Microbial

Acta Cytol, 1997 Sep-Oct, 41(5), 1463 - 7
Bronchial tuberculosis . Cytologic diagnosis of fiberoptic bronchoscopic brushings; Fang X et al.; OBJECTIVE: To determine the cytomorphologic features of bronchial tuberculosis on fiberoptic bronchoscopic brushings and its diagnostic value . STUDY DESIGN: Seven hundred forty-six bronchoscopic examinations were retrospectively studied . The patients' macroscopic findings made by fiberoptic bronchoscopic examination, as well as brush cytologic and biopsy findings, were reviewed . RESULTS: Of 746 bronchoscopic brushing specimens, 23 were diagnosed as endobronchial tuberculosis by cytomorphology; that accounted for about 3.1% of cases . The same or a similar diagnosis was made for both specimen types in 16 of the specimen pairs . Acid-fast stain showed that only one brushing was positive (4.3%); all the biopsy specimens were negative . Epithelioid cell granulomas and/or caseous necrosis were found in 23 cases of brush smears, while tuberculous granulomas accounted for 16 bronchial biopsies . Seven were nonspecific chronic bronchitis or normal bronchial mucosa . CONCLUSION: The cytomorphologic alterations of tuberculosis are suitable for diagnosing bronchial tuberculosis on fiberoptic bronchoscopic brushings . Its sensitivity for defining bronchial tuberculosis is not lower than that of bronchial histologic biopsies or bacteriologic examination.

Semin Vasc Surg, 1997 Sep, 10(3), 184 - 90
Management of infectious and cutaneous complications in vascular access; Kudva A et al.; Infectious complications in vascular access grafts, primarily seen in those using synthetic graft material, are the major cause of morbidity and mortality in this high-risk group of dialysis-dependent patients . These patients are more prone to infection because of their age, renal failure, and other associated diseases such as diabetes, and they do not fight infections well . This chapter discusses the pathogenesis and bacteriology of these infections and their clinical signs and symptoms . Preventive management can obviate most of these infectious complications and is also outlined . Surgical intervention must be specifically tailored to each patient and their graft, and in many cases alternatives need to be considered.

Dtsch Tierarztl Wochenschr, 1997 Jun, 104(6), 208 - 12
{Neospora caninum causes abortions in a cattle herd in North Rhine Westphalia}; Schares G et al.; In a cattle herd in North Rhine-Westphalia a series of eight abortions occurred between 15th August and 14th October, 1996 . Four of the aborted fetuses were histopathologically, virologically, bacteriologically and parasitologically examined . A multifocal necrotising encephalitis was observed in two fetuses . In addition, the liver of two fetuses and the placenta of one fetus contained infected foci . In three fetuses protozoan stages were detected which were identified as N . caninum by immunohistochemistry . A polymerase chain reaction conducted with histological material revealed N . caninum-DNA in the placenta of an aborted fetus . When seven cows that had aborted were tested for antibodies directed against N . caninum, six animals were positive by immunofluorescence and all seven by immunoblotting . The serological examination of the entire herd revealed a high herd seroprevalence of antibodies directed against N . caninum . Potential modes of infection with N . caninum in the herd are discussed, in particular the possibility of exposure to a point source (definitive host).

Commun Dis Intell, 1997 Sep 4, 21(18), 245 - 9
Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 1994 and 1995 . Report of the Australian Mycobacterium Reference Laboratory Network; Dawson D; The Australian Mycobacterium Reference Laboratory Network collected and analysed laboratory data on isolates of Mycobacterium tuberculosis reported during 1994 and 1995 . The total number of confirmed isolates was 708 in 1994 and 705 in 1995 . This represents an annual incidence of approximately 4 cases of laboratory confirmed tuberculosis per 100,000 population . These figures are similar to those reported in previous years and confirms that the incidence of tuberculosis in Australia remains stable . The incidence rate varied between States . Overall the male:female ratio fell, and there were signs of a downward shift in the median age . We were unable to assess the impact of HIV infection on the number of isolates reported . Positive microscopy was obtained in 55-60% of patients with pulmonary disease . Approximately 8% of isolates had in vitro resistance to at least one of the four standard anti-tuberculosis drugs . Over the two year period seven strains were found to be multi-drug resistant . Overall, the data from 1994-1995 gives no indication of a significant change in the drug susceptibility profiles of isolates from Australian patients with tuberculosis.

Rev Laryngol Otol Rhinol (Bord), 1997, 118(2), 87 - 9
{Complicated isolated inflammatory sphenoiditis (apropos of 23 cases)}; Stoll D et al.; Isolated inflammatory sphenoid sinusitis, associated with complications are rare . Authors report 23 cases in 8 years . The left sphenoid is the most often involved, in 50 years or more old females . Neurological complications are the most frequent (75% of the cases): isolated headache, neuro-ophtalmologic paralysis, meningitis, before respiratory complications (20%) . A bacteriological etiology was found in 60% of the cases, and a fungal etiology in 25% . The treatment is based on a large endoscopic marsupialization of the sphenoid . Recovery is the rule, except for neuro-ophtalmologic paralysis which recovery is inconstant.

Rev Laryngol Otol Rhinol (Bord), 1997, 118(2), 79 - 86
{Endocranial complications of cholesteatoma: apropos of 8 cases}; Darrouzet V et al.; The authors present a recent series of 8 cases of intracranial complications secondary to cholesteatoma . The series is made up of 3 temporal lobe abscesses, 1 parietal lobe abscess, 1 cerebellar abscess, 1 extradural abscess, one lateral sinus thrombo-phlebitis with subdural abscess and one meningitis on its own . Otological management with removal of the cholesteatoma was by open or closed technique, depending on the local anatomical conditions . It was supplemented by multiple antibiotic therapy, in turn guided by the bacteriological cultures and by any known epidemiological information . It was necessary to needle the abscess by a neurosurgical approach in two cases . The results of bacteriological samples taken for analysis from the intracranial abscesses are often negative, which limits their clinical value . In such cases, the choice of antibiotics rests on epidemiological information . The authors emphasise the progress that has been made towards the early diagnosis of intracranial complications . Appropriate combined medical and surgical treatment leads to complete cure without neurological sequelae in most cases.

Ann Chir, 1997, 51(3), 243 - 7
{Does laparoscopy increase the bacteriological risk of appendectomy? Results of a randomized prospective study}; Sezeur A et al.; OBJECTIVE: The authors compare the risk of bacteraemia in open and laparoscopic appendectomy in a prospective randomized study . METHODS: 35 patients with a presumptive diagnosis of acute appendicitis were randomized to have conventional open or laparoscopic surgical procedures . Before randomization, patients signed a consent form to participate in the study . Patients who were converted from laparoscopic to open appendectomy (3 cases), HIV+, allergic to Augmentin or who had contraindications to laparoscopic surgery were excluded from the study . A total of 32 patients were randomized: 17 to open (group I) and 15 to laparoscopic surgery (group II) . There were no significant differences with regard to age, ASA score, symptoms or macroscopic aspect of the appendix . Two patients had a normal appendix, 12 had acute appendicitis, 14 gangrenous appendicitis and 4 ruptured or abscessed appendicitis . All patients received preoperative antibiotic prophylaxis (Augmentin) after blood cultures (H1) were drawn . Five other blood cultures were performed in standard medium and medium neutralizing Augmentin: at the time of opening the peritoneum (H2), after appendectomy (H3), after closure of the abdomen (H4), and at 6 (H5) and 12 hours (H6) after the operation . Bacterial cultures from the appendix site were performed before (P1) and after (P2) appendectomy . RESULTS: The operative mortality rate after conventional or laparoscopic appendectomy was nil . The incidence of post-operative morbidity was 4 cases in group I and 2 cases in group II . No positive bacterial culture was obtained in 17 patients . The distribution of these patients was similar in groups I and II . Samples P1 and P2 were positive in 5 cases . Nine of 27 cases with negative P1 became positive in P2 (33%) . There was no significant difference between the two groups with regard to the appearance of the appendix . Only two patients had positive blood cultures at H1 . One of them had blood cultures at H3, H4 positive for a second germ . CONCLUSION: A low risk of bacteraemia exists for both open and laparoscopic appendectomy . This risk did not appear to increase for laparoscopy . Conventional and laparoscopic surgical procedures led to positive peritoneal bacterial cultures after appendectomy in 33% of cases.

G Chir, 1997 Jun-Jul, 18(6-7), 353 - 4
{Abdominal tuberculous lymphadenitis simulating pancreatis cancer}; Casolino V et al.; The Authors report the case of a patient symptomatic for fever, weight loss and abdominal pain submitted to abdominal sonography and CT which identified a mass of the pancreatic head . The patient underwent laparotomy plus biopsy; the istologic and bacteriological diagnosis demonstrated a tuberculous lymphoadenitis in spite of a normal cutaneous tuberculin test . Abdominal localization of TBC infection therefore is increasing in epidemiological studies, and thus it must be included in the differential diagnosis of subdiaphragmatic disease.

Acta Trop, 1997 Sep 15, 67(1-2), 107 - 11
Fine needle aspiration biopsy in the differential diagnosis of the liver cystic echinococcosis; Stefaniak J; Liver cystic echinococcosis (CE) in non-endemic areas poses several problems in the differential diagnosis of various space occupying lesions detected by US examination . Fine needle aspiration biopsy (FNAB) using teflon covered needles with a US visible marker may be very useful for the definitive diagnosis . In the Clinic of Parasitic and Tropical Diseases in Poznan, FNAB were performed in 121 patients with liver space occupying lesions, with an addition of an anthelmintic cover of albendazole . The biopsy material was examined parasitologically, cytologically, bacteriologically and immunologically . E . granulosus infection has been confirmed in 25 patients (20.6%), in 16 cases by finding parasite protoscoleces or hooks and in nine cases by detection of an antigen specific for E . granulosus, antigen 5 (Ag5) . Additionally nine cases of malignancy (7.4%), four of angioma (3.3%) and three bacterial abscesses (2.5%) were diagnosed . There were no complications related to FNAB puncture . The algorithm of the clinical management of space occupying lesions suspected for CE was proposed . FNAB is a very important technique in the differential diagnosis of cystic echinococcosis.

Rev Neurol, 1997 Sep, 25 Suppl 3, S281 - 93
{Infections with cutaneous and nervous system alterations}; Losada-Campa A et al.; OBJECTIVE: We review and update the clinical and diagnostic aspects in the most representative neurocutaneous infections, emphasizing the features of interdisciplinary interest . METHODS: Human skin is the primary host barrier against infection and his importance is critical in the immunocompromised population . The genetic hability of pathogen micro-organisms to bind the adhesion molecules of cellular membranes defines the anatomic affinity of each species . Cutaneous involvement can be crucial for diagnosis in infectious diseases . The characteristics of the elemental lesions and the accessible cytology, bacteriology and histopathology procedures, usually leads to a specific diagnosis . We highlight the cutaneous manifestations of the acute and subacute bacterial meningitides . We review the clinico-pathologic characteristics of the meningoencephalitidis associated to the viral exanthems . We describe the chronic bacterial entities with prominent cutaneous and neural affectation as lepra, syphilis and borreliosis, as well as the numerous clinical forms of presentation of herpesvirus hominis and varicellazoster . Finally, we stand out the transcendency of cutaneous findings in the HIV set . CONCLUSIONS: The appropriate interpretation of the infectious cutaneous semiology, supplemented with exams of direct samples, allow frequently to reach an ethiologic or orientated diagnosis, in a rapid, economic and non-invasive way . This information must be carefully incorporated to the study of high-morbidity infections, as there that concerns to the nervous system.

Arch Intern Med, 1997 Aug 11-25, 157(15), 1709 - 18
Incidence of community-acquired pneumonia requiring hospitalization . Results of a population-based active surveillance Study in Ohio . The Community-Based Pneumonia Incidence Study Group; Marston BJ et al.; BACKGROUND: Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined . METHODS: We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia . Information about risk factors, symptoms, and outcome was collected through interview and medical chart review . Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests . RESULTS: The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100,000 population; the overall case-fatality rate was 8.8% . Pneumonia incidence was higher among blacks than whites (337.7/100,000 vs 253.9/ 100,000; P < .001), was higher among males than females (291.4 vs 244.8; P < .001), and increased with age (91.6/100,000 for persons aged < 45 years, 277.2/ 100,000 for persons aged 45-64 years, and 1012.3/ 100,000 for persons aged > or = 65 years; P < .001) . Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485,000 . These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18,000), Mycoplasma pneumoniae (18,700-108,000), and Chlamydia pneumoniae (5890-49,700) . CONCLUSIONS: These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia . The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.

J Reprod Med, 1997 Aug, 42(8), 533 - 5
Fallopian tube and pulmonary sarcoidosis . A case report; Boakye K et al.; BACKGROUND: Female reproductive tract sarcoidosis is a rare clinical condition, especially when the fallopian tube is the site of involvement . A search of the medical literature revealed 22 cases of female genital tract sarcoidosis, with 6 cases involving the fallopian tube . CASE: Sarcoidosis of the genital tract occurred in a woman with a 16-year history of pulmonary sarcoidosis . CONCLUSION: Since various diseases, including sarcoidosis and tuberculosis, cause similar histologic changes, obtaining bacteriologic proof is mandatory, for the diagnosis can have therapeutic and public health implications.

Pathology, 1997 Aug, 29(3), 300 - 2
Prevalence of respiratory viruses and Mycoplasma pneumoniae in sputum samples from unselected adult patients; Kok T et al.; Sputum samples from adult patients are routinely used for bacteriological tests, but not for the diagnosis of viral/mycoplasmal infections . We examined 511 sputum samples submitted for bacterial tests from patients at the Royal Adelaide Hospital . Each specimen was tested directly (and after six days of cell culture amplification) for antigens to influenza A and B, parainfluenza 1, 2 and 3, adenovirus, respiratory syncytial virus (RSV) and Mycoplasma pneumoniae . Respiratory viruses or M . pneumoniae were found in 11% of all specimens but were most common (14%) in sputa reported as containing only "oral flora" . Respiratory virus or M . pneumoniae infection was significantly more common in medical patients (12%) than in surgical patients (5%), and was most common in oncology (hematology/radiotherapy) patients (25%) . Influenza A and RSV were equally common in medical patients, while RSV was the most frequent isolate in oncology patients . Respiratory viral infection is an underdiagnosed condition in adults, particularly the immunocompromised, which can be successfully diagnosed by virological examination of sputum.

Chest, 1997 Aug, 112(2), 466 - 71
Value of C-reactive protein in the detection of bacterial contamination at the time of presentation in drug-induced aspiration pneumonia; Adnet F et al.; STUDY OBJECTIVES: To compare the plasma concentration of C-reactive protein (CRP) with traditional markers for diagnosis of bacterial pneumonia in patients with suspected aspiration . DESIGN: Prospective, nonrandomized, controlled study of consecutive hospital admissions . SETTING: Toxicology ICU in a university hospital . PATIENTS OR PARTICIPANTS: Acutely poisoned comatose patients admitted to the hospital with suspicion of aspiration pneumonia . INTERVENTIONS: Distal protected catheter sampling per fiberoptic bronchoscopy and bacteriologic culture were employed as a standard to detect the bacterial component of suspected aspiration pneumonia . Plasma CRP concentrations, temperature, and WBC count were measured on hospital day 1 . MEASUREMENTS AND RESULTS: Sixty-six patients were evaluated . Thirty-two had bacterial contamination by positive culture (> or =10(3) cfu/mL) . Multiple receiver-operating characteristic (ROC) curves were used to compare each parameter for detection of infection secondary to aspiration . The ROC curve of CRP concentrations showed that a CRP >75 mg/L is associated with bacterial contamination with a sensitivity of 87%, specificity of 76%, positive predictive value of 78%, and negative predictive value of 87% . ROC curves of temperature and WBC count demonstrated poor diagnostic value of these markers in indicating the bacterial component of suspected aspiration pneumonia . CONCLUSIONS: Early measurement of CRP is useful for the diagnosis of aerobic bacterial content of aspiration pneumonia and perhaps in determining the need for invasive bacteriologic sampling . Temperature and WBC count are poor indicators of bacterial infection of aspiration pneumonia in poisoned patients.

Plast Reconstr Surg, 1997 Aug, 100(2), 397 - 401
The use of quantitative bacteriologic assessment of bone; Heller WA et al.; The purpose of this paper was to examine whether quantitative bacteriologic assessment of bone is a reliable indicator of the adequacy of debridement of draining wounds involving bone . This is a retrospective review of 31 consecutive patients treated for draining posttraumatic/ surgical wounds involving bone . Nineteen patients met the necessary criteria and were included in the study . These patients underwent radical debridement of bone and soft tissue, intraoperative assessment of the debrided wound by rapid slide quantitative bacteriologic assessment, and closure with well-vascularized tissue . Clinical assessment of vascularity and rapid slide quantitative bacteriologic assessment of cancellous bone and soft tissue were the only prerequisites used in determining the appropriateness of wound closure in this study . At the time of most recent follow-up, none of the 19 patients had recurrent wound drainage . Two patients required a second procedure to partially elevate their flaps and drain recurrent soft-tissue infections . None of the patients had recurrence of bony infection . Seventeen patients who presented initially with fractures or osteotomies all had successful bone unions . This study demonstrates that the technique of rapid slide quantitative bacteriologic assessment of cancellous bone is a useful adjunct to surgical judgment and allows one to close draining wounds (frequently with complex wound closure options) with a high level of confidence.

Hepatogastroenterology, 1997 Jul-Aug, 44(16), 968 - 74
Infected pancreatic necrosis complicated by multiple organ failure; Dominioni L et al.; BACKGROUND/AIMS: Sixteen patients with bacteriologically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical treatment were studied prospectively . METHODOLOGY: The severity of IPN was documented pre-operatively using the following scores: 1) degree of necrosis by CT scan {< 30% in three patients (19%); 30-50% in nine patients (56%); > 50% in four patients (25%)}; 2) Elebute and Stoner's sepsis score (16 +/- 4 points); 3) Goris' score of multiple organ failure (MOF) (5 +/- 2 points) . Sequential surgical treatment was carried out by the same surgical team, as follows: 1) abdominal re-explorations through a zipper for the first 7-10 days; 2) open abdomen and repeated peritoneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infection (range: 15-85 days) . No patient required further re-exploration . RESULTS: Mortality occurred in 3/16 patients (19%), due to MOF in all 3 cases . The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73 +/- 33 days, without fistulae . These results indicate that by treating severe IPN with the technique of sequential abdominal re-explorations, open drainage and continuous closed lavage, a low 19% mortality can be achieved . CONCLUSION: This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN: these data could facilitate future comparison of results obtained with other treatment modalities.

J Vet Diagn Invest, 1997 Jul, 9(3), 250 - 4
Otitis media in preweaned Holstein dairy calves in Michigan due to Mycoplasma bovis; Walz PH et al.; Mycoplasma bovis was isolated from the tympanic bullae of dairy calves with an exudative otitis media . The history, clinical signs, gross and histologic lesions, and bacteriologic findings are described for 5 preweaned Holstein calves with otitis media from a 600-cow dairy in Michigan . Clinical findings consisted of unilateral or bilateral ear droop, epiphora, head tilt, and recumbency in severely affected calves . Postmortem examination revealed unilateral or bilateral fibrinosuppurative to caseous exudate in the tympanic bullae . Histologically, a marked fibrinosuppurative to caseous exudate filled the tympanic air spaces . The partially ulcerated tympanic mucosa was markedly thickened with mononuclear cell infiltration and proliferation of fibrous connective tissue . Bone remodeling and periosteal hyperostosis were present in some osseous septa . Mycoplasma bovis was isolated from the tympanic bullae of all 5 calves and from the lungs of 2 calves and the frontal sinus of 1 calf . Mycoplasma bovis was isolated at > 100,000 colony forming units/ml from the bulk milk tank of the farm of origin . The isolation of M . bovis from the bulk milk tank, indicating subclinical mycoplasmal mastitis coupled with the feeding of waste milk from mastitic cows to calves is suggestive of a possible source of the infection resulting in otitis media in preweaned dairy calves.

J AOAC Int, 1997 Jul-Aug, 80(4), 806 - 23
Comparison of the Petrifilm dry rehydratable film and conventional culture methods for enumeration of yeasts and molds in foods: collaborative study; Knight MT et al.; A collaborative study was performed involving 18 laboratories and 6 food types to compare 3M Petrifilm yeast and mold count plates with the method described in the U.S . Food and Drug Administration's Bacteriological Analytical Manual . Four species of mold and 2 species of yeast were used to inoculate the following foods: hot dogs, corn meal, ketchup, orange juice, yogurt, and cake mix . Each collaborator received 15 samples of each food type: 5 low-level inoculations, 5 high-level inoculations, and 5 uninoculated samples . There was no significant difference between the means of the 2 methods for any product or inoculation level . The Petrifilm yeast and mold count plate method for enumeration of yeasts and molds in foods has been adopted first action by AOAC INTERNATIONAL.

Am J Surg, 1997 Jul, 174(1), 39 - 44
The influence of ischemic bowel wall damage on translocation, inflammatory response, and clinical course; Schoeffel U et al.; BACKGROUND: While vascular patency and overall viability of the gut can be evaluated perioperatively, damage to the mucosal barrier can hardly be judged in the perioperative setting and, moreover, will probably determine the clinical course . METHODS: In 19 consecutive cases with intestinal ischemia, the clinical course was correlated to the severity of the disease (APACHE II; Septic Severity Score, SSS), the intraabdominal and systemic inflammatory response, and the translocation of bacteria and endotoxin . RESULTS: The comparison of the 10 survivors with the nonsurviving group revealed no differences as to the length of history, serum lactate levels, white blood cell counts, body temperature, markers of the inflammatory response, or quantity and macroscopic quality of the exudate . Differences were found in intraperitoneal bacteriology (prevalence 0.37, negative predictive value for lethal outcome 0.8), endotoxin concentrations in the exudate (P = 0.02) and in the plasma (P = 0.015), fibrinopeptide A levels (exudate P = 0.036; plasma P = 0.015), PGE2 plasma concentration (P = 0.0357), and APACHE II (P = 0.0034) and SSS (P = 0.0027) values . CONCLUSION: The clinical course of ischemic bowel wall necrosis seems to depend on the severity of the disease at admission and on the integrity of the mucosal barrier rather than on inflammatory response, therapeutic measures, or supportive treatment.

Int J Syst Bacteriol, 1997 Jul, 47(3), 687 - 92
Actinomyces europaeus sp . nov., isolated from human clinical specimens; Funke G et al.; Ten strains of a hitherto undescribed catalase-negative, facultatively anaerobic, coryneform bacterium were isolated or collected by workers at three European clinical bacteriology laboratories or reference centers . These strains were isolated from humans, and most came from abscess material . Biochemical and chemotaxonomic characterization revealed that the strains belonged to the genus Actinomyces . The phenotypic features of the 10 strains were incompatible with the descriptions of the previously established Actinomyces species . A comparative 16S rRNA gene sequence analysis demonstrated that the previously undescribed strains constitute a new line in the genus Actinomyces . The name Actinomyces europaeus sp . nov . is proposed for these clinical isolates . The type strain is CCUG 32789A.

J Pediatr Gastroenterol Nutr, 1997 Jul, 25(1), 74 - 8
Normal gastric histology in Helicobacter pylori-infected children; Gottrand F et al.; BACKGROUND: In adults, Helicobacter pylori infection is always associated with gastritis or ulcer . However, very active gastritis and ulcers are rarely seen in children . The aim of the present work was to study the relationships between H . pylori and gastric mucosa in children . METHODS: Eighty infected children and adolescents including 48 (60%) neurologically impaired institutionalized patients, aged 2 months-22 years (mean 11.7 +/- 5.2 years) were studied retrospectively . All the patients underwent gastroscopy, and three antral and two fundic biopsy specimens were taken for histology and bacteriology . RESULTS: A normal gastric mucosa was found in 22 of 80 patients (27.5%), whereas the others had gastritis (n = 58, 72.5%) . There were no statistical differences between patients with normal histology and those presenting with gastritis for age, sex, ethnic background, symptoms, and the degree of bacterial colonization . The macroscopic aspect of gastritis was less frequently found in children with a normal histology compared with those with histological gastritis (p < 0.001) . CONCLUSIONS: These data show that H . pylori infection can be associated with a normal gastric histology in children.

J Comput Assist Tomogr, 1997 Jul-Aug, 21(4), 601 - 7
High resolution chest CT in tuberculosis: evolutive patterns and signs of activity; Poey C et al.; PURPOSE: The purpose of our study was to determine evolutive patterns and signs of active tuberculosis on high resolution CT (HRCT) scans . METHOD: We followed up over 15 months 27 patients with postprimary pulmonary tuberculosis that was proven bacteriologically . CT scans were performed before, during, and after 6 months of anti-tuberculosis treatment . Both 10-mm-thick sections and 1.5-mm-thick HRCT scans were performed . RESULTS: Ground-glass pattern was noticed 26 times, 9 times after 2 month treatment and only 2 times after 6 month treatment . Among these two patients, one did not undergo his treatment properly and the other one had an additional bacterial infection . Centrilobular nodules (n = 17) and poorly marginated nodules (n = 21) were present only before treatment . Reticular pattern (intralobular and septal thickening), interstitial nodules, and fibrosis were seen both before and after treatment . Ground-glass pattern, poorly marginated nodules, and infiltrates as well as centrilobular nodules were related to an active infection . CONCLUSION: This HRCT may be helpful to demonstrate activity in patients suspected of having tuberculosis and to assess antituberculous treatment efficiency.

Mayo Clin Proc, 1997 Jul, 72(7), 683 - 7
The yellow brick road to penicillin: a story of serendipity; Henderson JW; Approximately 14 years elapsed between Sir Alexander Fleming's discovery of penicillin (in 1928) and its full-scale production for therapeutic use (in 1942) in World War II . The following factors were responsible for the delay: a scientific explanation of Fleming's "phenomenon," classification of the fungus secreting the active substance, source of the mold, initial difficulty of other bacteriologists in reproducing Fleming's discovery, identifying the chemical makeup of penicillin, search for other penicillin-producing organisms to enhance production of penicillin, purification and crystallization of penicillin, experiments on animals (chiefly mice) to determine toxicity, hesitancy to administer the drug to humans, standardization of an effective dosage for humans, and search for equipment and financial resources to enhance full-scale production . The adjunctive role of serendipity (chance, happenstance, improbability, and luck) in overcoming these obstacles and in contributing to the successful, scientific conclusion of the penicillin project is an unusual story.

FEMS Microbiol Lett, 1997 Jun 15, 151(2), 249 - 55
Application of the variable region in 16S rDNA to create an index for rapid species identification in the genus Streptomyces; Kataoka M et al.; Partial nucleotide sequences (120 bp) of the 16S rRNA gene (rDNA) containing a variable alpha region were compared in 89 strains of the genus Streptomyces belonging to eight major clusters of category I in Bergey's Manual of Systematic Bacteriology . Fifty-seven kinds of partial 16S rDNA sequences were observed among the 89 strains . Forty-three of the strains were grouped into 11 'identity groups', based on the fact that the strains in each group shared an identical sequence in the 120-bp region . The results of a phylogenetic analysis based on the 16S rDNA 120-bp sequences revealed that 60 of the 89 strains could be categorized into seven clusters, each consisting of four or more strains . Based on these observations it was concluded that short nucleotide sequences bearing the variable alpha region are useful for Streptomyces species identification.

Brain Res, 1997 Jun 13, 759(2), 295 - 300
Establishment and characteristics of a practical and useful astrocyte cell line transformed by a temperature-sensitive mutant of simian virus 40; Kitamura Y et al.; A practical mouse astrocyte cell line (A640-IG) was established by transformation with a temperature-sensitive mutant of simian virus 40 (SV40) and the relationship between the function of SV40 large T antigen and the growth and differentiation of A640-IG cells, which are most clearly dependent on temperature that ever established, was reported . A640-IG cells proliferated actively with expression of large T antigen when they were cultured at 33 degrees C . They had a fibroblast-like appearance, and displayed faint immunoreactivity with an antibody against glial fibrillary acidic protein (GFAP) . However, when large T antigen expression ceased at 39 degrees C, the cells did not grow actively and differentiated into astrocytes as demonstrated by both their morphological and immunohistochemical characteristics . Differentiation into astrocytes was more obvious when the cells were plated on bacteriological dishes in high density . Western blotting confirmed immunohistochemical observations . A640-IG cells thus showed contrasting behaviour in terms of cell growth and differentiation depending on the temperature . This unique and practical astrocyte cell line is a useful model for investigating the mechanisms of astrocyte growth and differentiation.

Vet Rec, 1997 Jun 7, 140(23), 602 - 5
Transmission of Brucella melitensis from sheep to lambs; Grillo MJ et al.; Forty-one pregnant sheep showing positive immune responses to Brucella melitensis in serological or allergic tests were selected from naturally infected flocks and kept in an isolated pen for lambing . The resulting 62 lambs were maintained in the same pen with their dams during lactation . When the lambs were weaned, the dams were slaughtered for bacteriological study and the lambs were reared in a clean pen . Fourteen ewes excreted B melitensis during lactation and 17 were found to be infected postmortem, B melitensis was not isolated from seven lambs (three born to infected dams) which died after birth or from eight seronegative lambs (four born to infected dams) which were slaughtered between two and seven months after weaning . However, one permanently seropositive lamb born to a culture-negative dam was found to be infected when necropsied five months after weaning . The remaining 46 lambs were reared until adulthood and slaughtered at intervals for bacteriological study . Four ewe lambs (two born to culture-negative dams) were found to be infected postmortem, but were negative in immunological tests for B melitensis.

Berl Munch Tierarztl Wochenschr, 1997 Jun, 110(6), 206 - 10
{Comparison of the results from commercially available Brucella ELISA test kits for the investigation of bovine sera}; Staak C et al.; Bovine sera from a farm with bacteriologically confirmed brucellosis were taken for comparative serological studies using conventional methods (slow agglutination test--SAT, complement fixation test--CFT, Rose-Bengal-plate-agglutination-test--RBPT) and 5 different commercially available brucellosis ELISA testkits . These serum samples together with other infectious sera producing low level positive antibody titers in conventional tests did not react uniformly when tested by five different commercial ELISA testkits . The introduction of a standard control serum with a general cut-off resulted in a greater uniformity of ELISA results from 4 of 5 ELISA testkits and a closer approach to results of the CFT which is regarded as the confirmatory test for brucellosis . This control serum, on the other hand, was not suitable for the identification of the sensitivity of the various ELISA test kits . For this purpose, in SAT and CFT weakly positive reacting brucella sera from infected farms is needed.

J Epidemiol, 1997 Jun, 7(2), 93 - 8
Differing influence on delays in the case-finding process for tuberculosis between general physicians and specialists in Mongolia; Enkhbat S et al.; The objective of this study is to compare the influence on delays in the tuberculosis case-finding process according to the types of medical facilities initially visited . The subjects include 107 patients 16 years and older who were diagnosed with bacteriologically confirmed pulmonary tuberculosis at nine tuberculosis specialized facilities in Ulaanbaatar, Mongolia from May 1995 to March 1996 . Patients were interviewed about their demographic and socioeconomic factors and their medical records were reviewed for measuring delays . Fifty-five patients initially consulted general physicians and the remaining 52 patients initially visited other types of facilities including tuberculosis specialized facilities . Patients who initially consulted general physicians had shorter patient's delays and longer doctor's delays than those who had visited other facilities first . Since the reduction of patient's delay outweighs the extension of doctor's delay among patients who initially consulted general physicians, their total delay was shorter than that of patients who visited other facilities first . The beneficial influence of consulting general physicians first on the total delay was observed after adjusting for patient's age, sex, residence area, family income and family history of tuberculosis . This finding indicates that general physicians play an important role in improving the passive case-finding process in Mongolia.

Burns, 1997 Jun, 23(4), 345 - 8
Seven-year experience with a 'quarantine and isolation unit' for patients with burns . A retrospective analysis; van Rijn RR et al.; In the burns unit of the Red Cross Hospital, Beverwijk . The Netherlands we performed a retrospective analysis to evaluate whether the spread of multi-resistant micro-organisms (MRMO) in burn victims with a high risk of contamination can be prevented by isolation in a quarantine and isolation unit (QIU) . We analysed 1006 patients who where consecutively admitted to the burns unit between 26-03-1985 and 31-12-1992 . The age TBSA, and the bacteriological status of all patients were recorded . With regard to the stay in the QIU we recorded the actual number of days between the accident and the time of admission, the duration of the stay, and the therapy given . Of 1006 patients, 72 met the criteria of the Dutch Health Inspectorate for classification as high risk of MRMO contamination . Sixty-one of these 72 patients were treated in the QIU . The mean duration of stay in the QIU was 8.2 days, admission was at 10.2 days postburn, and 20 patients did harbour MRMO . There was no report of any cross-contamination . Since the QIU became operational there have been no outbreaks of MRMO in our burns unit . In our opinion this shows the effectiveness of the QIU.

APMIS, 1997 Jun, 105(6), 457 - 62
Eikenella corrodens-caused botryomycosis-type pneumonia in a barbary ape (Macaca sylvanus); Brack M; An 18-year-old female barbary ape in a safari park died from a mixed bacterial infection . Staphylococus aureus was isolated from a purulent necrotic mastitis and from a chronic purulent granulomatous sialoadenitis of the sublingual glands, Eikenella corrodens from a botryomycosis-type pneumonia . As judged by histopathology, mixed infection of S . aureus and E . corrodens was present in the sialoadenitis, and E . corrodens botryomycosis-type bacterial colonies were also present in the pancreatic parenchyma, though here no bacteriological isolation was attempted . A generalized amyloidosis, and especially pancreatic islet amyloidosis, probably indicated an altered immunological competence.

J Dairy Sci, 1997 Jun, 80(6), 1113 - 8
Evaluation of selected antibiotic residue screening tests for milk from individual goats; Contreras A et al.; Because somatic cell counts (SCC) of caprine milk are higher than SCC of bovine milk, the performance of antibiotic residue tests for screening bovine milk was investigated for caprine milk . Eighty-five does that were free of antibiotic usage for at least 30 d and that were free of clinical mastitis were sampled at three milkings during a 37-d period . At each sampling, foremilk was collected for bacteriological analysis, and composite bucket milk samples were collected for antibiotic testing and SCC . Day of lactation, parity, 305-d mature equivalent milk yield, and SCC averaged 221 d (57 to 577 d), 2.3 lactations (one to nine lactations), 1160 kg (623 to 1750 kg), and 2.2 x 10(6)/ml (0.3 to 30.7 x 10(6)/ml), respectively . The mean Dairy Herd Improvement Association test day milk yield for the month of sample collection was 3 kg (1.4 to 6.4 kg) . Intramammary infections were present in 54% of the goats and in 36% of the udder halves . Assays included positive (5 and 10 ppb of penicillin-G and 50 ppb of ceftiofur) and negative controls that had been prepared in caprine milk and controls supplied by the manufacturers . One false-negative outcome and one false-positive outcome were recorded . For one sampling day, a positive linear relationship existed between SCC and the results of one test, and a quadratic relationship existed between SCC and the results of another test . The antibiotic residue screening tests for milk from individual goats adequately identified milk that was free of antibiotic . These tests are therefore recommended for use with caprine milk.

Surg Laparosc Endosc, 1997 Jun, 7(3), 206 - 8
Reactive pleuropericarditis following laparoscopic fundoplication; Viste A et al.; Postpericardiotomy syndrome is not uncommon following cardiac surgery . The syndrome is characterized by fever, chest pain, leucocytosis, and signs of pericardial and pleural effusions . A patient with similar symptoms after laparoscopic treatment of reflux esophagitis is reported . Antibiotic treatment had no effect on a suspected bacteriological infection . There was a dramatic clinical response to corticosteroid treatment . The etiology and pathogenesis of the syndrome are discussed.

Eur Respir J, 1997 Jun, 10(6), 1327 - 31
Increased risk of tuberculosis transmission in families with microepidemics; Vidal R et al.; In the present study, we analysed: 1) prevalence of TB infection and incidence of disease among family contacts of a cohort of patients with TB; 2) differential characteristics of families with microepidemics and families with < or = 1 new case of TB; and 3) efficacy of chemoprophylaxis in this group of contacts . Three thousand and seventy one family contacts of 635 patients with TB were studied . The study consisted of tuberculin skin testing and chest radiography in all cases, and bacteriological studies when active disease was suspected . Contacts were classified as belonging to: families with microepidemics (FME) (those with > or = 2 new cases of TB); families with one new case; and families with with no new cases . Chemoprophylaxis was prescribed in contacts following standard recommendations; all were followed up for 12-18 months . Rates of TB infection and disease among families, as well as the incidence of TB disease between those compliant and noncompliant with chemoprophylaxis were compared . Among the 3,071 contacts, 1,264 (41%) were infected and 176 (6%) had TB . Twenty two families with FME (3%) yielded 55 new cases of TB . The prevalence of infection (excluding the TB cases) was 80% in families with FME, 52% in families with one new case, and 41% in families with no new case (odds ratio (OR) 3.7; 95% confidence interval (95% CI) 2.1-6.5) . Sputum smears were positive in 53% of cases in FME and 24% in non-FME families (OR 3.4; 95% CI 1.7-6.5) . Bronchial sample cultures were positive in 84% of patients from FME families but in only 40% of those from non-FME families (OR 7.5; 95% CI 3.6-15.8) . Chemoprophylaxis was prescribed in 356 contacts, of whom 296 complied and generated only one new case of TB, whilst there were 13 new cases among the 60 who did not comply (OR 81.6; 95% CI 26.7-248.7) . This study showed the prevalence of infection and incidence of tuberculosis among family contacts of patients with newly diagnosed tuberculosis to be very high . A small number of families with microepidemics accounted for most new cases of tuberculosis, which were also more infectious . The extremely high risk of transmission in these families, together with the proven efficacy of chemoprophylaxis, justifies prescription of chemoprophylaxis to all their members, regardless of age.

