Presse Med, 1997 Nov 15, 26(35), 1671 - 2 {Pneumopathy caused by minocycline}; Levy A et al.; BACKGROUND: Minocycline has been identified as a pathogenic agent in drug-induced pneumonia . We report a new case . CASE REPORT: A 38-year-old female asthmatic patient was given minocycline (100 mg/j) for facial acne . She was allergic to penicillin . Other treatments were theophylline, salbutamol and inhaled budesonide . Severe bilateral hypoxemia pneumonia developed with high eosinophil blood counts within a few days of treatment onset . The lung disease regressed with minocycline withdrawal . DISCUSSION: This case is exceptional because the minocycline-induced lung disease continued to progress despite high-dose corticosteroids in this asthmatic patient. Biosens Bioelectron, 1997, 12(9-10), 917 - 23 Application of fuzzy logic in multicomponent analysis by optodes; Wollenweber M et al.; Fuzzy logic can be a useful tool for the determination of substrate concentrations applying optode arrays in combination with flow injection analysis, UV-VIS spectroscopy and kinetics . The transient diffuse reflectance spectra in the visible wavelength region from four optodes were evaluated to carry out the simultaneous determination of artificial mixtures of ampicillin and penicillin . The discrimination of the samples was achieved by changing the composition of the receptor gel and working pH . Different algorithms of pre-processing were applied on the data to reduce the spectral information to a few analytic-specific variables . These variables were used to develop the fuzzy model . After calibration the model was validated by an independent test data set. Brain Res, 1997 Nov 28, 777(1-2), 86 - 94 The connection between absence-like seizures and hypothermia induced by penicillin: possible implication on other animal models of petit mal epilepsy; Ostojic ZS et al.; In this study we investigated the relationship between penicillin-induced hypothermia and petit mal epilepsy induced by this proconvulsant antibiotic . In order to find a possible dose-dependent relationship, we used two doses: 1500.000 and 1000.000 U/kg b.wt., both known as being sufficient to induce absence-like attacks with subsequent spike and wave discharges (SWD) in electrocorticogram (ECoG) . Because of experimental data suggesting penicillin binding to benzodiazepine receptor recognition site, we also studied penicillin-induced changes in body temperature after diazepam pretreatment . Results of this study clearly show that penicillin in doses known to induce petit mal-like epilepsy concomitantly induces statistically significant dose-dependent decrease in body temperature . Pretreatment with diazepam completely prevents both penicillin-induced hypothermia and SWDs . On the other hand, both the diazepam and mixed diazepam + penicillin treatments did not significantly alter body temperature . These results suggest, however, that at least some of the penicillin effects described could be assigned to its binding to the benzodiazepine receptor recognition site at GABA(A) ionophore . This may have an important clinical implication because the inhibitory action of penicillin at the benzodiazepine receptor recognition site could account for the mechanism of penicillin-induced unspecific encephalopathies in humans . The relationship between petit mal epilepsy and hypothermia sheds new light on the action mechanisms of penicillin-induced absence seizures. Vojnosanit Pregl, 1997 Jul-Aug, 54(4), 341 - 6 {Clinico-statistical analysis of the approach to retained foreign bodies in the extremities}; Ivanovski A; The investigation in 200 wounded in battles was performed by clinical-statistic analysis . The aim of the study was to analyze the procedure with foreign bodies in the extremities after the primary surgical management of the wound . It was established that primary surgical management of the wound, besides the coexisting difficulties (field work conditions, impaired supply etc.), was correctly performed with the early administration of 2 prophylactic antibiotics (Longaceph, Garamycin, Tolycar and Penicillin) in therapeutical doses during 3 to 10 days after the wounding . The "finishing" which included the repair of incompletely performed primary surgical management of the wound: incomplete nephrectomy, unadequate hemostasis, drainage, incorrect immobilization, etc . was performed in 32% of the wounded . The results imply that the accessible foreign bodies near the wound were removed without the excessive damage to the adjoining soft tissue . After the whole treatment, 3% of war wounds were found to be infected . Two fistulas from foreign bodies and 4 osteites were noticed and they were cured by the surgical treatment and antibiotic therapy. Epidemiol Infect, 1997 Dec, 119(3), 349 - 56 The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan; Luby SP et al.; To determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, we collected sera in 1993 from a geographically based random sample of residents, and in 1994 identified 15 HCV-infected individuals (cases) and 67 age and sex matched uninfected individuals (controls) . Initially we approached 504 households, and collected serum from a randomly selected household member in 309 (64%) . Twenty persons (6.5%) had anti-HCV antibody; 31% percent had hepatitis B core antibodies, and 4.3% had hepatitis B surface antigen . In the case-control study, persons who received more therapeutic injections (categorized as averaging 1, 2-4, 5-9 or > 10 injections per year in the previous 10 years) were more likely to be infected with HCV (odds ratio 0, 1.5, 2.5 and 6.9 respectively, P = 0.008) compared to persons averaging 0 injections per year . Efforts to limit therapeutic injections to only those that are medically indicated and that use sterile equipment are essential in order to prevent transmission of HCVPIP: To determine the prevalence of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, sera were collected in 1993 from a geographically representative random sample of 309 adults and children . 20 serum samples (6.5%) had anti-HCV antibodies, 89 (31%) had hepatitis B core antibodies, and 12 (4.3%) had hepatitis B surface antigens . The prevalence of HCV increased markedly with age; no cases were detected among children under 10 years old . A follow-up study of 15 of these HCV cases and 67 age- and sex-matched healthy controls was conducted in 1994 . Compared to noninfected controls, HCV cases were significantly more likely to have received 5 or more injections in the previous 10 years (odds ratio, 5.4; 95% confidence interval, 1.2-28.0) . Only 5 HCV cases had received blood transfusions, and none reported intravenous drug use . Inspection of 3 private health clinics in Hafizabad exposed disposable syringes and needles--used primarily for vitamin B complex, chloroquine, and penicillin--soaking in a bowl of tepid water . Extrapolation of this study's findings suggests 800 new cases of HCV and 109 HCV-related deaths in Hafizabad each year . HCV infection could be reduced substantially by efforts to limit injections to those that are medically essential and to ensure the use of sterile equipment . Adv Biochem Eng Biotechnol, 1998, 59, 1 - 46 Fed-batch bioproduction of spectinomycin; Gomes J et al.; Actinomycetes produce about 67% of the known antibiotics covering a wide range of chemical structures . However, their filamentous growth present several problems during industrial processes . Among these problems oxygen transfer limitation is critical . In this chapter we present the role of oxygen in spectinomycin production by a Streptomyces species . Spectinomycin, a broad spectrum antibiotic effective against penicillin resistant gonorrhea, is an aminoglycoside constituted from two glucose moieties . Its bioproduction is strongly influenced by glucose and oxygen . We have shown that for a fixed dissolved oxygen concentration, there are two specific glucose concentrations which give maximum final titers of spectinomycin . The bi-modal maximum indicates the influence of two intermediate metabolites in spectinomycin biosynthesis . We propose a mechanism for spectinomycin biosynthesis and subsequently develop a model based on this mechanism . The proposed mechanism for spectinomycin biosynthesis is validated by successfully reconstructing the air flow rate profiles . A nonlinear systems theory technique termed External Differential Representation, is implemented to reconstruct the spectinomycin bioconversion process which then predicts the spectinomycin concentration from the air flow rate profile . This signifies that spectinomycin titers in industrial fed-batch processes can be controlled if a priori information about the air flow rate profile yielding maximum spectinomycin is available. Curr Opin Struct Biol, 1997 Dec, 7(6), 857 - 64 Proteins of the penicillin biosynthesis pathway; Schofield CJ et al.; Two sequential steps are common to the biosynthesis of all penicillin-derived antibiotics: the reaction of three L-amino acids to give L-delta-(alpha-aminoadipoyl)-L-cysteinyl-D-valine, and the oxidation of this tripeptide to give isopenicillin N . Recent studies on the peptide synthetase and oxidase enzymes responsible for these steps have implications for the mechanisms and structures of related enzymes involved in a range of metabolic processes. Clin Exp Allergy, 1997 Dec, 27(12), 1425 - 31 Allergic reactions to ampicillin . Studies on the specificity and selectivity in subjects with immediate reactions; Romano A et al.; BACKGROUND: Ampicillin (AMP) is a drug that has been prescribed extensively . Reactions that have been reported include exanthema, desquamative contact eczema, urticaria and anaphylaxis . Experimental evidence indicates that the side chain of AMP is a structure that may induce a selective immune response either at the humoral or lymphocyte T-cell level . With regard to IgE reactions, the selectivity and specificity of the response needs to be studied in humans . OBJECTIVES: To study the specificity of the IgE response in a group of subjects who had an immediate allergic reaction after the administration of AMP . METHODS: Subjects developing an immediate response (anaphylaxis or urticaria) after the administration of AMP or an aminopenicillin derivative with the same side chain as AMP were studied . Skin tests were made to determinants generated from benzyl penicillin (BP): benzyl penicilloyl (BPO) and minor determinant mixture (MDM), as well as amoxicillin (AX) and AMP . Specific IgE antibodies were determined to benzyl penicilloyl polylisine (BPO-PLL), amoxicilloyl-polylisine (AX-PLL) and ampicilloyl-polylisine (AMP-PLL) . The specificity of the IgE antibody response was studied by RAST and RAST inhibition . Subjects were classified in three categories: group A: those who were skin test and/or RAST positive to determinants derived from benzylpenicllin, group B: those who were negative to determinants derived from benzylpenicillin but were skin test and/or RAST positive to determinants derived from AX and AMP and group C: those who were exclusively positive to determinants derived from AMP . RESULTS: A total of 48 subjects was included in the study . In group A there were 35 cases, in group B 10 cases, and in group C three cases . RAST inhibition studies showed that in some instances the side chain of AMP could induce specific responses with a variable degree of crossreactivity between BP and AX . CONCLUSIONS: Athough AMP can induce an immediate IgE response in subjects allergic to betalactams and the structure of the side chain may contribute to the specificity of the response, our results indicate that in most instances crossreactivity with the other penicillins exists and that in the groups studied selective reactions to just AMP derived determinants were uncommon. Prescrire Int, 1998 Feb, 7(33), 16 - 8 Pneumococcal vaccine: a second look . Solution for SC or IM injection: pneumococcal vaccine; Glutamate metabotropic receptors modulate the expression of in vitro epileptiform activity in rat hippocampal slices; Laboratorio di Farmacologia, Istituto Superiore di Sanita, Roma, ItalyThe effects of the mixed class I and II mGLUR agonist (+) 1S,3R-trans-amino-cyclopentane-1,3-dicarboxylic acid (ACPD) and antagonists (+) alpha-methyl-4-carboxyphenylglycine (MCPG) and L-2-amino-3-phosphonopropionic acid (L-AP3) on the basal neuronal excitability and on the expression of in vitro epileptiform activity produced by the convulsant drugs picrotoxin and penicillin were investigated in rat hippocampal slices . The duration of the CA1 epileptiform bursting produced by 0.05 mM picrotoxin or 1 mM penicillin or 0.075 mM ACPD was significantly (p<0.05) and dose-dependently decreased by 0.3-0.5 mM MCPG or L-AP3, but not by 0.05 mM ACPD . The data demonstrate an involvement of class I and II mGLURs in the basal neuronal excitability and in the expression of in vitro epileptiform activity produced by some convulsants. Bull Soc Pathol Exot, 1997, 90(3), 189 - 91 {Erysipelas of the leg in hospital environment in Lome (Togo)}; Pitche P et al.; A study was conducted during 5 years to determine the epidemiological clinical profile and the evolution of legs erysipelas in patients attending Lome teaching hospital . During this period, 60 subjects (43 females et 17 males) were hospitalized for legs erysipelas . The average age was 40 years old . General facilitating factors were noted in 58% of the patients (n = 35), and local in 50% of cases (n = 30) . The first line treatment was in all patients penicillin G . Satisfactory results were observed in 70% . Local complications were noted in 10% (n = 6), and recurrence