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, foll