Br J Surg, 1997 Jun, 84(6), 819 - 21
Perianal sepsis in children; Nix P et al.; BACKGROUND: Perianal sepsis is a relatively common surgical problem in children and yet the contribution of rare aetiological factors, the frequency of fistula formation complicating perianal abscess, the significance of bacteriological findings and the optimum treatment of fistula in ano are poorly understood . METHODS: A consecutive series of 58 children (51 boys, seven girls) with a perianal abscess or fistula attending a tertiary referral centre over a 4-year period was reviewed . RESULTS: Thirty-eight children (34 boys, four girls), ranging in age from 1 month to 12 years, presented with an abscess . After treatment, three developed a further abscess but only four developed a fistula . Fistula formation only occurred in those with enteric bacterial infection . Of 24 children with a perianal fistula five required further surgery for recurrence, four of whom were initially treated by fistulotomy . In most patients, the fistula was simple, low and direct, and treatment by fistulectomy resulted in significantly fewer recurrences . Apart from Crohn's disease, identifiable aetiological factors were rare . CONCLUSION: Perianal sepsis is most common in otherwise healthy boys under 2 years of age . Abscess is best treated by incision and drainage, and fistulectomy is successful for the small proportion who develop a fistula.

Clin Exp Immunol, 1997 Jun, 108(3), 490 - 6
Differential susceptibility to Mycoplasma pulmonis intranasal infection in X-linked immunodeficient (xid), severe combined immunodeficient (scid), and immunocompetent mice; Sandstedt K et al.; Mice with the scid mutation are highly susceptible to Mycoplasma pulmonis infection and develop a disseminated disease . In order to study the contribution of humoral immunity to the immune response, M . pulmonis was inoculated intranasally to X-linked immunodeficient (xid) mice . Severe combined immunodeficient (scid) and immunocompetent CBA mice were used as controls . The mice were killed and necropsied at day 30 or 37 post-infection . Samples from the nose, lungs and joints were taken for bacteriological and histological examination . Rhinitis was observed in all mouse strains . Chronic purulent bronchopneumonia was diagnosed in some of the CBA mice . Xid mice did not show severe lung lesions, despite the presence of numerous mycoplasma organisms in the lungs, in contrast to immunocompetent mice, which developed lung pathology . Scid mice showed less signs of pneumonia, but unlike in xid and CBA mice, there was spread of mycoplasmas from the respiratory tract and severe pathological changes in the joints . Our results indicate that B and/or T lymphocytes protect against dissemination of M . pulmonis from the airways . Innate immune reactions and/or bacterial virulence factors seem to contribute to the development of joint lesions, whereas IgG3 and IgM antibodies might be involved in lung pathology.

Can J Public Health, 1997 May-Jun, 88(3), 197 - 201
Issues in the management of contacts of patients with active pulmonary tuberculosis; Menzies D; The evidence regarding the transmission of tuberculosis and risk of infection and disease in several specific clinical situations has been reviewed . There is considerable epidemiologic evidence that contagiousness is not an all-or-nothing phenomenon and is affected by several factors, only one of which is the bacteriologic status of the patient's sputum . Although untreated smear negative, culture positive patients are less contagious on average, they still may transmit infection to their close and casual contacts . Compared with contacts with tuberculin conversion, persons who are already tuberculin positive have much lower risk of developing active tuberculosis after exposure, and persons with prior BCG vaccination are at somewhat lower risk . Preventive therapy will be of less benefit, but should still be recommended for contacts who are heavily exposed or are immune compromised . Epidemiologic studies using RFLP techniques could provide more precise answers to the questions in this review.

Arch Pediatr, 1997 May, 4(5), 460 - 3
{Treatment of infectious osteoarthritis in children}; Barthes X et al.; Treatment of septic arthritis is an emergency; therefore antibiotherapy must be started rapidly following the bacteriological sampling . The risk for the articles justifies that treatment be started with two antibiotics given intravenously, the choice of the antibiotics being dependent upon the clinical history . If the bacteria is isolated, an adopted monotherapy is then maintained . A drainage of the joint can be performed by needle aspiration or by a percutaneous catheter, and in case of difficulty to control the sepsis, by surgical debridment . Intravenous antibiotherapy is maintained for 7 to 15 days . Whenever a good response is observed the treatment is continued orally for a total duration of 4 to 6 weeks.

Vet Res, 1997 May-Jun, 28(3), 239 - 46
Use of an experimental chicks model for paratuberculosis enteritis (Johne's disease); Valente C et al.; Developments in the diagnosis and treatment of paratuberculosis is constrained by the lack of an experimental animal model . To investigate this problem conventional chicks immunodepressed by a Cyclophosphamide injection and concurrent inoculation of Infectious Bursal Disease Virus (IBDV) were infected with Mycobacterium paratuberculosis and kept for 4 months . The immunodepressed chicks eliminated mycobacteria with their faces from the first month until the third month and developed typical intestinal lesions of mycobacterial infection characterized by aggregation of macrophages with monocytes and lymphocytes . Diarrhoea was absent . The number of lymphocytes decreased by about 80% . The serological tests carried out with Complement Fixation test were negative . For the positive bacteriology and typical granulomatous lesions, the conventionally reared chicks proved to be a useful laboratory model for reproduction of Johne's disease.

J Antimicrob Chemother, 1997 May, 39(5), 663 - 6
Accelerated bacteriological evaluation in the management of lower respiratory tract infection in general practice; Shackley P et al.; This paper examines the use of overnight accelerated bacteriological evaluation (ABLE) in the treatment of lower respiratory tract infection in general practice . The use of ABLE is compared with the empirical prescribing of antibiotics . The results indicate that ABLE leads to a saving in resource use without a deterioration in clinical outcome . In view of there being additional benefits, such as reduced antibiotic exposure and repeat visits, it is concluded that the use of ABLE in the way described would improve the management of lower respiratory tract infection in general practice.

J Antimicrob Chemother, 1997 May, 39(5), 631 - 8
A multi-centre study to compare meropenem and cefotaxime and metronidazole in the treatment of hospitalized patients with serious infections; Mehtar S et al.; We conducted a prospective, multi-centre, open, randomized study in 11 UK hospitals to compare iv meropenem 1 g tds with the combination of iv cefotaxime 1 g tds and iv metronidazole 500 mg tds in patients with serious infections . One hundred and sixty-one patients were enrolled, of whom 131 were clinically evaluable (meropenem, n = 68; cefotaxime/metronidazole, n = 63) . The most common infections were subsequent to intra-abdominal pathology (meropenem, n = 77%; cefotaxime/metronidazole, n = 75%), and were usually accompanied by septicaemia (meropenem, n = 61%; cefotaxime/metronidazole, n = 53%) . The incidence of a satisfactory clinical response was similar in the two groups at the end of treatment (93% for meropenem; 92% for cefotaxime/metronidazole) and up to 8 weeks later (96% for meropenem; 93% for cefotaxime/metronidazole) . Satisfactory bacteriological response (success or presumed success) was recorded at the end of therapy in 86% of meropenem and 88% of cefotaxime/metronidazole patients . Adverse events were reported in 32% of meropenem and 25% of cefotaxime/metronidazole patients, and most were mild or moderate and did not require discontinuation of therapy . Twenty-one patients (ten meropenem and 11 cefotaxime/metronidazole) died during the trial, underlining the severity of the infections being treated in this group of patients . None of the deaths was thought to be related to study therapy.

J Cell Sci, 1997 May, 110 ( Pt 9), 1091 - 8
Binding of urokinase to plasminogen activator inhibitor type-1 mediates cell adhesion and spreading; Planus E et al.; Urokinase plasminogen activator and its receptor are both found at the surface of the cell membrane in many cell types . The plasminogen activator inhibitor type-1 (PAI-1) is often associated with the extracellular matrix . The spatial localization of these three molecules could account for their involvement in cell adhesion and/or migration . We have shown previously that the urokinase receptor mediates mechanical force transmission across the cell surface to the cytoskeleton . Here we investigated whether immobilized plasminogen activator inhibitor type 1 (PAI-1) could regulate cell spreading and cytoskeleton reorganization . Serum deprived human myogenic cells were plated in serum free medium onto bacteriologic dishes precoated with different extracellular matrix ligands (fibronectin, vitronectin, or type 1 collagen) or PAI-1 at increasing concentrations . The number of adherent cells and their projected area were quantitated after 3 hours of plating . PAI-1 promoted cell adhesion and spreading in a dose dependent manner . Addition of antibodies to PAI-1 inhibited the adhesion on PAI-1 coated dishes in a dose dependent way . The PAI-1 mediated cell adhesion required the presence of urokinase at the cell surface . Removal of the glycosylphosphatidylinositol (GPI)-linked proteins abolished cell adhesion on PAI-1 dish, suggesting its dependence on the presence of the urokinase receptor, a GPI-linked receptor . Furthermore, addition of antibodies against alpha v beta3 integrin completely inhibited cell adhesion on PAI-1, suggesting that alpha v beta3 might be the transmembrane molecule that physically connects the complex of PAI-1, urokinase, and urokinase receptor to the cytoskeleton . Visualization of spread cells stained for filamentous actin with confocal microscopy showed a dose-dependent increase of filopodia on PAI-1 coated dishes and cytoskeletal reorganization, suggesting a migratory profile . These data indicate that PAI-1 plays a direct role in dynamic cell adhesion particularly at the leading edge, where increased levels of urokinase plasminogen activator (uPA) and its receptor (uPAR) are localized in migrating cells . Immobilized PAI-1 could therefore serve to bridge the cell surface with the extracellular matrix via the formation of a multimolecular complex that includes alpha v beta3 integrins in myogenic cells.

J AOAC Int, 1997 May-Jun, 80(3), 530 - 43
Assurance enzyme immunoassay for detection of enterohemorrhagic Escherichia coli O157:H7 in selected foods: collaborative study; Feldsine PT et al.; Five foods types were analyzed by the Assurance EHEC (Escherichia coli O157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method . Each sample of each food type at each inoculation level was simultaneously analyzed by both methods . A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated . Samples were inoculated with E . coli O157:H7, except for one lot of poultry that was naturally contaminated . A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods . Thirteen samples were positive by BAM but negative by EIA . Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results . The Assurance method for detection of E . coli O157:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.

J AOAC Int, 1997 May-Jun, 80(3), 517 - 29
Visual immunoprecipitate assay (VIP) for detection of enterohemorrhagic Escherichia coli (EHEC) O157:H7 in selected foods: collaborative study; Feldsine PT et al.; Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli O157:H7 . A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated . Food types were inoculated with strains of E . coli O157:H7, with the exception of one lot of poultry, which was naturally contaminated . During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods . Two samples were positive by BAM and negative by VIP . Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results . The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.

Mil Med, 1997 May, 162(5), 366 - 70
Systemic sepsis following hemorrhagic shock: alleviation with oral interleukin-6; Rollwagen FM et al.; Gut-origin sepsis is a serious medical complication of military injuries following hemorrhage . Splanchnic ischemia induces intestinal necrosis leading to systemic bacteremia . Rat and mouse models of hemorrhagic shock were used to investigate bacterial translocation from the gut . Orally administered ameliorative treatments using the cytokine interleukin-6 (IL-6) were able to reduce or eliminate sepsis following hemorrhage . To mimic battlefield wounds and hemorrhage, anesthetized mice were bled from the femoral artery, held at a mean arterial blood pressure of 35 mm Hg for 1 hour, and then resuscitated with shed blood and 2-fold volume lactated Ringer's solution . Anesthetized rats were bled from the carotid artery at a rate of 15 ml/kg at 1 ml/minute . Bacteriological cultures of livers and mesenteric lymph nodes from hemorrhaged animals given recombinant IL-6 had significantly fewer colonies per gram of tissue than saline-fed controls . 125I-labeled IL-6 remained in the gut for up to 6 hours giving regional protection, whereas labeled interleukin-2 was disseminated throughout the body in the same time . In vivo and vitro studies of IL-6 showed that long incubations with high doses of trypsin, chymotrypsin, or intestinal contents were necessary to inactivate the bioactivity of this cytokine . Electron microscopy showed that epithelial cells from hemorrhaged mice fed saline had sparse or missing villi and vacuolated cytoplasm . Epithelial cells from control mice or mice hemorrhaged and fed cytokine appeared completely normal . Oral administration of IL-6 on the battlefield may be an important treatment for the prevention of sepsis following hemorrhage.

Mil Med, 1997 May, 162(5), 325 - 7
The achievements of William Crawford Gorgas; Craddock WL; From an obscure frontier surgeon George Crawford Gorgas became internationally acclaimed as a preventive medicine genius . By his initiative in translating the known scientific facts made possible during the blossoming of bacteriology, he performed service not only in the United States but in Cuba, Central and South America, South Africa, and Eastern Europe . He fought for 10 years successfully against yellow fever, malaria, and other diseases during the construction of the Panama Canal, and continued triumphs against disease in other world situations . This is a rather concise account emphasizing his continued devotion and dedication as a humanitarian . He fashioned the Army Medical Department into an efficient machine as Surgeon General, and following his amazing military career of over 38 years, made further contributions in preventive medicine with the Rockefeller Foundation.

Clin Infect Dis, 1997 May, 24(5), 810 - 5
Single daily dosing of aminoglycosides in immunocompromised adults: a systematic review; Hatala R et al.; We examined the efficacy and toxicity of single daily dosing (SDD) of aminoglycosides for febrile, immunocompromised adults by systematically reviewing four randomized, controlled trials of SDD vs . standard dosing regimens . We assessed the methodological quality of each study and extracted data pertaining to efficacy and toxicity outcomes . Pooled risk ratios for the efficacy outcomes were bacteriologic cure, 1.00 (95% confidence interval {CI}, 0.86-1.16); clinical cure, 0.97 (95% CI, 0.91-1.05); and mortality, 0.93 (95% CI, 0.62-1.41) . The pooled nephrotoxicity risk ratio was 0.78 (95% CI, 0.31-1.94) . Only one study assessed ototoxicity . Although our study was limited by the small number of trials available for review, the results suggest that SDD of aminoglycosides may be efficacious for febrile, immunocompromised patients . Additional studies are necessary for more precise quantification of the mortality and toxicity risk ratios.

Clin Infect Dis, 1997 May, 24(5), 786 - 95
A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides; Bailey TC et al.; We conducted a meta-analysis of 22 randomized, controlled trials in which extended-interval dosing of aminoglycosides was compared with multiple daily dosing . When we classified intermediate outcomes as successes, we found that patients receiving extended-interval dosing were at significantly reduced risk of clinical treatment failure (risk difference, -3.4%; 95% confidence interval {CI}, -6.7% to -0.2%; P = .039) and that there was a trend toward reduced risk of bacteriologic failure (risk difference, -1.7%; 95% CI, -5.4% to +2.1%; P = .38) . Reclassification of intermediate outcomes as failures yielded similar results . There was significant heterogeneity among the trials, necessitating cautious interpretation of these outcomes . There were negligible differences in the risk of nephrotoxicity (risk difference, -0.6%; 95% CI, -2.4% to +1.1%; P = .46) and ototoxicity (risk difference, +0.3%; 95% CI, -1.2% to +1.8%; P = .71) . We conclude that for many indications, extended-interval dosing of aminoglycosides appears to be as effective as conventional dosing, with similar rates of toxicity . The added convenience of extended-interval dosing makes it an attractive alternative to conventional dosing.

Am J Vet Res, 1997 May, 58(5), 472 - 7
Safety and immunogenicity of Brucella abortus strain RB51 vaccine in pregnant cattle; Palmer MV et al.; OBJECTIVE: To determine the safety and immunogenicity of Brucella abortus strain RB51 as a vaccine in pregnant cattle . ANIMALS: 12 Polled Hereford heifers obtained from a brucellosis-free herd and bred on site at 16 months of age to a brucellosis-free bull . PROCEDURE: Pregnant heifers were vaccinated at 6 months' gestation with 10(9) colony-forming units of B abortus strain RB51 (n = 5), 3 x 10(8) colony-forming units of B abortus strain 19 (n = 5), or sterile pyrogenfree saline solution (n = 2) . Samples were periodically collected for serologic testing and lymphocyte blastogenesis assays . At full gestation, heifers were euthanatized and specimens were collected for bacteriologic culture, histologic analysis, and lymphocyte blastogenesis assay, using various antigenic stimuli . RESULTS: None of the strain RB51- or strain 19-vaccinates aborted or had gross or microscopic lesions at necropsy that were consistent with brucellosis . Maternal blood mononuclear cells from strain RB51- and strain 19-vaccinates had proliferative responses to gamma-irradiated strain RB51 and strain 19 that were greater than responses by cells from nonvaccinated controls . In contrast, maternal superficial cervical lymph node cells from strain 19-vaccinates had proliferative responses to gamma-irradiated strain RB51 or strain 19 bacteria greater than those of cells from RB51-vaccinates and nonvaccinated controls . None of the heifers vaccinated with strain RB51 developed antibodies detected by use of the standard tube agglutination test, but all developed antibodies to strain RB51 that reacted in a dot ELISA, using irradiated strain RB51 as antigen . CONCLUSIONS: Pregnant cattle can be safely vaccinated with strain RB51 without subsequent abortion or placentitis . Furthermore, strain RB51 is immunogenic in pregnant cattle, resulting in humoral and cell-mediated immune responses, but does not interfere with serologic diagnosis of field infections.

Kyobu Geka, 1997 May, 50(5), 409 - 12
{Successful surgical treatment for giant non-specific cyst in the anterior mediastinum}; Wakiyama H et al.; A 46-year-old woman was admitted to our hospital with giant cyst in the anterior mediastinum . We strongly suspected the cyst would be cystic teratoma from preoperative examinations . Cystectomy was undergone through a right thoracotomy in the 6th intercostal space . The cyst, 15 x 14 x 13 cm in size, had a fibrous wall and contained yellowish serous fluid with hair-ball which revealed aseptic bacteriologically . In the pathological study, the cyst had no recognizable specific epithelium or mesothelium, and this finding was incompatible with cystic teratoma . Due to lack of teratoid elements, the final diagnosis was "non-specific mediastinal cyst" . The cyst was considered to be the result of inflammation or intracystic auto-digestion by enzymes from the alimentary tissue of the cystic teratoma.

J Clin Microbiol, 1997 May, 35(5), 1097 - 100
Direct detection and identification of Mycobacterium ulcerans in clinical specimens by PCR and oligonucleotide-specific capture plate hybridization; Portaels F et al.; We compared various diagnostic tests for their abilities to detect Mycobacterium ulcerans infection in specimens from patients with clinically active disease . Specimens from 10 patients from the area of Zangnanado (Department of Zou, Benin) with advanced, ulcerated active M . ulcerans infections were studied by direct smear, histopathology, culture, PCR, and oligonucleotide-specific capture plate hybridization (OSCPH) . A total of 27 specimens, including 12 swabs of exudate collected before debridement and 15 fragments of tissue obtained during debridement, were submitted to bacteriologic and histopathologic analysis . The histopathologic evaluation of tissues from all six patients so tested revealed changes typical of those caused by M . ulcerans infection . Five specimens were contaminated, and M . ulcerans was cultivated on Lowenstein-Jensen medium from 12 of the remaining 22 (54.5%) specimens . Detection of mycobacteria was performed by PCR, and M . ulcerans was detected by OSCPH with a new probe (5'-CACGGGATTCATGTCCTGT-3') reacting with M . ulcerans and Mycobacterium marinum . In 10 of 22 (45.5%) specimens, M . ulcerans was identified by PCR-OSCPH . There was no statistically significant difference between the detection of M . ulcerans by culture and by PCR-OSCPH (P > 0.05) . This is the first demonstration of an amplification system (PCR-OSCPH) with a sensitivity similar to that of culture for the direct and rapid recognition of M . ulcerans in clinical specimens . This system is capable of identifying M . ulcerans, even in paucibacillary lesions . Our findings suggest that PCR-OSCPH should be used in the quest for the elusive environmental reservoir(s) of M . ulcerans.

Presse Med, 1997 Apr 12, 26(12), 551 - 4
{Assay of lactic acid in the cerebrospinal fluid for the diagnosis of bacterial meningitis . Strategies for the choice of discriminatory threshold}; Pavese P et al.; OBJECTIVES: In search for a supplementary marker of bacterial meningitis in cases where conventional bacteriology, cytology and chemistry are insufficiently contributive to diagnosis, we assessed the value of cerebrospinal fluid lactate levels in children with bacterial meningitis . PATIENTS AND METHODS: Cerebrospinal fluid lactate levels were measured from all spinal taps performed in a pediatric emergency care unit over a two-year period . Of the 332 usable samples there were 32 cases of bacterial meningitis, 104 cases of viral meningitis and 196 other diagnoses (non meningitis) . RESULTS: Average lactate concentration 7 +/- 4 mmol/l in bacterial meningitis versus 2.1 +/- 0.6 mmol/l in viral meningitis (p < 0.0001) . The value of lactic acid concentrations in discriminating between bacterial and viral meningitis was found to be superior to that of other chemistry results: protein, glucose, chloride . The discriminatory threshold of cerebrospinal fluid lactate was 3.7 mmol/l with sensitivity of 80% and a specificity of 98% . CONCLUSION: We propose routine assay of cerebrospinal fluid lactate in all cases of suspected meningitis.

Presse Med, 1997 Apr 5, 26(11), 500 - 1
{Tuberculosis: epidemiological, bacteriological and therapeutic changes}; Pariente R; The regular decline in the incidence of tuberculosis up to 1985 left us with the hope that the disease might one day be totally irradicated . But from 1985 on the number of cases has remained unchanged at about 8000 new cases per year in France . Resistant strains have also been identified, requiring new treatment strategies . Polyresistant strains may develop because of non-compliance to standard treatment or, particularly in immunosuppressed patients with AIDS, infection with atypical mycobacteria such as Mycobacterium avium . In developed countries, prophylactic measures for tuberculosis should be based on early diagnosis, rapid initiation of a proven treatment protocol not only to obtain cure but also to reduce contagion, and avoiding contract between high-risk patients . Chemoprophylaxy should be prescribed in case of doubt about contact as the tuberculin test is no longer discriminate due to widespread vaccination . For AIDS patients, the treatment protocol is the same as for normal subjects but should be prolonged . In case of M . avium infection, the most effective treatment combines pyrazinamide, clarithromycin and a third anti-tuberculosis drug.

Acta Otorrinolaringol Esp, 1997 Apr, 48(3), 195 - 8
{Lower antrostomy in surgery of the maxillary sinus: experimental study}; Melgarejo Moreno PJ et al.; Inferior nasoantral windows, with or without radical surgical removal of the maxillary sinus mucosa, were evaluated in 15 New Zealand white rabbits . After three months, specimens were obtained for examination . Bacteriological cultures and light and electron microscopic studies were made . Mucociliary clearance was studied . Differences were found in the antrostomy patency rate between radical antrostomy and inferior nasoantral windows . After three months, the creation of a temporary inferior nasoantral window did not change the maxillary sinus mucosa and did not increase the rate of sinus infections in rabbits.

J Vet Diagn Invest, 1997 Apr, 9(2), 172 - 9
Investigation of the selenium status of aborted calves with cardiac failure and myocardial necrosis; Orr JP et al.; Lesions of heart failure, specifically cardiac dilation or hypertrophy along with a nodular liver (chronic passive congestion) and ascites, have been found in 4-5% of aborted bovine fetuses . In this study, a group of 22 such fetuses was compared with groups of aborted fetuses without lesions of heart failure and with nonaborted fetuses obtained from a slaughterhouse . The fetuses were necropsied, tissues were taken for histopathology, and samples were collected for routine bacteriologic and virologic examinations . Liver and kidney tissue was saved for selenium analysis . Histopathologic examinations of myocardium of fetuses with cardiac failure revealed myocardial necrosis and mineralization in 7 fetuses, lymphocytic myocarditis in 5 fetuses, myocardial fibrosis in 5 fetuses, or no microscopic lesions in 5 fetuses . Mean liver selenium levels were 5.5 mumol/kg in the fetuses with heart lesions, 6.5 mumol/kg in the fetuses without heart lesions and 7.5 mumol/kg in fetuses from the slaughterhouse; these differences were statistically significant . The results suggest that selenium deficiency in bovine fetuses may cause myocardial necrosis and heart failure . This study also provides data on normal liver and kidney selenium levels in bovine fetuses from the analyses of 19 nonaborted fetuses.

J Obstet Gynaecol Res, 1997 Apr, 23(2), 157 - 64
Effects of hormone replacement therapy on sexuality in postmenopausal women in a mideast country; Omu AE et al.; OBJECTIVE: During the postmenopausal period, sexual interest and activity seem to decline, as part of the menopausal effect of oestrogen deficiency . The aim of this study was to evaluate other factors that could contribute to sexual dysfunction and the effect of hormone replacement therapy among postmenopausal women in Kuwait . METHOD: Between June 1992, and June 1994, details of sexual history were compiled from 261 postmenopausal women that attended the Menopause Clinic at the Maternity Hospital, Kuwait . The effect of hormone replacement was analysed from the sexual history and the bacteriology of the lower genital tract . RESULTS: About 71% of the 261 postmenopausal women were still sexually active . Among those not sexually active, 38% had loss of interest, 22% because of divorce or death of husband, 20% from loss of interest by husband, and in 13% because the husbands had impotence from medical problems . Of the sexually active women, 41.1% had reduced libido . Contributing factors included vaginal symptoms like dyspareunia and vaginal dryness, vaginal infection, disturbances in the premenopausal menstrual pattern and disharmony with husbands . About 23 to 45% of the postmenopausal women with oestrogen replacement therapy, had significant relief of their symptoms of sexual dysfunction . Vasomotor symptoms had better response compared to sexual dysfunction (p < 0.01) . Natural oestrogen gave slightly better relief of symptoms of sexual dysfunction than other forms of oestrogen therapy . Livial gave complete relief of dyspareunia and vaginal dryness in 9.1% and 3.9% respectively, but none of those with libido and vaginal discharge had any relief . CONCLUSION: There is a decline in sexual response and activity in postmenopausal women in Kuwait . This is however, multifactorial in origin . Although oestrogen replacement therapy gives significant relief in symptoms of sexual dysfunction, other contributory factors should always be evaluated.

Clin Infect Dis, 1997 Apr, 24(4), 570 - 4
Dosing of amoxicillin/clavulanate given every 12 hours is as effective as dosing every 8 hours for treatment of lower respiratory tract infection . Lower Respiratory Tract Infection Collaborative Study Group; Calver AD et al.; In this double-blind study, 557 patients with lower respiratory tract infection were randomly assigned to receive amoxicillin/clavulanate orally either every 12 hours (875/125 mg) or every 8 hours (500/125 mg) for 7-15 days . For the 455 patients evaluable for clinical efficacy at the end of therapy, clinical success was similar in the two groups: 93% and 94% in the 12-hour and 8-hour groups, respectively (P = .42) . Bacteriologic success at the end of therapy was also comparable: 97% and 91% in the 12-hour and 8-hour groups, respectively (P = .86) . The occurrence of adverse events related to treatment was similar for the two groups, but fewer patients in the 12-hour group reported moderate or severe diarrhea . Amoxicillin/clavulanate (875/125 mg) given every 12 hours is as effective and safe as every-8-hours administration of the combination (500/125 mg) for the treatment of lower respiratory tract infection.

Eur J Obstet Gynecol Reprod Biol, 1997 Apr, 72(2), 121 - 6
Maternal plasma fibronectin: a predictor of preterm delivery; Zygmunt M et al.; OBJECTIVE: Current opinion holds that there are several distinct groups among patients with preterm labour: one of them is characterized by bacterial infection, another one by the presence of placental vascular abnormalities with endothelial damage . The aim of this study was to investigate plasma fibronectin, a suspected biochemical marker of endothelial damage, as an indicator for pregnancies with a high risk of preterm delivery . METHODS: Plasma fibronectin levels were measured in patients with preterm labour (n = 80) and in healthy pregnant women with uncomplicated (control) pregnancies (n = 64) between the 22nd and 36th week of gestation . Furthermore, the plasma concentrations of fibronectin in 15 newborns at term and ten babies born preterm were measured to study the relationship between preterm delivery and plasma fibronectin concentration in newborns . Fibronectin was measured by nephelometry . RESULTS: The mean concentration of fibronectin in patients with preterm labour was 0.44 g/l (S.D., 0.15) vs . 0.25 g/l (S.D., 0.12) in uncomplicated control pregnancies matched for gestational age . In control patients who actually delivered at term, fibronectin values were found to be lower than in control patients who underwent preterm delivery (0.25 g/l; S.D., 0.05; vs . 0.46 g/l; S.D., 0.15; P < 0.05) . Particularly high values were detected in patients with preterm labour delivering before 32 weeks of gestation (0.60 g/l; S.D., 0.16) . There was no significant difference between fibronectin concentrations in the umbilical arterial and venous blood of premature infants and mature infants . Leucocyte concentration, bacteriological smear and cervical dilatation did not correlate with fibronectin concentrations in patients with preterm delivery or controls . CONCLUSION: We conclude that the higher plasma concentrations of fibronectin in women with preterm labour may be a biochemical marker and a predictor of preterm delivery.

Eur J Clin Invest, 1997 Apr, 27(4), 308 - 15
Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia; Kosmas EN et al.; Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-alpha), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection . Thirty otherwise healthy hospitalized patients aged 48 +/- 3 years (mean +/- SEM) and with bacteriologically confirmed CAP were studied prospectively . IL-1 beta and IL-6 were found to be 15-fold higher on admission (122 +/- 9 pg mL-1 and 60 +/- 4 pg mL-1 respectively), whereas TNF-alpha was three-fold higher (102 +/- 5 pg mL-1) than those of controls, all of them showing a decline towards normal . Initial CRP levels were increased 90-fold (416 +/- 1 mg L-1), whereas fibronectin levels were reduced (242 +/- 9 mg dL-1) . The presence of parapneumonic effusion was associated with a higher TNF-alpha serum level (127 +/- 7 vs . 86 +/- 4 pg mL-1, P = 0.0002), a more rapid daily decline in TNF-alpha (-7.2 +/- 0.7 vs . -3.8 +/- 0.5 pg mL-1 day-1, P = 0.0005), a slower rate of decline in CRP (-42.8 +/- 3.0 vs . -54.6 +/- 3.0 mg L-1 day-1, P = 0.02) and a slower rate of increase in FBN (5.9 +/- 1.0 vs . 11.7 +/- 1.0 mg dL-1 day-1), P = 0.001} . Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar-arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.

Clin Microbiol Rev, 1997 Apr, 10(2), 277 - 97
Infection in the bone marrow transplant recipient and role of the microbiology laboratory in clinical transplantation; LaRocco MT et al.; Over the past quarter century, tremendous technological advances have been made in bone marrow and solid organ transplantation . Despite these advances, an enduring problem for the transplant recipient is infection . As immunosuppressive regimens have become more systematic, it is apparent that different pathogens affect the transplant recipient at different time points in the posttransplantation course, since they are influenced by multiple intrinsic and extrinsic factors . An understanding of this evolving risk for infection is essential to the management of the patient following transplantation and is a key to the early diagnosis and treatment of infection . Likewise, diagnosis of infection is dependent upon the quality of laboratory support, and services provided by the clinical microbiology laboratory play an important role in all phases of clinical transplantation . These include the prescreening of donors and recipients for evidence of active or latent infection, the timely and accurate microbiologic evaluation of the transplant patient with suspected infection, and the surveillance of asymptomatic allograft recipients for infection . Expert services in bacteriology, mycology, parasitology, virology, and serology are needed and communication between the laboratory and the transplantation team is paramount for providing clinically relevant, cost-effective diagnostic testing.

Int J Syst Bacteriol, 1997 Apr, 47(2), 590 - 2
List of Bacterial Names with Standing in Nomenclature: a folder available on the Internet; Euzeby JP; The List of Bacterial Names with Standing in Nomenclature includes, alphabetically and chronologically, the official names of bacteria as published or validated in the International Journal of Systematic Bacteriology . It encompasses 5,569 taxa (as of 31 December 1996) and is available on the Internet (URL: ftp:@ftp.cict.fr/pub/ bacterio/).

Eur J Med Res, 1997 Mar 24, 2(3), 136 - 8
Significance of the 14C-urea breath test in the determination of the location infected by Helicobacter pylori in the alimentary canal; Kopanski Z et al.; 118 patients with chronic gastritis were the subject of the tests; they were divided into two groups on the basis of a bacteriological (culture) diagnosis of the infections by Helicobacter pylori: group I-patients with the infection present only in the stomach; group II-patients with the infection synchronically occurring in the mouth and the stomach . Both groups underwent the 14C-urea breath test to detect the Helicobacter pylori infection . In general, for the patients of group I the radioactivity of the samples of blown air showed a single maximum after ca 15-25 min . For patients of group II two maxima were obtained, the first after ca 5 min and the second after ca 15-25 min . Our investigations indicate that the 14C-urea breath test can not only be used to detect patients infected by Helicobacter pylori but also to establish the location (mouth, stomach) in the alimentary canal of the infection by that bacterium.

Ned Tijdschr Geneeskd, 1997 Mar 22, 141(12), 581 - 4
{Tuberculosis in asylum seekers in The Netherlands}; Kuyvenhoven JV et al.; OBJECTIVE: To compare data of some features and treatment results of asylum seekers with TB in whom the diagnosis was made by a roentgenologic examination of the thorax a short time after arrival in the Netherlands with data of other TB-patients . DESIGN: Retrospective . SETTING: The Netherlands . METHOD: Data of patients with tuberculosis are collected in the National Tuberculosis Register . In 1993 this register included data of 1582 patients, among them III asylum seekers in whom TB was diagnosed after obligatory roentgenologic screening a short time after arrival in the Netherlands . The reason for examination, presence of complaints, forms of tuberculosis, presence of bacteriological confirmation, drug-resistance and results of treatment of them were compared with the data of other asylum seekers (n = 169) and other TB-patients (n = 1302) . RESULTS: The diagnosis TB in asylum seekers who are screened obligatorily was bacteriologically confirmed in 34 of III (31%) of the cases, while in 72 of 169 (43%) other asylum seekers and in 729 of 1302 (56%) of the other TB-patients (p < 0.001 for the difference between obligatory screened asylum seekers and other TB-patients) . Resistance against isoniazide and streptomycin was more frequent in asylum seekers (n = 106; 13% and 19% respectively) than in Dutch patients (n = 338; 2% and 3% respectively) (p < 0.001) . Obligatory screened asylum seekers with bacteriologically confirmed TB were cured in 82% of the cases and this did not differ from the other groups . Asylum seekers and other immigrants showed a higher default-rate than Dutch patients did (p < 0.001) . CONCLUSION: Among asylum seekers with tuberculosis discovered by the first obligatory screening was a lower percentage of bacteriological confirmation and a higher percentage of drug-resistance and defaulters . The results of treatment of asylum seekers with bacteriologically confirmed TB were good.

Enferm Infecc Microbiol Clin, 1997 Mar, 15(3), 144 - 6
{False tuberculosis outbreak caused by specimen contamination in a micro-bacteriology laboratory: confirmation by molecular techniques}; Aznar J et al.; BACKGROUND: The authors describe a false outbreak of tuberculosis by contamination in sample processing . METHODS: The longitudinal polymorphisms of restriction fragments (RFLPs) of 6 strains of Mycobacterium tuberculosis isolated in different patients over a three week period and which were apparently implicated in an outbreak of tuberculosis were analyzed . RESULTS: Four of the strains studied presented identical restriction pattern and the remaining two presented totally different patterns . Following study of the clinical histories and the epidemiologic relationships three cases of tuberculosis were confirmed . The other three strains isolated corresponded to contamination during the sampling process . CONCLUSIONS: In a possible outbreak of six cases of tuberculosis, molecular techniques have allowed identification of three true cases of tuberculosis and have demonstrated contamination during the sampling process in three other cases . The latter could not have been shown with the clinical and phenotypical data of the strains.

Int J Lepr Other Mycobact Dis, 1997 Mar, 65(1), 56 - 62
Immunotherapy of lepromin-negative borderline leprosy patients with low-dose Convit vaccine as an adjunct to multidrug therapy; a six-year follow-up study in Calcutta; Chaudhury S et al.; The present report, which describes management of lepromin-negative borderline leprosy patients with low-dose Convit vaccine, is an extension of our earlier study on the treatment of lepromatous leprosy patients with low-dose Convit vaccine as an adjunct to multidrug therapy (MDT) . The test Group I, consisting of 50 lepromin-negative, borderline leprosy patients, were given low-dose Convit vaccine plus MDT . The control group II consisted of 25 lepromin-negative, borderline leprosy patients given BCG vaccination plus MDT and 25 lepromin-negative, borderline leprosy patients given killed Mycobacterium leprae (human) vaccine plus MDT . The control group III consisted of 50 lepromin-positive, borderline leprosy patients not given any immunostimulation but given only MDT . Depending upon the lepromin unresponsiveness, the patients were given one to four inoculations of the various antileprosy vaccines and were followed up every 3 months for 2 years for clinical, bacteriological and immunological outcome . All patients belonging to the test and control groups showed clinical cure and bacteriological negativity within 2 years . However, immunologic potentiation, assessed by lepromin testing and the leukocyte migration inhibition test (LMIT), was better in the test patients receiving low-dose Convit vaccine plus MDT than in the control patients receiving BCG vaccine plus MDT or killed M . leprae vaccine plus MDT or MDT alone . But the capacity of clearance bacteria (CCB) test from the lepromin granuloma showed poor bacterial clearance in the test patients . However, there was no relapse during 6 years of follow up . Two mid-borderline (BB) patients had severe reversal reactions with lagophthalmos and wrist drop during immunotherapy despite being given low-dose Convit vaccine.

