process to form a great number of cavities and fistules, bacterioscopy of the native material, etc . help in establishing the diagnosis (before the results of bacteriological tests are obtained) . Purulent processes caused by a combination of anaerobic cocci and aerobic flora take a particularly unfavourable course . Antibiotic therapy should consists of high doses of one or two antibiotics combined with metronidazole and nystatin. Biochem J, 1989 May 15, 260(1), 259 - 63 A continuous fluorimetric assay for clostridial collagenase and Pz-peptidase activity; Barrett AJ et al.; The peptide derivative N alpha-(2,4-dinitrophenyl)-L-prolyl-L-leucyl-glycyl-L-prolyl-L-tryptophanyl-D- lysine (Dnp-Pro-Leu-Gly-Pro-Trp-D-Lys) has been found to be a convenient substrate for the assay of clostridial collagenase and Pz-peptidase . The substrate shows a 25-fold enhancement of fluorescence (gamma ex . 283 nm, lambda em . 350 nm) following hydrolysis of the Leu2-Gly3 peptide bond . The value of Km for clostridial collagenase was 17 microM . The substrate for the first time makes possible continuous fluorimetric assays for Pz-peptidase and clostridial collagenase. J Foot Surg, 1989 May-Jun, 28(3), 213 - 6 Nonclostridial gas gangrene; Markantone SS et al.; Podiatric physicians must realize that the presence of crepitus, and/or radiographic evidence of gas in the subcutaneous tissue, does not necessarily mean anaerobic clostridial gas gangrene . This is especially true in the diabetic where other gas producing organisms have been isolated . The authors provide a literature review, and case study, of nonclostridial gas gangrene. J Am Acad Dermatol, 1989 May, 20(5 Pt 1), 774 - 81 Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients; Umbert IJ et al.; We studied the clinical, microbiologic, and histopathologic findings from 14 patients with necrotizing fasciitis; also tissue obtained at autopsy was available from six patients . In all cases, material cultured was positive for multiple organisms, including Clostridia and fungi; organisms were identified by histochemical staining of tissue sections in 12 of 14 cases . The histologic pattern comprised edema, necrosis, and inflammation of skin, subcutaneous fat, and fascial tissue . Hyalin necrosis of sweat glands was observed in five patients . Thrombosis of vessels at all levels was a prominent feature, suggesting that study of coagulation factors may be important . Diagnosis may be confirmed by the histologic picture; however, microbiologic material is essential to guide therapy. Ann Vasc Surg, 1989 Apr, 3(2), 146 - 52 Human microvessel endothelial cell isolation and vascular graft sodding in the operating room; Williams SK et al.; We have evaluated multiple factors inherent to an operating room-compatible endothelial cell procurement and sodding procedure . Microvessel endothelial cell isolations have been performed on fat tissue obtained from over 140 patients with a 100% success rate . Liposuction-derived fat was optimal with respect to cell yield, and isolation time . The devices and equipment used were acceptable to the operating room and the complete cell procurement procedure was successful even in the hands of personnel with minimal training . Fat digestion was achieved using crude clostridial collagenase, with an average cell yield of 1 x 10(6) microvessel endothelial cells/gm of fat . Evaluation of this procedure with canine fat using an operating room acceptable procedure resulted in a 100% procurement success rate requiring 1.5 hours (+/- .5 hrs) for completion of the fat isolation, and cell isolation procedure . Microvessel EC could subsequently be used in graft seeding or sodding techniques to establish endothelial cell monolayers on vascular grafts . Our results indicate that one person with minimal cell isolation background can reproducibly isolate large quantities of sterile autologous endothelial cells in the operating room for immediate use in endothelial cell seeding/sodding procedures. Aust Paediatr J, 1989 Apr, 25(2), 99 - 100 Intestinal perforation in children; Wardhan H et al.; There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S . Hospital, Varanasi during a 3 year period . Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris lumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation . Radiological evidence of pneumoperitoneum was seen in 88% of patients . The majority of cases in this study were older than 5 years of age (48%) . Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro-organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes . The overall mortality rate was high (19%). Presse Med, 1989 Apr 1, 18(13), 675 - 8 {Gas gangrene after aseptic orthopedic surgery}; Moine P et al.; Gas gangrene following scheduled orthopedic surgery is not uncommon . In order to assess its frequency and prognosis, identify possible predisposing factors and suggest preventive measures, we reviewed the records of 22 patients (14 males and 8 females, mean age 40 +/- 20 years) admitted between 1969 and 1987 who developed gas gangrene in the wake of orthopedic surgery . In all cases the lower limbs were the site of operation: the knee in 9, the hip in 4, the femur in 4 and the leg in 5 cases . Surgical procedures included on-site foreign material in 19 cases, pneumatic tourniquet in 6 and prolonged vascular stretch in 9 . Infection was diagnosed within 1.4 +/- 1.1 days of surgery; local signs, especially crepitants and pain, were prominent for the diagnosis . Pathologic findings consisted of myonecrosis in 18 patients and cellulitis in 4 . Local bacteriological studies, carried out in 19 patients, yielded organisms in 14, including 12 with Clostridia perfringens . Four patients (one despite surgical treatment) died within 24 hours of admission . The remainder were treated with a combination of surgery, antimicrobial therapy (18) and