Bacteriological

J Commun Dis, 1996 Mar, 28(1), 8 - 14
Usefulness of ELISA using antigen A60 in serodiagnosis of neurotuberculosis; Thakur A et al.; Anti-mycobacterial antibody to A60 antigen were quantified in the sera and cerebrospinal fluid (csf) samples of one hundred patients of neurotuberculosis and twenty non-tubercular controls by immunoenzymatic (ELISA) assay . Sixty three patients (63%) had "significant" antibody titres in serum and/or CSF samples . In contrast, none of the samples from the control group showed this level of antibody concentration . The evaluation of this assay in tuberculoma (group A, 79 cases) vis-a-vis tubercular meningitis or TBM (group B, 21 patients) revealed significant antibody levels in the former 46 (58.2%) in comparison to 17 (77.3%) in the latter group . A positive relationship was observed in the titres of anti-mycobacterial antibodies in serum and in CSF both in cases of tuberculoma and TBM . This study indicates the utility of A60 antigen ELISA assay in categorising these patients into tubercular aetiology specially in the absence of bacteriological isolation from CSF which still remains the gold standard diagnostic criterion.

Pancreas, 1996 Mar, 12(2), 142 - 8
Nonsurgical treatment of acute necrotizing pancreatitis; Uomo G et al.; Our objective was to analyze conservative management in a large series of acute necrotizing pancreatitis (ANP) patients in a specialized center for pancreatic disease in the Internal Medicine and Emergency Department of a 1,500-bed hospital . One hundred ninety-nine patients with ANP were considered (mean age, 55.4 +/- 18.2 years; biliary etiology, 60.3%) . Identification of necrotizing forms of acute pancreatitis was obtained by ultrasonography, computed tomography scan, and surgery (53 cases) . Exclusion of infection of the necrosis was based on clinical findings and percutaneous aspiration with bacteriological sampling . Medical treatment was started in all cases; 37 patients required ICU treatment; 87 patients underwent early endoscopic cholangiopancreatography (ERCP), and endoscopic sphincterotomy was performed in 61 cases; and percutaneous guided aspiration of necrosis and fluid collections was performed in 78 cases and in 9 patients with acute pseudocysts . Fifty-three patients (26.6%) underwent surgery; all patients (n = 30) with infected necrosis were in this group . One hundred forty-six patients were unoperated (73.3%): clinical resolution of ANP and biochemical normalization was achieved in 132 cases (66.3%) at discharge . Ultrasonographic follow-up documented morphological resolution of necrosis and fluid collections in 84 cases (57.5%) at different periods from the onset of ANP (range, 2.2-63.5 weeks); 16 patients dropped out and seven patients are still being followed . Spontaneous regression of acute pseudocysts was observed in 59.2%; percutaneous/endoscopic aspiration was successful in 33.3% . Mortality was 9.5%, significantly lower than the mortality observed in operated patients (28.3%; p = 0.002) . Conservative treatment of ANP with sterile necrosis may allow healing in most cases, independent of the extent of necrosis or its association with major complications.

J Biomed Mater Res, 1996 Mar, 30(3), 373 - 83
Coupled influence of substratum hydrophilicity and surfactant on epithelial cell adhesion; Dewez JL et al.; The influence of substratum surface hydrophilicity and of a surfactant on human epithelial cell adhesion and protein adsorption was investigated . Therefore, tissue culture grade polystyrene (TCPS) and bacteriological grade polystyrene (BGPS) substrata were treated with different media, with or without Pluronic F68 {a poly(ethylene oxide) and poly(propylene oxide) triblock copolymer surfactant}, and with or without type I collagen as a typical extracellular matrix protein . The conditioned substrata were submitted to XPS analysis and assayed for cell adhesion by inoculating Hep G2 cells in a chemically defined nutritive medium . The presence of collagen at the substratum surface is required to obtain attachment and spreading of Hep G2 cells . With PS substrata, treating with a solution of collagen does not promote cell adhesion if the solution contains Pluronic; XPS data show that this is due either to prevention of collagen adsorption or to its desorption by rinsing . With less hydrophobic TCPS substrata, the presence of Pluronic in the conditioning solution does not preclude cell adhesion, nor collagen adsorption . The effect of BGPS and TCPS substrata on Hep G2 cell adhesion is thus mediated by the presence of a surfactant that affects the adsorption of collagen.

Nutr Hosp, 1996 Mar-Apr, 11(2), 102 - 7
{Enteral nutrition: reduction in the contamination risk}; Montemerlo H et al.; Enteral nutrition is used as a routine therapy in patients with caloric-protein malnutrition, severe dysphagia, major burns, intestinal resection, and enterocutaneous fistulae, as long as a portion of the digestive tract still has an active absorptive function . The administration takes place by means of surgical (ostomies) or non-surgical (nasogastric) tubes . In our country, a significant number of hospitalized patients with various diseases receive this type of nutrition . Given that the colonization of the digestive tract by hospital flora is the first step towards developing intra-hospital infections, the contamination implies serious risks . The objective of this study was to study the most appropriate conditions for the manufacturing, storage and administration of the mixture of nutrients of enteral nutrition, to guarantee nutrition with a lower contamination risk . This study was conducted by the Unit of Nutritional Assistance of the Mater Dei Clinic, by means of bacteriological controls, from January 1991 to December 1992, and in 1993 in which the work systematics were reviewed . The study was prospective, and those solutions whose bacteriological counts were lower than 100.000 colony forming units (CFU), and which showed an absence of enteropathological micro-organisms, were considered acceptable, and those solutions which had a bacteriological count greater than or equal to 100.000 CFU and or the presence of enteropathological micro-organisms, were considered unacceptable . During the first period, "usual working conditions", we analyzed the infra-structure, the personnel, the constituents, and the apparatus used in the manufacturing, for which 36 samples were studied at t0 (moment of preparation) . Afterwards, in the second period "special working conditions", we analyzed the manufacturing procedures, the storage and the administration of 103 solutions, corresponding to 36 patients, taking samples at t0 and t24 (after 24 hours of preparing) . In the first phase, we found a 53% contamination . In the second phase, 99.03% of the solutions were within the limits of acceptability, and only 0.07% were unacceptable . We conclude that it is necessary to have access to a working area which meets the biosecurity norms, to use sterile technique in the preparation, to prefer pharmacologically sterile products for the preparation, to store the prepared mixture between 4 and 8 degrees C, and to keep it cooled during the administration . Lastly, we saw the need to continuously capacitate the nursing, dietary (ABSTRACT TRUNCATED)

Ir Med J, 1996 Mar-Apr, 89(2), 62 - 3
Human Mycobacterium bovis infection in the south-west of Ireland 1983-1992: a comparison with M . tuberculosis; Cotter TP et al.; Epidemiological and bacteriological aspects of human Mycobacterium bovis disease were investigated in south-west Ireland (counties Cork & Kerry, population 536,000) over the years 1983-92 inclusive and compared to M . tuberculosis . Results showed a small, stable incidence of culture positive M . bovis human disease, mean annual incidence 0.56 per 100,000 population compared to a higher but declining incidence of culture positive M . tuberculosis (15.3 per 100,000 in 1983, 9.0 per 100,000 in 1992) . Male patients were the majority, 63.4 per cent of M . bovis; 62.4% of M . tuberculosis (p = 0.03) . Fifty three per cent of M . bovis cases (n = 30) were pulmonary, compared to 85% of M . tuberculosis (n = 626; p = 0.0001) . M . bovis patients were older (p = 0.02), mean age 58.4 years (SD 18.9) compared to 48.5 (SD 22.2) . The mycobacterial smear positive rate was similar in both groups taken as a whole . No rural-urban difference in incidence was found in either disease, suggesting in the case of M . bovis initial infection in childhood via contaminated milk in the pre-pasteurisation era.