Int J Lepr Other Mycobact Dis, 1997 Mar, 65(1), 37 - 44
Daily multidrug therapy for leprosy; results of a fourteen-year experience; de Carsalade GY et al.; Between 1980 and 1994, 67 new or relapsing leprosy patients were treated by daily administered multidrug regimens . Tuberculoid patients (23 TT/BT) received either bitherapy {rifampin + dapsone or clofazimine (RMP + DDS or CLO)} or tritherapy {RMP + DDS and/or CLO and/or ethionamide (ETH)} until clinical cure . Lepromatous patients (44 BB/BL/LL) received tritherapy (RMP + DDS and/or CLO and/or ETH) at least until bacteriological negativity . Of the 23 tuberculoid patients only one patient (5%) was cured at 6 months and about 70% needed between 6 and 24 months of treatment to obtain clinical cure (mean 19.5 months) . In the 44 lepromatous patients, the achievement of bacteriological negativity was significantly linked to the initial bacterial index (BI), and it occurred after 2 to 7 years (mean 66.5 months) of multidrug therapy (MDT) . The average BI decrease per year was 1.1+ during the first year, 0.9+ the second year, and then < 0.5+ per year . Reactional states significantly (p < 0.01) influenced the BI course: reversal reactions (RR) accelerated while erythema nodosum leprosum (ENL) delayed the BI decrease . Three of the 23 (13%) tuberculoid and 19 of the 44 (43%) lepromatous patients (p < 0.02) exhibited a RR and 18 of 44 (41%) lepromatous patients had ENL during MDT . A late RR (LRR) was observed in 1 (5%) and 6 (17%) of our tuberculoid and lepromatous patients, respectively, and 3 (8%) of our lepromatous patients suffered post-MDT ENL . No confirmed relapse has been observed within a follow-up period of 6 months to 7 years and 3 months {59 person-years at risk (PYR)} for TT/BT patients and of 4 months to 5 years and 10 months (100 PYR) for BB/BL/LL patients . When compared to the recommended WHO/MDT, it appears that daily MDT does not increase the clinical or the bacteriological cure rates either at 6 months in paucibacillary tuberculoid patients or at 2d years in multibacillary lepromatous patients . Moreover, as does the WHO/MDT, our regimens show a high frequency of reactional states both during and after treatment . This fact constitutes the main new problem of the actual treatment of leprosy.

Adv Contracept, 1997 Mar, 13(1), 71 - 8
Intrauterine device and pelvic inflammatory disease; Khomassuridze AG et al.; The IUD ML Cu375 was inserted, after bacteriological screening, into 620 women who were observed for 12 months . Bacterioscopy and, when needed, bacteriology of vaginal smears were performed 7 days, and 1, 3, 6 and 12 months after insertion . During the 12 months, pelvic inflammatory disease (PID) was diagnosed in 4 patients (0.6%) and sexually transmitted disease (STD) in 73 patients (11.8%) . Careful selection of patients and bacteriological screening can effectively reduce the risk of bacterial contamination and subsequent development of PID.

Minerva Chir, 1997 Mar, 52(3), 317 - 26
{Meropenem (Merrem) vs imipenem/cilastatin in hospital treatment of intra-abdominal infections . A multicenter study}; Tonelli F; OBJECTIVE: To determine clinical and bacteriological efficacy and tolerability of meropenem and imipenem/cilastatin, given intravenously, in the treatment of intra-abdominal infections in hospitalized patients . EXPERIMENTAL DESIGN: Open multicentre, randomized, parallel groups clinical trial, comparing meropenem and imipenem/cilastatin . ENVIRONMENT: Six Italian hospitals . PATIENTS: Eighty-six hospitalized patients, aged 16 or more, with intra-abdominal infections requiring parenteral antibiotic therapy, were randomized to two treatment groups (43 on meropenem, 43 on imipenem/cilastatin) . Eighty-four patients completed the study and 2 were excluded from efficacy analysis . TREATMENT: Meropenem and imipenem/cilastatin were administered intravenously at 1 g TID . Dosage was reduced in patients with renal impairment . Mean treatment duration in clinically evaluable patients was 7.0 days in meropenem group and 7.6 days in imipenem/cilastatin group . MEASUREMENTS: Clinical efficacy evaluated at the end of the therapy and 2-4 weeks after . Bacteriological efficacy before, during, and immediately after the end or the modification of the experimental treatment . All adverse events were recorded . RESULTS: 42/43 (98%) patients on meropenem and 39/41 (95%) on imipenem/cilastatin had satisfactory clinical response . In both groups bacteriological response was satisfactory in 26/27 (96%) evaluable patients . No statistically significant differences were found, both for clinical and bacteriological efficacy . Only two adverse reaction to study drug were observed (1 rash per treatment group) . CONCLUSIONS: Meropenem, broad spectrum antibiotic with high stability to human renal DHP-1, given alone for the treatment of intra-abdominal infections is as effective and well tolerated as imipenem/cilastatin.

J Heart Valve Dis, 1997 Mar, 6(2), 204 - 11
The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature; Lengyel M; BACKGROUND AND AIMS OF THE STUDY: Although prosthetic valve endocarditis (PVE) still has a poor prognosis, early diagnosis may improve clinical outcome . This study was designed to assess the diagnostic ability of transesophageal echocardiography (TEE) in PVE and compare clinical outcome in patients treated before and after the onset of complications . METHODS: Thirty one patients, each with PVE determined by morphologic or clinical Duke criteria, were studied . Patients were divided into two groups: group I (17 patients) presented with clinical complications of PVE; group II (14 patients) had no such clinical complications . There was no difference between groups in the type of prosthesis, location of PVE, type of PVE (early or late), or bacteriological findings . All patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE); the latter was performed by a multiplane technique in 20 of the 31 cases . RESULTS: TTE detected vegetations in two cases and abscesses in four, while TEE showed vegetation in 21 and abscess in 14 . Prosthetic valve obstruction was found in five cases by both techniques, while paravalvular leak was detected in 12 cases by TEE and in nine by TTE . Left atrial vegetation was detected by TEE in two cases . Ten patients were treated medically, six of whom died (all five who were in group I; one of five in group II) . In total, 21 patients were operated on, all in the active phase . The operative mortality was 38% (seven of 12 in group I (58%); one of nine in group II (11%)) . CONCLUSIONS: These studies showed that: (i) TEE provides the clinical criteria of PVE in 50% of the cases; (ii) TEE facilitates the treatment of PVE before the development of complications such as congestive heart failure and embolism; (iii) mortality is significantly lower in patients treated either surgically or medically before these complications develop; and (iv) surgery should not be delayed until congestive heart failure develops.

Chest, 1997 Mar, 111(3), 671 - 5
Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns; Hantson P et al.; OBJECTIVE: To evaluate the incidence of early pulmonary complications and the value of initial clinical signs and paraclinical investigations in victims of smoke inhalation not suffering from burns following structural fires . DESIGN: Retrospective chart review . SETTING: Thirteen-bed ICU . PATIENTS: Sixty-four victims of smoke inhalation following household fires were admitted to the ICU between January 1987 and December 1992 . Exclusion criteria from the study were patients with cutaneous burns or multiple trauma or blast injury, and patients found in cardiac arrest . METHODS: Clinical, biological, and radiologic parameters were collected over a 5-day period . RESULTS: The mortality rate in relation to progressive respiratory failure was 3.1% . Mean ICU stay was 5.8 days (range, 1 to 33 days), and was longer in the patients presenting with soot deposits in the oropharynx (p = 0.02), dysphonia (D) (p = 0.05), or ronchi (R) (p = 0.0004) at the first examination, and in those having a positive sputum bacteriologic analysis (p = 0.003) or requiring parenteral bronchodilator agents for more than 24 h (p = 0.04) . Thirty-five patients underwent mechanical ventilation (MV) for a mean of 101.2 h (range, 8 to 648 h) . Mean MV duration was higher in the patients presenting initially with R (p = 0.003), high carbon monoxide (but not cyanide) levels (p = 0.02), or a positive bacteriologic sample (p = 0.0001) . Positive bacteriologic sampling correlated with the presence of D (p = 0.02) or R (p = 0.04) and with immediate intubation (p = 0.0003) . No correlation was found with chest radiograph . CONCLUSIONS: In this selected series of fire victims without cutaneous burns, respiratory injury was frequent . The initial clinical signs may be helpful to predict pulmonary complications.

Crit Care Med, 1997 Mar, 25(3), 405 - 12
Sepsis and serum cytokine concentrations; Damas P et al.; OBJECTIVE: To look for relationships between the classification of sepsis and plasma cytokine concentrations . DESIGN: Prospective, consecutive entry study of patients meeting severe sepsis criteria and having bacteriologically documented infections . SETTING: University hospital, surgical intensive care unit . PATIENTS: Fifty consecutive patients developing severe sepsis or septic shock between December 1991 and December 1993 . MEASUREMENTS AND MAIN RESULTS: Concentrations of tumor necrosis factor, interleukin (IL)-6, IL-8, and leukemia inhibitory factor were measured by immunoradiometric assay in the plasma of patients as soon as they developed severe sepsis or septic shock . Septic shock patients were divided into three groups in a blinded fashion (i.e., without knowing the results of the concentrations of cytokines), according to the presence of sustained hyperlactacidemia and to the rapidity of the onset of sepsis . Peak concentrations of all cytokines were statistically different between severe sepsis and septic shock patients . This finding was almost exclusively due to the data from patients with rapid onset of septic shock, who demonstrated very high but transient cytokine concentrations . Septic shock patients may thus have different profiles in the time course of their cytokine concentrations . The transient, high peak concentrations of cytokines were also related to transient leukopenia . Among the cytokines measured, IL-8 appeared to be the one that correlated best with lactacidemia, the presence of disseminated intravascular coagulation, severe hypoxemia, the Acute Physiology and Chronic Health Evaluation II score, and mortality rate . CONCLUSIONS: According to the profiles of the cytokines, septic shock patients do not represent a homogeneous population . These profiles should be described in order to distinguish between patients, and the profiles may be useful to identify those patients susceptible to new therapies.

Clin Infect Dis, 1997 Mar, 24(3), 344 - 9
Clinical and bacteriologic impact of rifabutin prophylaxis for Mycobacterium avium complex infection in patients with human immunodeficiency virus infection; Maslo C et al.; We conducted a prospective observational study to determine the feasibility and impact of rifabutin prophylaxis (300 mg daily) for human immunodeficiency virus-infected patients whose CD4 cell counts were <100/mm3 . Three hundred seventy-one patients (65.2% of all patients with CD4 cell counts of <100/mm3 {mean +/- SD, 30 +/- 25/mm3}) received rifabutin prophylaxis for a mean duration +/- SD of 35.5 +/- 34.2 weeks; 198 patients (mean CD4 cell count +/- SD, 51.6 +/- 32/mm3) did not receive prophylaxis . Rifabutin prophylaxis for 8.4% of patients was interrupted because of adverse events . Mycobacterium avium complex (MAC) bacteremia developed in 17 (4.6%) of 371 patients receiving rifabutin prophylaxis and in 22 (11.1%) of 198 patients not receiving rifabutin prophylaxis . The mean CD4 cell count +/- SD at the diagnosis of MAC bacteremia was lower in patients receiving prophylaxis than in those not receiving prophylaxis (11.5 +/- 6.8/mm3 vs . 34.7 +/- 36/mm3, respectively; P < .01) . MICs for MAC strains isolated from patients receiving prophylaxis were less than or equal to those for strains isolated from patients not receiving prophylaxis.

Clin Chest Med, 1997 Mar, 18(1), 35 - 53
Mycobacteriology laboratory; Heifets L; This review summarizes the most important features of different mycobacterial species, and addresses the issues of specimen collection and shipment, bacteriological diagnosis of tuberculosis and other mycobacterial infections, and drug susceptibility testing of different mycobacteria . Special emphasis is placed on the expected turnaround time for the various laboratory reports from different methods . The potential of new methods of today and tomorrow to expedite laboratory results are discussed.

J Hosp Infect, 1997 Mar, 35(3), 215 - 22
Infection associated with the use of allograft bone from the north east Scotland Bone Bank; Sutherland AG et al.; To assess the rate of infection associated with use of banked allograft bone, the case records of patients receiving banked bone over one year were reviewed . The notes of patients undergoing autografting procedures during the same period were reviewed as controls . Eighty-two patients received 98 banked allograft femoral heads and there were 10 proven infections (12.2%) . Fifty-seven patients had autograft procedures, with two cases of infection (3.5%) . The results of bacteriological surveillance of grafts harvested during the same period were analysed; there was a discard rate due to bacterial contamination of 1.3%, and two patients received three contaminated grafts, one of these patients suffering a postoperative infection . The failure rate of procedures was 50% where there was postoperative infection and 4.2% where there was none . Procedures using banked allograft bone have a substantial infection risk, and this is associated with a much higher rate of failure of the procedure . Prospective audit of allograft use should be applied to reduce this risk.

Nippon Rinsho, 1997 Mar, 55(3), 651 - 4
{Bacteriological detection methods of enterohemorrhagic Escherichia coli}; Takeda Y; A rapid identification of enterohemorrhagic Escherichia coli is critical to diagnose and treat its infection due to a possible development of hemorrhagic colitis, hemolytic uremic syndrome and cerebral symptom . For that, several bacteriological detection methods are developed and some of them have been used in clinical microbiology laboratories . In this article, classical bacteriological methods, immunological methods and PCR for identification of enterohemorrhagic E . coli are reviewed and advantages as well as disadvantages of various methods are discussed.

Eur J Pediatr, 1997 Mar, 156(3), 182 - 5
Resolution of protein-losing hypertrophic gastropathy by eradication of Helicobacter pylori; Yamada M et al.; There is as yet no consensus about the need for treatment of Helicobacter pylori infections, except for H . pylori-associated peptic ulcer . We present a 3-year-old boy with a 3-month history of oedema and hypoproteinaemia associated with hypertrophic gastropathy . Abdominal scintigram using intravenous 99mTc-labelled human serum albumin scintigraphy and direct measurement of protein in gastric juice proved that serum proteins were massively secreted in the stomach . Histological findings of mucosal inflammation were observed and H . pylori was isolated from the gastric mucosa . The protein loss promptly stopped within 2 weeks of the beginning of eradication therapy . CONCLUSION: Protein-losing hypertrophic gastropathy may be induced by Helicobacter pylori-associated gastritis and should therefore be carefully evaluated by histological and bacteriological examination to provide a basis for eradication of H . pylori.

Intensive Care Med, 1997 Mar, 23(3), 317 - 25
Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients . Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research; Petri MG et al.; OBJECTIVE: To determine the epidemiological and clinical significance of invasive fungal infections in non-neutropenic patients in intensive care who stay longer than 10 days on the intensive care unit (ICU) . DESIGN: Prospective epidemiological multicenter study over a period of 11 months, based on strict clinical, bacteriological, serological and histological criteria . SETTING: Six surgical and two medical ICUs units in five university and two municipal hospitals . PATIENTS: 435 non-neutropenic patients from medical and surgical ICUs with an ICU stay of more than 10 days . MEASUREMENTS AND MAIN RESULTS: A new occurrence of invasive mycosis (3 sepsis/4 peritonitis/1 disseminated candidiasis), corresponding to the protocol conditions with onset after day 10 in the ICU, was detectable in 2.0% (95% confidence interval 0.85 to 3.8%) of the 409 patients who could be assessed . Candida species were identified as an infection-relevant pathogen in all cases . The most important risk factor for the development of an invasive mycosis was the onset of peritonitis by the day 11 in the ICU (odds ratio 11.3; p = 0.003) . A fungal colonization was detected in 64% of patients (Candida species 56%, Aspergillus 4%, and other fungi) . Six of 8 patients with an invasive mycosis died on the ICU; ICU mortality in patients with fungal colonization was 31% and in noncolonized patients 26% . Serological tests were not helpful clinically . The sensitivity was 88% for the Candida HAT (haemagglutination test) (threshold titer > 1:160), 100% for the Candida IFT (immunofluorescence test) (threshold titer > 1:80), and 50% for the Candida Antigen Test (Candtec Ramco, threshold titer > or = 1:8), and the specificity was 26, 6, and 73%, respectively . The specificity for the Aspergillus HAT (threshold titer > 1:10) was 29% . CONCLUSIONS: Invasive mycoses are rare in non-neutropenic ICU patients, even after a longer stay in the intensive care unit; fungal colonization, on the other hand, is frequently detectable . The mortality of invasive mycosis--even with systemic antimycotic therapy--was high; the mortality in patients with fungal colonization was not significantly increased compared to that in noncolonized patients . The serological test procedures, Candida HAT, Candida IFT, and the Candida Ramco Antigen Test, had a low specificity and were not helpful in diagnosing relevant invasive mycosis.

Infect Dis Clin North Am, 1997 Mar, 11(1), 223 - 39
Perinatally transmitted neonatal bacterial infections; Eichenwald EC; Perinatally acquired bacterial infections remain a major contributor to morbidity and mortality in newborn infants, especially those delivered prematurely . Our understanding of the epidemiology, bacteriology, and pathogenesis of these infections has allowed development of better treatment and prevention strategies . Just as the bacteriology of perinatally acquired bacterial infections has changed over the past few decades, however, it is likely to continue to evolve . Whether widespread use of intrapartum antibiotics will alter the bacteriology and antibiotic resistance patterns seen in early-onset neonatal bacterial infections requires ongoing surveillance.

Transfus Sci, 1997 Mar, 18(1), 27 - 32
Current methods for the preparation of platelet concentrates: laboratory and clinical aspects; Seghatchian J et al.; Modern blood transfusion services are striving to attain the highest standards through continual quality improvement and ensure that a formalised quality system is in place in the organisation for time management and waste reduction . With respect to the production of platelet concentrates (PCs), semi-automated and automated procedures are now available which are convenient and allow the processing of multiple packs simultaneously or the production of multiple doses of PCs with low leucocyte content . Nevertheless, PCs are highly heterogeneous on the basis of cellular content and storage stability . Statistical process control (SPC) is essential to ensure that optimal quality is maintained . In the light of new developments in platelet production, their clinical effect should be reappraised . This article highlights some of the key features in the production of PCs, focusing on basic concepts and quality indicators which reflect in vivo functions . The potential for bacteriological contamination and future production strategies are briefly mentioned.

Clin Infect Dis, 1997 Feb, 24 Suppl 2, S222 - 30
A multicenter study comparing intravenous meropenem with clindamycin plus gentamicin for the treatment of acute gynecologic and obstetric pelvic infections in hospitalized women; Hemsell DL et al.; We conducted a multicenter trial to compare the efficacy and safety of meropenem with the efficacy and safety of clindamycin plus gentamicin in the treatment of 515 hospitalized patients with acute gynecologic and obstetric pelvic infections . At the end of treatment, the rates of satisfactory clinical and bacteriologic response were high (88%) in both treatment groups: the rates of response were 90% for the meropenem group and 86% for the clindamycin/gentamicin group . No serious adverse events occurred . The most frequently reported drug-related adverse clinical events in the meropenem group were nausea and injection-site reactions (> 1% of patients), and the most common drug-related laboratory abnormality was thrombocythemia . Similar patterns of adverse events occurred in the clindamycin/gentamicin group; however, the incidence of diarrhea and eosinophilia was higher in this group . In summary, this trial demonstrated that meropenem is an effective and safe alternative to the combination of clindamycin plus gentamicin for the treatment of women with acute gynecologic and obstetric pelvic infections.

Clin Infect Dis, 1997 Feb, 24 Suppl 2, S197 - 206
Results of a randomized, multicenter trial of meropenem versus clindamycin/tobramycin for the treatment of intra-abdominal infections; Wilson SE; In a randomized, double-blind clinical trial conducted at 13 medical centers, meropenem (1,000 mg given iv every 8 hours) was compared with the combination of clindamycin (900 mg every 8 hours) plus tobramycin (5 mg/{kg.d} in three divided doses) given iv for the treatment of intra-abdominal infections that required surgery and parenteral antibiotic therapy . At the end of treatment, efficacy data on patients who met study inclusion criteria (intent-to-treat) were available for 132 of 215 patients in the meropenem group and 134 of 212 patients in the clindamycin/tobramycin group; 120 (91%) of 132 intent-to-treat patients in the meropenem group were cured, 115 (86%) of 134 intent-to-treat patients in the clindamycin/tobramycin group were cured (P value, not significant) . Of the patients treated with meropenem and considered evaluable according to the study protocol, 89 (92%) of 97 were cured, and 81 (86%) of 94 patients treated with clindamycin/tobramycin and considered evaluable were cured . Bacteriologic response rates for all evaluable patients (n = 191) were 96% (93 of 97 patients) among those randomized to the meropenem arm and 93% (87 of 94) among those randomized to the clindamycin/tobramycin arm . Adverse events occurred with similar frequency in both treatment groups; neither seizures nor deaths related to treatment were reported for any patients in either group . The results of this trial demonstrated that meropenem, together with appropriate surgical intervention, was safe and effective in the treatment of patients who had bacterial intra-abdominal infections, most of which were secondary to complicated appendicitis.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Feb, 35(2), 196 - 200
{Tuberculous pleuro-peritonitis showing increased levels of CA125}; Hirose T et al.; A 53-year-old woman was admitted because of dyspnea and coughing of about 8 months duration . On examination she had left pleural effusion and ascites . The serum CA125 level was high (1150 U/ml) but gynecological examinations were negative . Radiological and ultrasonic studies revealed bilateral pleural effusions and ascites . Cytological and bacteriological studies of the pleural effusions and ascites were all negative . The pleural fluid was exudate with high lymphocyte counts and elevated ADA (87.4 IU/l) and CA125 (1800 U/ml) . Tuberculous pleuritis was diagnosed based on the findings of sputum culture and of pleural biopsy . The latter revealed epithelioid cell granulomas and giant cells . Cells in both pleural effusion and ascites were stained with antibodies to CA125 . Antituberculous chemotherapy was started and the patient responded well . Both pleural effusions and ascites decreased; the level of CA125 also decreased to the normal range in about two months.

Eur J Vasc Endovasc Surg, 1997 Feb, 13(2), 127 - 33
Bacterial and clinical criteria relating to the outcome of patients undergoing in situ replacement of infected abdominal aortic grafts; Speziale F et al.; OBJECTIVES: In a retrospective non-randomised study we assessed the outcome after in situ replacement of infected knitted Dacron abdominal aortic grafts in patients without septicaemia or retroperitoneal abscesses . We also assessed whether the specific bacterial infection influenced outcome . MATERIALS AND METHODS: Over the 5 years studied, 18 patients (9 with perigraft infection and 9 with aortoenteric erosion) underwent in situ replacement of aortofemoral grafts . All patients were haemodynamically stable, none required emergency treatment . Preoperative assessment included CT, MRI, leukocyte-labelled scintigraphy, and bacterial cultures whenever possible . Infected grafts were totally excised and replaced in situ with standard PTFE prostheses . Bacterial diagnosis included intraoperative Gram-staining and postoperative graft cultures . None of the patients had retroperitoneal collections or proximal anastomotic dehiscence . All patients had 6 week intravenous antibiotic therapy . RESULTS: One patient died of myocardial infarction, and another of haemorrhagic shock from proximal anastomotic dehiscence, accounting for a graft-related mortality of 6% . Dehiscence resulted from a polymicrobial infection . Mean 37 month surveillance showed no amputations and no graft-related infections . CONCLUSIONS: In clinically and bacteriologically selected patients, total in situ replacement of infected abdominal aortic grafts offers an excellent outcome.

Clin Otolaryngol, 1997 Feb, 22(1), 44 - 6
A double blind, prospective trial of topical ciprofloxacin versus normal saline solution in the treatment of otorrhoea; Kasemsuwan L et al.; The clinical and bacteriological efficacy of topical ciprofloxacin in saline solution and a saline solution without antibiotics, for the treatment of otorrhoea, was assessed . Fifty affected ears which had an acute exacerbation of chronic otitis media with tympanic membrane perforation were included in this study . Only 35 ears completed the study . Both medications were randomly given to patients . Therapeutic efficacy was evaluated on the seventh day of treatment . A favourable clinical response was observed in 89.5% of the ciprofloxacin-treated group and in 43.8% of the saline-treated group, respectively (P < 0.005) . Bacteriological eradication was also observed to be higher in the ciprofloxacin-treated group (P < 0.005) . From these preliminary results, topical ciprofloxacin appears to be effective in curing the acute phase of chronic otitis media.

Dis Colon Rectum, 1997 Feb, 40(2), 222 - 8
Diversion-related experimental colitis in rats; Keli E et al.; PURPOSE: Diversion-related colitis is an inflammatory process that affects the colon and/or rectum distal to a colostomy . Its mechanisms are unknown, and many hypotheses have been considered . The aim of the present study was to create an experimental model of diversion-related colitis in rats, so in the future it will be possible to test different hypotheses . METHODS: Three groups of ten male Wistar rats were used for the study . Two groups underwent a colostomy and were kept alive for 6 or 17 weeks . One group of rats was killed at the onset of the experiment . Specimens were taken in bypassed segments in the rats who had had a colostomy and in the sigmoid colon for the control group . Histologic analysis using standard coloration, histochemical techniques, and bacterial preparation was used to find histologic or changes of colonic histology or flora . RESULTS: Exclusion was associated with vascular congestion, a decrease in length of glandular crypts (P < 0.01), and an erosion of surface epithelium; inflammation of the mucosa was absent in all control animals and present in all test animals . In contrast, the number of goblet cells was not changed by the procedure . There was also a significant change in distribution and intensity of sulfomucins and sialomucins and quantitative and qualitative changes of the colonic flora . CONCLUSION: This experimental model of diversion colitis is characterized by histologic and bacteriologic modifications comparable with those reported in humans but with different histochemical changes.

Intensive Care Med, 1997 Feb, 23(2), 218 - 25
Analysis of costs in a pediatric ICU; Garcia S et al.; OBJECTIVE: To analyze the actual cost of pediatric intensive care and its different components, particularly the differences between various patient groups, with special reference to the variable cost and the elements included in it . DESIGN: Prospective, observational study . SETTING: Multidisciplinary 12-bed pediatric intensive care unit (PICU) in a tertiary university hospital . PATIENTS: 495 admissions to the unit over 17 consecutive months; 64.2% were medical patients and 35.8% were surgical patients; the mean (SE) stay in the PICU was 6.6 +/- 0.4 days . MEASUREMENTS AND RESULTS: The fixed cost per day per patient was calculated, including the costs of physicians, nurses, auxiliary and other personnel who worked during the study period, and the costs of structural depreciation, maintenance, consumption, and disposable material . The variable cost was individually calculated from the costs of routine procedures and also included expenditure on pharmaceuticals, blood products, biochemical, hematological, and bacteriologic tests, radiology, image diagnosis procedures, and other procedures . The Physiologic Stability Index (PSI) was obtained in the first 24 h after admission . The mean fixed cost per patient per day was u.s . $608, which represents 72% of the total patient cost during this study; 86% of this amount was for personnel (58% for nurses and auxiliary staff) . Variable costs came to 28% of the total amount, and were $218 +/- 100 (M +/- SEM) per patient per day . In addition to the costs of their longer stay in the PICU, the daily variable costs of nonsurvivors were higher than those of survivors ($542 +/- 52 vs $179 +/- 7; p < 0.001) . We classified the patients into four groups according to their PSI score in the first 24 h; variable daily costs increased (p < 0.05) in all comparisons with the PSI level: group I: < 4 points ($155 +/- 0.5), group II: 5-9 points ($210 +/- 13), group III: 10-14 points ($324 +/- 54), group IV: > 15 points ($480 +/- 42) . However, this pattern was not found for all resources: the cost of treatment techniques and biochemical and hematological tests increased, but the consumption of antibiotics, parenteral nutrition, blood products, and bacteriologic tests reached their maximum level in groups I-III and radiology was not significantly influenced by PSI level . CONCLUSIONS: The cost of personnel was the biggest factor in intensive care costs: 62.4% of the total costs . Nonsurvivors generated 3 times the mean variable daily expenditure on survivors and had longer stays in the PICU . The increase in PSI score on the first day was associated with a global increase in variable costs . The cost of treatment techniques significantly increased as the illness became more severe but consumption of antibiotics and parenteral nutrition and use of bacteriologic tests and radiology did not.

Eur J Clin Invest, 1997 Feb, 27(2), 128 - 34
Circulating immune complexes in human tuberculosis sera: demonstration of specific antibodies against Mycobacterium tuberculosis glycolipid (DAT, PGLTb1, LOS) antigens in isolated circulating immune complexes; Simonney N et al.; An enzyme-linked immunosorbent assay (ELISA) for IgG using three glycolipid antigens from Mycobacterium tuberculosis in 65 tuberculosis (TB) patients and 50 healthy control subjects was performed . The circulating immune complexes (CICs) were isolated by precipitation with polyethylene glycol 6000 (PEG) . This method associated to ELISA measured the specific antibodies present in these CICs . PEG {optical density (OD) 280} was shown to be significantly elevated (P < 0.001) in tuberculous samples . The concentrations of IgG antibodies complexed to the three glycolipid antigens were shown to be higher in patient with tuberculosis than in normal control subjects (P < 0.001) . No correlation was observed between levels of free and CIC-bound antibodies . These antibodies isolated from CICs were responsible for almost all of the false-negative serological results . However, great heterogeneity was noticed depending on the antigen used, showing a more positive ELISAs against DAT (77%) than against LOS (71%) or PGLTb1 (18.5%) . No correlation was established between the presence of specific CIC-complexed IgG and the bacteriological load or the tuberculosis localization (pulmonary vs . extrapulmonary) . The sensitivity of ELISA for CIC-complexed IgG to DAT and LOS was lower in HIV-infected TB patients . From these results, we conclude that detection of complexed IgG DAT and LOS glycolipid antigen will be useful as a complementary technique for the serodiagnosis of tuberculosis.

J Dairy Sci, 1997 Feb, 80(2), 318 - 23
Efficacy of cefquinome for treatment of cows with mastitis experimentally induced using Escherichia coli; Shpigel NY et al.; The efficacy of intramuscularly and intramammarily administered cefquinome was evaluated in experimental Escherichia coli mastitis in dairy cows . Forty-seven multiparous, Israeli Holstein cows in early lactation that produced at least 25 L/d of milk were used, and 400 to 750 cfu of E . coli were infused into two healthy quarters of each cow . Cows were randomly assigned to one of the following treatment groups: 1) 75 mg of cefquinome administered intramammarily three times at 12-h intervals, 2) 75 mg of cefquinome administered intramammarily three times at 12-h intervals and 1 mg/kg of cefquinome administered intramuscularly two times at a 24-h interval, 3) 1 mg/kg of cefquinome administered intramuscularly two times at a 24-h interval, and 4) 75 mg of ampicillin and 200 mg of cloxacillin administered intramammarily three times at 12-h intervals . All cows developed typical signs of acute clinical mastitis by 12 to 16 h postinoculation . Parenteral cefquinome therapy, with or without intramammary cefquinome (groups 2 and 3), significantly improved clinical recovery and return to milk production . The bacteriological cure rates were considerably and significantly higher for cows in the groups treated with cefquinome than for cows in the group treated with ampicillin and cloxacillin . This study supported the efficacy of cefquinome in the treatment of clinical coliform mastitis in dairy cows.

Can J Surg, 1997 Feb, 40(1), 28 - 32
Impact of infection by verotoxigenic Escherichia coli O157:H7 on the use of surgical services in a children's hospital; Cimolai N et al.; OBJECTIVES: To determine the impact of Escherichia coli O157:H7 infection in children on the need for surgical assessment in a pediatric surgical practice and whether clinical and bacteriologic variables might contribute to that need . DESIGN: Examination of a case series . SETTING: A tertiary-care pediatric hospital . PATIENTS: Between 1990 and 1994, E . coli O157:H7 gastrointestinal infections were documented among 85 children, 29 of whom suffered from hemolytic-uremic syndrome . INTERVENTION: Surgical consultation for presumed or proven complications of the infection . MAIN OUTCOME MEASURES: The frequency of and reasons for surgical consultation, clinical and bacteriologic variables between patients who did or did not require surgical assessment . RESULTS: Of the 85 children, 17 (20%) were assessed by the surgical service . The majority of these children were inpatients . Two required abdominal surgery . Female gender, older age and progression to hemolytic-uremic syndrome were factors associated in univariate analyses with a likelihood of need for surgical assessment; variation in bacterial genotype was not . CONCLUSION: There is the potential for verotoxigenic E . coli O157:H7 infection to have a considerable impact on the utilization of pediatric surgical services.

Ned Tijdschr Geneeskd, 1997 Jan 11, 141(2), 89 - 93
{Echographic recognition of tuberculous peritonitis}; Portielje JE et al.; OBJECTIVE: To assess the role of ultrasonography (US) and US-guided puncture in the diagnostic procedure of tuberculous peritonitis . DESIGN: Retrospective study . SETTING: An inner-city hospital: Westeinde Ziekenhuis, The Hague, the Netherlands . METHODS: Of 12 patients with bacteriologically confirmed tuberculous peritonitis diagnosed between 1987 and 1995, the results of ultrasonography and the bacteriological and cytological results of US-guided puncture were studied . RESULTS: The ultrasonographic appearance of wet tuberculous peritonitis was recognized by the radiologist in all 11 cases . There was loculated ascites with fine septations as well as thickening of peritoneum, mesentery and omentum . Ultrasonography was of no merit in the one case of peritonitis sicca in this study . US-guided puncture of ascites and omentum yielded a bacteriological diagnosis in eight patients, six of whom had a positive Ziehl-Neelsen or auramine test . In two other patients cytological examination showed a granulomatous inflammation . On average, the ultrasonographic diagnosis of wet tuberculous peritonitis was suggested 3 days after admission and bacteriologically confirmed 10 days later . Eleven of the 12 patients were immigrants from countries where tuberculosis is endemic . The mean duration of residency in the Netherlands was 7 years . CONCLUSION: Ultrasonography is valuable in the diagnostic procedure of tuberculous peritonitis in that it considerably reduces diagnostic delay and unnecessary surgical procedures are avoided.

Acta Otolaryngol Suppl, 1997, 529, 22 - 6
Bacteriological findings and persistence of middle ear effusion in otitis media with effusion; Jero J et al.; The bacteriology of middle ear effusion (MEE) of asymptomatic otitis media with effusion (OME) was studied in 165 children, aged 5 months to 12 years, from the MEE samples obtained during tympanostomy under general anaesthesia in 1993-1994 . MEE had persisted for 1 to 12 (mean 3.5) months . Major otitis pathogens (S . pneumoniae, H . Influenzae, B . catarrhalis and S . pyogenes) were cultured in 41% of the children under 2 years of age and in 17% of older children (p < 0.001) . Respiratory infections and attacks of acute otitis media (AOM) during the last 6 months were also more frequent in children younger than 2 years (p < 0.001) . The proportion of S . pneumoniae (25%) and H . influenzae (38%), but not of other bacteria, was higher in the children with less than 2 months' persistence of MEE as compared with those with a longer duration (8% and 3%) (p < 0.01) . After 2 months, the occurrence of different bacteria remained relatively unchanged until 6 months' persistence of MEE, and thereafter no pathogens were culturable . Among the children adenotomized earlier, the proportion of those with major otitis pathogens in MEE was 8% compared with 32% in non-adenotomized children (p = 0.02) . S . pneumoniae, B . catarrhalis or S . pyogenes were not culturable in any of the adenotomized children, while MEE grew them in 25% of the non-adenotomized children (p < 0.001) . Since the MEE bacteriology of OME with less than 2 months' persistence resembles that of AOM, it may be that these cases represent a transitory phase between AOM and an established OME.

Arch Orthop Trauma Surg, 1997, 116(6-7), 321 - 3
Unusual locations of osteoarticular tuberculosis; Garcia S et al.; Tuberculosis continues to occur frequently in some underdeveloped regions . Bone and joint tuberculosis is less common than the pulmonary form . Fourteen cases of bone and joint tuberculosis in unusual locations are presented . Tuberculostatic treatment and surgical approach were associated in all the patients . In 6 cases an arthrodesis of the affected joint was carried out . A surgical debridement was done in 6 patients and a needle biopsy in 2 patients in order to obtain samples for pathology and bacteriology . Twelve of the 14 patients recovered . One patient who was affected by atlanto-axial tuberculosis died within the immediate postoperative period . A second one affected by the acquired immunodefiency syndrome died 4 months after surgery.

Bull Soc Pathol Exot, 1997, 90(1), 6 - 9
{Prevalence of Helicobacter pylori infection in Tananarive, Madagascar}; Cassel-Beraud AM et al.; During a 8-month period, Helicobacter pylori infection has been studied in 140 patients who presented upper gastrointestinal symptoms . Helicobacter pylori was searched in antral biopsy specimens using standard bacteriological methods (Gram-staining, urea-test, culture) and histological staining techniques (hematoxylin-eosin-saffron, undifferentiated Giemsa) . The global prevalence of H . pylori infection was 59% . The prevalence rates did not seem to differ with age and sex but H . pylori infection was significantly more frequent in patients with an active duodenal ulceration (30 of 41) compared with those with a normal endoscopy (21 of 47) (p < 0.02).

