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| Commun Dis Intell, 1998 Sep 3, 22(9), 183 - 8 Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 1996 . Report of the Australian Mycobacterium Reference Laboratory Network; Dawson D; The Australian Mycobacterium Reference Laboratory Network collected and analysed laboratory data on new diagnoses of infection with Mycobacterium tuberculosis complex during 1996 . A total of 750 cases were identified, representing an annual incidence of 4.1 cases of laboratory confirmed tuberculosis per 100,000 population . The incidence rate varied between States, reflecting differences in the distribution of persons belonging to 'high-risk' categories for tuberculosis . Incidence statistics were almost identical to those recorded by the Network in 1994 and 1995 . The male:female ratio remained at around 1.2:1 . As was the case in 1995, the median age group for males was 45-49 years and for females 35-39 years . The frequency of positive microscopy in pulmonary samples was stable at around 55% . Lymphatic disease accounted for 19% of the total cases in 1996 compared with 15% in the previous year, confirming that lymphadenitis is becoming more common in females with tuberculosis in Australia . Approximately 11% of isolates had in vitro resistance to at least one of the four standard anti-tuberculosis drugs, an increase from 8% in 1994-95 . Fifteen isolates were multi-drug resistant, compared with a total of only 38 during the previous seven years . Thus, the 1996 data points to an increasing frequency of multi-drug resistant strains among isolates from Australian patients with tuberculosis. Rev Med Interne, 1998 Feb, 19(2), 91 - 7 {Tuberculosis and systemic diseases . Apropos of 16 cases}; Darras-Joly C et al.; METHODS: We analyzed retrospectively 16 patients between 1976 and 1993 (six men, ten women, mean age: 49-year-old) suffering from connectivitis . HIV-negative and receiving corticosteroids, combined for six of them with immunosuppressive therapy, and suffering from tuberculosis . RESULTS: The mean period between first signs and diagnosis was 51 days (3-190 d) . Tuberculosis was pulmonary (n = 10) of which 4 miliary, pleurisy (n = 3), lymphadenitis (n = 5) . We only observed one meningitis, one otitis and one female genital tuberculosis . Six patients had more than one localisation . Diagnosis was proven bacteriologically eight times, histologically six times and for three patients diagnosis was certain because of efficacy of antituberculosis antibiotherapy . Evolution was always good, with antituberculosis antibiotherapy of maximum 18 months, without sequella . Because rifampicin enzymatic induction, connectivitis worsened in five patients . An increase in corticotherapy was necessary for these five patients . CONCLUSION: This series confirmed the frequently extrapulmonary feature of tuberculosis in immunosuppressed patients, the long delay of diagnosis and the risk of exacerbation of underlying disease with rifampicin. Neurol Neurochir Pol, 1998 May-Jun, 32(3), 677 - 87 {Difficulties in diagnosis and therapy in a case of brain inflammatory process in patient with Hodgkin's disease}; Bilinska M et al.; A rare case of cerebral probable viral inflammatory process in a patient with the Hodgkin's disease has been presented . The diagnosis of the neurological disorder was based on the clinical course of the disease, the dynamics of the process observed in CT and MRI examinations . The pathogen was not identified in bacteriological and viral tests . Hodgkin's disease restricted to the spleen was diagnosed in postmortem examination . The presented case demonstrates variability of the clinical picture and difficulties in diagnosing viral encephalitis. Rev Pneumol Clin, 1998 Feb, 54(1), 23 - 5 {Broncho-pulmonary cancer associated with pulmonary tuberculosis . Report of 4 cases}; Ben M'Rad S et al.; The association between bronchopulmonary carcinoma and pulmonary tuberculosis would not be fortuitous but related to increased susceptibility to opportunistic infections and tuberculosis in cancer patients . We present four cases demonstrating the gravity of the situation and the difficulties encountered in diagnosis and treatment . Diagnosis of tuberculosis in patients with bronchopulmonary carcinoma requires pathological evidence from histology biopsies or bacteriology samples . The diagnosis is further complicated in early stage neoplasms . In case of tuberculosis, surgical treatment of bronchopulmonary carcinoma may have to be postponed or even contraindicated . Inversely, chemotherapy and radiotherapy may favor extension of the tuberculosis. Res Microbiol, 1997 Jul-Aug, 148(6), 491 - 500 Glycolipid antigen for use in diagnostic assays for bovine tuberculosis; Ostyn A et al.; A glycolipid antigen, was isolated, purified and characterized from Mycobacterium bovis An5 . Chemical analysis (thin-layer chromatography, nuclear magnetic resonance and infrared spectra) showed that this glycolipid was a 2,3-di-O-acyl trehalose (DAT), similar to the DAT of M . tuberculosis . This antigen was used to establish ELISA-based serodiagnostic tests for M . bovis-infected cattle . The sensitivity and specificity of the assay were investigated using sera of cattle from tuberculosis-free herds and from tuberculosis-infected herds . No correlation was found between DAT-ELISA and the skin test, nor between DAT-ELISA and interferon-gamma with bovine purified protein derivative . The antibody titres were not related to cell-mediated immunity . Although the antigen was highly specific (95.9%), the sensitivity of DAT-ELISA, as judged from assays in bacteriologically confirmed tuberculosis, was low (29 to 36.8%) . The low sensitivity of ELISA might also be attributed to a reciprocal relationship between B-cell proliferation and T-cell protective immunity. Arch Bronconeumol, 1998 Jul-Aug, 34(7), 333 - 8 {Characteristics of tuberculosis in a tertiary hospital during the years 1993-1996 . Influence of the coinfection with HIV}; Cremades Romero MJ et al.; To assess and compare epidemiological factors, clinical and radiological signs, laboratory results and drug resistance in patients with tuberculosis (TB) with and without AIDS . Retrospective study of TB diagnosed bacteriologically between January 1993 and December 1996 at Hospital Universitario La Fe . Annual rates were 41.7, 47.1, 34.6 and 43.8 per 100,000 inhabitants in 1993 to 1996, respectively . AIDS was present in 22.4% . TB was pulmonary in 87% and 49.4% in patients without and with AIDS, respectively . Incidence was higher in the 25 to 34 age range . Prior contact with TB patients was established in 19.2% of cases . Pulmonary TB in patients with AIDS presented with normal lung X-rays in 30.1%; 16.2% of these had positive sputum cultures . Pulmonary cavitation was evident in 32.6% of TB patients without AIDS and 6.8% of those with AIDS . Pulmonary TB was diagnosed by culture of sputum taken at the time of admission in 25.9% of non AIDS patients and in 12.4% of patients with AIDS . Extrapulmonary TB was diagnosed by culture in most cases . Such forms predominated among TB plus AIDS patients, with most cases being ganglial and urogenital . Overall drug resistance was 8.3% (7.4% non-AIDS/11.5% AIDS) . Primary resistance (PR) was 6.3% and 7.1%, PR to hydrazides was 5% and 5.4%, and secondary resistance was 32.4% and 33.3% . Drug resistance in non-AIDS and AIDS patients, was associated with a history of TB and past treatment (p < 0.009), prior contact with TB patients (p < 0.004) and pulmonary cavitatin (p < 0.02) . TB with AIDS tends to occur in a younger population, is often extrapulmonary or with atypical lung involvement . Drug resistance is similar in patients with and without AIDS. Otolaryngol Pol, 1997, 51 Suppl 25, 195 - 8 {The study on biology of bacteriophages and their usage in the treatment of bacterial diseases and on the influence of different bacteriophages on cytokine production by leukocytes in human peripheral blood}; Kozminska J et al.; The authors showed the examinations of the biology bacteriophages and using them in the treatment of the bacteriology infection and influence difference bacteriophages in producing cytokinins by leukocytes of human peripheral blood. Int J Tuberc Lung Dis, 1998 Sep, 2(9), 732 - 5 Drug-resistant tuberculosis in Budapest; Fodor T et al.; SETTING: Sixteen districts of Budapest, Hungary . OBJECTIVE: To determine the frequency of primary and secondary drug resistance, and to recommend treatment regimens . DESIGN: A retrospective survey . METHODS: Mycobacterium tuberculosis isolates were collected from 264 newly diagnosed and 147 previously treated patients . All strains were tested against isoniazid (INH), rifampicin (RIF), streptomycin (SM) and ethambutol (EMB) using the proportion method . Bacteriologic examinations were performed in the Diagnostic Laboratory of the Koranyi National Institute for Tuberculosis and Pulmonology in Budapest . RESULTS: Primary resistance to INH alone was 4%, to SM alone 2%, to RIF alone 0.4%, to INH and SM 1%, and to INH, RIF, SM and EMB 0.4% . Of the isolates of 78 relapse cases, six (8%) were resistant to INH alone, one (1%) to INH and RIF, two (3%) to INH, RIF, SM and EMB . Of the isolates of 69 patients notified with active tuberculosis for over a year, 51 (74%) were susceptible to the drugs tested . CONCLUSION: Based on the level of primary drug resistance as well as on the resistance pattern of relapse cases, it is recommended to start the treatment of newly detected and relapse cases with four drugs . The high rate of chronic cases with susceptible strains can be explained by poor compliance . To prevent development of resistant cases and to achieve good compliance, it is necessary to apply direct observation of treatment in all types of patients. Eur J Cardiothorac Surg, 1998 Aug, 14(2), 206 - 10 The conventionally ventilated operating theatre and air contamination control during cardiac surgery--bacteriological and particulate matter control garment options for low level contamination; Verkkala K et al.; OBJECTIVE: The purpose of the study was to compare the usefulness of a conventional bacteriological technique with that of particle counting under lower air contamination and better aseptic conditions achieved with special staff garments and covering for the patient . Contamination levels were estimated with continuous on line air particle counting measurement, volumetric intermittent short period aerobic bacteriological cultures and wound surface contact cultures . METHODS: In a series of 66 consecutive coronary artery bypass operations performed by the same team and in the same theatre using different types of patient and staff clothing, the impact of a reduced bacteriological and particulate contamination were assessed . The volumetric air contamination of particles > or =5 microm and bacteria-carrying particles were monitored 30 cm above the sternal wound . The bacterial contamination and bacterial wound infections in the sternal and leg wounds were assessed as well . RESULTS: With the alternative garment and textile system, the air counts fell from 25 colony-forming units (CFU)/m3 to 7 CFU/m3 (P < 0.0038) . The contamination of the sternal wound was reduced by 46% and that of the leg wound by >90% . In order to give continuous contamination feedback during the whole operation to the theatre staff, particle counts > or =5 microm were monitored and visualized . Air particle counts decreased rapidly from 850 particles/m3 and stabilized to approximately 50 particles/m3 when the alternative clothing system was used (P < 0.001) . Low particle counts > or =5 microm should offer the possibility to indirectly estimate air bacteria carrying particle counts during the entire operation . Less than 20% of the total count in this size group carries bacteria . The low air contamination was achieved even in an ordinary ventilated theatre when individual team members used clean air suits in combination with impermeable patient drapes . When air particle level < or =50 particles/m3 is reached, the bacterial air contamination is in the order of that of orthopaedic hip operations . The staff must during the entire operation adjust their activity to air asepsis . CONCLUSIONS: The use of clean air suits and impermeable patient clothing results in a low exogenous contamination of air and wound . Continuous air particle monitoring is a good intraoperative method to monitor the air contamination longitudinally in an operating theatre. Arch Anat Cytol Pathol, 1998, 46(3), 193 - 8 {Cutaneous malacoplakia . An immunohistochemical and ultrastructural case study}; Chevallier A et al.; The authors report a case of a 70 year-old man with a past of myelodysplasia and presenting a voluminous lesion of the thigh corresponding to a cutaneous malacoplakia . Histologic study showed a dermo-hypoderma granuloma with numerous Von Hansemann cells containing some Michaelis-Gutmann bodies . Immunohistochemical study showed a positivity of these cells with the antibodies against CD68 (KP1, Mac 387, PGM1), the lysozyme and the alpha-chemotrypsine . Ultrastructural study confirmed the histiocytic origin of this infiltration by showing some regular and voluminous inclusions with a clear center and a peripheral and dense ring, and also some bacteria measuring 3 to 5 microns . Bacteriological study isolated an Escherichia coli . The evolution was favourable after surgical excision and antibiotherapy . Cutaneous malacoplakia is a very rare disease, usually with a perineal localization, and occurring in immunodeficient host . Michaelis-Gutmann bodies are sometimes difficult to identify by light microscopy underlying the rule of the immunohistochemical and the ultrastructural studies to perform the diagnosis. Ann Radiol (Paris), 1997, 40(1), 31 - 9 -Arthrography of the hip prosthesis-; Chicheportiche V; Arthrography of hip arthroplasties is a safe, easy-to-perform procedure . It is mainly indicated when infection of the arthroplasty is suspected: the contrast agent fills bone defects that may be present between normal bone and the prosthesis and reaspiration of injected fluids may lead to bacteriological diagnosis . Another indication for arthrography of hip arthroplasties is unexplained painful hip prosthesis. Ann Fr Anesth Reanim, 1998, 17(4), 291 - 5 {Quality of blood salvaged in orthopedic surgery by washing swabs}; Loeb T et al.; OBJECTIVE: To establish the feasibility and safety of recuperating blood absorbed by swabs used during orthopaedic surgery . STUDY DESIGN: Open, prospective study . PATIENTS: Included were children undergoing potentially haemorrhagic orthopaedic surgery for whom intraoperative blood salvage seemed possible . Excluded were those with contraindications for this procedure such as septic surgery and cancer surgery . METHOD: Intraoperative swabs used within the surgical field were collected by a surgical assistant, also in charge of weighing and washing them . The liquid was collected by the aspiration system of a recuperation-washing machine (RWM) . The salvaged red blood cells were collected and retransfused at the end of surgery . Several samples of the washing liquid of the swabs and salvaged blood were taken during the procedure . The correlation between the quantity of blood shed and salvaged was calculated . The biological and clinical tolerance of the transfusion was assessed . RESULTS: Twelve patients undergoing surgery for scoliosis have been included . An average of 278 mL of blood were salvaged . In the washed cell concentrates the haematocrit was 54% and the free haemoglobin concentration was 3.84 g.L-1 . All the bacteriological tests were negative over the first 24 hours . CONCLUSION: Provided that a strict operatory protocol is followed, this study demonstrates the possibility of recuperating blood from swabs used during major orthopaedic surgery. Int J Artif Organs, 1998 Jul, 21(7), 403 - 7 Fever in dialysis patients with recently rejected renal allografts; Sever MS et al.; INTRODUCTION: Fever of unknown origin is a complex problem in dialysis patients with recently rejected renal allografts, due to the contribution of the newly withheld immunosuppressive agents to the immunosuppression of uremia, resulting in an atypical presentation of infections, a main cause of fever in these cases . MATERIALS AND METHODS: Two dialysis patients with recently rejected renal allografts who were hospitalized because of fever of unknown origin are reported . Biochemical, bacteriological and imaging studies were performed for specific diagnosis . RESULTS: Extensive laboratory investigations failed to yield any diagnosis and allograft nephrectomy was performed in one patient, with a probable diagnosis of inflammation of the allograft, which resulted in no improvement . Eventually, both patients were found to have adrenal insufficiency responsible for the fever, which improved after steroid replacement . CONCLUSIONS: Adrenal insufficiency should be suspected in all dialysis patients presenting with fever and atypical symptoms, but only after other potential causes are eliminated; since steroid administration may normalize fever regardless of the etiology, it may mask the signs and symptoms and delay the treatment of other (if any) underlying disorder(s). Roum Arch Microbiol Immunol, 1998 Jan-Mar, 57(1), 59 - 66 Mycotic vaginitis caused by slow growth fungi; Caplan DM et al.; The bacteriological and mycological investigations performed in a female diabetic patient, aged 72, with genital secretion and local discomfort revealed slowly growing fungi, identified as Saccharamyces heterogenicus in the cervix uteri secretion . The cultures performed on Sabouraud medium were positive after 48 hrs incubation in liquid medium and after 4 days in solid medium . The strain was sensitive to: Clotrimazole, Diflucan, Nizoral, Nystatin. Jpn J Antibiot, 1997 Jul, 50(7), 622 - 7 {The clinical efficacy of imipenem/cilastatin sodium in orthopedic infections and drug levels in the bone tissue}; Handa N et al.; We evaluated the clinical efficacy of imipenem/cilastatin sodium (IPM/CS--a carbapenem antibiotic) against orthopedic infections, and the drug levels of the bone tissues were determined . The clinical efficacies for 6 patients in the infection group were good in 3 cases, and fair in the other 3; giving an efficacy rate of 50% . Bacteriologically, 8 strains were isolated from patients with the infection and an eradication rate of 87.5% was obtained upon the treatment . In 39 patients that were given the drug prophylactically, no postoperative infections occurred . Mean IPM levels in the bone and the bone marrow at 1 hour after administration in 5 patients of the prophylactic group were 17.3 micrograms/ml and 5.9 micrograms/g, respectively . The ratio of concentrations the bone to those in the bone marrow was 34.6% . The results of this study suggest that IMP/CS reaches to the bone tissue providing sufficient concentrations and that the drug is efficacious for the prophylaxis and the treatment of orthopedic infections. Kekkaku, 1998 Jul, 73(7), 477 - 83 {Time trend in incidence and mortality of tuberculosis and characteristics of notified tuberculosis patients in urban area of Mongolia}; Toyota M; Recent Mongolian political, social and economic changes have had a great impact on its health care system and tuberculosis control program . The objective of this study is to assess time trend in incidence and mortality of tuberculosis and characteristics of notified tuberculosis cases in Mongolia . 1) Data on statistics of tuberculosis are obtained from reports of the National Tuberculosis Center in Mongolia . The mortality of tuberculosis in Mongolia shows a downward trend during 1985-1995 . The number of notified tuberculosis cases had gradually decreased during 1985-1989 . It suddenly dropped in 1990 and was the lowest in 1993 . After that, about two fold increase in the notified cases was observed in recent three years from 1993 to 1995 . Such a large fluctuation in the number of notified cases after 1990 is unlikely to be associated with the epidemiologic situation of tuberculosis, but rather due to a reporting bias . The shortage of drugs and economic hardship prevented patients from consulting medical facilities . The shortage of drugs also prevented doctors from notifying patients to the tuberculosis registry, because the notification did not lead to treating the disease . The improvement of health care system and the supply of essential drugs since 1994 seems to contribute to the increase in the number of notified cases . 2) The study subjects include 618 patients who were diagnosed as active tuberculosis at ten tuberculosis specialized facilities in Ulaanbaatar, Mongolia from May 1995 to March 1996 . Patients were interviewed about their demographic factors and their medical records were reviewed . Fifty one percent of the cases were female . The mean age was 26.9 years old . Ninety percent of the cases underwent chest X-ray examination, while 72% of the cases underwent bacteriological examination and only 21% were confirmed bacteriologically . It is necessary to improve the quality control of sputum smear examination and the validity of diagnosis of tuberculosis in Mongolia . As for treatment regimens, only 29% of the cases were being treated with at least four drugs (isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin) . It is needed to provide directly observed treatment using the WHO recommended standard regimen to at least smear positive tuberculosis cases. Australas J Dermatol, 1998 Aug, 39(3), 183 - 5 Inoculation cutaneous tuberculosis; Jain S et al.; Two cases of inoculation cutaneous tuberculosis are presented . As commonly occurs, the diagnosis could not be confirmed bacteriologically due to the small numbers of organisms present . However, both patients responded to antituberculosis chemotherapy. Am J Vet Res, 1998 Sep, 59(9), 1087 - 91 Evaluation of a hand-held electrical conductivity meter for detection of subclinical mastitis in cattle; Musser JM et al.; OBJECTIVE: To assess, under field conditions, whether a hand-held electrical conductivity (EC) meter could be used to detect subclinical mastitis caused by pathogens most commonly associated with mastitis in dairy cows . ANIMALS: 425 lactating cows on 15 dairies in Costa Rica . PROCEDURE: Immediately prior to milking, milk samples from each quarter were tested, using a hand-held EC meter . A milk sample from the quarter with the highest score was submitted for bacteriologic culture . Results of bacteriologic culture were compared with highest absolute EC score for each cow and with differential EC score (ie, difference between the highest and lowest absolute EC scores for the 4 quarters of each cow) . RESULTS: Absolute EC score for cows with subclinical mastitis was significantly higher than that for cows without subclinical mastitis, and absolute EC score was significantly associated with detection of subclinical mastitis . If absolute EC score > or = 7 was considered indicative of subclinical mastitis, sensitivity was 0.43, specificity was 0.83, predictive value of a positive result was 0.39, and predictive value of a negative result was 0.85 . Differential EC score for cows with mastitis was significantly higher than that for cows without subclinical mastitis . If differential EC score > or = 2 was considered indicative of subclinical mastitis, sensitivity was 0.53, specificity was 0.77, predictive value of a positive result was 0.37, and predictive value of a negative result was 0.87 . CLINICAL IMPLICATIONS: A hand-held EC meter may be used to screen cows for subclinical mastitis. Chest, 1998 Aug, 114(2), 626 - 9 A case of concomitant tuberculosis and sarcoidosis with mycobacterial DNA present in the sarcoid lesion; Wong CF et al.; A 35-year-old Chinese woman initially presented with histologically and bacteriologically confirmed tuberculous lymphadenitis . She was also found to have thrombocytopenia, elevated serum alkaline phosphatase, and bilateral lung infiltrates . After 15 months of antituberculosis treatment, despite resolution of the cervical lymphadenopathy, she started to experience dyspnea . Chest radiograph appearance, thrombocyte count, and liver biochemistry had all deteriorated as well . Histologic findings from tissues obtained via transbronchial biopsy and open lung biopsy were consistent with sarcoidosis but also showed the presence of mycobacterial DNA by the polymerase chain reaction . She subsequently achieved a very good response clinically, radiographically, hematologically, and biochemically with 1-year of corticosteroid treatment for her sarcoidosis, and she remained relapse-free afterwards . The concomitant presence of tuberculosis and sarcoidosis in this patient together with the presence of mycobacterial DNA in the sarcoid lesion reiterate the possibility that mycobacteria or some of its components may be capable of inducing the immune response and the pathologic changes of sarcoidosis. Eur J Clin Microbiol Infect Dis, 1998 May, 17(5), 313 - 7 Efficacy, safety, and tolerance of piperacillin/tazobactam compared to co-amoxiclav plus an aminoglycoside in the treatment of severe pneumonia; Speich R et al.; An open, randomized, multicenter study was conducted to compare the efficacy and safety of piperacillin/tazobactam and co-amoxiclav plus aminoglycoside in the treatment of hospitalized patients with severe community-acquired or nosocomial pneumonia . Of the 89 patients who entered the study, 84 (94%) were clinically evaluable . A favorable clinical response was observed in 90% of the piperacillin/ tazobactam group and in 84% of the co-amoxiclav/aminoglycoside group (not significant) . The bacteriological efficacy was comparable in both groups (96% vs . 92%; not significant) . There was only one fatal outcome in the piperacillin/tazobactam group compared to six in the co-amoxiclav/aminoglycoside group regimen (P=0.058) . The adverse event rate was non-significantly lower in the piperacillin/ tazobactam group compared to the co-amoxiclav/aminoglycoside group (2% vs . 7%; P=0.32) . Piperacillin/tazobactam is safe and highly efficacious in the treatment of serious pneumonia in hospitalized patients . It compares favorably with the combination of co-amoxiclav/aminoglycoside. Hinyokika Kiyo, 1998 Jun, 44(6), 431 - 6 {Fleroxacin treatment for acute uncomplicated cystitis in women: comparison of 3-day and 7-day therapy}; Ishihara S et al.; The clinical efficacy of fleroxacin (FLRX), a new fluoroquinolone, for acute uncomplicated cystitis (AUC) in women was assessed . Two regimens, 3-day and 7-day courses of FLRX, 200 mg once a day, were compared . Clinical and bacteriological efficacy were evaluated after the therapy, and recurrence rate was evaluated 1 week and 4 weeks after termination of the therapy . Of 136 registered subjects, 35 in the 3-day group and 47 in the 7-day group were evaluated . According to the criteria of Japanese UTI Committee (3rd edition), the rate of excellent results was significantly higher in the 7-day group (78.9%) than in the 3-day group (48.6%), but the overall clinical efficacy rate was similar being 100% and 97.9%, respectively . Although no recurrence was seen 1 week after the therapy in either group, recurrence was seen in 14.3% and 7.4% of the cases in the 3-day and 7-day groups, respectively, 4 weeks after the therapy . Adverse reactions were observed in 2 and 3 cases in the 3-day and 7-day groups, respectively . Both 3-day and 7-day regimens of FLRX treatment showed good efficacy . Although the 7-day treatment was superior to the 3-day treatment as to high rate of excellent results and low rate of recurrence, the 3-day treatment was concluded to be sufficient for AUC. J Dent Res, 1998 Aug, 77(8), 1606 - 12 Synthetic integrin-binding peptides promote adhesion and proliferation of human periodontal ligament cells in vitro; Grzesik WJ et al.; Periodontal ligament (PDL) cells have been shown to express several integrins (alphav, alpha5, beta1, beta3) that use RGD (arginine-glycine-aspartic Acid)-dependent mechanisms for the recognition and binding of their ligands . The objective of this study was to evaluate the effects of certain integrin-binding cyclic and linear synthetic RGD-containing peptides on PDL cells' adhesion, proliferation, and de novo protein synthesis in vitro . Fifth passages of normal human PDL cells established from teeth extracted from patients (ages 12 to 14) for orthodontic reasons were used for all experiments . Synthetic peptides containing the EPRGDNYR sequence in two different spatial conformations (linear and cyclic) were covalently attached to bovine serum albumin (BSA) . Type I collagen, EPRGDNYR-BSA conjugates, 1:1 mixtures of type I collagen and conjugates, as well as BSA (a negative control) were coated on bacteriological plastic and evaluated for their attachment-promoting activities . In addition, the effects of these substrates on cell proliferation were evaluated by {3H}thymidine incorporation by the PDL cells . For attachment and spreading, the cyclic forms of EPRGDNYR-BSA conjugate and type I collagen were most potent, followed by linear EPRGDNYR-BSA conjugate . The effects of all collagen/conjugate mixtures were equivalent to that of type I collagen except for the collagen/linear EPRGDNYR-BSA mixture, which was less potent . The cyclic EPRGDNYR-BSA conjugate was the most effective substrate to stimulate cell proliferation, and it was followed in potency by the linear peptide-BSA conjugate . Collagen alone did not stimulate {3H}thymidine incorporation above the control level . Mixtures of collagen with all of the conjugates showed stimulatory effects similar to that of the cyclic peptide-BSA conjugate . No significant differences in de novo protein synthesis were detected . These results suggest that the synthetic RGD-containing peptides attached to a carrier are potent ligands for the human PDL cells, and that they could provide a basis for the development of new strategies aimed at the regeneration of the periodontium. Ann Surg, 1998 Aug, 228(2), 173 - 81 In Flanders fields: the Great War, Antoine Depage, and the resurgence of débridement; Helling TS et al.; OBJECTIVE: The care of traumatic wounds has evolved over hundreds of years, largely as a result of armed conflicts . The lessons learned during World War I in the treatment of extensive soft-tissue injuries proved invaluable in reducing infection and preventing loss of limb and life . Foremost among these was the use of debridement . This report reviews the development of debridement as standard treatment of war wounds and highlights the surgeon largely responsible for its resurgence during one of this century's saddest chapters . SUMMARY BACKGROUND DATA: Before World War I, the care of wounds consisted of minimal exploration and liberal use of then-new antiseptics . For limited injuries, this approach appeared adequate . World War I saw the introduction of devastating weapons that produced injuries that caused extensive devitalization of tissue . Standard treatment of these patients proved woefully inadequate to prevent life-threatening infections . METHODS: This is a historical review of the conditions that occurred during World War I that prompted a change in wound management . One of those responsible for this change was the Belgian surgeon Antoine Depage . His life and contributions to the care of war wounds are profiled . Depage reintroduced the discarded French practice of wound incision and exploration (debridement) and combined it with excision of devitalized tissue . RESULTS: Through the use of debridement, excision, and delayed wound closure based on bacteriologic survey, Depage was able to reduce the incidence of infectious complications of soft-tissue injuries, particularly those involving fractures . CONCLUSIONS: Through his experiences in the Great War, Antoine Depage was able to formulate a treatment plan for wounds of war . All such injuries were assumed to be contaminated and, as such, they required early and careful debridement . Depage thought that wound closure should often be delayed and based his decision to close on the bacteriologic status of the wound . To him, we owe our current management of traumatic wounds. Arch Surg, 1998 Aug, 133(8), 812 - 7; discussion 817-9 Necrotizing soft tissue infection masquerading as cutaneous abcess following illicit drug injection; Callahan TE et al.; OBJECTIVE: To assess factors that might predict serious necrotizing soft tissue infections following illicit drug injection . DESIGN: A retrospective review of a consecutive case series . SETTING: An urban municipal hospital . PATIENTS: Thirty patients presenting with cutaneous abscesses resulting from illicit drug injections during a 5-year period . All cases presented clinically with fluctuance, erythema, or induration but required extensive debridement at the time of incision and drainage . INTERVENTIONS: Operative treatment employed wide incision, routine subfascial examination, and aggressive debridement . Clinical management included broad-spectrum antibiotics, critical care support, and reconstructive procedures . MAIN OUTCOME MEASURES: Mortality, extent of debridement, preoperative vital signs and laboratory values, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, bacteriologic and pathologic test results . RESULTS: Postoperatively, all patients were housed in the intensive care unit for 8.4 +/- 14.5 days . Six patients died (20%) . On arrival at the intensive care unit, systolic blood pressure was 80 mm Hg or less in 2 patients, 1 of whom died . White blood cell count on hospital admission was elevated in 27 of 30 patients (mean, 27.2 +/- 15.3 x 10(9)/L) and 2 patients were identified as having human immunodeficiency virus infection . All patients underwent initial surgery less than 24 hours after admission; following debridement, the average wound size was 276 +/- 238 cm2 (range, 15-783 cm2) . Five patients required extremity amputation, and all other survivors underwent reconstruction with skin grafts and/or myocutaneous flaps . All but 1 patient were reexamined in the operating room within 12 hours and underwent an average of 3.1 +/- 1.6 operative procedures . Of those wound cultures obtained in the operating room, there was no pattern to the bacteriologic isolates . Seventeen patients had mixed isolates and 11 had single organisms . Pathologic findings in 20 patients included panniculitis (3 patients), necrotizing fasciitis (11 patients), myositis (6 patients), and osteomyelitis (1 patient) . We failed to identify any clinical factor, including temperature, heart rate, systolic blood pressure, white blood cell count, base deficit, albumin level, PO2, or APACHE II score that could predict mortality or the requirement for extensive debridement . CONCLUSIONS: Parenteral injections of illicit drugs can produce infections that present with signs of simple cutaneous abscess and yet unpredictably become extensive necrotizing soft tissue infections . Treatment requires a high index of suspicion along with an inquisitive operative approach to avoid missing these potentially serious infections. J Burn Care Rehabil, 1998 Jul-Aug, 19(4), 305 - 11 Intraoperative blood salvage in excisional burn surgery: an analysis of yield, bacteriology, and inflammatory mediators; Jeng JC et al.; The diminution of intraoperative hemorrhage remains a fundamental goal of the burn surgeon . We hypothesized that intraoperative blood salvage during burn excisions would be feasible if predicated on yield, bacteriology, and concentration of inflammatory mediators in the washed product . Reinfusion of culture-positive blood has a clear precedent in the trauma literature . Eight operations with immediate and complete collection of shed blood into a cell-saver device were prospectively studied . A median salvage rate of 43% of total shed red blood cells was estimated to have been recovered . Actual volumetric measurement of intraoperative blood loss was achieved . Bacterial contamination was consonant with the abdominal trauma experience . The levels of C3a, C5a, TNF alpha, and IL-1 beta in the final cell-saver product were all found to be at clinically insignificant levels. Crit Care Med, 1998 Aug, 26(8), 1452 - 7 Tunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials; Randolph AG et al.; OBJECTIVE: To evaluate the efficacy of tunneling short-term central venous catheters to prevent catheter-related infections . DATA SOURCES: MEDLINE, EMBASE, conference proceedings, citation review of relevant primary and review articles, personal files, and contact with expert informants . STUDY SELECTION: From a pool of 225 randomized, controlled trials of venous and arterial catheter management, we identified 12 relevant trials and included seven of these trials in the analysis . DATA EXTRACTION: In duplicate, independently, we abstracted data on the population, intervention, outcomes, and methodologic quality . DATA SYNTHESIS: Tunneling decreased bacterial colonization of the catheter by 39% (relative risk of 0.61; 95% confidence interval {CI} of 0.39 to 0.95) and decreased catheter-related sepsis with bacteriologic confirmation by 44% (relative risk of 0.56; 95% CI of 0.31 to 1) in comparison with standard placement . The majority of the benefit in the decreased rate of catheter-sepsis came from one trial at the internal jugular site (relative risk of 0.30, 95% CI of 0.10 to 0.89) and the reduction in risk was not significant when the data from five subclavian catheter trials were pooled (relative risk of 0.71, 95% CI of 0.36 to 1.43) . Tunneling was not associated with increased risk of mechanical complications from placement or technical difficulties during placement . However, this outcome was not rigorously evaluated . CONCLUSIONS: Tunneling decreases central venous catheter-related infections . However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions. Med Clin (Barc), 1998 Jun 27, 111(3), 88 - 91 {Prospective randomized trial of meropenem versus cefotaxime and metronidazole in the treatment of intraabdominal infections}; Sitges-Serra A et al.; BACKGROUND: The empiric antibiotic treatment of intraabdominal infections is in constant evolution . Monotherapy appears to be a desirable goal because of the simplicity of its administration, lack of toxic effects and wide spectrum . PATIENTS AND METHODS: A multicentre, prospective, randomized, open study was carried out to compare two antibiotic regimens in the treatment of intraabdominal infections in patients undergoing surgery . Ninety-eight consecutive patients were randomly allocated into two groups . One group (GM, n = 51) received meropenem (1 g/8 h) and the other (GCM, n = 47) a combination of cefotaxime (2 g/8 h) plus metronidazol (0.5 g/8 h) . Clinical and bacteriological responses were assessed at the end of treatment and at 2-4 weeks . RESULTS: The severity of patients as assessed by the APACHE II score was similar in both groups (GM: 7.2 and GCM: 8.1) . Three patients in each group could not be evaluated due to premature interruption of treatment or deviation from the protocol . The mean duration of treatment was 7.4 days in GM and 7.9 days in GCM . A satisfactory clinical response was obtained in 95% of patients in both groups . 31 patients (61%) in GM and 26 patients (55%) in GCM were bacteriologically evaluable . Bacteriological erradication was achieved in 94% of patients in GM and in 92% of patients in GCM . CONCLUSION: Meropenem is a good alternative for single antibiotic therapy in intraabdominal infections of moderate severity. J Clin Microbiol, 1998 Sep, 36(9), 2782 - 3 Isolation of Francisella tularensis by centrifugation of shell vial cell culture from an inoculation eschar; Fournier PE et al.; A 52-year-old man was admitted to the hospital following the development of an inoculation eschar and fever six days after being bitten by a tick . He was clinically diagnosed as suffering from rickettsiosis . Eschar biopsy cultures on standard bacteriological media remained sterile . However, inoculation of cells with the homogenized specimen by the centrifugation-shell vial technique (M . Marrero and D . Raoult, Am . J . Trop . Med . Hyg . 40:197-199, 1989) resulted in the recovery of a bacterium . Determination of the sequence of the 16S rRNA gene amplified from the organism and comparison of the sequence to other sequences identified it as a strain of Francisella tularensis, whereas the specific serology was still negative . Our findings demonstrate that the centrifugation-cell culture, which is a tool for investigation of tick-transmitted diseases, may have the potential to serve as a method for the cultural isolation of F . tularensis. Urol Int, 1998 Aug, 60(4), 229 - 34 Percutaneous suprapubic transvesical route: a new and comfortable method of intraprostatic injection; Yavascaoglu I et al.; To assess the efficacy and safety of the percutaneous suprapubic transvesical route (STR) for intraprostatic antibiotic injections and compare it with the transperineal route (TPR), a total of 37 patients suffering from chronic bacterial prostatitis, resistant even to treatment with fluoroquinolones, were randomized to intraprostatic amikacin injections using either STR (n = 19) or TPR (n = 18) . Follow-ups were done at weeks 4, 12, 24 and 52 . Patients found to have failures at the first follow-up were given an additional injection using the initial route . At the 24th week, 15 patients from both groups were given another injection using the alternative route and were asked to report any subsequent voiding difficulties and compare the discomfort and pain experienced . At the end of 52 weeks, bacteriological cure rates did not differ significantly (44.4 vs . 47.3%) . Overall improvement rates in the severity of symptoms and signs were similiar . Considerable difficulty in directing the needle to the prostate due to an excessive amount of subcutaneous fat was experienced, and more than 1 skin puncture was necessary in 5 of the STR group, whereas in the TPR group 7 patients with external hemorrhoids and 1 patient with a rectal fissure had prominent discomfort and pain during the transperineal procedures . Complications such as dysuria or hemospermia were encountered infrequently in both groups, but hematuria was observed more frequently in the STR group (85 vs . 