Gut, 1996 Mar, 38(3), 379 - 83
High frequency of helicobacter negative gastritis in patients with Crohn's disease; Halme L et al.; The frequency of gastric Crohn's disease has been considered low . This study was undertaken to determine the prevalence of chronic gastritis and Helicobacter pylori infection in patients with Crohn's disease . Oesophagogastroduodenoscopy was performed on 62 consecutive patients suffering from ileocolonic Crohn's disease . Biopsy specimens from the antrum and corpus were processed for both histological and bacteriological examinations . H pylori antibodies of IgG and IgA classes were measured in serum samples by enzyme immunoassay . Six patients (9.7%) were infected with H pylori, as shown by histology, and in five of them the infection was also verified by serology . Twenty one patients (32%) had chronic H pylori negative gastritis (negative by both histology and serology) and one of them also had atrophy in the antrum and corpus . Granulomas were found in four patients . The characteristic appearance of H pylori negative gastritis was focal and mostly mild inflammation resembling the inflammatory changes seen in the gut in Crohn's disease . Patients with H pylori negative chronic gastritis had a significantly more active disease in their gut than those with normal gastric mucosa (p < 0.01) . It is concluded that H pylori positive gastritis is rare, while H pylori negative gastritis is relatively common in patients with Crohn's disease . H pylori negative 'Crohn's gastritis' seems to be associated with active Crohn's disease.

World J Surg, 1996 Mar-Apr, 20(3), 309 - 12; discussion 312-3
Reuse of liver grafts after early death of the first recipient; Moreno Gonzalez E et al.; Three cases are reported of reuse of a transplanted liver graft after early death of the first recipient due to cerebral hemorrhage . The good condition of the donors; the excellent biochemical evolution of the graft in the first recipients; total ABO compatibility and donor-recipient crossmatch; the absence of positivity to hepatitis B virus (HBV), hepatitis C virus (HCV), and bacteriologic cultures; and early death made reuse possible . The shortage of donors in relation to patients on the waiting list and the poor clinical condition of the second recipients made it necessary to adopt the decision to reuse the graft in an attempt to save their lives . The evolution of the patients and the reused grafts was satisfactory, and there were no complications that could be attributed to the fact that the graft had been transplanted before.

Int J Lepr Other Mycobact Dis, 1996 Mar, 64(1), 26 - 36
Immunotherapy of far-advanced lepromatous leprosy patients with low-dose convit vaccine along with multidrug therapy (Calcutta trial); Majumder V et al.; This report describes a promising mode of treatment of lepromin-unresponsive, far-advanced, lepromatous (LL) leprosy patients with antileprosy vaccines as an adjunct to multidrug therapy (MDT) . The Trial Groups included 50 highly bacilliferous, lepromin-negative, untreated LL patients . They were given MDT for 2 years . Of them, 30 patients were administered a mixed antileprosy vaccine containing killed Mycobacterium leprae of human origin plus M . bovis BCG . The remaining 20 patients were given M . bovis BCG . Depending on the severity of lepromin unresponsiveness, they were given one to six inoculations at 3-month intervals . Another 20 similar LL patients were taken in the Control Group . They were given only MDT for 2 years . From the start of the study, all patients belonging to the Trial and Control Groups were followed every 3 months for clinical, bacteriological and immunological outcomes . Within 2 years all 50 patients of the Trial Groups and 19 of the 20 patients of the Control Group became clinically inactive and bacteriologically negative . However, the clinical cure and the falls of the bacterial and morphological indexes were much faster in those patients receiving the mixed vaccine therapy than in those patients who were given BCG plus MDT or only MDT . The immunological improvements in the patients of the Trial and Control Groups were assessed by: a) lepromin testing at the beginning of the study and at 3-month intervals and also by b) the in vitro leukocyte migration inhibition (LMI) test at both the beginning and end of the study . As the patients were given more and more vaccinations, the incidence of lepromin conversion increased, more so in the patients receiving the mixed vaccine . Thus, 63%, 15% and 5% of the patients became lepromin positive in those patients receiving the mixed vaccine, BCG, and MDT only, respectively . Lamentably, the vaccine-induced lepromin positivity was temporary and faded away within several months . At the beginning of the study, the LMI test against specific M . leprae antigen was negative in all patients of both the Trial and Control Groups . After the end of the chemo-immunotherapy schedule, the LMI test became positive in 50% and 20% of LL patients receiving the mixed vaccine and BCG, respectively . None of the Control Group could show LMI positivity after completion of the MDT schedule . These results show that treatment of LL patients with the mixed vaccine and MDT could quickly reverse the clinical course of the disease, remove immunologic anergy in some patients, and induce a rapid decrease in the bacterial load in them.

J Infect Dis, 1996 Mar, 173(3), 750 - 3
Treatment of Myocardium avium complex infection: does the beige mouse model predict therapeutic outcome in humans?
Sison JP, Yao Y, Kemper CA, Hamilton JR, Brummer E, Stevens DA, Deresinski SC.
To determine the predictive value of a standard murine model in the treatment of disseminated Myocardium avium complex (MAC) infection, beige mice were infected with MAC strains isolated from human immunodeficiency virus-infected patients and treated with the same antibiotic (ethambutol, clofazimine, or rifampin) that had been administered to the subject from whom that strain had been recovered . While ethambutol had the greatest bacteriologic efficacy in humans (mean decrease +/-SD, 1.0+/-0.5 log 10 cfu/mL of blood), clofazimine had the greatest bacteriostatic efficacy in mice (mean decrease +/- SD, 2.8 +/- 0.7 log(10) cfu/g of tissue) . A linear correlation was not observed between bacteriostatic activity in mouse liver or spleen and the degree of bacteriologic response in humans (P > or = to .1) . Odds ratios for a response in humans based on a bacteriologic response in mice were not significant for each agent (P > or = to .1, all cases).

J Infect Dis, 1996 Mar, 173(3), 677 - 83
Treatment of Mycobacterium avium complex infection: do the results of in vitro susceptibility tests predict therapeutic outcome in humans?
Sison JP, Yao Y, Kemper CA, Hamilton JR, Brummer E, Stevens DA, Deresinski SC.
The ability of various in vitro methods of antibiotic susceptibility testing to predict therapeutic outcome in patients infected with Mycobacterium avium complex (MAC) was evaluated . Pretreatment bloodstream MAC isolates from 38 patients with AIDS, previously treated in a randomized fashion with either ethambutol, rifampin, or clofazimine, were tested by three conventional methods using broth or agar, as well as by cocultivation with macrophages . The results obtained with each method were compared with the quantitatively determined bacteriologic response to the administration of the single agent in humans . None of the conventional in vitro susceptibility methods was predictive of therapeutic outcome, while the results of cocultivation with macrophages were of moderate predictive value . The positive predictive value of a response in humans based on a response in macrophages (defined by > or = to 1.0 log reduction in baseline colony counts after 5 days of treatment) was 74% . The negative predictive value was 82%.

Presse Med, 1996 Feb 10, 25(5), 199 - 201
{Visceral localizations of cat-scratch disease in an immunocompetent patient}; Bouchard O et al.; Locoregional expression of cat scratch disease is well known, but despite advances in microbiology over the last 10 years leading to the description of two new bacteria (Afipia felis, Bartonella henselae) the infective agent responsible for cat scratch syndrome remains unknown . Until the 80s, only one systemic disease was attributed to infection with a germ in the Bartonella genus: trench fever . With the onset of the AIDS epidemic, new clinical syndromes caused by Bartonella bacteria have been described: bacillary angiomatosis, hepatic peliosis, cases of recurrent septicemia, cases of endocarditis, etc . More recently, atypical forms of cat scratch disease including systemic diseases have been reported in immunocompetent subjects . Although quite rare (1% of the cases), such types of expression can raise questions as to diagnosis both in terms of clinical signs and in terms of bacteriological findings . Clinical and experimental data do not provide a clear direction for treatment but would suggest that prolonged use of aminoglycosides is useful.

Klin Oczna, 1996 Feb, 98(2), 125 - 7
{The value of bacteriologic examination in cataract surgery}; Szymulska M et al.; The purpose of our study was to compare the incidence of intrabulbar infections following cataract extraction and its correlation with the results of preoperative bacterial cultures . We examined 2344 patients who were operated on from 1st January 1993 to 31st December 1994 in our hospital . Patients were divided into 3 groups . In the first group surgery, was performed only in cases where preoperative cultures were negative, in the second group conjunctival cultures were prepared just before surgery . In the third group no preoperative cultures were prepared . Additionally in the second and the third group one drop of 5% Betadine solution was administered to the conjunctival sack just before surgery . We conclude that negative preoperative conjunctival cultures did not prevent from postoperative infections of the eye . After resigning of preoperative bacterial cultures the incidence of intrabulbar infections following cataract surgery did not increase in our study.