in 17% (n = 10) . The erysipela is common in hospital environment . The precocious penicillinotherapy allowed to have satisfactory results. Can J Neurol Sci, 1997 Nov, 24(4), 343 - 4 Reversal of syphilitic hydrocephalus with intravenous penicillin; Cosottini M et al.; BACKGROUND: CSF shunting procedures are generally considered the fundamental therapy of syphilitic hydrocephalus . METHODS: We followed up with CSF analysis and MR imaging a patient with progressive mental and gait disturbances and tetraventricular hydrocephalus due to tertiary syphilis who was treated for 14 days with high dose intravenous penicillin alone . RESULTS: Clinical and CSF abnormalities resolved within a few months, whereas the hydrocephalus disappeared only 30 months after therapy . CONCLUSIONS: Before consideration of a CSF shunting procedure, a trial of high dose intravenous penicillin is warranted for patients with syphilitic hydrocephalus. Am J Perinatol, 1997 Oct, 14(9), 553 - 4 Penicillin desensitization in the treatment of syphilis during pregnancy; Chisholm CA et al.; The objective of this study was to compare patients' hospital course, complications, and charges for oral and intravenous (i.v.) desensitization regimens for the treatment of syphilis in the penicillin-allergic gravida . We performed a retrospective search of medical records at two tertiary-level teaching hospitals and reviewed the hospital course of penicillin-allergic gravidas who underwent penicillin desensitization . Between August 1988 and December 1995, 16 procedures for penicillin desensitization were carried out: 11 oral procedures, and 6 i.v . procedures . There were no significant differences between the patients in the oral and i.v . desensitization groups with respect to demographic characteristics, duration of time in a monitored bed, or length of hospital stay . The oral regimen was less expensive than the i.v . regimen ($144.06 vs . $319.48) . In our experience, oral and i.v . regimens provide effective desensitization for the treatment of syphilis in penicillin-allergic gravidas . However, the oral route offers ease of administration and substantial cost savings, making it the preferred method. J Chromatogr B Biomed Sci Appl, 1997 Oct 10, 699(1-2), 269 - 86 Chromatographic and electrophoretic methods for modified hemoglobins; Frantzen F; The discovery of the clinically important glycohemoglobin adducts and their relation to diabetes mellitus have greatly stimulated the study of other minor post-translational modifications of hemoglobin . Chromatographic and electrophoretic procedures have played an important role in these studies . Today several hemoglobin adducts are known and the formation of adducts with glucose, phosphorylated carbohydrates, urea/cyanate, aspirin, vitamins, acetaldehyde, penicillin and acetyl CoA have been described . Furthermore, new adducts, such as those observed using hemoglobin as a biochemical marker monitoring environmental, occupational and lifestyle exposures to reactive toxic chemicals are constantly being reported . This review deals with chromatographic and electrophoretic separation methods available for the study of non-enzymatic post-translational modifications of hemoglobin . Suitability, perspectives and biomedical applications are discussed. J Allergy Clin Immunol, 1997 Nov, 100(5), 586 - 91 Skin testing with penicilloate and penilloate prepared by an improved method: amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents; Macy E et al.; BACKGROUND: Penicillin skin testing has been limited by the lack of commercially available penicilloate and penilloate reagents . OBJECTIVE: This project was proposed to produce a stable, well-characterized supply of penicilloate and penilloate for intrastate use by our health maintenance organization and to document clinical safety and efficacy . METHODS: An improved method of extraction for penicilloate and penilloate, which changed the solvents used during recrystallization, was developed . With these newly prepared reagents, penicillin skin testing was performed on 348 subjects . Skin testing was immediately followed by an oral challenge of 250 mg of amoxicillin in 215 of 288 (75%) subjects displaying a negative response to a battery of penicillin skin tests . RESULTS: Nuclear magnetic resonance and mass spectrometry of the newly produced penicilloate and penilloate showed no evidence of organic contamination . Penicillin skin testing resulted in 17.2% (60 of 348) positive test results, with 20% of the subjects with positive results only responding to the newly produced minor determinants . The rate of mild adverse reactions to penicillin skin testing was 1.1% (4 of 348) . The rate of mild acute adverse reactions was 5.1% (11 of 215), and the delayed reaction rate was 0.9% (2 of 215) with the amoxicillin challenge . CONCLUSIONS: This improved penicillin minor determinant extraction method allows for the reproducible production of very pure preparations of penicilloate and penilloate . Large-scale penicillin skin testing, followed by amoxicillin challenge if results are negative is feasible in a large group model health maintenance organization operating within a single state with the use of internally produced penicilloate and penilloate and commercially available penicillin, amoxicillin, and penicilloyl polylysine. J Tradit Chin Med, 1996 Jun, 16(2), 101 - 4 239 cases of high fever in viral upper respiratory infection (URI) treated with xiang shi qing jie (XSQJ) bag tea; Liu Z et al.; XSQJ bag tea was used to treat 239 cases of high fever caused by viral upper respiratory infection, widely spreading in summer and autumn . For comparison, a control group treated by penicillin combined with Ganmao Qingre Chongji or Banlangen Chongji was set up . The results showed the effect of XSQJ bag tea on the time of abating fever, resolving symptoms and physical signs were significantly better than that of the control group. Zhen Ci Yan Jiu, 1996, 21(2), 62 - 6 {Effect of electroacupuncture on cholecystokinin gene expression in rat hippocampus during penicillin-induced epileptic seizure}; Yang R et al.; Northern Blot and hybrization in situ techniques were used to investigate the effect of electroacupuncture (EA) on the changes of cholecystokinin (CCK) mRAN levels of the hippocampus in rat penicillin-induced epilepsy model . Epilepsy can significantly increase CCK mRNA levels in dentate gyrus and CA3 areas of hippocampus in diencephalic sections after penicillin-induced seizure, whereas EA not only can attenuate the seizure behaviors and EEG changes, but also can decrease the increase of CCK mRNA contents induced by the seizure . However, in the subiculum, dentate gyrus and CA3 areas of mesencephalic sections of rat hippocampus, EA can further increase the enhancement of CCK mRNA concentration induced by penicillin-induced seizure . The results suggest that EA inhibitory effects on the seizure's behaviors and epileptiform activities may be related to the alteration of CCK gene expression in the different area of hippocampus. Biochim Biophys Acta, 1997 Oct 23, 1329(2), 278 - 84 Alpha-helical conformation in the C-terminal anchoring domains of E . coli penicillin-binding proteins 4, 5 and 6; Siligardi G et al.; The E . coli low molecular mass penicillin-binding proteins (PBP's) are penicillin sensitive, enzymes involved in the terminal stages of peptidoglycan biosynthesesis . These PBP's are believed to anchor to the periplasmic face of the inner membrane via C-terminal amphiphilic alpha-helices but to date the only support for this hypothesis has been obtained from theoretical analysis . In this paper, the conformational behaviour of synthetic peptides corresponding to these C-terminal anchoring domains was studied as a function of solvent, pH, sodium dodecyl sulphate micelles and phospholipid (DOPC, DOPG) vesicles using circular dichroism (CD) spectroscopy . The CD data showed that in 2,2,2-trifluoroethanol or sodium dodecylsulphate, all three peptides have the capacity to form an alpha-helical conformation but in aqueous solution or in the presence of phospholipid vesicles only those peptides corresponding to the PBP5 and PBP6 C-termini were observed to do so . A pH dependent loss of alpha-helical conformation in the peptide corresponding to the PBP5 C-terminus was found to correlate with the susceptibility of PBP5 to membrane extraction . This correlation would agree with the hypothesis that an alpha-helical conformation is required for membrane interaction of the PBP5 C-terminal region. Biochem J, 1997 Oct 15, 327 ( Pt 2), 377 - 81 Site-directed mutagenesis of the Actinomadura R39 DD-peptidase; Zhao GH et al.; The role of various residues in the conserved structural elements of the Actinomadura R39 penicillin-sensitive dd-peptidase has been studied by site-directed mutagenesis . Replacement of Ser-298 of the 'SDN loop' by Ala or Gly significantly decreased the kcat/Km value for the peptide substrate, but only by a factor of 15 and had little effect on the other catalytic properties . Mutations of Asn-300 of the same loop and of Lys-410 of the KTG triad yielded very unstable proteins . However, the N300S mutant could be purified as a fusion protein with thioredoxin that exhibited decreased rates of acylation by the peptide substrate and various cephalosporins . Similar fusion proteins obtained with the N300A, K410H and K410N mutants were unstable and their catalytic and penicillin-binding properties were very strongly affected . In transpeptidation reactions, the presence of the acceptor influenced the kcat/Km values, which suggested a catalytic pathway more complex than a simple partition of the acyl-enzyme between hydrolysis and aminolysis . These results are compared with those obtained with two other penicillin-sensitive enzymes, the Streptomyces R61 dd-peptidase and Escherichia coli penicillin-binding protein (PBP) 5. Nat Biotechnol, 1997 Nov, 15(12), 1276 - 9 Creating a bifunctional protein by insertion of beta-lactamase into the maltodextrin-binding protein; Betton JM et al.; Hybrid proteins were generated by inserting the penicillin-hydrolyzing enzyme, TEM beta-lactamase (Bla), into the maltodextrin-binding protein (MalE) . The inserted Bla was functionally accommodated by MalE when it was placed within permissive sites . The maltose binding and penicillinase activities of purified hybrids were indistinguishable from those of the wild-type MalE and Bla proteins . Moreover, these hybrids displayed an additional unexpected property: maltose stabilized the active site of inserted Bla. Bioseparation, 1996, 6(6), 343 - 51 An efficient three steps preparative purification of penicillin acylase from Escherichia coli cells; Fargues C et al.; A new and efficient safe system for the purification of the penicillin acylase from Escherichia coli G271 is presented . It was found that after a selective precipitation with ammnonium sulphate, followed by two chromatographic steps (anion exchange followed by adsorption on hydroxyapatite support), the enzyme was enriched 98 times with a 100% activity recovery . An original way has also been used to study the chromatographic separation of the protein mixture in three major categories on DEAE resin, by an analysis of the concentrations of the different species in the breakthrough curve obtained from a complete saturation of the column. J Appl Microbiol, 1997 Oct, 83(4), 464 - 9 Bacterial influence on the production of paralytic shellfish toxins by dinoflagellated algae; Dantzer WR et al.; This study investigated the role of intracellular and extracellular bacteria in the production of paralytic shellfish toxins by dinoflagellated algal cells . Three strains of the toxic dinoflagellate species, Alexandrium tamarense, were purified by external bacteria using penicillin G (Pen . G) at levels of 500 and 1000 p.p.m . Levels of toxicity of the resulting purified dinoflagellate cultures were similar to those of the original strains contaminated with external bacteria, indicating that the external bacteria had no influence on toxicity . No bacterial colony forming units (cfu) arose from disruption of algal cells derived from penicillin-treated cultures, indicating that intracellular bacteria were not responsible for the toxicity of cultures. Diagn Microbiol Infect Dis, 1997 Sep, 29(1), 51 - 3 Fusospirochetal superinfection of pre-existing oral lesion in patients with acquired immunodeficiency syndrome; Bottone EJ et al.; Three patients with AIDS presented with nonbleeding, painful, fetid, oral ulcers overlaid with a grayish-black semiadherent membrane at the sites of a pre-existing lesion . These lesions persisted despite treatment directed toward the primary etiology (cytomegalovirus, Kaposi's sarcoma) . Gram- and Giemsa-stained smears of teased membrane fragments revealed an impressive bacterial flora with fusiforms and Borrelia-type spirochetes . Prompt treatment with penicillin brought amelioration of symptoms and sloughing of the overlaying membrane. Genet Anal, 1997 Jul, 14(2), 51 - 4 Location of regulatory gene in penicillin G acylase operon (pacR) of E . coli D816; Jiang L et al.; Regulatory gene in Penicillin G Acylase operon (pacR) of E . coli D816 was located in a Taq1-Dra1 fragment within the pac structure gene . Two ORFs were found in this fragment and their transcriptional orientations were opposite with pac . ORF2 was determined as pacR by point mutation. Acta Cardiol, 1997, 52(4), 363 - 8 Tricuspid valve infectious endocarditis associated with dental treatment; Fujito T et al.; A 52-year-old man with neither congenital heart disease nor history of drug abuse had a spiking fever after dental treatment and was diagnosed with pneumonia at a local clinic . He was treated with antibiotics and his fever went down . Ten months later, he had again pyrexia and suffered from congestive heart failure . He admitted to our hospital and tricuspid valve endocarditis was proved by echocardiography . He was treated with penicillin . However, during the treatment, he developed a pulmonary embolism . So he underwent surgical treatment . We should take dental treatment into account one of predisposing causes of tricuspid endocarditis. Schweiz Arch Tierheilkd, 1997, 139(3), 134 - 43 {Septic arthritis of the hoof joint in the horse--diagnosis, radiologic changes and therapy}; Stanek C; A retrospective study (1984-1994) was made of 10 cases of septic arthritis of the distal interphalangeal joint in horses aged 7 months to 17 years . In 6 cases a hind limb was affected, in 4 cases a front limb . The arthritis was caused either by a puncture wound in the sole area (8 cases), by a perforating wound in the coronary region (1) or iatrogenic (1) . All horses exhibited a severe lameness at the walk . Radiography showed no typical lesions in fresh cases, whilst later an increasing subluxation of the joint was observed followed by periosteal reactions . Therapy included partial resection of the deep flexor tendon and fenestration of the Lig.impar in cases of nail puncture, single or repeated joint lavages carried out either under general anesthesia or on the standing horse, and broad spectrum antibiotic therapy, using mainly penicillin and gentamicin . 