54%) . Less discomfort (p < 0.01) and pain (p < 0.01) were reported during access to the prostate by STR, but pain during the injection of the drug did not differ significantly . In conclusion, the percutaneous STR may well be used efficiently and comfortably as an alternative method to TPR when intraprostatic injections are needed in a limited number of cases such as those with a known hypersensitivity to fluoroquinolones or with a history of failure despite long-term systemic treatment with these agents. Zh Mikrobiol Epidemiol Immunobiol, 1998 May-Jun, (3), 16 - 20 {Emergency laboratory diagnosis of diphtheria}; Karal'nik BV et al.; The immune response to diphtheria toxin (clinically pronounced infection or carrier state with the presence of toxigenic bacteria) or toxoid (vaccination) the blood has been found to contain lymphocytes (1.00-5.71%), specifically binding diphtheria toxoid (DTX) . The method for the determination of lymphocytes, specifically binding DTX, may serve both for early diagnosis and in the process of the disease, irrespective of the injection of therapeutic serum to the patient . The result of the test is obtained 2-3 days earlier than the positive result of the bacteriological analysis . The set of immune reagents for the rapid diagnosis of diphtheria by the method of rosette formation has been developed. J Hosp Infect, 1998 Jul, 39(3), 173 - 80 Importance of air quality and related factors in the prevention of infection in orthopaedic implant surgery; Gosden PE et al.; Small numbers of organisms can cause orthopaedic implant infections, which give rise to a considerable degree of morbidity and also mortality . The periprosthetic infection rates have been shown to correlate with the number of airborne bacteria within 30 cm of the wound . This is influenced by factors such as the number of operating theatre personnel, their clothing and the type of ventilation system used . Guidance on routine bacteriological monitoring of ultraclean air theatres, based on the Department of Health document Health Technical Memorandum 2025, is discussed . Factors important in minimizing the number of postoperative implant infections such as the use of ultraclean air, ultraviolet radiation, different types of surgical clothing, prophylactic antibiotics and host-related factors are also discussed . The importance of proper scientific investigation into the effectiveness of practical preventative measures in the operating room is emphasized. J Epidemiol, 1998 Jun, 8(2), 90 - 3 Clinical characteristics differentiating bacteriologically positive pulmonary tuberculosis patients from negative ones in Mongolia; Toyota M et al.; The objective of this study is to clarify clinical characteristics which differentiate bacteriologically positive pulmonary tuberculosis patients from negative ones in Mongolia . The subjects include 338 patients aged 16 years and older who had undergone bacteriological examinations . Of them, 107 patients (31.7%) were confirmed bacteriologically . The proportion of bacteriological positive results increased significantly among patients who had cavities in the roentgenographic examination, cough at diagnosis and the family history of tuberculosis . Addressing these clinical characteristics will contribute to raising not only the sensitivity of the sputum examination, but also the specificity of the roentgenographic examination in the diagnostic process of tuberculosis. Eur J Surg, 1998 Jun, 164(6), 425 - 31 Laparoscopic cholecystectomy for acute cholecystitis and the consequences of gallbladder perforation, bile spillage, and "loss" of stones; Assaff Y et al.; OBJECTIVE: To study the factors associated with accidental perforation of the gallbladder and spillage of bile and stones and to assess the consequences of these mishaps . DESIGN: Prospective study with retrospective bacteriological evaluation . SETTING: Teaching hospital, Israel . SUBJECTS: 189 Patients who were treated for clinical acute cholecystitis between January 1994 and August 1996 . INTERVENTIONS: Emergency laparoscopic cholecystectomy . MAIN OUTCOME MEASURES: Incidence of accidental perforation of gallbladder and spillage of bile and stones and of conversion and complications in relation to preoperative and operative findings . RESULTS: Bile was spilt in 65 (34%) and gall-stones were "lost" in 27 (14%), 44 (23%) required conversion to an open approach and 36 (19%) developed complications . Preoperative duration of symptoms >96 hours and a palpable gallbladder were associated with accidental perforation of the gallbladder and spillage of bile . A palpable gallbladder, gangrenous cholecystitis, and WBC > 15 x 10(9)/L were associated with stones "lost" in the peritoneum . A history of biliary disease was inversely related to "lost" stones . Conversion of laparoscopic to open cholecystectomy was associated with male sex, age >60 years, a non-palpable gallbladder, WBC > 15 x 10(9)/L, and a gangrenous gallbladder . Complications of surgery were more common among men and associated with fever of >38 degrees C . Neither the conversion nor the complications were associated with perforation of the gallbladder or "lost" stones . CONCLUSION: Perforation of the gallbladder and intraperitoneal spillage of bile or stones during laparoscopic cholecystectomy for acute cholecystitis are not associated with undesirable events, are not indications for conversion, and are not associated with further complications . When patients are given appropriate antibiotics perioperatively and the spilt bile is properly aspirated and the peritoneum irrigated, the operative and postoperative courses are similar to those of patients with unperforated gallbladder. Acta Leprol, 1998, 11(2), 21 - 4 Progression of bone lesions in cured leprosy patients; Carpintero P et al.; A group of 52 patients deemed to be cured of Hansen's disease were examined in order to determine the appearance or aggravation of bone lesions after cure . A study was made of X-rays performed both at the moment these patients were considered to be cured and a minimum of 2 years later . During the elapsing interval, new lesions had appeared in 8 patients, and existing lesions had worsened in 12 patients . Factors associated with the progression of lesions were: impaired sensitivity, physical activity and appearance of plantar ulcers . The authors feel that leprosy patients, even when considered to be bacteriologically cured, should undergo regular checkups . Factors which might aggravate bone lesions should be borne in mind. Ir Med J, 1998 May-Jun, 91(3), 93 - 4 Tuberculosis incidence in Northern Ireland and the Republic of Ireland--a collaborative study; Varghese G et al.; We examined the incidence of tuberculosis in the Republic of Ireland and Northern Ireland for 1991 using the Census of Population for both jurisdictions, data from a National Survey of Tuberculosis for 1991 for the Republic and examination of nominal notification data for Northern Ireland . We showed that there is a significantly higher incidence of TB in the Republic of Ireland . More cases were reported (p < 1.0 x 10(-7)) as were more bacteriologically proven cases (p < 1.0 x 10(-7)) . The difference was true for each of the following age groups (< 15 years, 15-35 years, 35-54 years and > 55 years) but it is noteworthy that areas in the Republic which make use of neonatal BCG vaccine did not have a significantly different rate of tuberculosis for individuals less than 15 years (p = 0.34) compared to Northern Ireland. Vet Microbiol, 1998 May, 62(2), 163 - 9 Identification of porcine Serpulina strains in routine diagnostic bacteriology; Hommez J et al.; Serpulina strains from pigs were identified using simple tests . The large size of S . hyodysenteriae in stainings from colonic contents and faeces was found useful for the presumptive differentiation of this major pathogenic species from the other Serpulinae . However, this morphological characteristic gets lost upon cultivation . The 'ring phenomenon' aided to confirm the strong haemolysis typical for S . hyodysenteriae . The weakly haemolytic species S . innocens, S . pilosicoli, S . intermedia and S . hyodysenteriae could be differentiated with the help of the indole spot test and two or four other simple enzymatic tests . Nearly half of the S . hyodysenteriae strains isolated in Belgium were indole-negative . Such strains have only rarely been reported earlier, and were absent among the strains from other European countries examined. Ter Arkh, 1998, 70(6), 35 - 8 {Subacute bacterial endocarditis: diagnostic aspects}; Vinogradova TL et al.; AIM: To compare the proposed diagnostic criteria of subacute infectious endocarditis (SIE) to criteria developed by von Reyn et al . and by Duke Endocarditis Service . MATERIALS AND METHODS: 69 SIE cases and suspected recurrences have been analysed for patients observed in the Therapeutic Clinic of the Moscow medical University in 1990-1997 . RESULTS: According to the authors' criteria accurate and tentative SIE diagnosis were made in 82 and 18% of patients, respectively . The other two diagnostic approaches in this situation increase the percentage of presumptive diagnosis and decrease that of the definite one . CONCLUSION: The criteria proposed by the authors are more sensitive in diagnosis of definite SIE, are less dependent on echocardiography quality and bacteriological diagnosis. Rhinology, 1998 Jun, 36(2), 55 - 8 Difficulties in interpretation of culture results in sinusitis; Verschraegen G et al.; In this article, we try to explain the difficulties met in the bacteriology laboratory when dealing with samples to diagnose sinusitis . The sampling techniques are very important since there are 3 main types of specimen . The transportation also needs to be done in a proper way, because fastidious organisms stop growing if optimal conditions are not achieved, and on the contrary, the commensal flora can overgrow the pathogens . The processing in the laboratory itself follows certain rules in order to reach some standardization . Nevertheless, the culture results are sometimes difficult to interpret . Thus, the clinician as well as the bacteriologist, should relate laboratory results to clinical history. Acta Leprol, 1998, 11(1), 21 - 4 Progression of bone lesions in cured leprosy patients; Carpintero P et al.; A group of 52 patients deemed to be cured of Hansen's disease were examined in order to determine the appearance or aggravation of bone lesions after cure . A study was made of X-rays performed both at the moment these patients were considered to be cured and a minimum of 2 years later . During the elapsing interval, new lesions had appeared in 8 patients, and existing lesions had worsened in 12 patients . Factors associated with the progression of lesions were: impaired sensitivity, physical activity and appearance of plantar ulcers . The authors feel that leprosy patients, even when considered to be bacteriologically cured, should undergo regular checkups . Factors which might aggravate bone lesions should be borne in mind. Epidemiol Infect, 1998 Jun, 120(3), 239 - 43 Serum antibodies to secreted proteins in patients infected with Escherichia coli O157 and other VTEC; Chart H et al.; Certain strains of verotoxigenic Escherichia coli (VTEC), and in particular those belonging to serogroup O157, cause attaching and effacing (AE) lesions of the host gut mucosa during pathogenesis . The mechanisms involved with bacterial attachment and the destruction of microvilli are determined by a cluster of genes within the LEE region, which also encode five secreted proteins . Sera from patients with antibodies to the lipopolysaccharide (LPS) of E . coli O157 and other VTEC were tested for antibodies to these secreted proteins . Twenty-one of 34 (62%) sera with antibodies to the lipopolysaccharide (LPS) of E . coli O157 also contained antibodies to one or more of the secreted proteins . Five of 12 sera containing antibodies to the LPS of a range of other VTEC serogroups also contained antibodies to 1 or more of the 5 secreted proteins, as did 16 of 70 (23%) sera from patients with haemolytic uraemic syndrome (HUS), haemorrhagic colitis (HC) or diarrhoea, but without bacteriological evidence of infection with VTEC and which did not contain antibodies to VTEC serogroups O5, O115, O145, O153 or O157 . The detection of serum antibodies to secreted proteins may provide additional information for interpreting the results of established lipopolysaccharide-based VTEC serology. Respir Med, 1998 Mar, 92(3), 493 - 7 Radiographic spectrum of adult pulmonary tuberculosis in a developed country; Wilcke JT et al.; SETTING: Bispebjerg Hospital, Department of Pulmonary Medicine P . The referral centre of adult tuberculosis in the municipality of Copenhagen, Denmark . OBJECTIVE: To evaluate the radiographic spectrum of pulmonary tuberculosis (TB) in adults in a low-prevalence country and to correlate radiographic appearances with bacteriological results, clinical and demographic data . DESIGN: Retrospective review of medical files on 548 cases with pulmonary TB according to the criteria of WHO . RESULTS: Usual radiographic pattern of reactivating TB, with upper lobe involvement, was found in 92% (n = 504), eight percent (n = 44) showed unusual X-ray patterns for adults, such as isolated lower lobe infiltrations (n = 19), hilar adenopathy (n = 10), miliary TB (n = 7), tuberculoma (n = 2), pleural effusion (n = 1) and normal chest X-ray (n = 3) . Eight-nine percent of cases with cavitary lesions were positive by microscopy . CONCLUSION: The risk of missing a diagnosis of pulmonary TB may be high if patients present with an X-ray unusual for TB, but this is fortunately seen only in 8% of cases of pulmonary tuberculosis . Unusual X-ray is more commonly found in patients with concomitant disease, such as diabetes and cancer . If chest X-ray shows cavities, but the smear is negative for Mycobacterium, TB is unlikely and further diagnostic procedures should be performed without waiting for culture results. Recenti Prog Med, 1998 Jul-Aug, 89(7-8), 372 - 6 {Fever of unknown origin . Comparison of the diagnostic spectrum of 53 cases in a medical ward in an Italian hospital with those of other 9 countries}; Campanella N et al.; In the Institute of Medical Pathology of Ancona University, 53 cases of fever of unknown origin (FUO) were reviewed . In 44 cases (83%) the diagnosis was certainly stated . The diagnostic spectrum of the diagnosed cases was: 31 infectious (58%), 3 neoplastic (6%), 8 autoimmune (15%), 2 miscellaneous diseases (4%) . Nine cases (17%) were undiagnosed . The mortality rate of the diagnosed cases was 16% within 16 months . The diagnostic spectrum, compared with the FUO series from nine countries, is unlike because of a higher rate of infectious diseases and a lower rate of neoplastic diseases . The methods, successfully used to achieve the final diagnosis were: laboratory tests, including bacteriologic studies, in 39%, evaluation of the clinical course and follow-up in 25%, imaging scan tests, including radionuclide, ultrasound, magnetic resonance, computed tomography, in 23%, and anatomopathological studies in 13% . A three years' follow-up was successfully carried out in 7 out of the 9 undiagnosed patients: 5 were healed without any treatment, 1 healed through a course of non steroid anti-inflammatory drugs and only one died because of the FUO carrying disease . None was persistently sick . The data are discussed through a comparison with the series of FUO bearing patients from other 9 countries. Transfus Clin Biol, 1998 Jun, 5(3), 203 - 10 {Transfusion incidents related to bacterial contamination: review of the literature and hemovigilance data . For the working group Bacterial incidents of French Blood Agency, scientific advice of Bacthem and the French hemovigilance network}; Perez P et al.; The impact of transfusion reactions related to bacterial contamination (TRBC) of labile blood products (LBP) was identified in France soon after the implementation of the haemovigilance system . The aims of our communication were: 1) to confront published data on TRBC with available French data; 2) to describe measures implemented in France to prevent TRBC . Bacterial contamination of whole blood at the collection stage is found in 0.6 to 3% of blood donations . Systematic bacteriological controls detect frequent contaminations of LBP that vary according to studies and the nature of the product . The incidence of clinical TRBC was only estimated in recipients with malignant diseases . Based on French haemovigilance data, the incidence was estimated to two per 100,000 delivered units . The measures taken were the diffusion of information and recommendations and the implementation of studies . In the framework of the Bacthem study (a national case-control study on LBP-related bacterial contamination), standardised diagnostic criteria are applied to suspected TRBC notified to the Centre National d'Hemovigilance . Expected results should allow us to estimate the incidence of TRBC in France and to determine the recipients or situations at risk more precisely, in order to target additional preventive measures . Preliminary results, 11 months after the beginning of the study, show the feasibility and the relevance of completing the surveillance with specific studies within the haemovigilance network. Ann Otolaryngol Chir Cervicofac, 1997, 114(4), 105 - 15 {Caseous sinusitis . Clinical, x-ray computed, surgical, histopathological, biological, biochemical and myco-bacteriological aspects . Apropos of 33 cases}; Braun JJ et al.; We analyse the most important clinical, CT, surgical, histopathological, biological, biochemical, mycological and bacteriological features of caseous sinusitis, i.e . chronic, poorly symptomatic sinusitis which are resistant to usual treatment . CT shows an opacity of the maxillary sinus with often a hyperdense foreign body (dental overfilling) but no valid predictive criteria for fungal etiology . The endoscopic or surgical procedures point out a caseous mass often called fungal mass or aspergilloma . The biochemical composition of this mass (water, proteins, lipids) is similar to that of tissues surrounding the sinus . The calcium value is variable and shows no correlation with CT imaging . The qualitative and quantitative analysis of the metals (zinc, lead, silver, copper, iron) is of relevance for exogenic origin (dental overfilling) . The fungal etiology is inconstant (20 cases) after the mycological investigations . We discuss the nosologic and diagnostic features of caseous sinusitis, fungal or not, and which are often or too often called aspergillosis sinusitis. Vet Pathol, 1998 Jul, 35(4), 235 - 40 Mammary and systemic aspergillosis in dairy sheep; Perez V et al.; Mammary aspergillosis was diagnosed in four flocks of dairy sheep, comprising a total of 1,750 ewes . These animals had been treated prophylactically by intramammary infusion with cloxacillin 5 months prior to lambing . Mammary aspergillosis with concomitant spread to the regional lymph nodes was present in these flocks in a percentage ranging from 2% to 36.4% of treated sheep . Pathologic, bacteriologic, and mycologic studies were performed in seven of the affected ewes . Some of them also had lung, kidney, and liver involvement . The pathologic reaction within lesions ranged from the acute to subacute type, dominated by necrosis and vasculitis with thrombosis, to the chronic granulomatous type, with macrophages and giant cells . The distribution of lesions and the presence of a remarkable vasculitis with fungal thrombi in the mammary gland suggested a hematogenous dissemination of the infection from this organ . Immunologic staining with monoclonal antibody MAb-WF-AF-1, which reacts specifically with Aspergillus hyphae, identified the causative agent in histologic sections of the different affected tissues . The etiologic diagnosis was further supported by the isolation of Aspergillus fumigatus in pure culture from affected tissues and from eight samples of mammary secretions. Clin Nucl Med, 1998 Jul, 23(7), 423 - 8 Tc-99m HMPAO leukocyte and Tc-99m nanocolloid scintigraphy in posttraumatic bone infection; Papos M et al.; Posttraumatic osteomyelitis was investigated in 23 patients using nuclear medicine techniques . Tc-99m hexamethylpropilene amine oxime (HMPAO)-labeled leukocyte scintigraphy was performed in 11 patients, and Tc-99m nanocolloid scanning was performed in the other 12 patients . The scintigraphic findings were compared with clinical, laboratory, radiologic, and bacteriologic results . The findings on leukocyte imaging were consistent with the clinical symptoms in 7 of 11 patients, with the laboratory pattern in 7 of 10 patients, with the radiologic findings in 7 of 11 patients, and with the results of bacteriology in 6 of 7 patients . The findings on nanocolloid scintigraphy corresponded with the clinical symptoms in 9 of 12 patients, with the laboratory pattern in 8 of 10 patients, with the radiologic findings in 8 of 12 patients, and with the bacteriology in 4 of 5 patients . The results suggest that both methods were of similar value for the detection of chronic posttraumatic osteomyelitis regardless of whether the process was active . Conversely, on the basis of semiquantitative analysis of the images, leukocyte scintigraphy seemed to characterize the grade of inflammation better than did nanocolloid scintigraphy. J Med Assoc Thai, 1998 Jul, 81(7), 547 - 50 Bacteriological quality of holywater from Thai temples in Songkhla Province, southern Thailand; Phatthararangrong N et al.; Seventy-six holy water samples were collected from seventy-six Thai Buddhist temples in Songkhla Province, southern Thailand . The samples were examined for total heterotrophic aerobic bacterial count and total coliform count . The range of total heterotrophic aerobic bacterial count was 6.5 x 10(1)-1.6 x 10(5) CFU/ml, while the total coliform count was < 2- > 1,600 MPN/100 ml . Escherichia coli was isolated from positive coliform tests in a total of 22 samples (28.95 per cent) . According to the World Health Organization's (WHO) standards for drinking water (1993), only 9 of the samples (11.84 per cent) qualified . Interestingly, these 9 samples had originated from rain water. Ear Nose Throat J, 1998 Jun, 77(6 Suppl), 16 - 9; discussion 20-1 Treatment failures in otitis media--what can we learn? Dagan R, Leibovitch E, Fliss DM, Leiberman A. The role of antibiotics in acute otitis media is to eradicate the causative pathogen from the middle ear . It is therefore important to have antibiotics with good activity which reach the organism in an appropriate concentration at the infection site . Without these parameters successful treatment will not be achieved . The ultimate test of this concept is to demonstrate the eradication of a pathogen from middle ear aspirate post-treatment . Careful analysis of treatment failures show that increasing rate of resistance to existing drugs is associated with a decreased rate of pathogen eradication in acute otitis media and there is a clear correlation between bacteriologic failure and clinical failure. Nervenarzt, 1998 Jun, 69(6), 502 - 6 {Value of polymerase chain reaction (PCR) for diagnosis of tuberculoid meningitis}; Fresquet-Wolf C et al.; The prognosis of tuberculous meningitis (TBM) depends on early therapy based on rapid diagnosis . To study the clinical value of PCR in diagnosis of TBM, we investigated CSF specimens from 49 patients . After cell lysis and DNA preparation following a standard protocol, we performed a half-nested PCR with primers able to detect mycobacterial DNA . PCR results were evaluated according to clinical features, histopathological data, and bacteriological results . PCR detected four of five cases of confirmed TBM, corresponding to a sensitivity of 80% . Positive PCRs were also obtained in 25% CSF samples of non-TBM patients . Most of these false positive results were due to amplification of Mycobacteria fortuitum (M . fortuitum) as determined by direct sequencing analysis . To enhance specificity of our half nested protocol, the oligonucleotide primers that were specific for several mycobacterial subspecies were substituted by a primerpair, which allows selective amplification of DNA from Mycobacteria tuberculosis (M . tuberculosis) . By using the altered PCR protocol, the screening of CSF samples revealed a much higher specificity (97%) and constant sensitivity (80%) in diagnosis of TBM . These findings indicate, that M . fortuitum, as an ubiquitous mycobacterial subtype of low pathogenicity, can potentially contaminate clinical specimens and account for false positive PCR results . Therefore, the clinical value of PCR in diagnosis of TBM strongly depends on appropriate oligonucleotide primers, that allow to differentiate between mycobacterial subtypes. J Public Health Policy, 1998, 19(2), 184 - 99 Plague that never was: a review of the alleged plague outbreaks in India in 1994; Deodhar NS et al.; Judging by WHO criteria, there was not a single case in India in 1994 that could be taken as a confirmed case of plague . Both clinical and epidemiological features of the illness alleged to be plague were not at all compatible with those of plague-both bubonic and pneumonic types . The bacteriologic and serological evidence was limited to a few cases, and doubtful . PCR is a highly sensitive test, but the specificity of PCR for plague was not verified under field conditions in India . Just by the demonstration of the presence of a causative organism in the environment or in the body tissue, one cannot substantiate occurrence of an infection or disease in man . In view of the assessment and review presented in this paper, one can conclude that the outbreaks of illness that resembled plague during late 1994 in Beed District and Surat were certainly not due to plague . If the Mamla outbreak had not been declared to be plague, the probability of the Surat illness being labeled as plague was negligible . Whatever happened provides a very important lesson of the harm that can occur nationally and globally from decisions based on inadequate or incorrect information. J Public Health Policy, 1998, 19(2), 134 - 46; discussion 147-59 C.-E . A . Winslow: scientist, activist, and theoretician of the American public health movement throughout the first half of the twentieth century; Terris M; C.-E . A . Winslow was the leading theoretician of the American public health movement during the entire first half of the twentieth century . An eminent bacteriologist, he subsequently made outstanding scientific contributions to occupational health and to the hygiene of housing . As activist, theoretician and historian, he played an important role in environmental health, epidemiology and disease prevention, public health administrative practice, health education, public health nursing, mental health, medical care, and the improvement of living standards . When he died in 1957, the American Journal of Public Health commented that "For a long half century Professor Winslow could be found always at the thick of the struggle for the people's health . In whatever area new gains appeared possible of achievement, there he would be--planning, inspiring, leading, or digging in to hold the advance." Br J Surg, 1998 Jun, 85(6), 755 - 9 Percutaneous aspiration for bacteriological studies in patients with necrotizing pancreatitis; Paye F et al.; BACKGROUND: Percutaneous computed tomography (CT)-guided aspiration of abdominal collections is performed in necrotizing pancreatitis to detect infection of necrosis, which is an adverse prognostic factor and requires surgical drainage . However, in the case of sterile aspirates, the outcome and the optimum management are subject to debate . This study examined the clinical and bacteriological outcome of patients with severe acute pancreatitis with initially sterile necrosis and assessed the efficiency of percutaneous drainage in this setting . METHODS: Seventeen patients hospitalized for necrotizing pancreatitis with a septic course underwent a preliminary sterile CT-guided aspiration . Eight patients underwent simultaneous percutaneous drainage of the punctured collection . Supportive therapy was continued unless severe clinical deterioration or proven secondary infection of necrosis indicated the need for necrosectomy and drainage . RESULTS: Secondary infection of necrosis was observed in two patients of nine who had only fine-needle aspiration cytology of the collection, and in seven of eight it was drained percutaneously (P = 0.01) . Only one patient drained percutaneously recovered without surgery . Surgical drainage was required in 12 patients . The hospital mortality rate was 29 per cent and was not significantly affected by the bacteriological status of necrosis . CONCLUSION: Percutaneous drainage of sterile collections predisposed to secondary infection of the necrosis and did not cure the patients . A first sterile percutaneous aspiration did not predict a favourable course and surgery frequently remains necessary. Vestn Ross Akad Med Nauk, 1998, (5), 40 - 4 {Colonic microenvironment in familial helicobacter infection}; Shcherbakov PL et al.; To elucidate the significance of the familial microenvironment in the genesis of Helicobacter infection, a clinical and instrumental investigation was made of 13 families selected by the probands who had digestive diseases associated with H . pylori: gastroduodenitis and duodenal ulcer disease . The occurrence of Helicobacter infection and gastritis in the family members was ascertained to be largely determined by their concurrent residence in the limited area, i.e . by the way of life . The contribution of the "family" factor in antral gastritis, fundal gastritis, and H . pylori infection was 60.0, 40.0, and about 90.0%, respectively . The patients with gastroenterological abnormalities associated with H . pylori were found to show changes in the species-specific and quantitative composition of the colonic microbiocenosis, which were symptomatic and revealed by bacteriological studies in 47.5% of cases and severe in 32.5% . When antihelicobacter therapy is planned, a through treatment of all family members and, if possible, pets should be made . Colonic microbiocenosis should be monitored while treating Helicobacter infection. Harefuah, 1998 Feb 1, 134(3), 168 - 72, 248, 247 {Recurrent tuberculosis in a psychiatric hospital, recurrent outbreaks during 1987-1996}; Zeenreich A et al.; During 1987-1996, 39 of 720 patients hospitalized (most for severe schizophrenia) were diagnosed as having active pulmonary tuberculosis (5.4%, 975 per 105 per year) . In 1992-1993, after a cluster of 5 cases was found, all patients were screened by PPD skin test and chest X-ray and 16 more cases were identified . Diagnosis was confirmed bacteriologically in only 10 of them but there were typical radiological findings in the others . 39 were treated with a multi-drug regimen . In addition, 333 exposed patients and 21% who had converted their skin tests were given isoniazid preventive therapy . A small increase in levels of liver enzymes was common, but significant abnormality (over 4 times the upper limit of normal) was found in only 7 patients, in whom therapy was therefore stopped or changed . During a follow-up period of 4 years, 2 more developed tuberculosis and 33 converted their PPD reactivity status . We conclude that an outbreak of tuberculosis in a psychiatric hospital can be controlled with a relatively low rate of side-effects by using systematic diagnostic and therapeutic measures . However, single step screening is not sufficient . Routine screening of all new patients, a high index of suspicion and contact investigation are needed. Int J Tuberc Lung Dis, 1998 Jul, 2(7), 569 - 74 The changing pattern of intestinal tuberculosis: 30 years' experience; Wang HS et al.; SETTING: Although the incidence of tuberculosis had been decreasing for many years, it has recently risen . OBJECTIVES: To investigate the changes in the pattern and distribution of intestinal tuberculosis and to alert surgeons to the importance of maintaining a high index of suspicion for this disease entity . DESIGN: Retrospective analysis of 134 patients with intestinal tuberculosis discharged from the Veterans General Hospital in Taipei from 1965 to 1995 . All records, bacteriological examinations and pathological specimens were reviewed and extracted onto a standard questionnaire . RESULTS: A decline in the case numbers of intestinal tuberculosis was noted after 1975 . However, there seems to be a slight rise in case numbers since 1990 . The average age of those patients after 1990 (64.8 years) is higher than those before 1990 (44.4 years) . None of our patients had clinical signs of human immunodeficiency virus (HIV) infection . Most patients (81.3%, 109/134) had not received a definite diagnosis until surgery . Active pulmonary tuberculosis was found in 37 patients (29.1%) . CONCLUSION: The possible reasons for the rise in cases of intestinal tuberculosis in our patients may be linked to an increased life expectancy, the reappearance of some formerly 'silent' tuberculosis cases, and relapse in patients having received incomplete antituberculosis chemotherapy . Its insidious and non-specific clinical presentation makes the diagnosis of intestinal tuberculosis difficult . An increased index of suspicion and greater familiarity with the disease may shorten the time of diagnosis and may also prevent some unnecessary operations. Int J Tuberc Lung Dis, 1998 Jul, 2(7), 563 - 8 Abdominal tuberculosis in Qatar: a clinico-radiological study; Szmigielski W et al.; SETTING: Hamad General Hospital, the tertiary health centre for Doha, Qatar . OBJECTIVE: The purpose of the study was to define and correlate the role of radiology with clinical and pathological findings in abdominal tuberculosis . MATERIAL AND METHODS: A total of 59 patients (47 males and 12 females) diagnosed bacteriologically and/ or histologically for abdominal tuberculosis were radiologically assessed . Evaluation was based on the analysis of plain abdominal radiographs, gastro-intestinal contrast studies (barium meal follow through and barium enema), ultrasonography and computed tomography . RESULTS: Plain abdominal radiographs performed in 38 patients were positive in 19 cases (50%) . Gastrointestinal contrast examinations were positive in 27 out of 34 cases (80%) . Ultrasound examinations were abnormal in 25 out of 31 cases (81%), while computed tomography, performed in 24 patients, revealed abnormal findings in 19 cases (80%) . Combined radiographic and imaging procedures revealed peritoneal involvement (ascites) in 16 patients (27%), bowel involvement in 36 (61%), mass lesion in 11 (19%), lymphadenopathy in 13 (22%) and organ involvement in 13 (22%) . CONCLUSION: There was no single radiological method that provided all necessary information suggestive of abdominal tuberculosis . Although unequivocal diagnosis of abdominal tuberculosis can only be made by culture and histological findings, combined computed tomography and ultrasound findings were the most important imaging tools in the diagnostic process for abdominal tuberculosis, while contrast studies helped to assess the extent of bowel disease, hence influencing decisions concerning surgery. Am J Vet Res, 1998 Jul, 59(7), 869 - 73 Induction of temporary otitis media in specific-pathogen-free pigs by intratympanic inoculation of Mycoplasma hyorhinis; Morita T et al.; OBJECTIVE: To examine whether Mycoplasma hyorhinis inoculated into the tympanic cavity can cause otitis media in pigs . ANIMALS: 17- or 22-day-old specific-pathogen-free pigs . PROCEDURE: Histologic and bacteriologic examinations were performed on specimens from the tympanic cavity and auditory tube at 0, 7, 14, and 25 days after intratympanic inoculation of M hyorhinis (auditory tube cloning strain 14) . RESULTS: In M hyorhinis-inoculated pigs, mild to moderate inflammation of the auditory tube and tympanic cavity first appeared at postinoculation day (PID) 7 . In pigs euthanatized at PID 14, the degree of inflammation was aggravated . Immunohistochemical analysis revealed M hyorhinis antigens on the luminal surface of the auditory tube and tympanic cavity . By PID 25, lesions had lessened . By use of transmission and scanning electron microscopic examinations, mycoplasmal organisms were identified among the cilia in the auditory tubes at PID 14 but not at PID 25 . Results of bacteriologic examination indicated that 10(4) to 10(6) color-changing units of M hyorhinis were isolated from the tympanic cavity at PID 0 . Variable numbers of M hyorhinis were isolated at PID 7 and 14, and numbers were decreased at PID 25 . CONCLUSIONS: M hyorhinis inoculated into the tympanic cavity can cause a self-limiting otitis media in SPF pigs. Respir Med, 1998 Apr, 92(4), 659 - 63 Closed percutaneous pleural brushing: a new method for diagnosis of malignant pleural effusions; Emad A et al.; Pleural fluid cytology and pleural biopsy are the two most commonly employed diagnostic tests for malignant pleural effusions . Here, we have introduced a new diagnostic method, namely closed percutaneous pleural brushing, and have compared its diagnostic yield with those of pleural fluid cytology and pleural biopsy in patients with suspected malignant pleural effusion . Forty-three consecutive patients with suspected malignant pleural effusion underwent thoracentesis, closed pleural brushing and closed pleural biopsy using Cope's pleural biopsy needle and a cytological brush (BC-10C) which was introduced into the pleural cavity through the cannula of the same needle . All the samples were sent for bacteriological and cytological studies . Patients had a mean follow-up period of 9.28 +/- 1.87 months during which seven cases whose entire studies were non-diagnostic underwent thoracotomy and open pleural biopsy . Thirty-four cases were finally documented to have malignancy . Closed pleural brushing was positive in 31 (91%) of cases . This was superior to that achieved by either pleural fluid cytology (67%) (P = 0.01) or pleural biopsy (58%) (P = 0.002) . No pneumothorax or other major complications were encountered with this method . Closed pleural brushing via Cope's needle is a relatively safe, simple and well-tolerated technique with a high diagnostic yield for patients with malignant pleural effusion . It may substitute for other more invasive and more expensive procedures such as thoracoscopy and thoracotomy in this group of patients. Pneumonol Alergol Pol, 1998, 66(1-2), 17 - 23 {Analysis of diagnostic errors and recommendations of diagnostic procedures in bacteriologically negative pulmonary tuberculosis}; Szczuka I et al.; The paper presents a detailed analysis of errors in the diagnosis of bacteriologically negative pulmonary tuberculosis in a random sample of 560 patients out of all such patients registered in 1993 . The false diagnosis was found in 63 patients i.e . in 11.3% of the sample . Among the 63 patients with false diagnosis of tuberculosis there were 15 cases with lung cancer, 15 cases with pneumonia and/or pleuritis, 15 cases with disease of circulatory system with abnormal radiological of the lungs, 8 cases with old post-tuberculosis changes in the lung considered as relapses, 4 cases of bronchiolitis obliterans with organizing pneumonia, 3 cases of sarcoidosis and 1 case of aspergillosis in a post-tb cavity . The most serious errors were those related to failure in diagnosing (or of too late diagnosis) of lung cancer . These failures comprised 2.7% of patients in the sample . The chance to detect a lung cancer in the sample was 2900 cases in 100,000 men and 2200 cases in 100,000 women . This chance was much higher than in general population--29x for men and 100x for women . The main source of errors was false interpretation of radiological examinations and neglect to utilise other diagnostic procedures like bronchoscopy, cytology or tomography examinations . As an outcome of the analysis authors present their recommendations for diagnostic procedures in the diagnosis of bacteriologically negative pulmonary tuberculosis. Pneumonol Alergol Pol, 1998, 66(1-2), 9 - 16 {Evaluation of diagnostic and therapeutic management in patients with bacteriologically negative pulmonary tuberculosis}; Szczuka I et al.; The study aimed at assessing the frequency and type of errors in the diagnosis and management of newly registered bacteriologically negative cases of pulmonary tuberculosis . Random sample of 560 out of 7272 such patients registered in 1993 was subject of detailed analysis of all available medical documentation . The analysis was performed by an independent team of three specialists: pulmonologist, radiologist and epidemiologist . The results of the analysis indicate insufficient utilization of modern available diagnostic methods . Apart from clinical assessment the main basis for diagnosis of tuberculosis was A-P radiography . Tomography examination was performed in 35.5% of patient only, bronchoscopic in 19.8% and cytologic examination of sputum in 15.9% . Bacteriological examinations during the first phase of diagnosis, usually in hospitals, were satisfactory . Error in diagnosis was found in 63 patients, i.e . 11.3% of cases . The treatment in patients considered as correctly diagnosed, was in the intensive phase correct, but in the continuation phase--too long. Orv Hetil, 1998 Jun 7, 139(23), 1421 - 4 {Computer tomography and interventional radiologic methods in the diagnosis of acute pancreatitis}; Viczena P et al.; The authors supervised the case record of 51 patients admitted between 1994 January and 1996 March suffering from acute pancreatitis . Diagnosis was made upon clinical signs, laboratory findings, abdominal ultrasound and CT examinations . In total 121 CT examinations were made mostly by using contrast material . Patients were classified with the help of Balthazar's grade . The authors emphasize that CT currently is the most accurate single imaging modality for diagnosis, staging the severity of the inflammatory process, and detecting complications of acute pancreatitis . They suggest that the first CT examination should be done within 3 days from the onset of the illness . In cases falling under group "C", "D" or "E" of Balthazar's grade, the CT examination should at least be repeated within 10 days . With 6 patients in septic state the bacteriological findings gained by fine needle aspiration was of great value for the further treatment. Am J Respir Crit Care Med, 1998 Jul, 158(1), 139 - 47 Influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in ventilator-acquired pneumonia; Wermert D et al.; We investigated the influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in a clinically relevant model of ventilator-acquired pneumonia (VAP) . Twenty-seven piglets entered a 4-d protocol of ventilatory support under general anesthesia . Endotracheal aspirates (EA), protected specimen brush (PSB), and bronchoalveolar lavage (BAL) were obtained on Day 4 . PSB and BAL were performed under bronchoscopic guidance in dependent and nondependent lung segments . Immediately thereafter sternotomy allowed bilateral lung biopsies including the segments studied by bronchoscopic techniques . All respiratory specimens were then processed for microscopic examination and quantitative cultures (QC) . In this model where many of the confounding factors often present in human studies were absent, we found that (1) although the local bacterial burden tended to correlate with the presence and the severity of histologic lesions, no definite bacteriologic cutoff could differentiate the histologic presence or absence of pneumonia; (2) histologic lesions of pneumonia and parenchymal bacterial burden were unevenly distributed through the lungs; (3) this heterogeneity in bacterial distribution also held true for single bacterial species; (4) using discriminative values of >= 10(3) cfu/ml, >= 10(4) cfu/ml, and >= 10(5) cfu/ml to define positive PSB, BAL, and EA cultures, respectively, these techniques identified the histologic presence of pneumonia with a sensitivity of 69%, 78%, and 100%, respectively; (5) the specificity of these techniques in recognizing VAP was less than 50%; (6) with these discriminative values, less than 50% of PSB and BAL specimens correctly identified the causative organisms, whereas 94% of EA specimens correctly established the microbiologic diagnosis of pneumonia . We believe that the peculiar histologic and bacteriologic features of VAP may account for the difficulties of PSB and BAL, which combine QC with the use of discriminative thresholds, to reliably recognize pneumonia and to identify the causative organisms . For clinical practice, no technique confidently helps in recognizing pneumonia in mechanically ventilated patients . With regard to bacterial diagnosis, use of quantitative cultures of EA seems to be the best technique to identify the causative organisms in patients suffering VAP. Pneumoftiziologia, 1997 Jul-Sep, 46(3), 193 - 9 {The epidemiological profile and current evolutionary trends in tuberculosis in adolescents (15-19 years old) in the capital}; Didilescu C et al.; In Bucharest, the increasing TB incidence in the age group of 15 to 19 years till 100.11/100000 in 1996 has to become a concerning matter . The study of 585 cases aged 15 to 19 registered in Bucharest between 1991 and 1995 (more than 2/3 of all the cases in that period) revealed the important proportion of secondary TB (67.4%), as well as the frequency of pleural involvement (25.6%) . The main discovering methods remain the examination of symptomatic cases (78.6%) and epidemiological inquiry (10%) . The fact that 85% of the bacteriological confirmed cases had positive sputum specimens in microscopy confirms the idea of discovering the patients in advanced stages of disease, as well as epidemiological signification . Almost 50% of the ill teen-agers belong to families with low living status . At this age group we found an important degree of recovery after chemotherapy (82% rate of healing in the first year). Jpn J Antibiot, 1997 Nov, 50(11), 871 - 7 Concentration of levofloxacin in cervical mucus and its clinical effects on cervicitis; Chimura T et al.; An investigation was made on the concentration of levofloxacin (LVFX) in cervical mucus and its clinical effects on cervicitis . The results were as follows: 1) The concentrations of orally administered LVFX in the cervical mucus of 110 subjects were determined by HPLC . During 1-4 hour after the administration the mean concentration of LVFX in the cervical mucus reached a level of 2 micrograms/g, which was higher than the serum level . The transfer of LVFX to the cervical mucus was almost the same as that to other genital organs . 2) When LVFX was given to 102 patients at a dose of 100-200 mg, t.i.d for 4-5 days and the efficacy was evaluated with clinical improvement, the clinical efficacy rate of LVFX was 72/102 (70.6%) . Significant bacteriological effects were observed in 70/73 (95.9%), especially, the disappearance rate of C . trachomatis was 18/18 (100%) . 