hyperbaric oxygen (17) . Subsequently, 13 patients had severe functional disability, while 5 recovered without sequelae . In view of the poor prognosis of gas gangrene, several preventive measures are suggested during aseptic surgery of the lower limbs . Careful skin preparation, cleaning of the anal region and short-term prophylactic antibiotic therapy with cefamandole or amoxycillin-clavulanic acid, are among them. J Exp Med, 1989 Mar 1, 169(3), 1011 - 20 Activated murine macrophages secrete a metabolite of arginine with the bioactivity of endothelium-derived relaxing factor and the chemical reactivity of nitric oxide; Stuehr DJ et al.; L-arginine-dependent synthesis of nitrite (NO2-) and nitrate (NO3-) by macrophages correlates with and is required for their execution of nonspecific cytotoxicity toward some tumor cells and microbes . However, the bioactive L-arginine metabolites responsible for cytotoxicity are unknown . Mammalian endothelial cells have recently been shown to release nitric oxide (NO.); we therefore determined if this reactive metabolite was synthesized by activated murine macrophages . Macrophage-derived NO . was detected by two independent methods: a bioassay for NO.-mediated relaxation of preconstricted rings of rabbit aorta; and a spectroscopic measurement of the reaction of NO . with clostridial ferredoxin, an Fe-S protein . After activation with IFN-gamma and LPS, macrophages continuously secreted a substance that relaxed rabbit aortic rings denuded of endothelium . Production of the vasorelaxant was enhanced by 0.5 mM L-arginine and inhibited reversibly by NG-methylated L-arginine analogs that block macrophage NO2-/NO3- synthesis . The vasorelaxant was scavenged by ferrous myoglobin, was labile, and was neither NO2- nor a cyclooxygenase metabolite . Activated M phi also secreted a substance that bleached Fd, a reaction carried out by NO . and NO2, but not NO2- . Macrophage bleaching of Fd correlated directly with time, cell number, and concomitant NO2-/NO3- production, required L-arginine, and was independent of reactive oxygen intermediates . Thus, activated murine M phi release NO . and/or a closely related, highly reactive nitrogen oxide such as NO2, during their conversion of L-arginine to NO2-/NO3- . NO . and NO2 may mediate L-arginine-dependent pathologic effects of M phi, as well as physiologic effects not previously considered for this widely distributed cell type. Dtsch Med Wochenschr, 1989 Feb 24, 114(8), 293 - 7 {Neutropenic enterocolitis}; von Herbay A et al.; In three patients with neutropenia who had died after a short period from their basic disease (myelodysplasia, medullary carcinoma, acute myeloic leukaemia), autopsy revealed segmental necrotising enterocolitis in the caecal region (neutropenic enterocolitis) . Morphologically the enterocolitis was characterised by necrotized mucosa, marked oedema of the intestinal wall, intramural gas, the absence of pseudomembranes and a nearly complete absence of inflammatory cell infiltrates . In one case a palpable abdominal tumour had been produced by pseudotumorous thickening of the intestinal wall . The pathogenesis in these three cases might be a neutropenia-associated disturbance of the intestinal flora with selective proliferation of toxin-producing clostridia. Mol Biochem Parasitol, 1989 Jan 15, 32(2-3), 229 - 46 Identification, synthesis and immunogenicity of cuticular collagens from the filarial nematodes Brugia malayi and Brugia pahangi; Selkirk ME et al.; The major structural proteins of the cuticle of the filarial nematode parasites Brugia malayi and Brugia pahangi were identified by extrinsic iodination and sensitivity to clostridial collagenase . At least 16 acidic components were identified in adult worms by 2-dimensional electrophoresis, with molecular weights ranging from 35,000 to 160,000 . These proteins appear to be cross-linked by disulphide bonds, and localised in the basal and inner cortical layers of the cuticle . The outer cortex, containing the epicuticle, is insoluble in 1% sodium dodecyl sulphate and 5% 2-mercaptoethanol, and can be isolated free of cellular material . Despite their inaccessibility to the immune system in intact worms, antibodies to the cuticular collagens are provoked in humans infected with a variety of filarial parasites . Immunological cross-reactivity was demonstrated between a 35 kDa component and human type IV (basement membrane) collagen . Autoantibodies to type IV collagen were detected in a number of individuals with lymphatic filariasis, although no correlation could be drawn with observed pathology . Synthesis of cuticular collagens is discontinuous, occurs at negligible levels in mature adult male worms, and does not appear to involve the production of small molecular weight precursors, in contrast to Caenorhabditis elegans . Hybridisation with a heterologous cDNA probe coding for the alpha 2 chain of chicken type 1 collagen suggests that they are encoded by a multigene family. South Med J, 1989 Jan, 82(1), 29 - 31 Clostridial bloodstream infections; Ingram CW et al.; In a ten-year review at a large community teaching hospital clostridia accounted for less than 1% of all positive bloodstream isolates (26 episodes in 25 patients) . All but one of the isolates were clinically significant . Twenty-two patients (88%) had a serious underlying medical condition, and 17 of the episodes (65%) were associated with a bowel source; twelve patients (48%) died of their infection . Clostridial bloodstream infections are particularly clinically significant in patients with serious underlying disease. Khirurgiia (Mosk), 1989 Jan, (1), 78 - 80 {Non-clostridial anaerobes in the etiopathogenesis of perivesical cholangiogenic abscesses of the liver}; Zemskov VS et al.; The authors had under observation 318 patients who were subjected to operation and suffered from various