Eur Respir J, 1996 Feb, 9(2), 279 - 83
Risk factors for tuberculosis among HIV-infected patients in Switzerland . Swiss HIV Cohort Study; Sudre P et al.; The aim of this study was to determine the risk factors associated with tuberculosis among human immunodeficiency virus (HIV)-infected persons living in Switzerland, a country with low prevalence of tuberculous infection . We performed a nested case-control study and logistic regression . Cases (n = 239) were patients participating in the Swiss-HIV Cohort study (n = 7,103), diagnosed with bacteriologically confirmed tuberculosis . The rest of the cohort population was used as control . Patients from industrialized countries had a risk of tuberculosis similar to those from Switzerland (adjusted odds ratio (OR) 1.1; 95% confidence interval (95% CI) 0.7-1.5); whereas the risk among patients from Eastern Europe (OR 2.8, 95% CI 1.9-3.7), Brazil (OR 10.6; 95% CI 9.6-11.5), and Africa (OR 3.0; 95% CI 2.4-3.6) was markedly higher . Immune suppression, as indicated by low CD4 + cell count, was an independent risk factor for tuberculosis (OR 7.8; 95% CI 7.3-8.3 for patients with CD4 + < 50 cells.mm-3 compared to those with CD4 + > 500 cells.mm-3) . Age, sex and HIV-transmission category did not appear to increase the risk of tuberculosis after adjustment for other patient characteristics . In conclusion, in countries of low prevalence of Mycobacterium tuberculosis infection, to originate from a country with high prevalence of tuberculosis infection and to have advanced immunodeficiency are significant risk factors for tuberculosis . They may be used to complement the tuberculin skin test in targeting patients for preventive chemotherapy.

Cytokine, 1996 Feb, 8(2), 121 - 9
Systemic bacteraemia following haemorrhagic shock in mice: alleviation with oral Interleukin 6; Rollwagen FM et al.; A murine model of haemorrhagic shock was used to investigate bacterial translocation from the gut and subsequent systemic immunoreduction . Anaesthetized mice were bled from the femoral artery, and held at a mean arterial blood pressure of 35 mm Hg for one hour then resuscitated with shed blood and two-fold volume lactated Ringer's solution . Upon awakening, they were given cytokines or control media orally . Bacteriological cultures of livers, spleens and mesenteric lymph nodes from haemorrhaged mice given cytokine had significantly fewer bacteria/gm of tissue than those given media . Recombinant IL-6 mimicked the effects seen with crude cytokines . Reduction of proliferation among spleen cells from haemorrhaged mice was observed and could be partially returned to normal by cytokine feeding . Mixing experiments in which cells from haemorrhaged mice were added to those of normal mice in an MLR showed no suppressor activity . Flow cytometry analysis revealed a reduction in CD 3+ cells at 16 hours post-haemorrhage in mice fed control media or cytokines, suggesting that reduced proliferative capacity may be due to loss of function rather than active suppression . Histological examination of the intestines of haemorrhaged mice fed cytokines or media revealed restoration of intestinal mucosal integrity by cytokine administration . These results suggest that oral administration of IL-6 may be an important treatment for the prevention of systemic sepsis following haemorrhage.

Eur J Pediatr, 1996 Feb, 155(2), 106 - 11
Contribution of the polymerase chain reaction to the diagnosis of tuberculous infections in children; Fauville-Dufaux M et al.; The purpose of the study was to evaluate the contribution of polymerase chain reaction (PCR) to the diagnosis of tuberculous infection in children . Two different PCR techniques were compared to the standard bacteriological methods for the detection of Mycobacterium tuberculosis in 157 specimens obtained from the respiratory system of 51 children . Patients were classified in three groups: 12 patients with active disease (57 specimens), 12 patients with silent tuberculous infection (23 specimens) and 27 patients without tuberculosis (77 specimens) . One PCR method (PCR/Ag85) used amplification of a fragment of the genes coding for the mycobacterial antigen 85 followed by hybridization of a probe specific for M . tuberculosis on the Southern blot of amplified DNA . The other PCR technique was a nested PCR (NPCR) using double amplification of a fragment of the insertion element IS6110 only present in the M . tuberculosis genome . The sensitivities of the different techniques, compared to the clinical diagnosis, were 7.0% for acid fast staining, 22.8% for culture, 24.6% for PCR/Ag85 and 44.9% for NPCR in active disease, 4.3% for culture, 8.7% for PCR/Ag85 and 28.6% for NPCR in silent tuberculous infection . The specificities were 100% for culture, 94.8% for PCR/Ag85 and 87.9% for NPCR . Among the 12 children clinically considered as having active tuberculosis, 1 had smear positive samples, 4 had at least one positive culture, 7 at least one positive PCR/Ag85 and 9 at least one NPCR positive sample . Among the 12 children having silent tuberculous infection, none had positive smears, 1 had one positive culture, 2 had at least one positive PCR/Ag85 and 5 at least one NPCR positive sample . CONCLUSION: Our study suggests that both PCR techniques, and especially NPCR, are able to detect M . tuberculosis DNA in specimens containing few micro-organisms . PCR methods are more sensitive than culture and the results are available more quickly . Testing multiple samples from the same individual increased the sensitivity . In view of occasional false-positive results, cultures remain the gold standard to establish definitive diagnosis of primary tuberculous infection in children.

Cytometry, 1996 Feb 1, 23(2), 91 - 6
Fluorescent probes and flow cytometry: new insights into environmental bacteriology; Porter J et al.; Recent trends in flow cytometry have established new techniques in bacteriology . Advances in fluorescent dye technology complement these improvements, offering probes for a variety of cellular functions . Bacterial ecology requires the application of new techniques to help answer questions unanswerable by traditional methods alone . Here we review some aspects of how coupling the two technologies has enabled researchers to directly study individual bacterial cells, and revealed the complexity and heterogeneity present in both laboratory cultures and in environmental samples . Results are discussed with respect to viability analysis, stress induced changes, specific cell detection and cell sorting.

Thorax, 1996 Feb, 51(2), 119 - 25
In vivo effects of recombinant human DNase I on sputum in patients with cystic fibrosis; Shah PL et al.; BACKGROUND: Viscoelastic secretions in cystic fibrosis cause impaired mucus clearance and persistence of bacteria within the lung . The abnormal rheology is partly due to the presence of high molecular weight deoxyribonucleic acid (DNA) . Recombinant human DNase I (rhDNase) has been shown to depolymerise DNA and thereby reduce the in vitro viscoelasticity of sputum in patients with cystic fibrosis . A phase II double blind placebo controlled study showed that rhDNase improved pulmonary function in patients with cystic fibrosis . The object of the present study was to evaluate the in vivo effects of rhDNase on sputum rheology and to determine whether these were correlated with changes in pulmonary function . METHODS: Patients were randomised to receive either placebo or rhDNase 2.5 mg twice daily for 10 days . Sputum samples were collected in sterile containers during screening and during treatment with the study drug . Pulmonary function and rheological analysis were the primary outcomes evaluated . Other parameters assessed were quantitative sputum bacteriology, sputum DNA concentration, and change in molecular mass of DNA polymers . RESULTS: The viscoelasticity of the sputum in untreated patients with cystic fibrosis was high and treatment with rhDNase reduced all the rheological parameters measured: dynamic storage modulus (a measure of elasticity), dynamic loss modulus (a measure of viscosity), and log complex modulus (a measure of mucus rigidity) . The calculated cough clearance index was also improved following treatment with rhDNase . These rheological parameters showed a correlation with forced expiratory volume in one second (FEV1) which was improved by a mean (SE) of 13.3 (5.6)% on day 10 of treatment with rhDNase compared with a change of 0.2 (3.1)% in the placebo group . There was no change in bacterial colony counts or sputum DNA concentrations following treatment with rhDNase, but a small decrease in high molecular weight DNA was observed . CONCLUSIONS: Patients with cystic fibrosis treated with rhDNase show an improvement in rheological properties and pulmonary function, one of the mechanisms being a reduction in the proportion of high molecular weight DNA.

