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 approp