5 out of 10 horses were treated successfully. Eur J Clin Pharmacol, 1997, 52(6), 437 - 40 How Estonian and Finnish primary care doctors rate their need for common drugs; Lember M et al.; OBJECTIVE: To compare ratings of the necessity of drugs in the daily practice of experienced primary care doctors in Estonia and Finland to find out the differences and similarities in the therapeutic traditions of the two different societies . METHODS: A questionnaire was sent to all Estonian district doctors born in the 1940s and to all Finnish specialized general practitioners born in the 1940s, who then evaluated the necessity of the listed drugs on a visual analogue scale . The ratings, from 0 to 100, were entered into a computer, using a graphic tablet and a pressure sensitive pointer . RESULTS: The six most highly-evaluated drugs among the Estonian respondents were digoxin, glyceryl trinitrate, aspirin, calcium-channel blockers, beta-adrenoceptor blockers and frusemide; and among the Finnish general practitioners (GPs) were penicillin, insulin, glyceryl trinitrate, beta-adrenoceptor blockers, frusemide and angiotensin-converting enzyme (ACE) inhibitors . The ratings of 15 out of 33 drugs/drug groups were very similar both in Estonia and Finland . The biggest differences between the opinions of the Estonian and Finnish doctors appeared in the ratings regarding the necessity of antacids, cimetidine, insulin, sulphonylureas, reserpine . ACE inhibitors, oral contraceptives, penicillin, metronidazole, trimethoprim, indomethacin, phenobarbital and theophylline . CONCLUSION: The revealed differences are suggested to be related to the different health care systems (different task profiles of doctors, different pharmaceutical services), different education of doctors, different availability of drugs in the past and different prices, all of which influence therapeutic traditions. J Bacteriol, 1997 Oct, 179(19), 6005 - 9 The bimodular G57-V577 polypeptide chain of the class B penicillin-binding protein 3 of Escherichia coli catalyzes peptide bond formation from thiolesters and does not catalyze glycan chain polymerization from the lipid II intermediate; Adam M et al.; Because the specificity profile of the membrane anchor-free G57-V577 penicillin-binding protein 3 (PBP3) of Escherichia coli for a large series of beta-lactam antibiotics is similar to that of the full-size membrane-bound PBP, the truncated PBP is expected to adopt the native folded conformation . The truncated PBP3 functions as a thiolesterase . In aqueous media and in the presence of millimolar concentrations of a properly structured amino compound, it catalyzes the aminolysis of the thiolester until completion, suggesting that the penicillin-binding module of PBP3 is designed to catalyze transpeptidation reactions . In contrast, the truncated PBP3 is devoid of glycan polymerization activity on the E . coli lipid II intermediate, suggesting that the non-penicillin-binding module of PBP3 is not a transglycosylase. Schweiz Rundsch Med Prax, 1997 Jul 16, 86(29-30), 1143 - 6 {Whipple's disease: molecular biology--clinical aspects--therapy}; Blum HE; Whipple's disease is a rare systemic bacterial disease, affecting mostly middle-aged white men . Its clinical presentation is very variable . Arthralgias, fever of unknown origin or central nervous system symptoms may precede the more typical gastrointestinal manifestations with weight loss and chronic diarrhea . The diagnosis is based on the histopathologic demonstration of PAS-positive macrophages in duodenal or jejunal biopsies . In addition, it has become possible to detect the causative actinobacterium Tropheryma whippelii by amplification of a Whipple-specific PCR product . Therapeutic options are a sequential therapy with penicillin-streptomycin, followed by trimethoprim-sulfamethoxazole (TMP-SMX) or a monotherapy with TMP-SMX . These therapeutic modalities usually eradicate the infection and result in a rapid and sustained improvement of the Whipple-specific signs and symptoms . In view of the frequently uncharacteristic initial clinical presentation (arthralgias, fever, CNS symptoms), it is therefore of utmost importance to consider Whipple's disease in the differential diagnosis of the clinical signs and symptoms. Neuroscience, 1997 Dec, 81(4), 1111 - 22 The role of long-term potentiation in persistent epileptiform burst-induced hyperexcitability following GABAA receptor blockade; Schneiderman JH; Persistent hyperexcitability follows synchronized bursting induced in the CA3 region of hippocampal slices by perfusion with high concentrations (2000 IU/ml) of the GABAA antagonist, penicillin . This hyperexcitable state is characterized by: i) slow recovery from bursting following penicillin washout; ii) persistent "post-burst" field potential oscillations and iii) increased probability of spontaneous bursting with ordinarily sub-convulsant doses of GABAA antagonists . An N-methyl-D-aspartate-independent type of long-term potentiation of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)/kainate excitatory postsynaptic potentials occurred following bursting . However, similar increases in excitatory postsynaptic potential magnitude also occurred after a subconvulsant dose of penicillin (500 IU/ml) which did not produce the other features of persistent hyperexcitability . Furthermore, long-term potentiation either increased or remained stable after bursting stopped, whereas, post-burst oscillations gradually diminished with time . Low doses of the AMPA/kainate antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione, which restored the potentiated excitatory postsynaptic potentials to control levels, reduced but did not eliminate the post-burst oscillation . Tetanus-induced long-term potentiation did not reproduce the hyperexcitable state seen after bursting . These findings indicate that the epileptiform bursting caused by blocking GABAA-mediated inhibition induces long-term potentiation which is partially responsible for persistent burst-induced hyperexcitability but is not sufficient to entirely explain it . The hippocampus which is critical for normal memory is also frequently the generator of intractable epileptic seizures . Seizure-like discharges in the hippocampus induced long-lasting increases in synaptic efficacy similar to those thought to underlie normal memory . This form of long-term potentiation contributed to the network oscillations characteristics of the hyperexcitable state persisting after epileptiform activity but was not sufficient to entirely explain them . Epileptic seizures may engage normal memory mechanisms which increase neuronal excitability and predispose the hippocampal network to further seizures . This may, in part, account for the propensity for hippocampal seizure foci to become intractable. J Pharm Pharmacol, 1997 Jun, 49(6), 617 - 21 Influence of hydroxypropyl beta-cyclodextrin on the stability of benzylpenicillin in chloroacetate buffer; Ong JK et al.; Hydroxypropyl beta-cyclodextrin (HP beta CyD) has been shown to stabilize a wide variety of chemically distinct pharmaceutical entities through inclusion-complex formation between drug and cyclodextrin . The effect of HP beta CyD on the acid-catalysed hydrolysis of benzylpenicillin (penicillin G) was evaluated in chloroacetate buffer at pH 2.20 . At penicillin G: cyclodextrin molar concentration ratios from 1:1 to 1:10, HP beta CyD effected stabilization of penicillin G by 1.56- to 5.21-fold . At all temperatures, the observed first-order rate constant (kobs) values assumed a non-linear, Michaelis-Menten type decrease as a function of increasing HP beta CyD concentration . Degradation of penicillin G complexed with HP beta CyD (penicillin G-HP beta CyD), was approximately ninefold slower than uncomplexed penicillin G . The proportion of penicillin G degrading in either of these forms was, in turn, determined by the equilibrium constant for the complexation . The apparent thermodynamic and activation parameters for the complexation between penicillin G and HP beta CyD have also been evaluated . The negative standard enthalpy change (delta H degrees) for the complexation implied that the penicillin G-HP beta CyD complex would be predisposed towards enhanced stability, and thus the kobs value for the hydrolysis of penicillin G decreased with reduction of temperature in these systems . The lack of difference between the enthalpies of activation (delta H ++) for the hydrolysis of uncomplexed and complexed penicillin G seemed to be compensated by the significant difference between the entropies of activation (delta S ++) for these hydrolytic reactions . The results indicate that HP beta CyD represents a viable means of stabilization of penicillin G solutions at the pH employed in this study. Microbiol Immunol, 1997, 41(8), 587 - 93 Cyclophosphamide-induced bacterial translocation in Escherichia coli C25-monoassociated specific pathogen-free mice; Nakayama M et al.; The kinetics of bacterial translocation (BTL) from the intestine to the mesenteric lymph nodes (MLN) and the number of peripheral white blood cells (WBC), macrophages in Peyer's patches (PP) and M-cells on the surface of cecal PP after cyclophosphamide (CY) injection were examined in penicillin-G and streptomycin sulfate decontaminated and Escherichia coli C25-monoassociated specific pathogen-free mice . WBC are counted to confirm the immunological state of the mice . Until 8 days after CY injection, the number of WBC, bacteria in MLN and macrophages in PP decreased, but then significantly increased on day 14 . The levels again decreased to the control levels on day 16 . Although the number of M-cells decreased up to day 8, it did not return to the control level on day 16 . These results indicate that BTL is stimulated in an immunopotentiated state after CY injection, and this phenomenon may be closely related to the number of macrophages in the blood and PP. Microb Drug Resist, 1997 Fall, 3(3), 243 - 51 Molecular epidemiology of drug-resistant pneumococci: toward an international approach; Hermans PW et al.; An international multicenter study was undertaken to investigate the epidemiological dynamics of penicillin-resistant pneumococci . We compared the molecular epidemiological characteristics of 205 penicillin-resistant isolates originating from The Netherlands, Thailand, United States, Spain, Greece, Poland, Cuba, Germany, Finland, United Kingdom, South Africa, Hungary, Portugal, Croatia, and the Czech Republic . Eighty-four distinct restriction fragment end labeling (RFEL) types were observed . Twenty-eight genetic types were shared by two or more strains . Five genetic clusters consisted of strains originating from different countries, illustrating dissemination of penicillin-resistant pneumococci among countries . The strains displaying the two predominant RFEL types corresponding with the pandemic clones 23F and 9V were found in 10 and 6 different countries, respectively . This clearly demonstrates the pandemic behavior of these two clones . Twelve out of the 28 genetic clusters contained two or more serotypes . This finding indicates frequent horizontal transfer of capsular genes . Within distinct RFEL types, identical penicillin binding protein (PBP) genotypes were often observed, suggesting a high frequency of horizontal transfer of penicillin resistance genes . The most predominant PBP type was found in 15 distinct RFEL types, comprised 44% of the entire collection, and was observed in 11 countries . The vast majority of the strains belonging to the pandemic clones 23F and 9V shared this predominant PBP type . We hypothesize that the clones 23F and 9V are responsible for the worldwide increase of penicillin-resistance, because they serve as a genetic reservoir for susceptible pneumococci to acquire penicillin resistance. Zhonghua Hu Li Za Zhi, 1997 Mar, 32(3), 128 - 31 {Experimental morphological study of injection nerve injuries in rabbits}; Ding ZH et al.; The sciatic nerve of 16 rabbits were examined with the optical and electron microscope 2, 24, 72 hours and 7 days after injecting penicillin (200,000 U) into