J R Army Med Corps, 1996 Feb, 142(1), 43 - 7
Some account of the British military hospitals of World War I at Etaples, in the orbit of Sir Almroth Wright; Meynell EW; A group of British Military Hospitals was established between 1915 and 1918 along the estuary of the River Canche on the northern French coast . Their positions, now obliterated, can be identified from a plan of the time . With the growing realisation of the importance of bacteriology in the treatment of wound infection, the laboratory of Sir Almroth Wright in neighbouring Boulogne-sur-mer had a strong local influence.

J Nucl Med, 1996 Feb, 37(2), 233 - 8
Technetium-99m-MIBI scintigraphy in pulmonary tuberculosis; Onsel C et al.; We investigated the usefulness of 99mTc-methoxyisobutylisonitrile scintigraphy in patients with known or suspected pulmonary tuberculosis (PTB) in comparison with radiological and bacteriological findings . METHODS: Thirty-six patients aged 13-59 yr were scanned 15 and 60 min after intravenous injection of 370 MBq (10 mCi) 99mTc-methoxyisobutylisonitrile . Twenty-four patients had active PTB proven by chest radiograph and sputum examinations, two had miliary tuberculosis and ten were suspected of having relapsed PTB with negative sputum examinations and indeterminate chest radiographs . In 12 patients 99mTc-MIBI imaging was repeated 1-3 mo after chemotherapy . RESULTS: Of 24 patients with active localized PTB, 22 (92%) showed increased focal uptake of 99mTc-MIBI, but two patients with minimal infiltration on chest radiographs had no accumulation of 99mTc-MIBI . Both patients with miliary PTB showed diffuse 99mTc-MIBI uptake in the lungs . Among 10 patients with suspicion of relapse, 99mTc-MIBI scans were true-positive in 4 of 5 patients (80%) with culture-proven tuberculosis and false-positive in 2 of 5 (40%) patients with negative sputum cultures . For repeat imaging, 6 of 10 patients with active localized PTB showed reduced MIBI uptake, which correlated with chest radiograph findings, and one patient had increased MIBI uptake again concordant with clinical and radiological findings which were suggestive of resistance to first line chemotherapy of tuberculosis . The other three patients showed no significant scintigraphic changes despite clinical and partial radiological regression . CONCLUSION: Active PTB granulomas generally present considerable 99mTc-MIBI uptake that is most probably related to disease activity . Therefore, 99mTc-MIBI scanning could be used in the detection and follow-up of active PTB as a complement to routine techniques.

Arch Dis Child, 1996 Feb, 74(2), 144 - 7
Does BCG vaccine prevent tuberculous meningitis?
Thilothammal N, Krishnamurthy PV, Runyan DK, Banu K.
The reported efficacy of BCG vaccine in preventing pulmonary tuberculosis varies from 0-80%; however, its efficacy in preventing tuberculous meningitis ranges from 52%-84% . A case-control study was conducted to assess the efficacy of BCG in preventing tuberculous meningitis in children . New cases of tuberculous meningitis, confirmed bacteriologically, were registered as cases . Controls were children suffering from febrile convulsions attending the same hospital . A total of 107 cases and 321 controls, block matched for age, were registered . Vaccination status was determined from the history reported by the mother and by BCG scar reading . Data regarding socioeconomic status, crowding, and nutritional status were collected . Using multiple logistic regression analysis the odds ratio obtained for the presence of BCG scar was 0.23 (95% confidence interval (CI) 0.14 to 0.37) and the protective efficacy of BCG vaccine in preventing tuberculous meningitis in children was found to be 77% (95% CI 71 to 83%).

Scott Med J, 1996 Feb, 41(1), 12 - 4
Bacterial meningitis--the importance of cerebro-spinal fluid examination; McCarron B et al.; The role of lumbar puncture in bacterial meningitis has been debated in recent years, especially in the presence of worsening headache, alteration of conscious level, focal neurological signs, papilloedema or a haemorrhagic rash . However valuable bacteriological and epidemiological information will be lost if lumbar puncture is avoided, despite blood cultures being taken . This loss of information will be highlighted if pre-admission antibiotics are administered (this should now be standard practice).

J Pediatr, 1996 Feb, 128(2), 203 - 7
Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both; de Boissieu D et al.; OBJECTIVE: To evaluate the frequency of small-bowel bacterial overgrowth (SBBO) as a cause of chronic digestive symptoms in a large cohort of children, using the glucose breath hydrogen test (BHT) . DESIGN: Patients were 53 children (aged 2 months to 12 years) with chronic diarrhea, abdominal pain, or both . Diagnosis of SBBO was defined with a BHT by a change in H2 concentration of 10 ppm H2 or more in expired air after an oral glucose load . Patients with a positive BHT result were included in group 1 and treated with a combination of colistin and metronidazole for 10 days; a second BHT was performed 1 month later . Group 2 comprised patients with a negative BHT result . Group 3 (n = 15) was a control group of healthy subjects, and group 4 (n = 6) a comparison group of subjects with bacteriologically documented SBBO . RESULTS: Eighteen patients (34%) had a positive BHT result and 35 a negative result . The BHT results were comparable in groups 1 and 4 and in groups 2 and 3, respectively . Fasting H2 levels were higher in group 1 than in groups 2 (p < 0.001) and 3 (p < 0.01) . In group 1, children were younger than in group 2 (1 +/- 1 year vs 3.9 +/- 3 years; p < 0.001) and diarrhea was frequent (83%), but 17% of patients had abdominal pain alone . Fetid stools (p < 0.01), mucus in stools (p < 0.01), and flatulence (p < 0.05) were more frequent in group 1 than in group 2 . Antibiotic treatment of children in group 1 led to a rapid disappearance of symptoms and normalization of BHT results . CONCLUSION: SBBO appears to be a frequent cause of chronic digestive symptoms in children, especially before the age of 2 years . The BHT provides a simple and noninvasive method of detecting it . The recognition of SBBO in children leads to effective treatment.

Acad Med, 1996 Feb, 71(2), 146 - 51
Academic pediatrics: the view of New York City a century ago; Markel H; Pediatrics arose as an academic and medical specialty in the United States during the late nineteenth century . This paper documents the first three stages of academic pediatrics in the United States between 1850 and 1950: (1) 1850-1880, a period focused on sanitary reform as a means of reducing infant mortality; (2) 1880-1900, the era where discoveries being made in bacteriology, physiology, and nutrition began to be applied to improving the health of children; and (3) 1900-1930, when the field was characterized by an active health reform movement directed at parents and health care professionals . Three prominent pioneer pediatricians, Drs . Abraham Jacobi, Henry Koplik, and L . Emmett Holt, are profiled as representative practitioners of these eras.

Pediatr Clin North Am, 1996 Feb, 43(1), 213 - 34
Helicobacter pylori and peptic disease in the pediatric patient; Bujanover Y et al.; The data accumulated on Helicobacter pylori infection in children suggests an important causative role of the organism in gastritis and peptic ulcer disease in this age group . The importance of eradication of H pylori in asymptomatic children in relation to its role in peptic disease and cancer in adults is debatable . This article describes the current data on bacteriologic features, pathologic spectrum, clinical significance, epidemiology, methods of diagnosis, and treatment of H pylori infection in children . Further studies will provide the information on the pathogenicity, mode of transfer, and optimal treatment of H pylori infection.