Acta Med Croatica, 1997, 51(3), 159 - 62
Peroxyacetic acid effect on the bacteriologic status of war wound; Turcic J et al.; In this study, the efficiency of peroxyacetic acid as a local antiseptic in war wound healing was investigated . Peroxyacetic acid was specially prepared for local application . The acidity was reduced from pH 2 to pH 5 using acetate buffer, the concentration was reduced to 0.2% and the use of sulfuric acid was avoided in the peroxyacetic acid preparation . Thirty-five patients with at least two similar wounds requiring daily dressing were included on a voluntary basis . Cranial wounds and wounds on the right side of the body were treated by peroxyacetic acid compresses, while other wounds were treated by the application of hypertonic NaCl solution . On day 12, the wounds treated by peroxyacetic acid (chi 2 = 52; df = 4, P < 0.001) were observed to be statistically significantly cleansed than the wounds treated conventionally . The use of peroxyacetic acid as a local antiseptic has not yet been described in the available literature . The possibilities and efficiency of peroxyacetic acid for this purpose, previously prepared for use in living tissue, are emphasized.

Probl Tuberk, 1997, (2), 11 - 3
{Phthisiobacteriological service in the Republic of Sakha}; Alekseeva GI; The paper shows it expedient to decentralize the bacteriological service system by setting up a wide net of laboratory rooms at district antituberculosis dispensaries, as shown in the Republic of Sakha (Yakutia) . The establishment of a branched network of bacteriological rooms and the introduction of procedures of centralized preparation of yolk culture media as an intermediate products allowed the cohort of tuberculosis and risk groups to be bacteriologically studied to a greater extent.

Therapie, 1997 Jan-Feb, 52(1), 65 - 71
{Mycobacterium avium complex infections: the point on the treatments}; Brandissou S et al.; Mycobacterium avium complex (MAC) infections are the most frequent opportunistic infections in AIDS . Since progress in antiretroviral drugs enables AIDS patients to survive longer, these infections involve an increasing number of sick people . Few controlled assays have evaluated the efficiency of several antibiotics . When used in monotherapy, clarithromycin (one gram twice a day) appeared as the most efficient drug while the effectiveness of azithromycin, clofazimine, rifampin and liposomal encapsulated gentamicin have not been truly proved . Due to its bacteriologic and clinical effects, the most interesting polytherapeutic scheme is the association of clarithromycin (1 g twice a day), ethambutol (15 mg per kg and per day) and rifabutin (600 mg per day).

Antibiot Khimioter, 1997, 42(4), 28 - 33
{Aspects of solution of the postoperative infection problem in heart surgery}; Pkhakadze TIa et al.; The study of the incidence and etiological pattern of infectious complications included 376 patients operated for acquired valvular disease . 40,280 bacteriological tests of the materials from the patients obtained during the operations and during the postoperative period as well as 30,113 sanitary bacteriological tests of the specimens from the cardiological operation unit were conducted . The possible use of the results of bacteriological monitoring for prediction of septic complications and optimization of antibiotic prophylaxis and therapy as well as for development and operation of a system of sanitary and hygienic measures for infection prevention was shown and statistically confirmed.

Scand J Infect Dis, 1997, 29(2), 175 - 9
Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women; Sandberg T et al.; A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v . twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women . Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol . There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%) . A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%) . Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels . The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.

Scand J Urol Nephrol Suppl, 1997, 183, 11 - 6
Clinical enuresis phenotypes in familial nocturnal enuresis; von Gontard A et al.; The objective of the current study was to identify the associations between phenotype and genotype in children with nocturnal enuresis . Of the total of 167 wetting children, aged 5-10 years, without neurological or structural forms of incontinence, 110 were nocturnal enuretics . The examinations included a full psychiatric and psychological assessment, a paediatric and neurological examination, a family history with pedigree, ultrasonography, uroflowmetery, urinanalysis and bacteriology . Children with secondary nocturnal enuresis (n = 28) had a significantly higher rate of behavioural disorders, life events and continuous psychosocial stress than those with primary nocturnal enuresis (n = 82) . Of the latter group, children with primary monosymptomatic nocturnal enuresis (n = 50) had an especially low rate of behavioural problems, when in comparison to primary non-monosymptomatic nocturnal enuretics (n = 32) . Formal genetics point to a high genetic predisposition to nocturnal enuresis in all subgroups . Linkage studies to markers on chromosomes 8, 12 and 13 demonstrate both clinical, as well as genetic heterogeneity in nocturnal enuresis.

Minerva Ginecol, 1997 Jan-Feb, 49(1-2), 19 - 23
{Bacterial vaginosis and premature membrane rupture: an open study . Preliminary data}; Calleri L et al.; We tried to identify a correlation between bacterial vaginosis and PROM with the aim of proposing a future screening for pregnant women at risk for premature rupture of membranes . We made two vaginal bacteriological tests on women pregnant at 24th and 34th week, and we repeated the same test when it proved positive for infection after therapy . We did 375 tests and our study group was composed of 249 pregnant women, aged between 24 and 35 . We also evaluated some variable factors as ultrasonographic gestational age redetermination, number pregnancies of oral contraceptives or IUD use, presence of risk factors presence (recurrent abortion, previous PROM, glucose metabolism alteration, immunosuppression, condylomatosis) . 171 tests proved positive (total positivity percentage: 47.2%) . The most common micro-organism was Ureaplasma urealyticum (49.1%) that was related to PROM in 66.7% . This result contracts with affirmations of some England authors who think that Ureaplasma hasn't an important role in PROM . This fact, if related to the other data we obtained with our study, actually current, shows a strict correlation between PROM and bacterial vaginosis, but also a different distribution of vaginal infections in our country in comparison with English countries.

Bull Acad Natl Med, 1997 Jan, 181(1), 93 - 100; discussion 100-2
{The return of diphtheria in Europe . Is the French population protected?}; Rey M et al.; Following the generalized vaccination of children, the European countries achieved the elimination of diphtheria . However the huge epidemic which rages since 1990 in the New Independent States of ex-URSS, culminating in 1994-1995 (with respectively 47,802 and 50,412 notified cases), has showed that diphtheria could be still threatening . A serosurvey was carried out in France on 1,025 adult patients attending the emergency wards of three hospitals, located in different parts of this country . This study showed the insufficient immunity of adults, for lack of a routine programme for revaccination: only half of them have antibodies assuring their protection . The antitoxic immunity decreases according to age . This decline is more marked in women than in men, most of them being reimmunized during the military service . These data confirm the alarming results of similar serosurveys performed in others industrialized countries . The present risk of importing diphtheria in these countries requires a strengthening of clinical and bacteriological surveillance of all cases of infections attributable to C . diphtheriae, and could justify a revaccination programme for adult population, including a regular booster, at 10 year-interval, of a reduced dose of diphtheria toxoid (d), and/or using the combined toxoid Td in the wounded, instead of tetanus toxoid alone.

Exerc Immunol Rev, 1997, 3, 32 - 52
Vitamin C, neutrophil function, and upper respiratory tract infection risk in distance runners: the missing link; Peters-Futre EM; Moderate submaximal exercise results in neutrophilia and enhanced phagocytic and oxidative capacity of neutrophils . It has been hypothesized, however, that during intensive exercise and periods of intensive training this pro-oxidative effect becomes suppressive . Vitamin C is widely recognized for its antioxidant function in extracellular fluid, and it has been shown to neutralize O2-, HOCl, and .OH and to attenuate the suppression of phagocytic function . Clinical manifestation of reduced neutrophil function following participation in ultramarathon races has, however, not been observed . Although neutrophils constitute 50-60% of leukocytes and although they are the first line of defense to bacteriological invasion, postrace episodes of upper respiratory tract infection (URTI) are not correlated with a decrement in the function of this individual parameter of immune function . The efficacy of Vitamin C supplements in reducing the incidence of postrace URTI symptoms, therefore, cannot be fully explained at this stage.

Acta Vet Scand, 1997, 38(1), 69 - 78
Intrauterine fluid accumulation in oestrous mares; Reilas T et al.; Intrauterine fluid (IUF) was collected using a tampon from mid-oestrous mares (n = 57) with and without ultrasonically detectable accumulations of free intraluminal fluid . Bacteria were cultured and neutrophils counted from all samples (n = 57) . Total protein concentration, trypsin-inhibitor capacity (TIC), and plasmin, beta-glucuronidase (B-Gase) and N-acetyl-beta-D-glucosaminidase (NAGase) activities were determined in 27 IUF samples . The motility of spermatozoa in the presence of IUF, IUF extended with Kenney's medium (1:1) and Kenney's medium alone was analysed in 9 samples using a Hamilton-Thorn motility analyser . Thirty-five mares were inseminated immediately after collection of IUF, and every second day until ovulation . Embryos were recovered nonsurgically 6 days after ovulation . After embryo transfer, fluid accumulations were recorded during oestrus and an endometrial biopsy specimen taken (n = 53) . In the beginning of oestrus, fluid accumulations were detected in 39% (22/57) of mares, while on the day when IUF was collected, fluid accumulations were observed in 26% (15/57) of mares . The fluid was anechogenic, and in 80% of the mares located in the uterine body . None of the mares exhibited cytological or bacteriological evidence of acute endometritis . Total protein concentrations, TIC and B-Gase activities in IUF were statistically significantly lower in mares with fluid accumulations (n = 14) than in mares without fluid accumulations (n = 13) (p < 0.01) . The addition of undiluted IUF to extended semen significantly reduced total and progressive motilities, path velocities and percentages of rapid spermatozoa (p < 0.05) in vitro . On endometrial biopsy, fibrosis was found to be more prominent (p = 0.025) in mares with fluid accumulations (n = 9) than in mares without (n = 44) . It was concluded that anechogenic fluid accumulations during oestrus were associated with compositional changes in IUF . Although IUF had negative effects on spermatozoal motility in vitro, the presence of fluid accumulations at the time of insemination did not affect embryo recovery rates.

Vet Med (Praha), 1997 Jan, 42(1), 5 - 7
Brucellosis in fish; Salem SF et al.; Brucellosis is a zoonotic infectious disease that represents serious economic and health problems . It has been extensively studied in different species of livestock but literary references to fish brucellosis are scarce . Therefore, the purpose of the research hereby presented was to investigate the serologic-bacteriologic response of Nile catfish to experimental infection with brucellosis . Thirty predatory catfishes were used . They were divided into two groups . The first was subjected to s . c . infection with Brucella melitensis biovar 3, the other to s . c . application of physiological solution . Three fishes from each group were killed once a week within 5 weeks to subject them to serologic-bacteriologic examinations . It was found that brucella antibodies were detected in the blood of infected fishes after 7 days post-inoculation . The antibody titre was maintained throughout the period of observation . The organism was also recovered from visceral organs of infected fishes . On the other hand, none of control fishes showed any serologic or bacteriologic response . These results suggest that fish could be considered as a suspectable species to brucellosis . Subsequently, further studies are needed to clarify the possible role of fish in the disease transmission.

Khirurgiia (Mosk), 1997, (1), 25 - 8
{An experimental model of acute purulent peritonitis}; Buianov VM et al.; There are important shortcomings in all the existing models of acute peritonitis . The original model, most close to clinical conditions, has been proposed . The grey rabbits of 1.5-2.0 kg were used in experimental trials . The 5 cm laparotomy has been performed in all the rabbits under thiopental anesthesia . In rabbits of the control group the wound was closed without any manipulations in abdominal cavity . In the other animals the terminal part of the small intestine (15-18 cm) was isolated with two intestinal forceps and saline solution was injected inside . The intestine content was aspirated and mixed with the rabbits blood . The punctate without blood was injected in rabbits of the 2d group; in the 3d group-the mixture of punctate and blood (5 ml of blood per kg of body weight); 10 ml per kg were injected in rabbits of the 4th group; 15 ml per body weight-in the 5th group . In rabbits of the 1st, 2d and 3d groups there were no signs of peritonitis 7 days after the injection . In animals of the 4th and 5th groups clinical, morphological and bacteriological sings of acute peritonitis were detected . The severity of its course depended on the amount of blood in the mixture that was used for irritation of peritoneum . All animals of the 5th group died by the end of the 4th day . Thus, the use of 10 ml of autopunctuate of terminal part of small intestine in combination with the animals blood (10 ml per kg), is the most proper model of peritonitis, that is most close to clinical situations and enables to study its phases and test various methods of treatment.

Pathol Biol (Paris), 1997 Jan, 45(1), 82 - 5
{Isolation of Helicobacter pylori: necessity of control of transport conditions}; Meunier O et al.; The aim of the study was the influence of transport conditions of antrum biopsies on the diagnostis of Helicobacter pylori infection by mean of bacteriological methods . We compare bacteriological to anatomopathological methods of Helicobacter pylori infection during two periods which differed by the transport conditions for antrum biopsies . During the first period (P1), 57 specimens were carried to the laboratory at room temperature and physiological serum immersion was inconstant . During the second period (P2), 56 specimens were all correctly immerged into 5 ml of physiological serum, in a 15 mm diameter tube which was vertically maintained in ice . Anatomopathological methods were considered as the reference method for the diagnostic of Helicobacter pylori infection . The sensibility of bacteriological culture was increased from 59% (P1) to 84% (P2) (p < 0.05) when specificity was unchanged . Furthermore sensibility of bacteriological direct examination was increased from 41% (P1) to 61% (P2) . Complete biopsy immersion and ice transport of samples appear as necessary conditions for the optimal diagnostic of Helicobacter infections by mean of bacteriological methods.

Am J Nephrol, 1997, 17(2), 165 - 71
Helicobacter pylori and uremic gastritis: a histopathologic study and a correlation with endoscopic and bacteriologic findings; Moustafa FE et al.; In this work 70 asymptomatic uremic patients under maintenance hemodialysis in our institution underwent upper-gastrointestinal endoscopy as part of a routine investigation prior to kidney transplantation . Their endoscopic findings were scored and antral mucosal biopsies were obtained and subjected to histopathologic and bacteriologic assessment . Bacteriologic examination included culture, rapid urease test, and microscopic examination for detection of Helicobacter pylori . Histopathologic examination of the gastric mucosa showed chronic superficial gastritis in 52%, atrophic gastritis in 5.7% and intestinal metaplasia in 37% of the cases . Of the cases with superficial gastritis, 5 showed in addition gastric mucosal dysplastic changes . There was no correlation between the histopathologic and endoscopic findings . Nevertheless, there was a significant association between histopathologic changes and H . pylori infection (p = 0.0001) . All cases with atrophic gastritis showed H . pylori, and of 24 cases with chronic active superficial gastritis . H . pylori was detected in 18, while it was detected in only 2 of 13 cases with chronic inactive superficial gastritis and in 4 of 29 cases with normal antral mucosal biopsies . Among different variables in dialysis patients, only patients' ages were found to have significant association with H . pylori infection (p < 0.03) . We have concluded that in asymptomatic uremic patients under maintenance hemodialysis, relying only on endoscopy for critical assessment of the upper gastrointestinal tract is unsatisfactory and histopathologic examination of the antral mucosal biopsies is mandatory . Chronic superficial gastritis and atrophic gastritis should be expected in up to 60% of the patients, and there is a strong association between H . pylori infection and gastritis.

Dermatology, 1997, 194(2), 188 - 90
Dermoid cyst of the penis; Tomasini C et al.; A dermoid cyst of the penis has not been documented previously in the literature . We report a young Caucasian who had an important swelling of the penis dating back several months . On examination a subcutaneous mass on the dorsal aspect of the shaft and prepuce was present . A cutaneous sinus discharging purulent material was also noted above the mass . Laboratory tests including serology for syphilis and bacteriologic examination were negative . An excisional biopsy revealed a nodular lesion in the subcutaneous tissue with tufts of hair emerging from the surface . Histopathologic examination disclosed granulation tissue containing fragments of hair surrounded by granulomatous infiltrate . Serial sections allowed identification of a subcutaneous cyst . The wall was epidermoid and connected with several pilosebaceous units . A sinus tract lined by stratified squamous epithelium contiguous with the epidermis was also noted . Clinical and histopathologic differential diagnoses are discussed . Evidence for a congenital origin of this condition is given.

Eur Arch Otorhinolaryngol, 1997, 254 Suppl 1, S43 - 5
Studies of bronchoalveolar lavage in sudden infant death syndrome: a clinical-pathological study; Imrei L; The incidence of sudden infant death syndrome (SIDS) in Hungary was 0.3 per 1000 live births in 1992 . We investigated bronchoalveolar lavage (BAL) of eight infants with SIDS, using bacteriological, light and electron microscopic methods to collect data about the role of respiratory inflammations in SIDS children and to determine the usefulness of the BAL technique . Findings are discussed.

Jpn J Antibiot, 1997 Jan, 50(1), 22 - 38
{Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer}; Yoshida M et al.; Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer . Patients with other serious diseases were excluded and a total of 73 patients were enrolled . They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group) . IPM/CS was effective in 75% of the patients, both with and without surgery . The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion . IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater . Thus, IPM/CS treatment achieved good results . Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated . Safety was evaluated in all patients . Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy . In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

Eur Surg Res, 1997, 29(2), 75 - 83
Long-term function of experimental substitutes of the ileocecal valve; Ecker KW et al.; The bacteriological barrier function of the ileocecal valve (ICV) can be replaced according to the principle of the nipple-valve anastomosis . Since late complications due to technical measures for stabilizing the ileal nipple have been hitherto unknown, 12 adult beagle dogs were operated on by three technical modifications of a nipple-valve anastomosis and were followed up for 1 year: In three cases the ileal nipple was stabilized by longitudinal staples (NVA), in three cases an intestinal neosphincter (INS) was produced by healing of the muscular layers between the ileal nipple and colon, and in six cases an oral zone of stabilization, preserving an aboral valve zone (S-NVA) was constructed . Measures for valve function at the end of the study period were the weight course of the animals and the intestinal bacterial profile, considering morphological complications of the substituted valves . As reference the respective bacterial counts in ICV and end-to-end anastomosis (EEA) were used, which had been determined in the same animals in earlier experiments . Following an initial increase in weight the 3 animals with NVA and the three animals with INS continuously lost weight from the 4th postoperative month onward . The 6 animals with S-NVA, however, showed from the 4th postoperative month onward a significantly higher weight level (p < 0.05), which remained constant up to the end of the 1-year observation period . Because of a morphologically intact structure of the substituted valve a significantly (p < 0.05) better bacteriological clearance of the ileum was confirmed in these animals after 12 months when compared with the EEA group . In contrast, in the NVA and INS animals a severe bacterial overgrowth of the entire small intestine was observed . This was caused by an intestinal stagnation due to partial prolapse of the nipple in NVA and due to fibrotic stenosis in INS . The results of our study suggest that technical measures to relieve the tendency to devaginate are only successful, if they do not lead to obstruction of the orthograde intestinal passage in the long term . Thus, only the clinical introduction of the S-NVA model may be justified.

Infection, 1997 Jan-Feb, 25(1), 63 - 6
The use of rifabutin in Europe for the treatment of mycobacterial infection in AIDS patients; Dautzenberg B; The MICs of rifabutin on Mycobacterium avium are compatible with its efficacy in clinical infections . Two North American trials established the prophylactic effect of rifabutin in disseminated M . avium disease in AIDS patients . Several prospective non-randomized trials show the clinical and bacteriological efficacy of rifabutin . A large European study conducted from 1990 to 1993 randomized 382 patients, selected on a clinical basis, to receive a combination of ethambutol + clofazimine + isoniazid + placebo or rifabutin for 12 weeks . Of these, 200 were eligible, i.e . had a positive blood culture at day 0 . The percentage of patients with fever decreased from 78% to 23% in the rifabutin arm and from 76% to 11% in the placebo group (difference statistically not significant) . The percentage of positive blood cultures decreased from 100% to 70% and 29% in the placebo group and from 100% to 45% and 18% in the rifabutin group at weeks 0, 6 and 12 respectively . The rate of adverse events was 35% in the placebo and 30% in the rifabutin group (difference statistically not significant) . Two other French randomized trials are being analysed: the first one compares a 14-day regimen of rifabutin to placebo . It shows a 70% success rate in the rifabutin arm and a 8% success rate in the control group . The second trial demonstrates that when given in addition to clarithromycin, unlike clofazimine a combination of rifabutin + ethambutol is effective in decreasing the relapse rate with acquired resistance to clarithromycin . After clarithromycin, rifabutin is the second drug which was proven to be active against disseminated M . avium disease in a controlled placebo trial.

Infection, 1997 Jan-Feb, 25(1), 16 - 21
A randomized comparison of two clarithromycin doses for treatment of Mycobacterium avium complex infections; Dautzenberg B et al.; Two dosages of clarithromycin were compared for treatment of disseminated Mycobacterium avium disease of AIDS patients: high-dose (HD): 1,000 mg or 750 mg b.i.d . according to body weight, and low-dose (LD): 1,000 mg or 750 mg q.d . Patients with high probability of M . avium positive blood culture on day 0 received a 42-day clarithromycin treatment with HD (n = 27) or LD (n = 28) at random after stratification according to body weight . Assessment procedures, including quantitative blood cultures, were performed at days 14, 28 and 42 . Forty-five patients were eligible for clinical and 28 for bacteriological evaluation . Bacteriological success was observed in 12 HD and 11 LD patients, partial success in one HD and two LD and failure in none of the HD and two LD (p = 0.33) . Between days 0 and 42, log decreases in CFU counts/ml were (mean +/- SD) 3.13 +/- 0.82 (HD) and 2.67 +/- 1.8 (LD) (p = 0.38) . Fever and night sweats significantly improved similarly in both groups; no change in spleen and liver size was observed on CT scans . Eight patients died during the study but no death was reported as drug related . Sixteen patients (HD = 6, LD = 10) discontinued the treatment because of side effects . A trend towards improved bacteriological effectiveness and reduced tolerance was observed in the HD group but the difference was not significant . With a power of 0.70, no dose effect was demonstrated between the two tested dosages . A daily dose of 1,000 mg clarithromycin was tested in drug combinations to treat disseminated M . avium infection in AIDS patients.

Eur J Gastroenterol Hepatol, 1997 Jan, 9(1), 71 - 6
Spontaneous ascitic infection in different cirrhotic groups: prevalence, risk factors and the efficacy of cefotaxime therapy; Kaymakoglu S et al.; OBJECTIVE: To investigate the prevalence of spontaneous ascitic infection (SAI) in different cirrhotic groups, the risk factors for development of SAI, and the efficacy of cefotaxime therapy . DESIGN: A prospective study . SETTING: In-patient clinic of a university hospital . PATIENTS: Eighty cirrhotic patients with ascites were assigned to four groups: hepatitis B or D virus-related 34, alcoholic 18, hepatitis C virus-related 14, miscellaneous 14 . INTERVENTIONS: Paracentesis was performed on 80 patients during 92 consecutive hospitalizations . Ascitic fluid was cultured by the method of bedside inoculation of blood culture bottles with ascites . The patients with SAI were treated with cefotaxime (2 g, three times daily, intravenously) for 5 days . MAIN OUTCOME MEASURES: Frequency of SAI in cirrhotic groups; clinical, bacteriological and biochemical findings of SAI; rate of recovery-from infection . RESULTS: Twenty SAI episodes (22%) were found in 16 patients; 8 episodes were spontaneous bacterial peritonitis, 2 bacterascites, and 10 culture-negative neutrocytic ascites . SAI occurred more frequently in patients with hepatitis B or D virus-related liver cirrhosis (32%) than in the alcoholic (6%, P < 0.05), hepatitis C virus-related (14%) or miscellaneous (14%) cirrhotic groups in multivariate analysis, independent predictive factors associated with the development of SAI are chronic hepatitis B virus infection, ascitic fluid total protein and serum bilirubin . Escherichia coli was obtained in 5 of 10 positive ascitic fluid cultures . Cure of the infection was achieved in 95% of episodes . Hospitalization mortality rate in infected patients was 20% . CONCLUSION: Spontaneous ascitic infection occurs in approximately 20% of cirrhotic patients hospitalized with ascites . The patients with low ascitic protein concentration, high serum bilirubin level or hepatitis B virus cirrhosis are more predisposed to SAI . Cefotaxime may be an effective first-choice antibiotic for ascitic fluid infection.

Int J Food Microbiol, 1997 Jan, 34(1), 67 - 77
Reliability and practicability of bacteriological monitoring of beef carcass contamination and their rating within a hygiene quality control programme of abattoirs; Untermann F et al.; A total of 9600 swab samples from 900 carcasses originating from ten different abattoirs were subjected to bacteriological examination . Two sampling sites, brisket and forearm, consistently showed the highest contamination rates . The following sites are recommended for sampling: on the lateral side of the carcass neck, forearm, shoulder, brisket and abdomen . The neck is recommended for the medial side . Compared to the large variance of contamination either on individual carcasses or between different carcasses, the differences in the variance of results between double swab and incision sampling techniques should be of minor importance . Considering this big variance of colony counts, it is suggested to take five to six swab samples from each of at least ten to 15 carcasses once a month . With a view to a more differentiated and evident evaluation the results should be recorded in a 'box plots' and not in the form of mean values and standard deviations . The data confirms bacteriological monitoring of beef carcasses as a useful tool for the verification of slaughter hygiene.

J AOAC Int, 1997 Jan-Feb, 80(1), 43 - 8
Escherichia coli O157:H7 visual immunoprecipitate assay: a comparative validation study; Feldsine PT et al.; A wide variety of food products, with emphasis on raw meat products, were analyzed simultaneously by 3 methods: the Escherichia coli O157:H7 (EHEC) visual immunoprecipitate assay (VIP), the Assurance EHEC enzyme immunoassay, and a modified Bacteriological Analytical Manual (BAM) culture method . This paper reports results of a comparative study of the VIP and modified BAM methods . In this comparative study, 1050 samples and controls gave false-negative rates of 1.0 and 0%, respectively, for the VIP and the modified BAM culture methods . The overall agreement between the 2 methods was 99.4% . Cultural confirmation of presumptive positive samples was problematic because competitive flora were present in higher levels than EHEC in the enrichment broth after incubation and the target organism had nondescript characteristics on the primary selective agar, hemorrhagic coli agar, which necessitated picking of additional colonies in many instances.

J AOAC Int, 1997 Jan-Feb, 80(1), 37 - 42
Assurance Escherichia coli O157:H7: a comparative validation study; Feldsine PT et al.; A wide variety of food products, with emphasis on raw meat products, were analyzed simultaneously by 3 methods: the Assurance Escherichia coli O157:H7 (EHEC) enzyme immunosorbent assay (EIA), the EHEC visual immunoprecipitate assay (VIP), and a modified Bacteriological Analytical Manual (BAM) culture method . This paper reports results of a comparative study of the Assurance and modified BAM methods . In this comparative study, 1050 samples and controls gave false-negative rates of 1.0 and 0%, respectively, for the Assurance EIA and the modified BAM culture methods . The overall agreement between the 2 methods was 99.4% . Cultural confirmation of presumptive positive samples was problematic because competitive flora were present in higher levels than EHEC in the enrichment broth after incubation and the target organism had nondescript characteristics on the primary selective agar, hemorrhagic coli agar, which necessitated picking of additional colonies in many instances.

Cornea, 1997 Jan, 16(1), 21 - 6
Evaluation of infectious crystalline keratitis with confocal microscopy in a case series; Sutphin JE et al.; We sought to determine whether there are unique findings in infections crystalline keratitis (ICK) examined by confocal microscopy and if confocal microscopy is predictive for bacteriology in ICK . A retrospective review of consecutive patients with a presumed diagnosis of ICK by slit-lamp examination was performed . These patients were then examined with confocal microscope and cultured . Sixteen patients were identified by biomicroscopy . Average age was 71 years; 12 of 16 patients were women; 10 of 16 had prior penetrating keratoplasty; and 12 of 16 were taking topical steroids . Confocal microscopy revealed a variable appearance to the crystals in the corneal stroma . Eight of 16 patients had distinct needle-like deposits at varying depths in the stroma, and eight had amorphous deposits grouped at different levels of the stroma . The results of confocal microscopic examination resembled the reported histopathology with clusters of deposits, but its current resolution does not allow identification of bacterial morphology . There was no correlation of morphology with culture results . Organisms were recovered in 12 of 16 patients by culture . In 10 of 16 patients, the infection was successfully treated with topical antibiotics, usually cefazolin . Crystal morphology of ICK can be observed by confocal microscopy . No pathognomonic, single pattern for this disease is seen with the confocal microscope . The latter may be an aid in determining the clinical response to treatment.

AJR Am J Roentgenol, 1997 Jan, 168(1), 67 - 77
AIDS-related airway disease; McGuinness G et al.; To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted . This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients . Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment . The accuracy of CT in detecting airway disease {55-59} is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities {60, 61} . Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis . Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy . CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context . In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses.

J Clin Microbiol, 1997 Jan, 35(1), 295 - 7
Serological and bacteriological study of swine brucellosis; Lord VR et al.; A serological and bacteriological study was performed with sera taken from 2,228 swine from six states in Venezuela . None of the animals were vaccinated against brucellosis, and the prevalence of the disease varied from 5 to 89% on farms located in these states . Our studies indicated that the animals could be categorized into four groups depending on the degree of reactivity in serological tests . Brucella suis biovar 1 was isolated from the lymph nodes, spleens, and semen samples of seropositive animals and identified by oxidative metabolic techniques . B . suis could not be isolated from tissues of seronegative swine even from farms with cases of the disease (detected by serology) . Results suggest that, although the immunodiffusion assay using Brucella melitensis B115 polysaccharide B or B . abortus 1119-3 O-polysaccharide could be useful in the detection of active infections, it is perhaps not as sensitive as some of the other standard serological tests used in this study for the detection of swine brucellosis.

Vet Rec, 1996 Dec 21-28, 139(25), 624 - 7
Cost-benefit analysis of vaccination against paratuberculosis in dairy cattle; van Schaik G et al.; Paratuberculosis is an infectious and incurable disease which causes considerable economic losses in dairy cattle, due mainly to premature disposal and losses of milk production . In 1984 the Animal Health Service North-Netherlands started a vaccination trial in which young calves were vaccinated once, to test whether vaccination reduced the production losses and whether the overall costs of vaccination were outweighed by the benefits . Vaccination against paratuberculosis reduced the number of clinically infected animals by almost 90 per cent . It also reduced the numbers of subclinically infected animals and animals with a positive histological and/or bacteriological test result . Although vaccination did not prevent losses in milk production, it reduced the infection pressure and the clinical signs of the disease . Partial budgeting showed that vaccination against paratuberculosis was highly profitable . The costs of vaccination were US$15 per cow and the benefits (total returns minus costs) were US$142 per cow.

Arch Ital Urol Androl, 1996 Dec, 68(5 Suppl), 101 - 4
{Role of transrectal echography in the evaluation of obstructive seminal vesicle pathology in prostatitis syndrome}; Nicolai M et al.; Prostatitis syndromes are frequent and cause pain and discomfort in adult males . Non bacterial types occur more often than bacterial prostatitis . Transrectal ultrasound permits a perfect evaluation of prostate, seminal vesicles and ejaculatory ducts . Fifty-five patients affected by prostatis syndrome and with negative bacteriological studies, underwent transrectal ultrasonography performed with 7.5 MHz probe . In 38 cases (70%) we found abnormalities such as subacute vesiculitis, asymmetric dilation of the seminal vesicle, dilated and calcific ejaculatory ducts, mullerian duct cyst, utricular cyst and calcification . Ultrasonography is able to detect these lesions that often are responsible of the clinical symptom of the prostatitis syndrome, and may have a therapeutic value through guided transperineal needle aspiration or in the planning specific endoscopic surgery.

Gesundheitswesen, 1996 Dec, 58(12), 657 - 65
{Guidelines for environmental contact tracing in tuberculosis . German Central Committee for control of tuberculosis}; Ferlinz R; These guidelines were initiated by and worked out in cooperation with physicians of the public health service . Numerous publications and relevant legal regulations, particularly the Federal Law against Epidemics were taken into consideration . The responsibilities of the public health service in the fight against tuberculosis includes case finding, detection of the routes of infection and prevention of transmission . Within the scope of these duties contacts of index cases are traced after the notifications were received . The suspects of tuberculosis are examined considering their risk of infection and disease . While doing so the detection of the source of infection has priority . In general tuberculin tests, X-rays and bacteriology are available for public health services, in order to stick to the duties . The general procedures are explained and recommendations for intervals of investigations are given . Nevertheless there is leeway for decisions in isolated cases, but divergent steps should be documented with care . Specific features in the examination of contacts in institutions of communities and in companies are mentioned just as organizing and legal aspects . Requirements of coercive measures are described . Finally a short note is given on perspectives of molecular techniques on measures of the public health services.

Acta Orthop Scand, 1996 Dec, 67(6), 578 - 82
Zoned vertical ultraclean operating room ventilation . A novel concept making long side walls unnecessary; Friberg BE et al.; We evaluated a novel concept of High Efficiency Particulate Air (HEPA)-filtered vertical Laminar Air Flow (LAF) for operating room ventilation, designed to be used without side-walls . The LAF-unit has a central zone with an airflow of 0.4 m/s and a peripheral zone with an airflow of 0.2 m/s . The design provides an exponential downflow of air resembling an upside-down trumpet mouth and it was claimed to prevent entrainment of peripheral contaminated air . The unit was evaluated with regard to elimination of particles with focus on bacteria-carrying particles (colony-forming units = cfu) during rigidly standardized sham operations . Three different lengths of walls/enclosures (short-ending 2.0 m, medium 1.0 m and long 0.2 m above the floor) were tested . It provided a high degree of bacteriological cleanliness (0.05-4 cfu/m3 of air and 7-64 cfu/m2/h surface contamination) and its efficiency was proved to be independent of the length of the enclosures . We conclude that the novel zoned ultraclean vertical LAF unit is versatile, as it allows for omitting long side-walls, without compromising bacteriological safety.

Changgeng Yi Xue Za Zhi, 1996 Dec, 19(4), 298 - 304
{Endoscopic diagnosis and clinical experience of colonic tuberculosis}; Lin CJ et al.; From February 1979 to May 1994, 18 cases of colonic tuberculosis were detected by colonscopy at Chang Gung Momorial Hospital, Linkou Medical Center . There were 10 males and 8 females, with mean age of 43.6 . In ten, the diagnosis was confirmed histologically or bacteriologically in colonic biopsy material and post-operated lymph nodes . The remaining 8 patients was suspected on colonoscopy, and had good response to antituberculous therapy . The major symptoms were abdominal pain (83%), diarrhea (67%), and body weight loss (61%) . Average duration from symptoms to diagnosis was 4.1 months . Chest X-ray revealed active pulmonary tuberculosis in 14 of 18 patients (78%), 4 of 14 patients were military type . The colonic tuberculosis involved in ileocecal area in 6, ileocecum and contiguous colonic regions in 7, segmental colonic involvement in 4, and pancolitis in 1 patient . Multiple ulceration and ulcerohypertrophic lesions were the major colonoscopic findings . Typical caseating granuloma were found in 5 cases (36%) from colonoscopic biopsy, the other 5 from surgical resected specimens . Antituberculous therapy produced remarkable symptomatic improvement in all patients except 2 cases complicated with intestinal obstruction necessitating laparotomy . Colonoscopy with biopsy is a useful diagnostic tool in early diagnosis and avoiding unnecessary laparotomy in colonic tuberculosis.

Minerva Stomatol, 1996 Dec, 45(12), 563 - 8
{Periapical lesions of mixed etiology: bacterial and foreign body}; Bruno E et al.; After a review of the literature on periapical lesion pathogenesis, we studied histological, immunological, and bacteriological examinations of 10 overfilled teeth with periapical lesions . We found, in our research, a bacteriological etiology with foreign body reactions.

Vet Microbiol, 1996 Dec, 53(3-4), 325 - 37
Competitive enzyme-linked immunosorbent assay using monoclonal antibodies to the Brucella melitensis BP26 protein to evaluate antibody responses in infected and B . melitensis Rev.1 vaccinated sheep; Debbarh HS et al.; Competitive enzyme-linked immunosorbent assay (C-ELISA) was performed using 15 monoclonal antibodies (MAbs), specific for Brucella BP26 (previously also called CP28), a periplasmic protein antigen, to investigate antibody responses in naturally and B . melitensis H38 experimentally infected and B . melitensis Rev.1 vaccinated sheep . The antigen preparation consisted of cytosoluble protein extract (CPE) of B . melitensis B115 . By combining the C-ELISA results of several MAbs, a high percentage of naturally infected animals were detected which showed different status in the current conventional diagnostic tests . Indeed, 90% of sheep which were positive in the conventional bacteriological and serological tests were positive in C-ELISA . 72% of the bacteriologically negative but serologically and delayed type hypersensitivity positive sheep were also positive in the C-ELISA . Moreover, 79% of the bacteriologically and serologically negative sheep but delayed type hypersensitivity positive were also detected by C-ELISA . Thus, these results confirmed the importance of BP26 as a frequently recognized target of the humoral immune response of infected sheep . The 8 B . melitensis H38 experimentally infected sheep showed various degrees of antibody responses at the 90th day after infection, which was delayed in comparison to that against O-polysaccharide (O-PS) . Of the 15 MAbs tested, only one MAb was weakly inhibited (20 to 35% inhibition) by 56% of negative control sera . Furthermore, no antibody response against BP26 was detected in B . melitensis Rev.1 vaccinated sheep . Results of the C-ELISA with the 15 MAbs showed individual variability of the antibody responses against BP26 . Thus, it is suggested that several epitopes of BP26 are of interest for diagnosis of B . melitensis infection in sheep.