nerve or its peripheral in experiment group and control group . The experiment group showed successively nerve fiber tumefaction, myelin sheath lamellar separation and degeneration partly, the construction of axonal change abnormality myelin and axonal obvious degeneration from 2 hours to 7 days . The control group showed perinerve edema, hyperemia, epineurium hyperplasia, the nerve fiber of near epineurium had mild pathologic changes. Antimicrob Agents Chemother, 1997 Sep, 41(9), 2013 - 5 Penicillin-binding proteins and induction of AmpC beta-lactamase; Sanders CC et al.; In competition assays for radiolabeled penicillin, penicillin-binding proteins (PBPs) 4, 7a, and 7b showed very high affinities for strong inducers of AmpC beta-lactamase . Loss of PBP 4 resulted in diminished inducibility . This suggests that if PBPs are involved in induction of AmpC beta-lactamase, there is probably a redundancy in function among the different PBPs. Antimicrob Agents Chemother, 1997 Sep, 41(9), 1926 - 32 Rationale behind high-dose amoxicillin therapy for acute otitis media due to penicillin-nonsusceptible pneumococci: support from in vitro pharmacodynamic studies; Lister PD et al.; To evaluate whether increased doses of amoxicillin should be used to treat acute pneumococcal otitis media, an in vitro pharmacokinetic model was used to evaluate the killing of pneumococci by amoxicillin when middle ear pharmacokinetics were simulated . Logarithmic-phase cultures were exposed to peak concentrations of 3, 6, and 9 microg of amoxicillin per ml every 12 h, and an elimination half-life of 1.6 h was simulated . Changes in viable bacterial counts were measured over 36 h . All three doses rapidly decreased the viable bacterial counts of penicillin-susceptible strains below the 10-CFU/ml limit of detection by 6 to 10 h and maintained counts below this limit through 36 h . The 3-microg/ml peak dose was much less effective against two of three strains with intermediate penicillin resistance and all three penicillin-resistant strains, with bacterial counts approaching those in drug-free control cultures by 12 h . The 6-microg/ml peak dose completely eliminated two of three strains with intermediate penicillin resistance and maintained viable counts of the other nonsusceptible strains at 1.5 to 2 logs below the initial inoculum through 36 h . The 9-microg/ml peak dose was most effective, completely eliminating all three strains with intermediate penicillin resistance and maintaining the viable counts of the resistant strains at 3 to 4 logs below the original inoculum . The pharmacodynamics observed in this study suggest that peak concentrations of amoxicillin of 6 to 9 microg/ml may be sufficient for the elimination of penicillin-nonsusceptible pneumococcal strains causing otitis media, especially those with intermediate resistance to amoxicillin . In vivo pharmacokinetic studies are needed to determine if these levels can be achieved in middle ear fluid with amoxicillin at 70 to 90 mg/kg/day divided into two daily doses . If these levels are reliably achieved, then clinical studies are warranted. Appl Microbiol Biotechnol, 1997 Aug, 48(2), 191 - 7 Stabilization of Escherichia coli penicillin G acylase against thermal inactivation by cross-linking with dextran dialdehyde polymers; Kazan D et al.; The thermostabilization of penicillin G acylase (PGA) obtained from a mutant of Escherichia coli ATCC 11,105 by cross-linking with dextran dialdehyde molecules, at a molecular mass of 11,500, 37,700 and 71,000 Da, was studied . The thermal inactivation mechanisms of the native and modified PGA were both considered to obey first-order inactivation kinetics during prolonged heat treatment, forming fully active but temperature-sensitive transient states . The highest enhancement to the thermostability of PGA was obtained using dextran-71000-dialdehyde modification, as a nearly ninefold increase at temperatures above 50 degrees C . The modification of PGA by dextran-11500-dialdehyde resulted in a considerable reduction of the Vm and Km parameters of the enzyme . However, other dextran dialdehyde derivatives used for modification did not cause a meaningful change in either Vm and Km . Modification by dextran dialdehyde derivatives did not result in significant change to either the optimal temperature or the activation energy of PGA . All modified PGA preparations showed lower inactivation rate constants but higher half-lives for inactivation than those of the native PGA at all temperatures studied . As indicated by the half-life times and Ki values, dextran 71000-dialdehyde was found to be more effective at cross-linking in the thermo-stabilization of PGA than any other agent studied in this work. J Radiol, 1997 Jul, 78(7), 513 - 6 {Actinomycotic tubo-ovarian abscess . Contribution of pelvic angioscanner}; Bazot M et al.; Pelvic actinomycosis is uncommon and usually responsible for tubo-ovarian abscesses which are similar in aspect with nonactinomycotic abscesses . They are usually a complication of an intra-uterine device (IUD) that can be absent as in this case . The differential diagnosis is ovarian cancer . The role of the dynamic CT scan for differential diagnosis in this case is presented . Preoperative diagnosis in this affection is important because of the excellent response to Penicillin. J Bacteriol, 1997 Sep, 179(18), 5802 - 11 A promoter for the first nine genes of the Escherichia coli mra cluster of cell division and cell envelope biosynthesis genes, including ftsI and ftsW; Hara H et al.; We constructed a null allele of the ftsI gene encoding penicillin-binding protein 3 of Escherichia coli . It caused blockage of septation and loss of viability when expression of an extrachromosomal copy of ftsI was repressed, providing a final proof that ftsI is an essential cell division gene . In order to complement this null allele, the ftsI gene cloned on a single-copy mini-F plasmid required a region 1.9 kb upstream, which was found to contain a promoter sequence that could direct expression of a promoterless lacZ gene on a mini-F plasmid . This promoter sequence lies at the beginning of the mra cluster in the 2 min region of the E . coli chromosome, a cluster of 16 genes which, except for the first 2, are known to be involved in cell division and cell envelope biosynthesis . Disruption of this promoter, named the mra promoter, on the chromosome by inserting the lac promoter led to cell lysis in the absence of a lac inducer . The defect was complemented by a plasmid carrying a chromosomal fragment ranging from the mra promoter to ftsW, the fifth gene downstream of ftsI, but not by a plasmid lacking ftsW . Although several potential promoter sequences in this region of the mra cluster have been reported, we conclude that the promoter identified in this study is required for the first nine genes of the cluster to be fully expressed. J Clin Lab Anal, 1997, 11(5), 251 - 7 Determination of IgE antibodies to the benzylpenicilloyl determinant: a comparison of the sensitivity and specificity of three radio allergo sorbent test methods; Garcia JJ et al.; The quantitation of in vitro IgE antibodies to the benzylpenicilloyl determinant (BPO) is a useful tool for evaluating suspected penicillin allergic subjects . Although many different methods have been employed, few studies have compared their diagnostic specificity and sensitivity . In this study, the sensitivity and specificity of three different radio allergo sorbent test (RAST) methods for quantitating specific IgE antibodies to the BPO determinant were compared . Thirty positive control sera (serum samples from penicillin allergic subjects with a positive clinical history and a positive penicillin skin test) and 30 negative control sera (sera from subjects with no history of penicillin allergy and negative skin tests) were tested for BPO-specific IgE antibodies by RAST using three different conjugates coupled to the solid phase: benzylpenicillin conjugated to polylysine (BPO-PLL), benzylpenicillin conjugated to human serum albumin (BPO-HSA), and benzylpenicillin conjugated to an aminospacer (BPO-SP) . Receiver operator control curves (ROC analysis) were carried out by determining different cut-off points between positive and negative values . Contingence tables were constructed and sensitivity, specificity, negative predictive values (PV-), and positive predictive values (PV+) were calculated . Pearson correlation coefficients (r) and intraclass correlation coefficients (ICC) were determined and the differences between methods were compared by chi 2 analysis . Analysis of the areas defined by the ROC curves showed statistical differences among the three methods . When cut-off points for optimal sensitivity and specificity were chosen, the BPO-HSA assay was less sensitive and less specific and had a lower PV- and PV+ than the BPO-PLL and BPO-SP assays . Assessment of r and ICC indicated that the correlation was very high, but the concordance between the PLL and SP methods was higher than between the PLL and HSA or SP and HSA methods . We conclude that for quantitating IgE antibodies by RAST to the BPO determinant, BPO-SP or BPO-PLL conjugates offer advantages in sensitivity and specificity compared with BPO-HSA . These results support and extend previous in vitro studies by our group and highlight the importance of the carrier for RAST assays. Protein Expr Purif, 1997 Aug, 10(3), 309 - 19 High-level expression of soluble protein in Escherichia coli using a His6-tag and maltose-binding-protein double-affinity fusion system; Pryor KD et al.; Using the maltose-binding protein (MBP) fusion vector pMAL-c1 from C . V . Maina et al . (1988, Gene 74, 365-373), we have constructed expression vectors which contain a sequence encoding six consecutive histidine residues (His6-tag) at the 3' end of the MBP-encoding malE gene which is followed by either a thrombin-binding site (LVPRGS) or a factor Xa-binding site (IEGR) . The benefits of this approach include; (a) high expression levels of soluble MBP fusion proteins (exceeding 2% of the total cellular protein), (b) high-quality purification of proteins under various conditions (high salt, low salt, denaturing, nondenaturing, etc.), and (c) two alternative protease cleavage sites to test for the most efficient cleavage of each fusion protein . We also constructed these MBP-His 6-tag expression vectors with alternative selection markers (Ampr, Kanr) and alternative promoters (tac, T7) . Using these constructs, we expressed and purified several proteins of which we present two, penicillin-binding protein PBP2a and UDP-N-acetylmuramate:L-alanine ligase (MurC), and compare their expression level and purity with other expression systems . We also discuss the use of minimal media with supplements versus rich media and cell growth strategies to optimize the protein yield in general and for isotope labeling. Antimicrob Agents Chemother, 1997 Aug, 41(8), 1721 - 4 Altered permeability and beta-lactam resistance in a mutant of Mycobacterium smegmatis; Mukhopadhyay S et al.; Beta-lactam resistance in mycobacteria results from an interplay between the following: (i) beta-lactamase production, (ii) affinity of the penicillin-binding proteins (PBPs) for the drugs, and (iii) permeation of the drugs . A laboratory mutant of Mycobacterium smegmatis was studied in order to evaluate the roles of these factors in beta-lactam resistance . Mutant M13 was between 7- and 78-fold more resistant than the wild type to cephaloridine, cefoxitin, cefazolin, cefamandole, and cephalothin . Increased beta-lactamase activity toward these antibiotics was not observed in the mutant . The PBP profiles of the wild type and M13 were comparable . However, the affinities of PBP 1 for the beta-lactams tested were lower for the mutant than for the wild type . The permeation of the drugs measured in intact cells was lower for M13 than for the parent strain . The liposome swelling technique, which could be used for cephaloridine, also supported this view . Reduced permeation was not restricted to the beta-lactams alone . Glycine uptake was also lower in M13 . Taken together, the results suggest that decreased affinities of PBP 1 for beta-lactams, combined with the decreased permeability of the cell wall of the mutant, lead to the development of high-level acquired beta-lactam resistance. J Bacteriol, 1997 Aug, 179(15), 4761 - 7 Topographical and functional investigation of Escherichia coli penicillin-binding protein 1b by alanine stretch scanning mutagenesis; Lefevre F et al.; Penicillin-binding proteins (PBPs) are the targets of beta-lactam antibiotics . We have used a systematic five-alanine substitution method (called ASS {alanine stretch scanning} mutagenesis) to investigate the functional or structural role of various stretches of amino acids in the PBP1b of Escherichia coli . To probe the specific activity of each variant, the antibiotic discs assay was used with strain QCB1 (delta ponB) in the presence of cefaloridine, which totally inhibits the complementing action of PBP1a . This in vivo test has been combined with a quick and efficient in vitro test of the penicillin-binding activity of each of these variants with fluorescent penicillin . This approach has enabled us to show an unexpected role of the N-terminal and C-terminal tails of PBP1b . Moreover, we have established the correct position in PBP1b of the SMN motif that, with the SXXK and the KTG motifs, constitutes the signature of the penicilloyl serine transferases family . Finally, we have shown that the transglycosylase and the transpeptidase domains are separated by an inert linker region, where substitutions and