J Am Vet Med Assoc, 1996 Feb 1, 208(3), 401 - 3
Evaluation of an agar gel immunodiffusion test kit for detection of antibodies to Mycobacterium paratuberculosis in sheep; Dubash K et al.; OBJECTIVE--To determine whether a commercially available agar gel immunodiffusion test approved for detecting antibodies to Mycobacterium paratuberculosis in cattle could be used for sheep . DESIGN--Experimental trial . SAMPLE POPULATION--Serum samples from 27 sheep confirmed to have paratuberculosis by means of acid-fast staining of smears of ileal mucosa, histologic examination of tissues, or bacteriologic culture; 7 sheep with clinical signs of paratuberculosis; and 55 sheep from 5 uninfected flocks . PROCEDURE--Serum samples were tested concurrently with the commercially available test and with a previously validated agar gel immunodiffusion test . Multiple samples collected from 13 infected sheep over a period of 6 years were also tested so that each test's ability to detect onset of seropositivity could be compared . RESULTS--For both tests, results for samples from all 55 uninfected sheep were negative, results for samples from 32 of the 34 sheep with paratuberculosis were positive, and results for the remaining 2 sheep with paratuberculosis were negative . Results of both tests were in agreement for 50 of 54 samples obtained from 13 infected sheep over time . The 4 samples for which results of the 2 tests disagreed were the fourth, eighth, and ninth of 10 samples from 1 sheep and the first of 6 samples from a second sheep . For all 4 samples, the commercially available assay yielded a weak-positive result, but the previously described test yielded a negative result . CLINICAL IMPLICATIONS--The commercially available agar gel immunodiffusion test approved for use in cattle may be useful in the differential diagnosis of paratuberculosis in sheep.

AJR Am J Roentgenol, 1996 Feb, 166(2), 445 - 9
Laryngeal tuberculosis: CT findings; Moon WK et al.; OBJECTIVE: The purpose of this study was to evaluate the CT findings of laryngeal tuberculosis (TB) . SUBJECTS AND METHODS: CT scans, laryngoscopic examinations, and chest radiographs of 12 patients (21-63 years old) with histologically (n = 8) or bacteriologically (n = 4) confirmed laryngeal TB were retrospectively reviewed . RESULTS: Bilateral diffuse thickening of the vocal cords and diffuse thickening and increased density of the aryepiglottic folds and paralaryngeal tissues were present in all patients . Diffuse thickening of the epiglottis was observed in seven patients . In four patients, a focal mass was noted in the anterior portions of the vocal cords (n = 3) or tip of the epiglottis (n =1) . Destruction or sclerosis of cartilage was not found . Subglottic extension of the lesion was suspected in only one patient . Enlarged cervical lymph nodes were found in five patients . On laryngoscopic examinations, swelling of the vocal cords (n = 12) or epiglottis (n = 6) was present in all patients and was bilateral in nine patients . Vocal cord mobility was impaired in only one patient . Radiographic findings consistent with active pulmonary TB were present in all patients . CONCLUSION: Although the CT appearances of laryngeal TB are not specific, the possibility of laryngeal TB should be raised when bilateral and diffuse laryngeal lesions are encountered without destruction of the laryngeal architecture in patients with pulmonary TB.

Pneumonol Alergol Pol, 1996, 64 Suppl 2, 174 - 9
{The value of measuring adenosine deaminase activity in pericardial effusion fluid for diagnosing the etiology of pericardial effusion}; Fijalkowska A et al.; The diagnosis of tuberculous pericarditis is difficult . The cultures of the pericardial fluid for M.tuberculosis are often negative . The determination of ADA activity in pleural fluid in TB patients /PTS/ is very useful . It seemed reasonable to measure ADA activity in pericardial effusion . ADA activity in pericardial fluid of 40PTS/19 women and 21 men/with large pericardial effusion of different etiologies who were treated in our institute in years 1988-1995 was investigated . The median age was 44 years . In each case the pericardiocentesis was performed . PTS were grouped as follows: group I-4 PTS with strongly suspected TB pericarditis, group II-32 PTS with malignancy and group III-4 PTS with miscellaneous diseases . In group I the mean ADA activity was 24U/I(3-60), in group II 18U/I (3-60) and in group III 18U/I (0-37) (with a cutoff value for ADA activity of 40U/I) . It was definitive bacteriologic diagnosis of TB pericarditis in PTS of group I . Our observation does not confirm the earlier data about the high ADA activity in clinically suspected TB pericarditis without bacteriologic diagnosis . The value of ADA determination in pericardial fluid is its high specificity (97%) in excluding of TB etiology of pericardial effusion.

Antibiot Khimioter, 1996, 41(12), 24 - 9
{Use of cefpirome in the treatment of patients with skin and soft tissue infections}; Iakovlev VP et al.; The efficacy of cefpirome was estimated in the treatment of 25 patients: 15 patients with pyo-necrotic wounds of the soft tissue of various genesis and localization and 10 patients with deep thermal burns involving 8 to 40 per cent of the body surface . The clinical and bacteriological efficacies of the treatment in the patients with the wound infection amounted to 100 and 80 per cent respectively . In the patients with the burn infection the respective values were 90 and 80 per cent . The drug tolerance was good . Adverse reactions were observed in 1 patient . Bolus intravenous administration of the drug was preferable by comparison with the injections.

Antibiot Khimioter, 1996, 41(12), 14 - 8
{Treatment of patients with pneumonia, chronic obstructive bronchitis and mucoviscidosis with cefpirome}; Chuchalin AG et al.; Twenty two patients with inflammatory respiratory tract infection were treated with cefpirome . Among the patients 14 were with severe pneumonia, 4 with exacerbated obstructive chronic purulent bronchitis and 4 with mucoviscidosis . All the patients were subjected to clinical, laboratory and x-ray examinations, electrocardiography, estimation of the external respiration and sputum bacteriological tests . The cefpirome susceptibility was determined by the agar diffusion assay with standard disks from Roussel Uclaf . Cefpirome was administered by slow intravenous infusion in a daily dose of 2 to 4 g every 12 hours depending on the disease severity . After 2 or 3 days of the patient afebrile temperature and normal differential blood count the therapy was discontinued . The favourable time course of the disease was recorded in 12 out of the 14 patients with pneumonia . Recovery and clinical improvement were stated in 64.3 and 21.4 per cent of the cases respectively . In 2 patients the treatment failed . In all the patients with exacerbated severe chronic purulent bronchitis the cefpirome therapy resulted in the disease remission . The clinical effect of the mucoviscidosis treatment was observed in 3 out of the 4 patients . The drug tolerance in the doses used was good.

Acta Otolaryngol Suppl, 1996, 523, 252 - 5
Immediate tonsillectomy for peritonsillar abscess; Fujimoto M et al.; The usual treatment for peritonsillar abscess (PTAs) in Japan is antibiotic therapy, drainage and incision followed by tonsillectomy several weeks later . This is a retrospective study of cases treated by immediate tonsillectomy (IT) for PTAs between January 1990 and February 1995 in our hospital . There were 119 cases, 94 male and 25 female, ranging in age from 14 to 76 years (average: 36.6) . In all cases, we performed CT scan, which is the most reliable diagnostic method for PTAs . Five of the 119 cases were treated by IT under general anesthesia . All five were male and their ages ranged from 50 to 62 years (average: 56.2) . Two patients had diabetes mellitus . Bacteriological study revealed alpha-Streptcoccus in 1 case, but the others showed no remarkable findings . Anaerobacteria were not found in any patient . IT under general anesthesia is preferable for advanced PTAs.

Med Trop (Mars), 1996, 56(3), 303 - 7
{Tuberculosis in the Federal Islamic Republic of Comores in 1995}; Feyaerts P et al.; Tuberculosis is still a major health concern in the Federal Islamic Republic of the Comoros . An effective nationally organized program has been set up to fight against the disease . It is based on bacteriologic screening (105 new cases of BK+ disease since 1995) and quadruple chemotherapy in patients identified (2RZHE 4RH) with in-hospital starter treatment for 2 months and supervised outpatient treatment for 4 months . Patients are followed up monthly . Because of these measures and given the fact that access to health care is excellent (small island nation), compliance has been over 90% for several years and the overall rate of cure was around 92% in 1995 . From an epidemiologic standpoint the endemic status of tuberculosis in the Comoros has been stable with an overall incidence of about 25 cases per 100,000 inhabitants in the last 5 years . Extrapulmonary forms and relapses are uncommon (5.4% and 6.2% respectively in 1995) . The incidence of positive HIV1 serology in the general population of the Comoros is low and has not been a complicating factor since no seropositive BK+ patient has been identified since the beginning of systematic surveillance in 1988.