inflammatory diseases of the bile tract; perivesical and cholangiogenic abscesses of the liver were found in 33 of them . Bacteriological tests of the contents of the abscesses demonstrated most frequently the presence of Bacteroides fragilis as a monoculture in cholangiogenic abscesses and associations of anaerobic and aerobic bacteria in perivesical abscesses . Early operation with obligatory consideration for the anaerobic component of the microflora is recommended. Acta Chir Belg, 1989 Jan-Feb, 89(1), 25 - 8 "Spontaneous" non clostridial gas gangrene: case report and review of the literature; Hubens G et al.; The authors present a case of spontaneous non clostridial gas gangrene and discuss the possible etiology, the microbiology as well as the treatment compared to the literature. Klin Khir, 1989, (10), 3 - 5 {Acute anaerobic destruction of the lungs}; Grigo'rev EG et al.; Seventy eight patients with bacterial destruction of the lungs were under observation . Non-clostridial anaerobic microflora was identified by a method of gas-liquid chromatography in 57(74.6%) patients . Of them, 8 had gangrene, 49--acute pulmonary abscesses . In all the cases, there were associations of asporous anaerobic microflora with aerobic bacteria . In all the patients with destruction of pulmonary tissue, the increase in the content of the middle mass molecules was noted, the greatest--in patients with gangrene of a lung . In these patients, the bactericidal activity of blood serum, IgM and IgA content were low . In all patients, the complex treatment was performed. Z Rechtsmed, 1989, 103(1), 1 - 20 {Complications following cell therapy}; Bohl J et al.; So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system . The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA) . Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method . Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal . Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years . Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe . She died 25 days after the injection as a consequence of central and peripheral respiratory failure . Autopsy revealed the alterations typical for acute Landry-Guillain-Barre-Strohl syndrome . (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years . After an injection of cell suspensions a painful local swelling was observed . The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood . The patient was transferred to a surgical department for further therapy . Two days after the injection she suddenly died with signs of acute cardiovascular failure . Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barre syndrome with involvement of the autonomic nervous system . In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues . This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system . The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis) . The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure . The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised. J Comp Physiol {B}, 1989, 159(5), 517 - 25 The glue protein of ribbed mussels (Geukensia demissa): a natural adhesive with some features of collagen; Waite JH et al.; The Atlantic ribbed mussel Geukensia (Modiolus) demissa attaches itself to the roots of cord grass and other hard objects in tidal salt marshes by spinning adhesive byssal threads . The precursor of a protein apparently present in the adhesive plaques of the threads was isolated in quantity from the foot of the mussel . The protein has an apparent molecular weight of 130,000, a pI of 8.1, and contains a high proportion of Gly, Glu/Gln, Lys and 3,4-dihydroxyphenyl-L-alanine (DOPA) . Sequence of tryptic peptides suggests a pattern of repeated motifs, such as: Gly--DOPA--Lys, and X--Gly--DOPA--Y--Z--Gly--DOPA/Tyr--Lys, where X is Thr or Ala in octapeptides and Gln--Thr in nonapeptides . Y is variable, but more often than not hydrophobic; and Z is frequently Pro or 4-trans-hydroxyproline (Hyp) . The presence of Pro--Gly and Hyp--Gly sequences of delta-hydroxylysine in the protein is reminiscent of typical collagens; however, the protein is not labile to clostridial collagenase, nor does collagen cross-react with antibodies raised against the mussel protein . Unlike typical collagens, Gly probably occurs only at every 4th or 5th residue in this unusual mussel protein. J Rheumatol, 1988 Nov, 15(11), 1677 - 82 In vitro protection of the articular surface by cross-linking agents; Stanescu R et al.; The effects of cross-linking agents on the resistance of the articular surface to digestion with clostridial collagenase were studied using a described in vitro system . Mouse femoral heads were treated with various concentrations of glutaraldehyde, with osmium tetraoxide and with dithiobis (succinimydil propionate), digested with the enzyme, labeled with cationized ferritin and examined by electron microscopy . Collagenase alone caused disruption of the articular surface with penetration of the large marker into the cartilage matrix . After treatment of the femoral heads with the cross-linking agents, no effects on the morphology and on the labeling of the articular surface and no penetration of the label into the cartilage matrix were observed . Increasing cross-linking at the articular surface might be a new route for therapeutic intervention . However, experiments would be needed to assess the effect of the procedure on the viability and nutrition of chondrocytes and on the functional properties of the tissue. Postgrad Med, 1988 Oct, 84(5), 148 - 58, 161-3, 166-8 Systemic infections affecting the liver . Some cause jaundice, some do not; Cunha BA; The patient who has clinical jaundice, abnormal results on liver function tests, or both presents a difficult diagnostic challenge . Many infectious diseases affect the liver, and the extent of involvement determines the degree of clinically