Am J Surg, 1996 Dec, 172(6A), 7S - 12S
Soft tissue infections and the diabetic foot; Smith AJ et al.; Soft tissue infections are classified as local or spreading . Spreading soft tissue infections are potentially life-threatening conditions, requiring prompt diagnosis and treatment . The information presented is based on a literature review and the authors' clinical experience . Diagnosis of soft tissue infections is aimed at determining the level of infection (skin, fascia, muscle) and whether necrosis is present . The bacteriology of these infections is varied and is of secondary importance . Treatment of skin infections that have no dead tissue is with antibiotics alone . Infections at the fascial or muscle level and those with necrosis at any level require surgical debridement and adjuvant antibiotics . The feet of diabetic patients are prone to plantar forefoot ulcers associated with tissue destruction and infection . The vast majority are caused by mechanical factors . If local immune defenses are adequate, bacterial colonization occurs without infection . Most diabetic foot ulcers will respond to relief of pressure, which may require total contact casting . Antibiotics and debridement are required in infected or deep ulcers, or when the ulcer does not respond to total contact casting.

Ann Otol Rhinol Laryngol, 1996 Dec, 105(12), 968 - 74
Role of leukotriene B4 and interleukin-8 in acute bacterial and viral otitis media; Chonmaitree T et al.; In order to evaluate the role of polymorphonuclear leukocytes (PMNs) in acute otitis media (AOM), levels of leukotriene B4 (LTB4), a potent inflammatory product of PMNs, and interleukin-8 (IL-8), a PMN chemotactic cytokine, were measured in 271 middle ear fluid (MEF) samples from 106 children with AOM . Forty-two percent of the patients had evidence of respiratory viral infection . At the time of diagnosis, levels of both LTB4 and IL-8 were higher in the MEFs from patients with AOM associated with bacterial or bacterial and viral infection than those MEFs containing no pathogen (p < .05) . Antibiotic treatment was not associated with a significant change in levels of LTB4 or IL-8 in the MEFs obtained 2 to 5 days into treatment, compared to those obtained at diagnosis . Bacteriologic failure after 2 to 5 days of treatment was associated with high LTB4 levels in the initial MEFs (p = .05) . Recurrence of AOM within 1 month was associated with high IL-8 levels in the initial MEF (p = .04) . Our findings suggest that LTB4 and IL-8 are produced during acute infection of the middle ear, and these PMN-related inflammatory substances may play an important role in delaying recovery or in recurrence of AOM . Effective treatment of AOM may require eradication of bacteria by antibiotics, as well as pharmacologic agents that modulate PMN functions.

Am J Respir Crit Care Med, 1996 Dec, 154(6 Pt 1), 1784 - 7
Relationship between microbiologic and histologic features in bacterial pneumonia; Marquette CH et al.; To investigate the relationship between the lung damage resulting from pneumonia and the local bacterial burden, we conducted a study comparing histologic and bacteriologic findings in pigs infected with bacterial pneumonia while free of antibiotic therapy and previous or concomitant lung disease . Seventy-eight lung specimens were obtained from 17 animals . The main findings are the following: (1) histologic lesions of pneumonia as well as parenchymal bacterial burden were unevenly distributed within the lungs and even within the lung segments; (2) specimens showing histologic evidence of pneumonia had significantly higher bacterial counts than specimens with bronchial infection and specimens with neither bronchial nor lung infection; (3) there was no significant difference in bacterial counts between lesions defined as pneumonia, confluent pneumonia and abscessed pneumonia; (4) we could not define a clearcut threshold for quantitative cultures to discriminate the presence or absence of pneumonia . This study providing experimental insights into the relationship between microbiologic and histologic features in bacterial pneumonia confirms previous findings in humans . Although, for investigational purpose, lung cultures can be helpful in determining the bacterial etiology of pneumonia, these data do not support the use of quantitative cultures for establishing a definite diagnosis of pneumonia.

Infect Dis Clin North Am, 1996 Dec, 10(4), 857 - 78
Space-occupying and life-threatening infections of the head, neck, and thorax; Gradon JD; Infections of the deep structures of the head and neck are polymicrobial, rapidly progressive, and frequently life-threatening . The bacteriology, clinical presentation, and the need for multidisciplinary management of these infections are stressed . In addition, this article discusses selected head and neck infections of immunocompromised hosts and postexposure prophylaxis for serious infections of the pharynx.

Ned Tijdschr Geneeskd, 1996 Nov 16, 140(46), 2293 - 5
{Transmission of multiresistant tuberculosis in a Dutch hospital}; Lambregts-van Weezenbeek CS et al.; Nosocomial transmission of multiresistant tuberculosis in the Netherlands is described for the first time in this article . It was detected by systematic country-wide DNA-fingerprinting . By the time the contact case (a man aged 35) developed disease he was residing in another part of the country . Contact-investigation by the Municipal Health Services involved revealed that the (HIV negative) contact case had been in contact with the index case (a man aged 27) during hospitalisation two years earlier . An analysis of the infection control measures applied, showed that inadequate treatment, early discharge from isolation and lack of bacteriological control (no sputum conversion documented) led to this hospital transmission.

Zh Mikrobiol Epidemiol Immunobiol, 1996 Nov-Dec, (6), 7 - 10
{The need for revision of the bacteriological criteria of the etiological significance of diarrheogenic Escherichia strains in the diagnosis of acute intestinal infections}; Ulisko IN et al.; Different E . coli of 0-groups, enteropathogenic (EPEC), enteroinvasive, enterotoxigenic (ETEC) and diarrheogenic in sporadic child diarrhea (DESCD), regarded as the causative agents of enteric infections, were detected in 70-80% of cases (1,146 E.coli carriers) in the feces of child and adult patients with acute enteric infections (AEI) irrespective of their age; in 35% of cases the same patient had a combination of two or more varieties of EPEC, ETEC or DESCD . Only EPE were excreted by 3.5-11.3% of patients, depending on their age; only ETEC were excreted by 1.7-3.4% of patients and only DESCD, by 23.1-32.8% . In 30-40% of cases diarrheogenic E.coli of the corresponding 0-groups were isolated as monocultures . The complex of bacteriological criteria, serving as the basis for the diagnostics of AEI (the necessity of the quantitative and qualitative characterization of the contamination of the seed material, E.coli serological labeling, the determination of E.coli pathogenicity factors) is discussed.

Zh Mikrobiol Epidemiol Immunobiol, 1996 Nov-Dec, (6), 11 - 3
{The diagnosis of Helicobacter infections in patients with gastric and duodenal peptic ulcers}; Potashov LV et al.; The results of the study of 33 patients having gastroduodenal peptic ulcer, with 9 of them subjected to surgical treatment, are presented . The diagnostics of Helicobacter infection was made with the use of bacteriological and biochemical assays . The study revealed that in the overwhelming majority of cases peptic ulcer was associated with the presence of H.pylori, and the most informative method for the diagnostics of H.pylori infection was the bacteriological study of biopsies from the pyloric antrum characterized by the highest degree of massive contamination . The determination of ammonia concentration by biochemical assay with the use of Aerotest was most suitable for the diagnostics of H.pylori infection in patients with a short history of peptic ulcer.

Alcohol Alcohol, 1996 Nov, 31(6), 555 - 64
Aldehyde dehydrogenase activity and acetate production by aerobic bacteria representing the normal flora of human large intestine; Nosova T et al.; We have recently proposed the existence of a bacteriological pathway for ethanol oxidation, i.e . ethanol is oxidized by alcohol dehydrogenase of intestinal bacteria resulting in high intracolonic levels of reactive and toxic acetaldehyde . This study was aimed to examine aldehyde dehydrogenase (ALDH) activity, acetaldehyde consumption and production of acetate by aerobic bacteria (n = 27), representing the normal human colonic flora . Most bacterial strains did not show any membrane-associated aldehyde dehydrogenase, but possessed marked cytosolic NADP(+) - and NAD(+) - dependent aldehyde dehydrogenase activity, ranging from 155 nmol of NAD(P)H produced/min/mg of protein to zero with acetaldehyde as substrate . NADP(+)-linked ALDH activity was significantly higher than NAD(+)-linked activity in most of the tested bacteria . In addition, aerobic bacteria metabolized acetaldehyde effectively in vitro and this could be inhibited by cyanamide in nearly half of the tested strains . Production of acetate from acetaldehyde ranged from 2420 nmol/10(9) colony-forming units to almost negligible . In conclusion, many human aerobic colonic bacteria possess significant aldehyde dehydrogenase activity and can, consequently, produce acetate from acetaldehyde in vitro at least under the partially aerobic conditions proposed to prevail on the colonic mucosal surface . Individual variation in the capability of colonic flora to remove toxic acetaldehyde may be one factor regulating intracolonic acetaldehyde levels, as well as the rate of bacteriocolonic pathway for ethanol oxidation.

Infection, 1996 Nov-Dec, 24(6), 473 - 9
Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections; Kempf P et al.; In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery . Eighty-three patients had an evaluable clinical response . Significantly more patients in the meropenem group had a satisfactory clinical response at the end of treatment (41/43 {95.3%} vs 30/40 {75.0%}; p = 0.008) . The bacteriological response was also higher in the meropenem group (31/33 vs 26/32) . In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p = 0.03) . Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.

J La State Med Soc, 1996 Nov, 148(11), 451 - 4
Mycobacterial cervical lymphadenitis: a review; Fitzpatrick EL et al.; Over the last decade mycobacterial infections have been shown to be on the rise in the United States and worldwide . The diagnosis of mycobacterial cervical lymphadenitis, otherwise known as scrofula, should thus be entertained when faced with the hallmark presentation of chronic, nontender cervical lymphadenopathy . This article reviews current epidemiology, bacteriology, diagnostic techniques, and treatment options for tuberculous and nontuberculous mycobacterial cervical lymphadenitis.

Hum Reprod, 1996 Nov, 11(11), 2443 - 8
The cervico-vaginal epithelium during 20 cycles' use of a combined contraceptive vaginal ring; Roumen FJ et al.; The aim of the study was to evaluate the influence of a combined contraceptive vaginal ring (CCVR) made of Silastic on the cervico-vaginal epithelium during 20 cycles of use . A total of 76 volunteers used the CCVR releasing 0.120 mg etonogestrel and 0.015 mg ethinyloestradiol daily . Cytological samples were taken of the vaginal epithelium, the ectocervix and the endocervix before the start, at 4 and 12 months, and at the end of the study . Cytology, hormonal profiles, human papilloma virus (HPV) status, DNA-flow cytometry, bacterial flora, and morphometry was performed on these samples . Colposcopy and histopathology of biopsy specimens were performed at the end . No cytological changes of the squamous epithelium or the columnar epithelium were found . HPV was detected in three samples of three different women . At least two of them reverted to HPV negative during the rest of the study period . Aneuploidy was diagnosed in 11 women before the study . Seven of them changed to diploid during the study . No changes from diploid to aneuploid were seen . Aneuploidy was not seen in any of the HPV positive samples . Although bacterial flora showed considerable variation during the study, no significant influence of the CCVR could be established . Morphometrical analysis showed an increasing nucleus:cytoplasm ratio of the squamous cells during the study . Mild dysplasia was detected in one woman at the end of the study . It was concluded that no unfavourable cytological or bacteriological changes of the cervico-vaginal epithelium were demonstrated during 20 cycles of CCVR use . The vaginal epithelium became more progestogenic during the studyPIP: A study of a combined contraceptive vaginal ring showed no unfavorable cytologic or bacteriologic changes of the cervico-vaginal epithelium during 20 cycles of use . A Silastic ring releasing 0.120 mg of etonogestrel and 0.015 mg of ethinyl estradiol daily was inserted in 76 healthy volunteers 18-35 years of age . Participants used the vaginal ring for 21-day periods interrupted by 7-day ring-free intervals . Squamous cells were detectable in 94 (98%) vaginal smears, 95 (99%) ectocervical smears, and 17 (18%) endocervical smears . No cytologic changes of the squamous or the columnar epithelium were noted, and atypical metaplastic cells were not diagnosed . The percentage of smears with a mixed estrogen-progestogenic pattern decreased from 83% at baseline to 63% during cycle 4; 50% of smears showed a progestogenic pattern by the end of the study (cycle 20) . Half the women demonstrated aneuploidy at baseline, but two-thirds of these women reverted to diploid status during ring use; no changes from diploid to aneuploid were seen . The ring had no significant influence on the bacterial flora of the vagina or on human papillomavirus status . Further investigations involving larger sample sizes are urged to confirm that the combined contraceptive vaginal ring does not lead to cervical dysplasia or other lesions of the cervico-vaginal epithelium .

Hepatogastroenterology, 1996 Nov-Dec, 43(12), 1653 - 5
Tuberculous mesenteric lymphadenitis mimicking pancreatic carcinoma; Claro I et al.; Tuberculous mesenteric lymphadenitis is a rare clinical entity and non-surgical diagnosis of this condition remains a challenge . A 38-year-old Indian woman presented with a six-week history of epigastric pain, low-grade fever and anorexia . Upper endoscopy showed a gastric ulcer of the posterior wall of the stomach . On CT scan there was a 8 cm abdominal mass involving the pancreatic body and tail and the endoscopic ultrasonography was also compatible with a cystic pancreatic tumor which had eroded into the stomach . An exploratory laparotomy was performed and the diagnosis of tuberculous mesenteric lymphadenitis was confirmed by bacteriological and histological examinations . Medical therapy was started after surgery . At 18 months she is asymptomatic and abdominal CT scan is normal . Tuberculosis of mesenteric lymph nodes usually raises serious diagnostic problems . A high grade of suspicion is necessary in order to perform a pre-operative diagnosis.

Thorax, 1996 Nov, 51(11), 1115 - 22
Effects of upper respiratory tract infections in patients with cystic fibrosis; Collinson J et al.; BACKGROUND: The polymerase chain reaction has improved the detection of picornaviruses and rhinoviruses and our understanding of their role in reversible airways disease . The effects of colds on lower respiratory morbidity and bacterial colonisation in cystic fibrosis remain uncertain . METHODS: Children with cystic fibrosis were evaluated regularly in the clinic and the parents notified the investigators when their child developed a cold . Nasopharyngeal specimens were collected at the start of the infection for polymerase chain reaction, bacteriology was also undertaken and again three weeks later, and pulmonary function was measured in children aged > or = 6 years at four day intervals for three weeks . The effects of colds on rate of progression of cystic fibrosis were assessed by pulmonary function, Shwachman scores, and radiology . RESULTS: Thirty eight children suffered 147 colds over 17 months . Picornaviruses were detected in 51 (43%) of 119 nasopharyngeal specimens, and 21 of the 51 were further identified as rhinoviruses . Pulmonary dysfunction was similar following picornavirus and non-picornavirus infections; the mean change from baseline in forced expiratory volume in one second (FEV1) was -16.5% and -10.3% at 1-4 days and 21-24 days, respectively, after onset of a cold . Children who experienced more colds than average had evidence of disease progression with reduction in Shwachman score, increasing Chrispin-Norman score, and greater deterioration in FEV1 per annum . Ten of 12 new bacterial infections were associated with a cold . CONCLUSIONS: Picornavirus and non-picornavirus colds are associated with pulmonary function abnormalities and disease progression in patients with cystic fibrosis, and predispose to secondary bacterial infection and colonisation.

Vet Pathol, 1996 Nov, 33(6), 682 - 91
Experimental infection of pregnant cattle with the vaccine candidate Brucella abortus strain RB51: pathologic, bacteriologic, and serologic findings; Palmer MV et al.; To determine the placental tropism and abortigenicity of the vaccine candidate Brucella abortus strain RB51 (SRB51), a rough mutant of the virulent strain 2308, ten Polled Hereford heifers were inoculated intravenously in the 6th month of gestation . Heifers were euthanatized and examined at postinoculation week (PIW) 8 (n = 5) or at full term (n = 5) . Four of five infected heifers sampled at PIW 8 and three of four infected heifers at term had placentitis, whereas reproductive tissues of three normal cows used for comparison had no placentitis . Numerous macrophages, immunoreactive for SRB51 antigen, as well as neutrophils, fibrin, and cell debris filled the arcade zone between chorion and maternal septae . Trophoblastic epithelium of the placentomal arcade zone had intracellular bacteria that were immunoreactive for SRB51 antigen . The tips of maternal septa had a lymphoplasmacytic infiltrate with small multifocal erosions and ulcerations of maternal epithelium . SRB51 was cultured from all tissues in which lesions were seen . Placentae of one cow from each group had no placentitis and contained no SRB51 . In mammae, interstitial lymphoplasmacytic infiltrates and suppurative infiltrates within alveoli and intralobular ductules were seen in two of five heifers at PIW 8 . SRB51 was cultured from liver, spleen, lung, and bronchial lymph nodes in four of five calves at PIW 8 and three of four full-term calves, but no lesions were seen . One near-term heifer had disseminated infection, placentitis, and lymphoplasmacytic endometritis, and delivered a premature weak calf . These results establish that SRB51 is less abortifacient than previously published reports with strain 19, in that only one of four heifers delivered prematurely following intravenous inoculation with SRB51, whereas intravenous inoculation with strain 19 leads to 100% abortion . However, it also shows that SRB51 can infect the bovine placenta, mammary gland, and fetus, can induce placentitis, and, in some cases, can lead to preterm expulsion of the fetus.

J Burn Care Rehabil, 1996 Nov-Dec, 17(6 Pt 1), 522 - 7
Growth peptide release from biologic dressings: a comparison; Rennekampff HO et al.; Biologic dressings are believed to stimulate wound healing in a variety of wound types . Cryopreserved allograft skin (CAS) is used as a biologic dressing for excised wounds, partial-thickness wounds, and meshed split-thickness skin grafts, and the use of allogenic or autologous cultured epithelial sheets (CES) has been reported to enhance healing of skin ulcers and deep partial-thickness wounds . However, limitations of allograft skin include bacteriologic and viral safety, limited availability, cost, and ease of handling . Previously we have reported the successful use of human keratinocytes cultured to single-layer confluence on Hydroderm polyurethane membranes (HD/HK) for grafting of full-thickness wounds . In this study we evaluated the release of five different growth peptides (transforming growth factors alpha and beta (TGF-alpha, TGF-beta), interleukin-6, interleukin-8, and melanoma growth stimulatory activity from CAS, CES, and HD/HK grafts . Highest levels of TGF-alpha were found for HD/HK (728 +/- 115 pg/10 cm2 of membrane) followed by CES (491 +/- 137 pg/10 cm2; NS) . No TGF-alpha was detectable for CAS, and 3.7-fold, and 25-fold higher levels of interleukin-6 were found for CES (257 +/- 12.7 U/10 cm2) compared with HD/HK and CAS, respectively . Interleukin-8 had similar levels for CES (0.65 +/- 0.7 ng/10 cm2) and HD/HK (0.88 +/- 0.12 ng/10 cm2), whereas melanoma growth stimulatory activity was elevated in CES (2314 +/- 97 pg/10 cm2) compared with HD/HK (1071 +/- 55 pg/10 cm2) . TGF-beta was barely detectable for CES and HD/HK . Cryopreserved allograft showed high levels of TGF-beta (5.2 +/- 1.6 ng/10 cm2) . Overall mitogenic activity of the supernatants on keratinocyte cultures was assessed . Highest proliferation was seen for CES supernatants followed by HD/HK (NS) . Supernatants from CAS had an antiproliferative effect on keratinocytes . We conclude that a single layer of keratinocytes cultured on a polyurethane membrane facilitates keratinocyte proliferation similar to CES, whereas cryopreserved allograft has no mitogenic effect on keratinocytes.

J Infect, 1996 Nov, 33(3), 235 - 7
Common variable immunodeficiency presenting as a Mycoplasma hominis septic arthritis; Steuer A et al.; A case is reported of common variable immunodeficiency (CVID) presenting as an acute septic arthritis due to Mycoplasma hominis . The diagnosis was not considered until the hypogammaglobulinaemia was discovered and the synovial fluid cultured specifically for mycoplasmas . The importance of diagnosing immunodeficiency states and searching for mycoplasmas in 'bacteriologically culture negative' cases is emphasized.

Scand J Gastroenterol, 1996 Nov, 31(11), 1103 - 9
Luminal immunity in small-intestinal bacterial overgrowth and old age; Riordan SM et al.; BACKGROUND: The independent influences of small-intestinal bacterial overgrowth and old age on mucosal immunoglobulin production and secretion have not been assessed . This is an important issue, since luminal IgA deficiency may exacerbate small-intestinal bacterial overgrowth, the prevalence of which is high in selected elderly populations . METHODS: Proximal small-intestinal aspirates were obtained from 33 subjects for bacteriologic analysis and measurement of total IgA, IgM, total IgG . IgG subclass, and IgD concentrations . IgA subclasses were measured in 24 unselected subjects . Serum immunoglobulin and salivary IgA concentrations were measured in all subjects . RESULTS: IgA2 and IgG3 were predominant IgA and IgG subclasses in proximal small-intestinal luminal secretions . Luminal concentrations of IgA2 and IgM, but not IgG3 or any other IgG subclass, were significantly increased in small-intestinal bacterial overgrowth, which was present in 19 of 33 (57.6%) subjects . Old age did not influence these levels . Luminal immunoglobulin concentrations did not correlate significantly with either serum or salivary values . IgD was not measureable in proximal small-intestinal secretions . CONCLUSIONS: Increased luminal concentrations of the secretory immunoglobulins, IgA2 and IgM, occur in small-intestinal bacterial overgrowth . Local investigation is mandatory when assessing the mucosal immunopathology of this disorder . Luminal IgG3 is unlikely to be predominantly derived from serum . Old age does not independently influence luminal immunity.

Am J Vet Res, 1996 Nov, 57(11), 1604 - 7
Abortion and placentitis in pregnant bison (Bison bison) induced by the vaccine candidate, Brucella abortus strain RB51; Palmer MV et al.; OBJECTIVE: To determine the ability of Brucella abortus strain RB51 to induce placentitis and abortion in bison after SC vaccination . ANIMALS: 10 pregnant bison cows, 3 to 10 years old and at 3 to 8 months' gestation . PROCEDURE: Pregnant bison cows on a Montana ranch were vaccinated SC with 10(9) colony-forming units of B abortus strain RB51 . Two cows, identified prior to the study, were euthanatized and examined 5 weeks after vaccination to obtain optimal histologic samples of placenta . Other cows were euthanatized and examined after abortion . After euthanasia, tissue specimens were collected for histologic and immunohistochemical evaluation . Tissue and fluid specimens for bacteriologic culture were also collected during necropsy . RESULTS: Of 8 cows, 2 aborted at 68 and 107 days after vaccination . Aborting cows had endometritis . Strain RB51 was isolated from reproductive tissues and supramammary lymph nodes . Fetal lesions were not seen; however, fetal bronchial lymph nodes and amniotic fluid contained strain RB51 . Cows examined 5 weeks after vaccination had placentitis and endometritis, with numerous bacteria within trophoblastic epithelial cells that were immunoreactive for strain RB51 antigen . Strain RB51 was isolated from placentomes and numerous lymph nodes . Fetal lesions were not seen 5 weeks after vaccination; however, strain RB51 was isolated from numerous lymph nodes and lung, allantoic fluid, and rectal swab specimens . CONCLUSIONS: The vaccine candidate B abortus RB51 has tropism for the bison placenta, and can cause placentitis, which induces abortion in pregnant bison . The vaccine dose used was similar to that being tested in cattle, but may not be appropriate for pregnant bison.

Digestion, 1996 Nov-Dec, 57(6), 446 - 52
Bacterial translocation in the course of acute pancreatitis: beneficial role of nonabsorbable antibiotics and lactitol enemas; Marotta F et al.; Two-hundred Wistar rats were allocated to 4 groups . The groups, 3 representing our acute pancreatitis model induced by intrabiliary injection of a trypsin/enterokinase mixture, were studied as follows: (A) no treatment; (B) given a daily 30-ml enema with 20 mg/kg rifaximin; (C) given a daily 30-ml enema with 20 mg/kg rifaximin plus lactitol 0.5 g/kg, and (D) given a daily 30-ml enema with warm saline . A further group of healthy rats was given an intrabiliary injection of 0.15 ml saline . Sacrifices were made after 6, 12, 24, 48 and 72 h of observation . Serial blood samples were drawn to measure pancreatic enzymes and endotoxin . At sacrifice, ascites, lymph nodes, pancreas, spleen, portal vein blood, arterial blood and bile were obtained for bacteriological culture . Both enema treatments brought about a significant improvement in survival . Enema treatments did not affect the serum level of pancreatic enzymes . A time-course increase in endotoxin level was observed in untreated rats . However, significantly decreased levels were observed after both enema treatments . Overall, ascites was the sample most frequently infected . Lymph nodes contiguous to the gut were found to be infected more frequently than those close to major vessels . The histological pancreatic damage was of a significantly lesser degree in both enema treatment groups . Virtually all severe necrotico-hemorrhagic pancreatic lesions were associated with bacterial infection . These data suggest that bacterial translocation plays a relevant role in the outcome of experimental necrotizing pancreatitis . Intra-abdominal spread and lymphatics seem to be the pathways most likely involved in such processes . Colonic cleansing by non-absorbable antibiotics and lactitol seems to exert a beneficial effect on the supervening infection of experimental necrotizing pancreatitis.

Am J Respir Crit Care Med, 1996 Nov, 154(5), 1462 - 7
Efficacy and safety of rifabutin in the treatment of patients with newly diagnosed pulmonary tuberculosis; McGregor MM et al.; The efficacy and safety of rifabutin (RBT) and rifampicin (RMP) were compared in 298 patients with newly diagnosed pulmonary tuberculosis . In the initial 8-wk phase, all patients received isoniazid 400 mg/d, ethambutol 1200 mg/d, and pyrazinamide 2 g/d and were randomly allocated to receive either RMP 600 mg/d or RBT 300 mg/d . In the 16-wk continuation phase, patients received intermittent treatment (twice weekly) with isoniazid 600 mg/d, ethambutol 2400 mg/d and either RMP 600 mg/d or RBT 300 mg/d . Two hundred twenty-five (RMP = 118; RBT = 107) patients completed the 24-wk treatment period (evaluable patient population) . Bacteriologic conversion rates in the RMP and RBT groups were 87.7 versus 92.0% at Week 8, 99.1 versus 99.0% at Week 12, 93.5 versus 93.8% at Week 24, and 89.8 versus 95.3% at the last valid observation . The mean time to first bacteriologic conversion was 14.1 wk in the RMP group and 14.3 wk in the RBT group . None of these differences was significant . Adverse events were reported by four patients (five events) in the RMP group and six patients (six events) in the RBT group . Those events thought to be associated with RMP were increased SGOT and leucopenia and, with RBT, increased SGOT and thrombocytopenia . Two hundred four patients entered the follow-up phase, and, of these, 95 (RMP = 49; RBT = 46) completed the scheduled 24-mo period . The overall rate of relapse was 3.8% (4/106) for the RMP group and 5.1% (5/98) for the RBT group . These differences were not significant . All relapsed patients, except for two who could not be traced, were successfully retreated . We conclude that the efficacy and tolerability of RBT is equivalent to that of RMP in the treatment of newly diagnosed uncomplicated tuberculosis, and that RBT can be effectively administered in a part-daily, part-intermittent dosage schedule.

Cas Lek Cesk, 1996 Oct 23, 135(20), 653 - 6
{Tuberculosis in the Czech Republic in 1994 . Does compulsory notification give a true picture of tuberculosis morbidity?}; Trnka L et al.; In the Czech Republic in 1994 a total of 1960 new cases of TB of all forms and localizations were notified, i.e . 19.0 patients per 100,000 population . This number comprised 1644 cases of TB of the respiratory system (15.2 patients/100 000 population) . Bacteriological tests were made in 1058 new cases of respiratory TB (10.2/100,000, whereby in 524 patients in sputum acid resistant rods were detected under the microscope . Extrapulmonary forms accounted for 16% of all notified cases of TB and relapses of TB accounted for less than 3% of the total number of notified cases . The TB mortality varied near 0.8 deaths/100,000 population . These numbers did not differ significantly from data for 1992 and 1993 and it may be concluded that the stagnating trend of tuberculosis in this country persists . The notified data made it possible to create a set of direct and indirect epidemiological indicators (age distribution, notifications, prevalence of severe forms, regional distribution, mortality rate and comparison of hospital admission on account of TB), which helped to show that the validity of notification has not changed much in recent years . The data assembled in notifications can therefore be used for comparative studies and they can be considered a measure of the TB morbidity . However, every evaluation of morbidity based on notification cells for verification of the validity of the presented data.

J Int Fed Clin Chem, 1996 Nov, 8(4), 161, 164 - 6
Diagnosis of Helicobacter pylori infection; Leung VK et al.; A number of reliable methods are currently available for the diagnosis of Helicobacter pylori infection . These diagnostic tests can be classified into invasive methods that require endoscopy and gastric biopsy, and noninvasive methods . Invasive methods include gastric mucosal biopsies at endoscopy for bacteriologic culture, histology, and the rapid urease test . Noninvasive methods include the urea breath test and serologic tests . Each of these diagnostic tests has its advantages and disadvantages . Histologic examination remains the gold standard for diagnosis . It can also detect coccoidal forms of the bacteria and be used to assess the severity of gastritis . Culture of H pylori should be performed if antibiotic sensitivity of the organism is required . A rapid urease test is the quickest test for H pylori status . The urea breath test detects urease activity in the entire stomach, thus eliminating the possibility of a sampling error, which occurs in random gastric biopsies . Serologic tests using either ELISA or latex-agglutination methods are excellent for diagnosis of H pylori infection, but not useful for monitoring effects of therapy . Recently, the polymerase chain reaction has been applied to fixed-tissue biopsies, as well as body secretions in the diagnosis of H pylori infection.

Pol Merkuriusz Lek, 1996 Oct, 1(4), 252 - 3
{Microbiologic state of the vagina in labor and puerperal fever}; Blaszczyk G et al.; Vaginal smears have been collected from 520 delivering women for bacteriological evaluation and analysis of the relationship between present organisms with puerperal fever . A relationship between the composition of vaginal flora before labour and pathological organisms isolated during puerperal fever has been shown . Presence of the exogenous source of infections has also been confirmed.

Indian J Pathol Microbiol, 1996 Oct, 39(4), 271 - 5
Serum alpha-1-antitrypsin in ischemia and rheumatic heart diseases; Somayajulu GL et al.; Tissue damage, inflammation and necrosis are hallmarks of myocardial infarction . In the present study significant elevations of serum alpha-1-antitrypsin were noted in coronary artery disease and angina cases . Interestingly chronic rheumatic heart disease which is also characterized by tissue injury . Inflammation revealed normal levels of serum alpha-1-antitrypsin . The level in chronic rheumatic heart disease was 3.37 +/- 0.57 mumol/mt/ml (control level was 3.37 +/- 0.54 mumol/mt/ml) . The corollary of these observations is that in heart diseases acute phase response in terms of enhanced levels of alpha-1-antitrypsin differ depending on the causative factors . Except chronic rheumatic heart disease, in all other stressful states studied there is (to a certain degree) an altered systemic homeostasis and haemostasis . On the other hand chronic rheumatic heart disease encompass certain amount of acute phase status in terms of tissue damage and inflammation does exist unaccompanied by altered systemic homeostasis and haemostasis . However, bacteriological etiologies predominate the triggered immune responses . It is hypothesised that serum alpha-1-antitrypsin enhancement will not occur even though acute phase state exists if specific immune responses are also a part of the disease manifestation.

Rev Med Brux, 1996 Oct, 17(5), 324 - 30
{Infectious endocarditis: old myths and current concepts}; Sternon J et al.; Updating of several main themes concerning the infectious endocarditis with the aim to denounce various old myths and to precise different actual concepts . The authors consider principally the echocardiographic revolution and the new diagnostic criteria, the bacteriologic pitfalls and the preventive strategies.

Zentralbl Veterinarmed A, 1996 Oct, 43(8), 451 - 8
Total and differential cell count by direct microscopic method on ewe milk; Morgante M et al.; On 700 milk samples from single half udders of Comisana ewes, somatic cell count (SCC) and differential cell count (DCC) were determined, using a Fossomatic 90 cell counter (Foss Electric, Denmark) (SCCF) and milk smears stained with May Grunwald-Giemsa (DCCS) . SCC and DCC were also determined with modified KOVAH SYSTEM (Hicor Biomedical Inc . Irvine, CA, USA) (SCCK and DCCK, respectively) . Out of 665 milk samples from half udders without clinical signs of mastitis, 640 (Class I) were sterile, while 25 (Class II) were bacteriologically positive . Out of 35 milk samples (Class III) from half udders with clinical signs of mastitis, 25 were bacteriologically positive . Mean results (after logarithmic transformation of cells/ml/10(3)) of SCCF and SCCK for all the 700 milk samples were 1.89 +/- 0.58 and 1.86 +/- 0.60 with linear correlation coefficient (r) of 0.960, while least squares means for Class I, II and III were 1.78, 2.23 and 3.73 respectively and 1.75, 2.19 and 3.74 with r of 0.894, 0.979 and 0.987 . Mean results of DCCS and DCCK were 38.1 +/- 23.3, 34.9, 52.1, and 82.2 PMNL% and 41.8 +/- 21.7, 38.6, 60.2, and 87.3 PMNL% with r of 0.855, 0.812, 0.697 and 0.805 . The results showed high correlation coefficients and a good reliability between SCCK and SCCF and high correlation coefficients for DCC methods . In conclusion, it could be suggested that the possibility of routine use of the KOVAH SYSTEM method is particularly useful in detecting if an abnormal SCC is due to a polymorphonuclear neutrophil leukocytes increase.

Acta Odontol Scand, 1996 Oct, 54(5), 309 - 13
Incidence of infections requiring hospitalization associated with partially erupted third molars; Berge TI; A retrospective study of patients hospitalized for infections associated with partially erupted third molars during a 10-year period (1985-94) showed a total of 17 cases: 6 women and 11 men, aged 18 to 57 years . Eight patients were in the third decade . No deviation from the habits of the general population with regard to cigarette smoking and alcohol consumption or overrepresentation of general health problems was found . All infections were of pericoronal origin . Bacteriologic cultures from six patients showed mixed aerobic-anaerobic oral flora, without any penicillin-resistant strains . The incidence rate of serious orofacial infections associated with partially erupted third molars was calculated to be 0.016 cases per year per 1000 patients at risk.

Appl Environ Microbiol, 1996 Oct, 62(10), 3818 - 25
Phenotypic and genotypic characterization of phenanthrene-degrading fluorescent Pseudomonas biovars; Johnsen K et al.; A total of 41 phenanthrene degraders were isolated from a former coal gasification site by using Pseudomonas-selective Gould's S1 medium . All isolates were found to belong to the fluorescent Pseudomonas group and were subjected to characterization by phenotypic methods, including classical taxonomic tests, API 20NE, and Biolog GN, and the strains were further characterized by the genotypic method repetitive extragenic palindromic PCR (REP-PCR) . By using classical tests, the population was found to consist of 38 strains belonging to P . fluorescens, 2 P . putida strains, and 1 Pseudomonas sp . Bacteria in phenograms from Biolog GN and REP-PCR data were divided into groups, which were in good agreement with classical test and API 20NE results . We found a nonfluorescent group of 22 bacteria inconsistent with any Pseudomonas sp . in Bergey's Manual of Systematic Bacteriology . The group showed small differences in the genotypic test, indicating that all 22 isolates were not recent clones of the same isolate . Analyses of the nonfluorescent group indicated that it belonged to Pseudomonas, but the group could not be affiliated with P . fluorescens because of differences in DNA-DNA hybridization . Identifications using classical tests and API 20NE were found to correlate, but Biolog GN identifications after 24-h incubation resulted very often in the distantly related P . corrugata . The reproducibilities of individual tests of each phenotypic method were assessed, and low reproducibilities were mainly found to be associated with specific Biolog GN test wells . Classical tests and API 20NE proved to be the best for identification of isolates, whereas Biolog GN and REP-PCR were found to be the best tests for high resolution among these closely related isolates.

Vet Rec, 1996 Sep 21, 139(12), 287 - 9
Prophylaxis of intravenous catheter-related thrombophlebitis in cattle; Pusterla N et al.; Two methods of preventing intravenous catheter-related thrombophlebitis of the jugular vein, using clinical and ultrasonographic criteria, were compared . The first method consisted of minimising bacteriological contamination by the preparation of the skin as if for surgery . The second method involved the daily subcutaneous administration of low doses of heparin to decrease procoagulant activity . The results showed that the preparation of the skin before the placement of an indwelling catheter in the jugular vein and adequate daily maintenance of the catheter were of great importance in the prevention of thrombophlebitis induced by bacteriological contamination . The use of heparin should be limited to cases that require long-term catheterisation or are predisposed to thrombosis or other clotting abnormalities.

Ugeskr Laeger, 1996 Sep 2, 158(36), 5041 - 3
{Rhinoslceroma in an elderly Danish woman}; Stougaard MJ et al.; A case of rhinoscleroma in an elderly Danish woman is presented . The characteristics of the disease are described . An 84-year old female presented with serous rhinorrhoea, swelling of the columella and the upper lip and granulomatous masses in the right inferior concha and the right maxillary sinus . The diagnosis was confirmed by histological studies . Until now no serological or bacteriological cultures have been positive . The patient recovered clinically after surgical debridement and three months of orally administered ciprofloxacin 500 mg twice daily . There remains, however, a sclerotic swelling in the columella and the upper lip . No obvious explanation as to how this patient had caught the disease could be found.

Oral Dis, 1996 Sep, 2(3), 242 - 3
Oral tuberculosis; Kolokotronis A et al.; A case with oral tuberculosis and unaware of systemic tuberculosis is reported . The oral lesions clinically manifested as two painless ulcerations in the hard palate . Pulmonary tuberculosis was diagnosed following the histopathologic and bacteriologic examination of the oral lesions.