insertions can be made without hindering the in vivo and in vitro activity of the protein. N Engl J Med, 1997 Jul 31, 337(5), 307 - 14 A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection . The Syphilis and HIV Study Group; Rolfs RT et al.; BACKGROUND: Reports of neurosyphilis and invasion of cerebrospinal fluid by Treponema pallidum in patients with human immunodeficiency virus (HIV) infection have led to doubts about the adequacy of the recommended penicillin G benzathine therapy for early syphilis . METHODS: In a multicenter, randomized, double-blind trial, we assessed two treatments for early syphilis: 2.4 million units of penicillin G benzathine and that therapy enhanced with a 10-day course of amoxicillin and probenecid . The serologic and clinical responses of patients with and without HIV infection were studied during one year of follow-up . RESULTS: From 1991 through 1994, 541 patients were enrolled, including 101 patients (19 percent) who had HIV infection but differed little from the uninfected patients in their clinical presentations . The rates at which chancres and rashes resolved did not differ significantly according to treatment assignment or HIV status . Serologically defined treatment failures were more common among the HIV-infected patients . The single clinically defined treatment failure was in an HIV-infected patient . Rates of serologically defined treatment failure did not differ according to treatment group (18 percent at six months with usual therapy; 17 percent with enhanced therapy) . T . pallidum was found at enrollment in the cerebrospinal fluid of 32 of 131 patients (24 percent) and after therapy in 7 of 35 patients tested . None had clinically evident neurosyphilis, and the rate of detection of T . pallidum did not differ according to HIV status . CONCLUSIONS: After treatment for primary or secondary syphilis, the HIV-infected patients responded less well serologically than the patients without HIV infection, but clinically defined failure was uncommon in both groups . Enhanced treatment with amoxicillin and probenecid did not improve the outcomes . Although T . pallidum was detected in cerebrospinal fluid before therapy in a quarter of the patients tested, such a finding did not predict treatment failure . The current recommendations for treating early syphilis appear adequate for most patients, whether or not they have HIV infection. Pharmacoeconomics, 1997 Aug, 12(2 Pt 1), 161 - 74 The cost effectiveness of pneumococcal vaccination strategies; Gable CB et al.; Pneumonia and influenza, combined, are the sixth leading causes of death in the US . The age-adjusted mortality rate for these diseases increased by 20% between 1979 and 1993, perhaps as a result of the emergence of multi-drug-resistant and penicillin-resistant strains of bacteria that cause pneumonia . Of the approximately $US23 billion annual cost of community-acquired pneumonia, pneumococcal pneumonia is currently estimated to account for up to $US18 billion . Considering the clinical and economic consequences of pneumococcal disease, vaccination appears to be a valuable preventive strategy . However, despite Medicare coverage and the recommendations of the Advisory Committee on Immunisation Practices (ACIP), only 28% of elderly and high-risk patients received the pneumococcal vaccine in 1993 . This article reviews the epidemiology and economic factors that determine the cost effectiveness of pneumococcal vaccination strategies . The strategies are taken from a review of 10 published economic analyses of the pneumococcal vaccine . Cost savings and favourable cost-effectiveness ratios are associated with key factors that increase vaccination programme benefits by maximising averted direct medical costs as well as reducing vaccination programme costs, such as through public vaccination campaigns. J Chromatogr B Biomed Sci Appl, 1997 Jul 4, 694(2), 383 - 91 Simultaneous determination of six penicillins in cows' raw milk by a multiresidue high-performance liquid chromatographic method; Sorensen LK et al.; A high-performance liquid chromatographic method based on C18 solid-phase extraction and ultraviolet detection at 323 nm of analytes derivatized with benzoic anhydride and 1,2,4-triazole mercuric chloride solution was developed for the simultaneous determination of amoxicillin, penicillin G (benzylpenicillin), ampicillin, oxacillin, cloxacillin and dicloxacillin residues in raw milk . The detection limit of the method was 1.3 microg/l for penicillin G; 1.4 microg/l for amoxicillin, oxacillin and cloxacillin, 1.5 microg/l for ampicillin and 2.7 microg/l for dicloxacillin . The mean recovery was 95-102% for amoxicillin, penicillin G and ampicillin, 92-98% for oxacillin and cloxacillin and 87-94% for dicloxacillin, measured by using an internal standard . The relative repeatability standard deviation was 4-9% on level 4-15 micro/l, respectively, 2-7% on level 30-40 microg/l. J Ind Microbiol Biotechnol, 1997 Jul, 19(1), 18 - 27 Analysis of a commercially improved Penicillium chrysogenum strain series: involvement of recombinogenic regions in amplification and deletion of the penicillin biosynthesis gene cluster; Newbert RW et al.; Several commercially improved strains of Penicillium chrysogenum have been shown to carry amplifications of the entire penicillin biosynthesis gene cluster . Analysis previously carried out using the strain BW 1890 has here been extended to the characterisation of other members of the SmithKline Beecham strain improvement series . We have determined the length of the amplicon to be 57.4 kb and shown a general increase in copy number and penicillin titre through the series . Sequence analyses of the promoter regions of the acvA, ipnA and aat genes in the high titre strain BW 1901, and comparisons with wild-type sequences have not identified any potentially titre-enhancing mutations . In addition, cDNA screening has failed to identify any further transcribed elements within the co-amplified region . The homogeneity of hybridisation patterns and the identification and analysis of a single copy revertant has shown that the amplification is of a direct tandem nature and we propose a model of chromatid misalignment and recombination as its mode of generation . Hybridisation analysis of penicillin non-producing mutants has indicated the loss, in all those investigated, of the entire penicillin biosynthesis gene cluster, similarities between the deletion junctions in these strains and comparison with previously published data indicating the presence of recombinogenic regions flanking the penicillin biosynthesis gene cluster. Medicine (Baltimore), 1997 Jul, 76(4), 295 - 303 Invasive pneumococcal infections . A comparison between adults and children; Rahav G et al.; A similar number of adults and children had invasive pneumococcal infection . There was male predominance, and different ethnic distribution between children and adults . The majority of adults (78%), had underlying diseases, but this was less frequent in children (24%) . The presenting illness differed between adults and children . Complications of invasive pneumococcal infection occurred more frequently in adults than in children . The mortality rate in adults was 21.5%; in children, only 3.8% . The rate of penicillin-resistant pneumococci at our hospital was 23%, while cefotaxime resistance was 4.2% . Penicillin-resistant pneumococci were not isolated more frequently from children than from adults . Patients with penicillin-resistant pneumococci had longer duration of hospitalization and more nosocomially acquired infections . No difference in the mortality rate was found between patients with resistant or sensitive pneumococci . Ninety-five percent of strains were included in the current vaccine, but less than 2% of patients had been vaccinated . Isolates prevalent in Europe and the United States (19, 5, 1, 14, 6, 18, 12, 4, 9, 23, 7) were also most prevalent in Jerusalem . The distribution of serotypes differed between children and adults, and between patients from whom resistant organisms were isolated as opposed to sensitive organisms. Clin Exp Rheumatol, 1997 Jul-Aug, 15(4), 445 - 8 Actinomycotic splenic abscesses presenting with arthritis; Quintero-Del-Rio AI et al.; An 18-month-old Caucasian female began with a high fever . She developed swelling in one finger and one toe . Abdominal ultrasound revealed multiple abscesses in her spleen . Multiple blood culture and splenic abscess aspirations grew no pathogens . She had transient response to multiple antibiotics and splenic abscess drainage, but fever returned along with subcutaneous nodules . Culture of splenic tissue from her second splenic drainage eventually grew one organism identified as Actinomyces naeslundii . Therapy with high dose penicillin followed by amoxicillin p.o . and total splenectomy led to complete recovery. Neth J Med, 1997 Jul, 51(1), 39 - 45 A rare case of disseminated actinomycosis caused by Actinomyces meyeri; van Mook WN et al.; A case of disseminated actinomycosis caused by Actinomyces meyeri in a 43-year-old man is described . The patient presented with signs of pericarditis, weight loss, dry cough, and subsequently an inferior vena cava syndrome . Diagnosis of thoracic as well as abdominal actinomycosis was made 4 months after admission . This article stresses the importance of considering the diagnosis of the disease . Cure was achieved by administering penicillin for several months. Biosci Biotechnol Biochem, 1997 Jul, 61(7), 1150 - 5 Effects of medium-chain fatty acids and their acylglycerols on the transport of penicillin V across Caco-2 cell monolayers; Shima M et al.; The transport-enhancing effects of medium-chain fatty acids (caproic, caprylic, and capric acids) and their acylglycerols (mono-, di-, and triacylglycerols) were investigated by using Caco-2 cell monolayers as a model of the human intestinal epithelium . Penicillin V was used as a model for a hydrophilic bioactive compound . Among the fatty acids and acylglycerols tested, 1,2-dicaproin, monocaprin, monocaprylin, and capric acid sodium salt effectively enhanced the transport rate, whereas other substances enhanced the rate only slightly or not at all . With each of these four substances, the rate of enhancement was proportional to the concentration at low concentrations, but leveled off at high concentrations . The transport-enhancing effects were well correlated with the reduction in surface tension and with a physico-chemical parameter, denoted by the surface energy-lowering coefficient, characterizing the surface activity of a substance. Phys Med Biol, 1997 Jul, 42(7), 1415 - 26 An optical phantom with tissue-like properties in the visible for use in PDT and fluorescence spectroscopy; Wagnieres G et al.; The design and characterization of optical phantoms which have the same absorption and scattering characteristics as biological tissues in a broad spectral window (between 400 and 650 nm) are presented . These low-cost phantoms use agarose dissolved in water as the transparent matrix . The latter is loaded with various amounts of silicon dioxide, Intralipid, ink, blood, azide, penicillin, bovine serum, and fluorochromes . The silicon dioxide and Intralipid particles are responsible for the light scattering whereas the ink and blood are the absorbers . The penicillin and the azide are used to ensure the conservation of such phantoms when stored at 4 degrees C . The serum and fluorochromes, such as Coumarin 30, produce an autofluorescence similar to human tissues . Various fluorochromes or photosensitizers can be added to these phantoms to simulate a cancer photodetection procedure . The absorption and fluorescence spectroscopy of the porphyrin-type fluorescent markers used clinically for such photodetection procedures is similar in these phantoms and in live tissues . The mechanical properties of these gelatinous phantoms are also of interest as they can easily be moulded and reshaped with a conventional cutter, so that complex structures and shapes, with different optical properties, can be designed . The optical properties of these phantoms were determined between 400 and 650 nm by measuring their effective attenuation coefficient (mu eff) and total reflectance (Rd) . The microscopic absorption and reduced scattering coefficients (mu a, mu s') were deduced from mu eff and Rd using a Monte Carlo simulation. Prev Vet Med, 1997 Jul, 31(1-2), 133 - 46 Associations between off-label feed additives and farm size, veterinary consultant use, and animal age; Dewey CE et al.; Data from the United States National Swine Survey collected by the National Animal Health Monitoring System were used to describe the use of feed additives in swine feeds . Data were collected from 710 farms . The concentration of feed additives expressed in grams per ton of complete feed was described by stage of production, and the use of feed additives above the labeled treatment levels (i.e . off-label) was identified . Of the 3328 feeds, about 79% contained feed additives used in the labeled manner . For all classes of pigs, the prevalence of labeled feed additive use was greater than 75% . Penicillin was used according to its label most often, followed by apramycin, bacitracin, tetracyclines, lincomycin, and tylosin . Carbadox had the highest prevalence of off-label use . Of the 699 feeds that included feed additives in an off-label manner, about 57% included additives at greater than the recommended concentrations or were fed to an incorrect class of pig . About 56% of the feeds had off-label combinations of additives . Small farms were more likely to use rations with no feed additives