apparent jaundice . Some diseases that affect the liver minimally cause no jaundice at all . An important clue to the cause of the disorder is the pattern of abnormal results on liver function tests . Increased alkaline phosphatase predominates with Q fever, secondary or tertiary syphilis, clonorchiasis, and hepatic candidiasis, while elevated levels of serum transaminases characterize viral hepatitis, leptospirosis, mononucleosis syndromes, legionnaires' disease, typhoid fever, toxic shock syndrome, and yellow fever . Increases in serum bilirubin are typical with jaundice caused by clostridial myelonecrosis, severe bacterial sepsis, and relapsing fever (borreliosis) . These findings together with the patient's history, physical findings, and basic laboratory tests provide a presumptive diagnosis in most cases. Mol Biochem Parasitol, 1988 Oct, 31(1), 27 - 33 Nucleotide sequence analysis of an Entamoeba histolytica ferredoxin gene; Huber M et al.; A cDNA clone (subclone B) previously isolated from the human parasite Entamoeba histolytica was characterized . DNA sequence analysis of subclone B identified the DNA as that encoding apoferredoxin . E . histolytica ferredoxin cDNA contains unusually short 5' and 3' noncoding regions of 9 and 25 nucleotides, respectively . A genomic ferredoxin clone was isolated from E . histolytica DNA, and comparison of genomic and cDNA sequences revealed that the ferredoxin gene is unspliced . The deduced amino acid sequence of E . histolytica ferredoxin resembles clostridial type of ferredoxins, and shows an arrangement of cysteines characteristic for the coordination of 2{4Fe-4S} centres . Of interest is the absence of an aromatic amino acid in the N-terminal region of the protein, a feature which is conserved in clostridial ferredoxins . Southern blot analysis of three different E . histolytica strains (200:NIH, Rahman and HM-1:IMSS) demonstrated the presence of a family of at least two ferredoxin genes . One of these genes is marked by restriction length polymorphisms in different strains of E . histolytica. J Am Vet Med Assoc, 1988 Sep 15, 193(6), 668 - 70 Intramuscular injection techniques and the development of clostridial myositis or cellulitis in horses; Brown CM et al.; A survey of 584 veterinarians in equine practice was performed to determine their intramuscular injection techniques and the influence of those techniques on the development of clostridial myositis or cellulitis . Usable responses were obtained from 439 veterinarians (75.2%) . Of these, 414 used a new needle and syringe for each injection, 241 swabbed the site with a cleansing/disinfectant agent, and 242 swabbed the top of multidose injection bottles with a similar solution . Only 2 clipped the hair at the injection site . Twenty eight of the respondents reported that at least 1 horse developed a clostridial infection at the injection site following 1 of their injections . None of the various injection techniques had a significant influence on the development of clostridial infection at the injection site. J Chromatogr, 1988 Jun 17, 442, 267 - 77 Detection by high-performance liquid chromatography of polyamines formed by clostridial putrefaction of caseins; Karlsson S et al.; Casein incorporated in building materials is degraded by species of alkali-tolerant Clostridia . A whole range of compounds have previously been detected in degraded building materials containing casein as an additive by gas chromatography (GC), including volatile and non-volatile organic acids, alcohols, ketones, aldehydes and monoamines . Using high-performance liquid chromatography (HPLC) it was possible, however, also to detect polyamines formed in degraded caseins . Histamine, agmatine, serotonine, tyramine, tryptamine, putrescine and cadaverine were detected in solutions containing casein in which the alkali-tolerant Clostriadia had been grown . Uninoculated, sterile incubated caseins contained no detectable amounts of polyamines . This gives clear evidence of the role of the biotic environment in the degradation of caseins . A combination of GC and HPLC therefore, provides a convenient set of techniques for studying the degradation products of casein. J Biol Chem, 1988 Jun 5, 263(16), 7717 - 25 Isolation and characterization of the Saccharomyces cerevisiae MIS1 gene encoding mitochondrial C1-tetrahydrofolate synthase; Shannon KW et al.; C1-Tetrahydrofolate synthase is a trifunctional polypeptide found in eukaryotic organisms that catalyzes 10-formyltetrahydrofolate synthetase (EC 6.3.4.3), 5,10-methenyltetrahydrofolate cyclohydrolase (EC 3.5.4.9), and 5,10-methylenetetrahydrofolate dehydrogenase (EC 1.5.1.5) activities . In Saccharomyces cerevisiae, C1-tetrahydrofolate synthase is found in both the cytoplasm and the mitochondria . The gene encoding yeast mitochondrial C1-tetrahydrofolate synthase was isolated using synthetic oligonucleotide probes based on the amino-terminal sequence of the purified protein . Hybridization analysis shows that the gene (designated MIS1) has a single copy in the yeast genome . The predicted amino acid sequence of mitochondrial C1-tetrahydrofolate synthase shares 71% identity with yeast C1-tetrahydrofolate synthase and shares 39% identity with clostridial 10-formyltetrahydrofolate synthetase . Chromosomal deletions of the mitochondrial C1-tetrahydrofolate synthase gene were generated using the cloned MIS1 gene . Mutant strains which lack a functional MIS1 gene are viable and can grow in medium containing a nonfermentable carbon source . In fact, deletion of the MIS1 locus has no detectable effect on cell growth. Development, 1988 Jun, 103(2), 259 - 67 The role of interstitial collagens in cleft formation of mouse embryonic submandibular gland during initial branching; Fukuda Y et al.; An interstitial collagenase was purified from the explant medium of bovine dental pulp and was