Indian J Med Sci, 1996 Sep, 50(9), 313 - 7
Evaluation of safety and efficacy of azithromycin in lower respiratory tract infections (LRTI)
Adhikari P, Hegde BM, Pereira P, Bhat P, Chowta N, Ramesh KV, Venkatadri TV, Pai MM.
Azithromycin was given to 55 cases of lower respiratory tract infections in the doses of 500 mg on day 1, followed by 250 mg on days 2-5 . It produced bacteriological cure in 70.8% patients and clinical cure or improvement in 69.09% of patients . 4.27% of patients had throat colonisation with new organisms, of which 9.09% needed a second antibiotic . The drug was well tolerated and minor side effects were noted . Gastrointestinal disturbances (16.36%) headache and giddiness (14.55%), rash (3.64%) were the noted side effects . Reduction of platelet count by 50% occurred in 12.29% of the cases compared to 0.2% reported earlier . But this thrombocytopenia was clinically not significant, as it did not cause any symptoms.

Urol Nefrol (Mosk), 1996 Sep-Oct, (5), 41 - 4
{The immune status of patients with acute and chronic epididymitis}; Boris IuB et al.; The trial entered 49 patients with epididymitis and 18 age-matched control subjects without this disease . The patients were divided into 3 groups: 21 patients of group 1 were treated surgically (epididymotomy with drainage of the scrotal cavity), 15 patients of group 2 were inoperable, 13 patients of group 3 suffered from exacerbation of chronic epididymitis . Before treatment the patients were examined clinically, bacteriologically and immunologically . Measured were: main populations and subpopulations of lymphocytes using indirect immunofluorescence and monoclonal antibodies; concentration of serum immunoglobulins using radial immunodiffusion; overall content of circulating immune complexes precipitating by polyetilene glycol-6000; phagocytosing neutrophil function by absorption of latex particles . The immunogram of epididymitis patients was indicative of the inflammation stage and activity which is important for choice of treatment . Immunogram of group 1 patients was characteristic of the peak of acute inflammation, of group 2 was typical for attenuation of acute inflammation . Immunogram of group 3 patients corresponded to exacerbation of chronic inflammation and secondary immunodeficiency.

Rev Sci Tech, 1996 Sep, 15(3), 985 - 1005
Tuberculosis in sea lions and fur seals from the south-western Atlantic coast; Bernardelli A et al.; Diverse pathological conditions causing the strandings and/or deaths of several species of sea lions and seals on the northern coast of the province of Buenos Aires are being studied . Tuberculosis was diagnosed in six cases of strandings, involving two otariid seal species (one Otaria flavescens and five Arctocephalus australis), between March 1989 and December 1992 . Necropsies were performed on all six cases . Granulomatous lesions were observed in the prescapular and hepatic lymph nodes . Lesions were also seen in the lungs, pleura, liver, spleen and peritoneum . Bacteriological isolation was attempted from all the samples . The isolates were identified as belonging to the Mycobacterium tuberculosis complex . Some showed characteristics consistent with M . bovis, whereas others demonstrated properties of M . tuberculosis . Genomic deoxyribonucleic acid (DNA) from these strains was analysed by restriction fragment length polymorphism (RFLP), using IS6110, a genetic marker found only in the Mycobacterium tuberculosis complex . Using the IS6110 probe, similar fingerprints were obtained, suggesting a common source of infection . However, the pattern of DNA differed from DNA patterns of M . bovis isolated from humans and cattle in Argentina, which generally contain a unique 1.9 kbp band . These results suggest that mycobacteria isolated from wild seals form a different grouping inside the M . tuberculosis complex . This is the first time that tuberculosis has been detected in wild seals from the south-western Atlantic coast.

Thorax, 1996 Sep, 51(9), 929 - 31
Comparison of bronchoscopic diagnostic techniques with histological findings in brain dead organ donors without suspected pneumonia; Sole-Violan J et al.; BACKGROUND: The techniques for recognising pneumonia in mechanically ventilated patients were evaluated as no "gold standard" is available to establish the diagnosis in these patients . METHODS: A prospective study was performed on nine brain dead organ donors not suspected of having pneumonia to assess the specificity of bacteriological results from different samples by comparing them with the histological findings from an open pulmonary biopsy specimen taken immediately after death through a mini-thoracotomy . RESULTS: Seven of the nine organ donors without clinical evidence of pulmonary infection and not on antibiotic therapy showed histological features of bronchopneumonia . There was no association between the histological findings and quantitative cultures of the lung biopsy specimen . CONCLUSIONS: Histological evidence of pneumonia was common in this group of ventilated patients who had no clinical signs of the disease.

Nucl Med Commun, 1996 Sep, 17(9), 749 - 57
Simultaneous administration of 99Tcm-HMPAO-labelled autologous leukocytes and 111In-labelled non-specific polyclonal human immunoglobulin G in bone and joint infections; de Lima Ramos PA et al.; The aim of this study was to investigate the ability of 111In-labelled human polyclonal immunoglobulin G (111In-IgG) to localize bone and joint infections compared with 99Tcm-HMAPO-labelled leukocytes (99Tcm-WBC) . Thirty-four patients routinely referred for investigation of bone and joint infections were studied . In all patients, a bone scan using 99Tcm-MDP was initially obtained . Subsequently, 99Tcm-WBC and 111In-IgG were simultaneously injected and images obtained at 30 min, 4 h and 24 h post-injection . Diagnostic accuracy was established by bacteriology of specimens obtained by needle aspiration and/or surgery, other imaging methods and clinical follow-up . The images were read by three experienced observers blinded to any other information; the clinical suspicion of infection and the diagnosis were established when two observers agreed . Infection was confirmed in 11 patients . The 99Tcm-WBC scans gave 8 true-positive, 5 false-positive, 18 true-negative and 3 false-negative results . With 111In-IgG, the figures were 7, 6, 17 and 4, respectively . The sensitivity, specificity and accuracy were 72.7%, 78.2% and 76.4% respectively for the labelled leukocytes and 63.6%, 73.9% and 70.6% respectively for 111In-IgG . There was greater agreement between the observers with 99Tcm-WBC than 111In-IgG . In this study, 111In-IgG was less sensitive and less specific than 99Tcm-WBC scintigraphy for the diagnosis of chronic infections, but these differences were not significant . Both tracers appear to be useful in the diagnosis of bone and joint infections . However, our results were less reliable for the diagnosis of an infected prosthesis.

Vet Pathol, 1996 Sep, 33(5), 542 - 50
Light microscopic and ultrastructural changes in the ceca of chicks inoculated with human and canine Serpulina pilosicoli; Muniappa N et al.; Light microscopic and ultrastructural changes were observed in chicks challenged with North American Serpulina pilosicoli, a weakly beta-hemolytic intestinal spirochete (WBHIS) associated with human and canine intestinal spirochetosis . Chicks in control groups received trypticase soy broth or canine Serpulina innocens . The birds were necropsied at weekly intervals, and the ceca were processed for bacteriologic and pathologic examinations . No WBHIS were isolated from the ceca of chicks in the control groups, but WBHIS with genotypes similar to the parent isolates were isolated from the ceca of chicks inoculated with human and canine S . pilosicoli . Gross examination revealed no significant changes in the ceca of chicks at any time post-inoculation . Light microscopic examination revealed no spirochetal attachment in the ceca of chicks in control groups . In contrast, focal to diffuse thickening of the brush border of the surface epithelium along with dilation of the crypt lumina and mild focal lamina propria heterophil infiltration were present in the ceca of chicks inoculated with human and canine S . pilosicoli . Scanning electron microscopic examination revealed focal to confluent spirochetal attachment mainly in the furrow region at the periphery of the crypt units . Transmission electron microscopic examination revealed spirochetes attached to the brush border of the cecal epithelium, causing effacement of the microvilli and disruption of the terminal web microfilaments . The cecal epithelium of chicks inoculated with the canine S . pilosicoli also had caplike elevations of the apical membrane at the point of attachment of the spirochetes together with large numbers of vesicles in the cytoplasm immediately beneath the terminal web and evidence of spirochetal invasion beyond the mucosal barrier . The changes observed suggested that the mechanism of attachment of human and canine S . pilosicoli to the cecal epithelium of chicks was analogous to but different from that described previously for other attaching and effacing gastroenteric bacterical pathogens of human beings and animals.

Int J Lepr Other Mycobact Dis, 1996 Sep, 64(3), 306 - 10
Silent iritis in treated bacillary negative leprosy; Thompson K et al.; Iridectomy specimens from 59 leprosy patients who had adequate medical records of whom 33 belong to the lepromatous (LL) leprosy variety and 16 normal controls were studied histopathologically . All patients were bacteriologically negative and had received dapsone followed by multidrug therapy (MDT), or MDT only, or only dapsone for varying periods . It was found that leprosy, particularly lepromatous disease, did not significantly decrease the age of formation of cataract . Of the 33 LL patients studied 60.6% had silent iritis . The duration of treatment had no obvious influence on the persistence of iritis . Treatment with only 2 years of MDT for LL patients did not significantly increase the prevalence of persistent silent iritis compared to those who received other types of antileprosy therapy for long periods . It is pointed out that chronic iritis is a serious complication that continues even after the patient is declared clinically and bacteriologically cured, especially in patients who had a history of chronic iritis clinically.

Jpn J Antibiot, 1996 Aug, 49(8), 808 - 12
{Clinical study of tazobactam/piperacillin in obstetrics and gynecological infections}; Chimura T et al.; A clinical study was carried out to investigate clinical efficacy and safety of tazobactam/piperacillin (TAZ/PIPC), a newly developed antibiotic agent for injections . The obtained results are as follows: 1 . In 10 patients with obstetrics and gynecological infections (7 patients with endometrial infections, one patient with pelvic peritonitis, one patient with ovarian abscess and one patient with Bartholins's abscess) intravenous drip infusion of TAZ/PIPC, 5.0 g/day, was administered for 5 to 10 days . The total doses were 2550 g/body . 2 . Clinical efficacy was evaluated in the above cases . As a result, an excellent result was obtained in one patient and good efficacies in 9 patients . The efficacy rate was 100% (10/10) . Concerning the clinical bacteriological effect, eradication ratio was 83.3% (5/6) . Concerning the bacteriological effect against 11 strains of clinical isolates, 4 strains were eradicated, 6 strains were replaced and one strain was unchanged . 3 . Neither subjective/objective side effects nor abnormal laboratory test results were observed upon administration of TAZ/PIPC . These results suggested the usefulness of tazobactam/piperacillin in obstetrics and gynecological infections.

Jpn J Antibiot, 1996 Aug, 49(8), 782 - 99
{Clinical studies on vancomycin in the treatment of MRSA infection}; Shimizu K et al.; We evaluated the effectiveness and safety of vancomycin (VCM) alone and in combination with beta-lactam antibiotics in the treatment of MRSA infections, and obtained the following results: 1 . Effectiveness . (1) In cases of MRSA infections alone, the improvement rate was 71.4% (5/7 patients) with VCM alone and 77.8% (35/45) with VCM in combination with beta-lactam antibiotics . (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the improvement rate in combination use with beta-lactam antibiotics was 71.8% (28/39) . 2 . Bacteriological effect . (1) In cases of single infection with MRSA, the rate of bacterial eradication was 71.4% (5/7) with VCM alone and 68.2% (30/44) with VCM in combination with beta-lactam antibiotics . (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the rate of bacterial eradication in combination use with be ta-lactam antibiotics was 63.2% (24/38) against MRSA and 31.6% (12/38) against polymicrobial agents including MRSA . 3 . Safety . Occurrences of adverse reactions and abnormal laboratory test values when VCM was used alone or when it is used in combination with another drug were about the same in these uses . As a whole, advance reactions were observed in 16 patients (9.5%) . Main adverse reactions were whole body redness, drug eruption, and rash etc . Abnormal laboratory test values were observed mainly in hepatic functions, and renal functions . 4 . VCM concentrations in blood was determined in 38 patients . Doses of 0.5 g and 1.0 g of VCM was administered by intravenous drip infusion over a period of 1 to 2 hours, and mean blood concentrations 1 to 2 hours after the completion of drip infusion were 25.4 micrograms/ml and 14.4 micrograms/ml, respectively . 5 . Synergic effects between VCM and other antibiotics tested were observed in FIC index against all of the six MRSA strains isolated from six patients, and the clinical effects of improvement or better were obtained against five of them.

Tierarztl Prax, 1996 Aug, 24(4), 359 - 67
{The cerebrospinal fluid from healthy pigs and pigs with central nervous system diseases}; Heinritzi K et al.; CSF samples were taken from 50 healthy pigs of both sexes and cytologically and biochemically examined . With the aid of regression calculations it was investigated, whether deep freezing of CSF samples influences the laboratory results . The parameters glucose, urea, creatinine, total protein, magnesium, anorganic phosphate, AST and AP were in good agreement with the values of the original samples exhibiting only slight variations . Minor age relationship was only seen with respect to the two enzymes LDH and HBDH . A linear relationship was found between values in CSF and in serum of the parameters urea, creatinine, sodium and potassium . CSF examination should include cell count, Pandy's test and bacteriological investigation as well as the determination of the levels of the enzymes LDH and HBDH . The activity of the enzymes AST and ALT increases along with the severity of the tissue damage (meningitis) . The specific gravity increases similarly to the total protein level in cases of chronic compression of the spinal cord, and Pandy's test becomes positive . However, CSF glucose levels are partly reduced in animals with central nervous symptoms . The levels of the enzymes AP and CK are often increased in central nervous disturbances, but do not admit drawing a conclusion on the degree of damage.

Eur J Epidemiol, 1996 Aug, 12(4), 395 - 401
Prevalence of Borrelia burgdorferi (sensu lato) in Ixodes ricinus (L.) populations in France, according to a phytoecological zoning of the territory; Gilot B et al.; Ixodes ricinus is considered as the main vector of Lyme Borreliosis in France . The aim of our investigations was to obtain a comprehensive view of the spatial risk linked to the distribution of the species in our country . Previous studies {1} have provided strong evidence that the species populations are widely distributed, so the objective of the present work was to ascertain the bacteriological infection of the tick by the agent of the zoonosis (Borrelia burgdorferi, sensu lato), over the French territory, whatever the ecological conditions may be . For this purpose, we kept the same framework as that used in our acarological investigation, a phytoecological zoning of the territory into 54 geographically separate and ecologically distinct units distributed into three climatic zones . Batches of ticks, picked up in these different phytoecological units (only two thirds of which were sampled), were submitted for bacteriological investigation . A total of 4,673 ticks were examined, individually, for the presence of Borrelia burgdorferi, by immunofluorescence . Percentages of infection according to the various stages of Ixodes ricinus free stages, collected by flagging, were as follows: 4.95% in 3,247 nymphs, 11.2% in 699 males, 12.5% in 727 females . Larvae were ignored . Practically all the tested units harboured the bacterium . The percentage of tick samples (25 ticks or more) absolutely free of Borrelia, wherever they came from, is very low (not exceeding 10 percent of the sampled forests) . Our study confirms the assessment of a widespread distribution of the zoonosis in France which was, until now, exclusively based on an approximate distribution of limited human cases observed in the country.

Artif Intell Med, 1996 Aug, 8(4), 359 - 75
Retrieval of clinical science information using an interactive activation and competition network; Cheng KJ; A method for storing and retrieving tabulated clinical science information is described . This method uses the interactive activation and competition network and belongs to the realm of parallel distributed processing . The advantages of this method are that information is readily retrievable by name and by any content, and that the best matched information is automatically returned when partially incorrect cues are given . Furthermore, it allows a variable degree of association among different units of information . The basic principles of this method are illustrated through a simple example from clinical bacteriology . In addition an application of this method to the retrieval of information in cardiology is presented.

J Dairy Res, 1996 Aug, 63(3), 351 - 60
Acute phase response in heifers with experimentally induced mastitis; Hirvonen J et al.; Ten pregnant heifers were inoculated in both hind udder quarters with a mixture of Actinomyces pyogenes, Fusobacterium necrophorum and Peptostreptococcus indolicus . Development of the experimental mastitis was monitored by sequential clinical and bacteriological examinations, and by blood acute phase protein profiles . Sequential changes in plasma fibrinogen, serum haptoglobin, acid-soluble glyco-proteins and alpha 1-proteinase inhibitor activity were analysed and compared with both the clinical and bacteriological findings and the final outcome of the disease after calving . All ten heifers developed moderate to severe clinical mastitis . Four recovered completely, had a normal lactation after calving and exhibited only transient fever and moderate local signs . In six of the heifers the course of the disease was severe, and the inoculated quarters failed to produce milk after calving . The acute phase response of the four heifers that recovered was also significantly milder than that of the other six heifers . Haptoglobin and acid-soluble glycoproteins were most effective in indicating the severity of the infection and predicting the final outcome of the disease . Fibrinogen was a reliable indicator for detecting the presence of bacterial infection in all heifers . alpha 1-Proteinase inhibitor activity was of low diagnostic value in this study.

Aliment Pharmacol Ther, 1996 Aug, 10(4), 557 - 61
Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole; Lewis SJ et al.; BACKGROUND: The dramatic inhibitory effect of proton pump inhibitors on acid secretion has raised concern about possible side-effects, such as small bowel bacterial overgrowth, which may result in further gut dysfunction . The aim of this study was to assess the effect of proton pump inhibitors on duodenal bacteriology, carbohydrate absorption and bowel habit . METHODS: Small bowel bacterial overgrowth and xylose absorption were measured by culture of aspirated duodenal fluid and a combined 1 g 14C-D-xylose absorption-metabolism test in 20 patients with peptic ulcer disease . Tests were repeated after 4 weeks of treatment with omeprazole 20 mg daily . Intestinal transit was assessed by recording interdefecatory intervals and stool form . RESULTS: All patients showed an increase in duodenal bacterial counts following treatment, geometric mean counts increasing from 330 to 95000 CFU/mL . The geometric mean of the difference was 290 CFU/mL (95% CI, 110-720 CFU/mL; P < 0.0001) . No changes were noted in the xylose absorption or metabolism tests . Mean interdefecatory intervals decreased by 32% from 31.7 to 21.6 h, the mean difference being 10.1 h (95% CI, 1.6-18.5 h: P = 0.01) . The mean stool form index increased from 2.95 to 4.70, mean difference 1.75 (95% CI, 1.10-2.40: P < 0.0001), with four patients reporting diarrhoea . CONCLUSION: The results indicate that conventional treatment for duodenal ulcers with a proton pump inhibitor significantly increases bacterial colonization of the duodenum and the speed of intestinal transit.

Australas Radiol, 1996 Aug, 40(3), 244 - 9
The radiology of melioidosis; Chong VF et al.; Melioidosis varies from subclinical infection to fulminating disease with multiple organ involvement . Although endemic in South-East Asia and northern Australia, it may be imported into temperate zones . It is the wide spectrum of manifestation that makes it 'the great imitator' . The purpose of this pictorial essay is to familiarize the radiologist with the range of radiological manifestations of this disease . Intrathoracic findings include pulmonary nodules, consolidation, necrotizing lesions, pleural effusion, pleural thickening and mediastinal abscess . Abscess in almost all organ systems can be seen in the septicaemic and suppurative infections . Both clinical and radiological findings are non-specific . A high index of suspicion is required to focus the search for bacteriological confirmation . A prompt diagnosis is essential, as melioidosis is often rapidly fatal.

S Afr Med J, 1996 Aug, 86(8), 960 - 5
A controlled trial of a 4-weekly supplement of rifampicin, pyrazinamide and streptomycin in the continuation phase of a 7-month daily chemotherapy regimen for pulmonary tuberculosis . Tanzania/British Medical Research Council Collaborative Investigation; Differentiation of Chlamydia spp . by sequence determination and restriction endonuclease cleavage of RNase P RNA genes; Department of Clinical Microbiology, University Hospital, Uppsala, Sweden . Bjorn.Herrmann@klinbakt.uu.se

The amplification of DNA from Chlamydia trachomatis by PCR with degenerated primers yielded a 345-bp fragment of the putative RNase P RNA gene . From the deduced DNA sequence of this gene in C . trachomatis, a modified primer pair was designed . The primer pair was subsequently used to obtain the corresponding gene products from Chlamydia pneumoniae and Chlamydia psittaci . Sequence comparisons revealed similarities of 76.6% between C . trachomatis and C . pneumoniae, 79.5% between C . trachomatis and C . psittaci, and 84.7% between C . pneumoniae and C . psittaci . Furthermore, the three species were differentiated by fragment length polymorphism analysis after restriction enzyme cleavage of the PCR products . Sequence variations among 14 serotypes of C . trachomatis were confined to one purine base substitution in the putative RNase P RNA gene of lymphogranuloma venereum strains L1 to L3 . Complete sequence similarity was found for nine strains of C . pneumoniae of different geographic origins . Taken together, our results indicate a possibility of the general application of this method in clinical bacteriology . Analysis of the secondary structures of the putative RNase P RNA genes from the different Chlamydia species suggested that a novel structural element in the domain of RNase P RNA is involved in base pairing with the 3'-terminal CCA motif of a tRNA precursor . This structure has not previously been found among RNase P RNAs of members of the division Bacteria.

Tuber Lung Dis, 1996 Aug, 77(4), 353 - 7
Evaluation of polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous meningitis; Seth P et al.; SETTING: Since conventional bacteriological methods rarely detect Mycobacterium tuberculosis in cerebrospinal fluid (CSF) and are of limited use in the diagnosis of tuberculous meningitis (TBM), clinical features suggestive of TBM supported by indirect evidence such as CSF examination and computerized tomography (CT) of the head have been used for the early diagnosis of TBM . OBJECTIVE: We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of TBM . METHODS: Coded CSF samples from 40 patients with TBM and from 49 patients with other neurological disorders were processed . In the absence of a reliable sensitive and specific test for M . tuberculosis in CSF, we used a set of established clinical criteria as the gold standard . Accordingly, the patients were divided into definite, highly probable, probable and possible TBM . The samples were decoded only after completion of the laboratory tests . RESULTS: PCR was positive in 2/4, 19/20, 13/16 patients with highly probable, probable and possible TBM respectively . None of the samples were positive by conventional bacteriological methods . However, 3/49 CSF samples from non-TBM patients were also found positive by PCR . PCR detected M . tuberculosis genomic DNA in the CSF of 85% of clinically suspected TBM cases and 6.1% of non-tuberculous controls . CONCLUSION: PCR, along with the suggested clinical criteria, offers a rapid and fairly accurate diagnosis of TBM.

Tuber Lung Dis, 1996 Aug, 77(4), 302 - 7
Directly observed intermittent short-course chemotherapy in the Kathmandu valley; Neher A et al.; SETTING: Within the national tuberculosis control programme in Nepal, cure rates of only 30%-40% were achieved using standard chemotherapy . High cure rates are particularly difficult to achieve in the Kathmandu valley, because of the mobility of the population and the large numbers of private practitioners . Short-course chemotherapy (SCC) was not used in tuberculosis (TB) control programmes in Nepal before 1991 . Therefore we started our pilot programme with a fully supervised, intermittent SCC regimen . In addition we established a mycobacteriological laboratory for routine culture and susceptibility tests . OBJECTIVE: The main objective was to demonstrate the high effectiveness of a three-times weekly SCC regimen and the feasibility of directly observed treatment (DOT) . DESIGN: In our new out-patient department we put all active TB patients under SCC . The duration of therapy was 9 months or longer, depending upon bacteriological and radiological needs . The results were well recorded and evaluated by central supervision . Outcome of treatment was recorded at 24-48 months . RESULTS: From January 1990 to December 1993, 771 pulmonary TB patients (618 new cases and 153 old cases) commenced treatment . Of these, 645 (84%) were cured or completed treatment, 84 (11%) defaulted, 15 (2%) died, 15 (2%) were treatment failures and 12 (3.0%) relapsed . CONCLUSION: Directly observed intermittent SCC is highly cost-effective . The results of our service programme showed that it is possible to introduce such a regimen in an urban area of Nepal.

Tuber Lung Dis, 1996 Aug, 77(4), 297 - 301
Tuberculosis in Siberia: 2 . Diagnosis, chemoprophylaxis and treatment; Drobniewski F et al.; OBJECTIVE: To assess tuberculosis diagnosis, chemoprophylaxis and therapy in Siberia as a paradigm for the Russian Federation . DESIGN: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994 . RESULTS: Tuberculosis disease and cure is classified according to a Dispensary Group Register based principally on clinical and radiological criteria . Isoniazid is widely used for chemoprophylaxis and post-therapy and may be linked to high levels of isoniazid resistance . Combination drug therapy is individualized, frequently changed, and given orally, parenterally or intra-bronchially . Galvanization, autotransfusion of ultra-violet irradiated blood, antioxidants and steroids are used as adjunct treatment . Ambulatory treatment is uncommon . Surgical treatments including lobectomy and pneumonectomy are used in 5-10% of patients . CONCLUSION: Tuberculosis is increasing in Siberia . An improved drug supply using short course standardized regimens is required supported by high quality co-ordinated bacteriological services . Surgery retains a useful role, but many adjunct therapies should be abandoned.

Nuklearmedizin, 1996 Aug, 35(4), 116 - 21
Follow-up of osteomyelitis of infants with systemic serum parameters and bone scintigraphy; Aigner RM et al.; AIM: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed . This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC) . METHODS: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography . RESULTS: CRP was the most effective serum parameter for follow-up of disease . The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion . Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment . CONCLUSION: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO . Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

Am J Med, 1996 Aug, 101(2), 177 - 83
Comparison of once-daily versus pharmacokinetic dosing of aminoglycosides in elderly patients; Koo J et al.; PURPOSE: Once-daily dosing has been suggested as an alternative method of dosing aminoglycosides that would reduce their toxicity while maintaining efficacy . There have been no studies published to date comparing once-daily dosing and pharmacokinetic dosing of aminoglycosides . We conducted a randomized controlled trial comparing the safety and effectiveness of 4 mg/kg IV once-daily dosing of gentamicin or tobramycin with a pharmacokinetic dosing method using an initial dose of 2 mg/kg IV every 12 hours . PATIENTS AND METHODS: Ninety-six patients were randomly assigned to either the once-daily dosing group (4 mg/kg) or the pharmacokinetic dosing group (initial dose of 2 mg/kg every 12 hours) . In the once-daily dosing group, the dosing interval was extended by 12 to 24 hours to maintain a serum trough concentration < 1.5 mg/L regardless of the peak concentration . Dosing in the other group was adjusted based on the individual pharmacokinetic data to achieve a serum peak concentration of 6 to 10 mg/L and a trough concentration below 1.5 mg/L . The patients studied were predominantly elderly males (mean age 69 years) . All patients were assessed for treatment efficacy and nephrotoxicity . RESULTS: There was no significant difference between the two groups with regard to clinical and bacteriologic efficacy . Incidence of nephrotoxicity was 24% in the once-daily group and 14% in the pharmacokinetic dosing group but the difference was not statistically significant (P = 0.13) . Unlike previous studies, we found a correlation between high serum peak concentration and incidence of nephrotoxicity in the once-daily dosing group . Nephrotoxicity developed in six out of 10 patients (60%) with an initial serum peak concentration greater than 12.0 mg/L compared to two out of 24 patients (8.3%) with an initial peak concentration less than 12.0 mg/L (P < 0.001) in the once-daily group . Serum peak concentrations in the pharmacokinetic dosing group were not correlated with nephrotoxicity . CONCLUSIONS: Once-daily dosing and pharmacokinetic dosing of aminoglycosides appear to have equal efficacy and toxicity . However, in the elderly population, high serum peak concentrations that occur with once-daily aminoglycoside dosing may increase the risk of nephrotoxicity.

J Am Vet Med Assoc, 1996 Aug 1, 209(3), 647 - 9
Mycoplasma bovis-associated pneumonia and arthritis complicated with pyogranulomatous tenosynovitis in calves; Adegboye DS et al.; Immunohistochemistry and bacteriologic culturing were used to detect Mycoplasma bovis in tissue specimens from feedlot calves affected with pneumonia and arthritis . Two herds with 110 Charolais calves and 25 Angus calves were examined . Clinical signs included severe respiratory distress, anorexia, pyrexia, and lameness, which affected nearly a third of the calves . Lung lesions were characterized by numerous abscesses . Synovial lesions of the limbs included pyogranulomatous tenosynovitis, bursitis, and synovitis, particularly in the areas of the carpal and elbow joints . Abscesses in lung and synovial tissues contained accumulations of M bovis antigens, as revealed by immunohistochemistry . The findings of this report indicate that infection with M bovis may result in a pneumonia-arthritis syndrome with pyogranulomatous lesions in calves.

Ann N Y Acad Sci, 1996 Jul 23, 791, 248 - 54
Isolation and identification of bacteria associated with the screwworm fly Cochliomyia hominivorax, coquerel and its myiasis; Caballero M et al.; We studied eight different myiasis of sheep caused by screwworm flies under laboratory conditions . Swabs were taken from the wound, before, during, and after the myiasis . Seven hundred and thirty-one samples were streaked on different bacteriological media . All samples were identified by Api System (bioMerieuex) . We found thirty-eight different bacterial species in the exudates from the myiasis (before, during, and after the parasitic cycle) . The analysis of bacterial flora of the screwworm showed, on larvae stage 1, 10 different bacterial species, on larvae 2, 12 bacterial species; larvae 3, 15 bacterial species; crawl off, 15 bacteria species, pupa, 9 bacterial species; and adults, 2 bacterial species and on the pioneer fly, 14 different bacterial species were isolated and identified.

Sante, 1996 Jul-Aug, 6(4), 245 - 8
{Subcutaneous and soft tissue involvement associated with AIDS: ultrasonographic aspects . Apropos of 3 cases}; N'Gbesso RD et al.; Subcutaneous and soft tissue involvement is frequent in AIDS patients . Although the relevant clinical characteristics have been extensively described in the literature, there has been little work on the radiological features . We therefore report three cases of AIDS with subcutaneous and soft tissue involvement: two cases of pyomyositis and one case of non-Hodgkin's lymphoma . All three were black African men and were aged 22, 28 and 41 years . They were diagnosed as suffering from AIDS and were HIV1 and HIV2 positive . Diagnosis was established using needle puncture and histological (lymphoma) and bacteriological (pyomyositis) examination . We report ultrasound scan findings . The features of the pyomyositis differed from those usually observed in immunocompetent patients . The lymphoma nodules were similar to those described in the literature . They were hypoechoic and homogeneous, with no necrotic center . We believe that subcutaneous and soft tissue infectious involvement, for example pyomyositis, is more frequent in tropical regions than tumors (Kaposi's sarcoma, lymphoma) which are more frequent in Europe . This soft tissue involvement can be considered to be part of the particular picture which is "tropical AIDS".

Arch Pediatr, 1996 Jul, 3(7), 694 - 6
{Inaugural acute cholestasis of Kawasaki disease}; Desgripes A et al.; BACKGROUND: Hepatic dysfunction with mild obstructive jaundice occurs occasionally in Kawasaki disease . Acute episode of cholestasis as a presenting symptom has never been reported . CASE REPORT: A 14 year-old-boy was admitted with fever and cholestasis . He subsequently developed the classical manifestations of Kawasaki disease . No signs of liver cell injury or hepatic failure were present . Bacteriological cultures and seroimmunologic markers for viral infection remained negative . There was no ultrasonic abnormality of bile ducts . The child was given intravenous gamma globulins and salicylate . The outcome was favourable without any cardiovascular complications . CONCLUSION: A persistent febrile cholestasis of unknown etiology should evoke the diagnosis of Kawasaki disease.

Eur J Clin Microbiol Infect Dis, 1996 Jul, 15(7), 551 - 5
Detection and identification of Mycobacterium avium in the blood of AIDS patients by the polymerase chain reaction; De Francesco MA et al.; One hundred fifty-three blood samples from patients positive for the human immunodeficiency virus (HIV) were analyzed by polymerase chain reaction (PCR) to detect the presence of Mycobacterium avium . Samples were collected from patients who also had blood cultures performed by a radiometric method . Blood samples were centrifuged on a Ficoll-Hypaque gradient to purify peripheral blood mononuclear cells . The purified cells were washed and incubated with a resin, boiled to release mycobacterial DNA, and then amplified . Polymerase chain reaction products were detected by a nonisotopic method . A 123 base-pair (bp) insertion sequence, namely IS6110, from Mycobacterium tuberculosis complex was also included in the reaction as an internal control of Taq polymerase activity to exclude the presence of enzyme inhibitors . This IS6110 fragment can be distinguished from the 383 bp target product on ethidium bromide-stained agarose gel and may also be used in a colorimetric assay . Such results were compared with the results of culture and indicated that the assay is as sensitive as bacteriological methods, though faster.

J Vet Diagn Invest, 1996 Jul, 8(3), 351 - 4
Distribution of lesions in cattle infected with Mycobacterium bovis; Whipple DL et al.; Detailed postmortem examinations were conducted on 30 cattle from a dairy herd with bovine tuberculosis to determine the distribution of lesions in Mycobacterium bovis-infected cattle . Twenty-four different tissue specimens from each animal were examined for gross lesions and collected for bacteriologic culturing and histologic examination . Tuberculosis was confirmed in 15 cattle with evidence of infection in 1 or more of the following tissues: medial retropharyngeal, parotid, tracheobronchial, mediastinal, caudal deep cervical, and subiliac lymph nodes; palatine tonsil; and lung . Gross and histologic lesions were present most frequently in lymph nodes of the thoracic region . Mycobacterium bovis was isolated from 3 cattle that had no gross lesions of tuberculosis . One animal had lesions only in the subiliac lymph node, which is not routinely examined during slaughter surveillance . Results of this study indicate that not all cattle infected with M . bovis have visible lesions of tuberculosis in sites that are routinely inspected . These findings are important because detection of gross lesions of tuberculosis during inspection of carcasses at slaughter is the primary method for detection of tuberculous cattle and herds in the United States.

J Hand Surg {Am}, 1996 Jul, 21(4), 696 - 9
Human immunodeficiency virus infection in an emergency hand service; Ching V et al.; A study prompted by the high number of human immunodeficiency virus (HIV) patients in the South African population was performed to evaluate the incidence of HIV in patients attending our Emergency Hand Service . Over a 6-month period, more than 500 consecutive emergency patients were tested for HIV . In our series, 24 patients tested HIV-positive . Of these, 14 presented with hand sepsis and 10 with hand injuries . Bacteriology was performed on all patients with sepsis to document bacteria type and sensitivity . CD4 counts (T4 lymphocyte counts) were done on 12 patients to assess immunocompetence . Other factors examined included hospital stay, number of operations, postoperative morbidity, and mechanism of injury . Results indicate that septic HIV patients spent more time in the hospital and required more operations than septic non-HIV patients . Furthermore, of all of the population of emergency hand patients, a larger percentage of HIV-positive persons than HIV-negative persons was likely to be seen for infection.

New Microbiol, 1996 Jul, 19(3), 235 - 42
Leptospira interrogans in the genital tract of sheep . Research on ewes and rams experimentally infected with serovar hardjo (hardjobovis); Farina R et al.; To verify if Leptospira hardjo can colonize the male and female genital organs of sheep, 9 animals (6 non pregnant ewes and 3 mature rams) were infected with a strain of L . hardjobovis recently recovered from the kidneys of a seropositive ewe . Postinfection controls (bacteriologic, serologic, immunohistochemistry and electron microscopy) failed to disclose the presence of leptospires in the uterus and oviducts, testicles, epididymis, prostate and bulbourethral glands of animals used for the experiment and slaughtered from 37 to 242 postinfection days . All animals showed a renal localization of L . hardjobovis lasting for the entire period of the study (over 8 months) . These results emphasize the important role of sheep as maintenance hosts of the serovar.

Acta Chir Belg, 1996 Jul-Aug, 96(4), 179 - 81
Noma (Cancrum Oris) associated with Kwashiorkor: a case report and review of the literature; Takkal AM et al.; Noma (Cancrum Oris/Ulcerogingivostomstitis) is a rare devastating grangrenous orofacial disease . It may lead to severe facial mutilation and deformities with dysfunctional effects . This disease primarily affects malnourished children from underdeveloped countries . It has recently been associated with AIDS in North America and Western Europe . We will be reporting and discussing the pathogenesis, bacteriological complications and treatments according to the literature.

J Vet Intern Med, 1996 Jul-Aug, 10(4), 252 - 7
Naturally occurring acute coliform mastitis in Holstein cattle; Cebra CK et al.; Physical examination and clinicopathologic findings from 44 adult Holstein cows with naturally occurring coliform mastitis were studied . The cattle were grouped for comparison by stage of lactation and survival . Cattle within the first 4 weeks of lactation maintained higher median mature neutrophil counts (1,200 versus 300/microL) in peripheral blood than cattle later in lactation . Nonsurviving cows had higher median creatinine concentration (2.5 versus 1.6 mg/dL) and anion gap (25 versus 20 mEq/L), and lower serum protein (7.1 versus 7.6 gm/dL) and total CO2 (19.8 versus 25 mEq/L) concentrations than surviving cows (P < .05) . These findings indicate that cattle with uremia and metabolic acidosis are less likely to survive the infection . Bacteriologic blood cultures were performed on 34 of the 44 cows studied . Escherichia coli was isolated from the blood in 11 (32%) cows . Clinical presentation and clinicopathologic data were compared in bacteremic versus nonbacteremic cows to evaluate these data as predictors of bacteremia . Bacteremic cows were sick longer prior to admission (2 versus 1 days), maintained higher median counts of total nucleated cells (6.6 versus 2.4 x 10(3) cells/microL), myelocytes (0.2 versus 0 x 10(3) cells/microL), metamyelocytes (0.5 versus 0.02 x 10(3) cells/microL), band neutrophils (0.7 versus 0.1 x 10(3) cells/microL), and lymphocytes (2.1 versus 1.4 x 10(3) cells/microL) than nonbacteremic cows, and had higher plasma fibrinogen concentration (600 versus 500 mg/dL) (P < .05) . There were no differences between the physical or serum biochemical measurements . Four of 11 bacteremic cows and 5 of 23 nonbacteremic cows died or were euthanized (P > .05) . The high prevalence of bacteremia seen in cows with coliform mastitis has not been reported previously, and may have been due to the duration of disease, severity of signs, or culture technique . These findings suggest that systemic antibiotic therapy may be beneficial in some severe cases of coliform mastitis.