Bull Soc Belge Ophtalmol, 1996, 260, 93 - 9
{Role of vitrectomy and intra-vitreous injections in the treatment of traumtic and iatrogenic endophthalmitis}; Gribomont AC; The survey of recent literature emphasises the usefulness of primary vitrectomy in the treatment of the most serious endophthalmitis . As soon as vitreous and aqueous humor samples have been obtained for bacteriologic analysis, intravitreal injection of a combination of antibiotics able to cover the most common causative germs is established as the standard of care . The beneficial effect of intravitreally-injected corticosteroids is still controversial.

Bull Soc Belge Ophtalmol, 1996, 260, 41 - 3
{Emergency corneal grafts}; Marechal-Courtois C et al.; Corneal ulceration leading to perforation can mainly occur after infection, trauma, corneal dryness and exposure keratitis . When corneal ulceration does not respond to medical treatment, a penetrating keratoplasty allows the elimination of infected tissue and antigenic material . It can restore the integrity of the anterior segment of the eye . The tissue taken could serve for bacteriologic research . In spite of the great number of complications the percentage of success is about 50%.

Zentralbl Chir, 1996, 121(10), 872 - 5
{Forgotten Dresden surgeons (II)}; Klimpel V; With the introduction of anaesthesiology and asepsis, with the progresses of bacteriology and of the hospital buildings the surgery at Dresden had changed too . A new type of surgeons replaced the old predominantly universal and military surgeon . At Dresden pupils of Gunther, Zeis, Kuster, Volkmann, Thiersch, Friedrich and Trendelenburg worked among others . The new technical and scientific possibilities permitted innovations of urological surgery (Grunert), paediatric surgery (Rupprecht), general surgery (Leonhardi, Stelzner, Lindner, Crede) and of plastic surgery as well as anaesthesia (Noesske).

Arch Virol Suppl, 1996, 12, 7 - 19
Overview of viral gastroenteritis; Kapikian AZ; Diarrheal illnesses in humans have been recognized since antiquity . Such illnesses continue to take a great toll of lives, with a disproportionately high mortality in infants and young children in developing countries . Bacteriologic and parasitologic advances made during the past century led to the discovery of the etiology of some of the diarrheal illnesses, but the etiology of the major portion remained unknown . It was assumed that viruses caused most of these illnesses because: (i) bacteria were recovered from only a small proportion of episodes, and (ii) bacteria-free filtrates were found to induce gastroenteritis in adult volunteer studies . However, an etiologic agent could not be recovered despite the "golden age" of virology in the 1950's and 1960's when tissue culture technology enabled the discovery of numerous cultivatable enteric viruses, none of which emerged as an important etiologic agent of gastroenteritis . The discoveries of the Norwalk virus in 1972, and of rotaviruses in 1973, both without the benefit of in vitro tissue culture systems, ushered in a new era in the study of the etiology of viral gastroenteritis . The Norwalk virus was found to be an important cause of non-bacterial epidemic gastroenteritis in adults and older children, and rotaviruses were shown to be the single most important etiologic agents of severe diarrheal illnesses of infants and young children in both developed and developing countries . With the major advances in the study of rotaviruses, there is a high degree of optimism that in the not-too-distant future, a rotavirus vaccine will be available . In addition, the recent molecular biologic advances in the study of the Norwalk and Norwalk-like viruses, now firmly established as caliviviruses, represent a major new horizon in the study of these viruses.

Rev Med Interne, 1996, 17(12), 987 - 91
{Clinical manifestations of Chlamydia pneumoniae infections}; Gaillat J; Chlamydia pneumoniae is a newly described and ubiquitous bacterium . Most infections are asymptomatic as shown by a high worldwide seroprevalence (> 50% of cases) . It is a common cause of acute respiratory infections, mainly pneumonia (> 50% of cases) and other acute respiratory tract infections (25% of acute bronchitis, < 5% of sinusitis, otitis and pharyngitis) . About 10% of the community acquired pneumonia cases have been associated with Chlamydia pneumoniae infection . This incidence depends on a cyclic epidemiology with a high incidence for 2 to 3 years followed by a low prevalence for 3 to 4 years . Most chlamydial infections are mild but occasionally severe with death especially in old people . Mostly acute infections are recurrent infections . The seroprevalence is higher in asthmatic patients, its role in acute exacerbation of chronic bronchitis is not definitely established . Extra-respiratory acute infections are less frequent, either fever alone, or cardiovascular diseases (acute myocarditis, pericarditis and endocarditis) or neurological (encephalitis, meningitis or Guillain-Barre syndrome) . In addition, seroepidemiology studies have shown an association with coronary artery disease, Chlamydia pneumoniae was detected in coronary atheroma by immunochemistry, polymerase chain reaction and by electron microscopy . Chlamydia pneumoniae may be involved in the atherosclerotic process . To define the clinical spectrum of infection requires precise laboratory diagnosis, the most efficient tests (PCR, direct immunofluorescence and culture) are done in specialized laboratories, serological tests are less reliable . Macrolides, cyclines and fluoroquinolones are the most potent antibiotics but with differences in vitro within and between these families of antibiotics . Bacteriological failures are described despite the in vitro activity . A lot of questions on clinical aspects, epidemiology and treatment are unanswered, we need more studies.

Antibiot Khimioter, 1996, 41(9), 47 - 9
{Clinical and pharmacokinetic evaluation of ofloxacin under various regimens of administration in patients with bronchopulmonary infections}; Belousov OB et al.; Ofloxacin was used in the treatment of 24 patients with chronic bronchitis or pneumonia at the background of chronic bronchopulmonary and cardiovascular diseases . The drug was administered in accordance with 2 regimens: orally in a dose of 400 mg once a day (group I) and intravenously in a dose of 200 mg twice a day for 2 to 4 days followed by the drug oral use in the same dosage for 6 to 8 days (group II) . The trial included comparison of the treatment efficacy by a complex of clinicobacteriological indices, estimation of the drug pharmacokinetics under the two regimens and prediction of the drug concentrations in blood with the mathematical models . High clinical and bacteriological efficacies of ofloxacin were shown under both the regimens . The pathogen eradication under both the regimens was observed in 61.5 and 72.7 per cent of the cases in groups I and II respectively . Dependence of the ofloxacin blood concentrations in the patients on the dosage regimen was detected . The pharmacokinetic studies demonstrated the possible prediction of the drug blood concentrations after the multiple administrations based on the calculated parameters.

Rev Chir Orthop Reparatrice Appar Mot, 1996, 82(3), 251 - 54
{Percutaneous drainage of septic hip arthritis in children}; Griffet J et al.; INTRODUCTION: Hip arthritis is a therapeutic emergency which requires sure diagnosis and pus evacuation . Two methods are presently in use: isolated or oriterative punction and arthrotomy . TECHNIQUE: A Pleurocath is introduced under general anesthesia and under fluoroscopic control by an obturator approach . It contains a perforated trocart which allows a flexible catheter, perforated over the last few centimeters to be inserted . The introduction point must be as far posterior as possible, in the plane of the anterior border of the femoral neck to promote declivious downward . It allows for pus evacuation, confirmation of the diagnosis and bacteriological samples to be taken . The lavage is done using ionized polyvidone dilution in physiological saline solution . The catheter is inserted in the center of the trocart and pushed intra-articularly under fluoroscopic control . The trocart is pulled out . The catheter is fixed on the skin using non resorbable thread . An occlusive dressing is made . A three way cock is installed for aspiration and lavage . Drainage is declivious . MATERIAL AND METHODS: This percutaneous drainage technique was used in three cases of septic hip arthritis in children . Treatment associated drainage, immobilization by traction and double or triple intravenous antibiotics . The hips healed without any detrimental effects . DISCUSSION: The punction had both a diagnosis and a therapeutic objective, as it allows pus evacuation in the same time . It can be repeated according to the patient's progress . Most authors prefer arthrotomy with careful lavage and good drainage . We suggest an intermediate technique which includes punction and allows clinical and bacteriological diagnosis, joint lavage and drainage . Using permanent drainage, the hip joint is protected from high pressure . It makes repeated lavage possible when the pus is thick, and avoids the drain from becoming plugged . CONCLUSION: This approach enables the pus to be evacuated, bacteriological samples to be taken, lavage and drainage . The drainage must be left until apyrexia and normal biological inflammation criteria are obtained.