shown to degrade collagens I and III but not IV and V . The enzyme halted cleft initiation in the epithelium of 12-day mouse embryonic submandibular glands in vitro, indicating the active involvement of interstitial collagens in the branching morphogenesis . Transmission electron microscopic observation of the intact 12-day gland without any clefts showed the scattered localization of a few collagen fibrils at the epithelial-mesenchymal interface of the bulb and also revealed the presence of numerous microfibrils around the stalk . Collagen bundles were regularly seen close to the wavy basal lamina at the bottom of clefts of the intact 13-day gland and 12-day gland cultured for 17 h under normal conditions . Mesenchymal cells were found in the clefts together with the frequent localization of peripheral nerve fibres and capillary endothelial cells . The collagen bundles were more often observed in the 12-day gland cultured in the presence of bovine dental pulp collagenase inhibitor, which had been shown to enhance cleft formation . In contrast, collagen fibrils were rarely found at the epithelial-mesenchymal interface of the 12-day gland cultured in the presence of Clostridial or bovine dental pulp collagenase . The findings indicated that the formation of interstitial collagen bundles is essential to form clefts in the epithelium both in vivo and in vitro. FEBS Lett, 1988 May 9, 232(1), 145 - 7 Inhibition of N-acetylneuraminate lyase by N-acetyl-4-oxo-D-neuraminic acid; Gross HJ et al.; We show that the 4-oxo analogue of N-acetyl-D-neuraminic acid strongly inhibits N-acetylneuraminate lyase (NeuAc aldolase, EC 4.1.3.3) from Clostridum perfringens (Ki = 0.025 mM) and Escherichia coli (Ki = 0.15 mM) . In each case the inhibition was competitive . N-Acetyl-D-neuraminic acid; N-Acetylneuraminate lyase; N-Acetyl-D-neuraminic acid analog; 5-Acetamido-3,5-dideoxy-beta-D-manno-non-2,4-diulosonic acid; 2-Deoxy-2,3-didehydro-N-acetyl-4-oxo-neuraminic acid; Competitive inhibitor. Biochem J, 1988 Mar 1, 250(2), 605 - 12 CO oxidoreductase from Streptomyces strain G26 is a molybdenum hydroxylase; Bell JM et al.; CO oxidoreductase was purified to 95% homogeneity from crude mycelial extracts of Streptomyces G26 . The purified preparation has a specific activity of 25.7 units/mg, a 13-fold improvement on crude soluble mycelial extracts . The native enzyme (Mr 282,000) is composed of non-identical subunits of Mr 110,000 and 33,000 . It is a molybdenum hydroxylase containing 1.6 mol of FAD, 7.3 mol of Fe, 8.3 mol of acid-labile sulphide and 1.3 mol of Mo per mol of enzyme . Purified CO oxidoreductase catalyses the reduction of benzyl viologen, confirming the previously reported ability of this enzyme to interact with low-potential acceptors . Cytochrome c reduction cannot be accounted for entirely by non-enzymic reduction by superoxide radicals . NAD+ and NADP+ are not reduced, nor is clostridial ferredoxin. Clin Orthop, 1988 Mar, (228), 265 - 9 Postoperative clostridial infection . A case report; Moehring HD; The classic fulminating, rapidly progressive, and potentially lethal clostridial myonecrosis (CM), also known as gas gangrene, is a familiar entity . Nevertheless, individual experience with this dreaded disease is extremely rare or nonexistent . Clostridial cellulitis does not involve muscle necrosis and is associated with a lower mortality rate . Although still potentially limb threatening, clostridial cellulitis is a source of considerable morbidity . In a 13-year-old boy the symptoms did not appear until two weeks postoperatively . Definitive treatment was not instituted until five days later. Rev Infect Dis, 1988 Mar-Apr, 10(2), 347 - 64 Unusual infections associated with colorectal cancer; Panwalker AP; Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to the presence of a malignancy . The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors . Seven patients seen at one hospital over a 5-year period illustrate the clinical presentations of such infections . The infections identified in these seven patients include endocarditis, meningitis, nontraumatic gas gangrene, empyema, hepatic abscesses, retroperitoneal abscess, clostridial sepsis, and colovesical fistulae with urosepsis . A computer-assisted search of the English-language literature and cross-checks from other review articles identified other infections associated with colon cancer, which include nontraumatic crepitant cellulitis, suppurative thyroiditis, pericarditis, appendicitis, pulmonary microabscesses, septic arthritis, and fever of unknown origin . The clinical importance of these infections and their correlation with colorectal malignancies are reviewed. Vestn Khir Im I I Grek, 1988 Mar, 140(3), 50 - 4 {Complications of non-clostridial anaerobic peritonitis}; Shurkalin BK et al.; Under observation there were 71 patients with non-clostridial anaerobic peritonitis, 37 of them having complications--suppurations of operation wounds, phlegmons of the abdominal wall, abscesses of the abdominal cavity, postoperative non-clostridial peritonitis . Fourteen patients died (37.8%). J Pediatr Surg, 1988 Feb, 23(2), 130 - 4 Umbilical gangrene in the newborn; Stunden RJ et al.; Six neonates are described with a gangrenous omphalitis, a disease not reported for many years . They had many features in common including previous good health . In two, the disease was preceded by the application of tobacco ash to the umbilical stump . Clinically there was gangrene of the umbilicus with a blood-stained discharge and extensive cellulitis radiating into the abdominal wall . Despite aggressive therapy including excision of the affected area, the systemic effects of the local disease progressed rapidly until all of the first five infants who presented, died . Microbiologically there was a polybacterial infection involving a wide variety of organisms