Br J Surg, 1996 Jul, 83(7), 930 - 3
Surgical strategy and management of infected pancreatic necrosis; Farkas G et al.; Infected pancreatic necrosis and sepsis are the leading causes of death in patients with necrotizing pancreatitis . Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area . Surgical treatment was performed a mean of 18.5 days after the onset of acute pancreatitis . Operative management consisted of wide-ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39.5 days, with a median of 6.5 litres of normal saline per day . In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed . Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients . The overall hospital mortality rate was 7 per cent (nine patients died) . Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, long-standing lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication.

Zentralbl Veterinarmed B, 1996 Jul, 43(5), 267 - 76
Immunological studies on venereal spirochetosis of rabbits (rabbit syphilis); Umemoto T et al.; White rabbits in a family, which were clinically diagnosed as moderately or severely diseased with spirochetosis, were bacteriologically and immunologically examined . The specimens from the diseased rabbits, including affected prepuces, scrotum, or skins with an occasional presence of the spirochetes, did not, however, result in growth in six conventional culture media . Serological tests, including quantitative complement fixation test, rapid plasma reagin card test, Treponema pallidum hemagglutination test, and microscopic agglutination test for leptospires using sera from diseased rabbits showed no differences when compared with those of pooled normal rabbit sera . Immunoblot analysis of the polypeptides from three human oral treponemes and three non-oral spirochetes demonstrated that antibodies against several treponemal polypeptides were detected.

J Laryngol Otol, 1996 Jul, 110(7), 644 - 8
Submucosal glands after maxillary sinus surgery . An experimental study in rabbits; Melgarejo-Moreno PJ et al.; Thirty New Zealand White rabbits underwent unilateral partial or complete removal of maxillary sinus mucosa in order to evaluate submucosal maxillary sinus glands . After three months, specimens were taken for examination from all operated on and control sinuses . Bacteriological cultures, light and electron microscopy were performed . Histopathological findings showed a decrease in the number of serous glands and significant inflammation was present in the sinus in which there was complete surgical removal . Electron microscopy revealed changes in the secretory cells of the serous glands in the regenerated post-surgical mucosa.

J AOAC Int, 1996 Jul-Aug, 79(4), 858 - 60
Evaluation of a rapid and automated enzyme-linked fluorescent immunoassay for detecting Escherichia coli serogroup O157 in cheese; Cohen AE et al.; The Vitek Immunodiagnostic Assay System (VI-DAS) for Escherichia coli O157, a rapid and fully automated test, was evaluated for use in detecting the foodborne pathogen E . coli O157:H7 in soft, semisoft, and hard cheeses . Sixty-five cheese samples were artificially contaminated at low (2-4 colonyforming units {cfu}/25 g) and high (7-10 cfu/25 g) levels with one of 2 strains of enterohemorrhagic E . coli O157:H7 . Contamination at high levels was detected in all cheeses by VIDAS, whereas in 5 cheeses (7.7%) inoculated at low levels, contamination was not detected . In 15 additional cheeses inoculated with cold-stressed cells, both VIDAS and the Bacteriological Analytical Manual cultural assay detected all high and low levels of contamination . No false positives or interference from product background fluorescence was encountered in any of the cheeses tested by VIDAS.

Chest, 1996 Jul, 110(1), 172 - 9
Usefulness of airway visualization in the diagnosis of nosocomial pneumonia in ventilated patients; Timsit JF et al.; Clinical diagnosis of nosocomial pneumonia in ventilated patients remains a challenge in the ICU as none of the clinical biological and radiologic parameters can predict its diagnosis . To our knowledge, however, the accuracy of direct visualization of the bronchial tree has never been investigated . PURPOSE: To evaluate the interest of airway visualization and to select independent parameters that predict nosocomial pneumonia in ventilated patients . SETTING: A ten-bed medical-surgical ICU . METHODS: All consecutive patients suspected of having nosocomial pneumonia who underwent bronchoscopy with protected specimen brush, culture examination of BAL, and direct examination of BAL were studied . Clinical and biological data and airways findings were recorded prospectively . Patients were classified as having pneumonia or not according to the results of distal bacteriologic samples, follow-up, and histologic study . Respective accuracies of each variable were calculated using univariate analysis and stepwise logistic regression . RESULTS: Ninety-one patients with suspected nosocomial pneumonia were studied . Patients were randomly assigned to a construction group (n = 46) and a validation group (n = 45) . Using multivariate analysis, 3 factors were associated with pneumonia (a decrease in PaO2/fraction of inspired oxygen ratio > or = 50 mm Hg, odds ratio {OR} = 9.97, p = 0.026; the presence of distal purulent secretions, OR = 7.46, p = 0.044; the persistence of distal secretions surging from distal bronchi during exhalation, OR = 12.25, p = 0.013) . These three factors remained associated with pneumonia in the validation group . Interobserver repeatability of the bronchoscopic parameters was good . Having 2 or more of these 3 independent factors was able to predict pneumonia with a 94% sensitivity and a 89% specificity in the construction group and with a 78% sensitivity and a 89% specificity in the validation group . CONCLUSION: We conclude that direct visualization of the bronchial tree can immediately and accurately predict nosocomial pneumonia in ventilated patients before obtaining definite results of protected samples.

Am J Gastroenterol, 1996 Jul, 91(7), 1395 - 9
Low H . pylori reinfection rate after triple therapy in Chilean duodenal ulcer patients; Figueroa G et al.; OBJECTIVES . We studied prospectively in a single-blind controlled manner the efficacy of 4-wk triple-antibiotic therapy, with amoxicillin (500 mg p.o., t.i.d.), metronidazole (250 mg p.o., t.i.d.), and bismuth subsalicylate tablets (524 mg p.o., q.i.d.), plus omeprazole (20 mg p.o., q.d.) and compared it with omeprazole (id) in the treatment of duodenal ulcer (DU) patients colonized with Helicobacter pylori . METHODS . One hundred DU patients were entered prospectively over a 12-month period . Fifty-seven of them received triple therapy plus omeprazole and 43 received omeprazole alone . Clinical, endoscopic, and bacteriological evaluations were performed on admission and at 28 days, 4, 8, and 12 months after treatment . RESULTS . After 4-wk treatment (day 28), the ulcer healing rate was high, but there was no significant difference between rates in the triple therapy and omeprazole groups (99% vs . 91%) . In contrast, the long-term DU recurrence rate after 12-month follow-up was significantly lower (p > 0.01) for triple therapy (3/57, 5%), compared with omeprazole (34/43, 79%) . The difference (higher relapse rate for omeprazole-treated patients) was significant (p < 0.001) by the second evaluation, 4 months after treatment . The eradication rate of H . pylori was also significantly higher among DU patients treated with triple therapy (p < 0.001) during all prospective evaluations, grand mean, 82% (range 82-87%), compared with the omeprazole-treated group, in which there were no cases in which H . pylori was eradicated . Follow-up revealed that 2/47 H . pylori-eradicated patients became reinfected after 1 yr, giving a reinfection rate of 4.2 patient/yr . CONCLUSIONS . Four-week triple-antibiotic therapy plus omeprazole constitutes an adequate alternative for treatment of Chilean DU patients.

Eur J Nucl Med, 1996 Jul, 23(7), 792 - 7
Chronic osteomyelitis: diagnosis with technetium-99m-d, l-hexamethylpropylene amine oxime labelled leucocytes; Krznaric E et al.; To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients . Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan . The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26) . We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis . When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively . Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations . The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.

Pol Tyg Lek, 1996 Jun, 51(23-26), 318 - 20,323
{Sepsis--a generalized infection . Etiopathogenetic, diagnostic and clinical problems in adults based on personal experiences}; Olejnik Z et al.; Etiopathogenetic, diagnostic, and clinical problems seen in the adult patients with sepsis have been discussed . An emphasis is on the diagnostic problems in an early stage of infection as well as bacteriological findings . The authors stress that sepsis usually develops in patients with depressed immunological system.

Antibiot Khimioter, 1996 Jun, 41(6), 39 - 43
{Use of pefloxacin in the treatment of infected burn wounds}; Iakovlev VP et al.; The efficacy of a home-made pefloxacin was estimated in clinico-laboratory trials including 25 patients with wound infection . The fluoroquinolone was used in a dose of 400 mg administered orally twice a day for 4-16 days . Good and satisfactory results were stated in 24 patients (96 per cent) . The isolates from the patients were mainly susceptible to the drug (86.2 per cent) . The bacteriological efficacy amounted to 92 per cent . No side effects to the use of pefloxacin were observed.

Rhinology, 1996 Jun, 34(2), 110 - 3
Radical or partial maxillary sinus surgery: a dilemma today? An experimental study; Melgarejo-Moreno PJ et al.; To evaluate partial or radical surgical removal of the maxillary sinus mucosa, 20 New-Zealand albino rabbits were used . After three months, specimens were taken for examination . Bacteriological cultures, light- and electron microscopy were performed, and mucociliary transport was studied . These experimental findings add further support to the concept of performing a conservative sinus procedure rather than a radical removal as a first procedure.

J Wound Care, 1996 Jun, 5(6), 277 - 80
Qualitative bacteriology and leg ulcer healing; Trengove NJ et al.; This study investigated the bacterial profile of leg ulcers in 52 patients attending the Fremantle Hospital leg ulcer clinic . The aim was to identify whether the presence of specific bacterial groups delays healing, whether the bacterial flora changes as ulcers heal and, if so, whether these changes influence healing . The results show that the presence of any one specific bacterial group did not appear to delay healing, although the presence of four or more bacterial groups was associated with delayed healing . This was found to be statistically significant . It was noted that the bacterial flora does change as ulcers heal and that these changes were not related to changes in healing, with the exception of skin flora.

Changgeng Yi Xue Za Zhi, 1996 Jun, 19(2), 149 - 53
Nasopharyngeal tuberculosis; Eng HL et al.; Tuberculosis of the nasopharynx is uncommon and may mimic malignant disease . In this study, 14 patients (17-61 years old; 12 women, 2 men) who were histologically diagnosed as having nasopharyngeal tuberculosis were described . None of them bad known previous history of tuberculosis . Half of our patients had isolated nasopharyngeal tuberculosis with no apparent pulmonary involvement . Eleven patients present with enlarged neck lymph nodes and 6 of the 14 had blood-tinged nasal discharge . A bulging mass, with or without ulceration was the most common nasopharyngeal lesion encountered in 11 patients . Clinically, it appeared to resemble cancer presenting as a nasopharyngeal mass lesion with concomitant enlarged neck lymph nodes . It is important to consider tuberculosis in the differential diagnosis of nasopharyngeal lesions and take biopsy specimens for histological and bacteriological studies.

Shock, 1996 Jun, 5(6), 446 - 54
A sustained release bacterial inoculum infusion model of intra-abdominal infection in conscious rats: bacteriology, metabolism, and histopathology; Martineau L et al.; This report describes the development of a rat peritonitis model that simulates a slow, sustained bacterial release from the gut . Septic animals (SEP) received an intraperitoneal infusion of a bacterial inoculum (6.5 x 10(8) colony forming units Escherichia coli) over 12 h, while control rats (CON) received a sterile inoculum . This model yielded a 52% mortality over 7 days in SEP, with deaths usually occurring 24-48 h after the onset of infusion . Septic rats showed greater febrile responses and body weight losses than those of CON, as well as mild hyperlactacidemia, hypoglycemia, and episodic bacteremia . Maximum bacterial counts in peritoneal fluid and several organs of SEP were observed at 36 h, with bacterial counts progressively decreasing by 7 days to levels similar to those observed at 12 h . Lung and spleen wet weights increased by 17% at 36 h and 7 days post-infection in SEP . Histological evaluation of random organ samples revealed mild to moderate morphological changes in SEP while CON showed no or minimal changes in the parameters measured during the study . This new model of chronic peritonitis in the rat reproduces many of the clinical features observed in human sepsis, and thus should prove to be a useful tool in further studies of the pathophysiology of peritonitis.

Rev Prat, 1996 Jun 1, 46(11), 1357 - 61
{Management of tuberculous contact}; Chretien J; The diagnosis of tuberculosis in a person means that measures must be taken to prevent the transmission of Mycobacterium tuberculosis from source cases to healthy individuals . Tuberculosis needs to be rapidly identified, bacteriologically confirmed and treated . Contact tracing allows subjects to be found among close (home), regular (school, creche, workplace), or occasional contacts . Besides clinical features, cutaneous tuberculin reactions and chest X-ray are the principal examinations that permit a decision to be taken regarding follow-up, chemoprophylaxis or BCG vaccination.

J Hand Surg {Br}, 1996 Jun, 21(3), 351 - 4
Mycobacterial tenosynovitis of the flexor tendons of the hand . A report of five cases; Regnard PJ et al.; We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers . These cases were observed during the last 12 years and treated by the same surgeon . This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity . The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist . Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics . The functional result is usually good, but recurrence is not uncommon . Long-term follow-up is necessary . Local corticosteroid therapy could have a part in the causation of this condition.

Chest, 1996 Jun, 109(6), 1423 - 9
Prospective evaluation of a semiquantitative dip slide method compared with quantitative bacterial cultures of BAL fluid; Speich R et al.; BACKGROUND: Quantitative bacteriologic workup of BAL fluid (BALF) has evolved as a sensitive and specific technique for the diagnosis of bacterial pneumonia . Conventional quantitative cultures are expensive, time-consuming, and often unavailable on a 24-h basis . Therefore, we evaluated a dip slide method for the semiquantitative measurement of bacterial cultures in BALF specimens and compared the results with those from conventional quantitative cultures . METHODS: Fifty BALF specimens from 45 patients with suspected pulmonary infection were examined prospectively with both methods . We compared the microbiologic results of conventional quantitative cultures with those of the dip slide method that is commercially available for blood cultures . Cost-effectiveness analysis of both methods was performed . RESULTS: In 37 BALF specimens, 64 bacterial strains were detected with both techniques . The dip slide method and conventional cultures showed a high correlation with respect to the colony counts of the individual organisms per milliliter BALF (r=0.935; p= 0.0001) and the sum of colony counts in individual patients (r=0.947; p=0.0001) . Although five strains were not detected by the dip slide technique, the diagnostic accuracy was not influenced . In 13 BALF samples, there was no growth of bacteria with both techniques . While the diagnostic yield of both methods was similar, the dip slide technique was 44 to 66% less expensive than conventional cultures . CONCLUSIONS: The examination of BALF with a clip slide method is highly comparable to conventional quantitative culture techniques, less expensive, and can be used independently of a specialized microbiology laboratory on a 24-h basis.

Tuber Lung Dis, 1996 Jun, 77(3), 226 - 32
Pulmonary tuberculosis in Guinea-Bissau: clinical and bacteriological findings, human immunodeficiency virus status and short term survival of hospitalized patients; Naucler A et al.; OBJECTIVE: To study tuberculosis patients in Guinea-Bissau with regard to clinical findings, bacteriologically verified diagnosis, human immunodeficiency virus (HIV) status and short term survival . DESIGN: 763 consecutive patients referred to the tuberculosis clinic with pulmonary symptoms underwent clinical examination and Ziehl-Neelsen sputum microscopy . Sputum for culture of mycobacteria on Lowenstein-Jensen medium was collected from all hospitalized patients, who were also screened by enzyme linked immunosorbent assay for the presence of HIV-1 and HIV-2 antibodies . HIV-positivity was confirmed by Western blot . RESULTS: 350 patients were diagnosed with tuberculosis and hospitalized . Adequate sputum samples were obtained from 301 patients, of whom 184 (61%) were positive on direct microscopy and the remaining 116 patients were diagnosed from clinical findings . Mycobacterium tuberculosis was cultured from 184 patients and M . avium in 16 patients, whereas in 101 patients the culture was negative . HIV-1 antibodies were found in 3.0%, HIV-2 antibodies in 16.4%, and dual infections in 2.0% . These figures, however, did not differ significantly from those of randomly selected age and sex matched controls . The prevalence of HIV-antibodies was statistically as common in patients with culture verified tuberculosis as in patients with clinically defined tuberculosis . Clinical acquired immunodeficiency syndrome was commonly diagnosed (80/301 patients) but significantly more often in HIV-positive, culture-positive tuberculosis patients, as were weight loss and lymphadenopathy . There was no statistical difference in short-time survival rate between the various patient groups . CONCLUSION: The diagnostic criteria applied, which are generally used in developing countries, identified most patients with pulmonary tuberculosis; however, a substantial number of patients are treated for tuberculosis without definite diagnostic criteria . The prevalence of HIV-infection was high but statistically no significant difference was demonstrated between the patient groups, controls and patients hospitalized for diseases other than tuberculosis.

Lepr Rev, 1996 Jun, 67(2), 141 - 4
Dry skin lesions with marked hair loss in a case of BL leprosy . A case report; Edward VK et al.; Skin lesions of leprosy that are anaesthetic, well defined, limited in number and dry with significant hair loss generally fit into the paucibacillary (PB) spectrum . The bacteriological index (BI) is expected to be negative or low . We have reported a case who presented with such findings but whose BI readings were high . Together with the biopsy findings the patient was classified as having borderline (BL) leprosy . The role of the skin smear examination and the misleading nature of some clinical features are highlighted . The authors feel that skin smear examinations should be performed on all leprosy patients at the time of diagnosis.

Am J Surg, 1996 Jun, 171(6), 570 - 5
The value of clinical judgment in the diagnosis of nosocomial pneumonia; Helling TS et al.; BACKGROUND: Nosocomial pneumonia presents a diagnostic and therapeutic challenge in the care of critically ill patients . The present study was designed to determine as closely as possible the occurrence of nosocomial pneumonia in surgical intensive care unit (ICU) patients using clinical, radiographic, and bacteriological parameters in a prospective concurrent fashion . METHODS: This clinical study enrolled all surgical, trauma, and neurosurgical patients admitted to a surgical ICU over a 13-month period . Routine surveillance was used to identify those patients suspected of developing nosocomial pneumonia . Numerous clinical parameters concerning ventilatory support, acute lung injury, organ dysfunction, nutrition, and length of stays were used to identify factors disposing to development of pneumonia . Univariate and multivariate analyses were used for this purpose . Patients thought to have pneumonia were then followed concurrently to determine, as closely as possible, whether pneumonia was present by serial examination of clinical, bacteriologic, and radiographic data . Those "validated" by this process were then compared to those "nonvalidated" to see if any distinction could be made . RESULTS: Of the 352 patients enrolled, 46 (13%) were initially labeled as having developed nosocomial pneumonia when compared to the 306 patients without pneumonia . Univariate analysis demonstrated a greater need for intubation and mechanical ventilation, longer mechanical ventilation, more acute lung injury, longer ICU and hospital stays, poorer nutrition, and higher mortality (17% versus 5%, P < 0.01) . Multivariate analysis demonstrated only length of ICU stay and length of intubation/mechanical ventilation as longer in the pneumonia group . On further concurrent review, 23 of 46 patients were validated as having pneumonia while the rest were felt not to have pneumonia . When the two groups were compared, only asymmetric and segmental radiographic infiltrates distinguished validated from nonvalidated pneumonia patients and all other clinical parameters, including mortality and length of stay, were similar . CONCLUSION: Nosocomial pneumonia was initially suspected in 13% of this ICU population . Numerous clinical parameters clearly distinguished these pneumonia patients from others and they suffered a substantially higher mortality . However, within this pneumonia group, only half of the patients could be validated as truly having pneumonia using available clinical parameters . Nevertheless, those validated were indistinguishable in their clinical behavior from those who were not . This calls into question the need for elaborate and sometimes expensive investigations for diagnosis of nosocomial pneumonia.

Zentralbl Veterinarmed B, 1996 May, 43(3), 155 - 61
Isolation of Mycoplasma conjunctivae from conjunctival swabs of Alpine ibex (Capra ibex ibex) affected with infectious keratoconjunctivitis; Mayer D et al.; Mycoplasma conjunctivae was isolated four times from the eyes of nine Alpine ibex (Capra ibex ibex) suffering from keratoconjunctivitis . The animals examined were affected in two different outbreaks in the Swiss Alps . Parasitological and bacteriological studies, including investigations for chlamydia and mycoplasmas, were performed . The results indicate that M . conjunctivae is the primary pathogenic agent causing infectious keratoconjunctivitis in this species.

Clin Ther, 1996 May-Jun, 18(3), 440 - 7
Ofloxacin versus trimethoprim-sulfamethoxazole in the treatment of patients with acute exacerbation of chronic bronchitis . Study of Ofloxacin in Lower Respiratory Tract Infections Research Group; Perez-Gonzalvo ME et al.; An open-label, randomized, comparative, parallel-group study of ofloxacin and trimethoprim-sulfamethoxazole was performed in 162 outpatients diagnosed with acute exacerbation of chronic bronchitis . Ofloxacin 400 mg once daily was administered orally; the dose could be increased to 400 mg twice daily if patients had not improved after 72 hours of treatment . The other treatment group received trimethoprim-sulfamethoxazole 960 mg twice daily orally . The duration of treatment was 10 to 14 days for both treatment groups . Successful clinical response (defined as cure or major improvement in symptoms) was achieved in 65 (80.2%) patients in the ofloxacin group and in 42 (51.9%) patients in the trimethoprim-sulfamethoxazole group; the differences between groups were statistically significant . Bacteriologic success (classified as eradication or presumptive eradication of the causative pathogen) was achieved in 27 (50.0%) patients in the ofloxacin group and in 16 (29.1%) patients in the trimethoprim-sulfamethoxazole group; these differences between groups were also statistically significant . Reinfection occurred in 18 (33.3%) and 4 (7.3%) patients treated with ofloxacin and trimethoprim-sulfamethoxazole, respectively . No serious adverse events were reported.

Eur Respir J, 1996 May, 9(5), 1097 - 104
Surveillance of tuberculosis in Europe . Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting on tuberculosis cases; Rieder HL et al.; Consensus-based recommendations have been developed by a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) on uniform reporting of tuberculosis surveillance data in the countries of Europe . A uniform case definition and a minimum set of variables for reporting on each case have been agreed which, when collated on a national basis, will allow comparison of the epidemiology of tuberculosis in different European countries . The Working Group recommends that the case definition includes "definite" cases, where the diagnosis has been confirmed by culture (or supported by microscopy findings in countries where diagnostic culture facilities are not available), and "other than definite cases" based on a clinical diagnosis of tuberculosis combined with the intention to treat with a full course of antituberculosis therapy . Both "definite" and "other than definite" cases should be notified by physicians and, in addition, laboratories should be required to report "definite" cases . The minimum set of variables to be collected on each case of tuberculosis should include: date of starting treatment, place of residence, date of birth, gender, and country of origin, to characterize the patient . Recommended disease-specific variables include: site of disease, bacteriological status (microscopy and culture), and history of previous antituberculosis chemotherapy . The minimum set of variables should be collated on all patients and should be as complete as possible . Additional variables may be collected for individual, local or national purposes, but, in general, completeness of reporting on cases is likely to be better if the information requested is kept to a minimum . Timely reporting of cases is essential for appropriate public health action . Cases should be reported to the health authority at the local and/or regional level within 1 week of starting treatment . Individual-case based information should be reported to the national level by the local or regional level . Feedback to reporters is essential . At the national level, preliminary quarterly reports should be produced and final reports should be published annually.

Zh Mikrobiol Epidemiol Immunobiol, 1996 May-Jun, (3), 80 - 3
{The information value of Escherichia coli persistence markers in the bacteriological diagnosis of chronic pyelonephritis in children}; Gritsenko VA et al.; In 181 E . coli strains isolated from sick children having chronic pyelonephritis and risk factors of its development, as well as from healthy children, the complex of phenotypic signs, and among them bacterial persistence markers (antilysozyme, anticomplementary and "anti-interferon" activity), adhesive capacity, antibiotic resistance and colicinogenicity, were analyzed . The specific bioprofiles of E . coli, the causative agents of pyelonephritis, were established . The most informative biological characteristics of E . coli were determined and used as the basis for the development of the algorithm for differentiating the causative agents of pyelonephritis from transitory and contaminating flora . The effectiveness of the proposed diagnostic algorithm was confirmed by clinical approbation.

Res Microbiol, 1996 May, 147(4), 237 - 49
Lack of production of the 19-kDa glycolipoprotein in certain strains of Mycobacterium tuberculosis; Lathigra R et al.; The 19-kDa glycolipoprotein of Mycobacterium tuberculosis (PT19) is a prominent antigen recognized by both T cells and antibodies from tuberculosis patients . We report here that two strains, I2646 and S1, when grown either in bacteriological culture or during infection of mice, do not produce this constituent, as judged by ELISA and Western blot assays . Southern blot analysis of the chromosomal DNA showed that both strains displayed the restriction fragment as in H37Rv DNA, suggesting the lack of gross gene alterations . Sequence analysis revealed multiple microlesions including small deletions, point mutations and nucleotide insertions, leading to either premature termination or alteration of open reading frame in both strains . Transformation of both mutant strains with the wild-type gene on a multicopy plasmid resulted in overproduction of native PT19 . Infection of mice suggested that the I2646 is of low virulence and that the transformant-producing native PT19 exhibited higher virulence, as assessed by viable counts and gross lesions in the infected organs . The mechanisms and significance of the lack of PT19 production in certain M . tuberculosis strains is discussed.

Trans R Soc Trop Med Hyg, 1996 May-Jun, 90(3), 241 - 3
Bartonellosis in Zamora Chinchipe province in Ecuador; Cooper P et al.; Human bartonellosis was investigated in the Ecuadorian province of Zamora Chinchipe; 17 cases were identified retrospectively from hospital records over the period 1984-1995, mostly from 6 communities in the provincial district of Zumba . A questionnaire concerning risk factors for disease transmission was administered in these 6 communities . Blood samples were taken from individuals with current febrile illnesses or skin lesions suggestive of bartonellosis . Samples for detection of Bartonella bacilliformis were also taken from all school-age children in communities where historical cases had been identified by questionnaire . No bacteriologically positive case was identified and no evidence of asymptomatic infection was detected . Risk factors for disease transmission, identified by the questionnaire, included the presence of sick or dying chickens and guinea-pigs . It was suggested that bartonellosis is a zoonosis with wild animals, probably rodents, as the reservoir . The widespread use of residual insecticides and the easy availability of antibiotics is likely to have modified the epidemiology of this disease over the last decade.

J Burn Care Rehabil, 1996 May-Jun, 17(3), 246 - 51
Dermasorb versus Jelonet in patients with burns skin graft donor sites; Cadier MA et al.; A prospective and randomized trial that compares Jelonet (Smith & Nephew PLC, London, England) with a new hydrocolloid dressing, Dermasorb (Convatec Ltd., Clwyd, United Kingdom), is presented . The dressings were applied on contiguous donor sites in 21 patients that required skin grafting for burn wounds . Pain experienced with the dressing in situ was assessed on days 2, 4, 7, and on two subsequent occasions . During dressing changes, pain experienced was again assessed, bacteriologic swabs were taken, and the percentage of epithelialization was recorded . Questionnaires completed by investigators and patients were used to assess the perceived performances of both dressings . The results showed that Dermasorb is a less painful dressing than Jelonet, in which wounds heal faster . Dermasorb was preferred by both investigators and patients . No clinical or laboratory evidence of any differences of colonization or infection were found . All results were statistically significant . We would strongly recommend the use of Dermasorb as a split-thickness skin graft donor site dressing for a patient with burns.

J Am Anim Hosp Assoc, 1996 May-Jun, 32(3), 199 - 210
Hematological and biochemical changes and results of aerobic bacteriological culturing in dogs undergoing splenectomy; Richardson EF et al.; Changes in complete blood count (CBC), bone marrow, reticulocyte count, coagulation profile, biochemical analysis, and serum iron, transferrin, and immunoglobulin M (IgM) concentrations were measured three and 10 days after splenectomy in 12 dogs . Spleens were cultured aerobically for bacteria and submitted for histopathological evaluation in 23 dogs undergoing splenectomy . There were no consistent changes in red blood cell (RBC), white blood cell (WBC), or platelet counts; bone-marrow samples; or biochemical profiles . Serum iron, transferrin, and IgM concentrations remained normal . Eight (35%) bacterial cultures yielded growth . Five of the 23 dogs had pyrexic episodes two-to-five days after surgery . In contrast to previous reports done on healthy dogs, this study shows that dogs with splenic disease have no characteristic changes in hematological or biochemical parameters after splenectomy . Rather, the changes tended to reflect the primary disease process . Splenic vascular compromise or a decrease in processing of bacteria may have resulted in the bacterial growth . There was no direct correlation to pyrexic postoperative episodes.

Burns, 1996 May, 22(3), 177 - 81
Quantitative microbiology in the management of burn patients . II . Relationship between bacterial counts obtained by burn wound biopsy culture and surface alginate swab culture, with clinical outcome following burn surgery and change of dressings; Steer JA et al.; The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss . To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings . The mean per cent TBSA burn was 16 (range 1-65) . There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006) . There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without . With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated . It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.

Burns, 1996 May, 22(3), 173 - 6
Quantitative microbiology in the management of burn patients . I . Correlation between quantitative and qualitative burn wound biopsy culture and surface alginate swab culture; Steer JA et al.; The diagnosis and treatment of burn wound infection is commonly determined by clinical impression and the qualitative results of surface swabs . It has been suggested that quantitative bacteriology from burn wound biopsies confirms burn wound infection and improves patient management . Methods for quantitating surface flora have been described, but comparisons with biopsy specimens have been contradictory . The quantitative and qualitative results of 141 pairs of biopsies and surface swabs, from 74 burn patients, were compared . Staph . aureus was the commonest organism isolated (29 per cent of biopsies and 35 per cent of swabs) . Recovery of the same set of species from biopsy and swab occurred in 54 per cent of pairs . There was a significant correlation between the bacterial count obtained by biopsy and by surface swab (P < 0.001), but using various threshold values, the predictive value of the counts obtained by one method to predict the counts obtained by the other was poor . Parallel cultures taken on 18 occasions, showed a significant correlation between bacterial counts obtained from two biopsies or two swabs taken simultaneously (P < 0.002), but there was wide variation in bacterial densities from the same burn wound at the same time . Recovery of the same set of species from both biopsies occurred in 56 per cent of pairs, and from both swabs in 50 per cent of pairs . The use of quantitative microbiology in burns is limited by the unreliability of a single surface swab or biopsy to represent the whole burn wound.

S Afr Med J, 1996 May, 86(5), 551 - 2
A massive outbreak of food poisoning--a reminder of the importance of proper toxic waste control; Benade JG; Because of rapid urbanisation in South Africa, scavenging from waste disposal sites by poor communities poses an increasing health risk . Reject cough lozenges, some of which contained larger amounts of dextromethorphan than usual, were illegally removed from a disposal site and, after resale by informal traders, caused moderately severe symptoms of toxicity in 171/540 (24%) primary school pupils . Although dextromethorphan was implicated as a cause, contributing effects of other toxins could not be excluded . Bacteriological cultures and a pesticide screen were negative . Had more toxic substances been involved, the consequences would have been disastrous . This incident supports calls for an integrated national waste management policy and waste control act to govern the management and control of waste from generation to disposal . Such a policy is necessary to prevent potentially serious incidents in the future.

J Pathol, 1996 May, 179(1), 121 - 4
Practical histological microdissection for PCR analysis; Going JJ et al.; Recovery of cells by histological microdissection is increasingly used for analysis by polymerase chain reaction (PCR) or microchemical techniques . This paper describes techniques of histological microdissection . Sections of archival formalin-fixed, paraffin-embedded tissue up to 15 years old were mounted on plain glass slides . Sections 6-7 microns in thickness stained with toluidine blue were dissected under proteinase K buffer solution, using an electrolytically sharpened tungsten needle in a bacteriological loop-holder and a Leitz mechanical micromanipulator (model M) . Detached cell groups were recovered in a silicone-coated pipette tip for PCR analysis after digestion in 25-50 microliters of proteinase K (500/ml) in TRIS-HCl buffer (pH 8.3) . Consistent amplification and analysis of microsatellite loci were obtained from 2 microliters of crude lysate using 28-30 cycles of PCR incorporating a 32P 5'-end-labelled primer, electrophoresis under denaturing conditions on 6 per cent polyacrylamide gels, and autoradiographic detection.

Ther Umsch, 1996 May, 53(5), 346 - 53
{Technique and outcome of surgical therapy in acute pancreatitis}; Uhl W et al.; The most important diagnostic step in the management of patients with acute pancreatitis is to discriminate between interstitial edematous and necrotizing pancreatitis . Measurement of necroses indicating parameters in the serum, like CRP and PMN-elastase are useful in detecting the necrotizing course of acute pancreatitis . While patients with acute edematous pancreatitis can be treated on a regular ward, patients with a necrotizing course of disease should be treated in the intensive-care unit . Patients with biliary acute pancreatitis should be examined by ERCP with the performance of a papillotomy with stone removal in case of impacted ampullary stones within 24 hours . Surgical decision-making in patients with necrotizing pancreatitis should be based on the development of septic signs due to infected pancreatic necrosis . The information about infected pancreatic necrosis can be easily obtained by a bedside ultrasound-guided fine needle aspiration and bacteriological examination of the aspirate {gram stain plus culture} . Patients without organ complications and with focal necroses should be treated conservatively while patients with persisting organ insufficiencies or progressive multiple organ failure despite maximum intensive care measures are candidates for surgical therapy . The procedure of choice in necrotizing pancreatitis is the careful removal of necrotic tissue {necrosectomy} followed and supplemented by a postoperative regimen for the continuous evacuation of further necrotic debris . For this postoperative therapeutical concept three comparable procedures are available today, the closed continuous lavage, the 'open packing technique' and the management by planned, staged re-laparotomies . Hospital mortality in severe acute pancreatitis has been reduced to less than 15% by these procedures in experienced hands.

Clin Radiol, 1996 May, 51(5), 354 - 8
Mammographic features of breast tuberculosis: the skin bulge and sinus tract sign; Makanjuola D et al.; Six cases with bacteriologically and/or histologically proven breast tuberculosis were analysed out of 1152 consecutive mammograms performed . The objective was to identify some factors that may facilitate pre-operative mammographic and ultrasonographic diagnosis of breast tuberculosis . Nipple retraction and coarse stromal texture occurred in all six cases . In five cases there was an ill-defined breast mass, skin thickening, and a reduction in size of the affected breast . A unique finding was a sinus tract connecting the breast density to a localized skin thickening and bulge which occurred in only two cases . Ultrasonography showed cystic masses . The incidence of breast tuberculosis in the studied population was 0.52% . A mammographic demonstration of a dense tract connecting an ill-defined breast mass to a localized skin thickening and bulge (skin bulge and sinus tract sign) is strongly suggestive of tuberculous breast abscess . Change in shape and outline of the breast mass can be seen in the standard breast views.

J Neurosurg, 1996 May, 84(5), 733 - 6
Adjuvant combined modality therapy for malignant meningiomas; Chamberlain MC; Malignant meningiomas constitute 10% to 15% of all meningiomas and limited information exists regarding adjuvant treatment of these aggressive primary brain tumors . Fourteen patients (eight men, six women), ranging in age from 28 to 61 years (median 51 years), were prospectively treated for primary malignant meningiomas according to an institutional protocol . All patients underwent surgery (gross-total in four and subtotal resection in 10 patients) followed in 2 to 4 weeks by involved-field radiotherapy (range 59-60 Gy, median dose 60 Gy) . Two to 4 weeks after radiotherapy all patients were treated with adjuvant chemotherapy that included cyclophosphamide, adriamycin, and vincristine (CAV) . Patients who underwent gross-total resection received three cycles, whereas those with subtotal resection received six cycles of CAV . Four patients required CAV dose reduction due to myelosuppression, and in three patients, myelosuppression prevented administration of the planned course of CAV . Four patients required transfusions (four received red blood cells, three received platelets), and two developed neutropenic fever without bacteriological documentation . Neuroradiographic response included three partial responses and 11 with stable disease . The median time to tumor progression was 4.6 years (range 2.2-7.1 years) and median survival was 5.3 years (range 2.6-7.6 years) . The author concludes that combined modality therapy for the treatment of malignant meningiomas is associated with acceptable toxicity and a modest improvement in survival when compared to patients treated with surgery alone.

Vet Rec, 1996 Apr 27, 138(17), 409 - 11
Comparison of two selective media for the isolation of Brucella melitensis from naturally infected sheep and goats; Marin CM et al.; The efficacy of two selective media for the isolation of Brucella melitensis from naturally infected sheep and goats was compared . Two hundred and eighty sheep and 60 goats belonging to B melitensis-infected flocks were slaughtered and samples of milk (when available) and seven tissues were taken from each animal for bacteriological analyses . A modified Thayer-Martin's medium was more sensitive than Farrell's medium; by the combined use of both media 142 infected sheep and 40 infected goats were detected, and 486 of the samples from the sheep and 179 of the samples from the goats were found to be infected.