than intermediate or large farms (P < 0.001) . Of those farms using feed additives, the odds of a small farm using all feed additives in the labeled manner was 7.7 times that of an intermediate or large farm (P < 0.0001) . After controlling for herd size, producers who used a veterinary consultant were 2.1 times more likely to use feeds with feed additives (P < 0.0001). Crit Care Med, 1997 Jul, 25(7), 1187 - 90 Effects of prolonged controlled mechanical ventilation on diaphragmatic function in healthy adult baboons; Anzueto A et al.; OBJECTIVE: To study diaphragmatic strength and endurance after a prolonged period of mechanical ventilation . DESIGN: Prospective animal study . SETTING: Animal research laboratory . SUBJECTS: Seven uninjured adult baboons (Papio cynocephalus) were anesthetized with ketamine, sedated, paralyzed, and mechanically ventilated . Animals were monitored with pulmonary arterial and peripheral arterial catheters . INTERVENTIONS: Mechanical ventilation was provided for 11 days with an FIO2 of 0.21 and tidal volume of 15 mL/kg . Pulmonary function tests, including lung volumes, arterial blood gases, and chest radiographs were also monitored . Nursing care procedures included frequent turning, chest physiotherapy, and endotracheal suction . Antacids and prophylactic antibiotics (intravenous penicillin, topical polymyxin B, and gentamicin sulfate) were administered . In three animals, fishhook electrodes were surgically placed around both phrenic nerves on both day 0 and after 11 days of mechanical ventilation for diaphragmatic stimulation . On day 0, the electrodes were removed after phrenic nerve stimulation studies were performed . After 11 days of mechanical ventilation, animals were electively killed and full autopsy performed . MEASUREMENTS AND MAIN RESULTS: Hemodynamic and pulmonary function parameters were measured at baseline and every day during the 11 days of mechanical ventilation . Diaphragmatic strength and endurance were measured on days 0 and 11 . Diaphragmatic endurance was determined by an inspiratory resistive loading protocol . There were no significant changes in hemodynamics, lung volumes, or gas exchange during the period of mechanical ventilation . On day 7, the chest radiographs showed patchy lobar atelectasis in six animals, which cleared by day 11 in all but two of the animals . Lung pathology showed mild, focal pneumonitis . By day 11, maximum transdiaphragmatic pressure had decreased by 25% from day 0 and diaphragmatic endurance had decreased by 36% . CONCLUSIONS: Eleven days of mechanical ventilation and neuromuscular blockade in healthy baboons resulted in nonsignificant changes in hemodynamics, oxygenation, and/or lung function . However, significant impairment in diaphragmatic endurance and strength were seen . Based on these results, it is likely that prolonged mechanical ventilation by itself impairs diaphragmatic function independent of underlying lung disease. Arch Pediatr Adolesc Med, 1997 Jul, 151(7), 701 - 4 A randomized controlled trial of penicillin vs clindamycin for the treatment of aspiration pneumonia in children; Jacobson SJ et al.; OBJECTIVE: To compare the effectiveness of intravenous penicillin vs clindamycin for the treatment of aspiration pneumonia . DESIGN: A double-blind, randomized controlled trial . SETTING: A tertiary care pediatric hospital . PATIENTS: We enrolled 42 children, aged 6 months to 18 years, who were admitted to the hospital for the treatment of aspiration pneumonia . All of the children had underlying conditions that predispose to aspiration . INTERVENTION: The patients were randomly assigned to receive intravenous penicillin G sodium, 250,000 U/kg every 24 hours, or intravenous clindamycin phosphate, 30 mg/kg every 24 hours . MAIN OUTCOME MEASURE: The primary outcome measure was "time to ready for discharge" from the hospital . RESULTS: In an effectiveness (intention to treat) analysis, the median time (interquartile range) to ready for discharge from the hospital was 4.9 days (range, 2.8-6.5 days) in the penicillin-treated group and 3.4 days (range, 2.3-6.8 days) in the clindamycin-treated group (P = .66) . Results were not markedly altered when adjusted for the age difference of the groups or in the efficacy analysis (after the exclusion of 9 patients who withdrew from the trial) . Rates for readmission to the hospital were similar in the 2 groups . CONCLUSION: Penicillin and clindamycin seem to be equally effective for the treatment of aspiration pneumonia in children hospitalized for this illness. Int J Syst Bacteriol, 1997 Jul, 47(3), 763 - 6 Spiroplasma platyhelix sp . nov., a new mollicute with unusual morphology and genome size from the dragonfly Pachydiplax longipennis; Williamson DL et al.; Spiroplasma strain PALS-1T from the gut of the dragonfly Pachydiplax longipennis was shown to be distinct from other species, groups, and subgroups of the genus Spiroplasma as determined by reciprocal serological metabolism inhibition and deformation tests . However, this strain cross-reacted extensively with representatives of other groups when it was used as an antigen . Electron microscopy of cells of strain PALS-1T revealed cells surrounded by a single cytoplasmic membrane . Light microscopy revealed helical cells that exhibited twisting motility rather than rotatory or flexing motility . Variations in the tightness of coiling were transmitted from one end of the helix to the other . The strain was resistant to penicillin, which confirmed that no cell wall was present . The organism grew well in M1D and SP-4 liquid media under either aerobic or anaerobic conditions . Growth also occurred in 1% serum fraction medium and in conventional horse serum medium . The optimum temperature for growth was 30 degrees C, at which the doubling time was 6.4 h . Multiplication occurred at temperatures from 10 to 32 degrees C . Strain PALS-1T catabolized glucose and hydrolyzed arginine but not urea . The guanine-plus-cytosine content of the DNA was 29 +/- 1 mol% . The genome size was 780 kbp, the smallest genome size in the genus Spiroplasma . Strain PALS-1 (= ATCC 51748) is designated the type strain of a new species, Spiroplasma platyhelix. J Bacteriol, 1997 Jul, 179(14), 4627 - 30 Dual multimodular class A penicillin-binding proteins in Mycobacterium leprae; Lepage S et al.; The ponA gene of cosmid L222 of the Mycobacterium leprae genome library encodes a multimodular class A penicillin-binding protein (PBP), PBP1 . The PBP, labelled with a polyhistidine sequence, has been produced in Escherichia coli, extracted from the membranes with 3-{(3-cholamidopropyl)-dimethylammonio}-1-propane-sulfonate (CHAPS) and purified by Ni2(+)-nitrilotriacetic acid-agarose chromatography . In contrast to the pon1-encoded class A PBP1, PBP1 undergoes denaturation at temperatures higher than 25 degrees C, it catalyzes acyl transfer reactions on properly structured thiolesters, and it binds penicillin with high affinity. Ann Trop Paediatr, 1997 Jun, 17(2), 175 - 7 Intraosseous infusion in an emergency situation: a case report; Nafiu OO et al.; An 18-month-old boy who had cardiopulmonary arrest secondary to penicillin anaphylaxis was successfully resuscitated by intraosseous administration of emergency resuscitative medications because peripheral vascular access was impossible . He was discharged 2 weeks later in a satisfactory clinical condition. FEMS Microbiol Lett, 1997 Jun 1, 151(1), 9 - 16 Identification of the pac promoter from Kluyvera citrophila; Roa A et al.; The nucleotide sequence of the 5'-terminal region of the pac gene encoding the penicillin G acylase from Kluyvera citrophila ATCC 21285 has been determined . The transcriptional start site has been identified by primer extension analysis in a different position to that previously found for the homologous pac gene of Escherichia coli W ATCC 11105 . Two nucleotide changes in the -35 box appear to be responsible of the promoter displacement in K . citrophila . A putative upstream promoter element (A+T-rich enhancer sequence) and a binding site for the cAMP receptor protein (CRP) were located upstream of the -35 box . Transcriptional lacZ and cat fusions demonstrated that pac expression was subjected to catabolite repression mediated by cAMP and its receptor protein . Remarkably, phenylacetic acid which is a potent inducer of the penicillin G acylase from E . coli, was only able to cause a significant induction of the pac expression in CRP+ cells cultured in the presence of glucose, suggesting that this effect is CRP-dependent. Brain Res Mol Brain Res, 1997 Jun, 46(1-2), 177 - 84 Induction of FOS and JUN proteins during focal epilepsy: congruences with and differences to {14C}deoxyglucose metabolism; Gass P et al.; fos and jun belong to multigene families coding for transcription factors . These cellular immediate-early genes (IEGs) are thought to be involved in coupling neuronal excitation to changes of target gene expression . Immunocytochemistry with specific antisera was used to assess regional levels of five IEG-encoded proteins (c-FOS, FOS B, c-JUN, JUN B and JUN D) in a rat model of penicillin-induced focal epilepsy . To assess whether brain regions with post-ictal de novo transcription factor synthesis correspond to those areas with increased glucose metabolism, IEG expression patterns were compared with {14C}deoxyglucose autoradiography performed in a subset of animals . The results demonstrated marked induction of c-FOS, FOS B, c-JUN and JUN B but not JUN D in the cortical epileptic focus . Thereby, individual IEG-encoded proteins exhibited differential temporal and spatial expression patterns . Within the epileptic focus, IEG expression correlated with increased glucose metabolism . In contrast, IEG induction was not observed in brain areas distant from the epileptic focus that also demonstrated increased glucose metabolism, such as homotopic contralateral motor cortex and ipsilateral thalamic nuclei . These findings indicate that in focal epilepsy changes of the genetic programme are restricted to neurons of the epileptic focus . In contrast, the increased {14C}deoxyglucose metabolism in contralateral motor cortex and ipsilateral thalamus seems to indicate functional changes. J Bacteriol, 1997 Jun, 179(12), 4061 - 5 A putative monofunctional glycosyltransferase is expressed in Ralstonia eutropha; Paik J et al.; A gene, mgt, encoding a protein homologous to the N-terminal module of class A high-molecular-mass penicillin-binding proteins was identified in Ralstonia eutropha . By using specific antibodies, the corresponding Mgt protein was detected in association with the membrane, confirming that the N-terminal hydrophobic segment functioned as a membrane anchor . A derivative in which the hydrophobic sequence was deleted was overexpressed as a maltose-binding fusion protein in Escherichia coli . Cleavage of the product resulted in substantial amounts of soluble Mgt derivative, indicating that folding occurs independently on other proteins or on homologous domains of penicillin-binding proteins. Infect Immun, 1997 Jun, 65(6), 2206 - 10 Temperature-sensitive mutants of Actinobacillus pleuropneumoniae induce protection in mice; Byrd W et al.; Temperature-sensitive mutants of Actinobacillus pleuropneumoniae 4074, serotype 1, were isolated after treatment with nitrosoguanidine and enrichment with penicillin and D-cycloserine . Of the four temperature-sensitive mutants evaluated in mice, one (A-1) had a tight phenotype (i.e., it ceased replication immediately after transfer to the nonpermissive temperature {37 degrees C}) and three (1-2, 4-1, and 12-1) were coasters that continued replication for up to three generations after transfer to 37 degrees C . The reversion frequencies ranged from 10(-6) to 10(-9), and cutoff temperatures ranged from 33 to 35 degrees C . No major changes were detected in the biochemical profiles; agglutination reactions; electrophoretic profiles of the lipopolysaccharides, outer membrane proteins, and hemolysin proteins; hemolytic titers; or CAMP factor reactions of the mutants and the wild-type bacteria . Groups of 3- to 5-week-old, female ICR mice were immunized intranasally with three doses of 3.5 x 10(6) CFU of the mutants over 3 weeks and subsequently challenged intranasally with 5 50% lethal doses of the parental wild-type . Protection was induced by both the tight and the coaster mutants, with the 4-1 and 12-1 coasters eliciting greater protection (67 and 82%, respectively) than that induced by the A-1 tight mutant (57%) . Intranasal immunization with both phenotypes induced serum antibody responses against the surface antigens and the hemolysin protein. Schweiz Med Wochenschr, 1997 May 31, 127(22), 940 - 4 {Neurosyphilis 12 years after treatment of primary infection in a meanwhile HIV infected patient}; Eriksson U et al.; A 33-year-old male HIV-positive patient developed pure right motor hemiplegia due to meningovascular neurosyphilis . 