3) The administration LVFX did not cause any subjective or objective side effects and any abnormalities were not detected in the laboratory test done in this study . These results demonstrate that LVFX can be sufficiently transferred to the cervical mucus for the treatment of cervicitis due to the infection of C . trachomatis etc. Neurologia, 1998 May, 13(5), 250 - 3 {Focal dystonia and tremor secondary to brain stem tuberculoma}; Winkel M et al.; Brainstem tuberculoma is exceptionally observed . We report a 44 year-old immunocompetent man with proven diagnosis of miliary tuberculosis (TBC) who developed a complex neurological syndrome characterized by right ophtalmoplegia, left-sided hemiparesis and hemihypoesthesia and a gross ipsilateral postural and action tremor with hand dystonia . A ponto-mesencephalic mass was detected by CT and MRI studies of the brain . Clinical, bacteriological and neuroimaging studies allowed to suspect a ponto-mesencephalic tuberculoma . Long-term therapy with anti-TBC drugs and steroids was started, achieving clinical and imaging improvement which retrospectively confirmed the diagnosis . Although with less amplitude, tremor persisted but a complete disappearance of focal dystonia was observed . The pathogenesis of both abnormal movements is particularly discussed since hand dystonia has never been mentioned in the literature as a consequence of brainstem damage. Vet Microbiol, 1998 Mar 15, 61(1-2), 145 - 50 Tularemia in a common marmoset (Callithrix jacchus) diagnosed by 16S rRNA sequencing; Posthaus H et al.; We report a case of tularemia in a common marmoset (Callithrix jacchus) diagnosed by determination of the isolate's 16S ribosomal RNA (rRNA) gene sequence . Pathological examination of the animal revealed a multifocal acute necrotizing hepatitis, interstitial nephritis, splenitis, and lymphangitis of the mandibular, retropharyngeal, and cervical and mesenteric lymph nodes . Moreover, multiple foci of acute necrosis were found in the epithelium of the jejunum and the interstitium of the lung . Bacteriological investigations revealed a septicemia . The isolated infectious agent was uncommon, not routinely diagnosed in our laboratory and therefore difficult to identify by conventional tools in a reasonable time and effort . thus, we decided to perform a genetic analysis based on the 16S rRNA gene sequence . Thereby, an infection with Francisella tularensis, the causative agent of tularemia, was unambiguously diagnosed . This shows the great advantage 16S rRNA gene sequencing has as a general identification approach for unusual or rare isolates. Anat Anz, 1998 Jun, 180(3), 203 - 9 {Genesis and importance so-called inflammatory infiltration of the placenta . II . Immunohistochemical findings}; Emmrich P et al.; We investigated the morphologically distinct forms of inflammatory infiltration of the placenta both histologically and immunohistologically (n = 24) . Our material included cases of membraneous inflammation (chorioamnionitis), inflammatory infiltration of arteries in the chorionic membrane, basal and intervillous placentitis . NACE staining was used to detect myeloid cells and monoclonal antibodies (LCA, CD3, CD8, CD20, CD68) . To detect lymphoid and macrophageal cells we also measured the proliferation activity with MiB 1 . In cases of chorioamnionitis and subchorial demarcation and in the arteries of the chorionic membranes the main inflammatory cell is the myeloid cell (most often the mature neutrophil granulocyte) . T-lymphocytes were only occasionally found . In cases of intervillous placentitis, on the other hand, lymphocytic infiltration predominates, consisting of T-lymphocytes which are mostly CD8 negative, and some monocytes and macrophages . Basal inflammation in the demarcation zone was characterized by T-lymphocytes . We interpret this as indicating basal demarcation . According to our histological and immunohistological observations, "asphyxial infiltrates" are abortive forms of a placental (bacteriological) inflammation, possibly infective in origin . We do not consider asphyxial infiltration to be a separate entity with its own causal pathogenesis. Acta Otorrinolaringol Esp, 1998 Apr, 49(3), 211 - 5 {The study of postoperative infection in patients after laryngeal cancer surgery}; Mozota Nunez M et al.; We evaluated wound infections in major oncological surgery for laryngeal neoplasm and functional neck dissection . Our objective was to determine the incidence and prevalence of infection in a group of laryngectomized patients; we evaluated the temperature, duration of fever, and analytical findings in the postoperative period, antibiotic prophylaxis, and the treatment of infectious complications . A retrospective study was designed to examine the infectious complications that appeared in 97 patients who underwent laryngectomy and neck dissection for laryngeal carcinoma from 1994 to 1996 in an ENT department . Factors that influence wound infection were examined: fever, granulocytopenia, preoperative assessment, bacteriological culture, therapy and prophylaxis, and treatment . The data were analyzed statistically and compared with findings by other authors. Antibiot Khimioter, 1998, 43(6), 7 - 11 {Stepwise therapy of community-acquired pneumonia . Results of cefuroxime and cefuroxime axetil study}; Iakovlev SV et al.; The efficacy of a 7-day switch therapy with parenteral cefuroxime in a dose of 750 mg for 3-5 days followed by the use of oral cefuroxime axetil in a dose of 500 mg every 12 hours was compared with that of a 7-day therapy with parenteral cefuroxime in a dose of 750 mg every 8 hours in hospitalized patients with community-acquired pneumonia . The clinical and bacteriological efficacies and pharmacokinetic properties of both the dosage forms were estimated . It was shown that the clinical and bacteriological effects did not significantly differ in the patients under the parenteral regimen with cefuroxime and under the parenteral-to-oral regimen with cefuroxime and cefuroxime axetil: the cure in 75 and 83 per cent of the patients and the bacteriological response in 100 and 86 per cent of the cases respectively . The results indicated that the cost of the switch therapy was much lower while the efficacy did not decrease. Collegian, 1998 Apr, 5(2), 38 - 9 Legionellae; Leaver M; Legionellae cannot be eradicated from the water supply, since they are naturally occurring and ubiquitous . Routine bacteriologic culturing of man made aquatic environments is not recommended (Soule et al 1995) . Therefore any water use that results in production of aerosols should be regularly evaluated to ensure the source has not been contaminated with the bacteria . Any aerosolised water entering a sterile area such as the lungs should be sterile . Tap water should not be used to rinse any respiratory therapy equipment . Routine maintenance of water supplies to eliminate sediment and scale from tanks and trays is essential (Benenson 1995, Lowry & Tompkins 1993) . Australian & New Zealand Standard AS/NZ 3666-1995 Parts 1 and 2 outline these requirements. Rev Med Brux, 1998 Apr, 19(2), 73 - 5 {Pneumococcal spondylodiscitis . A case report}; Vandemergel X et al.; We report on a case of a 66 years-old patient suffering weight loss and lumbar pain, localized at L2-L3 . A spondylodiscitis was revealed by CT and MRI; intervertebral disc puncture was positive for Pneumococcus Pneumoniae . The clinical evolution was good with the anti-bacterial treatment, while the patient developed a synostosis L2-L3 . Incidence, bacteriology, imaging and therapy of spondylodicitis are discussed. Nephrol Dial Transplant, 1998 Jun, 13(6), 1543 - 6 PCR diagnosis on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in chronic dialysis patients of cervico-mediastinal tuberculous lymphadenitis; Tarng DC et al.; BACKGROUND: Bacteriologic studies often provide negative results in tuberculous infection, and do not favour early diagnosis . Polymerase chain reaction (PCR) is known to diagnose tuberculosis quickly . With this in mind, we used PCR to detect mycobacterial DNA on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in two dialysis patients with cervico-mediastinal lymphadenopathy . METHODS: Sections of neck lymph nodes were cut at two different levels . At each level, two semi-adjacent sections with a thickness of 5 microm each were cut using standard microtomes with disposable blades . The first section mounted on a glass slide was stained by Ziehl-Neelsen, and the second section was examined by PCR based on a 123 bp fragment of IS6110 that is specific for the Mycobacterium tuberculosis complex . RESULTS: The histology of lymph nodes disclosed inflammatory necrotizing granulomas, but acid-fast stain for M . tuberculosis was negative in the two patients . DNA of M . tuberculosis was detected in lymph node samples from each patient by PCR on the IS6110 element and by dot-blot hybridization . CONCLUSIONS: PCR assay is a potentially useful approach for early and rapid diagnosis of tuberculous lymphadenitis in chronic dialysis patients, since mycobacterial staining and culture often provide negative results. Ophthalmic Surg Lasers, 1998 Jun, 29(6), 497 - 501 Lack of effect of prophylactic gentamicin treatment on intraocular and extraocular fluid cultures after pars plana vitrectomy; Gelfand YA et al.; BACKGROUND AND OBJECTIVE: To analyze the effect of preoperative prophylatic 0.3% gentamicin sulfate eyedrops on intraocular and extraocular fluid cultures after pars plana vitrectomy . PATIENTS AND METHODS: Forty consecutive patients undergoing pars plana vitrectomy were randomly assigned to receive either 0.3% gentamicin eyedrops or placebo preoperatively . Fluids from the vitreous cavity and from the conjunctival sac were collected for bacteriologic studies . RESULTS: Positive cultures from extraocular fluids were obtained in 30.4% of the gentamicin group and 35.3% of the placebo group (P = .75) . Furthermore, 1 (3%) of 40 cultures of intraocular fluid and 13 (33%) of 40 cultures of extraocular fluid were positive . Culture growth positivity was not influenced by the patients' age, by diabetes, or by the duration of the operation . CONCLUSIONS: Prophylactic gentamicin treatment by the method applied in this study is not effective on reducing growth positivity . Contaminated extraocular fluid may play an important role in the pathogenesis of bacterial endophthalmitis following pars plana vitrectomy. J Cardiovasc Surg (Torino), 1998 Apr, 39(2), 171 - 3 Osteomyelitis of the fibula due to septic embolism: a rare complication of a graft enteric erosion . Case report; Moreau PM; We report the case of a 70-year-old female who experienced a graft enteric erosion (GEE) three years after a right aorto-femoral bypass . She was treated by right axillo-femoral bypass, removal of the aortic prosthesis and direct aortic suture . The duodenum was stitched up and separated from the aorta by omentoplasty . Bacteriological culture of the removed graft identified Escherichia coli and Peptostreptococcus . Antibiotic therapy consisting of Amoxicillin and Gentamycin was given for seven days . A month later this patient developed a fibula osteomyelitis due to the same germs . She was then treated by surgical excision of the infected tissues and by antibiotics: Amoxicillin, Metronidazole and Gentamycin for one month . This case of embolism into bone due to GEE is a rare complication which indisputably establishes a link between the spontaneously septic cavity of the bowel and bone tissue by way of blood via the interstices of the fabric . The prosthesis may be responsible for blood seeding infection and not only a mere victim . The prosthesis acts as a porous membrane which allows two opposite flows: the passage of blood from graft to bowel and germ migration from naturally septic bowel to blood . When a GEE is encountered, a rigorous management is required to prevent septic embolism . The precise timing of each step of the surgical procedure remains difficult to codify. Zentralbl Hyg Umweltmed, 1997 Oct, 200(4), 319 - 33 Factors affecting the bacteriological contamination of commercial washing machines; Legnani PP et al.; Wash water from self-service washing machines in three commercial launderettes of Bologna (Italy) were examined to verify which factors affect their bacterial contamination and to determine which procedures in the laundering process have the most significant effects on the removal of bacteria . Four washing formulas were compared: a delicates cycle (programmed temperature 25-30 degrees C; actual temperature: 28-31 degrees C); a whites cycle (programmed temperature: 80-90 degrees C; actual temperature: 50-57.5 degrees C); a delicates cycle with the addition of an oxygen-based bleach safe for delicate fabrics and a whites cycle with the addition of an oxygen-based bleach . Bacterial contamination of washing machines was higher in the launderette most heavely used, and, furthermore, it was in relation with the washing temperature and the use of bleaches . The low temperature laundering cycle (20-30 degrees C) did not guarantee elimination of bacterial content from either the inside of the washing machine or from the fabric being washed . Washing with water at a higher temperature, of about 55 degrees C, or adding an oxygen-based bleach to the low temperature cycle did ensure a significant reduction in bacterial recovery from water samples and fabrics, but did not prevent bacteria such as P . aeruginosa from surviving inside the washing machine . Only the addition of bleaches to the hot water program ensured the almost total elimination of bacteria and also guaranteed their elimination from protected parts of the drum. Kekkaku, 1998 May, 73(5), 365 - 70 {Establishment of new diagnostic technique and its clinical application for nontuberculous mycobacterial infections}; Koga H; The clinical futures of 52 patients with pulmonary Mycobacterium avium complex infection (MAC group), 7 M . kansasii infection (MK group), and 5 M . chelonae infection (MC group) were studied . Aged female was dominant in MAC and MC group, while middleaged man was dominant in MK group . Although body mass index (BMI) was the lowest in MAC group, there was no difference between the groups in clinical sign, symptom, and laboratory data . Type III radiological finding was dominant in MAC group, while type II in MK and MC groups . Bacteriological eradication rate of causative organisms was 86% in MK group, 54% in MAC group, and 40% in MC group . However, the relation between clinical efficacy of chemotherapy, BMI, serum protein level, and cavity formation in chest radiogram was not observed . MAC was detected in clinical samples such as sputum, bronchial washing fluid, and gastric juice with 5 to 10% in frequency by Amplicor, one of commercially available PCR detection kits for mycobacteria . Furthermore 60% to 80% of the MAC positive cases were diagnosed and treated as nontuberculous mycobacteriosis . Although MAC is occasionally exist in oral cavity or clinical environment, the positive result of genetic diagnostic method such as Amplicor should be carefully considered. Kekkaku, 1998 May, 73(5), 349 - 53 {Diagnostic usefulness of the tuberculin reaction by PPD-B in Mycobacterium avium complex disease}; Harada Y et al.; This study was carried out to clarify the diagnostic usefulness of the skin tests of purified protein derivatives from M . intracellulare (PPD-B) and M . tuberculosis (PPDs) . Study subjects consisted of 41 patients with primary infection type of M . avium complex (MAC) disease, 36 patients with pulmonary tuberculosis (TB) and 29 patients with other bacterial respiratory infections including COPD (OB) . The patients were sorted out to middle (50-69 y.o.) and old (70-89 y.o.) age groups of each disease . The size of skin redness elicited 48 hours after the PPD-B and PPDs intradermal injections were compared among them . The results were as follows . 1) Both PPD-B and PPDs skin reactions were larger in the middle age group than in the old one for each disease . 2) In PPDs skin tests, the reaction of TB group was the largest among the three diseases . In PPD-B skin tests, that of MAC was the largest . 3) In TB group, PPDs skin reaction was significantly larger than that of PPD-B, while in MAC and OB groups there was no significant difference between the skin reactions of PPDs and PPD-B . 4) Defining significant positive reaction to PPD-B as PPD-B skin reaction exceeding 10 mm and larger than that of PPDs skin reaction, the rate of significant positive reaction to PPD-B was significantly higher in MAC than TB in both age groups . These results showed that the simultaneous skin tests of PPD-B and PPDs were a useful aid in the diagnosis of MAC infection disease when mycobacterial infection diseases were clinically suspected by bacteriological or chest radiographic examinations. Am J Respir Crit Care Med, 1998 Jun, 157(6 Pt 1), 1726 - 33 Rifapentine and isoniazid in the continuation phase of treating pulmonary tuberculosis . Initial report; Tam CM et al.; A randomized comparison has been made of three times weekly rifampin plus isoniazid (HR3) with rifapentine plus isoniazid given once weekly (HRp1) or on 2 of 3 wk (HRp1.2/3) in the continuation phase of 6-mo regimens (each starting with an initial 2 mo of 4-drug therapy) for the treatment of pulmonary tuberculosis in 672 Chinese patients in Hong Kong . Because of poor bioavailability of the rifapentine used (produced in China), its dose size was increased from 600 mg initially to about 750 mg in the last third of patients to obtain serum concentrations similar to those with rifapentine of Western origin; all doses were given after a meal promoting absorption . After initial exclusions, an intent to treat analysis, done on the remaining 592 patients, showed 45 adverse treatment events in 7 of 190 HR3 patients, in 17 of 199 HRp1 patients, and in 21 of 203 HRp1.2/3 patients; of these, 42 were bacteriological or radiographic relapses after the end of treatment (HR3 versus HRp1, p = 0.04; HR3 versus HRp1.2/3, p = 0.01) . Patients with organisms initially sensitive or resistant to isoniazid or streptomycin had similar relapse rates . The high relapse rate in the HRp1 regimen suggests that the rifapentine dose should be increased . Similarity of relapse rates, 8.9% and 10.4%, after the HRp1 and HRp1.2/3 regimens, respectively, indicates that irregularity in taking rifapentine/isoniazid could be tolerated . The few adverse side effects in the continuation phase in the rifapentine regimens were less frequent than in the HR3 regimen. Clin Infect Dis, 1998 Jun, 26(6), 1296 - 9 Characterization of Bartonella henselae isolated from bacillary angiomatosis lesions in a human immunodeficiency virus-infected patient in Germany; Arvand M et al.; Infections with Bartonella (Rochalimaea) henselae can result in a variety of clinical entities, including bacillary angiomatosis in immunocompromised hosts . The fastidious nature of this bacterium has so far prevented the culture of many clinical isolates . We report the recovery of the first European B . henselae isolate associated with bacillary angiomatosis . The isolate was cultured in a frozen skin biopsy specimen from a human immunodeficiency virus (HIV)-infected patient and was characterized by means of biochemical, bacteriologic, immunologic, and molecular biological methods including pulsed-field gel electrophoresis . This strain was compared with two B . henselae strains isolated in the United States to determine the relationship between the isolates . We found that it was phenotypically and genotypically indiscernible from B . henselae Houston-1, a blood culture isolate from an HIV-infected patient in Houston . These data suggest that one B . henselae clone is associated with human infections in Europe and the United States. Ann Fr Anesth Reanim, 1996, 15(8), 1178 - 92 {Diagnostic characteristics of acquired pneumonia in patients under mechanical respiration}; Bregeon F et al.; Ventilator-associated pneumonias (VAP) are the most frequent nosocomial lung infections . Histological diagnosis is the standard for reference . A diagnosis of VAP can be considered in presence of fever or hypothermia, hyperleucocytosis or leucopenia, worsening of blood gases, and new radiological infiltrate . Their diagnostical value is dependent on the number of included manifestations . A clinical pulmonary infection score (CPIS) has been produced and compared with histological data . Bacteriological data are essential for an adapted antibiotherapy . The blind non-protected specimen brush is inexpensive and reliable at levels of 10(4) and 10(6) CFU.mL-1, the sensitivity and specificity reach 60% . The double-protected catheter is a sensitive and specific test at the level of 10(3) CFU.mL-1 . At present its accuracy has only been compared with bronchial brushing . The culture of a 20 mL mini-broncho-alveolar lavage (same material) is specific (50%) but not sensitive enough (< 70%) at the level of 10(3) CFU.mL-1 . The culture of the protected telescopic brush is the most expensive test . It does not carry a risk of contamination, but does not detect a significant amount of VAP even at a level below 10(3) CFU.mL-1 . Due to its high specificity it is used as the reference test in numerous studies . The endoscopic broncho-alveolar lavage provides a rapid diagnosis . Although not protected, it carries a low risk of false positives . It also allows the diagnosis of non-bacterial or atypical bacterial lung infections . The diagnosis can also be obtained with lung biopsy which however carries a risk in case of mechanical ventilation, whatever the technique . Except for the protected double catheter, a direct examination has been advocated, for the differentiation between infection and colonization and the improvement of the performances of the simple culture of the broncho-alveolar lavage (search for intra-cellular bacteria). Schweiz Med Wochenschr, 1998 May 9, 128(19), 737 - 41 {Tuberculosis: contact tracing and preventive chemotherapy}; Zellweger JP; Tuberculosis is transmitted from patients with lung disease to sensitive individuals by inhalation of infectious particles expelled during cough . Therefore, the search for infected subjects among relatives of patients with infectious tuberculosis is the best method of preventing later development of the disease in populations where the prevalence of tuberculosis is low . Contact tracing relies on the tuberculin skin test, followed by chest X-ray if indicated and bacteriological examination of sputum . In recently infected subjects, particularly the young, preventive chemotherapy has been shown to decrease the risk of later disease. Rev Argent Microbiol, 1998 Jan-Mar, 30(1), 30 - 8 {Bacteriological quality of Bendetti Lake (Santo Tomé, Santa Fe Province, Argentina) and associated environmental variables}; Emiliani F et al.; The main objective was to determine the bacteriological quality of a shallow lake in the lower Salado River Basin (Bedetti, 31 degrees 40' S and 60 degrees 45' W) . Seventy samples were tested by the most probable number (MPN) method, throughout three years . The number of thermotolerant coliforms was very variable: from 20 MPN/100 ml to 130,000 MPN/100 ml . These variations were mainly associated to the local rains (rs = 0.4853, p = 0.0001) and to the hydrometric level-h-(rs = 0.3835, p = 0.008) . Statistically significant correlations between coliform bacteria and other variables (temperature, oxygen, pH, conductivity and transparency) were not found . The increase of coliforms associated to the increase of the hydrometric level indicates the presence of diffuse contamination sources . It was found that the rains affected the bacteriological quality, specially during the low water periods (h < 3.60) . During the high water periods (h > 4.70) one of the main coliform contributor was represented by the incoming floating islans and aquatic macrophyte, from allochthonous fluvial systems . The coliform concentrations between the Bedetti lake and the Salado river were compared . The results show a better bacteriological quality of the lake (geometric average = 1,990/100 ml vs . 420/100 ml, n = 56) so that, connecting them by the construction of an artificial channel is not advisable. Otolaryngol Head Neck Surg, 1998 Jun, 118(6), 883 - 5 A new dosage regimen for topical application of ciprofloxacin in the management of chronic suppurative otitis media; Aslan A et al.; The clinical and bacteriologic efficacy of topically applied ciprofloxacin was studied in 60 patients with chronic suppurative otitis media . Two hundred fifty and 125 microg/ml concentrations of ciprofloxacin solutions were given to two groups of patients . The duration of therapy was determined according to the clinical cure at follow-up . More than 21 days of therapy was not needed in any patient . The clinical cure rate with 250 microg/ml ciprofloxacin was 78.1% at 14 days and with 125 microg/ml it was 83.3% . However, a 100% clinical cure rate and complete bacteriologic eradication was obtained in 21 days in both groups . In each group only one patient had otomycosis by the fourteenth day of therapy, although ear discharge had ceased . It was concluded that 125 microg/ml ciprofloxacin could be applied as successfully as 250 microg/ml, and the duration of therapy had to be at least 14 days . This new dosage regimen can be adopted as an optimal dosage for ototopical application of ciprofloxacin in chronic suppurative otitis media . It will also obviously decrease the expense of therapy. Int J Tuberc Lung Dis, 1998 Jun, 2(6), 462 - 70 Clarithromycin with minocycline and clofazimine for Mycobacterium avium intracellulare complex lung disease in patients without the acquired immune deficiency syndrome . GETIM . Groupe d'Etude et de Traitement des Infections à Mycobactéries; Roussel G et al.; SETTING: An open clinical trial for the treatment of Mycobacterium avium intracellulare complex (MAIC) lung disease in human immunodeficiency virus (HIV)-seronegative patients . OBJECTIVE: To assess the efficacy and tolerance of clarithromycin (0.75-2 g/day) combined with minocycline (200 mg/day) and clofazimine (100 mg/day) for 15 months . DESIGN: The study was carried out from August 1992 to June 1994 by pulmonologists of various French medical centres . The patients to be enrolled were of either sex, over 18 years of age, HIV-seronegative and suffering from MAIC lung disease, with a confirmed bacteriological and radiological diagnosis . Examinations were to be performed after 1, 2, 3, 6, 9, 12 and 15 months of treatment . RESULTS: Thirty patients were included, 16 males and 14 females . Eight did not complete the study due to deviations from protocol or adverse effects . The remainder completed the study with a post-treatment follow-up of 27 +/- 7 months . Among the 22 evaluable patients, 18 had a history of lung disease . Tolerance to the drugs was generally good, apart from three cases of hepatic disturbances and three cases of ototoxicity, which required a decrease in clarithromycin dosage after a short interruption of treatment . There were 14 treatment successes, seven treatment failures, defined by absence of bacteriologic conversion, and in one patient the disease evolution remains uncertain . CONCLUSION: The combination of clarithromycin with minocycline and clofazimine proved effective with persistently negative cultures in 64% of the patients, and an overall good drug tolerance. Microbiol Immunol, 1998, 42(4), 281 - 7 Diagnostic value of the Amplicor PCR assay for initial diagnosis and assessment of treatment response for pulmonary tuberculosis; Iinuma Y et al.; We evaluated the Amplicor PCR assay as an initial diagnostic tool on the basis of clinical diagnosis, and assessed this assay as a follow-up test for patients with pulmonary tuberculosis during chemotherapy . Of the 208 specimens from 155 patients who were bacteriologically and/or clinically diagnosed with active tuberculosis before chemotherapy, 144 were Amplicor PCR-positive (sensitivity, 69.2%), which was equal to the results of culturing . Among 89 specimens which showed positive results by smear and culturing, the Amplicor PCR assay detected 87 (97.8%), whereas among 55 specimens which showed smear-negative but culture-positive results, the Amplicor PCR assay detected 46 (83.6 %)(P= 0.003) . No false positive results were found in the two systems (specificity, 100%, 120/120) . The Amplicor PCR assay was also evaluated as a follow-up test using 926 specimens from 207 patients receiving active tuberculosis chemotherapy . Among 433 specimens which showed Amplicor-PCR positive, 222 (51.3%) were culture-negative . On the other hand, among 233 culture-positive specimens, only 12 (5.2%) were Amplicor PCR-negative . Therefore, this assay is useful for the rapid diagnosis of tuberculosis . The duration of Amplicor PCR-positive after culture-negative conversion was significantly associated with the presence of cavitary lesion, smear-positive specimens before treatment, and smear-positive specimens with negative cultures during chemotherapy. Eur Respir J, 1998 Apr, 11(4), 804 - 8 Transmission of tuberculosis in the metropolitan area of Zurich: a 3 year survey based on DNA fingerprinting; Pfyffer GE et al.; Between 1991 and 1993, 444 inhabitants of the metropolitan area of Zurich were reported as confirmed or suspected cases of tuberculosis (TB) . Overall, isolates of Mycobacterium tuberculosis of 361 patients (90% of the bacteriologically confirmed cases) were available to study the frequency of transmission of the strains on a molecular level . Restriction fragment length polymorphism (RFLP) analysis was performed by using IS6110 and the polymorphic GC-rich sequence (PGRS) as genetic markers . Ninety nine isolates shared by 77 patients (21.3%) were associated with 28 IS6110-defined clusters . However, secondary typing of low copy number isolates decreased the number of clusters to 25, encompassing 81 isolates from 63 (17.5%) patients . By deoxyribonucleic acid (DNA) fingerprinting plus conventional contact tracing, definite transmission of TB was proven in only five patients (1.4%) and assumed in 20 patients (5.6%) . In all other cluster-associated isolates, no epidemiological connections between the patients could be found using the clinical and sociodemographic data available . The present study demonstrates that in the time period studied only minor transmission occurred. Ned Tijdschr Geneeskd, 1998 Apr 25, 142(17), 965 - 9 {Infections with Mycobacterium kansasii in the Academic Medical Center in Amsterdam: the changing clinical spectrum since the start of the HIV epidemic}; van der Meer JT et al.; OBJECTIVE: Inventory of patients with a Mycobacterium kansasii infection . DESIGN: Descriptive, retrospective . SETTING: Academic Medical Centre, Amsterdam, the Netherlands . METHOD: Review of the medical records of all patients with a bacteriologically confirmed infection with M . kansasii from January 1987 until the end of December 1996 . RESULTS: M . kansasii was isolated from 17 patients . Of 15 HIV-tested patients 13 were seropositive . Their median CD4 count was 10 x 10(6)/l . Ten HIV-positive individuals used trimethoprim-sulfamethoxazole prophylaxis . In 1 HIV-seropositive and in 1 HIV-seronegative patient no chest X-rays were made . Caverns were present in none of 12 HIV-positive patients and in 1 of 3 HIV-negative patients . Of the HIV-positive patients 1 fulfilled the criteria for pulmonary infection of the American Thoracic Society (ATS) . According to these criteria 9 of the HIV-positive patients were colonized with M . kansasii . In 6 of these patients there were indications of infection: regression of pulmonary infiltrates with therapy (n = 3), positive histology and culture of lung tissue at autopsy (n = 1), and dissemination (n = 2) . Disseminated infection occurred in a total of 4 HIV-infected patients . CONCLUSION: HIV-infected patients are at an increased risk for M . kansasii infection . Trimethoprim-sulfamethoxazole does not offer protection against this infection . The diagnostic criteria of the ATS are not applicable to these patients . M . kansasii infection confirmed by isolation in an HIV-positive individual should always be treated. J Med Assoc Thai, 1998 Apr, 81(4), 265 - 71 Cefoperazone/sulbactam + co-trimoxazole vs ceftazidime + co-trimoxazole in the treatment of severe melioidosis: a randomized, double-blind, controlled study; Thamprajamchit S et al.; A prospective randomized, double-blind, controlled study of cefoperazone/sulbactam (cefoperazone 25 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) vs ceftazidime (100 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) in the treatment of severe melioidosis was conducted at Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, from July 1995 to September 1996 . A total of 84 patients were enrolled in the study . Forty of them (48%) had culture-proven melioidosis and were randomly assigned to one of the two treatment groups, each group with 20 patients . Two cases (one in each treatment group) were excluded from the final analysis due to incomplete data . There was no significant difference in the mortality rate between the two groups-16 per cent (3/19) in the cefoperazone/sulbactam group vs 21 per cent (4/19) in the ceftazidime group (p > 0.05) . Bacteriological responses of successfully treated patients were similar in both groups, and both treatment regimens were well tolerated . Cefoperazone/sulbactam + co-trimoxazole can therefore be used as an alternative treatment for severe melioidosis . However, to further support this conclusion, a study with a larger patient population is needed. Rapid Commun Mass Spectrom, 1998, 12(10), 625 - 9 Detection of the bacteriological sex factor in E . coli by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; Karty JA et al.; Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry is employed to detect the presence of the bacteriological sex factor, a trait that allows some bacteria to transfer genetic information to others by means of conjugation . The principal advantage of the method is its speed . Twenty different strains of E . coli were analyzed and the results were consistent with previously known genetic information . The sex factor could be transferred from one strain to another and the outcome verified by mass spectrometry. Minerva Stomatol, 1998 Mar, 47(3), 87 - 93 {Sinusoscopy in stomatology . Review of a 5-year clinical experience}; Romagnoli R et al.; BACKGROUND: Investigative sinus endoscopy for purely diagnostic purposes has become an important therapeutic tool for disorders of the paranasal system thanks to the enormous technological developments of the last twenty years . METHODS: In a retrospective study, sinus endoscopies carried out between 1990 and 1994 on 57 patients, mean age 43 years, were subjected to critical re-evaluation, with the aim of evaluating the efficacy of endoscopic treatment . In the first phase, the documentation available for each patient was examined; it included clinical data, preoperative traditional and CT radiographs, rhinoscopic and sinus endoscopic findings . Once the analysis of the available documentation had been completed the patients were recalled and subjected to clinical and radiological evaluation . Radiographic examination was carried out by traditional radiography . RESULTS: CT scanning was only performed for those patients in whom the clinical findings indicated a possible relapse . Immediate and delayed complications occurring after the endoscopic sinus surgery were taken into consideration . CONCLUSIONS: In conclusion, sinus endoscopy is a fundamental instrumental investigation in the diagnosis of rhinosinusopathies . It can no longer be considered as only a diagnostic investigation able to provide clear visual images, it also allows specimens to be taken for bacteriological, micological, cytological and histological analysis . Furthermore, endoscopic surgery can treat pathologies for which, until a few years ago, operations were necessary which respected the physiology of the paranasal system to a much lesser extent (Denker-Caldwell-Luc). Arch Ital Urol Androl, 1998 Apr, 70(2), 93 - 101 {Seminal fluid today}; Patelli E et al.; Semen analysis is still today a fundamental stage in male fertility diagnosis . In fact it's essential to evaluate didimal functional state and particularly the sperm genesis . But a semen analysis with normal parameters does not assure male fertility . Except the cases of azoospermia it does not distinguishes fertile from infertile patients, but when the sperm quality decrease, the pregnancy rate also decrease but rarely touch zero . Reliability of the analysis depends on the experience and on the analyst's ability who has to give an opinion about fundamental parameters like motility and sperm morphology . It is most correct to talk about semen analysis instead of semen examination because is possible to obtain not only number and quality of spermatozoa but also hormonal, immunological, bacteriological, cytogenetic, biomolecular data . Furthermore in the last ten years a lot of functional tests have been perfected, able to value accurately the integrity of some spermatozoa's "functional compartments" like membrane, acrosoma, DNA, nuclear proteins but these examinations have been considered at level assessment only for select cases . Semen analysis remains therefore a fundamental examinations in the study of male infertility even if rarely it is able to express definitive trials about infertility . In fact this always represents a couple problem, particularly of the couple in study. Rev Pneumol Clin, 1997, 53(6), 325 - 31 {Efficacy and tolerability of pristinamycin vs amoxicillin-clavulanic acid combination in the treatment of acute community-acquired pneumonia in hospitalized adults}; Poirier R et al.; The aim of this double-blind, 2 parallel group, randomized, multicenter study was to compare the efficacy and the safety of pristinamycin (P), 1 g bid, versus amoxicillin-clavulanic acid (AAC), 500 mg q.i.d., for 10-14 days in the treatment of non severe community-acquired pneumonia in hospitalized adults . From December 1992 to July 1994, 180 patients were included: 92 in the group P and 88 in the group AAC . The both groups were similar on demographic, clinical and bacteriological criteria . 96 pathogens of which more than half were pneumococci, were isolated in 79/180 (44%) patients . The primary assessment was the global success rate defined as long-term (D40 +/- 7), clinical, radiological and bacteriological efficacy in the "per protocol" population (75 patients in the group P and 83 in the group AAC) . The global success was obtained in 63/75 (84%) patients in the group P and 70/83 (84.3%) patients in the group AAC . At the end of treatment (D14 +/- 3), theses rates were respectively 85.4% and 84.3% . The both treatments were equivalents . Adverse events (mainly gastro-intestinal disorders) were reported by 55/92 (59.8%) patients in the group P and 49/87 (56.2%) patients in the group AAC. Respir Med, 1998 Feb, 92(2), 156 - 61 Ventilation in a Birmingham intensive care unit 1993-1995: outcome for patients with chronic obstructive pulmonary disease; Hill AT et al.; The aims of the study were to look at information on which the decision to ventilate chronic obstructive pulmonary disease (COPD) patients admitted to an intensive care unit (ITU) was based (including whether there was discussion with the patient, relatives and consultant), to identify indicators of poor prognosis, and to assess the outcomes of ventilation and functional capacity after discharge . A retrospective study of 27 months of admissions was carried out . The following variables were studied to see if they influenced prognosis: premorbid history, admission diagnosis, consultant involvement in the decision to transfer to ITU, admission chest radiograph, sputum bacteriology, arterial blood gases, APACHE II scores, duration of ventilation and complications in ITU . In-hospital mortality, post-discharge mortality and length of hospital stay were recorded . Functional capacity after discharge was assessed from the hospital clinic records and from general practitioners . Forty-six percent of case notes had inadequate premorbid information and no documented discussion occurred in 66% of patients/relatives . Poor prognostic indicators were admissions after cardiorespiratory arrest, cases discussed with consultants regarding ITU transfer, previous therapy with long-term oral steroids, and developing renal or cardiac failure in ITU . APACHE II scores were higher in the group that died . There was 49% hospital mortality and 59% 1-year mortality . Fifty-three percent of survivors were dependent upon carers and housebound, and general practitioners felt that 59% of survivors had a higher dependence on carers, a worse exercise tolerance and a poorer quality of life than before admission . The decision to ventilate is often made with inadequate background history, which could be sought from general practitioners, hospital case notes and family . There is significant morbidity and mortality following ventilation . Further prospective studies are required to help select which COPD patients should be ventilated. Prog Urol, 1998 Apr, 8(2), 240 - 3 {Epididymal manifestations of urogenital tuberculosis}; Gueye SM et al.; OBJECTIVE: To define the epidemiological, anatomical, clinical and therapeutic aspects of tuberculous epididymitis in adults in the tropics . MATERIAL AND METHODS: This was a retrospective study of 11 cases of confirmed and treated tuberculous epididymitis . RESULTS: The most frequently affected age-group was 40-49 years . The commonest expression was that of a chronic epididymal nodule . The diagnosis was confirmed by histological examination of the epididymectomy specimen (10 cases) and bacteriology in one case . Combination antituberculous chemotherapy was systematically administered and epididymectomy was performed in all patients . CONCLUSION: The diagnosis of tuberculous epididymitis is often very difficult in the absence of a history of recent or active tuberculosis . However, this diagnosis must be considered in any case of chronic epididymal nodule, particularly in a context of infertility . The very mutilating treatment consists of epididymectomy in chronic forms, which also constitutes a diagnostic confirmation procedure, hence the value of prevention based on eradication of tuberculosis. Ter Arkh, 1998, 70(4), 54 - 60 {Current aspects of diagnosis and treatment of atopic diseases complicated by secondary immunodeficiency}; Mikheeva GN et al.; AIM: The study of clinicoimmunological features of current course of atopic diseases (AD) and design of effective etiopathogenic scheme of treating AD complicated by secondary immunodeficiency (SID) . MATERIALS AND METHODS: After comprehensive clinical, instrumental, x-ray, functional and bacteriological investigations 186 AD patients were divided into 4 groups: 25 patients untreated by immunomodulators (controls), 35 patients treated by diuciphone (200 g i.m . each other day for 12 days), 83 patients treated by polyoxidonium (6 mg i.m . each other day for 12 days, a total course dose 30 mg, or 6 mg i.m . daily for 2 days then 6 mg each other day for 3 days then 6 mg twice a week for 14 days, a course dose 45 mg), 33 patients received likopid (1 or 10 mg daily per os for 10 days or 10 mg daily for 10 days then 2 mg twice a week for 14 days) . RESULTS: A scheme of combined 3-staged treatment of AD complicated by SID is suggested . Stage 1-conventional treatment inhibiting aggravation of atopic reaction, improving functional condition of the defense systems plus antiinfection therapy, immunomodulators . Stage 2-primarily specific immunotherapy . Stage 3-outpatient prophylaxis of immunodeficiency and resistant forms of atopic reactions . CONCLUSION: Combined staged pharmacological and immunological control of allergic inflammation and immunodeficiency is the main principle of control of AD with SID. Nihon Kokyuki Gakkai Zasshi, 1998 Jan, 36(1), 81 - 5 {Percutaneous drainage of a bulla with tuberculous infection in a patient}; Yanase K et al.; A 63-year-old man complaining of low grade fever and dry cough was admitted to our hospital . Chest X-ray showed infiltrative shadows and a bulla with a fluid level in the left upper lung field . Bacteriological examination of sputum and bronchoalveolar lavage fluid did not yield any diagnostic results . Percutaneous aspiration of the bulla under fluoroscopy was performed . Bulla with tuberculous infection was considered because a high ADA level was detected in the fluid of the bulla . A culture of the bulla fluid was positive for mycobacterium tuberculosis (TB), which was sensitive to all anti-mycobacterial drugs . The fluid in the bulla gradually increased, and occupied the entire space of the bulla three months later . Percutaneous aspiration of the bulla was performed again and a fluid smear was positive for TB . It was thought that systemic administration of anti-mycobacterial drugs had been ineffective, so percutaneous drainage and subsequent injection of anti-mycobacterial drugs into the bulla was performed . The fluid in the bulla subsequently disappeared and the bulla shrank gradually . Percutaneous drainage of a bulla with tuberculous infection should be considered in those who do not respond to medical management. Radiology, 1998 Jun, 207(3), 759 - 65 Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle; Lucidarme O et al.; PURPOSE: To evaluate a lung biopsy technique in which a detachable, 18-gauge, coaxial guide around a central notched stylet is used as a cutting needle . MATERIALS AND METHODS: The records of 89 consecutive patients (41 women, 48 men; aged 21-86 years) who underwent coaxial percutaneous core biopsy of 91 lung lesions that required needle passage through normal lung tissue (mean lesion size, 33.6 mm; range, 9-80 mm) were studied . Detachable, 18-gauge, coaxial automated cutting needles were used . RESULTS: The mean number of needle passes was 2.5 (range, 1-4) . All biopsies yielded sufficient tissue for histopathologic (n = 91) and, if necessary, bacteriologic (n = 12) evaluation (mean core length, 5 mm; range, 1-15 mm) . Eighty-nine lesions had definitive diagnoses . Seventy-five lesions were proved to be malignant; seventy (93%) could be accurately diagnosed with coaxial percutaneous core biopsy samples . Fourteen lesions were proved to be benign; 10 (71%) were specifically diagnosed with biopsy samples . Among the 91 biopsies, the overall diagnostic accuracy was 88% (80 of 91 lesions) . A pneumothorax occurred in 31 cases (34%), three (3%) of which necessitated placement of a chest tube . Postbiopsy hemoptysis occurred and resolved spontaneously in nine cases (10%) . CONCLUSION: This technique provides a core biopsy specimen without the need for an on-site cytopathologist during the procedure . It has a high diagnostic accuracy and an acceptable rate of complications. Wiad Lek, 1998, 51(1-2), 64 - 70 {Necrotizing dermatitis, infections of soft tissue and deep fascia: classification and treatment}; Marszal M et al.; Nectrotizing fasciitis is a mixed infection of skin and subcutaneous tissue with a characteristic clinical and pathological appearance . Necrotizing soft tissue infections, caused by aerobic, anaerobic and mixed bacterial flora are an increasing problem in medical and surgical practice . The apparently wide variety of these infections is systematized . Etiology and bacteriology are discussed, as the role of surgery, antibiotics and hyperbaric chamber in the treatment of the infections . Early and radical surgical excision of all affected tissue is the treatment of choice . Adjuvant hyperbaric oxygen appears to be important in refractory progressive bacterial gangrene . A combination of hyperbaric oxygen, surgical treatment and antibiotics gives the lowest mortality and morbidity in gas gangrene compared with other treatment modifications . Extensive clinical experience shows the efficacy of these treatment protocols. Acta Orthop Scand, 1998 Apr, 69(2), 169 - 72 Zoned exponential, vertical and horizontal ultra-clean laminar airflows . No differences in bacteriological efficiency; Friberg BE et al.; We compared the novel zoned exponential ultra-clean operating room ventilation, needing no extra side-walls with the traditionally used ultra-clean air systems having vertical or horizontal laminar airflow, but requiring extra side-walls . The three units were evaluated with regard to elimination of particles with focus on airborne and sedimenting bacteria-carrying particles (colony forming units, cfu) during rigidly standardized sham operations . Although minor differences were recorded inside the ultra-clean airflows, the three systems were comparable with regard to bacteriological efficiency and ensured a low air and surface contamination (0.05-4 cfu/m3 and 7-72 cfu/m2/h, depending on the site of sampling) . We conclude that all three systems fulfilled well the criteria for ultra-clean air (< 10 cfu/m3), but that exponential airflow is the most versatile alternative, as additional side-walls around the operating area can be omitted. Vet Rec, 1998 Apr 25, 142(17), 459 - 62 Aorto-iliac thrombosis in a foal; Moore LA et al.; A six-day-old Missouri foxtrotter colt was examined because it had had diarrhoea since it was 24 hours old . A diagnosis of colitis, septicaemia, and disruption of the arterial blood flow to the pelvic limbs was made on the basis of clinical and laboratory findings . Despite intensive medical therapy, the foal died 13 hours after being examined . Postmortem examination revealed diffuse fibrinous enteritis with lymphoid necrosis, multifocal fibrinonecrotic typhlocolitis, disseminated intravascular coagulation, and a large occluding thrombus at the aortic termination . The results of bacteriological culturing supported the diagnosis of septicaemia leading to activation of the clotting cascade, disseminated intravascular coagulation, aorto-iliac thrombosis and infarction of the pelvic limbs. Vnitr Lek, 1997 Apr, 43(4), 226 - 9 {Principles of monitoring patients with exacerbation of chronic obstructive pulmonary disease}; Musil J et al.; In patient treated on account of exacerbations of chronic obstructive pulmonary disease the authors monitor the peak expiration frequency (PEF) or spirometry, blood gases, pulse and respiration rate, grade of dyspnoea, ECG, blood count, blood sugar level, serum lactate concentration theophyllinaemia . It is necessary also to make an X-ray examination of the chest and bacteriological examination of sputum . The authors describe the method of different examinations and the relationship of the monitored parameters to the pathophysiology of the disease. Indian J Med Res, 1998 Mar, 107, 113 - 7 Preparation & standardization of the goat lung surfactant extract; Narayanan S et al.; Exogenous goat lung surfactant extract (GLSE) was obtained by chloroform-methanol extraction of the centrifuged lung lavage . Four lungs provided around 250 mg of surfactant . GLSE has a phospholipid content of 50 percent, cholesterol of 1.5 percent and protein content under 1 percent . The preparation was bacteriologically sterile and had a shelf life of at least one month at 4 degrees C . Endotracheal administration of surfactant (50 mg/kg) in a rat lung model rendered surfactant deficient by saline lavage, restored the compliance characteristics to normal, thus documenting biological activity of the preparation . The cost of a course of 2 doses of surfactant replacement therapy was estimated to be as low as Rs 500/- . The study opens up the possibility of surfactant replacement therapy for the management of neonatal respiratory distress syndrome in India by an indigenous product at an affordable cost. J Clin Microbiol, 1998 Apr, 36(4), 1003 - 7 Diversity of DNA fingerprints of Mycobacterium tuberculosis isolates in the United States; Yang Z et al.; To investigate the diversity of IS6110 fingerprints of Mycobacterium tuberculosis isolates in the United States and to determine if matching IS6110 fingerprints represent recent interstate tuberculosis transmission, we performed restriction fragment length polymorphism analysis of M . tuberculosis isolates from 1,326 patients in three geographically separated states . Seven hundred ninety-five different IS6110 fingerprint patterns were generated, and pattern diversity was similar in each state . Ninety-six percent of the fingerprint patterns were observed in only one state, demonstrating that most IS6110 fingerprint patterns are confined to a single geographic location . Of the IS6110 fingerprint patterns that were shared by isolates from more than one state, most isolates with 1 to 5 IS6110 copies were separable by pTBN12 fingerprinting whereas those with > 15 copies were not . One high-copy-number M . tuberculosis strain had identical IS6110 and pTBN12 fingerprints and included 57 isolates from three states . Epidemiological data demonstrated significant recent transmission of tuberculosis within each city but not among the states . This suggests that identical fingerprints of isolates from geographically separate locations most likely reflect interstate tuberculosis transmission in the past, with subsequent intrastate spread of disease . Further evaluation of M . tuberculosis strains that cause outbreaks in different geographic locations will provide insight into the epidemiological and bacteriological factors that facilitate the spread of tuberculosis. Eur Respir J, 1998 Mar, 11(3), 554 - 9 Platelet-derived growth factor expression in primary pulmonary hypertension: comparison of HIV seropositive and HIV seronegative patients; Humbert M et al.; Primary pulmonary hypertension (PPH) is characterized by intimal fibrosis and cell proliferation (including fibroblasts, smooth muscle and endothelial cells) in the distal pulmonary arterial tree . Considerable interest has been generated by recent reports of PPH in human immunodeficiency virus (HIV)-1-infected individuals . Although the lack of evidence for a pulmonary artery infection has suggested that in such cases HIV may act through mediator release rather than by direct endothelial infection, the mechanisms underlying HIV-associated PPH remain poorly defined . Platelet-derived growth factor (PDGF) has the ability to induce smooth muscle cell and fibroblast proliferation and migration . Given these considerations, we have attempted to document a possible role for PDGF in PPH occurring in HIV seropositive and seronegative patients . Using semiquantitative polymerase chain reaction (PCR), PDGF A-chain messenger ribonucleic acid (mRNA) expression was analysed in surgical lung biopsies from 13 HIV seronegative patients and one HIV seropositive patient, all displaying severe PPH . In parallel, lung samples from two patients with HIV-1-associated PPH were studied by immunohistochemistry and in situ hybridization . Results were compared to those obtained in three HIV-1-infected individuals with no pulmonary complication (as demonstrated by clinical, radiological, bacteriological, and necropsy findings) and five control lung biopsies . As compared to controls, PDGF A-chain mRNA expression is elevated in lung biopsies from patients displaying PPH (p=0.029) . In HIV-1-associated PPH, interstitial perivascular cells expressing PDGF A-chain mRNA and protein could be detected by in situ hybridization and immunohistochemistry, respectively . Platelet-derived growth factor expression is elevated in lung biopsies of patients displaying primary pulmonary hypertension . Growth factors such as platelet-derived growth factor may play a part in the initiation and/or progression of primary pulmonary hypertension. Acta Trop, 1998 May, 69(2), 165 - 73 The early diagnosis of typhoid fever prior to the Widal test and bacteriological culture results; Khan M et al.; In an attempt to evaluate various clinical and laboratory features available within 24 h of admission, prior to the Widal test and bacteriological culture results as potential diagnostic aids in typhoid fever, we undertook a retrospective unit-based case control study in 90 febrile adult and paediatric patients admitted to King Edward VIII Hospital, Durban, South Africa with an initial diagnosis of typhoid fever . A total of 30 blood culture-proven typhoid fever patients (cases) were matched to 60 patients confirmed as not having typhoid fever (controls) by age, sex, race and severity of illness on admission . Features significantly associated with a final diagnosis of typhoid fever were: a pre-admission duration of fever > or = 7 days (odds ratio (OR) 6.9); hepatomegaly (OR 3.2); a normal leucocyte count (OR 10.8); a leucocyte count of < 10.0 x 10(3)/mm3 (OR 30.2); and leucopenia due to absolute neutropenia with a relative lymphocytosis (OR 11.8) . Although the sensitivity, specificity and predictive values of any of these features cannot be used reliably to distinguish typhoid fever from other non-typhoidal febrile illness, it is concluded that leucopenia due to absolute neutropenia with relative lymphocytosis, when present, is highly suggestive of typhoid fever . A leucocyte count of > 10.0 x 10(3)/mm3 (OR 0.03) provides strong presumptive evidence against such a diagnosis. J Formos Med Assoc, 1998 Apr, 97(4), 278 - 82 Short-course chemotherapy for isoniazid-resistant pulmonary tuberculosis; Bai KJ et al.; Standard short-course chemotherapy including isoniazid, rifampicin, pyrazinamide, and ethambutol has been the recommended treatment for tuberculosis in Taiwan since November 1990 . The effectiveness of this treatment was evaluated retrospectively in 108 patients with isolates resistant to isoniazid alone and 115 patients with drug-susceptible pulmonary tuberculosis diagnosed and treated at the Taiwan Provincial Chronic Disease Control Bureau from November 1990 through December 1995 . The success rate of treatment was 94.4% in patients with isoniazid-resistant Mycobacterium tuberculosis strains, which was not significantly different from the 97.4% rate in patients with susceptible strains . Of the patients treated successfully, no bacteriologic relapse was found in 97 patients with isoniazid-resistant strains or 103 patients with drug-susceptible strains 12 months after the end of chemotherapy . No significant advantage in treatment outcome was found in patients infected with isoniazid-resistant strains who received chemotherapy for more than 6 months (successful treatment rate, 95.0% vs 92.8%), but the failure rate was higher in patients with a previous history of antituberculosis therapy (17.6% vs 3.3%) . We conclude that short-course chemotherapy is effective for isoniazid-resistant pulmonary tuberculosis and that there is no significant difference in treatment outcome between patients with or without isoniazid-resistant disease. J Cardiothorac Vasc Anesth, 1998 Apr, 12(2), 145 - 52 Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment; Chapotte C et al.; OBJECTIVE: To evaluate the frequency and severity of airway compression due to congenital heart disease in children and validate the use of the fiberoptic bronchoscope to assess them . DESIGN: A retrospective study . SETTING: A single-institutional study in a university hospital . PARTICIPANTS: Seventy-two children with congenital heart disease . INTERVENTIONS: Airway endoscopy was performed in an awake child in cases of clinical and/or radiologic respiratory signs or in cases of preoperative assessment of a cardiac abnormality that is known to accompany airway compression . MEASUREMENTS AND MAIN RESULTS: Endoscopy was well tolerated; 71% of the children had endoscopic abnormalities and 50% had airway compression . The locations of these compressions are the same as those described in the literature in the cases of vascular rings and left-to-right shunts . The other endoscopic findings were laryngeal and bronchial abnormalities, tracheobronchial malacia, respiratory signs of gastroesophageal reflux, and positive bacteriologic sputum samples . CONCLUSION: Endoscopy in an awake patient is the only way to evaluate the functional component of a compression due to malacia; the resulting collapse of the airway can cause trapping of air and secretions . Furthermore, fiberoptic bronchoscopy offers a complete examination of the airways and can help detect airway abnormalities that are potential causes of complications . Fiberoptic bronchoscopy is a suitable and well-tolerated examination that is easy to perform at the bedside of the child . This technique optimizes the preoperative assessment of children with congenital heart disease. Am J Vet Res, 1998 May, 59(5), 546 - 51 Venezuelan field trials of vaccines against brucellosis in swine; Lord VR et al.; OBJECTIVE: To evaluate live attenuated Brucella abortus RB51, killed B suis cells, O-polysaccharide (OPS) from B abortus 1119-3 and OPS from B suis 1330, for protection of swine against B suis challenge exposure under farm conditions . ANIMALS: 10 infected boars, 160 unvaccinated control sows and their 1,040 progeny, and 610 vaccinated sows and their 6,600 progeny . PROCEDURE: Gilts (45 to 65 days or 4 to 6 months old) were vaccinated or not vaccinated . For the latter gilts, additional variables studied were dose, number of doses, and delivery route . Mature gilts were mated with 4 infected boars, then serologic reaction to Brucella spp, results of bacteriologic culture of vaginal secretions, presence of abortion, and litter size were assessed . Various tissues obtained from aborted fetuses were obtained for culture of Brucella spp . RESULTS: About 40% of unvaccinated control gilts seroconverted to Brucella spp, 27% were positive for OPS precipitation by use of agar gel immunodiffusion, 23% aborted their fetuses, and the remaining gilts had litters of 5 to 8 pigs . Killed B suis cells provided the following protection: 25% of vaccinates were seropositive, 5% had positive results of agar gel immunodiffusion, 5% aborted, and the remaining gilts had litters of 7 to 8 pigs . Gilts that received live RB51 or OPS vaccine were protected . Serologic reactions were always negative, abortion did not occur (i.e., 100% were protected), and litter size was 10 to 12 pigs . CONCLUSIONS: Live attenuated B abortus RB51 or purified OPS was effective in protecting gilts against B suis infections . Dose (10(6) to 10(9) cells, 100 to 500 micrograms, respectively), number of doses (1 or 3), or route (IM or PO) made little difference . Further research is required to determine why these 2 vaccine candidates are similar in protection effectiveness and whether they can be used after infection as a treatment. Genitourin Med, 1997 Dec, 73(6), 545 - 7 Vulvodynia and HIV: causal or casual association? Raiteri R, Sinicco A, Pippione M, Tomasini C, Solaroli C, Vitale L, Morticelli L, Gioannini P. BACKGROUND: No study exists on HIV and vulvodynia . OBJECTIVE: To evaluate vulvodynia in HIV infected women and its possible association with HIV . DESIGN: Cross sectional study . SETTING: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Turin . METHODS: 235 HIV positive and 272 HIV negative women were studied for vulvar pain between June 1995 and January 1997 . Diagnosis of vulvodynia was based on clinical history, dermatological and vulvovaginal examination, and bacteriology . Colposcopy and vulvar biopsy were performed and psychometric examination was done . RESULTS: Vulvodynia was diagnosed in five women with HIV and in one uninfected woman (odds ratio = 2.5; 95% confidence interval: 0.1-62.6) . High neuroticism scores were observed in women with history of vulvar pain, the highest in HIV infected vulvodynia patients (p = 0.000) . CONCLUSIONS: Confirming the association of gynaecological pain with neurotic personality, our study suggests causal link between HIV and vulvodynia. J Antimicrob Chemother, 1998 Mar, 41 Suppl B, 81 - 4 Comparison of roxithromycin with co-amoxiclav in patients with sinusitis; Chatzimanolis E et al.; In an open, randomized study of 60 patients with acute or recurrent sinusitis, the bacteriological and clinical efficacy of roxithromycin 150 mg bd were compared with those of po co-amoxiclav (625 mg) tds . Of 52 patients who underwent sinus puncture for isolation of causative organisms, 48 had pathogens sensitive to both antibiotics . Satisfactory clinical response was obtained in 93.1% (27/29) evaluable patients receiving roxithromycin and 88.8% (24/27) receiving co-amoxiclav . Tolerability was significantly better in the roxithromycin group, with 1/29 (3.4%) patients in this group experiencing gastrointestinal side-effects, compared with 7/27 (25.9%) patients in the co-amoxiclav group (P < 0.05) . Although the study had limited power to detect differences, roxithromycin demonstrated clinical, bacteriological and overall efficacy similar to that of co-amoxiclav, but with better tolerability . Roxithromycin thus appears to be an effective and well-tolerated drug for the treatment of acute and recurrent sinusitis. Minerva Stomatol, 1998 Jan-Feb, 47(1-2), 19 - 26 {An in-vivo bacteriological study on the effects of acid etching at the bottom of cavities}; Luglie PF et al.; BACKGROUND AND AIMS: The authors evaluate the effect of etching on the presence of bacterial colonies at the bottom of sockets . METHODS: For this purpose, 19 molars with first class carious lesions were selected belonging to patients age between 20 and 26 years old, referred for treatment at the outpatient clinics of the Dentistry Clinic . The teeth were due to undergo repair with amalgam using, as a foundation, fourth generation dentinal enamel adhesives . The clinical trial, which was performed in strict conditions of asepsis, included the preparation of Black's first class sockets at the bottom of which the author's looked for the mark of the "cri dentinaire" . Samples were collected of dentin presenting these characteristics before and after etching treatment . The latter consisted in the application of 37% orthophosphoric acid to dentin for 10 seconds; this served to remove the smear layer . The samples obtained in this way were sent to the Institute of Microbiology and Virology to undergo culture tests . RESULTS: The results obtained show that before etching 75% of the sample was positive for the presence of bacteria; this percentage fell to 53% of the sample after treatment . CONCLUSIONS: The authors conclude that prepared sockets, even if ready for restoration, are in the majority of cases still septic and that the total etch technique is not capable of fully removing any bacteria present . Given that the effects of acid mordanting on dental tissues are well known, the authors recommended paying particular attention to dentinal disinfection before using an adhesive system that involves the removal of the smear layer. Sangre (Barc), 1998 Feb, 43(1), 71 - 6 {Blood preservation . Bacteriological, immunohematological, hematological and hemorrheological studies}; Rasia RJ et al.; The knowledge of erythrocyte viability during blood bank storage period has been a major problem for transfusional practice . This problem must be considered by taking into account blood flowing properties which are directly related to the rheological properties of erythrocytes . The aim of this work was to perform an interdisciplinary study of the modifications induced in erythrocyte properties during 29 days storage of whole blood in a blood bank . Three samples of venous blood collected from healthy adults in plastic bags, anticoagulated with ACD (citric acid, citrate, dextrose) and stored at 4 degrees C were studied . Rheological properties (deformability, membrane elasticity and surface viscosity), immunohematological conditions (antigenicity) of erythrocytes, haematological index variation and bacteriological cultures of blood were weekly analysed . Rheological studies were performed using the Erythrodeformeter, a polymicroviscosimeter (paper filter) and erythrocyte filtration through polycarbonate membranes of 5 microns pore diameter . Impairment of membrane rheological properties, loss of antigenicity and decreases of Ht, Hb, MCHC and MHC were observed . Bacteriological cultures gave always negative results . The studies performed showed significant alterations of erythrocyte rheological parameters . It becomes evident that such modifications would influence the erythrocyte mechanical behavior in microcirculation and impair the in vivo viability of the transfused red cells. Klin Lab Diagn, 1998 Mar, (3), 34 - 6 {Tasks and possibilities of bacteriological laboratories in computer-assisted control of hospital infections}; Men'shikov DD et al.; The authors discuss the organization of epidemiological surveillance of hospital infections, carried out by bacteriological laboratories . The principal tasks of epidemiological surveillance of pyoseptic infections in surgical hospitals are formulated . The potentialities of using the data of computer monitoring of nosocomial infections are discussed . This method helps adopt epidemiologically justified decisions. Langenbecks Arch Chir Suppl Kongressbd, 1997, 114, 577 - 80 {Necrotizing fasciitis of the lower extremity}; Krawzak HW et al.; Three cases of a necrotizing fasciitis, a rare but life- and limb-threatening infection, were treated in the Department of Surgery at the University Hospital of the Ruhr University Bochum (MHH) between October 1992 and January 1994 . We compare our experiences with regard to bacteriological etiology, risk factors, localization, and place of entry, course, therapy and mortality with those in the literature. Aliment Pharmacol Ther, 1998 Mar, 12(3), 207 - 11 Antibiotic prophylaxis for ERCP: a comparison of oral ciprofloxacin with intravenous cephazolin in the prophylaxis of high-risk patients; Davis AJ et al.; BACKGROUND: Cholangitis and septicaemia are serious complications of endoscopic retrograde cholangiopancreatography (ERCP) . They occur mainly following therapeutic ERCP in the setting of an obstructed biliary system . The optimum prophylactic antibiotic regimen in such patients is not yet defined but usually depends on intravenous agents . AIM: To compare the efficacy of oral ciprofloxacin with intravenous cephazolin . METHODS: One hundred and fifty patients at high risk from septic complications were randomized prospectively to either oral ciprofloxacin (750 mg b.d.) or intravenous cephazolin (1 g b.d.), commenced at least 90 min prior to the ERCP and continued for 3 days . Bacteriological cultures were taken from bile during the procedure and from blood both immediately and at 24 h post-procedure . RESULTS: There were no significant differences between the two treatment groups in the pre-ERCP clinical or radiological findings or in the types of procedure performed . One patient did not undergo an ERCP and was excluded from the final analysis . Of the 77 patients in the ciprofloxacin group there were no positive blood cultures and one positive culture from a nasobiliary drain . Two out of the 72 cephazolin patients had positive blood cultures immediately post-ERCP; one of these two patients and one other cephazolin patient had positive bile cultures . There were no cases of cholangitis or septicaemia in the ciprofloxacin group and three cases in the cephazolin group . One patient from each treatment group died within the 7-day study . Adverse drug reactions were minimal and none of the different clinical outcomes in the two groups reached statistical significance . CONCLUSION: Oral ciprofloxacin is a cost-effective prophylactic agent for high-risk ERCP. Pneumoftiziologia, 1997 Apr-Jun, 46(2), 127 - 30 {Secondary active-evolutive cavitary pulmonary tuberculosis of the apicodorsal segment of the left upper lobe associated with bronchial tuberculosis and bronchial geotrichosis}; Popescu L et al.; A case of active pulmonary secondary tuberculosis associated with bronchial tuberculosis and bronchial geotrichosis is presented . This association is infrequent . Favoring factors: local and general immunodepression (recurrent infection with pyogenic germs, rubella, neutropenia, aggressive antibiotherapy, iron deficiency) . The diagnosis was based mainly on the bacteriological sputum examination for bK (smear and culture) and the mycologic examination (smear and culture) of the bronchial aspiration, identifying Geotrichum candidum . The treatment consisted of antituberculous and antimycotic drugs, bronchodilators, bronchial aspirations and local endoscopic administration of antimycotic drugs. Pneumoftiziologia, 1997 Apr-Jun, 46(2), 109 - 12 {The results of the chemotherapy of a patient cohort with pulmonary tuberculosis followed-up for a 3-year period}; Mihailescu P et al.; In 1992, in the fourth district of Bucharest 184 news adult patients with pulmonary tuberculosis were registered, and they received specific chemotherapy . The initial sputum bacteriological examination was M+C+ in 63.1% of these patients, M-C+ in 21.7% and M-C- in 15.2% . After three years of surveillance the results of the treatment were evaluated . 27 patients were excluded from the initial group, because they failed to be controlled . The final results were influenced by the sex and the initial bacteriological examination of sputum: the persistent negativation of sputum was obtained in 96.2% of the women, and only in 89.5% of men; depending on the initial bacteriological sputum examination, 100% of the M-C+ cases were negated, but only 86.4% of the M+C+ group. Ultramicroscopy, 1998 Mar, 71(1-4), 321 - 5 Near-field optical imaging of unstained bacteria: comparison with normal atomic force and far-field optical microscopy in air and aqueous media; Ben-Ami N et al.; Simultaneous near-field scanning optical and atomic force imaging of bacteria is presented . The bacteria imaged in these studies were unstained . The near-field optical images had excellent signal-to-noise and showed excellent contrast even in these unstained specimens . The images obtained were interpreted in terms of the images that have been obtained by transmission electron microscopy and X-ray imaging . The results show that bacterial near-field optical imaging is going to be a very important tool in the arsenal of the bacteriologist both in terms of understanding the fundamental processes in the life cycle of bacteria with and without cytochemical staining and in terms of clinical diagnostic applications. J Craniomaxillofac Surg, 1998 Feb, 26(1), 63 - 7 Actinomycotic osteomyelitis of the mandible: review of 15 cases; Bartkowski SB et al.; The authors have analysed 15 cases of actinomycotic osteomyelitis of the mandible . Primary actinomycotic inflammation of the mandible was diagnosed in nine patients, secondary in six patients (following fracture or resection of the mandible) . The diagnosis was established on the basis of the clinical examination confirmed by bacteriological and/or histopathological tests . The basic method of treatment was antibiotic therapy of long duration . Surgical treatment was performed in all patients . Twelve of fifteen patients who had received the therapy and proved asymptomatic for 1 year to 23 years were recognized to be cured of the disease . In three patients, a single recurrence of the disease was observed after 1.5-2 months. Przegl Epidemiol, 1997, 51(4), 389 - 404 {Epidemiology of tuberculosis in Poland and in the world}; Miller M et al.; The paper describes the risk of tuberculosis infection and the incidence of the disease as measures of the epidemiological situation and presents data on the epidemiological situation of tuberculosis in Poland and the world . It also describes the effectiveness of the national tuberculosis control programme in Poland . The annual risk of tuberculosis infection in Poland is estimated at 0.2% which is about 10 times higher than the lowest one in Europe (the Netherland), but there are countries in the world with the risk of 2.0% and higher . The incidence of tuberculosis in Poland (all forms) declined from 182.6/100,000 in 1965 to less than 40,0/100,000 in 1996, of which less than half were bacteriologically positive cases . The incidence of smear positive cases, the most infectious group, declined from 18.7/100,000 in 1980 to 9.7/100,000 in 1995 . All cases of tuberculosis in Poland are treated with 4-drugs regimen in the intensive phase of treatment and 3-drugs in the continuation phase . The duration of treatment is 6-8 months and the cure rate is above 90%. Int J Tuberc Lung Dis, 1998 Feb, 2(2), 116 - 23 Procedures for developing a simple scoring method based on unsophisticated criteria for screening children for tuberculosis; Fourie PB et al.; OBJECTIVE: To develop a scoring system for screening children for tuberculosis (TB) and for selecting suspects for further investigation in tuberculosis control programmes . Application of the score model, which would not require sophisticated or expensive technology, would be directed towards resource-poor countries with high prevalences of tuberculosis, where health care workers have to deal with diagnostic problems away from district hospitals or diagnostic facilities . DESIGN: Based on contributions from members of an IUATLD task group from 10 countries on the use of diagnostic criteria in childhood tuberculosis, criteria were selected to be used as elements in a score model . Data were collected by standardised questionnaire on 879 subjects aged under 15 years . Of these, 794 were considered probable or confirmed cases of tuberculosis by the diagnosing doctors . From each record, the criteria/procedures used in the diagnosis of probable/confirmed TB and regarded by the doctors as relevant criteria were selected . Bacteriology, histology and chest radiography were used either singly or collectively as the definitive reference (gold standard) against which the more subjective criteria (symptoms, clinical signs, skin test) would be evaluated . The latter criteria cited as relevant were then ranked and further explored for inclusion in the score model . The relative importance of each criterion to every other criterion on the list was expressed as weights, determined by employing a logarithmic least squares method to solve the ratio scale estimation problem which underlies decision-making involving more than one criterion . The resultant values were then assigned to each criterion in the final score model . RESULTS: The five clinical criteria thought to be most relevant as predictors of disease in children were history of contact with a case of tuberculosis, positive skin test, persistent cough, low weight for age, and unexplained/prolonged fever . In selecting the optimal cut-off points for the model at which tuberculosis would be suspected, low sensitivity and specificity (below 70%) but reasonably good positive predictive values (60%-77%) were obtained, depending on age group and epidemiological setting . In low tuberculosis prevalence settings, heavy reliance is placed by the model on a history of contact with a household case of tuberculosis and on a positive skin test, both of which have to be true . For high prevalence settings, more or less equal weighting is assigned to all five elements . Case contact and skin tests are less important, with low body weight, prolonged fever and cough being more indicative of tuberculosis . CONCLUSION: The model provides for epidemiological differences between target populations and should prove successful as a screening tool to select children for further investigation by radiography and bacteriology. Int J Tuberc Lung Dis, 1998 Jan, 2(1), 27 - 36 The seventh nationwide tuberculosis prevalence survey in Korea, 1995; Hong YP et al.; SETTING: Nationwide random sample survey for tuberculosis prevalence in Korea in 1995 . OBJECTIVE: To investigate the prevalence of tuberculosis infection, morbidity and drug resistance, and BCG coverage, and to compare the findings with those of the previous six surveys . DESIGN: The following investigations were performed: tuberculin test, BCG scar screening, chest miniature radiography (70 x 70 mm) for those aged over five years, sputum direct smear, culture and drug susceptibility test, and a questionnaire to obtain history of antituberculosis chemotherapy and symptoms . RESULTS: The coverages of the 1995 survey were as follows: tuberculin 87.0%, radiology 88.4%, bacteriology 98.3% . The observed tuberculin positivity (> or =10 mm in diameter) of subjects aged under 30 was 15.5% . The prevalence of pulmonary tuberculosis per 100000 has decreased in the last 30 years: direct smear positive from 686 to 93, smear and/or culture positive from 940 to 219, active tuberculosis from 5065 to 1032 . Rates of drug resistance have also fallen: of those with no previous chemotherapy from 26.2% to 5.8%, of those with history of chemotherapy from 55.2% to 25.0%, and in total from 38.0% to 9.9% . BCG scar prevalence of infants (aged under one year) was 87.7%, and of those under 30 it was 91.8% in 1995 . CONCLUSION: Tuberculosis prevalences and the drug resistance rates have decreased significantly. Roum Arch Microbiol Immunol, 1997 Jan-Jun, 56(1-2), 55 - 61 Application of ELISA with antigenic glycolipids in early diagnosis of pulmonary tuberculosis; Branaru-Gheorghiu M et al.; Antibodies against M . tuberculosis antigenic glycolipids were determined by enzyme-linked immunosorbent assay (ELISA) in 80 sera from patients suspected of pulmonary tuberculosis, with suggestive clinical signs and radiological abnormalities, but smears negative . The test was also performed on 68 control sera from patients with bacteriologically confirmed pulmonary tuberculosis, in different stages of disease . We obtained the test sensitivity of 89.5% for the confirmed tuberculosis patient sera . Low levels of specific antibodies and the sensitivity of 75% were found when using ELISA in smears negative patients at the onset of clinical tuberculosis . The experimental results showed that ELISA could be used as a supporting test in early diagnosis of pulmonary tuberculosis. Acta Vet Hung, 1997, 45(4), 409 - 16 Diagnostic value of certain mastitis markers in following up the clinical and bacteriological changes in pharmacotherapeutic studies; Huszenicza G et al.; Trends of certain mastitis markers were studied in udder quarters (n = 201) showing clinical symptoms of acute mastitis . Besides the clinical examination, before the first treatment (baseline sample), and about 3 weeks later, 17 to 24 days following the last treatment (control sample) milk samples were collected for bacteriological identification of the mastitis pathogens and for the determination of certain inflammatory markers: somatic cell count (SCC), N-acetyl-beta-D-glucosaminidase (NAGase) and alpha 1-antitrypsin (ATR) activities, as well as bovine serum albumin (BSA) and chloride (Cl-) concentrations . Based upon the clinical and bacteriological status as well as the SCC recorded at the control investigations, 6 groups were established (recovered, latently infected, subclinical mastitis: bacteriologically positive and negative, as well as clinical mastitis: bacteriologically positive and negative) . As compared to the baseline samples, all parameters decreased in the case of recovered udder quarters, as well as in those with abated latent infection or subclinical mastitis at the time of control examination . Comparing the control samples of the different categories, characteristic differences were found in NAGase activity, indicating the grade of cytodamaging effect of mastitis . Of the other markers, ATR and Cl- proved to be more adequate for the differentiation than BSA . It can be concluded that, in addition to SCC, first of all NAGase can be recommended for use as an inflammatory parameter in pharmacodynamic studies . Besides these two parameters, ATR and Cl- can also be chosen as a possible third marker. Zentralbl Veterinarmed B, 1998 Mar, 45(2), 105 - 14 Late lesions of experimental contagious caprine pleuropneumonia caused by Mycoplasma capricolum ssp . capripneumoniae; Wesonga HO et al.; A clinical, bacteriological, serological and patho-anatomical study was carried out on 12 goats surviving the acute stage of contagious caprine pleuropneumonia (CCPP), experimentally produced with Mycoplasma capricolum ssp . capripneumoniae (M . capripneumoniae), with the major aims of investigating the chronic stage of the disease and elucidating the possibility of a carrier state beyond the acute fulminant phase . The goats were killed 9, 16, 82 or 126 days after the onset of acute clinical signs . On day 9, clinical signs included low grade fever and persistent coughing . Thereafter, only intermittent coughing was recorded . Serum titres of complement-fixing antibodies to M . capripneumoniae were high at the period of fever but dropped thereafter . Post-mortem examination showed acute fibrinous pleuropneumonia on days 9 and 16, and chronic pleuropneumonia on days 82 and 126, including sequester formations in goats killed on day 126 . Mycoplasma capripneumoniae was isolated on days 9 and 16 but not on later occasions . The study showed that goats recovered from acute CCPP may have lesions for a long time thereafter but provide no evidence of a carrier state among long-term survivors. Ann Pathol, 1998 Feb, 18(1), 55 - 7 {Stomatococcus mucilaginosus infection . A rare cause of cutaneous histiocytic infiltrate}; Lazure T et al.; We report the case of a systemic infection due to Stomatococcus mucilaginosus with cutaneous localisations occurring in a neutropenic child . The histological features of this cutaneous involvement are very unusual and the diagnosis can be suggested before bacteriological results. Kekkaku, 1998 Feb, 73(2), 83 - 5 {Nontuberculous mycobacteriosis; the present status and in the future . 3-(2) Long-term prognosis of Mycobacterium avium complex disease}; Shigeto E; This paper shows long-term course of 71 patients with Mycobacterium avium complex (MAC) disease treated in National Hiroshima Hospital between 1977 and 1991 and were observed for more than 5 years or died between 6 months and years from the onset . In the patients who were not treated with chemotherapeutic agent or treated with less than 3 drugs, about 60 per cent deteriorated and few obtained persistent negativity of bacteria . In patients treated with at least 3 drugs out of isoniazid, rifampicin, ethambutol, ethionamide, cycloserine, clarithromycin and new-quinolones for more than 12 months, 59.2 per cent deteriorated, while 29.6 per cent obtained negative conversion of bacteria by initial chemotherapy . However only 18.5 per cent remained negative during long term observation . In patients treated with at least 3 drugs including one aminoglycoside such as streptomycin for more than 12 months, 64.7 per cent obtained negative conversion and 35.5 per cent remained negative bacteriologically, while 23.5 per cent deteriorated . In twelve patients who were operated, only one patient deteriorated . The long-term prognosis of MAC disease under the chemotherapy mainly by antituberculous agents up to this time was still poor compared to that by short-term observation . Anticipated new regimens for MAC should be multidrug, to prevent secondary drug resistance. Ann Hematol, 1998 Feb, 76(2), 91 - 2 Fournier's gangrene during induction treatment of acute promyelocytic leukemia, a case report; Levy V et al.; Fournier's gangrene is described as a fulminant necrotizing fasciitis of the scrotum and penis . Few cases have been reported in the context of acute leukemia . We describe a case, complicating the induction treatment of an acute promyelocytic leukemia with all-trans-retinoic acid and chemotherapy . The evolution was favorable, following surgical excision and broad-spectrum antibiotic therapy . The respective roles of all-trans-retinoic acid and granulocytopenia are discussed . This devastating and life-threatening infection must be kept in mind for early clinical, bacteriological, and radiological diagnosis and surgical management. J Cardiovasc Surg (Torino), 1998 Feb, 39(1), 95 - 7 Management of postoperative fever in cardiovascular surgery; Ishikawa S et al.; BACKGROUND: The causes and management of postoperative fever were studied . MATERIALS AND METHODS: During a four-year-period beginning in January of 1991, high fever over 38.5 degrees C max occurred in twenty-five (6%) out of 395 patients who underwent cardiovascular surgery . RESULTS: Nine of the patients (28%) evidenced bacteriological infections as follows; 3 cases of mediastinitis, 2 cases of respiratory tract infection, 1 case of MRSA colitis and a wound infection in one case . The three patients with mediastinitis died and the two cases of MRSA were detected from the culture of pacemaker leads . Bacteriological infection was not detected in other 18 (72%) patients with fever . However, we speculated that the clinical causes of fever in 9 out of 18 patients were as follows; catheter fever in 3 patients, acalculous cholecystitis in 2, fungus infection in 2, aseptic meningitis in one and viral myelitis in one patient . Two patients with acalculous cholecystitis recovered after percutaneous transhepatic gallbladder drainage . The causes of fever were not apparent in nine patients, however the source might be related to artificial prostheses used intraoperatively in five patients . C-reactive protein (CRP) was elevated beyond 10 mg/dl in 13 (52%) of the 25 patients . CRP increased in all seven bacteriologically positive patients and in six (32%) of the bacteriologically negative patients . CONCLUSIONS: Precise and prompt bacterial examinations are necessary in patients with CRP elevation because the origins of fever were bacteriological in only 28% of the patients with a high fever . Good prognoses may be obtained by suitable management in bacteriologically negative patients. Eur J Nucl Med, 1998 Feb, 25(2), 132 - 8 Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection; Devillers A et al.; We conducted a prospective study in order to evaluate the contribution of technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocyte scintigraphy to the diagnosis and follow-up of osteomyelitis in the diabetic foot . The study was conducted between October 1992 and November 1996 and included 42 patients (30 men and 12 women; mean age 63 years) with diabetes mellitus (type 1, n = 22, type 2, n = 20) who had a total of 56 diabetic foot ulcers . The initial exploration included standard radiography, three-phase bone scintigraphy and 99mTc-HMPAO labelled leucocyte scintigraphy (HMPAO-LS), performed within a 3-day interval . For the 56 ulceration sites, 26 cases of osteomyelitis were diagnosed: ten on the basis of radiographic and histological/bacteriological criteria after bone biopsy, 11 after radiographic follow-up and five on the basis of biopsy results alone . No osteomyelitis was present at 30 sites, there were seven cases of cellulitis . The sensitivity and specificity of 99mTc-HMPAO-LS were 88.4% and 96.6% respectively (23 true-positives, 29 true-negatives, one false-positive, three false-negatives) . The accuracy of radiography, 99mTc-methylene diphosphonate and HMPAO-LS was 69.6%, 62.5%, and 92.9%, respectively . Follow-up scintigraphy (n = 14) 4 months after initial diagnosis and 1 month after antibiotic withdrawal confirmed cure of osteomyelitis despite the absence of complete clinical regression of the ulcers . In conclusion, 99mTc-HMPAO labelled leucocyte scintigraphy was found to be an excellent method for the diagnosis of osteomyelitis in the diabetic foot . It can contribute to follow-up, particularly when clinical regression of perforating ulcers is incomplete and cure of osteomyelitis must be confirmed in order that antibiotic treatment may be discontinued. Avian Dis, 1998 Jan-Mar, 42(1), 194 - 8 Colonization of the chicken trachea by an avirulent avian Escherichia coli transformed with plasmid pHK11; Wooley RE et al.; Recombinant plasmid pHK11 was transformed into an avirulent, wild-type avian Escherichia coli (E . coli Av) in order to study the plasmid's effect on colonization of the chicken trachea . The transformant (E . coli Av + pHK11) produced colicin V (ColV), had type F1 fimbriae, and was motile . The E . coli Av recipient possessed type F1 fimbriae but was nonmotile; it did not produce ColV . Four-day-old chicks were inoculated in the trachea with 100 microliters of an overnight culture (approximately 10(8) colony-forming units) of E . coli Av, E . coli Av + pHK11, or sterile brain-heart infusion (BHI) broth . A group of uninoculated chicks was also included . Samples of the trachea were taken on days 4 and 10 postinoculation and compared histologically and bacteriologically . Birds inoculated with E . coli Av + pHK11 had enhanced tracheal colonization and showed increased histologic changes as compared with those inoculated with E . coli Av or BHI broth or uninoculated controls . These results indicate that production of ColV and motility enhance the colonization of the trachea and may be involved in the cause of pathologic lesions. Ter Arkh, 1998, 70(1), 37 - 41 {New cases of helicobacter pylori associated duodenal ulcer}; Minushkin ON et al.; AIM: Generalization of the results obtained through analysis of examinations of new cases of duodenal ulcer (DU) with patients suffering from DU of different duration, made in two main aspects: the patients' Helicobacter pylori (HP) status determined by histological, bacteriological, immunological studies and rapid urease test and their clinical manifestations, including analysis of risk factors predisposing to peptic ulcer . MATERIALS AND METHODS: Two groups of patients with DU: 1) 23 new cases; 2) (a group of comparison) 43 patients with DU of different duration were examined . Family history, risk factors (smoking, alcohol consumption, use of nonsteroidal antiinflammatory agents), concurrent diseases were analyzed . Esophagogastroduodenoscopy (EGDS), ph metry, histological, bacteriological studies, rapid urease test and IgG antiHP determination were made . RESULTS: More than 95% of patients with DU were found to have HP just at the moment of diagnosis . New cases of DU have less HP colonization in the mucosa . The best diagnostic results were obtained with a combination of a histological study and a rapid urease test . 