particularly E coli and Clostridia species . There appeared to be an appropriate response by the infants to an acute bacterial infection, and two patients investigated showed no evidence of cellular or humoral immunodeficiency . The pathology was an infection causing local tissue necrosis with a vasculitis and microabscess formation, which involved adjacent structures by direct extension . The severe systemic symptoms were attributable to an endotoxemia or exotoxemia . The evolution of therapy for gangreneous omphalitis in the newborn, successful in the sixth patient, is discussed. J Invest Dermatol, 1988 Feb, 90(2), 127 - 33 Epidermolysis bullosa acquisita antigen: relationship between the collagenase-sensitive and -insensitive domains; Yoshiike T et al.; To clarify the relationship of the 290 and 145 kDa chains of the epidermolysis bullosa acquisita (EBA) antigen, we subjected urea extracts of skin basement membrane zone (BMZ) proteins and isolated 290 and 145 kDa chains of the EBA antigen cut out of sodium dodecyl sulfate polyacrylamide gels to treatment with clostridial collagenase . When the reaction products were electrophoresed, transblotted, and reacted with EBA patient sera or two monoclonal antibodies to the EBA antigen, the 290 kDa chain was degraded into the 145 kDa band that was resistant to cleavage with collagenase . The 145 kDa domain, isolated after collagenase treatment of the whole BMZ extract, was resistant to degradation by hyaluronidase, chondroitinase ABC, heparinase, and heparitinase but was readily degraded by V-8 protease . These data suggest that the EBA antigen consists of collagen and noncollagen domains of identical size (Mr 145,000), and that the 145 kDa noncollagen domain is generated via degradation of the native 290 kDa species by collagenase. Z Erkr Atmungsorgane, 1988, 170(1), 70 - 5 {Diagnosis of anaerobic bacteria in bronchial secretions in pulmonary diseases}; Wendel H et al.; In 50 bronchoscopic examinations the microflora of bronchial secretions has been investigated especially in order to detect anaerobic microbes with the use of the glove-box-method . In 19 patients we found the bronchial secretions steril (particularly carcinomas) . Eight patients showed anaerobic gramnegative rods (Bacteroides and Fusobacteria) as predominant germs . Also in eight patients we found a mixed culture consisting in several anaerobic gram-negative rods, anaerobic gram-positive sporeless rods, anaerobic cocci, partly Clostridia and aerobes (carcinomas, pneumonias) . A contamination can be excluded . In a series of patients anaerobes must be considered as infectious agent, in abscessed pneumonias particularly Bacteroides and Fusobacteria . Repeatedly an impressive clinical improvement has been established under the treatment by Metronidazol . The evidence of anaerobes especially succeeded in cases with copious mucopurulent or pure purulent secretions . The accumulation of anaerobes in bronchial secretions in alcoholics is evident. Vestn Khir Im I I Grek, 1988 Jan, 140(1), 74 - 7 {Surgical tactics in anaerobic non-clostridial peritonitis}; Shurkalin BK et al.; Under observation there were 128 patients with neclostridial peritonitis (NP) which made up 19.3% of the total number of patients with peritonitis . In spreaded NP when the source of NP was successfully eliminated and fibrinous layers on the peritoneum the laparotomy wound was tightly sutured up to the aponeurosis (included), primary delayed sutures were put on the skin . When it was impossible to completely remove all the fibrin from the peritoneum, the wound was sutured through all the layers, the sutures were tied in bows followed by numerous revisions of the abdominal cavity . Laparotomy was performed in postoperative NP with phlegmons of the abdominal cavity . The use of the tactics described allowed lethality to be reduced from 39.4% to 13.7%. Agents Actions, 1987 Dec, 22(3-4), 310 - 3 Multisystem toxicity of indomethacin: effects on kidney, liver and intestine in the rat; Fracasso ME et al.; Some studies on the relationships among toxic effects in rat liver, kidney and intestine have been carried out . Indomethacin caused a marked reduction in microsomal enzymes, such as cytochrome P450, cytochrome b5 and aminopyrine N-demethylase in the kidney and the liver, greater in the former and for a shorter time than in the latter . Indomethacin induced intestinal lesions and marked overgrowth of intestinal bacteria, mainly of aerobic bacteria in the first 24 hours after its administration and anaerobic bacteria such as Clostridii in the second day . These findings enable us to suggest that the drug induces multisystem lesions through different mechanisms involving either a direct effect on the tissue or other microbiological or pharmacological factors. Postgrad Med, 1987 Nov 1, 82(6), 77 - 9, 82, 84-5 Overwhelming infections in trauma; Hitchcock CR; Following trauma, wound contamination with aerobic and/or anaerobic bacteria should always be suspected . Treatment with antibacterial antibiotics should begin immediately in the emergency room, particularly for those patients with fractures . Patients with serious trauma are best treated by a team of specialists including general surgeons, orthopedists, infectious disease specialists, and intensive care specialists . The author recommends transport of seriously injured patients to major hospitals specializing in the care of trauma . Particularly when gas gangrene secondary to clostridial infection is suspected, the patient should be moved to a major trauma center with the capability for hyperbaric oxygen therapy. Gastroenterology, 1987 Nov, 93(5), 986 - 93 Comparison of the biochemical changes in the jejunal mucosa of dogs with aerobic and anaerobic bacterial overgrowth; Batt RM et al.; Subcellular biochemical changes in the jejunal mucosa have been compared in dogs with either