Swed Dent J, 1996, 20(5), 199 - 207
Salivary factors in children with recurrent parotitis . Part 2: Protein, albumin, amylase, IgA, lactoferrin lysozyme and kallikrein concentrations; Ericson S et al.; The concentrations of total protein, albumin, amylase, IgA, lactoferrin, lysozyme and kallikrein in parotid saliva from 17 children with juvenile recurrent parotitis (JRP) in a non-active phase of disease and in healthy controls of the same number, sex and age were analysed after gustatory stimulation with 1%, 2% and 6% citric acid . There was a great individual variation in all analysed variables, especially in saliva from the diseased glands . Significantly raised levels of albumin, IgA, lactoferrin and kallikrein were found in the saliva from the JRP-children compared with the controls (p < 0.01-0.001), while total protein and alpha-amylase did not differ significantly . The sialo-chemical findings are discussed in the light of histological and bacteriological findings and support the hypothesis that the etiology of juvenile recurrent parotitis is a combination of congenital malformation of portions of the salivary ducts and a set-in infection.

Acta Vet Scand, 1996, 37(3), 293 - 313
A long-term study on the health status and performance of sows on different feed allowances during late pregnancy . III . Escherichia coli and other bacteria, total cell content, polymorphonuclear leucocytes and pH in colostrum and milk during the first 3 weeks of lactation; Persson A et al.; The objectives of this study were to (1) estimate the clinical status of the mammary glands and (2) compare it with the bacteriological findings, the total cell content (TCC) and its percentage of polymorphonuclear leucocytes (PMNLs) and pH in colostrum and milk secretion of sows on 2 different feeding regimes, high versus low, during late pregnancy . The milk samples were collected from both agalactia post partum (APP) sows and clinically healthy sows . Sows with a rectal temperature exceeding 39.5 degrees C within 48 h after parturition were considered to be diseased in APP and treated medically . The sows were sampled on days 1, 3, 8 and 22 of lactation during 6 consecutive lactations . Irrespective of feeding regimes, 49 out of 77 lactations among the APP sows and 15 out of 96 lactations among the clinically healthy sows revealed E . coli in pure cultures with a concomitant TCC exceeding 10 x 10(6) cell/ml already on the first day of lactation . The healthy sows with E . coli infection were denominated as being subclinically infected sows . The intensity in growth of E . coli successively declined, and the bacteria were finally eliminated between days 3 and 8 of lactation . The TCC were 82 x 10(6) cells/ml and 157 x 10(6) cells/ml in the clinically and subclinically E . coli infected glands, respectively, on the first day of sampling . The TCC declined gradually in both groups of sows, but was still higher than in bacteriologically negative milk on day 22 of lactation . The percentages of PMNLs were 66% and 79% in clinically and subclinically infected glands, respectively, on day 1 of lactation, thereafter decreasing to approximately 50% on day 22 of lactation in both groups of sows . In APP sows, swelling, reddening and/or soreness were registered in 38 out of 87 mammary glands with E . coli mastitis on the first sampling occasion . The TCC in bacteriologically negative colostrum and milk collected from APP sows on day 1 of lactation was significantly higher, 2.27 x 10(6) cells/ml, when compared with the TCC in bacteriologically negative milk secretion from the clinically healthy or subclinically infected sows, 1.38 x 10(6) cells/ml versus 1.51 x 10(6) cells/ml, respectively . The PMNLs were higher on day 1 in clinically healthy sows, 59.6%, than in subclinically infected and APP sows (43.5% and 48.3% respectively) . The pH in secretion from clinically or subclinically E . coli infected glands (6.57 versus 6.46) were higher than in bacteriologically negative colostrum samples (6.29) from clinically diseased sows on the first day of sampling . On day 22 of lactation, pH-values had stabilized on a level of approximately 7.00 in all milk samples from earlier bacteriologically positive or negative mammary glands . The 2 feeding regimes, low versus high, were not found to influence TCC, PMNLs or pH except for TCC in bacteriologically negative samples of APP sows (2.69 versus 3.62) . The lactation number influenced the PMNLs in both groups of sows with E . coli infected mammary glands, and both the TCC and PMNLs in bacteriologically negative colostrum and milk.

Acta Vet Scand, 1996, 37(3), 279 - 91
A long-term study on the health status and performance of sows on different feed allowances during late pregnancy . II . The total cell content and its percentage of polymorphonuclear leucocytes in pathogen-free colostrum and milk collected from clinically healthy sows; Persson A et al.; The main objective of this study was to determine the total cell content, TCC, and the percentage of polymorphonuclear leucocytes, PMNLs, in colostrum and milk collected from sows during the first 22 days of lactation . The pH-values during the same sampling period were also determined . It should be emphasized that all the values obtained emanate from bacteriologically negative colostrum and milk . The potential influence of different levels of late gestation feeding regimes was also evaluated . The TCC-values obtained from milk samples during the first 3 weeks of lactation and exceeding the designated threshold of 10 x 10(6) cells/ml varied between 4% and 21% . Within the TCC-limitation of 10-19.99 x 10(6) cells/ml neither the preceding nor the succeeding cell counts exceeded the threshold in 26.8% . TCC-values above 19.99 x 10(6) cells/ml were preceded and succeeded by cell counts below the threshold in 58.8% and 58.8%, respectively . The TCC-levels below the threshold of 10 x 10(6) cells/ml, expressed as geometric least square means, increased significantly from day 1 to day 3 (1.23 x 10(6) cells/ml versus 1.86 x 10(6) cells/ml) and decreased thereafter gradually to day 22 (1.38 x 10(6) cells/ml) . When all values were included, the TCC-values increased in a similar pattern from day 1 to day 3 (1.38 x 10(6) cells/ml versus 3.18 x 10(6) cells/ml) . The value on day 22 of lactation was still on a significantly elevated level compared with that of day 1 (2.10 x 10(6) cells/ml versus 1.38 x 10(6) cells/ml) . The 2 different feeding regimes were not found to influence the TCC-values during the first 22 days of lactation . In the whole material the PMNL-values, expressed as percentages of the TCC, declined from approximately 60% on day 1 of lactation to between 40% and 50% for the remaining sampling period . This decline was comparable with the one seen in the cell class below the threshold of 10 x 10(6) cells/ml . In the 2 cell classes above 9.99 x 10(6) cells/ml, 78.0% and 88.8% of PMNLs on day 1 declined to about 40% on day 22 . This might indicate an inflammatory response on day 1 but without any detectable bacteriological growth . The increase in lactation number, if lactation 1 was compared with the following lactations, revealed a significant rise (p < 0.05) in TCC-level and percentage level of PMNLs . A stepwise and significant increase in pH-level occurred between days 1, 3 and 8 (6.18, 6.56, 7.03) followed by a significant decrease to day 22 (6.91) when pH-values from milk of all cell classes were included.

Probl Tuberk, 1996, (5), 11 - 3
{Use of microscopy and inoculation for bacteriologic diagnosis in tuberculosis patients by the materials of Ivanovo region}; Golyshevskaia VG et al.; The paper describes guidelines for isolation of Mycobacterium tuberculosis by bacterioscopy . It shows high detection rates for Mycobacteria in patients included into the programme . The detection rates of patients by bacterioscopy are not different in two quarters.