74% of new DU cases have scarring-ulcerative deformity of the duodenal bulk and, therefore, the onset of peptic ulcer was asymptomatic or mild . DU accompanied by hemorrhage averaged 4.5% . A third of new cases have simultaneously 2 ulcer defects in the duodenal bulb . The pains and symptoms of gastric dyspepsia are typical of the two groups of patients; however, of particular significance for their formation are functional disorders in new cases and organic changes in other patients . CONCLUSION: The comparison of the diagnostic techniques for HP allows the authors to recommend a combination of a histological study and a rapid urease test as the most informative tool. Clin Auton Res, 1998 Feb, 8(1), 1 - 5 Ludwig Robert Müller (1870-1962)--a pioneer of autonomic nervous system research; Neundorfer B et al.; Ludwig Robert Muller, MD, professor of internal medicine, born in 1870 in Augsburg, Bavaria, studied medicine from 1890 to 1893 in various European cities and specialized in pathology and bacteriology . In 1895, he joined A . Strumpell, one of Germany's outstanding internists and neurologists, in Erlangen, Germany . Henceforth, Muller focused on the autonomic nervous system . In his 1898 Habilitation, a thesis required to join the academic faculty, which he entitled Anatomy and pathology of the lower spinal cord, he presented studies on the autonomic innervation of the bladder and colon . Based on animal studies, he continued to publish essential findings on the autonomic innervation of heart, lungs, and gastrointestinal tract . Muller was the first to report afferent pathways from internal organs to the brain . His book The vegetative nervous system was first published in 1920 . In 1931, he wrote the book Lebensnerven und Lebenstriebe (Life nerves and life instincts) . Many of his papers dealt with the regulation of thirst, hunger and sleep . He was Chairman of Internal Medicine in Wurzburg, Germany, from 1914 to 1920, and also in Erlangen as Strumpell's successor from 1920 to 1936 . The broad scope of Muller's publications makes him one of the important pioneers of autonomic nervous system research. Orthopade, 1998 Feb, 27(2), 136 - 42 {Type I collagen in xenogenic bone material regulates attachment and spreading of osteoblasts over the beta1 integrin subunit}; Basle MF et al.; Xenogenic bone biomaterials have been proposed as an alternative to autografts or allografts in human bone restoring or in complement of prosthetic surgery . When appropriate treatments were applied, immunological, inflammatory, bacteriological or virological adverse responses can be prevented . However, these treatments may interact with type I collagen, the major component of the organic bone matrix . Type I collagen can bind osteoblasts via specific cell surface receptors, the integrins . In this work, two different xenogenic biomaterials were studied . Both biomaterials have a bovine bone origin . They displayed similar architectural organization with connected plates and rods and similar surface topography and roughness . They differed by the presence or not of collagen type I . The first one was characterized by preservation of the type I collagen matrix associated with spindle-shaped hydroxypatite crystals and the second was solely composed by heat-modified apatite crystals . Osteoblast-like cells (Saos-2) were cultured on both biomaterials and examined in scanning and transmission electron microscopy after 7 and 14 days . Both biomaterials were cytocompatible as demonstrated by good ultrastructural cell preservation . (1) At the surface of the collagen containing biomaterial, cells were elongated in shape and oriented according to the trabecular architecture and to the superficial collagen network . After 14 days of culture, cells were confluent and the biomaterial surface was hidden by the cell sheet . The beta 1 integrin subunit was detected by immunogold in transmission electron microscopy in close relationship with the superficial collagen fibres of the biomaterial and with the outer cell surface . When cultures were carried out in presence of anti beta 1 integrin subunit, cells were packed and piled up with lack of specific orientation . (2) At the surface of the deproteinized biomaterial, cells were globular without specific disposition and often partially attached to the surface . After 14 days of culture, large areas of the biomaterial surface remained uncovered . Anti beta 1 subunits conjugated with gold particles were detected around the cells but with no specific association with the deproteinized biomaterial . These results strongly suggest that presence of type I collagen fibres in the matrix of a bone biomaterial is of major interest to determine cell attachment, spreading and orientation via interaction between type I collagen and beta 1 integrin subunit of osteoblasts. J Am Vet Med Assoc, 1998 Mar 15, 212(6), 827 - 9 Granulomatous meningitis caused by Coccidioides immitis in a dog; Burtch M; Granulomatous meningitis attributable to Coccidioides immitis was diagnosed on postmortem examination in a 4-year-old Border Collie . Clinical signs included CNS disease, aspiration pneumonia secondary to a megaesophagus, and otitis externa . Central nervous system signs included central vestibular and cranial nerve dysfunction . Cerebellar and medullary infiltrates seen on histologic examination affected cranial nerves VIII, IX, and X . Despite extensive diagnostics, diagnosis was not made antemortem . Analysis of CSF suggested suppurative meningitis, but bacteriologic culture results were negative . Coccidioides endospores were identified on reexamination of brain tissue . The clinical course of disease and rate of Coccidioides immitis infection is variable . Causative agents of granulomatous or inflammatory CNS disease may include fungal infection more often than is currently suspected. Transfus Clin Biol, 1997 Dec, 4(6), 549 - 57 {Consequences for labile blood products of leukocyte depletion by whole blood filtration using the Leucoflex LST1 in-line filter . Evaluation of the Leucoflex LST1 filter}; Janus G et al.; The aim of this study is to evaluate the effects of whole blood filtration after a storage time of 20-24 hours at laboratory temperature using the in line filter Leucoflex LST1 . The study concerns 49 blood donations in which we studied leukocyte depletion, proteins (IgG, IgA, IgM, haptoglobin, C3, C4), coagulation factors (fibrinogen, factors XII, XI, IX, VIII, V, proteins S and C, plasminogen, tPA, D-Dimers, PDF) at day 1, the parameters of conservation (ATP, 2-3 DPG, extra cellular potassium, haemolysis, pH) of red blood cell concentrates (RCCs) and bacteriological sterility at day 1 and 42 . Despite a correct leukocyte depletion (mean depletion of 3.96 log), a 10 fold higher mean level of residual leukocytes/unit than with buffy coat poor RCC filtration (0.514.10(6) vs 0.051.10(6)) is observed . Moreover a lot of concentrates are not in accordance with French regulations (7/42 with more than 1.10(6) leukocytes/unit) . The variation of the rates of IgG, IgA, IgM, haptoglobin, C4 and protein C is not significant . For the others there is a slight decrease with a mean level remaining in a physiological range . No sign of activation is noted . The sterility assays remain negative and the RCC conservation is not altered . In conclusion, even if the quality of the leukocyte depletion is not satisfactory in our study and has to be stated more precisely by multicenter studies, the whole blood filtration does not alter the quality of the derived components and allows us obtain RCC in a bigger volume and containing more haemoglobin than with the classical procedure after removing the buffy-coat {10}. Int J Tuberc Lung Dis, 1998 Mar, 2(3), 225 - 30 Physician compliance with national tuberculosis treatment guidelines: a university hospital study; Arif K et al.; SETTING: The Aga Khan University Hospital, in Karachi, Pakistan, is a 650-bed university teaching hospital . OBJECTIVES: There is little data from Pakistan on the awareness and application of the World Health Organization (WHO)'s tuberculosis treatment guidelines among physicians . This study evaluates physician compliance with these guidelines . DESIGN: A questionnaire to measure physician compliance was developed, pilot tested and standardised . Case records of all patients hospitalized with tuberculosis were reviewed (January-December 1995, n = 229), and were classified into WHO Category 1 (n = 191), Category 2 (n = 9) and Category 3 (n = 29) . RESULTS: A total of 53 (23%) patients had a diagnostic bacteriological sputum smear examination, of which 38% were smear positive and 47% culture positive . Of 25 cerebrospinal fluid cultures 12% were positive . No sputum smear tests were conducted during treatment . Of 58 patients in Category 1 who completed therapy 74% received a 2-month intensive phase consisting of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) (n = 43), while 41% received a 6 month continuation phase with HE (n = 24) . Over 70% patients were lost to follow up, more than half of these during the intensive phase . CONCLUSION: Our study reflects poor awareness of the WHO guidelines and low compliance among physicians, and a high loss to follow-up . Efforts are needed to create physician awareness about the WHO guidelines and their use . This study can be used to assess the effectiveness of any future physician education and to identify areas of weakness in health care. J Pediatr Gastroenterol Nutr, 1998 Mar, 26(3), 291 - 6 The 13carbon urea breath test for the noninvasive detection of Helicobacter pylori in children: comparison with culture and determination of minimum analysis requirements; Kalach N et al.; BACKGROUND: The purpose of the study was to determine the accuracy of the labelled 13carbon urea breath test for the diagnosis of Helicobacter pylori in children and to simplify the 13carbon urea breath test in identifying the most discriminating sampling time . METHODS: H . pylori was searched for in 100 children aged 10.5+/-4.5 years by histology, bacteriological counts, and culture on antral biopsies together with serology and 13carbon urea breath test . Breath samples were obtained before ingestion (T0) of 75 mg urea-13C and every 10 minutes after until T60 . 13CO2 excess ratio was measured by isotope ratio mass spectrometry, and values expressed as delta per mil over baseline enrichment (delta 13CO2) . The arithmetic mean (Mdelta 13CO2) of T20 to T60 values was calculated and the test considered positive with Mdelta 3CO2 higher than Mdelta 13CO2 + 3 SD as determined in noninfected children . RESULTS: Mdelta 13CO2 of noninfected children as assessed by culture was 1.4+/-0.6 per mil, determining a positive cut-off value of 3.44 per mil . Mdelta 13CO2 was correlated in 11 children with biopsy bacteriological counts . Both culture and 13carbon urea breath test were positive in 38 of 100 children, without any discordance . Plotting 13carbon urea breath test results at each sampling time versus Mdelta 13CO2 showed weaker correlations at T20, T30, T50, and T60, than at T40 . The two-sample method at T0 and T30, T40, T50, had high sensitivity and specificity . Single-sample analysis obtained at T40 gave a comparable sensitivity and a slightly reduced specificity . CONCLUSION: 13carbon urea breath test is sensitive and specific in children . Two samples collected at T0 and T40 provide the most discriminating procedure. Pol Merkuriusz Lek, 1997 Dec, 3(18), 274 - 8 {Use of long-acting drainage (sino-ject) in treatment of chronic maxillary sinusitis}; Jurkiewicz D et al.; The authors present the results of treatment of chronic maxillary sinusitis with punctures and with permanent drainage (sino-ject) . The use of permanent drainage shortened the time of treatment and increased percentage of very good results of treatment . Presented method of permanent drainage of maxillary sinus avoid many punctures of sinus . The drainage of sinus allow for each day rinsing of sinus with physiological saline and with drugs (mucolitic, antibiotic) and also for bacteriological examination of sinus secretion . As in classical puncture of maxillary sinus the permanent drainage play a diagnostic and therapeutic roles . The permanent drainage of maxillary sinus allow for inflow of oxygen into sinus and protect from anaerobic infection . The fact that puncture needle is pushed to a depth of only 1 cm greatly reduces the risk of injuring neighbouring structures . This method enables puncture of maxillary sinus with minimum trauma and hardly any pain. P N G Med J, 1995 Dec, 38(4), 305 - 14 Typhoid in the highlands of Papua New Guinea 1984-1990: a hospital-based perspective; Richens J; A first-hand account is given of the epidemic of typhoid in the Goroka area as it evolved from 1984 to 1990 . The monthly admissions for typhoid to Goroka Base Hospital showed a peak in 1988 . The sex and age distribution showed a predominance of young adults . The overall case fatality rate of hospitalized patients was of the order of 10-15%; in a carefully documented group of 374 patients 27% were assessed as having severe typhoid and this subgroup had a case fatality rate of 44% . The clinical features were studied in 516 patients . The high mortality appeared to result from septic shock; ileal perforation was found in only 1.3% of patients . A skin lesion equivalent to but significantly different from the classic rose spot was found in 30% of patients . The typhoid facies was commonly encountered in patients with well-established typhoid . Cerebellar tremor and hearing loss were frequent diagnostic findings . Blood and bone marrow cultures were used to confirm the diagnosis; bone marrow culture proved practicable but gave little increased yield over blood culture . A clinical algorithm to help distinguish typhoid and malaria was developed, principally for use in health centres in the highlands . The mainstay of treatment was chloramphenicol and very few problems were encountered with its use in inpatients . Bacteriological resistance to chloramphenicol did not develop over the study period . Other drugs, such as fluorinated quinolones, may be more effective when all aspects are considered, despite higher cost, but this remains to be investigated . Hydrocortisone in patients with severe disease was evaluated and shown to be ineffective but whether high-dose dexamethasone would reduce the mortality from typhoid in patients in Papua New Guinea still remains an unanswered question. Thorax, 1997 Dec, 52(12), 1060 - 7 Tuberculosis in England and Wales in 1993: results of a national survey . Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group; Kumar D et al.; BACKGROUND: A national survey of tuberculosis notifications in England and Wales was carried out in 1993 to determine the notification rate of tuberculosis and the trends in the occurrence of disease by ethnic group in comparison with the findings of similar surveys in 1978/79, 1983, and 1988 . The prevalence of HIV infection in adults notified with tuberculosis in the survey period was also estimated . METHODS: Clinical, bacteriological, and sociodemographic information was obtained on all newly notified cases of tuberculosis in England and Wales during the six months from 2 January to 2 July 1993 . The prevalence of HIV infection in 16-54 year old patients with tuberculosis notified throughout 1993 was assessed using "unlinked anonymous" testing supplemented by matching of the register of patients with tuberculosis with that of patients with AIDS reported to the PHLS AIDS centre . Annual notification rates were calculated using population estimates from the 1993 Labour Force Survey . RESULTS: A total of 2706 newly notified patients was eligible for inclusion in the survey of whom 2458 were previously untreated the comparable figures for 1988 were 2408 and 2163 . The number of patients of white ethnic origin decreased from 1142 (53%) in 1988 to 1088 (44%) in 1993 whereas those of patients of Indian, Pakistani, or Bangladeshi (Indian subcontinent (ISC)) ethnic origin increased from 843 (39%) in 1988 to 1014 (41%) and those of "other" (non-white, non-ISC) ethnic origins increased from 178 (8%) to 356 (14%) . The largest increase was seen in the black African ethnic group from 37 in 1988 to 171 in 1993 . Forty nine per cent of patients had been born abroad and the highest rates were seen in those who had recently arrived in this country . The overall annual notification rate for previously untreated tuberculosis in England and Wales increased between 1988 and 1993 from 8.4 to 9.2 per 100,000 population . The rate declined in the white, Indian, and black Caribbean ethnic groups and increased in all other groups . In the white group the rate of decline has slowed since the last survey: in several age groups the rates were higher in 1993 than 1988 but the numbers in these groups were small . Thirty six (4.1%) of the 882 previously untreated respiratory cases were resistant to isoniazid and three (0.3%) to isoniazid and rifampicin . Sixty two (2.3%) adults aged 16-54 years were estimated to be HIV-infected . Evidence of under-reporting of HIV positive tuberculosis patients was found . CONCLUSIONS: The number of cases and annual notification rate for previously untreated tuberculosis increased between 1988 and 1993 . Although the decline in rates in the white population has continued, the rate of decline has slowed . The high rates in the ISC ethnic group population have continued to decline since 1988 whereas rates in the black African group have increased . An increased proportion of cases were found among people born abroad, particularly those recently arrived in this country . In previously untreated cases the level of drug resistance remains low and multi-drug resistance is rare . A small proportion of adults with tuberculosis were infected with HIV but there may be selective undernotification of tuberculosis in these patients. Ital J Gastroenterol Hepatol, 1997 Dec, 29(6), 574 - 6 A growing demand for Helicobacter pylori culture in the near future? Megraud F. Culture is the basic method in bacteriology . It allowed the discovery of Helicobacter pylori . Problems in the culture of this fragile, slow-growing bacterium concern transport and processing in the laboratory, but they can be solved . Culture has a 100% specificity . When performed properly, it has a sensitivity in the range of the other best diagnostic methods for Helicobacter pylori . It allows strain typing and, most importantly, susceptibility testing to antibiotics, because an increased rate of acquired resistance of Helicobacter pylori is currently observed . Culture must be performed in clinical trials, at least when antibiotics, to which Helicobacter pylori may be resistant, are used . In clinical practice, culture and susceptibility testing can generally be restricted to treatment failures . However, it is important to monitor Helicobacter pylori susceptibility to antibiotics at a national or regional level in order to give recommendations for primary treatment. Eur J Clin Microbiol Infect Dis, 1998 Jan, 17(1), 14 - 9 A new histological procedure for re-evaluation of the serological test for Helicobacter pylori; Misawa K et al.; To re-evaluate the accuracy of the serological test for Helicobacter pylori, fixation of biopsy specimens with Carnoy's solution (preserving the mucous layer in tissue preparations) followed by immunohistochemical staining (a new histological procedure) was used as the reference histological method instead of 10% formalin fixation followed by hematoxylin-eosin staining (the conventional histological procedure) . Biopsy specimens (antrum and body) from 114 patients with gastritis (including non-ulcer dyspepsia) or gastric and/or duodenal ulcers were obtained by endoscopy and used for both bacteriological culture and histological examination . Serum samples were taken from all patients at the time of endoscopy . The serum levels of specific IgG and IgA antibodies for Helicobacter pylori were measured by commercial enzyme immunoassay kits . The reliability of the IgG and IgA measurements was evaluated by analyzing receiver operating characteristic curves obtained using the two histological procedures . With the conventional histological procedure as the reference, the sensitivity and specificity levels of the serological test were 87.2% and 82.1%, respectively . With the new histological procedure as reference, sensitivity and specificity were 94% and 96.7%, respectively . The insufficient accuracy reported for the serological test could be due to false-positive or false-negative results obtained when the conventional histological procedure is used as the reference . The new histological procedure used here revealed that the serological test for Helicobacter pylori is more reliable than previously thought. J Med Microbiol, 1998 Mar, 47(3), 275 - 80 Morphologic and temporal characterisation of lesions in an enhanced murine model of Serpulina hyodysenteriae infection; Hutto DL et al.; This laboratory has previously reported a murine model of Serpulina hyodysenteriae infection in which mice fed a defined diet, Teklad 85420 (TD), developed caecal lesions more consistently than mice fed a conventional rodent chow (CRC) . The objectives of the current studies were to characterise and compare the time of onset of lesions, the morphological nature and severity of lesions and the extent of colonisation by S . hyodysenteriae in mice fed the two diets . In the first of two experiments, 50 C3H/HeJ and 50 C3H/HeOuJ mice were fed either TD or CRC and then half of each group was infected with S . hyodysenteriae . Mice (n = 5) from each group were killed and examined on days, 1, 2, 4, 9 or 17 after infection . Each mouse was examined grossly and microscopically and assigned lesion scores based on lesion severity . The second experiment was designed in an identical way to the first, but had slightly smaller group sizes (n=20) . Mice (n=4) were killed for necropsy at the same five time points after infection and their caeca were homogenised and examined by quantitative bacteriology with media selective for S . hyodysenteriae . There were no differences in any finding due to mouse strain . Group lesion scores over the entire experimental period were significantly higher in mice fed TD (mean total lesion index = 13) than in mice fed CRC (mean total lesion index = 8.8) . Lesions were also temporally distributed in a significantly different manner in that they appeared earlier (day 1) and persisted longer in the TD-fed mice in comparison to CRC-fed mice . Furthermore, lesions of equivalent severity from each treatment group presented identical microscopic features . Finally, quantitative bacteriological results indicated that there was no significant difference in the number of cfu of S . hyodysenteriae isolated from mice fed TD and those fed CRC . These results demonstrate that the characteristic severe lesions associated with S . hyodysenteriae infection in mice can occur 1 day after oral challenge in mice fed Teklad diet 85420 . Bacteriological results further indicate that the enhancement of lesion formation in this model is not due to any significant effect of the diet on numbers of spirochaetes in the caeca of infected mice. Trans R Soc Trop Med Hyg, 1997 Nov-Dec, 91(6), 704 - 7 Directly observed therapy for tuberculosis given twice weekly in the workplace in urban South Africa; Bechan S et al.; Effective models of delivery of directly observed therapy (DOT) for tuberculosis in resource-poor settings are needed . Intermittent chemotherapy may be an important component of DOT delivered in the community as it means fewer visits to supervisors . There is no published evidence on the efficacy of twice weekly therapy given from the start of treatment without an intensive daily phase . We analysed data from 3 large cohort studies in a migrant, urban workforce in South Africa between 1975 and 1983 . All patients received 4 drugs (isoniazid, rifampicin, pyrazinamide and streptomycin) twice weekly under direct observation by a nurse in the workplace . Of 444 patients, 378 (85.1%) completed treatment . Cure could be assessed in 362, and 348 (96.1%, 95% confidence interval 93.7-97.8%) were bacteriologically cured . Sputum status was assessed at 2-3 months in 343 patients and 309 (90.1%) were sputum negative . Eighteen patients relapsed (5.7%; 2.9/100 patient-years of observation) . DOT can be effectively delivered to a migrant, urban workforce, and 4-drug therapy given twice weekly under direct observation is efficacious. Probl Tuberk, 1997, (6), 44 - 5 {Seeding rates of atypical mycobacterium in patients at L'vov regional phthisiopulmonological center}; Sibirnyi AV; Mycobacterial seeding rates were retrospectively analyzed in patients from 1986 to 1995 by the results obtained by the Centralized Bacteriological Laboratory, Lvov Regional Phthisiopulmonological Center, and the Laboratory of Bacteriology and Immunology, Department of Tuberculosis and the Research Laboratory of the Lvov Research Institute of Epidemiology and Hygiene . The findings suggest that in the past decade there has been a rise in the rate of isolation of atypical Mycobacteria, as well as an undulatory dynamics in their seeding with a stable upward tendency for the ratio of isolated atypical Mycobacteria to the total number of Mycobacteria in new cases. Kansenshogaku Zasshi, 1998 Jan, 72(1), 1 - 4 {Result of antibiotic therapy for children with Escherichia coli O26:H11 infection}; Sakata H et al.; Between the end of November 1996 and the beginning of March 1997, there was an outbreak of Escherichia coli O26:H11 infection in Asahikawa . The strain produced only verotoxin type 1 . The minimal inhibitory concentrations (microgram/ml) of the strain under aerobic condition and those of anaerobic were as follows: chloramphenicol (1.56, 0.78), minocycline (12.5, 3.13), kanamycin (3.13, 25), ampicillin (> 100, > 100), fosfomycin (12.5, 1.56), norfloxacin (0.1, 0.1), and cefaclor (6.25, 3.13) . Forty-one episodes of antibiotic therapy to 32 children, who were treated in Asahikawa Kosei Hospital, Asahikawa Municipal Hospital, and Asahikawa Red Cross Hospital, were evaluated bacteriologically . In 26 episodes treated with fosfomycin, the pathogen from stools of 19 were eradicated, 4 were not eradicated, and 3 were isolated again within 2 weeks after the cessation of therapy . Eight episodes treated with norfloxacin and 5 episodes in kanamycin were all eradicated. Clin Radiol, 1998 Feb, 53(2), 126 - 30 Post-radiotherapy osteomyelitis of the symphysis pubis: computed tomographic features; Wignall TA et al.; We report the clinical and computed tomography (CT) features of seven patients with osteomyelitis of the symphysis pubis following radiotherapy for bladder (n=4) or cervical (n=3) carcinoma . The patients presented with fistulae (n=5), pain (n=1) or small bowel obstruction (n=1) between 6 and 19 years after radiotherapy . The diagnosis was confirmed by surgery with histology or bacteriology of the symphysis pubis and/or associated abscess in all patients . In addition to bone destruction, other features identified on CT included abscesses, bowel loops adherent to the symphysis pubis and/or communicating with an abscess cavity, a soft tissue mass enveloping the residual bone, and fistulae . The combination of clinical and radiological features suggests osteomyelitis and, for patients who have had pelvic radiotherapy, this treatable condition should be included in the differential diagnosis of solitary symphysis pubis destruction. Chir Narzadow Ruchu Ortop Pol, 1997, 62(6), 529 - 38 {Principles of treatment for infected pseudarthoses}; Bielawski J et al.; Review of literature and own experience of the authors make them conclude, that assessment of extremity blood supply and precise bacteriologic evaluation with establishing the lowest efficient antibiotic concentration is necessary in planning of the treatment . It must include improvement of the blood supply by surgical reconstruction in case of impaired blood flow through great vessels and lumbar sympathectomy if crural arteries are compromised . Correct fixation of the fragments is equally important; the choice of the method depends on bony changes . Frequently, the management must be multi-stage . Improvement of the blood supply must always be included in the first stage . Rational surgical treatment supplemented by contemporary topical antibiotic administration allowed for termination of infection and bony union even in patients who were earlier considered for an amputation. Hepatology, 1998 Mar, 27(3), 662 - 5 Time dependent changes in the concentration and type of bacterial sequences found in cholesterol gallstones; Swidsinski A et al.; The role of bacteria in gallstone formation could not be conclusively evaluated until bacterial presence or absence in a stone was consistently shown . Cultural bacteriologic investigations at the time of cholecystectomy, however, led to the assumption that cholesterol gallstones were free of bacteria . In this study, we used a culture independent, molecular genetic approach to detect, quantify, and identify bacteria in cholesterol gallstones from 100 patients at the time of cholecystectomy and 6 months following . Bacterial growth was recorded in the culture in 9 of 100 gallstones; bacterial DNA, however, was detected in 82 of 91 sterile gallstones . High concentrations corresponding to between 10(6) to 10(7) bacteria/g were detected in 11 stones and low concentrations of 10(5) bacteria/g were detected in 71 sterile stones . The infection in stones with a positive bacterial culture was characterized by the predominance of single bacterial sequence(s) of the bacteria cultured . A similar predominance, indicating a recent infection, was found in sterile gallstones with low DNA concentrations . A high diversity of non-repeating bacterial sequences, possibly arising from previous overlapping infections, was found in sterile gallstones with high concentrations of bacterial DNA . After 6 months concentrations of bacterial DNA fell significantly in all groups of gallstones . As bacterial DNA is quickly destroyed upon storage, but is nevertheless readily found in most gallstones at the time of cholecystectomy, there must be a mechanism by which it is replenished . One such mechanism is the frequently reoccurring, possibly self-terminating infection and another one is the permanent colonization of the gallstone with bacteria at low concentrations . Both can promote cholecystolithiasis. Rev Med Interne, 1997, 18(11), 876 - 81 {Aneurysm of the thoracic aorta and spondylodiscitis disclosing brucellosis}; Blain H et al.; Brucellosis, which decreased during the eighties in France, remains a public health problem in many Mediterranean countries . We report the case of a 65-year old patient native of Morocco, of thoracic aorta aneurysm and lumbar spondylodiscitis due to Brucella melitensis, revealed by haemoptysis and lumbar pains, with a favourable outcome after aortic graft resection, spinal plaster immobilization and specific lengthy antibiotic treatment . This case report is characterized by the absence of endocarditis or infectious focus near the aneurysm . Diagnosis of aneurysm and spondilitis due to Brucella melitensis is based on imaging and bacteriological and serological examination . Because of a clinical and biological intolerance for rifampicin and cotrimoxazole, this patient received ofloxacin-doxycyclin-streptomycin . We discuss antibiotic recommendations and stress the interest of the early diagnosis of complicated forms of brucellosis for a better prognosis. Otolaryngol Pol, 1995, 49 Suppl 23, 178 - 82 {Results of conservative treatment of chronic purulent sinusitis}; Ziuzio S et al.; Results of conservative treatment 159 patients with chronic purulent maxillary sinusitis has been discussed . In I group (75 sinuses) into sinus has been given clindamycin, in II group (56 sinuses) clindamycin, gentamycin or amikacin with metronidazol, in III group (comparative) others antibiotics . Basic results of bacteriological study and methods of treatment has been presented . In compare with group III statistically better results of treatment has been in group I and II. Chest, 1998 Feb, 113(2), 344 - 50 Bronchial stenosis due to anthracofibrosis; Chung MP et al.; STUDY OBJECTIVES: To define the clinical characteristics of the patients showing bronchoscopic findings of bronchial narrowing or obliteration with black pigmentation on overlying mucosa (we named this finding as "anthracofibrosis"), and to determine the association of anthracofibrosis with tuberculosis . PATIENTS and METHODS: The subjects of this study consisted of 28 patients; 8 men and 20 women, ranging in age from 42 to 86 years . The distinctive clinical features, natures of bronchoscopic lesions, and radiologic findings were analyzed retrospectively and summarized . Bacteriologic studies and results of pathologic examinations were also assessed . RESULTS: Chief complaints were cough (20/28) and dyspnea on exertion (17/28) . The abnormal bronchoscopic findings were identified most frequently in the right middle lobe bronchus (n=21/28) while more than one part of the bronchial tree was narrowed in 22 patients . Abnormalities of bronchial airways on CT were associated with peribronchial cuffs of soft tissue or surrounding lymph nodes . In 17 patients, active tuberculous infection was confirmed either bacteriologically (n=15) and/or histologically (n=8) . Pathologic study of the lesion obtained by bronchoscopic biopsy or thoracotomy showed dense bronchial and/or peribronchial fibrosis with interspersed black pigments . CONCLUSIONS: These findings strongly suggest that bronchial stenosis or obliteration with anthracotic pigmentation in the mucosa was caused by a fibrotic response to active or old tuberculous infection . To prevent the spread of tuberculosis and avoid unnecessary invasive procedures, detailed examinations for the presence of active tuberculosis should be performed in patients with this unique bronchoscopic finding. J Immunol, 1998 Mar 1, 160(5), 2037 - 41 CD40 ligand is not essential for the development of cell-mediated immunity and resistance to Mycobacterium tuberculosis; Campos-Neto A et al.; It has been proposed that the induction of cellular immunity and resistance to intracellular pathogens is dependent upon CD40 ligand (CD40L) . In the present study we show that this proposal is not ubiquitously supported . Mice genetically deficient in CD40L (CD40LKO) were resistant to i.v . infection with Mycobacterium tuberculosis when assessed by survival and bacteriologic burden in the spleen, liver, and lungs . Infected CD40LKO mice developed granulomas that lacked epithelioid cells and were less numerous and markedly smaller than those observed in control mice . Upon stimulation with purified protein derivative of M . tuberculosis, CD4+ T cells from infected CD40LKO mice proliferated and produced high levels of IFN-gamma but not IL-4 . Finally, spleen cells from CD40LKO mice stimulated with M . tuberculosis produced IL-12, TNF, and nitric oxide levels comparable to those produced by control cells . In contrast to original proposals, these data clearly show that protective Thl immunity can be achieved against intracellular pathogens (e.g., Mycobacterium) independently of CD40L. Egypt Dent J, 1995 Apr, 41(2), 1167 - 78 Bacteriological and clinical assessment of tetracycline as root conditioning in adjunct to periodontal surgery; Darhous MS et al.; The present study was conducted on 14 quadrants from seven solicited patients . After initial phase of plaque control, six different clinical parameters were recorded and scaling and root planning performed . In each of the seven patients two Modified Widman flaps were done . One served as a control and the other as experimental in which irrigation by Tetracycline-Hcl solution 100 mg/ml for 5 minutes was performed . On comparing the two treatment modalities the tetracycline-Hcl root conditioning showed a better improvement in all the clinical parameters tested . Tetracycline irrigation gave less bacterial counts than the control group right after irrigation, however after two weeks the bacterial counts increased again and were insignificantly different in the two groups. Egypt Dent J, 1995 Jan, 41(1), 1007 - 12 A bacteriologic aid in the differential diagnosis of periapical and periodontal abscesses; el-Sayed JM et al.; The aim of the present investigation was to determine whether spirochaetal count could help differentiate between periodontal and periapical abscesses . 