12 years ago he was successfully treated for early syphilis with a single dose of 2.4 million units penicillin G benzathine without subsequent evidence of new infection or disease progression . Repeated HIV tests remained negative until 1993 when the HIV infection was diagnosed . It is well known that Treponema pallidum, the etiologic agent of syphilis, may be detected in the cerebrospinal fluid during early infection . Thus the former recommended regimen of single-dose penicillin G benzathine may not reliably eradicate T . pallidum from the CNS . Residual organisms may serve as a reservoir for relapse and dissemination in an immunocompromised host. Ugeskr Laeger, 1997 May 19, 159(21), 3175 - 7 {Lyme neuro-borreliosis in a 66-year old women . Differential diagnosis of cerebral metastases and cerebral infarction}; Henriksen TB; A 66-year-old woman with medically treated hypertension and a recent operation for breast cancer was admitted because of burning pain localized between her shoulder blades and a paretic, dysaesthetic right arm . CSF examination revealed lymphocytic pleocytosis and specific IgM Borrelia burgdorferi antibodies . CT was normal . The patient was treated intravenously with high doses of penicillin for 14 days, and within one month of admission she had recovered completely neurologically . During the first days of treatment a drop in blood pressure, ECG changes, and further neurological changes were observed, but disappeared spontaneously within three days . The patient did not recall a tick bite, and the case illustrates that neuroborreliosis may be a differential diagnosis to stroke or cerebral neoplasms in elderly patients. Med J Aust, 1997 May 5, 166(9), 464 - 7 A profile of inpatient STD-related pelvic inflammatory disease in the Top End of the Northern Territory of Australia; Mein J et al.; OBJECTIVE: To obtain a profile of inpatient STD-related pelvic inflammatory disease (PID) in the Top End of the Northern Territory . DESIGN: Review of case records . SETTING: The Royal Darwin Hospital, the tertiary referral centre for the Top End, during the three years from June 1991 to May 1994 . PATIENTS: All admissions with a diagnosis of STD-related PID . MAIN OUTCOME MEASURES: The presentation and incidence of STD-related PID in Aboriginal and non-Aboriginal women . RESULTS: PID was the reason for 14% of admissions of Aboriginal women and 2% of non-Aboriginal women . Of 175 episodes of PID in 169 patients admitted over the three years of the study, 41 (23%) had gonorrhoea, 64 (37%) had chlamydia and 7 (4%) had both organisms isolated on genital swab . Aboriginal women were more than twice as likely to have gonorrhoea (38% versus 18%; risk ratio, 2.12; 95% confidence interval, 1.27-3.53) as non-Aboriginal women . Median time from first symptoms to presentation was six days . All gonococcal isolates were penicillin susceptible . CONCLUSIONS: STD-related pelvic inflammatory disease is an important problem among women in the Top End of the Northern Territory . As PID is a preventable illness, further measures aimed at prevention and earlier, more effective treatment of STDs that cause PID are urgently required. J Emerg Med, 1997 May-Jun, 15(3), 303 - 7 Unusual presentation of cervicothoracic actinomycosis complicated by pericardial effusion: a case report; Beier KH et al.; Actinomycosis is a chronic-suppurative disease characterized by abscesses and draining sinus tracts, with fibrosis and granulation involving the face and neck and thoracic or pelvic-abdominal regions . Dermatological findings in patients at high risk are the key to the correct diagnosis . Actinomycosis is frequently undiagnosed or misdiagnosed until the correct diagnosis is made after surgical resection . Alcoholic, homeless, and disadvantaged individuals and patients with other factors predisposing to infection including poor dentition, alcoholism, seizures, and trauma are common in the emergency department; thus, emergency physicians should be aware of the different presentations and complications of this disease . The treatment of choice is a high dose of penicillin in conjunction with surgical debridement . The prognosis is excellent with correct diagnosis and therapy. Analyst, 1997 May, 122(5), 447 - 53 Modified fluorimetric assay for estimating ampicilloate concentrations and its use for detecting beta-lactamase and penicillin acylase activity in bacteria; Baker WL; Sodium ampicilloate concentrations were estimated fluorimetrically by heating solutions with ascorbic acid, EDTA and a modified Lowry A reagent which was prepared by including copper sulfate and potassium sodium tartrate in 0.5 mol dm-3 acetate buffer at pH 4 . A concentration range of 0.5-50 mumol dm-3 was used for the estimations . The reaction was used to estimate beta-lactamase activity on ampicillin but the substrate also showed some fluorescence and a calculation was required to determine the amount of ampicilloate formed when both substances were present in the one reaction mixture . The beta-lactamase was inhibited by treatment with trichloroacetic acid so the procedure could be used to assay the enzyme activity after a fixed time . 6-Aminopenicillanic acid did not fluoresce on treatment with the modified reagent and organisms which contained penicillin acylase lowered the amount of ampicillin which could be converted to ampicilloate . When penicillin acylase and beta-lactamase co-existed in the one organism, the respective activities were determined by use of the copper-ascorbate-EDTA fluorescence assay for ampicilloate coupled with a fluorescamine assay for 6-aminopenicillanic acid determinations . On prolonged incubation, some organisms containing penicillin acylases lowered the amount of ampicilloate which formed a fluorescent product . This effect was attributed to deacylation of ampicilloate by the penicillin acylases. J Infect, 1997 May, 34(3), 265 - 7 The combined value of chemoprophylaxis and pneumococcal vaccine in the prevention of recurrent pneumococcal meningitis; Hristea A et al.; We report the case of an immunocompetent patient who has been the subject of 39 episodes of recurrent pneumococcal meningitis over a 20 year period . The recurrences of bacterial meningitis due to cerebrospinal fluid leakage and the presence of chronic sinusitis were not influenced by the surgical repair of a fistula and the repeated surgical draining interventions on suppurating chronic sinusital foci . Phenoxymethylpenicillin treatment reduced the number of recurrences and the combination of pneumococcal vaccine and penicillin prophylaxis allowed a 5 year period free of any recurrences. Pediatr Dermatol, 1997 May-Jun, 14(3), 226 - 8 Congenital syphilis associated with hyperlipoproteinemia; Mestrovic J et al.; An infant with congenital syphilis associated with transient disturbances of lipoprotein metabolism is reported . The dominant clinical sign was hepatosplenomegaly . Laboratory investigation upon admission revealed hyperimmunoglobulinemia and hyperchylomicronemia . After the administration of penicillin, the chylomicronemia ceased, but an increase of very low density lipoprotein fraction was observed . As the infant recovered, all the laboratory findings returned to normal . Hyperchylomicronemia was attributed to hyperimmunoglobulinemia . Absorption of immunoglobulins to lipoproteins can inhibit lipoprotein lipase activity . The increase in the very low density lipoprotein fraction was probably caused by the increase in serum lipoprotein production and the decrease in lipoprotein clearance that are frequently seen in patients with infectious diseases. Epilepsy Res, 1997 May, 27(2), 127 - 37 Coupling of cortical and thalamic metabolism in experimentally induced visual and somatosensory focal epilepsy; Redecker C et al.; Focal epileptic activity induces widespread metabolic disturbances beyond the area of the electroencephalographically detectable focus . In order to find out whether the metabolic coupling between the epileptic focus and other brain regions depends on the localization of the focus, two groups of rats with epileptic foci at different sites were investigated . In the first group acute epileptic activity was induced by application of penicillin to the secondary visual cortex (Oc2), and in the second group to the primary somatosensory cortex (Par1) . Metabolism was analyzed using the {14C}deoxyglucose autoradiographic method . In both groups of animals, hypermetabolism in the area of the focus and in specific functionally coupled thalamic nuclei was observed . Focal epileptic activity in the secondary visual cortex induced significant hypometabolism in remote ipsilateral cortical areas . In rats with epileptic foci in the primary somatosensory cortex hypometabolism in extrafocal ipsilateral cortical areas was less prominent . These findings provide further support for the integral involvement of the thalamus in modulating metabolism in remote cortical brain regions during focal epileptic activity . The extent of metabolic alterations may depend on the site of the epileptic focus and the connectivity of the recruited thalamic nuclei. Nippon Rinsho, 1997 May, 55(5), 1200 - 5 {Genetics of multiresistant MRSA}; Ito T et al.; Since the introduction of methicillin, methicillin resistant S . aureus (MRSA) was appeared in 1961 in England . MRSA produces specific penicillin-binding protein PBP2' which shows very low affinity to most of beta-lactam antibiotics . The region around mecA is called additional DNA or mec DNA and is thought to be extraspecies origin . From the study of mec DNA, it was revealed that there were three types of mec DNA . In the case of mec DNA of N315, a transposon Tn554 which encoded erythromysin and spectinomycin resistance, and a plasmid pUB110 which encoded resistance to kanamycin, tobramycin, and bleomycin were integrated . MRSA became resistant to many antibiotics during a few years which were effective at the time of introduction, such as, carbapenems, new quinolones, and minocycline . MRSA has changed their properties by obtaining resistance-genes or generating mutations on its chromosomal DNA. Ann Emerg Med, 1997 May, 29(5), 683 - 6 Descending necrotizing mediastinitis: complication of a simple dental infection; Haraden BM et al.; Descending necrotizing mediastinitis (DNM) is a rare complication of periodontic infection . The delay in diagnosis of DNM is believed to contribute to its high mortality rate . We report the case of a healthy 23-year-old man who was seen in the urgent care center, given the diagnosis of dental infection, prescribed penicillin, and sent home . He returned 48 hours later complaining of myalgias, purulent drainage from around his teeth, chest pain, and dyspnea . DNM was diagnosed, and aggressive treatment comprising thoracotomy, cervical incision and drainage, and antibiotics was begun . The patient responded well to treatment and was discharged from the hospital on postoperative day 20 . Prompt diagnosis and immediate therapy are imperative for this rare condition. J Bacteriol, 1997 May, 179(9), 2823 - 34 Murein segregation in Escherichia coli; de Pedro MA et al.; Peptidoglycan (murein) segregation has been studied by means of a new labeling method . The method relies on the ability of Escherichia coli cells to incorporate D-Cys into macromolecular murein . The incorporation depends on a periplasmic amino acid exchange reaction . At low concentrations, D-Cys is innocuous to the cell . The distribution of modified murein in purified sacculi can be traced and visualized by immunodetection of the -SH groups by fluorescence and electron microscopy techniques . Analysis of murein segregation in wild-type and cell division mutant strains revealed that murein in polar caps is metabolically inert and is segregated in a conservative fashion . Elongation of the sacculus apparently occurs by diffuse insertion of precursors over the cylindrical part of the cell surface . At the initiation of cell division, there is a FtsZ-dependent localized activation of murein synthesis at the potential division sites . Penicillin-binding protein 3 and the products of the division genes ftsA and ftsQ are dispensable for the activation of division sites . As a consequence, under restrictive conditions ftsA,ftsI,or ftsQ mutants generate filamentous sacculi with rings of all-new murein at the positions where septa would otherwise develop. Int Arch Allergy Immunol, 1997 May-Jul, 113(1-3), 342 - 4 IgG and IgE antibodies in subjects allergic to penicillins recognize different parts of the penicillin molecule; Torres MJ et al.; BACKGROUND: IgE and IgG antibodies to penicillins can have different specificities . However, this response, including the recognition of the different parts of penicillin, has never been studied in the same subject . OBJECTIVE: Study of the specificity of IgE and IgG antibodies and the relevant parts of the penicillin molecule that contribute to the hapten binding site in sera from human . METHODS: Specific IgE antibodies were determined by RAST and specific IgG antibodies by ELISA . The recognition of the different molecules was studied by inhibition studies . RESULTS: Seven sera with IgG and IgE antibodies to amoxicillin and benzyl penicillin were analyzed . IgE antibodies recognized mainly two different epitopes: in one, the side chain was a relevant part of the epitope, in the other, it was the nuclear portion . IgG antibodies recognized the nuclear portion in all instances . In the same subject, antibodies of different isotype and specificity were found . CONCLUSIONS: Subjects who develop simultaneously IgE and IgG antibodies to penicillins show different specificities . This proves that different populations of antibodies recognize different epitopes. Int Arch Allergy Immunol, 1997 May-Jul, 113(1-3), 177 - 80 High IL-5 production by human drug-specific T cell clones; Pichler WJ et al.; To analyze whether and how T cells are involved in drug allergies, we analyzed the drug-induced activation of T cell subsets, T cell receptor V-beta usage and cytokine secretion of T cells from the peripheral blood of drug-allergic individuals . The specificity of the T cells was demonstrated by specific restimulation of drug specific clones . We found that drugs which do not need to be metabolized to become immunogenic (haptens like penicillin G) can stimulate CD4+ and CD8+ T cells in vitro . The T cell response to penicillin can be oligoclonal (use of a certain T cell receptor Vbeta only) or polyclonal . Only polyclonal T cell lines were cross-reactive with other beta-lactam antibiotics . Sulfamethoxazole and lidocaine are thought to gain their ability to bind to proteins by intracellular drug metabolism . They were found to stimulate CD4+ and CD8+ T cells in vitro, and some reactive T cell lines were oligoclonal . The majority of lidocaine-specific clones secreted rather high amounts of IL-5 and IL-4 after PMA/ionomycin stimulations (Th2-like), but some CD4+ and all CD8+ clones had a Th1-like phenotype (high INF-gamma and TNF-alpha) . The data clearly demonstrate the existence of drug-specific alphabeta+ T cells in the circulation of drug-allergic individuals and reveal a great heterogeneity of T-cell-mediated responses . Further studies are needed to correlate the type of T cell response to the clinical picture, which can be quite heterogeneous. J Clin Microbiol, 1997 May, 35(5), 1157 - 60 Molecular study of persistence of Nocardia asteroides and Nocardia otitidiscaviarum strains in patients with long-term nocardiosis; Provost F et al.; Three Nocardia asteroides and five Nocardia otitidiscaviarum isolates recovered from three patients with long-term nocardiosis were compared by random amplification of polymorphic DNA fingerprinting, antibiotic susceptibility testing, and enzymatic characterization . Results obtained with primer DKU49 (P . Palittapongarnpim, S . Chomyc, A . Fanning, and D . Kunimoto, J . Infect . Dis . 