Ann Intern Med, 1996 Apr 15, 124(8), 717 - 25
Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis; Hatala R et al.; OBJECTIVE: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily aminoglycoside dosing with those of standard aminoglycoside regimens in immuno-competent adults . DATA SOURCES: A structured MEDLINE search from 1966 to April 1995 using the keywords aminoglycosides, drug administration schedule, and adult; bibliographic searching of review articles, position papers, and references of the selected articles; contact with primary authors of selected articles to obtain information not in the published reports and lists of potentially relevant articles . STUDY SELECTION: Randomized, controlled trials that 1) compared an intravenous once-daily aminoglycoside regimen with a standard aminoglycoside regimen in infected immunocompetent adults and 2) examined efficacy, mortality, or toxicity . DATA EXTRACTION: For each selected study, two independent reviewers assessed methodologic quality and abstracted data . The heterogeneity of individual study risk ratios was assessed and data were pooled using a random-effects model . RESULTS: Forty-two studies were reviewed for possible inclusion . Thirteen independent studies met the selection criteria, and their results were pooled . The trials had a mean methodologic quality score of 0.69 (range, 0.50 to 0.91) . Heterogeneity exists among the individual risk ratios for clinical cure (P = 0.07); significant heterogeneity does not exist for the other outcomes . For the pooled efficacy outcomes, the risk ratio for bacteriologic cure is 1.02 (95% CI, 0.99 to 1.05), and the risk ratio for mortality is 0.91 (CI, 0.63 to 1.31) . For the pooled toxicity outcomes, the risk ratio for nephrotoxicity is 0.87 (CI, 0.60 to 1.26), and the risk ratio for ototoxicity is 0.67 (CI, 0.35 to 1.28) . CONCLUSIONS: Standard and once-daily aminoglycoside dosing regimens are equivalent with regard to bacteriologic cure, and once-daily dosing shows a trend toward reduced mortality and toxicity . However, additional studies are needed for more precise estimates of mortality and toxicity risk ratios . The equivalency of the dosing regimens, the ease of administration, reduced nursing time, and reduced variability in the timing of drug administration that are associated with once-daily dosing may mean that the once-daily regimen is clinically advantageous.

Pediatr Pol, 1996 Apr, 71(4), 367 - 71
{Diagnostic problems in pediatric tuberculosis: a description of two cases}; Szychowska Z et al.; This paper describes two cases of tuberculosis (tbc) in children in whom tbc was misdiagnosed and who were initially treated with antibiotics (and corticosteroids) as for non-specific lower respiratory tract infections . Chest radiograms, good response to antituberculosis drugs (in both children), bacteriologic and histologic examinations and a history of family contact with infectious tbc (in case I) confirmed the diagnosis of tbc . We suggest that the most important factor in rapidly diagnosing tuberculosis is a high index of suspicion in children with respiratory tract infections.

J Am Osteopath Assoc, 1996 Apr, 96(4), 253 - 6
Tuberculous pericarditis; Kutoloski KS et al.; A patient with a 5-month history of pericardial effusion and unsuccessful steroid treatment was found at pericardial exploration to have thickened pericardium adhered to the heart . After anterior pericardiectomy, histologic examination revealed severe granulomatous pericarditis resulting from infection with Mycobacterium tuberculosis . Despite the pericardiectomy and antituberculous therapy, the patient continued to have symptoms, including bilateral pleural effusions, 4 days after discharge from the hospital . After a second exploration (after echocardiography revealed decreased left ventricular function and hemodynamic findings showed persistent constriction), anterior and posterior cardiectomy was deemed necessary . Pleural effusion did not recur, and the patient was discharged with antituberculous drug therapy . This rare extrapulmonary form of tuberculosis can have an insidious or sudden onset, and diagnosis is complicated by false-negative tuberculin tests, nonspecific radiographic and echocardiographic findings, and time-consuming bacteriologic culture . Previous high mortality with the disease has been decreased to approximately 40% by the advent of antituberculous drug therapy . The still significant mortality reflects the difficulty in early diagnosis and the serious effects of pericardial effusion and constriction.

Int Surg, 1996 Apr-Jun, 81(2), 189 - 94
Atherosclerotic abdominal aorta saccular protrusion; Iwai T et al.; Fourteen saccular abdominal aortic protrusion patients (ages ranged from 55 to 84, mean age 69.1 years) were reported . Their lesions were pathologically or bacteriologically suggested to be of atherosclerotic origin . Other origins were eliminated by using the patients past history or physical and diagnostic examination . All patients were classified into 1 of 3 types; solitary, adjacent to fusiform AAA, and independent of fusiform AAA . Diagnosis and surgical techniques were complicated when coexisting with a fusiform abdominal aortic aneurysm (AAA) and located in the AAA neck . The treatment of choice for 13 patients was surgery . Postoperatively two patients died of hepatic failure at 5 weeks, and from apoplexia at four months, after surgery, respectively . The remaining patients' prognosis is good after a 3-month to 6-year follow-up with a mean period of 2.9 years except 1 medically treated patient . Accordingly, atherosclerotic abdominal aorta saccular protrusion should be carefully diagnosed and be surgically treated in the usual AAA manner . Only juxtarenal saccular protrusions require careful reconstruction, preserving the renal or visceral function.

Avian Dis, 1996 Apr-Jun, 40(2), 321 - 5
Ultrasound for detecting osteomyelitis in turkeys; Mutalib A et al.; One thousand turkey legs were examined for osteomyelitis (OM) by ultrasonographic, pathologic, and bacteriologic examinations . OM lesions were recognized as hyperechoic (brighter white) disruptions in cortical bone in the growth plate region by ultrasound examination OM was confirmed histologically in 139 of 1000 legs . OM was detected by ultrasound in 109 of 139 OM-positive legs for a sensitivity rate of 78% . OM was not detected by ultrasound in 713 of the 861 OM-negative legs for a specificity rate of 83% . Ultrasonography was superior to current use of green liver discoloration for detection of tibial OM in turkeys at processing . The economic benefit to the turkey industry from the approval and application of this procedure could be considerable.

Pathol Biol (Paris), 1996 Apr, 44(4), 269 - 74
{Evaluation of the mortality related to nosocomial infections . An approach by a homogeneous group of patients, from bacteriology and data of hospitalization (1989-1993)}; Legras B et al.; We cross matched the informations from the medical records of the PMSI (French Program of Medicalisation of the Information System) with those from the bacteriology data base . The hospitalisation summaries provide the length of hospital stay, the mortality and the pathology defined by DRG (Diagnosis Related Group) . Bacteriological data allow the diagnosis of nosocomial infections (NI) when using an appropriate methodology ("doubles" and early samples are not taken in account) . Then it is possible to estimate the mortality when there are NI and No . 4499 stays NI were compared with 140,463 stays without NI . Mortality is 14.4% in NI group (17.5% in medecine and 8.6% in surgery) against 2.1% in the group without NI (2.5% in medecine and 0.8% in surgery) . Among the 58 DRG's studied (more than 19 cases with NI), mortality and relative risk varie a lot . Results are estimations because they are many bias.

Arch Pediatr, 1996 Apr, 3(4), 329 - 34
{Symptomatic Helicobacter pylori infection: prospective study of epidemiological, diagnostic and therapeutic aspects in children in Tunisia}; Maherzi A et al.; BACKGROUND: Epidemiology, criteria for diagnosis and treatment of Helicobacter pylori (HP)-related infection in children are still debated . POPULATION AND METHODS: A total of 130 children and teenagers who presented recurrent episodes of unexplained abdominal pain underwent an endoscopic examination . Gastric biopsies were studied for histology and search for HP (Giemsa and Gram staining, testing for urease and culture in an appropriate environment) . Serological tests (Elisa) were performed . HP infection was considered as present when two investigations at least proved positive . Infected children were given one drug (amoxicillin, cimetidine or antiacids) or two drugs (amoxicillin plus tinidazole) . Clinical and endoscopic control including histological and bacteriological studies were done for the following 12 to 18 months . RESULTS: HP infection was present in 70 children (54%) . It was associated chronic gastritis in 64 cases (91%) and with duodenal ulcer in the remaining cases (9%) . Recurrent abdominal pain, anorexia, weight loss and family history of peptic diseases were significantly associated with HP infection (P < 0.05) . Endoscopic examination was normal in 35 infected children (50%); nodular antritis was inconstant (30%) but always associated with HP-related infection (P < 0.001) as was atrophic or follicular chronic gastritis . Eradication of HP, associated with the disappearance of chronic gastritis, was seen in 53% of children given amoxicillin alone and in 85% of those given amoxicillin plus tinidazole, but never in those receiving cimetidine or antiacids . Relapse of the HP-related infection was observed in four children (16%), 6 to 12 months after the first episode . CONCLUSION: These results show high prevalence of HP-related infections in the Tunisian children who suffer from recurrent episodes of abdominal pain . They also confirm the role of HP in the inflammatory process and the development of gastroduodenal ulcer in children.

Tuber Lung Dis, 1996 Apr, 77(2), 124 - 9
Sputum smear conversion during directly observed treatment for tuberculosis; Rieder HL; SETTING: Treatment program for tuberculosis in a refugee camp in Thailand . OBJECTIVES: To determine the cumulative frequency of conversion of sputum smears examined by direct microscopy by month of treatment and to identify factors predicting failure to convert . METHODS: Analysis of conversion based on three sputum smear examinations (performed monthly) in a cohort of patients with sputum smear-positive tuberculosis treated with a directly observed daily regimen containing rifampicin throughout . Nested case-control study of patients failing to convert definitively within four months compared to controls who did convert . RESULTS: Sputum conversion after the 2-month intensive phase was 75.0%, with a range from 61.7% to 90.9% in patients with initially strongly- and weakly-positive smears, respectively . The strongest predictor identified for no definitive conversion within four months of treatment was a positive sputum smear result at the end of the 2-month intensive phase (adjusted relative odds 4.2, 95% confidence interval 1.5-11.4) . Of those patients who did not convert, positive smears were an isolated phenomenon in 15, repeatedly in four who definitely converted with a prolongation of treatment, and persistently positive in two requiring a re-treatment regimen . CONCLUSIONS: Definitive sputum smear conversion is judged to be slower if a strict program of sputum smear examination is undertaken than under routine program conditions, but positive results late in the course are commonly an isolated phenomenon and possibly of little significance . Sputum smear results at two months strongly predict bacteriologic results beyond three months of treatment, and thus identify cases who might benefit from a prolongation of the intensive phase.

Tuber Lung Dis, 1996 Apr, 77(2), 112 - 6
Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study; Alcaide J et al.; SETTING: The association between smoking and pulmonary tuberculosis has not often been studied . OBJECTIVE: To assess the influence of cigarette smoking on the development of active pulmonary tuberculosis in young people who were close contacts of new cases of smear-positive pulmonary tuberculosis . DESIGN: A case-control study in which 46 'cases' (patients with active pulmonary tuberculosis: isolation of Mycobacterium tuberculosis or clinical and/or radiographic evidence of current pulmonary tuberculosis, with a positive tuberculin skin test) and 46 'controls' (persons with positive tuberculin reaction, negative bacteriological test and without clinical and/or radiological evidence of pulmonary tuberculosis) were included . Smoking habits were investigated by questionnaire . Univariate and multivariate analysis was performed, and odds ratio (OR) was adjusted for age, gender and socio-economic status . RESULTS: Statistically significant differences were found in active smokers (occasional and daily smokers) (OR: 3.65; 95% CI, 1.46 and 9.21; P < 0.01), daily smokers (OR: 3.53; 95% CI, 1.34 and 9.26; P < 0.05), and individuals who were both passive and active smokers (OR: 5.10; 95% CI, 1.97 and 13.22; P < 0.01) and passive and daily smokers (OR: 5.59; 95% CI, 2.07 and 15.10; P < 0.001) . There was a dose-response relationship between the number of cigarettes smoked daily and the risk of active pulmonary tuberculosis . CONCLUSIONS: The data studied show that cigarette smoking is a risk factor for pulmonary tuberculosis in young people, with a dose-response relationship with the number of cigarettes consumed daily.

Clin Infect Dis, 1996 Apr, 22(4), 705 - 8
Rifabutin versus placebo in combination with three drugs in the treatment of nontuberculous mycobacterial infection in patients with AIDS; Dautzenberg B et al.; The aim of this double-blind, randomized, placebo-controlled, 12-week study was to assess the efficacy of rifabutin (450 or 600 mg/d) in the treatment of disseminated nontuberculous mycobacterial infection in patients with AIDS . Companion drugs in both arms of the study were ethambutol, clofazimine, and isoniazid . Because of low accrual, the study was prematurely terminated when a total of 382 patients had been enrolled, of which 200 were eligible (i.e., their specimens were culture-positive for Mycobacterium avium complex {MAC} or Mycobacterium xenopi at baseline) and 102 were evaluable (i.e., they were eligible, were treated for a minimum of 6 weeks, and had at least one culture assessment after baseline) . The original protocol called for a total of 220 evaluable patients . At week 12, rifabutin treatment was associated with higher, although nonsignificant, rates of bacteriologic conversion than was the placebo arm, with regard to both the eligible patients (25% vs . 18%) and the evaluable patients (45% vs . 38%) . Corresponding median times to culture conversion were 42 vs . 63 days (eligible patients) and 43 vs . 69 days (evaluable patients) . No significant difference was observed in clinical improvement, mortality, or toxicity between the two treatment arms . The addition of rifabutin to a triple-drug regimen may contribute to the clearance of disseminated MAC infection in patients with AIDS, without causing additional toxicity.

J Antimicrob Chemother, 1996 Apr, 37(4), 645 - 63
A meta-analysis of studies on the safety and efficacy of aminoglycosides given either once daily or as divided doses; Munckhof WJ et al.; We performed a meta-analysis of randomised clinical studies in which the efficacy and toxicity of the same total daily dose of aminoglycosides administered once-daily was compared with multiple divided daily dosing for treating human infections . Of twenty-eight publications identified from a literature search using Medline 19 publications of 20 study comparisons involving 2881 patients met the criteria for analysis . Netilmicin was investigated in 11 studies, amikacin in seven studies and gentamicin in two studies but no studies of tobramycin met the inclusion criteria . The meta-analysis showed that there was a small, statistically significant difference in clinical efficacy of 3.5% (95% confidence intervals 0.5% to 6.5%, P = 0.027) in favour of once-daily administration but no significant differences in bacteriological efficacy or nephrotoxicity were detected . Auditory and vestibular toxicity rates were low for all agents and no differences in these toxicities were identified between once-daily or multiple-dose administration regimens either clinically or by audiometry or electronystagmography . Aminoglycosides can be given once-daily without loss of efficacy or increased toxicity offering greater simplicity and potentially improved cost-effectiveness than can be achieved by giving these drugs in divided doses.

New Microbiol, 1996 Apr, 19(2), 175 - 8
Leptospira interrogans serovar hardjo in the kidneys and genital tracts of naturally infected sheep; Cerri D et al.; A bacteriological study was carried out to identify possible renal and/or genital carriers of Leptospira interrogans serovar hardjo . L . hardjo was found at slaughter in the kidneys of three seropositive ewes, but not in uterus or salpinges of these animals.

Ir J Med Sci, 1996 Apr-Jun, 165(2), 93 - 4
Appropriateness of laboratory tests: requests for atypical pneumonia serology in a teaching hospital; Jackson LM et al.; The cost of providing medical care is ever-increasing but the resources available are at best static . Major savings can be made by reducing inappropriate investigations . Using serological testing for organisms causing atypical pneumonia as an example, we examined the appropriateness of requests and also physicians' understanding of the test . Of 119 patients tested, only 3 had titres indicative of acute infection . Most patients were tested within 2 days of hospital admission, before receipt of results excluding more likely diagnoses . Forty-five patients had no current or recent respiratory symptoms, in whom infection was highly unlikely . Titres were most often requested by the least experienced members of the clinical team . Of 70 patients with an acute illness in whom a definitive diagnosis, bacteriological or otherwise, was not made, in only 9 was a convalescent specimen sent for follow-up titres . Most requests for serology for organisms causing atypical pneumonia were inappropriate . Furthermore, in the majority of cases the test was incorrectly used.

Genitourin Med, 1996 Apr, 72(2), 93 - 7
Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises; Thorpe EM Jr et al.; STUDY GOAL: To compare the efficacy and safety of single 1 g oral azithromycin with doxycycline, 100 mg twice daily for seven days for treatment of uncomplicated urogenital chlamydial infection . STUDY DESIGN: Randomised, unblinded, comparative trial, involving 597 patients demonstrating clinical evidence of genital chlamydia and a positive non-culture assay for Chlamydia trachomatis . RESULTS: Among the azithromycin- and doxycycline-treated patients 61% and 60%, respectively, were asymptomatic within one week after the first dose . At two weeks, these figures increased to 86% and 83%, respectively . Bacteriological eradication, based on a negative assay, occurred in 338 (97%) of 347 azithromycin-treated patients and 161 (99%) of 163 doxycycline-treated patients . CONCLUSION: Treatment of uncomplicated chlamydial cervicitis and urethritis with single 1 g oral azithromycin is equivalent to standard therapy with doxycycline . Drug-related adverse events were approximately twice as common as previously reported for both drugs.

Trop Doct, 1996 Apr, 26(2), 62 - 4
Early diagnosis of septicaemia in infants with respiratory distress in the tropics; Rabasa AI et al.; A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken . Thirty-two infants (29.6%)had positive blood cultures . The buffy coat was stained with methylene blue and with Gram's stain . Using methylene blue staining, 94% shared organisms in the buffy coat . Whereas using Gram's stain only 50% were positive--all of which were also positive with methylene blue . Twenty-four infants with negative blood cultures had radiological signs of pneumonia . Of these, 83% showed organisms in the buffy coat with both methylene blue and Gram staining . We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distressPIP: A prospective study of buffy coat microscopy in newborns with respiratory distress confirmed the reliability of this procedure in the early diagnosis of neonatal septicemia or lung infection . The buffy coat smear examination was performed on 108 consecutive infants admitted to the University of Benin (Nigeria) Teaching Hospital from April to August 1991 with signs of respiratory distress (e.g., respiratory rate of 60 or more per minute, retraction score of 4 or more, and grunting respirations) during the first 48 hours of life . Bacteriologic cultures indicated that 32 infants (30.7%) were septic . When methylene blue staining was used, 30 septic infants (94%) shared organisms in the buffy coat compared to only 16 (50%) with Gram staining . Of the 76 infants with negative cultures, 24 had radiologic evidence of pulmonary infiltration consistent with pneumonia . (The lack of microbiologic evidence of infection in these infants may reflect the administration of antibiotics prior to delivery.) Of these 24 infants, 20 (83%) showed organisms in the buffy coat with both methylene blue and Gram staining . The specificity of negative buffy coat smears in the non-septic group with normal chest x-rays was greatest (88.5%) when the results of methylene blue staining and Gram staining were combined .

Biochem J, 1996 Apr 1, 315 ( Pt 1), 119 - 26
A 33 kDa serine proteinase from Scedosporium apiospermum; Larcher G et al.; An extracellular proteinase produced by the filamentous fungus Scedosporium apiospermum has been purified and characterized . Initially, in vitro conditions for enzyme synthesis were investigated . The highest yield of enzyme production was obtained when the fungus was cultivated in modified Czapek-Dox liquid medium supplemented with 0.1% bacteriological peptone and 1% (w/v) glucose as the nitrogen and carbon sources respectively . Purification to homogeneity of the proteinase was accomplished by (NH4)2SO4 precipitation, followed by gel filtration through Sephadex G-75 and finally affinity chromatography through immobilized phenylalanine . Analysis of the purified enzyme by SDS/PAGE revealed a single polypeptide chain with an apparent molecular mass of 33 kDa . Further investigation of its physical and biochemical properties disclosed numerous similarities with those of the previously described serine proteinase of Aspergillus fumigatus . The enzyme was not glycosylated and its pI was 9.3 . Proteinase activity was optimum between 37 and 50 degrees C and at pH 9.0, but remained high within a large range of pH values between 7 and 11 . The inhibition profile and N-terminal amino acid sequencing confirmed that this enzyme belongs to the subtilisin family of serine proteinases . In agreement with this, the specific synthetic substrate N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide proved to be an excellent substrate for the proteinase with an estimated Km of 0.35 mM . Like the alkaline proteinase of A . fumigatus, this enzyme was able to degrade human fibrinogen, and thus may act as a mediator of the severe chronic bronchopulmonary inflammation from which cystic fibrosis patients suffer.

Unfallchirurg, 1996 Apr, 99(4), 283 - 7
{Vacuum assisted wound closure after dermatofasciotomy of the lower extremity}; Fleischmann W et al.; Between 1 January 1992 and 15 March 1994 25 patients with compartment syndromes of the lower limb were treated by the vacuum-sealing technique (VS) . Ten out of 25 patients had multiple injuries . Eight compartment syndromes were located in the thigh, 14 in the lower leg and 3 in the foot . The average time of VS was 12.7 (4-31) days with 2.1 (1-8) changes per patient . The wounds were either closed by secondary suturing (n = 20) or by skin grafts after partial closure of the wounds by suturing (n = 5) . One patient developed a superficial wound necrosis, which healed spontaneously without invasive surgical treatment . In 52 intraoperative swabs of the wound surface there was bacterial growth in five bacteriologic specimens, but there were no clinical signs of infection.

J Am Vet Med Assoc, 1996 Apr 1, 208(7), 1054 - 7
Sensitivity and specificity analysis for somatic cell count (SCC) used to predict bacteriologically positive subclinical mastitis at calving in a dairy herd with low SCC; Kirk JH et al.; OBJECTIVE--Validate, by sensitivity and specificity analyses, use of somatic cell count (SCC) to predict bacteriologically positive subclinical mastitis in a California dairy herd with low SCC . DESIGN--Study of monthly dairy herd improvement SCC obtained from the immediate preceding lactation and individual cow composite milk sample microbiologic isolates collected at calving . ANIMALS--515 California dairy cows with SCC and culture data . PROCEDURE--Somatic cell count sensitivity and specificity analyses with combinations of SCC parameter and at various thresholds were done, using the bacterial isolates as the standard . RESULTS--Combination of SCC threshold and SCC parameters could not be developed that had sufficient sensitivity and specificity to be a useful predictor of cows that would calve with subclinical mastitis . CLINICAL IMPLICATIONS--Under the conditions at this particular dairy, SCC could not be used as a basis of prediction of cows that would calve with bacteriologically positive subclinical mastitis or require selective nonlactating-cow antibiotic treatment.

Arch Surg, 1996 Apr, 131(4), 389 - 94
Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones; Csendes A et al.; OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings . METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones . In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures . RESULTS: Control subjects had no bacteria in gallbladder bile . Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%) . Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%) . Age greater than 60 years had a significant influence on the rate of positive bile cultures . There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures . In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile . CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract . Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease . Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.

Tidsskr Nor Laegeforen, 1996 Mar 10, 116(7), 866 - 8
{Brain abscess . A difficult diagnosis?}; Harbo HF; It is vital to diagnose brain abscess early, but this can be intricate . Four cases of brain abscess are described, illustrating the diagnostic difficulties . One of the patients had multiple brain abscesses . Important aspects of brain abscess are discussed . Brain abscess should be suspected in cases of increasing intracranial pressure combined with focal neurological signs or epileptic seizures, even with no apparent signs of infection . The characteristic contrast-enhancing ring lesion and surrounding oedema may be sufficient for diagnosis, but biopsy and bacteriological culture are often necessary . Epileptic seizures and various neurological sequelae are common, even if the abscess is treated immediately . Delay in diagnosis may lead to fatal outcome.

MMWR Morb Mortal Wkly Rep, 1996 Mar 8, 45(9), 193 - 6
Clinical laboratory performance on proficiency testing samples--United States, 1994; Hospital care of tuberculosis patients referred for directly observed therapy in New York City: identifying factors in prolonged stays; Mount Sinai Hospital Tuberculosis Elimination Program, New York, New York, USAIndividuals hospitalized and treated for tuberculosis (TB) who were then enrolled into TB directly observed therapy at four study hospitals in New York City (NYC) were identified . Review of hospital medical records determined whether the hospitalizations were warranted and whether lengths of stay were prolonged . Most hospitalizations were appropriate but over 70 percent of cases analyzed had prolonged stays . Of these, almost half were to document bacteriologic response to anti-TB treatment . Some were prolonged due to misunderstanding of state recommendations . Focused educational efforts could significantly reduce lengths of stay and save up to $9.7 million annually in NYC hospitalization costs.

Srp Arh Celok Lek, 1996 Mar-Apr, 124(3-4), 82 - 6
{Neuroleukemia in adults}; Beslac-Bumbasirevic Lj et al.; Involvement of CNS with leukemic cells is well recognized complication of acute lymphatic leukemia (ALL) in childhood, but with recent improvements in systemic treatment and longer survival the incidence of this complication has increased in adults . Neurological symptomatology in patients with CNS leukemia is due to meningeal infiltration, but sometimes also to diffuse and nodular cerebral infiltration . Between January 1991 and December 1994, 36 patients suffering of acute leukemia, 28 with ALL, and 8 with acute myeloid leukemia (AML) were demonstrated to have neuroleukemia by the following criteria: (1) the presence at lumbar puncture (LP) pleocytosis and blast cells on CSF sediment (without positive bacteriologic and fungal cultures), and (2) the presence of neurological symptoms and signs . All 36 patients had 46 episodes of CNS involvement . All patients had neurological examinations during every episode, and according to the neurological abnormalities were classified into four categories . LP was performed in all, and CSF sediments obtained by sedimentation in Sayk's chambers, were routinely stained by MGG and cytochemical stains to detection of leukemic cells (Fig . 1) . EEG was done during 21 episodes, CT scan during 15 . We divided patients into four groups according to the most prominent neurological symptoms and signs . First was the group included 23 episodes (50%), (18 ALL, 5 AML), where symptoms and signs of meningeal irritation predominated, mimicking the clinical picture of meningitis . This meningeal syndrome can sometimes produce differential diagnostic problems with CNS infections, when CSF examination is of primary importance . Second was the group of 9 patients (6 ALL and 3 AML) with 10 episodes (21.74%) where cranial nerve symptoms and signs-predominated, or were exclusively present . Most frequently affected were bulbomotors, facials and opticus . Third group consisted of 8 ALL patients (8 episodes, 17.39%) with dominant spinal root symptomatology, caused by pathological infiltration of either spinal roots or meninges surrounding them . This group includes also one patient with mononeuritis multiplex and the other with painful polyneuropathy . All patients in this group had pain on straight leg raising, but we stress here that all patients from other groups had positive Lazarevitsh's sign, too . So, it can be a good differential diagnostic parameter for distinguishing toxic medicamentous polyneuropathy from leukemic poliradiculoneuropathy . Fourth group included 5 patients (5 episodes, 10.87%) . 4 ALL and 1 AML, where cerebral symptoms, such as seizures, hemiparesis and psychoorganic syndromes were prominent . CSF was obtained during all episodes by lumbar puncture . The protein concentration ranged from 21-3180 mg/dl, and was above normal (45 mg/dl) during 28 episodes . Mild hypoglycoracchia was present during 16 episodes . Cell count ranged from 11-4816 cells/cm3, malignant cells were identified during all episodes with same morphological and cytochemical characteristics of identified type of leukaemia . It has been established that the most valuable diagnostic procedure in CNS leukemia is CSF examination, and detection of blasts is sufficient for diagnosis . All other procedures like EEG, myelography and CT have only supplemental diagnostic significance . Finally, in this study we showed that neurological symptomatology in patients with acute leukemia is not dependent of the type of leukemia, moreover different types of AL can have same neurological manifestations . As others, we sometimes used the term CNS leukemia in this paper, although it is clear that meninges and peripheral nervous system are most often involved . This is the reason why we suggest that neuroleukemia, or NS leukemia should be used as more appropriate expressions.

J Clin Microbiol, 1996 Mar, 34(3), 516 - 9
Isolation of enterohemorrhagic Escherichia coli O157 strains from patients with hemolytic-uremic syndrome by using immunomagnetic separation, DNA-based methods, and direct culture; Karch H et al.; We examined 30 children with classical hemolytic-uremic syndrome (HUS) for the presence of enterohemorrhagic Escherichia coli (EHEC) strains in stool samples and determined the specific immune response to O157 lipopolysaccharide in acute-phase serum samples from these patients . EHEC O157 strains were isolated from stool samples of 18 (60%) of the patients, and non-O157 EHEC strains were isolated from 5 (17%) of the patients . For O157 strain isolation from stools, we introduced a selective enrichment step using O157-specific antibodies attached to paramagnetic particles (immunomagnetic separation {IMS} method) . This procedure allowed the detection of O157 strains at 10(2) CFU/g of stool in the presence of 10(7) coliform background flora organisms . By using IMS followed by plating on sorbitol MacConkey (SMAC) agar and cefixime-tellurite SMAC (CT-SMAC) agar, O157 strains were detected in 18 samples, whereas colony hybridization detected a subset of 12 positive samples and direct culture on CT-SMAC or SMAC agar detected only 7 . Three of the 18 O157-positive stools were negative by cytotoxicity assay performed with stool filtrates and by direct PCR with DNA extracted from stools . The IMS technique allowed the isolation of O157 strains from 18 of 20 patients with serological evidence for O157 infection . Apart from the increase in sensitivity in O157 detection compared with that of direct culture, the IMS technique also has the advantage of being less labor-intensive and less time-consuming than the molecular methods . IMS can therefore be considered an efficient method for wide-spread use in the detection of O157 strains in clinical microbiology laboratories . However, because a significant number of HUS cases were attributable to non-O157 EHEC serogroups, the use of additional methods besides IMS in the bacteriological diagnosis of HUS is necessary.

J Clin Microbiol, 1996 Mar, 34(3), 512 - 5
Rapid diagnosis of Mycobacterium tuberculosis bacteremia by PCR; Folgueira L et al.; A method based on DNA amplification and hybridization has been used for the rapid detection of Mycobacterium tuberculosis in blood samples from 38 hospitalized patients (15 human immunodeficiency virus {HIV} positive and 23 HIV negative) in whom localized or disseminated forms of tuberculosis were suspected . In 32 of these patients, the diagnosis of tuberculosis was eventually confirmed by conventional bacteriological or histological procedures . M . tuberculosis DNA was detected with the PCR technique in the peripheral blood mononuclear cells from 9 of 11 (82%) HIV-infected patients and in 7 of 21 (33%) HIV-negative patients (P < 0.01), while M . tuberculosis blood cultures were positive in 1 of 8 (12.5%) and 1 of 18 (5.5%) patients, respectively . PCR was positive in all cases with disseminated disease in both HIV-negative and HIV-positive patients and also in the HIV-positive patients with extrapulmonary tuberculosis . Seven samples from patients with documented illness other than tuberculosis and 12 specimens from healthy volunteers, including seven volunteers with a recent positive purified protein derivative test, were used as controls and had a negative PCR . These results suggest that detection of M . tuberculosis DNA in peripheral blood mononuclear cells may be a useful tool for rapid diagnosis of disseminated and extrapulmonary forms of tuberculosis, especially in an HIV-positive population.

AIDS, 1996 Mar, 10(3), 299 - 309
An epidemiological study of tuberculosis and HIV infection in Tanzania, 1991-1993; Chum HJ et al.; OBJECTIVE: In Tanzania during the past 6 years reported tuberculosis (TB) cases have nearly doubled, with proportionately much greater increases in smear-negative and extrapulmonary cases compared with smear-positive cases . At the same time, HIV infection has become widespread throughout the country . This survey was undertaken in order to study the association of TB and HIV and to determine the impact of HIV on present and future TB cases in Tanzania . METHODS: The survey design provided for HIV testing of a representative country-wide sample of approximately one-sixth of all new and relapse cases registered between January 1991 and December 1993, with linkage to demographic, clinical and bacteriological data for these cases . HIV surveillance data were used for comparison purposes . RESULTS: A total of 6928 TB cases from all of the country's 20 mainland regions were tested . The overall HIV seroprevalence was 32% . Both crude and adjusted odds ratios (OR) for HIV infection were higher in women, those aged 25-44 years, urban residents, cases of smear-negative and extrapulmonary disease, and persons with a bacille Calmette-Guerin (BCG) vaccination scar . The age-and sex-adjusted relative risk for HIV infection in TB patients compared to blood donors in the same regions was 7.1 (95% confidence interval, 6.6-7.5), and was significantly higher among those aged 25-34 years . Of 3360 patients with bacteriological culture results 46% were culture-positive for Mycobacterium tuberculosis . Drug susceptibility tests were performed on 1164 isolates with the overall rate of drug resistance of 6.2% . Rates of initial resistance were low in both HIV-positive (4%) and HIV-negative (5.8%) patients . Rates of acquired resistance were higher (19% overall) and did not vary significantly by HIV serostatus . Initial combined resistance to both isoniazid and rifampicin was uncommon (0.4%) as was monoresistance to rifampicin (0.3%) . CONCLUSIONS: The higher OR for women and young adults reflect the higher rates of HIV infection in those populations . The finding that smear-positive relapse cases were no more likely to have HIV infection than new smear-positive cases suggests that the treatment regimen for new cases is effective in HIV-associated TB . The low rates of both initial and acquired drug resistance in HIV-positive patients is further evidence of adequacy of treatment . The higher relative risk for HIV infection among patients aged 25-34 years suggests increased HIV-related TB transmission . Finally, it is estimated that approximately two-thirds of the increase in the rate of smear-positive tuberculosis in the country can be directly attributed to HIV infectionPIP: The number of tuberculosis (TB) cases reported in Tanzania during the past six years has nearly doubled . Concurrently, HIV infection has become widespread throughout the country . This survey was conducted to study the association between TB and HIV, and to determine the impact of HIV upon present and future TB cases in the country . The survey design provided for HIV testing of a representative country-wide sample of approximately 17% of all new and relapse TB cases registered between January 1991 and December 1993 . 6928 TB cases were tested from all of the country's mainland regions to find an overall HIV seroprevalence of 32% . Both crude and adjusted odds ratios for HIV infection were higher in women, those aged 25-44 years, urban residents, cases of smear-negative and extrapulmonary disease, and persons with a BCG vaccination scar . The age- and sex-adjusted relative risk for HIV infection in TB patients compared to blood donors in the same regions was 7.1, and was significantly higher among those aged 25-34 years . 46% of the 3360 patients with bacteriological culture results were culture-positive for Mycobacterium tuberculosis . Drug susceptibility tests were performed on 1164 isolates with the overall drug resistance rate of 6.2% . Rates of initial resistance were 4% among HIV-positive patients and 5.8% among HIV-negative patients . There was a 19% overall rate of acquired resistance which did not vary significantly by HIV serostatus . Initial combined resistance to both isoniazid and rifampicin was 0.4%; there was a 0.3% monoresistance to rifampicin . The authors estimate that approximately two-thirds of the increase in the rate of smear-positive TB in Tanzania can be directly attributed to HIV infection .

J Pain Symptom Manage, 1996 Mar, 11(3), 158 - 62
The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers; Finlay IG et al.; The unpleasant smell of infected fungating tumors and benign cutaneous ulcers is a distressing clinical problem, known to be associated with anaerobic infection . Topical metronidazole 0.8% gel has been shown to decrease smell from fungating malodorous tumors . This study was conducted to assess prospectively the subjective and bacteriological response to 0.75% metronidazole gel to decrease smell from these lesions and to assess whether bacterial contamination of the tubes of gel occurs during use . Forty-seven patients with benign or malignant cutaneous lesions associated with a foul smell were assessed for smell, pain, appearance, and bacteriological profile before entry and at 7 and 14 days . Forty-one (95%) of the 43 patients assessed at 14 days reported decreased smell . Anaerobic infection was initially found in 25 (53%) of patients and was eliminated in 21 (84%) of these . At review after 7 days, patients reported less pain from the lesions . Discharge and associated cellulitis were also observed to decrease significantly.

Onderstepoort J Vet Res, 1996 Mar, 63(1), 47 - 51
Brucellosis surveillance and control in Zimbabwe: bacteriological and serological investigation in dairy herds; Mohan K et al.; Brucellosis in dairy cattle is endemic in Zimbabwe . The prevalence continues to be monitored intensively . Only milk and serum samples are routinely screened . Attempts to culture Brucella spp . from clinical specimens are seldom made . Consequently, incidence of various Brucella spp . within Zimbabwe is virtually unknown, despite the high serepositivity reported . This information is paramount in understanding the transmission cycle and is also significant to public health; particularly as B melitensis infects humans more often than do the other brucellae . This paper describes the results of bacteriological and serological investigations of brucellosis in a dairy from near Bulawayo . The said farm was selected for the present pilot study because of the high incidence of reported abortion . The milk ring test was employed to test the bulk pooled milk samples once a month for 14 months . The test was recorded highly positive on all 14 occasions . To locate reactors, milk samples from 36 individual cows were similarly tested . Of these, 21 (almost 59%) were found to be reacting positively . One hundred and seventy-seven animals were marked for serotesting . Of these 40 (approximately 25%) showed quite high serum titres (> 1:360) in both the STT and the Rosebengal test . The farmer was advised to havet all abortions full investigated . However, all the clinical material from cases of abortion, except one, were received in an advanced state of putrefaction . From this, Brucella was isolated on culture from stomach contents and cotyledons . The isolates from both the sites were characterized in detail, employing dye inhibition, phagetyping; the oxidative metabolic test and agglutination with monospecific sera . Both the isolates belonged to B . abortus biovar I, which was confirmed by the Central Veterinary Research Laboratory, Weybridge . The significance of isolation and the need to intensify similar studies have been discussed.

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