23 draining abscesses were included, where 15 were diagnosed as periodontal and 8 as periapical, based on clinical and radiographic data . Exudate samples were collected aseptically and examined by both darkfield microscopy and Gram-stained smear . The results revealed a statistically high increase in spirochaetal count in periodontal abscesses compared to periapical ones . The obvious difference appeared adequate to differentiate both lesions and establish a rapid chairside diagnostic aid. Rev Mal Respir, 1997 Dec, 14 Suppl 5, S142 - 51 {Manifestations, diagnosis and treatment of non-tuberculous mycobacterial infections in patients with HIV infection}; Payen MC et al.; The most frequent bacterial infections in patients infected with HIV and suffering from AIDS are non-tuberculous mycobacterial infections . Their incidence is increasing all the more as the survival of profoundly immunocompromised patients is prolonged . There are unknown factors as regards the precise origin of these infections and as to the exact epidemiology of atypical mycobacteria . It is known that 95 per cent of atypical mycobacterial infections are due to M . avium . If the pathophysiology of the infection (involving the intervention of cytokines and also factors in relation to the virulence of the germ) is imperfectly understood, the atypical mycobacteria are an independent cause of mortality in advanced stages of the disease . The clinical picture is that of a low grade fever with weight loss and a deterioration in the general physical state . There are subtle physical signs such as a fall in the functional capacity accompanied by weight loss and an unexplained anaemia these should also suggest a diagnosis . More rarely the infection will be localised . The clinical diagnosis will be confirmed by bacteriology which has been aided by recent progress in molecular biology . With the arrival of the newer macrolides it has been shown that treatment prolongs survival in a significant manner . Current recommendations consist of a treatment with a combined regime including a minimum of Clarithyromycin and Ethambutol . The place for polychemotherapy remains to be determined in particular the role for Rifabutine and Amikacine . Immunomodulation by interferon-gamma or GCSF are also under review . The duration of treatment and the necessity of long term suppressive treatment is the object of randomised studies . Prophylaxis is currently recommended for patients with CD4 < 75/mm3 . The role of Rifabutine and the new macrolides remains to be determined . Finally, in a large European study the objective is to compare prophylaxis to systematic bacteriological surveillance both as regards efficacy, tolerance, and in terms of pharmaco-economics. Nephrologie, 1997, 18(7), 303 - 6 {Tuberculosis in hemodialysis}; Zahiri K et al.; The authors report a retrospective study in order to illustrate the particular features of tuberculosis in hemodialysis population . Thirty two patients over 203 (15.8%) in periodic hemodialysis, have presented a tuberculosis between 1983 and 1996 . There were 17 men and 15 women aged from 14 to 60 years old . The features of the tuberculosis in these cases were marked by the extrapulmonary localizations (50%) notably nodes tuberculosis, and the difficulties of the diagnosis certainty . The diagnosis was suspected basing on the fever, the weigh loss, the rate sedimentation increase and the radiologic lesions in pulmonary tuberculosis and peripheric or deep lymph nodes involvement . The diagnosis confirmation was established bacteriologically in 6 cases (18.7%) and histologically in 14 cases (43.8%) . The treatment consisted on the association of isoniazide, rifampicin and pyrazinamide which leads to recovery in 87.5% . This treatment was a diagnosis proof in the absence of confirmation. Indian J Dent Res, 1993 Jul-Dec, 4(3-4), 81 - 9 Inappropriateness of the term "periodontal disease"; Kaimenyi JT; Traditionally, diseases that affect the periodontium have over the years been referred to as periodontal disease . This implies that these diseases are a single disease entity or only one disease, "periodontal disease," affects the periodontium . To date, dental literature is replete with several diseases that affect the periodontium . Most of these diseases exhibit unique bacteriological, immunological, biochemical and clinical features . It is these characteristics that qualify them to be regarded as individual or different disease entities . Biased by these recent reports on distinct diseases that affect the periodontium, several dental authors have written articles where they have preferred the term "periodontal diseases" to "periodontal disease," when discussing and reporting on the diseases that affect the periodontium . This paper suggests and discusses the reasons why scientists have continued to use the term periodontal disease and presents arguments why this terminology is inappropriate . It is suggested that the term "periodontal disease" be replaced by the term "periodontal diseases". Indian J Dent Res, 1996 Apr-Jun, 7(2), 51 - 3 Resinifying therapy in endodontics . II--Histological and bacteriological evaluation; Sikri VK et al.; This study was conducted on six rabbits, six rats and six human permanent teeth to evaluate histologically the effect of resin resorcinol in the periapical areas, the bacteriological aspect of the resin and the penetration of resin in the dentinal tubules . After 12 days period of observation plenty of lymphocytes and macrophages were evident along with granulomas which are suggestive of the tendency of the resin to stay longer . It was observed that the resin penetrate approximately three fourth distance inside the dentinal tubules . In the last phase the resin was found to be effective against the eight commonly found micro organisms . Though the histological results indicated that the periapical tissue would take longer time for complete repair, yet clinically the tooth functions well . Resinifying therapy is effective and economical method in root canal treatment. Radiology, 1998 Mar, 206(3), 749 - 54 Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings; Guhlmann A et al.; PURPOSE: To evaluate use of positron emission tomography (PET) with 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) in detection of chronic osteomyelitis . MATERIALS AND METHODS: Thirty-one patients suspected to have chronic osteomyelitis in the peripheral (n = 21) or central (n = 10) skeleton were evaluated prospectively with FDG PET . Analysis of the receiver operating characteristic curve was performed . The final diagnosis was made by means of bacteriologic culture of surgical specimens and histopathologic analysis . RESULTS: FDG PET allowed identification of 17 of 18 patients with osteomyelitis and 12 of 13 without osteomyelitis . There was one false-positive and one equivocal result . The area under the ROC curve was 0.96 for all patients, 1.00 for patients suspected to have osteomyelitis in the peripheral skeleton, and 0.88 for patients suspected to have osteomyelitis in the central skeleton . The overall accuracy of FDG PET was 97% with a high degree of interobserver concordance (kappa = 0.93) . The overall sensitivity and specificity were 100% and 92%, respectively . CONCLUSION: FDG PET enables noninvasive detection and demonstration of the extent of chronic osteomyelitis with a high degree of accuracy . Especially in the central skeleton within active bone marrow, FDG PET is highly accurate and shows great promise in diagnosis of chronic osteomyelitis. Kekkaku, 1998 Jan, 73(1), 1 - 3 {The diagnostic value of thoracoscopic examinations in tuberculous pleurisy}; Yano S et al.; We evaluated the diagnostic value of thoracoscopic examinations in eleven patients who had pleural effusion and were diagnosed as tuberculous pleurisy . The characteristic white or yellowish-white micronodules were observed by thoracoscopy in eight patients and all their biopsied tissue were compatible with tuberculosis . We had some cases which were not determined as tuberculous pleurisy from bacteriological examinations and were determined only from the thoracoscopic findings. J Dairy Sci, 1998 Jan, 81(1), 283 - 8 Johne's disease: a hidden threat; Stabel JR; Paratuberculosis, which is also known as Johne's disease, is a chronic, progressive enteric disease of ruminants caused by infection with Mycobacterium paratuberculosis . Cattle become infected with M . paratuberculosis as calves but often do not develop clinical signs until 2 to 5 yr of age . The clinical disease is characterized by chronic or intermittent diarrhea, emaciation, and death . Although animals with clinical disease are often culled from the herd, animals with subclinical paratuberculosis may cause economic losses because of reduced milk production and poor reproductive performance . Although the economic impact of paratuberculosis on the national cattle industry has not been determined, it is estimated to exceed $1.5 billion/yr . The diagnosis of subclinical paratuberculosis is difficult . Bacteriologic culture is the most definitive method of diagnosis, but culture is time consuming and labor intensive . Serological assays are not very useful because animals do not develop an antibody response until the clinical stages of disease . Development of assays to measure cell-mediated immunity is critical to accurate detection of paratuberculosis in subclinically infected animals . Although not considered a zoonotic agent, M . paratuberculosis has been identified in intestinal biopsy tissue from patients with Crohn's disease, an inflammatory enteritis in humans . Currently, the potential human health risk is being addressed by research evaluating pasteurization of dairy products in the US. Indian J Med Sci, 1997 Aug, 51(8), 265 - 9 Haemagglutination system for the simultaneous detection of LPS and anti LPS antibodies of S.typhi; Shukla S et al.; In view of the limitations of Widal test for the diagnosis of typhoid, haemagglutination test using sensitized sheep red blood cells was designed at our laboratory . The test gave only 1.8% positivity at 1:40 dilution among 500 normal persons . Eighteen of the 30 culture proven cases gave the HA test positive while the positivity was 62.5% among suspected cases of typhoid . Thus, the anti LPS haemagglutination test showed a sensitivity of 60% and specificity of 98.2% . The positive predictive value and negative predictive value were 66.66% and 96.7% respectively . The haemagglutination inhibition test was also developed for the detection of LPS antigen of S . typhi in the serum samples of typhoid cases and could detect 1.5625 micrograms/ mL of S . typhi LPS antigen but failed to detect LPS in the sera of bacteriologically proven cases of typhoid . However, it could detect the growth of simulated blood cultures of S . typhi within one hour of inoculation and did not give any cross reactions with other bacterial cultures . The data suggest that the haemagglutination test could be a good adjunct for Widal test and the haemagglutination inhibition test could help the early detection of S . typhi in culture. J Am Vet Med Assoc, 1998 Feb 15, 212(4), 557 - 9 Tuberculosis in adult beef cattle of Mexican origin shipped direct-to-slaughter into Texas; Brown WH et al.; OBJECTIVE: To evaluate differences in prevalence of tuberculosis (TB) in adult beef cattle that originated from different states in Mexico and were shipped direct-to-slaughter into Texas in 1995 . DESIGN: Epidemiologic survey . ANIMALS: Approximately 65,000 adult beef cattle . PROCEDURES: Postmortem examinations of carcasses for detection of Mycobacterium bovis infection were conducted at slaughter plants in Texas . Specimens were collected from cattle with granulomatous lesions, stored in neutral-buffered 10% formalin or saturated sodium borate solution, and processed for histologic and bacteriologic diagnosis . Prevalence and 95% confidence intervals were estimated by state of origin . Difference between prevalences for different states was tested for significance (P < 0.05), using the proportion test . RESULTS: Overall prevalence of TB at slaughter in adult beef cattle that originated from Mexico was approximately 0.5/1,000 (34/65,233) . Prevalence of TB in cattle that originated from Chihuahua (0.07) was significantly lower than that in cattle from Coahuila (0.80), Nuevo Leon (1.27), and Tamaulipas (1.81) . CLINICAL IMPLICATIONS: Prevalence of M bovis infection in adult beef cattle may be significantly different between states in the northern border region of Mexico . On the basis of disease prevalence and numbers of exported cattle and provided safeguards such as TB testing are continued, cattle from Chihuahua may pose a lower risk of TB transmission to Texas cattle than do cattle from Coahuila, Nuevo Leon, and Tamaulipas . To allow interstate/international movement of cattle from northern border states of Mexico, TB testing requirements should be continued . In the context of international trade, southern border states of the United States should continue collaborating with northern border states of Mexico to control and eradicate this disease. Dermatol Surg, 1998 Feb, 24(2), 243 - 7; discussion 247-8 Necrotizing soft tissue infections . Surgical or conservative treatment? Hsiao GH, Chang CH, Hsiao CW, Fanchiang JH, Jee SH. BACKGROUND: Both surgeons and dermatologists are increasingly challenged with the prompt diagnosis and management of severe soft tissue infections . Although early surgical intervention appears to be for life-saving in many patients, especially those diagnosed as necrotizing fasciitis, some patients recover well with only conservative treatment . Because most of these infections have similar initial clinical presentations, there remains a need to find reliable clinical and/or laboratory parameters that can predict the prognosis and to accordingly judge the necessity and timing of operation . METHODS: We conducted a retrospective study of case records of patients with necrotizing soft tissue infections . The clinical presentation, laboratory findings, management, and therapeutic outcome of 34 cases with necrotizing soft tissue infections were reviewed . RESULTS: These infections were potentially life-threatening, with an overall mortality of 26.5% . Shock on admission was an extremely grave sign associated with a poor prognosis (P < 0.05) . In this grave condition, most (80%) patients died regardless of the choice of treatment . Coagulation parameters, including platelet counts, prothrombin time (PT), and partial thromboplastin time (PTT), were available in 21 patients, of whom 16 had at least one abnormality at their initial presentation . In these 16 patients, those who underwent surgery had a significantly higher survival rate than those who were treated conservatively (P < 0.05) . Prolonged PT was significantly associated with a higher mortality (P < 0.05) . Surgery did seem to correct coagulopathies . However, in patients presenting with substantial alteration of all three coagulation parameters, there was no significant difference between medical treatment and surgical intervention in terms of mortality . In such cases, mortality was high (75%) . On the other hand, the prognoses of patients who presented with normal coagulation profiles were rather good . Most of them recovered well despite the therapeutic option . Surgical treatment did not seem to increase additional benefits on chances of survival . Extent of tissue plane involvement, bacteriology, and site of infection had no significant influence on patients' survival . CONCLUSIONS: A comprehensive, well-organized, universal approach, regardless of classification, is essential for all suspected cases of necrotizing soft tissue infections . Prompt diagnostic studies are needed, and platelet counts, PT, and PTT are readily available parameters that provide substantial information on diagnosis and treatment, thus avoiding an unwarranted loss of life or unnecessary operative sequelae . Early diagnosis and, in most cases, prompt radical surgical, intervention remain the cornerstone of successful management in these infections. Scand J Gastroenterol, 1998 Jan, 33(1), 63 - 70 Bacterial overgrowth, intestinal transit, and nutrition after total gastrectomy . Comparison of a jejunal pouch with Roux-en-Y reconstruction in a prospective random study; Iivonen MK et al.; BACKGROUND: Jejunal pouches after total gastrectomy have been introduced to diminish postgastrectomy symptoms and improve nutrition . However, the effect of a pouch on the intestinal bacteriology and transit is controversial . METHODS: Bacterial overgrowth was measured with the glucose breath test and the mouth-to-caecum transit time (MCT) by means of the lactulose breath test after total gastrectomy and Roux-en-Y reconstruction in 24 patients with a pouch (Pouch group) and in 22 patients without a pouch (Roux-en-Y group) . Postoperative symptoms were evaluated with a standard questionnaire, and nutrition was measured by blood chemistry and weight loss . RESULTS: MCTT was 110 +/- 44 min in the Roux-en-Y group and 117 +/- 44 min in the Pouch group (NS) . Eighty-six per cent of the patients in the Roux-en-Y group and 91% of the patients in the Pouch group had bacterial overgrowth (NS) . Transit time was shorter in patients with severe dumping than patients without dumping (60 +/- 28 min versus 115 +/- 41 min; P = 0.04) . Maximal hydrogen concentration in the glucose breath test correlated negatively with serum albumin and iron concentrations and with postoperative weight loss, and positively with serum alkaline phosphatase activity . CONCLUSIONS: Bacterial overgrowth is common in the upper intestine after total gastrectomy . Pouch reconstruction does not delay the transit of liquids . Bacterial overgrowth may be one of the main aetiologic factors in postgastrectomy malnutrition. Int J Tuberc Lung Dis, 1997 Dec, 1(6), 563 - 9 The role of 67gallium scintigraphy and high resolution computed tomography as predictors of disease activity in sputum smear-negative pulmonary tuberculosis; Lai FM et al.; SETTING: University Hospital, Kuala Lumpur, Malaysia . OBJECTIVE: To determine whether 67Gallium (Ga) scintigraphy and high resolution computed tomography (HRCT) of the lung improve the diagnostic accuracy of sputum smear-negative active pulmonary tuberculosis . DESIGN: Patients suspected of having active pulmonary tuberculosis but who were sputum smear-negative underwent 67Ga scintigraphic and HRCT scanning of the lung . Results of these scans were correlated with results of bacteriology and histopathology as well as clinical data on follow-up . RESULTS: Although none of the patients was culture-positive for Mycobacterium tuberculosis, 14 were considered to have active disease either because of positive direct smears of respiratory tract specimens other than sputum, positive histopathology, or clinical and radiological improvement following antituberculosis chemotherapy . A positive 67Ga scan had a sensitivity of 100% and a specificity of 83% for active pulmonary tuberculosis . Of the HRCT findings, the presence of centrilobular lesions had a 93% sensitivity and 100% specificity in determining disease activity in this group of patients . CONCLUSION: Both 67Ga scintigraphic and HRCT scans are helpful in determining disease activity in sputum smear-negative pulmonary tuberculosis. Int J Tuberc Lung Dis, 1997 Dec, 1(6), 498 - 501 Pleural tuberculosis and human immunodeficiency virus co-infection; Trajman A et al.; SETTING: Department of internal medicine in a general hospital in Rio de Janeiro, Brazil, which provides secondary care to the poor population . OBJECTIVE: The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV) infection in patients with pleural tuberculosis (TB) and to compare its manifestations in HIV-negative and HIV-infected patients . DESIGN: Cross-sectional study . METHODS: Forty-three patients with a final diagnosis of pleural TB were submitted to HIV testing (ELISA), chest X-ray, and thoracentesis for biochemical, cytological and bacteriological analysis . Pleural tissue was obtained in 36 patients for histopathological examination . PPD testing was performed in 29 patients . Whenever productive cough was present, sputum acid-fast smears and culture for Mycobacterium tuberculosis were performed . RESULTS: The HIV prevalence was high (30%) . TB symptoms were similar in both groups . Atypical radiological aspects were observed in HIV-infected patients with concurrent pulmonary TB (P = 0.03) . Pleural fluid, tissue aspects and PPD testing were comparable in both groups . CONCLUSION: Only atypical radiographic patterns in patients with concurrent pulmonary TB were indicative of HIV infection . Therefore, a high index of suspicion is necessary for the early recognition of HIV/TB co-infection . We suggest that all patients presenting with pleural TB should be screened for anti-HIV antibodies. J Clin Laser Med Surg, 1996 Feb, 14(1), 33 - 6 Treatment of infection with the use of carbon dioxide laser: a 10-year experience; Suarez Savio O et al.; Despite technical advances in the surgical treatment of infected wounds, this surgery remains a serious problem as it represents more than 27% of infection complications . In the majority of these operations, the wounds are left open and patients undergo long treatments of antibiotics . When the carbon dioxide laser technique was introduced in our country in 1984, it was tested using quantitative bacteriology: it was shown that when used on infected wounds, it reduced the bacterial population of these lesions to low levels with low tissue injury . At our center, between August 1984 and 1994, 539 patients with infected wounds were treated using a carbon dioxide laser . Out of 495 patients (91.84%) 1 patient was cured, 37 patients (6.86%) required more than one operation to be cured, and in 7 patients (1.30%) the treatment failed. Gesundheitswesen, 1997 Dec, 59(12), 679 - 85 {Infection or epidemic? On the problem of mono-causal thinking in medicine . The contribution of Adolf Gottstein (1857-1941)}; Labisch A; Robert Koch (1843-1910) had by the end of the 1870 invented a definite and reproducible method of determine bacteria . During the first decades after the origin of bacteriology he and his disciples developed in practice a strictly monocausal theory: where there is a specific germ, only the specific disease occurs . The importance of Adolf Gottstein (1857-1941) must be viewed against this background . As a general practitioner Gottstein noticed that there are considerable differences between the single specific infection and its massive spread as an epidemic . As one of the first clinical epidemiologists he learnt how to verify his experience and presumptions by systematical, quantitative analyses . His epidemiologically founded publications were a key factor in the process of abandoning the monocausal theory of illness of the early period of the Koch era and giving way to a multicausal view . The dynamic aetiology of Gottstein was a major contribution to the development of social hygiene and public health care. Enferm Intensiva, 1997 Jul-Sep, 8(3), 111 - 20 Pharmacy economic repercussions and other expenses in changing vascular equipment with no change in the rate of infection}; Garcia Lavandera MV et al.; OBJECTIVE: Comparison of infections when modifying the protocol of change of vascular equipment, from 48 to 72 hours, and its repercussion on pharmacy expenses and fungibles . DESIGN: Prospective study of operation . CONTEXT: Medical and surgical ICU of a University Hospital . PATIENTS: Bacteriological data of the catheters and hemocultures of two groups of patients are studied . The Control Group is formed by 105 patients admitted for three months, and the Study Group are 106 patients admitted in the other months of the following year, after the change in the protocol of vascular catheters . OPERATIONS: In the first group of patients, the vascular equipment (Monitoring kit of pressure, drop equipment, stopcock valves, accuracy valves and medication) were changed according to the established protocol, every 48 hours . In the second group of patients, the same changes were done every 72 hours . MAIN RESULTS: The diagnosis, age, average stay and survival were recorded in both groups . The infection rate by catheters and bacteremias did not show significant differences between both groups . However, the load of nursing work was reduced when changing the equipment every 72 hours and, in the same way, there was a noticeable saving in the pharmacy and fungible material consumption . CONCLUSIONS: The changes of equipment of vascular catheters may be done every 72 hours without having a higher rate of infections and with an optimum use of resources. J Formos Med Assoc, 1998 Jan, 97(1), 26 - 31 Nonspinal tuberculous osteomyelitis in children; Chen SC et al.; Tuberculous osteomyelitis is uncommon in children but its incidence seems to have increased in our hospital recently . From April 1984 to December 1994, we treated 12 children with this problem . Three cases were diagnosed in the first 7 years and nine cases in the latter 4 years . Primary spinal lesion was excluded . There were seven boys and five girls, with an average age of 2.4 years (range 1-4.5) . Anatomic sites of involvement were distal femur in three patients, proximal tibia in three, foot in three, proximal femur in one, proximal humerus in one, proximal radius in one, distal radius in one, and rib in one . Except for one case of hip lesion, the most common symptom was localized swelling . Delay in diagnosis was 6.6 months on average . The diagnosis was confirmed bacteriologically or histologically in all patients after surgical debridement and curettage . Anti-tuberculosis (TB) drugs were administered for 6 months postoperatively . All patients were followed-up for an average of 3.8 years (range 2-8) with satisfactory healing of their tuberculous lesions . Two cases were complicated with physeal bar formation . One patient had residual flexion contracture of the knee . Although the mortality from TB has decreased in Taiwan, the frequently reported late cases of TB deserve attention . Physicians should be aware that TB remains an important cause of bone lesions . These lesions can be healed by combined therapy with surgical debridement and anti-TB medication for 6 months. J Formos Med Assoc, 1998 Jan, 97(1), 21 - 5 Colonofiberscopic diagnosis of intestinal tuberculosis; Hsiao TJ et al.; The purpose of this study was to assess the predictive value of colonofiberscopy in the diagnosis of intestinal tuberculosis . The records of more than 14,000 colonofiberscopic examinations performed at the National Taiwan University Hospital from 1971 to 1995 were studied retrospectively . Colonofiberscopic diagnosis of intestinal tuberculosis required at least one of the following: circumferential ulcers, a single transverse axis ulcer with uneven base and elevated or nodular margin surrounded by nodular and hyperemic mucosa, or pseudopolyps . Sixty cases were diagnosed as intestinal tuberculosis based on these criteria, 29 of which were confirmed by histologic or bacteriologic findings or on the basis of clinical response to antituberculosis therapy . The positive predictive value of colonofiberscopy for intestinal tuberculosis was thus 43.3% (95% confidence interval 31-57%) . Secondary intestinal tuberculosis with pulmonary tuberculosis accounted for 84% of cases . The most commonly involved area of the gastrointestinal tract was the ileocecal region, followed by the ascending colon and ileum . Based on our findings, colonofiberscopic examination with histopathologic and bacteriologic study of biopsy specimens is a powerful tool for the diagnosis of intestinal tuberculosis. Bull Soc Pathol Exot, 1997, 90(4), 233 - 7 {The health of asylum seekers: from communicable disease screening to post-traumatic disorders}; Loutan L et al.; As the end of this century approaches, the pressure of migration is increasing . It is difficult to limit with restrictive measures the number of refugees and persons seeking asylum in Europe in each country, medical screening programs are organised for arriving refugees and asylum seekers . In Switzerland, they are screened for tuberculosis and hepatitis B . They are offered standard vaccinations and immunized for hepatitis B according to screening results . The prevalence of tuberculosis in asylum seekers is 414 per 100,000, 227 per 100,000 of bacteriologically active tuberculosis . Anti-HBc antibody is present in 22% of women and 39% of men . The frequency increases with age and varies greatly according to origin . Initially, refugees were screened for intestinal parasites . Over a quarter were carriers, a large majority asymptomatic . Increasing numbers of asylum seekers come from countries affected by war and insecurity . Systematic screening carried out in Geneva for previous exposure to violence revealed that 61% reported major trauma, 18% reported torture and 37% complained of symptoms such as nightmares, insomnia, flashbacks, etc . The authors discuss issues related to medical screening programs, and their relative usefulness in an increasingly mobile world where the distinction between travellers and migrants is not always clear. Am J Respir Crit Care Med, 1998 Feb, 157(2), 394 - 402 Bronchial neutrophilia in patients with noninfectious status asthmaticus; Lamblin C et al.; Cellular events that occur in status asthmaticus (SA) remain poorly investigated . Autopsy studies frequently emphasized about the presence of eosinophils in bronchial airway wall, whereas recent studies reported increased number of neutrophils in patients dying of sudden-onset fatal asthma . Mucus plugs occluding the bronchial lumen are almost constant features during SA . Bronchial lavage (BL) may be useful to remove mucus plugs in cases of atelectasis and/or refractory SA . We investigated the contribution of different cell types and cellular mediators (neutrophil elastase, eosinophil cationic protein {ECP}, histamine, interleukin-8 {IL-8}) to the pathogenesis of SA . We studied 16 BL from eight patients undergoing mechanical ventilation (MV) for SA (time interval from onset of MV = Day 0 to Day 11), four BL from patients undergoing MV without preexisting respiratory disease (V), 11 BL from patients with stable asthma (A) and eight BL from healthy controls (C) . SA exhibited higher number and percentage of neutrophils (81.5 +/- 4.5%) than V (44.3 +/- 12.2) (p < 0.05), A (6.9 +/- 2.7) and C (9.5 +/- 3.8) (p < 0.0001), and higher number of eosinophils than V, A, and C (p < 0.01) . Neutrophil elastase, ECP, and IL-8 levels were dramatically increased in SA . Histamine was higher in SA than in C and V (p < 0.05) . Bronchial neutrophilia was not related to concomitant bacterial infection as bacteriological cultures were positive in only three BL . Eosinophils, mast cells and histamine were higher in BL performed within the first 48 h of MV (p < 0.05) than in BL performed later on . Our results indicate that bronchial inflammation in SA differs from bronchial inflammation in mild asthma . Persistent bronchial neutrophilia is associated with increased eosinophils and mast cells in the early phase of SA . Neutrophils may result in tissue damage and participate to the shedding of the epithelium in SA. Epidemiol Mikrobiol Imunol, 1997 Sep, 46(3), 104 - 7 {Serodiagnostic detection of IGA-specific antibodies in tuberculosis}; Kubin M et al.; The objective of the submitted paper is evaluation of the possible use of detection of serum antibodies class IgA against the mycobacterial antigen Kp-90 ImCRA in the serodiagnostics of tuberculosis . Antibodies were detected by means of a commercially available IgA set Enzymimmunoassay Kreatech (Kreatech Diagnostics, Amsterdam, Netherlands) . By means of the mentioned diagnostic kit antibodies class IgA were assessed in 26 patients with respiratory TB positive on microscopic examination and cultivation, 35 patients with tuberculosis of the lungs or extrapulmonary TB confirmed on cultivation and in 48 subjects with various clinical diagnoses, where TB was not confirmed clinically nor by bacteriological examination . In 64.3% of the patients with TB positive microscopical and cultivation optic density values (OD) higher than 1.2 were recorded, in 57% of these patients OD was higher than 1.5 . The reactivity of patients in the control group (subjects with non-specific respiratory diseases) was strikingly low and all subjects with the exception of two had OD values lower than 1.2 . The sensitivity of the test was 46.0%, the specificity 95.8% . The assembled results confirmed the reactivity of the majority of TB patients to mycobacterial antigen Kp-90 in the class of IgA serum antibodies and a low seroreactivity of controls with non-tuberculous affections of the airways where only two cases of high titres from a total of 48 examinations were recorded . The evaluated test--IgA Immunoassay Kreatech--thus extends the possibilities to detect the immunoreactivity of the patient when assessing the diagnosis and during the further follow up of the tuberculous finding. J Clin Oncol, 1998 Feb, 16(2), 642 - 50 Effects of granulocyte-macrophage colony-stimulating factor and dose intensification of V-ICE chemotherapy in small-cell lung cancer: a prospective randomized study of 300 patients; Steward WP et al.; PURPOSE: To assess whether granulocyte-macrophage colony-stimulating factor (GM-CSF) reduces the toxicity of chemotherapy and alters delivered dose-intensity . To assess the feasibility of dose-intensification of chemotherapy in small-cell lung cancer (SCLC) and determine whether it has an impact on outcome . MATERIALS AND METHODS: Patients with good- or intermediate-prognosis SCLC entered a prospective multicenter study that involved a 2 x 2 factorial design with randomization to six cycles of chemotherapy with ifosfamide 5 g/m2, carboplatin 300 mg/m2, etoposide 120 mg/m2 intravenously (I.V.) on days 1 and 2 and 240 mg/m2 orally on day 3, and vincristine 0.5 mg/m2 I.V . on day 15 (V-ICE) every 3 weeks (intensified arm) or every 4 weeks (standard arm) . A second double-blind randomization to subcutaneous GM-CSF (250 microg/m2/d) or placebo for 14 days between chemotherapy cycles was made . RESULTS: Three hundred patients were entered . Myelosuppression was the main toxicity, with no significant difference in the incidence or grade between treatment groups . The incidence of febrile neutropenia and bacteriologically confirmed sepsis was unaffected by chemotherapy schedule or use of GM-CSF . Twenty-six percent greater dose-intensity was delivered in the intensified arm, with a trend for greater dose-intensity for those who received GM-CSF . Eighty-three percent of patients achieved a response (51% complete response {CR} rate), with no significant difference in response rates between treatment groups . Survival was significantly increased in the intensified compared with the standard arm (P = .0014); median survival rates were 443 versus 351 days and 2-year survival rates were 33% versus 18%, respectively . CONCLUSION: GM-CSF does not reduce the incidence of complications from myelosuppression of aggressive chemotherapy . Dose intensification of V-ICE to a 3-week schedule in SCLC is not associated with increased toxicity, but appears to improve survival significantly . Future studies should aim to deliver chemotherapy in maximal-tolerated dose-intensities. Onderstepoort J Vet Res, 1997 Sep, 64(3), 175 - 87 Escherichia coli serotypes in pigs in South Africa; Henton MM et al.; This retrospective study was based on 674 cases of colibacillosis in pigs submitted to the diagnostic bacteriology laboratory of the Onderstepoort Veterinary Institute (OVI) over the 20-year period ranging from 1971-1991 . During this time, 28,840 cases from various livestock species were received, of which 4162 (14.4%) were from pigs . The 674 porcine cases selected for this study were included if an E . coli infection had been suspected by the referring veterinarian, and typable E . coli strains were then isolated by this laboratory . Enteritis (45.5%) and septicaemia (46.9%) were the most common syndromes, with agalactiae (1.4%) and abortion (1.1 %) representing a far lower prevalence . Oedema-disease signs were described by the submitting veterinarian in only 12 cases . Samples were received from weaners and sucklers in relatively equal numbers until 1981, but subsequently samples from sucklers declined, while those from weaners remained high . There were 69 different somatic and capsulated (OK) antigen groups associated with E . coli infections in pigs . Escherichia coli O149 was the most common isolate (45.8%), while E . coli O141 was the next most common isolate (18.3%) . This was followed by O9 (8.9%), O20 (5.2%) and O8 (3.1%) . All other serotypes together accounted for less than 20% of the total number of cases, and were isolated fewer than 20 times each . The fimbrial attachment factor, F4 (K88) was found associated with 46.9% of isolates. Trans R Soc Trop Med Hyg, 1997 Sep-Oct, 91(5), 544 - 6 An outbreak of bartonellosis in Zamora Chinchipe Province in Ecuador; Cooper P et al.; We report an outbreak of human bartonellosis in Zamora Chinchipe Province in Ecuador, which occurred in 1995-1996 . Nineteen cases were seen, of which 18 presented with classical oroya fever (fever and profound anaemia) and one with verruga peruana; 11 of the cases (58%) had positive blood films containing Bartonella bacilliformis . The houses of cases and neighbouring controls were visited; blood samples for thin films and cultures were collected from members of each house and a questionnaire was administered to investigate possible risk factors for disease transmission . In none of those sampled was B . bacilliformis bacteriologically demonstrable . All case houses were located in isolated areas at the margin of forest and the presence of dead rodents was reported only in case houses (P < 0.05) . We suggest that human bartonellosis is a zoonosis with a natural rodent reservoir and that migrant humans infected in this way may become a temporary reservoir host in populated areas. Gut, 1997 Dec, 41(6), 832 - 40 The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis; Rau B et al.; BACKGROUND: Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis . Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis . Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis . AIMS: To analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis . PATIENTS AND METHODS: Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III) . After admission serum samples were drawn daily for two weeks . Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8) . The routine parameter C-reactive protein was determined by laser nephelometry (upper reference range 10 mg/l) . RESULTS: Median concentrations of PCT and IL-8 were significantly higher in patients with infected necrosis than in those with sterile necrosis during the observation period, whereas there was no difference in C-reactive protein . In oedematous pancreatitis overall median concentrations of all three parameters were low . By receiver operating characteristics best cut off levels for predicting infected necrosis or persisting pancreatic sepsis were 1.8 ng/ml for PCT and 112 pg/ml for IL-8 . If these cut off levels were reached on at least two days, sensitivity, specificity, and accuracy for the prediction of infected necrosis were 94%, 91%, and 92% for PCT and 72%, 75%, and 74% for IL-8, respectively . After surgical treatment of infected necrosis median PCT and IL-8 values continued to be significantly higher in patients with persisting pancreatic sepsis (n = 11) compared with those having an uneventful postoperative course (n = 7) . For the preoperative differentiation between infected necrosis and sterile necrosis guided fine needle aspiration was performed in 24 patients with necrotising pancreatitis and reached a diagnostic accuracy of 84% compared with 87% for PCT, and 68% for IL-8 . There was no correlation between the aetiology of acute pancreatitis or the extent of necrosis and PCT or IL-8 . CONCLUSION: PCT and IL-8 are found in high concentrations in infected necrosis and associated systemic complications in patients with acute pancreatitis . The course of PCT shows the closest correlation with the presence of infected necrosis . Monitoring of serum PCT is a potential new marker for the non-invasive and accurate prediction of infected necrosis as well as for the selection of patients with persisting septic complications after surgical debridement. Pol Merkuriusz Lek, 1997 Oct, 3(16), 199 - 201 {Bronchitis and alveolitis in the course of Chlamydia pneumoniae infection}; Nalepa P et al.; A case of a 38-year old male with respiratory failure in the course of infection by Chlamydia pneumoniae has been described . Inflammation of bronchioles and alveoli was diagnosed on the basis of clinical examination and analysis of cellular components of bronchoalveolar lavage fluid (BALF) . The diagnosis was confirmed by bacteriological examination of the culture infected by the material collected from the patient . Therapy with doxycycline was instituted which resulted in remission of symptoms . The case described confirms the findings of other authors that infection by Chlamydia pneumoniae may be the cause of serious respiratory distress. Spine, 1998 Jan 1, 23(1), 139 - 43 Concomitant tuberculosis and pyogenic infection of the cervical spine . A case report; Fu WK et al.; STUDY DESIGN: This case report describes a middle-aged woman with concomitant tuberculosis and pyogenic infection of the cervical spine . OBJECTIVE: To describe an unusual case of concomitant tuberculosis and pyogenic infection of the cervical spine . SUMMARY OF BACKGROUND DATA: Neither tuberculosis nor pyogenic spondylitis of the cervical spine is a common disorder . This case report describes a concomitant infection of C3-C4 in an otherwise healthy patient . To the authors' knowledge, such a case has never been reported . METHODS: This 52-year-old woman had spontaneous neck pain and myelopathy . Radiologic examination revealed the presence of an epidural abscess with destruction of C3-C4 vertebral bodies . RESULTS: Anterior decompression and fusion were performed, followed by therapy with antituberculosis drugs and antibiotics . The patient completely recovered . A follow-up radiograph revealed that solid fusion had been achieved . CONCLUSION: A case of concomitant tuberculosis and pyogenic infection of the cervical spine is presented . The possibility of this differential diagnosis should be considered, especially in areas of endemic tuberculosis . Examination of biopsy samples for histologic and bacteriologic findings is important to confirm this diagnosis . Radical debridement and combination therapy are strongly recommended to treat patients with this combination of infections. Spine, 1998 Jan 1, 23(1), 81 - 5 Computed tomography-guided biopsy of the spine . A review of 103 patients; Kornblum MB et al.; STUDY DESIGN: A retrospective study of 103 computed tomography-guided biopsies of the spine . These represent a consecutive series of patients with spinal lesions or disorders observed over a 32-month period . OBJECTIVES: To determine the diagnostic accuracy and clinical usefulness of computed tomography-guided biopsies with respect to major influencing variables . SUMMARY OF BACKGROUND DATA: Computer tomographic-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination technique . A study comparing its diagnostic accuracy with respect to all the variables of age, gender, radiographic appearance, spinal level, tissue type, or pathologic diagnosis has not been done . METHODS: Biopsy specimens were sent for cytologic and histologic analysis . Bacteriologic studies were performed when clinically indicated . The biopsy results were analyzed for adequacy and diagnostic accuracy, i.e., the ability to generate a tissue sample adequate for pathologic examination and one that yields diagnostic information . RESULTS: The mean age of patients was 60 years, with a range of 4-91 years . The spines of 52 males and 51 females were studied . There were eight cervical, 28 thoracic, 53 lumbar, and 14 sacral lesions used as biopsy sites . The radiographic appearance of spinal lesions were lytic in 74 cases, blastic in four cases, and mixed in two cases . Tissues undergoing biopsy included bone (63 cases), soft tissue (35 cases), and mixed specimens (five cases) . The pathologic examinations revealed 18 infections, 23 primary neoplasms, 34 metastases, and 19 normal tissues . An adequate specimen for pathologic examination was obtained in 90 biopsies (87%) . A diagnosis was achieved in 67 of 94 patients (71%) . Diagnostic rates obtained in thoracic level biopsies were lower than those from biopsies of other spinal levels (P = .007) . CONCLUSION: Computed tomography-guided biopsy is an important tool in the evaluation of spinal lesions . A positive biopsy result may preclude the need for open surgical intervention . This study included one of the largest series of patients in the medical literature . In addition, it determined the diagnostic rates of this procedure with respect to the major influencing variables . Thoracic-level biopsies have a diagnostic rate that is significantly lower than that of other spinal levels . No significant correlation was found between diagnostic accuracy and age, gender, radiographic appearance, tissue type, or eventual diagnosis. Zh Mikrobiol Epidemiol Immunobiol, 1997 Sep-Oct, (5), 85 - 7 {The diagnostic value of the polymerase chain reaction in tuberculosis}; Dzadzieva MF et al.; The comparative study of material obtained from tuberculosis patients in the Vladivostok Tuberculosis Dispensary was carried out with the use of polymerase chain reaction (PCR), the bacterioscopic and bacteriological methods . The study was made on different groups of tuberculosis patients (in the phase of the active course of the disease and after convalescence), patients with nonspecific pulmonary diseases and persons having contacts with tuberculosis patients . The study revealed that PCR was 2-3 times more effective than the other above-mentioned methods and made it possible to obtain results as early as 3-5 days after material was taken. Orv Hetil, 1997 Nov 16, 138(46), 2933 - 5 {Mycoplasma pneumoniae epidemic as zoonosis}; Mikola I et al.; At a secondary school in Budapest, in the first class, 30 students became sick with fever and upper respiratory catarrhal symptoms between September 19 and October 31, 1995 . Two children were hospitalized with a diagnosis of pneumonia, in case of the two children treated at the Szent Laszlo Hospital, suspect of Mycoplasma infection raised which was also confirmed by cold agglutination test . During the epizootiological examination on the spot they found a terrarium in the classroom where the students raised a Syrian gold hamster family . Mycoplasmas were isolated from the lung samples of the hamsters during the pathological examination which proved to be Mycoplasma pneumoniae . Owing to the close etiologic relationships between epidemiological anamnesis, characteristics of the epidemic, as well as findings of patients and pathological or histological findings in the hamsters together with the results of bacteriological examinations, the epidemic should be considered as a zoonosis. J Clin Microbiol, 1998 Jan, 36(1), 275 - 6 Inhibition of PCR by agar from bacteriological transport media; Gibb AP et al.; We observed inhibition of PCR in throat swabs submitted in routine bacteriological transport media . Experimental studies showed that agar, which was extracted with DNA by DNAzol (Gibco BRL, Gaithersburg, Md.), was the inhibitory agent . No inhibitory effect was observed with a transport medium which did not contain agar. Rinsho Shinkeigaku, 1997 Sep, 37(9), 834 - 40 {A case of rheumatoid pachymeningitis}; Otsuka M et al.; Here we present a 53-year-old woman with rheumatoid pachymeningitis . The subject had rheumatoid arthritis (RA) for 15 years . In April, 1996 she began to experience intermittent headaches . In September, her headaches became severe and continuous . In October, she suddenly developed ptosis of the left eye and diplopia . She also started to have dysphagia and she found it increasingly difficult to eat . She was admitted to our hospital on November 1, 1996 . Neurological examinations revealed palsies of the left IIIrd, IVth, and VIth, and bilateral IXth, and Xth cranial nerves . Laboratory findings showed leukocytosis, elevated blood sedimentation rate, and positive CRP . Serum RA titer was positive (30x) . The cerebrospinal fluid was normal and bacteriological examination was negative . T1-weighted MRI demonstrated hypertrophic cranial dura extending from the falx cerebri to tentorium cerebelli, which was enhanced markedly by Gd-DTPA . The dura adjacent to the cavernous sinus and the clivus were also thickened, which probably caused her cranial polyneuropathies . The dural biopsy showed massive infiltration of the inflammatory cells throughout the dura, proliferation of collagen fibers, and necrotic granuloma with neutrophilic infiltrations . Neither rheumatoid nodules, nor vasculitis were found . Despite the absence of rheumatoid nodules in the dural biopsy, the clinical features, pathologic specimens, and MRI findings of the thickened dura were most consistent with rheumatoid pachymeningitis . Administration of dexamethason ameliorated her headache on the 4th hospital day, and the cranial polyneuropathies completely disappeared on the 35th hospital day . The dural enhancement previously seen on the contrast T1-weighted MRI was diminished . Serum RA titer was also normalized (10x) . Rheumatoid pachymeningitis is an extremely rare disease, and only 16 cases were reported in the literatures . Hypertrophic pachymeningitis should be considered as a diagnostic possibility in RA patients who have prolonged headache, and Gd-DTPA MRI is recommended to demonstrate the dural involvement. Dtsch Med Wochenschr, 1997 Oct 17, 122(42), 1275 - 80 {Refractory hydrothorax in primary biliary cirrhosis: successful treatment with transjugular intrahepatic portosystemic stent shunt}; Nolte W et al.; HISTORY AND CLINICAL FINDINGS: A 55-year-old woman with known primary biliary cirrhosis (PBC) was hospitalized because of increasing dyspnoea . A year before she had for the first time experienced a right-sided pleural effusion which had to be drained every 4 weeks . Physical examination revealed dullness on percussion and greatly decreased breath sounds on auscultation over the entire right thorax . In addition there were signs of moderate ascites and leg oedema . INVESTIGATIONS: Chest radiograph showed a homogeneous shadowing of the right thorax without mediastinal shift . Diagnostic thoracocentesis produced a serous effusion, a transudate on chemical analysis, comparable to the composition of the ascitic fluid . Bacteriological and cytological tests on both fluids were unremarkable . TREATMENT AND COURSE: The right pleural effusion was presumed to be due to a hydrothorax from the ascites caused by portal hypertension associated with the PBC . Despite continuous diuretic treatment and thoracocentesis with albumin substitution every 3 days there was no improvement and implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) was performed . This effectively lowered portal pressure and markedly improved the patient's condition so that further thoracocentesis were no longer necessary . 