167:975-978, 1993) provide evidence that patient A was infected by two N . asteroides strains during a single episode of nocardiosis and that patients B and C remained infected by the same strain, respectively . Resistance to minocycline that was present in the first isolate recovered from patient B reverted to intermediate resistance in the second isolate and reverted to susceptibility in the third isolate . Resistance to penicillin G and beta-lactams was acquired by the second isolate obtained from patient C. Ugeskr Laeger, 1997 Apr 14, 159(16), 2389 - 91 {Penicillin treatment of non-nosocomial pneumonia in Danish medical departments . A questionnaire}; Gjersoe P et al.; This study describes the most common penicillin-regime for hospitalized patients with community-acquired pneumonia in Denmark . One hundred and seventy-one consultant physicians received an anonymous questionnaire, 85% were returned and 75% were evaluated . The most common regime is a treatment duration of six to ten days with 3-6 million IU of penicillin daily given in three doses . The most common route of administration is intravenously until the patient's body temperature drops . Then the same dose is given orally . Variations in strategy were revealed and call for further investigations to establish and maintain restrictive antibiotic regimes. Ned Tijdschr Geneeskd, 1997 Apr 12, 141(15), 723 - 6 {Clinical judgment and decision making in clinical practice . A music conductor with epilepsy followed by memory disorders}; Rinkel GJ et al.; A 40-year-old conductor was admitted because of increasing drowsiness and confusion . Two years before admission he had had a first seizure . One year before admission he had a generalized convulsive status epilepticus; the following months he was less able to concentrate . A second status epilepticus was followed by transient weakness of his left arm and a depressed level of consciousness for several weeks . After awakening, he had delusions, and his wife found him demented . In the following months his confusion and drowsiness gradually deteriorated . He had previously had gonorrhoea, an episode of fever and exanthema, and was found to have oligospermia as cause of his infertility . On examination he was disoriented, and he had dysarthria . His left pupil was smaller, but both pupils reacted normally . There was left hemianopia and cerebellar ataxia . CT and MR showed large ventricles and periventricular diffuse lesions in the white matter . CSF examination revealed leucocytosis and increased protein content . Further examination were focussed on serological evidence of syphilis, and finally neurosyphilis was diagnosed . After treatment with penicillin, the patient started to recover. Brain Res, 1997 Apr 4, 753(1), 86 - 97 Critical volume of rat cortex and extracellular threshold concentration for a pentylenetetrazol-induced epileptic focus; Schwindt W et al.; The initiation of focal interictal epileptiform activity (FIEA) has been shown to depend on the activation of a sufficiently large volume of brain tissue . We estimated the size of this 'critical volume' for the convulsant pentylenetetrazol (PTZ) by analyzing the diffusion following its microinjection into rat motor cortex . PTZ concentration was monitored 100-200 microm away from the injection site with a PTZ-sensitive microelectrode . Diffusion analysis in 0.3% agar yielded the free diffusion coefficient D (8.50 +/- 0.15 X 10(-6) cm2 x s(-1) at 37 degrees C, median +/- S.E.M.) . In brain tissue, diffusion was modified by extracellular volume fraction (alpha), tortuosity (lambda = (D/ADC)1/2; ADC = apparent diffusion coefficient) and non-specific uptake (k') . Using a value of 0.2 for alpha from previous studies, we found values of lambda = 1.61 +/- 0.01, k' = 3.37 +/- 0.15 X 10(-3) s(-1) and an injected volume U of 5.16 +/- 0.45 X 10(-10) l for pulses without FIEA, and lambda = 1.95 +/- 0.06, k' = 6.24 +/- 1.73 X 10(-3) s(-1) and U = 7.40 +/- 0.66 X 10(-10) l for pulses with FIEA . From the calculated concentration distribution of PTZ during FIEA we estimated a threshold concentration of about 1.77 mM PTZ and a volume with a radius of about 219 microm in which this concentration had to be exceeded . Since this critical volume was comparable in size to foci elicited by penicillin or electric stimuli in previous studies, it is concluded that it is determined by intrinsic tissue properties rather than by the convulsive agent being used. Rinsho Shinkeigaku, 1997 Apr, 37(4), 341 - 3 {A case of tabes dorsalis observed in an HTLV-1 carrier}; Nagata A et al.; We report a case of a 53-year-old female HTLV-1 carrier with tabes dorsalis . In addition to typical symptoms of tabes dorsalis, she presented HTLV-1 associated myelopathy (HAM) like clinical features such as sensory disturbance with thoracic sensory levels and bladder disturbance (pollakiuria) . Although penicillin treatment did not improve in her neurological symptoms, steroid therapy was effective especially in HAM like symptoms . The CSF neopterin level was markedly decreased after steroid therapy, indicating that inflammation in the spinal cord was settled down after treatment . Our case suggests that CNS infection like tabes dorsalis may be modified by HTLV-1 infection and then present some atypical clinical features based upon altered immunological aspects of HTLV-1 carriers. Biochimie, 1997 Apr, 79(4), 171 - 4 An investigation into the ability of C-terminal homologues of Escherichia coli low molecular mass penicillin-binding proteins 4, 5 and 6 to undergo membrane interaction; Harris F et al.; The Escherichia coli low molecular mass penicillin-binding proteins (PBP4, PBP5 and PBP6) are a group of penicillin-sensitive enzymes involved in the final stages of cell wall assembly . It has been suggested that these proteins may interact with the periplasmic face of the inner membrane via C-terminal amphiphilic alpha-helices . Theoretical analysis has predicted that these C-terminal helical regions may be membrane interactive . We have tested this hypothesis by assaying PBP C-terminal homologues (P4, P5 and P6) for haemolytic activity . Our results show that the PBP5 and PBP6 C-terminal homologues readily lyse sheep erythrocytes in a pH-dependent manner with LD50's of 3.5 x 10(-6) M and 6.8 x 10(-7) M respectively at pH 7 . These results appear to support the present model for the membrane anchoring of PBP5 and PBP6 . The PBP4 C-terminal homologue shows no evidence of haemolytic activity which could imply a different means of membrane association for PBP4. Appl Microbiol Biotechnol, 1997 Apr, 47(4), 373 - 8 Localization and characterization of inclusion bodies in recombinant Escherichia coli cells overproducing penicillin G acylase; Sriubolmas N et al.; Various concentrations of isopropyl beta-D-thiogalactopyranoside (IPTG) were used to induce production of the enzyme penicillin G acylase by recombinant Escherichia coli harboring plasmid pQEA11 . The plasmid pQEA11 carries a wild-type pga gene, which is under the control of the tac promoter and lacIq . At low IPTG concentrations (0.025-0.1 mM), enzyme activity increased with increasing IPTG concentrations . At higher IPTG concentrations (0.2 and 0.5 mM), enzyme activity declined progressively . Examination of induced recombinant E . coli cells by transmission electron microscopy showed the presence of only periplasmic inclusion bodies at low IPTG concentrations (up to 0.1 mM) and both periplasmic and cytoplasmic inclusion bodies at high IPTG concentrations (0.2 mM and 0.5 mM) . Results from sodium dodecyl sulfate/polyacrylamide gel electrophoresis and immunoblots of whole-cell proteins, membrane proteins and inclusion body proteins in these cells indicated that cytoplasmic inclusion bodies constituted an accumulation of preproenzyme (i.e., precursor polypeptide containing a signal peptide) and that periplasmic inclusion bodies constituted an accumulation of proenzyme (i.e., precursor polypeptide lacking a signal peptide). Mech Ageing Dev, 1997 Apr, 95(1-2), 101 - 11 Effects of transforming growth factor-beta 1 and interleukin-1 alpha on matrix synthesis in osteoarthritic cartilage of the temporo-mandibular joint in aged mice; Blumenfeld I et al.; Osteoarthritic lesions were observed in the mandibular condyle cartilage of mice aged 7 months and older . These lesions appeared as fibrillations along the articular surface and were accompanied by reduced extracellular matrix synthesis and chondrocyte proliferation . Explants of mandibular condyle cartilage were cultured in serum-free BGJb medium supplemented with ascorbic acid (300 micrograms/ml), penicillin (100 U/ml) and streptomycin (100 micrograms/ml) for up to 72 h . Cultures were further supplemented with either hTGF-beta 1 (0.1-5.0 ng/ml) or human IL-1 alpha (40 U/ml) . {3H}thymidine (2 microCi/ml) and {35S}SO4 (10 microCi/ml) were added to the culture medium for the last 24 h of culture and incorporation into DNA and sulfated proteoglycans, respectively, studied . The results indicated that protein and DNA contents, {3H}thymidine and {35S}SO4 incorporation, as well as the specific activity of alkaline phosphatase, were increased by TGF-beta 1 . Addition of 1.0 or 5.0 ng/ml hTGF-beta 1 to the cultures for 48 h, had the most stimulatory effect on matrix synthesis and cell proliferation, whereas 0.1 ng/ml hTGF-beta 1 appeared to be inhibitory when compared to controls . Increased {35S}SO4 labeling of chondrocyte clusters was observed by autoradiography in tissue sections from cultures treated with TGF-beta 1 (1.0 and 5.0 ng/ml) . In contrast, IL-1 alpha exerted inhibitory effects on cell proliferation and matrix synthesis . However, it induced the activity of acid phosphatase in these cultures . The results of the present study show that IL-1 alpha had catabolic effect on his tissue, while TGF-beta 1 enhanced proliferation and induced synthetic activity of the cartilage cells . Such action by TGF-beta suggests the existance of a possible repair process in osteoarthritic cartilage of the temporo-mandibular joint of aged mice. Arch Ophthalmol, 1997 Apr, 115(4), 469 - 73 Syphilitic uveitis in human immunodeficiency virus-infected patients; Shalaby IA et al.; OBJECTIVE: To document the incidence and clinical features of syphilitic uveitis in patients coinfected with human immunodeficiency virus (HIV) . DESIGN: Retrospective chart review . SETTINGS: Single tertiary uveitis referral center . PATIENTS: The charts of HIV-infected patients with uveitis and a reactive fluorescent treponemal antibody absorption test seen between November 1983 and June 1995 were reviewed . RESULTS: Syphilis was the most common bacterial cause of uveitis in this group . Thirteen patients (0.6% of the 2085 HIV-positive patients seen in the clinic during the study period) were dually infected . Twelve patients were male . Six patients (46%) had previously been treated for syphilis, 4 with intramuscular penicillin G benzathine only . Four patients (31%) had isolated anterior uveitis, 3 patients (23%) had anterior and intermediate uveitis, and 5 patients (38%) had panuveitis . One patient (8%) presented with optic nerve and retinal atrophy . Eight patients were treated with intravenous penicillin, 3 with intravenous and intramuscular penicillin, and 1 with intravenous ceftriaxone sodium . Of the 12 patients for whom follow-up examinations were available after treatment, ocular inflammation decreased in 11 (92%) and visual acuity improved in 8 (67%) . Rapid plasma reagin titers decreased a median of 64-fold compared with pretreatment levels, and all patients with reactive cerebrospinal fluid who underwent pretreatment and posttreatment lumbar punctures normalized following therapy with intravenous antibiotics . CONCLUSIONS: Syphilis is an uncommon cause of uveitis in HIV-infected patients . Anterior uveitis is the most common ocular manifestation, but panuveitis is more common than isolated anterior uveitis . Intravenous penicillin is effective therapy. Pediatr Infect Dis J, 1997 Apr, 16(4), 376 - 81 Continuous twice daily or once daily amoxicillin prophylaxis compared wit