aerobic or anaerobic bacterial overgrowth to explore relationships between composition of the flora and mucosal damage . Affected animals comprised 17 German shepherd dogs with chronic diarrhea or weight loss, or both . Analysis of duodenal juice demonstrated aerobic overgrowth in 10 cases, most frequently comprising enterococci and Escherichia coli, and obligate anaerobic overgrowth in 7 cases, most frequently including Clostridia spp . Histologic changes were minimal; however, examination of peroral jejunal biopsy specimens by sucrose density gradient centrifugation revealed specific biochemical abnormalities . In the dogs with aerobic overgrowth, there was a selective loss of brush border alkaline phosphatase activity, and gamma-glutamyl transferase activity was increased, whereas activities of disaccharidases and aminopeptidase N were unaltered . In contrast, anaerobic overgrowth was associated with a reduction in brush border density, indicative of a considerable fall in the glycoprotein-to-lipid ratio of the brush border membrane, whereas brush border enzyme activities were unaltered . There was a loss of peroxisomal catalase activity in dogs with aerobic overgrowth, and an indication of mitochondrial disruption in dogs with anaerobic overgrowth, but little evidence for damage to other subcellular organelles . These findings demonstrate that aerobic and anaerobic overgrowth may be associated with distinct but different mucosal abnormalities particularly affecting the brush border membrane. J Biol Chem, 1987 Oct 5, 262(28), 13706 - 12 Anchoring fibrils contain the carboxyl-terminal globular domain of type VII procollagen, but lack the amino-terminal globular domain; Lunstrum GP et al.; Type VII procollagen has been characterized as a product of epithelial cell lines . As secreted, it contains a large triple-helical domain terminated by a multi-globular-domained carboxyl terminus (NC-1), and a smaller amino-terminal globule (NC-2) . The triple helix and the NC-1 domain have previously been identified in anchoring fibril-containing tissues by biochemical and immunochemical means, leading to the conclusion that type VII collagen is a major component of anchoring fibrils . In order to better characterize the tissue form of type VII collagen, we have produced a panel of monoclonal antibodies which recognize the NC-1 domain . Peptide mapping of these epitopes indicate that they are independent and span approximately 125,000 kDa of the total 150,000 kDa of each alpha chain contained in NC-1 . All these antibodies elicit immunofluorescent staining of the basement membrane zone in tissues . Type VII collagen has been extracted from tissues . As previously reported, it is smaller than type VII procollagen, (Woodley, D . T., Burgeson, R . E., Lunstrum, G . P., Bruckner-Tuderman, L., and Briggaman, R . A., submitted for publication), and we now find that it predominantly occurs as a dimer . Following clostridial collagenase digestion, intact NC-1 has been recognized, indicating that the difference in apparent Mr between the tissue form of the molecule and type VII procollagen results from modification of the amino terminus . The size of the amino-terminal globule has been determined to be between approximately 96 and 102 kDa . Rotary shadowing analyses of extracted molecules indicate that dimeric molecules contain the NC-1 domain, but are missing intact NC-2 . We propose that the tissue form monomer, Mr = 960,000, be referred to as "type VII collagen." These studies strongly suggest that anchoring fibrils contain dimeric molecules with intact NC-1 domains . The data also support the previous suggestion that the NC-2 domain is involved in the formation of disulfide bond-stabilized type VII collagen dimers, and is subsequently removed by physiological proteolytic processing. Klin Monatsbl Augenheilkd, 1987 Oct, 191(4), 292 - 5 {Gas gangrene of the eyelids and orbits}; Pittke EC et al.; Infections with Clostridia are very rare in the orbital region . On the basis of a case report of such an infection in the orbit the authors discuss the clinical behavior, diagnosis, and therapy of this infection with anaerobic bacteria . Computerized tomography was been very helpful in the diagnostic procedure. Vestn Khir Im I I Grek, 1987 Sep, 139(9), 55 - 8 {Principles of treatment of non-clostridial anaerobic infection in the surgery of inflammatory diseases of the biliary tract}; Arik'iants MS; Based upon the clinico-bacteriological examination of 196 patients with different inflammatory diseases of bile ducts the author has established the role of non-clostridial anaerobic infection in the appearance of these diseases . Clinical symptoms of the infection have been systematically described . New principles of the surgical tactics and antibacterial prophylactics have been developed and used which allowed postoperative lethality to be reduced to 1% . The duration of treatment at the hospital became shorter (8.4 days). Vestn Khir Im I I Grek, 1987 Jul, 139(7), 139 - 41 {Treatment of non-clostridial anaerobic infections in patients with diabetes mellitus in an isolated controlled abacterial medium}; Kuleshov EV et al.; The work presents data on treatment of 28 patients with neclostridial anaerobic infection developed against the background of diabetes mellitus . It was shown that characteristics clinical symptoms of the ailment and express-microscopic examination of the native material from the wound facilitated making the correct diagnosis in most cases without using complicated microbiological and chromatographic investigations. J Theor Biol, 1987 May 7, 126(1), 15 - 32 Antibacterial immunity and its modeling in experimental tumor tetanus and wound tetanus of the mouse; Schneeweiss U et al.; The experimental and theoretical analysis of the tumor-tetanus phenomenon has provided us with new insights into the pathogenesis