3 weeks after TIPSS implantation she was discharged in good condition . Radiography 3 weeks later demonstrated continued reduction in the hydrothorax . CONCLUSION: Hydrothorax is a rare complication of liver cirrhosis . TIPSS implantation can provide lasting resolution and corresponding clinical improvement of a hydrothorax, especially in those conditions which are refractory to diuretic treatment and thoracocentesis. Zentralbl Hyg Umweltmed, 1996 Mar, 198(4), 340 - 54 {Effects of different procedures of disinfection on the bacteriologic quality of hemodialysis monitors of the Cobe CS3 and AK 100 type}; Di Majo P et al.; }n recent years, hemodialysis treatment for chronic renal failure has been increasing . Although the technical evolutions have improved the therapy, the problem of microbial, toxic and chemical contamination of the dialysis fluid is now re-emerging . Most of all, because of increasing use of high-flux dialysis and its potential for transmembrane transport of bacteria into patients, one should be aware that dialysis fluid pathways may be colonised with bacteria . On the bacterial point of view, the French legislation proposed 100 CFU/mL as a maximum for total count of aerobic bacteria in the bi-osmosed water used for dilution of the dialysis concentrate . This study took place during 8 weeks in the children-hospital dialysis unit in Nancy (France) . Our laboratory have succeeded in validating an aseptic bacteriological sampling procedure within fluid pathways of haemodialysis monitors Cobe CS3 and AK 100 . It has also be shown that 6 to 12 hours of dialysis monitoring doesn't affect the quantitative and qualitative bacterial contamination of the biosmosed water (mean: 5 CFU/100 mL) drained through the 5 years' old internal pipes of the 2 monitors . So it has whatever the 4 different disinfection procedures applied and on the monitors (Formol or Formol + Citric acid + Chlorine or Heat or Heat + dehydrated Citric acid). CLAO J, 1997 Oct, 23(4), 270 - 4 Contact lens care using chlorhexidine acetate with ethyl-6-O-decanoyl-glucoside: a comparative clinical and bacteriological study; Vaahtoranta-Lehtonen HH et al.; PURPOSE: We compared Ethyl-6-O-decanoyl-glucoside 0.005% (EDG) combined with 0.00025% chlorhexidine acetate (EDGC) to a commercial polyaminpropylbiguanide (PAPB) . METHODS: Fifty-nine subjects wearing both ionic and non-ionic contact lenses for 8-16 hours daily used either EDGC or PAPB as a cleaning and disinfectant agent . Neither mechanical nor separate cleaning agents were employed . The study period was for 8 weeks . The following symptoms were compared for each solution: blurred vision, dryness, foreign body sensation, redness, and dirty lenses . The following signs were also compared for each solution: conjunctival hyperemia, papillary hypertrophy, corneal deposits, purulence, limbal vascularization, subepithelial scarring, visual acuity, bulbar hyperemia, and tear breakup time . RESULTS: After 8 weeks, 52% of the subjects in the EDGC group showed no evidence of corneal or conjunctival abnormalities . In contrast, only 19% of the subjects in the PAPB group showed no abnormalities of the conjunctiva or cornea (P = 0.012) . After 8 weeks, 25% of the EDGC group showed evidence of papillary hypertrophy, whereas 50% of the PAPB group showed similar findings (P = 0.007) . In addition, after 8 weeks of wear, 21% of the subjects using EDGC had positive conjunctival cultures, whereas the rate of positive cultures in the PAPB group was 50% (P = 0.035) . At the conclusion of the study, the protein contents of the lenses were 131 micrograms +/- 48 micrograms (N = 29) in the EDGC group and 185 micrograms +/- 65 micrograms (N = 26) in the PAPB group (P = 0.001) . CONCLUSION: Subjects using EDGC had fewer pathological findings than subjects using PAPB as their cleaning and disinfecting agent . The mechanism by which EDGC reduced the rate of papillary hypertrophy needs further investigation. Rev Med Chir Soc Med Nat Iasi, 1996 Jul-Dec, 100(3-4), 138 - 42 {Helicobacter heilmanii gastritis: the bacteriological, endoscopic and histopathological considerations in 18 cases of infection in children}; Coman G et al.; The investigations on the presence of Helicobacter pylori in gastric mucosa biopsy specimens have evidenced another morphologically distinct spiral bacterium, Helicobacter heilmanii, which is associated with histopathological lesions of antral gastritis . The authors found 18 cases of such infection in a number of 1508 children with dyspeptic manifestations examined endoscopically . While H . pylori-associated infection was detected in 48.7% of the cases, H . heilmanii-associated gastritis had a much lower prevalence, 1.1% . The diagnosis was made by microscopic examination of the gram fuchsin-stained smear from a biopsy fragment, the urease test being more commonly erratic or late positive . In 10 cases, the endoscopic examination of gastric mucosa revealed nodularity of antral mucosa, in one of these cases a ulcer lesion at the level of the great curvature being also associated . Histopathological changers of active chronic gastritis have been found but in 4 out of children, the examined fragments of gastric mucosa being collected in most cases from the fundic area: in the child with gastric ulceration the histopathological lesions were of antral acute gastritis . Clinical, bacteriological, endoscopic and histological cure of H . heilmanii gastritis is possible by therapy with bismuth compounds alone. Avian Dis, 1997 Oct-Dec, 41(4), 930 - 4 Effect of drinking water containing ammonium chloride or sodium bicarbonate on Mycoplasma gallisepticum isolation in experimentally infected broiler chickens; Branton SL et al.; In each of three trials, 150 day-old broiler chicks were eyedrop inoculated with 0.04 ml of high-passage F strain Mycoplasma gallisepticum (MG) and housed in biological isolation units at 10 chicks per unit . At 4 wk of age, 50 chickens were designated as controls and remained on tap water (pH 7.30), 50 chickens were provided tap water containing 0.63% ammonium chloride (NH4Cl, pH 6.91), and 50 chickens were provided tap water containing 1.26% sodium bicarbonate (NaHCO3, pH 8.17) . Fluids were supplied for ad libitum consumption . At 5 wk of age, all chickens were swabbed from the choanal cleft for MG isolation and bled from the left cutanea ulnea vein for pH determination . As a percent of total swabs obtained, significantly fewer chickens that consumed water containing NH4Cl (38.3%) were positive for MG by culture compared with either the NaHCO3 group (61.3%) or the control group (67.6%) . Nonmycoplasmal swab contamination was significantly higher for chickens that consumed water containing NH4Cl (59.7%) compared with either controls (31.8%) or NaHCO3-treated chickens (38.7%) . When contaminated cultures were discarded, MG isolations from the tap water group were not significantly different from MG isolations from either the NH4Cl or NaHCO3 group . However, MG isolations from the NH4Cl group (95%) were significantly less compared with the NaHCO3 group (100%) . Mortality was significantly higher in chickens that consumed water containing NaHCO3 (8.7%) compared with either controls (1.3%) or the NH4Cl-treated chickens (0.7%) . Blood pH values were lower for the NH4Cl group (7.927), higher for the NaHCO3 group (8.093), and intermediate for controls (8.035) . Results of this study suggest that water containing NH4Cl hinders the bacteriological recovery of MG from the choanal cleft. Antimicrob Agents Chemother, 1998 Jan, 42(1), 28 - 36 Comparison of strategies using cefpirome and ceftazidime for empiric treatment of pneumonia in intensive care patients . The Cefpirome Pneumonia Study Group; Wolff M; In an international, multicenter, open-label, randomized comparative study, adult patients in intensive care units were enrolled to receive cefpirome intravenously at 2 g twice daily or ceftazidime intravenously at 2 g three times daily for the empiric treatment of pneumonia . Randomization was performed after a double stratification according to the investigator's initial choice of monotherapy or combination therapy and then on the basis of the severity of disease . The primary endpoint was the clinical response at the end of treatment in the intent-to-treat population . Data for all patients were reviewed by a blinded observer . Of the 400 enrolled patients, 201 received cefpirome (monotherapy, 56%) and 199 received ceftazidime (monotherapy, 51%) . Pneumonia was hospital acquired for 75% of the patients . Clinical failures rates were 34 versus 36% (odds ratio = 0.922; upper bound of 90% confidence interval = 1.301) in the intent-to-treat analysis for cefpirome and ceftazidime, respectively . For the cefpirome and ceftazidime groups, there were 35 versus 30% clinical failures among monotherapy-stratified patients, respectively, and 34 versus 42% clinical failures among combination therapy-stratified patients, respectively . The rates of clinical failures in the per-protocol analysis were 38 and 42%, respectively . In the population of patients evaluable for bacteriologic efficacy, eradication or presumed eradication was obtained for 71% (172 of 241) and 70% (162 of 230) of the pathogens isolated from the patients receiving cefpirome and ceftazidime, respectively . The mortality rates within 2 weeks after the end of treatment were similar (cefpirome group, 31%; ceftazidime group, 26%), as were the percentages of patients with at least one treatment-related adverse event (17 and 19%, respectively) . An empiric treatment strategy with cefpirome at 2 g twice daily is equivalent in terms of efficacy and tolerance to ceftazidime at 2 g three times daily for the treatment of pneumonia in patients in intensive care units. Eur J Clin Microbiol Infect Dis, 1997 Nov, 16(11), 783 - 8 Clarithromycin versus amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia; Genne D et al.; In an open, prospective, randomised study, the clinical and bacteriological efficacy of intravenously administered clarithromycin was compared with that of amoxicillin-clavulanic acid in 112 patients with community-acquired pneumonia requiring hospitalisation . Clinical cure or improvement occurred in 86% (48/56) of the clarithromycin-treated patients and 84% (47/56) of the amoxicillin-clavulanic acid-treated patients . The rate of bacteriologic eradication was similar for the two drugs as were the rapidity of a clinical response and the rate of improvement of radiological signs . Clarithromycin had a slightly higher rate of side-effects mainly due to phlebitis caused by the intravenous treatment, but treatment could be continued in all cases . Clarithromycin should be used with caution in patients being treated with digoxin because of a significant risk of bradycardia resulting from drug interaction. Unfallchirurgie, 1997 Oct, 23(5), 205 - 9 {Correlation between postoperative duration of Redon drainage and wound healing . A study of 150 patients with total endoprosthetic hip replacement}; Schmitt S et al.; The influence of the residual application of postoperative wound suction drainage devices on wound healing was examined in 150 patients with total hip replacement . The duration of continuous wound-draining as well as their bacterial contamination were analysed and the possible correlation was evaluated . Another aim of the study was to observe if the bacteriologic result is a proper method to obtain evidence about the wound situation . The 150 patients were divided in 3 groups . Two groups (of 50 patients each) had total hip replacement at the same time period . One group had postoperative wound complications or infection that had to be reoperated . The other 50 patients had normal wound healing without any complication . The third group of 50 patients with a shorter draining period was analysed and compared with the others . As a control factor the indication for operation, the sex and the age of the patients were similar in each group . We could show an increasing number of bacteriological contamination in drainage tubes which had a longer suction period than 3 days . In the reoperated group we found a significantly higher number of contaminated tips (37.4%) than in the groups with uncomplicated wound healing (8% and 2.8%) . The comparison of the bacteriological examination of the drainages with the smear of reoperated wounds showed the same constellation of germs in 64.3% of the cases . It seems to be a good method to get information about the bacterial wound conditions. Orthopade, 1997 Oct, 26(10), 889 - 93 {Primary chronic osteomyelitis}; Jundt G et al.; The term primary chronic osteomyelitis covers a heterogeneous spectrum of clinical features that should be separated for therapeutic reasons . Unifocal manifestations should be distinguished from multifocal ones . While bacteria are often found in the first group, bacteriological investigations are usually negative in the second group . Additionally, multifocal forms often recur (chronic multifocal recurrent osteomyelitis), possess a long clinical course and may be combined with dermatological disorders (SAPHO syndrome) . A biopsy is often necessary for tumor exclusion and obtaining material for bacteriology . Histology cannot differentiate between the respective forms of chronic osteomyelitis. Acta Otorhinolaryngol Belg, 1997, 51(4), 339 - 52 Mycotic sinusitis; Eloy P et al.; In recent years, Extramucosal Fungal Sinusitis (EFS) in immunocompetent hosts have aroused increasing interest from both clinicians and pathologists . Histopathologically, they are characterized by the presence of fungal hyphae in the lumen of the sinus with no tissue invasion . They include two different entities: the mycetoma and the atopical fungal sinusitis (AFS) . The mycetoma is the most frequent and best recognized form of EFS . The clinical picture is that of a unilateral symptomatic chronic sinusitis, often painful, unresponsive to appropriate medical treatment . CT scanning is very evocative in most cases . Definitive diagnosis requires histological and bacteriological examinations of the sinus contents . Surgery is the treatment of choice . Additional antifungal therapy is not indicated unless there is fungal tissue invasion . AFS is a distinct form of EFS . It typically occurs in an atopic patient with a long story of either chronic sinusitis or recalcitrant nasal polyposis recurring after adequate medical treatment or previous sinus surgery . Histopathologically, the pathognomonic pattern shows an "allergic mucin" and scanty fragmented fungal hyphae . Culture is the only way to identify the causative agent . Management should include wide radical sinus surgery combined with long-term nasal steroids . In spite of proper medico-surgical management, the prognosis remains variable and recurrences frequently arise. Acta Otorhinolaryngol Belg, 1997, 51(4), 209 - 17 Inflammatory mechanisms in chronic sinusitis; Bachert C et al.; Apart from ventilatory and bacteriologic aspects, understanding the pathomechanisms of inflammation in chronic sinusitis and nasal polyposis seems crucial for further success in disease treatment . New insights into inflammatory processes became recently possible by investigating the pattern of cytokines and chemokines as well as adhesion molecules in different acute and chronic sinus diseases . The proinflammatory cytokines interleukin (IL)-1 beta, IL-6 and especially the neutrophil-chemoattractant IL-8 play a dominant role in acute sinusitis, as was shown before for viral and allergic rhinitis . In contrast, IL-3 protein dominates the cytokine profile in chronic sinusitis, giving support to a variety of inflammatory cells . The most striking finding was the increased synthesis of IL-5 protein in bilateral nasal polyposis, whereas IL-5 was not found in controls or antrochoanal polyps . As this cytokine is known to enhance eosinophil activation and survival, our data point to IL-5 as a key protein in the pathomechanism of tissue eosinophilia in nasal polyposis . The investigation of cytokine patterns may furthermore help to differentiate between sinusitis subgroups, e.g . in the classification of sinus diseases. Int J Tuberc Lung Dis, 1997 Apr, 1(2), 147 - 51 Does pulmonary tuberculosis change with ageing? Rocha M, Pereira S, Barros H, Seabra J. SETTING: In most low prevalence countries, tuberculosis has become a disease of the aged; it has recently been suggested that the elderly may present a specific pattern . OBJECTIVE: To compare clinical, bacteriological and radiological features of pulmonary tuberculosis between young and elderly populations in a high incidence country . PARTICIPANTS AND METHODS: We retrospectively studied 337 consecutive pulmonary tuberculosis patients without confirmed HIV infection, hospitalised from 1989 to 1993 . The clinical, bacteriological and radiological features of the two age groups considered, young adults (< 60 years) and elderly (> or = 60 years), were compared . RESULTS: Thoracic pain (16.3% vs 32.7%) and fever (27.2% vs 50.6%) were significantly less frequent in the elderly, while the frequency and duration of other symptoms before hospitalisation were similar . After admission, fever remained longer in young patients (P < 0.05) . No significant differences were found regarding the general health status at hospitalisation, or associated illnesses (83.7% vs 73.5%; P = 0.068) . Radiological lesions not related to the present diagnosis (14.1% vs 2.0%; P < 0.05), and a presumed diagnosis of tuberculosis (11.7% vs 4.1%; P = 0.02) were more frequent in the elderly . CONCLUSION: This study showed no specific clinical, bacteriological or radiological features between age groups, and does not support the hypothesis of any age-related patterns in pulmonary tuberculosis. Int J Tuberc Lung Dis, 1997 Feb, 1(1), 75 - 80 Isolation of environmental mycobacteria from clinical specimens in south-east England: 1973-1993; Yates MD et al.; SETTING: A reference centre for tuberculosis bacteriology serving South-East England . OBJECTIVE: The number of cultures of environmental mycobacteria (EM) submitted to regional and reference laboratories in the UK is increasing, and is adding considerably to the workload of these laboratories . The changing trends in the numbers and nature of EM submitted to the Dulwich Public Health Laboratory Regional Tuberculosis Centre (RTC), have been analysed to establish the nature of the increase . DESIGN: This study is based on all cultures of EM submitted to RTC between 1973 and 1993 . The cultures were grouped according to year of first isolation, number of isolates and data supplied by the client laboratories, including age and human immunodeficiency virus (HIV) status of the patients and the anatomical sites from which the mycobacteria were isolated . RESULTS: A total of 9379 EM from 6668 patients was received . Single and multiple isolates were received, respectively, from 4681 and 1192 patients not known to be HIV positive and from 477 and 318 who were known to be HIV positive . The annual number of patients not known to be HIV positive with isolates of probable clinical significance increased steadily from less than 40 in 1973 to over 100 per year since 1990 . Isolates of doubtful clinical significance also showed an increase over time . The annual numbers from HIV positive patients increased steeply following the first such isolates in 1984 . CONCLUSIONS: The data show that the annual number of isolates of EM from both HIV positive and negative patients is increasing both absolutely and relatively to isolates of Mycobacterium tuberculosis . This trend should be considered when planning the future scope and activities of mycobacterium reference laboratories, including the introduction of new DNA-based diagnostic methods. Eur J Med Res, 1996 Sep 20, 1(11), 520 - 2 Role of the enterotest in the diagnosis of the Helicobacter pylori infections; Kopanski Z et al.; Among 128 patients with gastric and duodenal ulcer a diagnosis was made of Helicobacter pylori infections using the 14C-urea breath test (reference) as well as by a bacteriological test; from each patient the material for culture was obtained in two ways: Through gastroscopy-segments, and through an enterotest . It was shown that the diagnostic value of the enteroprobe in the detection of the Helicobacter pylori infection was relatively high in comparison with the results of the culture of the segments of the mucosa, especially for ulcers of the pyloric area and of the duodenum, whereas that value fell considerably for located in the cardia of the stomach . The entero-probe is thus recommended as a method of diagnosing Helicobacter pylori infections (using the bacterial material for culture and the antibiogram) but only for peptic ulcers of a selected location (pyloric area, duodenum). Am J Rhinol, 1997 Nov-Dec, 11(6), 467 - 71 Bacteriology of chronic sinusitis after ampicillin therapy; Jiang RS et al.; The bacteriologies of the maxillary and ethmoid sinuses were studied in 74 chronic sinusitis patients who took ampicillin (500 mg every 6 hours) for 2 weeks preoperatively . The specimens from one ipsilateral maxillary and ethmoid sinuses were obtained when undergoing functional endoscopic sinus surgery . In 74 specimens of the maxillary sinus, 38 bacterial isolates were recovered . The culture rate was 46.0% . On the other hand, 34 bacterial isolates were taken from the ethmoid sinus specimens . The culture rate was 41.9% . As compared with a previous group who did not take any antibiotic preoperatively, the culture rate significantly decreased in the maxillary as well as the ethmoid sinus specimens . Not surprisingly, a significantly decreased sensitivity to ampicillin was also found in the recovered bacteria from both the maxillary sinus (23.7%) and ethmoid sinus (5.9%) specimens . These results demonstrate that antibiotic therapy with ampicillin could eradicate most sensitive bacteria in chronic sinusitis . However, persistence of resistant bacteria was demonstrated. Rinsho Kyobu Geka, 1990 Feb, 10(1), 49 - 52 {Treatment of secondary empyema following lung resection complicated with internal fistula}; Anno H et al.; To clarify the results of treatment of secondary empyema following lung resection complicated with internal fistula, 81 cases treated at 31 different institutions during the 5 years period from 1983 to 1987 were analysed . 1) All cases of thoracic empyema treated surgically and secondary empyema following lung resection complicated with internal fistula did not decreased during the study period, in spite of the remarkable decrease of surgical cases for pulmonary tuberculosis . 2) The highest rate was observed in males over 50 years of age . 3) Bacteriologically positive case in empyema space was occupied about 70% . 4) 196 operations (including drainage) of 17 types were performed on 81 patients . Only 16% of the cases were successfully treated with one stage of operation . 5) Principal surgical procedure applied in cases under this study was drainage followed by closure of fistula with muscle plombage and with or without thoracoplasty . Case of air plombage and omental pedicle flap plombage have increased recently in Japan . 6) Success rate was 55.6%, failure rate was 32.1% and the mortality was 12.3% . These results indicate the difficulty involved in treatment . Therefore, to avoid occurrence of secondary empyema cases, careful selection of surgical indication, sufficient training in surgical technique and good preoperative and postoperative management are crucial. Helicobacter, 1997 Dec, 2(4), 185 - 7 Failed treatment of Helicobacter pylori infection associated with resistance to clarithromycin; Tompkins DS et al.; BACKGROUND . Resistance of Helicobacter pylori to clarithromycin is uncommon . Initial studies have suggested that primary resistance has a significant adverse effect on bacteriological cure rates and acquired resistance develops frequently with failure of treatment following regimens containing clarithromycin . MATERIALS AND METHODS . H . pylori isolates were obtained from patients with duodenal ulcer treated with clarithromycin and omeprazole and examined for susceptibility to clarithromycin using the E-test method . A 13C urea breath test was used to confirm infection with H . pylori and successful treatment . RESULTS . H . pylori infection was successfully treated in 101 patients, all with susceptible isolates, and persisted in 30 patients of whom 4 had resistant isolates . Of 16 patients with bacteriological cure failure who had susceptible isolates pretreatment, 11 (68.8%) had resistant isolates post-treatment . CONCLUSIONS . This study confirms previous reports that acquired resistance of H . pylori to clarithromycin develops frequently (68.8-96%) in individuals with failed dual therapy regimens . Primary resistance, although uncommon (3%), was 100% predictive of treatment failure with the regimen used in this study . Effective treatment of H . pylori infection should help to prevent the development of resistance to clarithromycin. Dermatology, 1997, 195(3), 293 - 6 Polymerase chain reaction and reverse cross blot hybridization assay for detection of mycobacterial DNA in lupus vulgaris; Sanguinetti M et al.; For 5 years, an 83-year-old man had been suffering from slightly itchy erythematous plaques with clearcut margins, located on his left thigh and on his right arm; in addition, on his right auricle there was an erythematous patch with yellowish shadings that had appeared about 3 years before and had progressively spread to the temporal-zygomatic region, the chin and the mandibular arch . These lesions were strongly suggestive of lupus vulgaris; however the conventional bacteriological examinations performed on the biopsy specimen from lesional skin were negative . A diagnosis of lupus vulgaris was achieved through the detection of the 16S rRNA gene of Mycobacterium tuberculosis in a skin biopsy of the patient by means of a polymerase chain reaction followed by a reverse cross blot hybridization, a method which allows the identification of different mycobacterial species in a single hybridization procedure. Medicine (Baltimore), 1997 Nov, 76(6), 423 - 31 Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS) . Report of 6 cases and review; Lesprit P et al.; Cerebral tuberculosis (TB) was diagnosed in 6 (4%) of 156 HIV-infected patients with TB seen at our institution over 6 years . We describe here the clinical and radiologic features of these cases and of 15 others reported in the literature . Of the 21 patients, 59% were intravenous drug users . Presenting symptoms were fever (76%), confusion (52%), seizures (38%), and headache (38%) . Fourteen patients (66%) had previous or active extracerebral TB at presentation . Cranial CT scan showed ring-(62%) or nodular-(24%) enhancing lesions or mixed forms (14%) . Among the 12 patients who underwent a brain biopsy, bacteriologic evidence of TB was found in 9 . Four patients (19%) died during hospitalization . Among the 17 others who received antituberculous therapy, only 1 developed neurologic sequelae . Five patients also received steroid therapy to control cerebral edema or paradoxical growth of the cerebral mass lesions . TB should be considered as a cause of cerebral mass lesions in HIV-infected patients, especially if tuberculous infection is suspected at other sites. Antibiot Khimioter, 1997, 42(10), 19 - 22 {Coamoxiclav in the empirical monotherapy in outpatients with community acquired pneumonia}; Yakovlev SV et al.; Amoxyclav (amoxycillin/potassium clavulanate, A/PC) was used in a dose of 625 mg 3 times a day in the treatment of 68 outpatients at the age of 17 to 88 years (the average age of 49 years) with slight or moderate community-acquired pneumonia . In 49 per cent of the patients the pneumonia developed at the background of concomitant chronic diseases . The positive clinical effect was observed in 94 per cent of the patients . In 76 per cent of them a short-term treatment course of 5 days was sufficient . Before the treatment 91.8 per cent of the isolates proved to be susceptible to A/PC . The pathogen eradication after completion of the treatment was stated in 72 per cent of the cases . Moderate gastrointestinal adverse reactions developed in 4 patients (6 per cent) . The results demonstrated high clinical and bacteriological efficacies of A/PC and made it possible to recommend the drug as the 1st class agent for the initial empirical therapy of community-acquired pneumonia in outpatients. Arch Esp Urol, 1997 Sep, 50(7), 802 - 4 {Adrenal tuberculosis . Diagnosis using polymerase chain reaction}; Lanzas Prieto JM et al.; OBJECTIVE: To present a case of a patient suffering from adrenocortical insufficiency (Addison's disease) and to demonstrate the utility of the polymerase chain reaction (PCR) in the diagnosis of adrenal cortex tuberculosis . METHODS/RESULTS: Herein we describe a patient with Addison's disease who had developed pulmonary tuberculosis a few years earlier . CT and PCR test were utilized in making the diagnosis . CONCLUSION: Although adrenocortical tuberculosis is uncommon today, it must be considered when evaluating adrenocortical insufficiency, especially if the patient has or has had tuberculosis . Although Mycobacterium tuberculosis might not be demonstrated by bacteriologic techniques, PCR can be useful in making the etiological diagnosis. Rev Med Brux, 1997 Sep, 18(4), 241 - 4 {Particular aspects of ulcers in children}; Dangoisse C et al.; Leg ulcers of juvenile onset are uncommon . The infectious origin is fairly frequent but the presence of leg ulcers in children should prompt an investigation into possible underlying causes especially hemangioma, vasculitis, inborn errors of metabolism (i.e . prolidase deficiency), hemoglobinopathies, occult spinal dysraphism and immunodeficiencies . Bacteriological investigations are essential and a skin biopsy specimen may be able to differentiate some of these disorders. Rev Clin Esp, 1997 Sep, 197(9), 623 - 6 {Brucellar meningitis as a peculiar form of clear fluid meningitis . Clinical study}; Sanchez Rodriguez A et al.; Out of 200 patients diagnosed of acute of chronic brucellosis, cases were first selected who had neurologic involvement (14%) and then those who had brucellar meningitis (CDC criteria) which corresponds to 4% of the total of the series . The clinical course, evolution time, neurologic manifestations and serologic and bacteriologic characteristics in blood and specifically in the cerebrospinal fluid (CSF) . This study was contrasted with the literature review and the conclusion is reached that brucellar meningitis is a peculiar form of clear fluid meningitis, not exceptional in our environment considering the prevalence of brucellosis. Przegl Epidemiol, 1997, 51(3), 275 - 84 {Can we control pertussis better? I . Changes in the epidemiology of pertussis}; Galazka A; In many industrialized countries pertussis has been successfully controlled due to introduction of immunization programmes . However, decline trends in pertussis incidence, observed since more than 20 years, has been recently halted in individual countries, including Poland . In some industrialized countries, even absolute increase of pertussis incidence is recorded . Important changes in age distribution of pertussis patients are noted; from one side, there is an increase of pertussis incidence in infants, and a slow but continuous shift towards older age . There is an increasing body of evidence that adults may be the main reservoir of pertussis organisms and play an important role in the transmission of pertussis infection to younger children . Studies on the role of adults in transmission of pertussis infection to younger children should be undertaken in Poland . Early beginning and early completion of series of primary immunizations with DTP vaccine in infants and maintainance of a high immunization coverage with all doses of DTP vaccine specified in the immunization calendar are needed to successful control of pertussis . There is an urgent need to improve the diagnosis of pertussis in Poland, and especially the bacteriological confirmation of the diagnosis. Contracept Fertil Sex, 1997 Jul-Aug, 25(7-8), 585 - 6 {Identification and treatment of endometritis}; Cravello L et al.; Endometritis represent a debatable entity because genital infectious disease is a contre-indication of endoscopy . So, the diagnosis is rarely realized by hysteroscopy . Two kinds of endometritis are discerned: acute endometritis characterized by an oedema of bleeding endometrium, covered by an abnormal mucus; chronic endometritis with areas of red endometrium, flushed, with a white central point, localized or scattered out the cavity . This is the "strawberry aspect" . Whereas, the correlation between hysteroscopic aspect and histologic or bacteriologic samples exists in only 35% of cases . According to R . Frydman and J . Hamou, chronic endometritis is occurred among 22% of patients in IVF program, in 14% of unexplained infertility and 23.6% of women with an history of first trimester miscarriages . Chlamydiae an Ureaplasma seem to be the most frequent germs . In this way, in case of unexplained infertility, the hysteroscopic diagnosis of chronic endometritis can lead to an antibiotic treatment test. Enferm Infecc Microbiol Clin, 1997 Oct, 15 Suppl 3, 2 - 7 {Diagnosis of pneumonia in intubated patients: a controversy without resolution?}; Correa H et al.; There is yet no accurate, fast, innocuous and inexpensive method for the diagnosis of pneumonia associated to ventilation (NAV) . Here we analyse three diagnostic lines of increasing level of certainty . CLINICA METHOD: Associates radiological image, pus in the trachea and temperature changes and or leukocytosis . Although it is quite sensitive in the absence of distress, is it not very specific . Nevertheless, it must be appreciated for its function as a guide, recalling that in its absence bacterial counts are of scarce value . QUANTITATIVE BACTERIOLOGICAL STUDIES OF DEEP SPECIMENS: Broncho-alveolar lavage (BAL) and protected brush (PB) serve a double objective: to discriminate colonisation from infection, and the identification of the etiological agent . The sensitivity of BAL/PB is approximately 70% while specificity is close to 80% . The method performs better in the absence of previous antibiotic therapy . HISTOLOGICAL DIAGNOSIS: Almost never obtained while the patient is alive, it is nevertheless the golden standard . The absolute diagnosis of NAV is: histological for pneumonia, with a positive tissue culture . USE OF DIAGNOSIS IN THERAPY: Empirical treatment results in a 40% failure rate . The specific treatment requires therapeutic changes in more than 1/3 of cases . Treatment when the micro-organism is known is followed by longer survival . Perhaps the correct approach would be: early empirical treatment after taking deep samples and correction according to the results obtained. J R Coll Physicians Lond, 1997 Nov-Dec, 31(6), 666 - 8 The management of lymph node tuberculosis notified in England and Wales in 1993; Ormerod LP et al.; We have compared the management of 219 cases of lymph node tuberculosis reported to the 1993 national notification survey with the recommended standards of treatment . The diagnosis was supported by positive histology and bacteriology in 81 cases (37%), positive histology in 70 (32%), positive bacteriology in 26 (12%), and on only clinical grounds in 40 (18%) . Most patients (88%) were under the care of thoracic physicians . Almost all (97%) were commenced on a recommended drug combination, but only 81% continued to receive it, with thoracic physicians more likely than other physicians to use a recommended combination . Non-standard durations of the initial and/or continuation phases of treatment were used in 83 patients, but in only 49 cases was a satisfactory reason given for the modification . Definite or suspected drug toxicity was reported in 22 cases (10%), and was significantly more likely with non-standard regimens . There were no deaths . Of the 209 patients observed to treatment completion, 129 (62%) were then discharged . There were adequate reasons for follow-up after the end of treatment in all but 32 (15%) of those so managed . Further education is required to increase the percentage of patients treated with evidence-based regimens and durations of chemotherapy. Acta Orthop Scand, 1997 Oct, 68(5), 461 - 5 Periprosthetic low-grade hip infections . Erythrocyte sedimentation rate and C-reactive protein in 23 cases; Sanzen L et al.; We followed 23 patients from the primary total hip arthroplasty to revision for a bacteriologically proven deep infection with a low virulent organism . The median time to revision was 14 (4-65) months . During this period, the maximum ESR value was median 50 (22-110) mm and the maximum CRP value was 35 (9-95) mg/L . 25 of the 98 CRP values recorded were normal (< 9 mg/L) and 22/89 ESR values were below 30 mm/h . In 6 patients, all CRP values were below 20 mg/L, but 5 of these patients had an ESR > 30 mm . Before the revision, normal values for both tests were found in only 1 patient . Both normal values and slight-to-moderate increases in ESR and/or CRP are consistent with a low-grade periprosthetic hip infection . We recommend that ESR should be determined preoperatively in all patients scheduled for total hip replacement to establish a baseline. Rev Prat, 1997 Oct 1, 47(15), 1645 - 50 {Examination of the vulva and the vagina: from clinics to biopsy}; Piechon L et al.; The purpose of this article is to describe clinical and colposcopic examination of vaginal and vulvar pathologies . Diagnosis tests are described as Hewitt's test, Collins test and epicutaneous test . According to clinical aspect, samples for bacteriological or cytological examinations are performed . Biopsy sites are selected by colposcopy to exclude atypia or malignancy. Dermatology, 1997, 195 Suppl 2, 49 - 52 Profile of patients treated with Betadine cream and ointment in a major burn centre over a period of ten years (1986-1995); van der Merwe AE; The management of burns has shown substantial progress over the years . The application of an effective topical agent improves the healing rate of burns . Betadine cream and ointment have been used in all the burn admissions since 1986 . The data collected over 10 years are analysed in this report . All the burn patients admitted were evaluated and the factors investigated included patient age, sex, cause of injury, extent of burn wound, length of hospital stay, bacteriology, multi-organ failure and mortality . A total of 6,056 patients were admitted to a 40-bed unit during the 10-year period . Sixty-two percent were adults and 37% children . There were 67.5% males and 32.5% females . Eighty-one percent were admitted directly to the unit . Intensive/high care admissions accounted for 19.2% patients . The major cause of injury was accidental scalding in 34.2% patients, and the majority (65.4%) stayed between 1 and 4 weeks in hospital . There were 452 deaths . This audit reviewing 6,056 sequential burn cases represents a 10-year experience of burn management, using Betadine cream and ointment as topical agent. Neurosurgery, 1997 Dec, 41(6), 1263 - 8; discussion 1268-9 Infratentorial empyema: analysis of 22 cases; Nathoo N et al.; OBJECTIVE: Infratentorial empyema is an uncommon form of intracranial suppuration that is usually secondary to neglected otogenic infection . The diagnosis is frequently delayed and often confused with that of meningitis . The associated mortality is distressingly high, yet it has, as a clinical entity, received scant attention in the literature . We present a 13-year experience of this condition . PATIENTS AND METHODS: From a retrospective analysis of 3865 patients with intracranial suppuration during a 13-year period, 22 patients with infratentorial empyema were identified . The inpatient notes for these patients were analyzed with reference to clinical, radiological, bacteriological, operative, and outcome data . RESULTS: Twenty-two patients with infratentorial empyema accounted for 0.6% of admissions caused by intracranial suppuration during the study period . Of these 22 empyemas, 13 were subdural and 9 epidural . Hydrocephalus was present in 17 (77.3%) . Except for two epidural empyemas that did not warrant neurosurgical intervention, all patients underwent standard surgical management (wide posterior fossa craniectomy) . Nineteen underwent mastoidectomy because the source of infection was otogenic . Concomitant and persistent hydrocephalus was treated aggressively . Five patients died (mortality rate of 22.7%) . All fatalities had subdural empyemas, and all three patients with cerebellopontine angle extension of subdural purulent collections died . CONCLUSION: Although rare, infratentorial empyema, especially when subdural, is a lethal disease . Cerebellopontine angle extension of pus was a particularly ominous sign in our experience . Early surgical drainage via wide posterior fossa craniectomy, aggressive treatment of associated hydrocephalus, eradication of the primary source of sepsis, and, finally, intravenous high dosage of appropriate antibiotics form the mainstay of treatment. Orthopade, 1997 Oct, 26(10), 894 - 901 {Lymphoplasmacellular osteomyelitis}; Krauspe R et al.; Chronic lymphoplasmacellular osteomyelitis may occur in children, adolescents and adults, but has not been found in newborns or babies either in our series or in the literature . Symptoms suggesting an acute disease like fever are uncommon, but a primary chronic course with symptomatic and asymptomatic periods is typical . Pain and swelling are the main symptoms; painless masses are rare . In children and adolescents the clavicle and metaphyseal regions of long bones are typical sites of chronic abacterial osteomyelitis . In adults the clavicles or the first two ribs are mainly affected with synovitis of the adjacent joints, but the long bones are rarely involved . Laboratory findings are non-specific but important for the differential diagnosis . The sedimentation rate and c-reactive protein might be elevated . The X-ray examination shows osteolytic, sclerotic or mixed bony changes and, in case of a diaphyseal involvement, onionskinlike periosteal bone formation may be present, suggesting a malignant process . In late stages sclerotic bone formations may be seen as a rest . Uni- or multifocal lesions can be detected by bonescan, as can asymptomatic lesions . Magnetic resonance imaging shows gross signal intensity differences both in the bone and perifocal soft tissue and involvement of the synovium with gadolinium DPTA enhancement in T1-weighted images . In early stages of the disease granulocytes, microabscesses and new bone formations might suggest bacterial osteomyelitis that cannot be differentiated by histology . In intermediate phases lymphocytic and plasma-cellular infiltrates are found, whereas in late phases sclerotic bone formations and fibrosis of the bone marrow are seen histologically . In chronic lymphoplasmacellular osteomyelitis, all clinical, radiological and histological findings, as well as negative bacteriological cultures, are mandatory and will allow a definitive diagnosis to be made . The disease may be uni- or multifocal, and new bone lesions may occur over time, as well as skin manifestations, which can be found years before or after bone involvement . The association with dermatological diseases and/or synovitis led to the acronym SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteomyelitis) . For the treatment nonsteroidal anti-inflammatory drugs are effective for pain relief, reduction of swelling and dysfunction . Antibiotics have been used in several series and are not effective . Major surgery is not recommended even for recurrences, and the prognosis for growth and function is excellent in the long term despite recurrences over several years. J Clin Oncol, 1997 Dec, 15(12), 3427 - 32 Salvage chemotherapy with paclitaxel for recurrent oligodendrogliomas; Chamberlain MC et al.; PURPOSE: A prospective phase II study of paclitaxel was performed in adult patients with recurrent hemispheric oligodendrogliomas . PATIENTS AND METHODS: Twenty adult patients (14 men and six women), ages 18 to 52 years (median, 40.5), with recurrent supratentorial hemispheric oligodendrogliomas were treated . All patients had previously been treated with surgery, involved-field radiotherapy (median dose, 55 Gy; range 54 to 55 Gy) and nitrosourea-based (procarbazine, lomustine {CCNU}, and vincristine {PCV-3 regimen}) chemotherapy (median number of cycles, five; range, four to six) . Fourteen patients were treated adjuvantly with radiotherapy and nitrosourea-based chemotherapy; six were treated at recurrence following initial gross total resection with reoperation (subtotal resection in all), radiotherapy, and nitrosourea-based chemotherapy . Paclitaxel was administered intravenously at a dose of 175 mg/m2 every 3 to 4 weeks with neurologic and neuroradiographic evaluation every 8 weeks . RESULTS: A median of three cycles of paclitaxel (range, two to 10) were administered . All patients were assessable . Toxicity included partial alopecia (12 patients), thrombocytopenia (six), neutropenia (three), and anemia (one) . One patient developed neutropenic fever without bacteriologic documentation and four required transfusion of blood products (RBCs, n = 2; platelet, n = 2) . No treatment-related deaths occurred . Ten patients (50%) demonstrated either a neuroradiographic partial response (n = 3) or stable disease (n = 7), with a median response and stable disease duration of 10 months (range, 5 to 14) . CONCLUSION: Paclitaxel demonstrated modest efficacy with minimal toxicity in this pretreated cohort of adult patients with recurrent hemispheric oligodendrogliomas. Acta Radiol, 1997 Nov, 38(6), 978 - 81 CT-guided core-needle biopsy in omental pathology; Pombo F et al.; PURPOSE: To assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology . MATERIAL AND METHODS: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n = 2) or diffuse (n = 23) omental pathology . These results were compared to the final diagnoses as determined by laparotomy (n = 15), laparoscopic biopsy (n = 3), endoscopic biopsy (n = 1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n = 6) . The final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement . The CT-guided biopsies were performed with 1.0-1.8-mm Surecut core-needles . RESULTS: In 16 patients, the final diagnosis was metastatic adenocarcinoma--with the primary tumor sites in the ovary (n = 3), stomach (n = 1), appendix (n = 2), and unknown (n = 10) . In the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1 . Sufficient histological (n = 16) or cytological (n = 8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case . In differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92% . It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders . There were no biopsy-related complications . CONCLUSION: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology. Crit Care Nurs Q, 1997 Nov, 20(3), 69 - 78; quiz 103-4 Management of wounds and wound infections in the intensive care unit; Geehan DM et al.; Many factors combine to make management of wounds and wound infections in patients in intensive care units (ICUs) a complex task . An understanding of the anatomy, pathophysiology, and bacteriology provides a framework to approach these patients . The patient's underlying disease influences the care of the wound . Wound factors such as necrotic tissue, bacterial load, or presence of fistulae or a foreign body have important impact on the patient's care . With assessment and knowledge of normal healing, timely intervention in the ICU can identify patients whose wounds are not healing properly and allow for corrective interventions to help the patient return to normal function. Zhonghua Jie He He Hu Xi Za Zhi, 1996 Apr, 19(2), 104 - 6 {Effects of intermittent short-course chemotherapy under full-course supervision on the treatment of smear positive pulmonary tuberculosis}; Yan S et al.; OBJECTIVE: To evaluate the effects of intermittent short-course chemotherapy under full-course supervision on the treatment of smear positive pulmonary tuberculosis . METHOD: The regimens of 2H3R3Z3S3(E3)/4H3R3 and 2H3R3Z3S3E3/6H3R3E3 were respectively used in 125 initial and 249 relapse smear positive pulmonary tuberculosis cases under full-course supervision and management . RESULTS: The total rate of treatment completion was 99.7%, and the rates of sputum negative conversion in initial and relapse cases were 96.7% and 84.8% respectively . During three-year follow-up, the bacteriological relapse rates were found to be 1.8% in initial cases and 10.2% in relapse cases . CONCLUSIONS: The regimen was proved to be convenient, economical and effective in tuberculosis control programme. Curr Opin Pulm Med, 1996 May, 2(3), 186 - 91 Severe community-acquired pneumonia; Cassiere HA et al.; Community-acquired pneumonia is an important public health concern and a recent focus of clinical practice guidelines . What has become clear from this renewed focus of attention is that a subgroup of patients with community-acquired pneumonia have severe disease with a differing spectrum of pathogens and prognosis . This article reviews the definition, bacteriology, diagnostic approach, and treatment of patients categorized as having severe community-acquired pneumonia . Although some of what is discussed is controversial and the literature in this area continues to expand, we focus on an evidence-based approach to this clinical problem. Curr Opin Obstet Gynecol, 1997 Oct, 9(5), 332 - 6 Interstitial cystitis; Sant GR; Interstitial cystitis is a urologic disorder with protean pelvic manifestations (urologic, gynecologic, gastroenterologic) and variable prevalence . Although current research indicates a non-bacteriologic etiology, interstitial cystitis has features suggestive of autoimmunity, a deficient bladder wall lining, activated bladder sensory neuropeptides and bladder mastocytosis . Pentosan polysulfate sodium is a recently approved oral treatment for interstitial cystitis . Further research into the gynecologic and pain aspects of interstitial cystitis is clearly needed. J Wildl Dis, 1996 Oct, 32(4), 581 - 5 The pathogenicity of Brucella suis biovar 4 for bison; Bevins JS et al.; The pathogenicity of Brucella suis biovar 4 for bison (Bison bison) was evaluated by inoculation of 2.1 x 10(7) colony forming units (CFU) in 0.1 ml saline into the conjunctival sac of six pregnant cows . Six pregnant bison were inoculated with 1.27 x 10(7) CFU of Brucella abortus strain 2308 as a positive control . Bison were inoculated on 23 January 1992, and observed until calving or abortion after which they were euthanized, and necropsied . Bacteriological and histological examinations were conducted on lymph nodes, reproductive tract, mammary gland, and internal organs . Terminal serum samples from calves and cows were evaluated by card, rivanol precipitation, standard tube agglutination, cold complement fixation tube, indirect bison conjugated enzyme linked immunosorbent assay (ELISA), competitive ELISA, and particle-concentration fluorescence immunoassay . No clinical signs of brucellosis were seen in bison inoculated with B . suis biovar 4, and infection was found only in lymph nodes of two animals . There was no evidence of metastasis of this organism to the mammary gland or the reproductive tract . There were no detectable levels of antibodies to Brucella spp . in terminal blood samples taken from B . suis biovar 4-challenged bison . Brucella abortus was isolated from several tissues in all control bison . All B . abortus-challenged animals developed uterine infection and five developed mammary gland infection . Reproductive disease resulted in abortions in five B . abortus-challenged bison and neonatal death in the remaining calf . Brucella suis biovar 4 does not appear to be pathogenic for bison. J Cardiovasc Surg (Torino), 1997 Oct, 38(5), 513 - 5 Percutaneous transhepatic gallbladder drainage for acute acalculous cholecystitis following cardiovascular surgery; Ishikawa S et al.; Four (1.2%) out of 321 patients required percutaneous transhepatic gallbladder drainage (PTGBD) following cardiovascular surgery . Cholecystitis was initially suspected based upon the occurrence of postoperative fever and the results of abdominal X-ray films . The main physical finding was tenderness of the right upper quadrant abdomen in all patients . Spontaneous pain and Blumberg's sign were not apparent . Distension of the gallbladder and sludge in the gall-bladder were detected in all four patients by ultrasonography, but calculi were not observed . Thickening and edema of the gallbladder wall, generally suggestive of cholecystitis, were observed in only one patient . PTGBD was performed from 5 to 43 (mean 16) days after surgery . The drained fluid was concentrated bile and not purulent . High fever dropped and serum transaminase and C-reactive protein levels decreased within three days after PTGBD . Bacteriologic examinations of the bile and arterial blood were negative in all cases . No complications as a result of PTGBD introduction occurred . PTGBD is a safe and effective procedure, and therefore should be actively performed even in the early phase of acute cholecystitis. Drugs, 1997, 54 Suppl 2, 1 - 7; discussion 28-9 Rationale for the prevention of disseminated Mycobacterium avium-intracellulare complex disease; Dautzenberg B; The survival rate in patients with AIDS who have CD4+ cell counts < 75 cells/microliter is increasing because of improved preventive and treatment strategies for opportunistic infections and also because of the efficacy of antiretroviral drug treatment . These patients are at high risk of developing disseminated Mycobacterium avium-intracellulare (MAC) disease, which decreases both quality of life and life expectancy . Measures aimed at preventing MAC contamination are largely ineffective in decreasing the incidence of disseminated MAC disease in patients with AIDS, because of the large natural reservoir of MAC . Chemoprophylaxis is superior to early bacteriological diagnosis as a preventive strategy, and it is preferable to wait for the appearance of symptoms of disseminated MAC disease before a curative treatment is initiated . Well-conducted studies of clarithromycin or rifabutin monotherapy as chemoprophylaxis have demonstrated a decrease in the incidence of disseminated MAC disease, as well as an increase in quality of life and survival . Clarithromycin, azithromycin and rifabutin have all been shown to be effective as prophylaxis against disseminated MAC disease . Although some combinations of drugs have been shown to be more effective than monotherapy in preventing disseminated MAC disease, these regimens are more costly and have less favourable tolerability profiles than single-agent treatment . In conclusion, chemoprophylaxis is the most effective preventive strategy against disseminated MAC disease and has been shown to improve quality of life and to decrease the risk of death associated with this disease in AIDS patients. J Infect, 1997 Sep, 35(2), 125 - 8 Routine surveillance blood cultures: their place in the management of critically ill patients; Levin PD et al.; The use of surveillance blood cultures has been advocated as a means to allow earlier detection of septic episodes amongst intensive care patients, and therefore earlier institution of appropriate antibiotic therapy . We compared the results of surveillance cultures and clinically indicated blood cultures for bacterial isolates grown and the influence of culture results on patient management . Blood cultures were obtained from all intensive care unit (ICU) patients over the course of 3 months at a set surveillance time (surveillance group) or according to clinical indications (clinical group) . Bacteriological results were compared and real-time chart review performed to assess the influence of the surveillance cultures on patient management, with particular reference to antibiotic therapy . Two hundred and forty-nine blood culture sets were collected over 3 months, 99 in the surveillance group and 150 in the clinical group . A total of 256 bacterial isolates were grown, 95 in the surveillance group and 161 in the clinical group . For the surveillance group 36%, 20%, and 44% of the isolates represented bacteraemia, line colonization and culture contamination, respectively . For the clinical group the distibution was 69%, 7%, and 24% respectively (P<0.001, P<0.01, and P<0.0027 for comparisons of percentages within each classification) . On only one occasion was antibiotic therapy started based on the result of a surveillance culture, and on only one occasion was a septic episode detected earlier by a surveillance culture; however, this culture result did not lead to a change in patient management . Surveillance blood cultures are expensive and add very little to the management of patients in the intensive care environment. J Comp Pathol, 1997 Aug, 117(2), 127 - 36 Histological and immunohistochemical findings in thoracic lymph nodes of cattle with contagious bovine pleuropneumonia; Scanziani E et al.; Outbreaks of contagious bovine pleuropneumonia (CBPP) were reported in Lombardy, Northern Italy, at the end of 1990 . For the purpose of this study, 54 slaughtered Holstein-Friesian cows showing typical lung lesions of CBPP from which the small colony type of Mycoplasma mycoides subspecies mycoides (M . m . mycoides SC) was isolated, were selected . Thoracic lymph nodes from these animals were sampled for bacteriological, histological and immunohistochemical analysis . Acute, subacute and chronic lesions were observed in 13, 12 and 29 cases, respectively . In the 13 animals showing acute lung lesions, an increased number of macrophages was observed, especially in the subcapsular sinuses, but frequently also in the cortical and medullary sinuses of the thoracic lymph nodes; in all 13 acute cases M . m . mycoides SC antigen was detected immunohistochemically in the cytoplasm of the macrophages . In 10 out of the 12 cases with subacute lung lesions, mycoplasma antigen was observed in macrophages located in sinuses, as well as in those scattered in the lymph node parenchyma . Hyperplasia of germinal centres in follicles was observed histologically in most of the 29 cases with chronic lung lesions . In immunohistochemically labelled sections, the characteristic finding observed in 27 of the chronic cases, was the presence of a variable amount of positive material in the germinal centres . These findings demonstrate the involvement of thoracic lymph nodes in CBPP. Clin Orthop, 1997 Oct, (343), 164 - 72 Total knee arthroplasty infections associated with dental procedures; Waldman BJ et al.; Total knee arthroplasties are at risk for hematogenous seeding secondary to procedures that create a transient bacteremia . To define the risk of infection associated with dental surgery, a retrospective review of the records of 3490 patients treated with total knee arthroplasty by the authors between 1982 and 1993 was performed . Sixty-two total knee arthroplasties with late infections (greater than 6 months after their procedure) were identified, and of these, seven infections were associated strongly with a dental procedure temporally and bacteriologically . These seven cases represented 11% of the identified infections or 0.2% of the total knee arthroplasty procedures performed during this period . In addition, among 12 patients referred for infected total knee arthroplasties from outside institutions, two infections were associated with a dental procedure . Five of the nine (56%) patients had systemic risk factors that predisposed them to infection, including diabetes and rheumatoid arthritis . All dental procedures were extensive in nature (average, 115 minutes; range, 75-205 minutes) . Eight of the patients received no antibiotic prophylaxis . One patient had only one preoperative dose . Infections associated with dental procedures may be more common than previously suspected . Eight of these patients had no prophylactic antibiotics, and one had inadequate coverage . The authors think that patients with a total knee arthroplasty who have systemic disease that compromises host defense mechanisms against infections and who undergo extensive dental procedures should receive prophylactic antibiotics . A first generation cephalosporin, given 1 hour preoperatively and 8 hours postoperatively would provide the best prophylaxis against the organisms identified in this study. Dtsch Tierarztl Wochenschr, 1997 Aug, 104(8), 313 - 6 {Examination of the appropriateness of anamnestic and clinical parameters for the prediction of the course of pregnancy under field conditions}; Heilkenbrinker T et al.; In this paper, fertility relevant parameters which are routinely examined in practice were evaluated on the basis of their correlation to one another and their influence on the foaling rates and incidence of early embryonic death in 175 brood mares of the Hanover breeding stock . The aim was to evaluate the suitability of these parameters for inclusion in a scheme for increasing the precision of predicting the subsequent course of pregnancy, as compared to such prognoses based exclusively on the histological evaluation of the endometrium . After establishing the breeding history and completing a clinical examination, two swab specimens were obtained for bacteriological culture and cytologic smears and one biopsy specimen was taken from the endometrium for histological examination . The most statistically significant effect on the foaling rate (analysed by logistic regression with two variables) have biopsy grade (p = 0.0087) and mare age (p = 0.0259) . A mare between two and nine years of age with a biopsy grade of 1 has a 71% probability of carrying a pregnancy to term . This probability decreases to 43% for a mare 15 years and older with the same biopsy grade . Mare age had a statistically significant effect on biopsy grade (p = 0.005) and on the frequency and degree of endometrosis (p = 0.001) . The mare group was significantly correlated (p = 0.012) with the foaling rate (maiden mares 70.6%, foaling mares 60%, problem mares 36.1%) . There is a difference of 24% between the foaling rates of foaling and problem mares, although the age and biopsy grade distributions are almost identical in the two groups . The number of barren years had a statistically significant effect (p = 0.0235) on the foaling rate . Mares that bore a foal in the previous breeding period had a foaling rate of 50.7% in the year of examination; mares that had been barren for one year hat a subsequent foaling rate of 40.6% . Mares that had been barren for two years or more had a foaling rate of only 22.7% . The overall impression resulting from the clinical examination was significantly correlated with the foaling rate (p = 0.018%) . Mares without abnormal findings had a foaling rate of 54.2%, mares with poor vulval conformation a rate of 46.7% . Mares with a history of pregnancy loss in the current breeding period had a foaling rate of 25% and mares with clinical evidence of endometritis had one of 22.2%. Dtsch Tierarztl Wochenschr, 1997 Aug, 104(8), 277 - 84 {Examination of a novel wax teat bougie for treatment of wounds in the papillary lactiferous sinus of dairy cows with special regard to endoscopic documentation of mucosal reactions compared with conventional teat bougies and a teat cannula}; Seeh C et al.; The present study on a novel wax-teat bougie, developed by Dr . T . GEISHAUSER for treatment of wounds in the papillary lactiferous sinus of dairy cows, has been performed in two phases of investigation . In a first step, fourteen healthy dairy cows (Deutsch Schwarzbunt) in state of early lactation were dried off temporarily for five days, after checking milk samples of all quarters for six following-on days on their bacteriological status, number of somatic cells, conductivity and results of the California-Mastitis-Test (CMT) . The drying off was performed on two Quarters with similar cell-count in milk samples each . In one teat of the selected pairs off udder quarters, the wax-bougie was applied (group I), the other corresponding udder quarters were used as a control (group II) . After five days of drying off, lactation was started again after removing the bougies in treated quarters . For another five days milk samples out of the quarters in groups I and II were checked in the laboratory tests named above and mean values and increase differences of results were compared . Comparison of increase differences with t-test showed no statistically significant difference between drying off procedures with the wax-bougie and without any treatment in the parameters named above . Courses of counts of somatic cells, conductivity and CMT showed no significant differences between drying off probands by using the novel wax-bougie and drying off without further treatment . In the second phase of the study, fifteen lactating, healthy dairy cows as probands have been split in five groups . Three cows (twelve udder quarters) were dried off for five days by using the novel teat bougie (group D), in three groups (A,B,C) two different types of conventional teat bougies and one type of cannula were used, and, as a control three cows (group E) were dried off without any treatment . Before drying off the udder quarters and after starting lactation again, the condition of the mucosa in the teat papillary lactiferous sinus has been documented by means of endoscopy and the bacteriological status of milk samples has been determined . As a result all udder quarters dried off temporarily showed endoscopically detectable inflammatory-proliferating reactions in the mucosa of the papillary lactiferous sinus, whereas in cows treated with the novel wax-bougie (group D), as well as in the cows of the control group (E), there were no inflammatory reactions detectable at all . These different reactions, basing on the Fisher-test, have to be considered statistically significant (p < 0.001). J Paediatr Child Health, 1997 Aug, 33(4), 329 - 34 Usefulness of stable microbubble test of tracheal aspirate for the diagnosis of neonatal respiratory distress syndrome; Boo NY et al.; OBJECTIVES: To compare the overall accuracy of the stable microbubble test (SM test) with measurement of level of surfactant protein A (SP-A) of tracheal aspirate for the diagnosis of respiratory distress syndrome (RDS) . METHODOLOGY: Tracheal aspirates were obtained from neonates on ventilatory support . The SM test was carried out on specimens of tracheal aspirate immediately after collection . Levels of SP-A in tracheal aspirates were determined by enzyme-linked immunosorbent assay (ELISA) method . The results of the SM test and SP-A level of the tracheal aspirates were compared against the clinical diagnosis of RDS based on clinical, radiological and bacteriological findings . RESULTS: Both the median microbubble counts (6 microbubbles/mm2, range = 0-90) and median SP-A levels (100 micrograms/L, range = 0-67447) of infants with RDS were significantly lower than those of infants with no obvious lung pathology (P < 0.0001), and pneumonia (P < 0.0001) . The SM test of tracheal aspirates had higher overall accuracy for the diagnosis of RDS than measurement of SP-A levels (94.6% vs 82.4%) . When the receiver operating characteristic (ROC) curves of both tests for RDS were compared, the area under the ROC curve of the SM test was larger (0.9689) than that of the SP-A method (0.8965) . CONCLUSIONS: This study showed that the SM test of tracheal aspirate was a useful bedside diagnostic test for RDS . It could be carried out at any time after birth on infants requiring ventilatory support. Zh Mikrobiol Epidemiol Immunobiol, 1997 Jul-Aug, (4), 42 - 6 {The possibility of preserving the causative agent of plague in soil in resting (nonculturable) form}; Suchkov IuG et al.; The parallel study of soil specimens from the burrows of great gerbils, taken in the natural focus of infection at the period between epidemics, by the bacteriological method and with the use of polymerase chain reaction (PCR) demonstrated that, simultaneously with the negative results of inoculations into nutrient media, PCR revealed the presence of Y . pestis in 4 out of 72 soil specimens . The serological study (in the indirect hemagglutination test) revealed the presence of Y . pestis capsular antigen (fraction l) in 16 out of 75 soil specimens . The transition of Y . pestis (strain EV) into the nonculturable state was experimentally shown in sterile soil extract and in association with protozoa, algae and Euglena . Bacteriologically detected Y . pestis disappeared or were represented by a few cells after day 7, while PCR could register the presence of Y . pestis at a concentration of 10(4)-10(5) microbial cells per ml until the end of the term of observation (30 days) . After the enrichment of the nutrient medium with fetal serum the complete reversion of Y . pestis nonculturable forms was observed: the concentration of bacteria grown on agar was 10(5) colony-forming units per ml . Transition into the nonculturable state was also observed in distilled water . The results of this investigation are discussed with special emphasis to the possibility of the preservation of Y . pestis in the nonculturable from during the period between epidemics as applied to the problem of plague epizootic. Ugeskr Laeger, 1997 Sep 22, 159(39), 5804 - 5 {Intestinal tuberculosis}; Homann C et al.; Since the symptoms and clinical presentation of intestinal tuberculosis is nonspecific, the diagnosis is frequently delayed and may be achieved at autopsy only . Intestinal tuberculosis is very rare in Denmark, but may now be seen more often because of increasing numbers of immigrants from countries of the third world with a high prevalence of tuberculosis . A case of intestinal tuberculosis in a 28 year old Somalian female is reported . Methods of diagnosing intestinal tuberculosis are commented, and the frequent necessity of starting medical treatment before a bacteriological diagnosis is reached is emphasized. Srp Arh Celok Lek, 1997 Sep-Oct, 125(9-10), 295 - 8 {Adrenal gland hemorrhage in neonates--radiologic aspects}; Smoljanic Z et al.; INTRODUCTION: The relatively large adrenal glands of the newborn are vulnerable to mechanical trauma during delivery . Great birth weight, difficult labor, perinatal hypoxia and prematurity are predisposing factors of adrenal haemorrhage . Minor adrenal haemorrhage may not cause symptoms . Massive adrenal haemorrhage is uncommon . Symptoms include anaemia and jaundice associated with a suprarenal mass . In cases with severe blood loss acute shock may develop . In 5 to 10 per cent of cases the haemorrhage is bilateral . Ultrasonography has replaced urography in the diagnosis of this condition demonstrating the site and size of the lesion and allowing an accurate follow-up . Within a month after haemorrhage the blood and necrotic adrenal tissue are resorbed and thin calcification appears at the periphery of the gland . Surgery is necessary if haemorrhagic pseudocyst is large and does not resorb spontaneously . MATERIAL AND METHODS: From 1992 to 1996, five patients with neonatal adrenal haemorrhage were treated at the University Children's Hospital in Belgrade . Two of them were females . All patients were born at term by vaginal delivery . Their birth weights ranged between 3200 and 4050 g . At hospitalization infants were aged from 6 hours to 18 days . The first symptom of adrenal haemorrhage was an abdominal mass in three patients . One of them had laparoschisis with guts and stomach protruding out; the surgeon discovered a mass in the right retroperitoneum during operation . Two patients had jaundice associated with anaemia, and sepsis another two . Ultrasonography was done in all patients . We punctured the haemorrhagic pseudocyst (diameter above 5 cm) in three patients and made cystography . Liquid components of pseudocysts were aspirated and sent to bacteriological and cytological analyses . RESULTS: The diagnosis of adrenal haemorrhage was confirmed by ultrasonography in all patients, demonstrating a right adrenal mass (unilateral in all patients), mostly hypoechoic, which displaced the right kidney . Calcification at the periphery of the pseudocyst appeared in one patient . The adrenal haemorrhage disappeared spontaneously in two patients after two months . An attempt to support the adrenal hemorrhagic pseudocystic regression by puncturing and aspirating its content in three patients was successful in one infant . The patient with laparoschisis died because of sepsis and thrombocytopenia . In a patient the haemorrhagic pseudocyst persisted (6 cm in diameter) and was surgically removed . DISCUSSION: Ultrasound is the method of choice in the diagnosis of adrenal haemorrhage, antenatally and neonatally . It also allows diagnosis of coexisting complications such as renal vein or inferior vena cava thrombosis and a proper follow-up . Puncture of pseudocyst and aspiration of liquid components may support involution of large haemorrhagic pseudocysts . If it is unsuccessful, surgery is necessary. Pneumonol Alergol Pol, 1997, 65(5-6), 364 - 9 {Pleural empyema as a complication of descending necrotizing mediastinitis}; Sobolewska E et al.; Fulminant infections of oropharyngeal origin may cause the most lethal form of mediastinitis due to extension of the infection along the neck fascial planes or by lymphatic way: descending necrotizing mediastinitis . Two cases of this rare life-threatening entity of odontogenic and tonsillar origin are reported . A pleural empyema and pericarditis as complications were observed . Bacteriologic etiology, possibilities of the early diagnosis and the aggressive treatment by means of a thoracotomy are discussed. Arch Pediatr, 1997 Aug, 4(8), 744 - 50 {Epidemiological estimation of the effectiveness of the pertussis vaccination during outbreaks in a community . Les pédiatres et bactériologistes du réseau RENACOQ}; Baron S et al.; BACKGROUND: With the recent pertussis vaccine trials, the efficacy of acellular vaccines is now well known, estimated at 85% for multicomponent vaccines . On the other hand, the estimates of whole cell vaccines efficacy varies from 36% to 98% with the different vaccines used . We evaluated the field effectiveness of the French whole cell pertussis vaccine during outbreaks in schools and centers for disabled children . METHODS: Four limited outbreaks between 1993 and 1995 were investigated using a retrospective cohort study design . Vaccine effectiveness (VE) was assessed for the following case definition: clinical pertussis, laboratory-confirmed pertussis, epidemiologically confirmed pertussis (documented contact with a laboratory confirmed case) . Immunization history was obtained by reviewing the child health record book . Effectiveness of a whole vaccination (four injections) and of a partial vaccination (one to three injections) were estimated as 1-(attack rate among vaccinated/attack rate among non-vaccinated) . RESULTS: A whole immunization conferred good protection against pertussis with an estimated VE higher than 92% in three surveys, lower in the fourth survey (84%) in which antibiotic prophylaxis was set up very rapidly . A partial immunization conferred a mild protection (median: 60%) . CONCLUSIONS: These results are consistent with a previous report about the effectiveness of this whole cell vaccine using the screening method in a hospital network survey in France . In the same way, a large efficacy trial in Senegal comparing it with an acellular bivalent vaccine estimated its efficacy at 96% . This high efficacy together with a satisfactory vaccine coverage leads to the current epidemiological profile of pertussis in childhood in France: majority of cases occurring before 6 months of age, limited outbreaks in school children, many of whom being unvaccinated or partially vaccinated. Crit Care Med, 1997 Oct, 25(10), 1663 - 70 Empiric treatment of hospital-acquired lower respiratory tract infections with meropenem or ceftazidime with tobramycin: a randomized study . Meropenem Lower Respiratory Infection Group; Sieger B et al.; OBJECTIVE: To evaluate the efficacy and tolerability of intravenous empiric treatment with meropenem compared with ceftazidime-tobramycin in patients with hospital-acquired lower respiratory tract infections . DESIGN: Prospective, nonblind, randomized trial . SETTING: Multicenter trial conducted at 22 centers . PATIENTS: Two hundred eleven patients were enrolled and 121 were evaluable for the analysis of both clinical and bacteriologic efficacy . INTERVENTIONS: One hundred four patients were randomized to receive intravenous meropenem (1000 mg) every 8 hrs and 107 patients were randomized to receive intravenous ceftazidime (2000 mg) plus tobramycin (1 mg/kg) every 8 hrs . Sixty-three meropenem-treated patients and 58 ceftazidime-tobramycin-treated patients were eligible for the analysis of clinical and bacteriologic efficacy . In the ceftazidime-tobramycin group, 32 (55%) evaluable patients received more than six doses of tobramycin, 24 (41%) received six doses or fewer, and two (3%) did not receive any tobramycin . MEASUREMENTS AND MAIN RESULTS: The analysis of efficacy was based on the clinical and bacteriologic responses at the end of treatment . Satisfactory clinical responses occurred in 56 (89%) of 63 of the meropenem-treated patients and in 42 (72%) of 58 of the ceftazidime-tobramycin-treated patients (p = .04) . Corresponding bacteriologic response rates were 89% and 67%, respectively (p = .006) . The frequency and profile of drug-related adverse events was similar across treatment groups . Seizures were reported in three meropenem-treated patients, but these seizures were considered by the investigator to be unrelated to treatment . CONCLUSIONS: Meropenem is well tolerated and more efficacious than the combination of ceftazidime and tobramycin for the initial empiric treatment of hospital-acquired bacterial pneumonia. J Clin Microbiol, 1997 Oct, 35(10), 2503 - 10 Use of different molecular typing techniques for bacteriological follow-up in a clinical trial with AIDS patients with Mycobacterium avium bacteremia; Picardeau M et al.; One hundred ninety-six Mycobacterium avium isolates from blood samples recovered from 93 AIDS patients for several months were typed by serotyping, by IS1245 restriction fragment length polymorphism (RFLP) analysis and in some cases RFLP analysis with plasmids pVT2 and pLR7 as probes, and by pulsed-field gel electrophoresis (PFGE) . PCR typing of single colonies was also used to detect polyclonal infections . Strains belonged mainly to serotypes 1, 4, and 8 . pVT2- and pLR7-related plasmids were detected in strains from 49% of the patients . The IS1245 RFLP and PFGE analyses showed a 96.8% diversity of the M . avium strains from the 93 patients . The vast majority (95.2%) of infections were monoclonal, indicating that recent infection is unlikely, even at an advanced stage of AIDS . For one patient, sequential isolates gave divergent patterns of sensitivity and resistance to clarithromycin, but all were identified as the initial clone . RFLP analysis and PCR typing of single colonies allowed for the detection of three polyclonal infections during the bacteriological follow-up . Among strains from patients whose samples were positive by culture after treatment for 2 to 15 months, 97.4% were the same as the initial strain . In conclusion, relapses and failures were mostly due to the initial strain . These relapses and failures resulted either from the selection of resistant mutants or the reappearance of sensitive strains, suggesting the persistence of nonsterilized tissue reservoirs. Acta Chir Belg, 1997 Aug, 97(4), 163 - 7 Anatomic, physiologic, bacteriologic and immunologic aspects of peritonitis; Gandawidjaja L et al.; The anatomic aspect of peritonitis describes the division of the abdominal cavity into the supracolic, infracolic and paracolic spaces, moreover the lesser sac and the cul-de-sac of the pelvis . Physiologically the peritoneum plays an important role in the passive exchange of fluid and absorption of particles . Endotoxin, which is elaborated by bacteria activates the classical as well as the alternative complement pathway . It activates also the arachidonic acid metabolism, leading to the release of prostaglandins (PG) and leukotriens (LTC) . The local host defense against a bacterial invasion includes the activation of cellular and humeral immunologic defense mechanism, in which the final product of the complement pathway (C5b-9), as well as chemoattractants C3a, C5a and C567 play a key role. Clin Infect Dis, 1997 Sep, 25(3), 621 - 9 Comparison of combination therapy regimens for treatment of human immunodeficiency virus-infected patients with disseminated bacteremia due to Mycobacterium avium . ANRS Trial 033 Curavium Group . Agence Nationale de Recherche sur le Sida; May T et al.; We conducted a randomized, open-label trial in 42 French hospitals to compare the clinical and bacteriologic efficacy of combination therapy with clarithromycin/clofazimine (Clm/Clof) with that of combination therapy with clarithromycin/rifabutin/ethambutol (Clm/Rib/Eth) as treatment for Mycobacterium avium bacteremia . One hundred forty-four human immunodeficiency virus-seropositive patients older than 18 years of age who had CD4 lymphocyte counts of <100/mm3 and a blood culture positive for M . avium were enrolled in the study . The main measures of outcome were blood cultures, abatement of clinical symptoms (fever), and survival . Treatment success (defined as patient living, either no fever or a reduction of > or = 1 degrees C in initial body temperature, and a blood culture negative for M . avium) was similar in both treatment groups at months 2 and 6 . However, following initial resolution of infection, relapse of M . avium bacteremia occurred in more patients in the Clm/Clof group than in the Clm/Rib/Eth group (22 vs . six, respectively; P < .001); these relapses were accompanied by emergence of strains resistant to clarithromycin in 21 and two patients, respectively . In conclusion, combination therapy with Clm/Rib/Eth prevented relapse of mycobacterial disease and, compared with combination therapy with Clm/Clof, was associated with a significant decrease in the emergence of resistant M . avium strains in HIV-infected patients treated for at least 28 weeks. Isr J Med Sci, 1997 Mar, 33(3), 160 - 3 Comparison of various Helicobacter pylori detection methods: serology, histology and bacteriology; Sternberg A et al.; The current gold standard test for diagnosis of Helicobacter pylori involves histological staining and/or urease testing of antral biopsy specimens . However, these methods are invasive, and alternative non-invasive methods, i.e . the urease breath test and serological tests, are available . The test for H . pylori-specific serum immunoglobulin G (IgG) is now available commercially . The aim of this study was to compare the gold standard tests for diagnosis of H . pylori to the non-invasive method of detecting IgG antibody in the serum . Two hundred and twenty-five (225) subjects were tested for H . pylori by histological staining, urease testing, direct microscopy of antral biopsy specimens and quantification of serum IgG antibody . The population examined was divided into 2 groups--a group of 52 patients with no gastrointestinal symptoms and a group of 173 patients with dyspepsia . Out of 173 dyspeptic patients, 22 (12.7%) were false-positive to H . pylori . Out of 52 non-dyspeptic subjects, 30 (57.7%) were false-positive (p < 0.0001) . The sensitivity and specificity were 91.6% and 51.7%, respectively . The specificity and positive predictive value increased by approximately 30% when the subjects examined were in the younger age group (< 30 years), while the sensitivity and the negative predictive value did not change significantly . This study indicates that serological testing is not recommended for diagnosis nor is it recommended for follow-up treatment, especially among the older age group (> 30 years). Folia Med Cracov, 1996, 37(1-2), 3 - 14 {The effect of Helicobacter pylori infection and duodenogastric reflux on the histology of gastric mucosa in peptic ulcers}; Kopanski Z et al.; In a group of 96 patients with peptic ulcer (36 patients with ulcer of the stomach, 60 patients with ulcer of the duodenum) we analysed the alterations of the mucosa of the stomach associated with the ulcer . A significantly frequent occurrence was shown of the athropic gastritis and of the dysplasia in patients with ulcer of the stomach in comparison with the group of patients with ulcer of the stomach in the comparison with the group of the patients with ulcer of the duodenum . Among the patients analysed we also appraised the alterations on the picture of the stomach mucosa of the Helicobacter pylori infection, of the duodeno-gastric reflux as well as of the concentration of the bile acids and of lysolecithin contained in the gastric juice in the ulcerous disease of the stomach and of the duodenum . The presence of the Helicobacter pylori infection was identified bacteriologically, the duodeno-gastric reflux was diagnosed with the radionucleide method and the concentration of the bile acids and lysolecithin in gastric juice was determined chromatographically . It was confirmed that the Helicobacter pylori infection as well as the bile acids and the lysolecithin the concentration of which in the gastric juice in patients with an ulcer in the stomach were significantly higher in comparison with patients with and the ulcer in the duodenum, were a decisive factor for more exacerbated histological alterations of the mucosa of the stomach in case of ulcer of the stomach. Clin Infect Dis, 1997 Sep, 25 Suppl 2, S246 - 8 Diagnostic anaerobic bacteriology in Italy: state of the art . Italian Anaerobic Study Group; Botta GA et al.; A total of 220 microbiology departments in 205 general hospitals, 12 university hospitals, and 3 military hospitals were surveyed by questionnaire during the period March-May 1996 in order to evaluate the status of diagnostic anaerobic bacteriology in Italy . Responses were received from 47 laboratories (21.3%) . The number of beds in the responding facilities varied widely (129-2,200), as did the number of specimens tested for anaerobic bacteriology (50-29,900) . In most cases (94%), the microbiologist made the decision to culture and to proceed to further identification of isolates (mainly by commercial systems), depending on the adequacy of samples . Antibiotic susceptibility testing was performed in 52.5% of laboratories surveyed . Although it is difficult to draw relevant conclusions owing to the poor response rate, it seems that the condition of anaerobic bacteriology in Italy is far from satisfactory . Among major limitations are low interest in the field, lack of standardization of procedures, poor utilization of reference centers, and limited technological resources. Pharmacoeconomics, 1997 Nov, 12(5), 596 - 611 Azithromycin . A pharmacoeconomic review of its use as a single-dose regimen in the treatment of uncomplicated urogenital Chlamydia trachomatis infections in women; Lea AP et al.; In women, Chlamydia trachomatis infection often occurs in the urethra or cervix, with up to 70% of infections associated with few or no symptoms . Inadequate treatment may lead to infection of the upper genital tract and subsequent pelvic inflammatory disease (PID) in 10 to 40% of patients . PID causes an increased relative risk of ectopic pregnancy of 2.5 to 7.9 and PID may also lead to tubal infertility in about 17% of patients . 60% of infants born of mothers with C . trachomatis infection may become infected, leading to conjunctivitis in 23% and pneumonia in 21% . All of these sequelae of C . trachomatis infection may require in- or outpatient treatment . With > 4 million infections estimated to occur each year in the US, C . trachomatis is one of the most common and costly of the sexually transmitted pathogens . Treatment options for uncomplicated C . trachomatis infections in nonpregnant women include single-dose azithromycin 1000 mg or doxycycline 100 mg twice daily for 7 days orally . In clinical trials, the bacteriological cure rate of single dose azithromycin 1000 mg (95 to 100%) was similar to that of oral doxycycline 200 mg/day for 7 days (88 to 100%) in nonpregnant women . Azithromycin was at least as well tolerated as doxycycline and was associated with mainly mild gastrointestinal adverse effects including diarrhoea, nausea and abdominal pain . Pharmacoeconomic analyses have sought to determine if the 2.7- to 12-fold higher acquisition costs of azithromycin in comparison with doxycycline are offset by its simple single-dose regimen which is likely to aid patient compliance and so optimise drug efficacy . All analyses were retrospective cost-effectiveness decision-tree models and mainly considered direct costs . All models incorporated an estimate of noncompliance with doxycycline and its influence on efficacy . For the treatment of confirmed C . trachomatis infection, azithromycin saved around $US1200 per major outcome avoided (1993 values; third-party payer perspective in the US) or US$3502 per case of PID avoided (1993 values; US healthcare system perspective) compared with doxycycline . If infection was treated empirically, azithromycin was more costly than doxycycline by $US792 (1993 values), but the result was sensitive to changes of some parameters of the model . Azithromycin was more costly than doxycycline from the perspective of a public health clinic which paid for the treatment of initial infection and acute sequelae only . Thus, pharmacoeconomic data from the US support the use of azithromycin in the treatment of nonpregnant women with confirmed C . trachomatis urogenital infections from the perspective of the healthcare system or third-party payer; however, from the perspective of a public clinic, doxycycline is the less costly option . Decreases in doxycycline compliance or azithromycin acquisition cost are factors that favour azithromycin.
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