of tetanus infection . Our theoretical model of clostridial propagation in the proliferating tissue is based upon the principle of mitosis-controlled rod division (hit and cloning model) . It has lent itself to the description of early growth stages of the clostridial rod population in our experiments of tumor tetanus and of wound tetanus of the mouse . However, the later course of the tetanus lethality curves under antitoxin protection, about a week following injection of the tumor cell-spore or CaCl2-spore suspensions, reveals a pronounced delay in clostridial propagation . Based on our model we can explain this process by a humoral immune reaction directed against the clostridial rods taking into account the variability of elimination of the heterologous tetanus antitoxin applied . The experimental results are in good agreement with those obtained by computer simulation . The theoretical knowledge resulting from these studies can be used for the interpretation of the serodiagnostic tumor test with apathogenic clostridia as well as for the quantitative assessment of the malignancy of neoplastic growth. Vet Rec, 1987 May 2, 120(18), 435 - 9 Injection site reactions and antibody responses in sheep and goats after the use of multivalent clostridial vaccines; Green DS et al.; Uncertainty concerning the use, efficacy and possible adverse effects of clostridial vaccination in goats prompted a study of the injection site reactions and antibody responses in 40 goats and 40 sheep . The vaccines used were Covexin 8, Heptavac and Tasvax 8 . In all the animals swellings averaging 2.5 cm in diameter were present at the injection site seven days after vaccination and were still apparent 28 days after vaccination . The injection site reactions could not be attributed to faulty vaccination technique because they did not occur in a control group injected with sterile water . By 14 days the reactions were significantly larger in sheep than in goats and by 28 days the reactions to Covexin 8 were larger than those to the other vaccines in sheep and goats . Serum antibody was present in all groups before vaccination and, with the exception of the goats vaccinated with Heptavac, increased 14 days after vaccination . The increase was greater in sheep than in goats . By 28 days antibody levels had declined in all but the sheep vaccinated with Heptavac in which a further increase occurred . At that time, the antibody levels in vaccinated sheep were still higher than in the unvaccinated sheep whereas the antibody levels in vaccinated goats were no longer different from those in the control goats . These results suggest that there is a difference between the vaccines used and between the responses of the two species and support the clinical observation that the protection afforded to goats by multivalent clostridial vaccines is poorer than that afforded to sheep. J Vasc Surg, 1987 May, 5(5), 787 - 90 Control of infection in the diabetic foot: the role of microbiology, immunopathology, antibiotics, and guillotine amputation; McIntyre KE; Newer culture techniques have demonstrated that diabetic foot infections are polymicrobial, involving both anaerobic and aerobic bacteria . These infections are characteristically foul-smelling and create immense tissue destruction . Occasionally, despite the absence of clostridial organisms, subcutaneous gas may be present . The importance of adequate surgical debridement has been emphasized . In the event of advancing, unremitting infection involving the foot, ankle guillotine amputation may be a life-saving technique . Finally, the role of host-defense mechanism in diabetes is important . Polymorphonuclear leukocyte chemotaxis and phagocytosis are energy-dependent processes that are deficient in the diabetic . Better diabetic control with maintenance of normal blood sugars and avoidance of ketoacidosis may be the key to prevention of these morbid, lower extremity infections. Vestn Khir Im I I Grek, 1987 Apr, 138(4), 38 - 42 {Effect of low-frequency ultrasound on non-clostridial anaerobic microflora}; Gostishchev VK et al.; Under analysis is an experience with the treatment of 78 patients with various purulent diseases of soft tissues caused by non-clostridial anaerobic microorganisms in a pure form or in combination with aerobic microflora treated with using low frequency ultrasound . The ultrasound was found not to alter the antimicrobial properties of antibacterial drugs . The degree of bacterial dissemination of the wounds was reliably lower . By the end of the treatment (on the 10-11th days) no growth of microflora was found in 25.7% of the examined patients . The sensitivity of anaerobic microorganisms to antibiotics not only became higher in the process of treatment with ultrasound but there appeared strains sensitive to other antibiotics. Arch Pathol Lab Med, 1987 Apr, 111(4), 342 - 5 A method for cytologic examination of cartilaginous lesions; Mitchell ML et al.; Chondrocytes, dissociated from their matrix with trypsin and clostridial collagenase, retain their cytologic integrity . Successful preparations have been made from postmortem as well as surgical specimens . The method may lend itself to diagnosis of both neoplastic and developmental lesions. Ann Chir Gynaecol, 1987, 76(2), 136 - 7 Perineal progressive myonecrosis following Thiersch's operation for rectal prolapse; Rye BA et al.; An extremely rare case of progressive perineal clostridial myonecrosis secondary to Thiersch's operation for rectal prolapse illustrates the need for early recognition of the initial clinical findings to maximize the chances for survival . Management of these infections include prompt administration of shock therapy, a broad spectrum of antibiotics, and thorough surgical debridement of all involved tissue . Prophylactic systemic antibiotic therapy must be considered, especially in hig