Pneumonol Alergol Pol, 1996, 64(7-8), 403 - 12
{Results of anti-tuberculosis treatment of patients with tuberculosis--children and adolescents treated in Poland in 1993}; Szczuka I et al.; Treatment of 581 new cases tuberculosis in 215 children and 366 adolescents reported in 1993 were followed up for 12 months . The results show that 96.6% bacteriologically confirmed cases were cured (93.8% of children and 97.2% of adolescents) . Among 409 bacteriologically negative cases (183 children and 222 adolescents) only in 7 (4 children and 3 adolescents) i.e . in 1.7% no radiological improvement was observed . 75.7% of cases BK+ received 4 drugs treatment regimen-85.4% adolescents and 40.6% children . Children with bacteriologically negative tuberculosis were treated with 2 drugs regimen -(53% of cases) and with 3 drugs regimen 43.2% of cases, while in adolescents majority of cases received 4 drugs (59.0%) or 3 drugs (33.8%) . In almost all regiments there were INH and RMP . In spite of high efficacy of applied regimens, the duration of treatment was relatively long . In children BK+ , in 87.8% of cases it was longer than 6 months (in 43.8% of cases it was longer than 9 months) . In adolescents BK+, in 81.2% of cases duration of treatment was longer than 6 months (in 34.7% it was longer than 9 months) . Among cases BK(-), in 82.5% of children duration of treatment was longer than 6 months and 53.7% adolescents BK(-) were treated longer than 6 months.

Parazitologiia, 1996 Jan-Feb, 30(1), 13 - 8
{The isolation of Borrelia from the tick Ixodes trianguliceps (Ixodidae) and the possible significance of this species in the epizootiology of ixodid tick-borne borrelioses}; Gorelova NB et al.; Ixodes trianguliceps is a common tick species of the Eurasian forest zone . These ticks live probably in natural foci of ixodid tick-borne borrelioses (ITBB) from Western Europe to Transbaikalia, but their role in circulation of corresponding pathogens remains unclear . This study was performed in a natural ITBB focus located in the Perm region of Russia (near the Urals), where Borrelia garinii and B . afzelii circulate and I . persulcatus serves as their main vector . In July-August of 1994, 296 small mammals (mostly Clethrionomys glareolus) were tested for tick infestation . From these mammals, 49 I . trianguliceps and 252 I . persulcatus ticks were collected (16.3 and 83.7%, respectively) . I . trianguliceps ticks were found on 33 rodents of three species: Cl . glareolus, Cl . rutilus, and Microtus oeconomus . The abundance of I . trianguliceps (on average, less than 0.2 ticks per animal) was approximately five times lower than that of I . persulcatus . I . trianguliceps larvae, nymphs, and adults (22, 15, and 5 specimens, respectively) were analyzed for Borrelia infection by plating their internal organs on the BSK-2 medium . Spirochete isolates were obtained from four nymphs . Three infected nymphs were collected from different Cl . glareolus specimens, and one was found on Cl . rutilus . According to the results of RFLP analysis, all four isolates were classified as B . garinii . This experiment is the first successful attempt to isolate one of ITBB pathogens from I . trianguliceps ticks . These ticks do not attack people, and their role in ITBB foci should be analyzed only in terms of epizootiology . The results of previous zoological-parasitological and bacteriological studies performed in the Ural region suggest that I . trianguliceps and I . persulcatus populations are maintained there by the same species of small rodents and insectivores, which mostly belong to the genera . Clethrionomys and Sorex . Many of them were identified as the reservoir hosts of Borrelia . These data, in complex with the fact of B . garinii isolation from I . trianguliceps, suggest that I . trianguliceps ticks are involved in the maintenance of Borrelia circulation in natural ITBB foci . Taking into account the low abundance of these ticks in the Ural forests, they should be regarded as an important but not principal component of the epizootic process . It is suggested that such a conclusion about the significance of I . trianguliceps ticks also pertains to ITBB foci of other regions.

Acta Leprol, 1996, 10(1), 29 - 35
{Organization of a program for the prevention of disabilities and physical rehabilitation at the center of a national program in the campaign against leprosy: practical advice}; Diallo AM et al.; Patients treated and cured on the bacteriological level by multidrug therapy may nevertheless present handicaps, such as deformities resulting from the disease, which have personal and social consequences . It is actually the handicap and disability from which most patients suffer and which concern populations . The number of persons suffering from such handicaps worldwide has been estimated at 4 million . Therefore, the main goal is to gradually integrate the activities of the prevention of disabilities and physical rehabilitation programme (PIRP) into the national leprosy control programme (PNL) . The persons involved in the implementation of the programme outline the activities planned under the PIRP, detailed objectives, priorities, the means by which they will be implemented, the content of training programmes, assessment criteria and documents available.

Proc AMIA Annu Fall Symp . 1996;:2-6.
A comparison of hypertext and Boolean access to biomedical information; Friedman CP et al.; This study explored which of two modes of access to a biomedical database better supported problem solving in bacteriology . Boolean access, which allowed subjects to frame their queries as combinations of keywords, was compared to hypertext access, which allowed subjects to navigate from one database node to another . The accessible biomedical data were identical across systems . Data were collected from 42 first year medical students, each randomized to the Boolean or hypertext system, before and after their bacteriology course . Subjects worked eight clinical case problems, first using only their personal knowledge and, subsequently, with aid from the database . Database retrievals enabled students to answer questions they could not answer based on personal knowledge only . This effect was greater when personal knowledge of bacteriology was lower . The results also suggest that hypertext was superior to Boolean access in helping subjects identify possible infectious agents in these clinical case problems.

Rev Mal Respir, 1996, 13(4), 433 - 6
{Nocardia respiratory infection in patients with chronic obstructive lung disease}; Lacassagne L et al.; Pulmonary nocardiosis is a respiratory infection which is usually described in the immunocompromised . We report three cases in patients suffering from chronic airflow obstruction . In two cases there was a parenchymal disorder and in one case bronchial suppuration without involvement of the alveolar region . The diagnosis was made in all cases by bacteriological examination from specimens obtained at fiberoptic bronchoscopy . The outcome was favourable in all three cases after appropriate treatment . These observations underline the diversity of the clinical forms of respiratory nocardiosis . Furthermore, it demonstrates their possible occurrence in non-immunocompromised patients and the need to look for this germ specifically in long drawn infections . A bacteriological diagnosis is vital to start early and appropriate antibiotic therapy which should be prolonged because of the risk of recurrence and disseminated infection.

Ann Fr Anesth Reanim, 1996, 15(4), 547 - 52
{Quality control of human albumin solutions}; Flan B; Human albumin is a major product of the fractionation of human plasma, with a long history of clinical use . While the manufacturing process of human albumin solutions has not undergone significant changes, these products have benefited from progress in pharmaceutical technology, quality control and quality assurance, which enhance their clinical safety . Besides the strict requirements of pharmacopoeia monographs which describe the minimal quality criteria with which products must comply, the quality of the final products relies on a careful in-process control, to guarantee the applicability of validated manufacturing processes and to prevent risks of chemical, bacteriological, viral or endotoxic contamination of the product . The development of new analytical methods for quality control and/or their increasing sensitivity also contributes to the improvement of the quality of these products.

Masui, 1996 Jan, 45(1), 49 - 58
{Damage of intestinal mucosal barrier function after fluid resuscitation during hemorrhagic shock}; Shimada J; The aim of this study is to evaluate the effects of fluid resuscitation during hemorrhagic shock on bacterial overgrowth, bacterial translocation and intestinal pathology . Thirty male Sprague-Dawley rats were divided into three groups as follows: sham shock (anesthesia and femoral artery catheterization, control) was performed on group C, on group B, blood was withdrawn and maintained at a mean blood pressure of 25 mmHg for 30 min, followed by resuscitation with whole shed blood; and on group L, shock was induced by the same method, followed by resuscitation with the same shed blood volume of lactated Ringer's solution . Rats were sacrificed at 24h postshock, and bacterial cultures of blood, liver, mesenteric lymph node and cecum were obtained for standard bacteriological examinations . Furthermore, histologic examination of the end of the ileum was performed . The results indicate the pathologic mucosal injury, bacterial overgrowth and the high magnitudes of translocation occurred more frequently in group L than in groups C and B . Thus, resuscitation with lactated Ringer's solution alone for hemorrhagic shock induces intestinal histologic damage and bacterial overgrowth and leads to increase bacterial translocation.

Kekkaku, 1996 Jan, 71(1), 47 - 56
{From the aspects of complicated diseases}; Hara H; Pulmonary tuberculosis is one of the most prevalent infectious diseases in Japan . Host defense mechanisms may play an important role in every aspect of the disease, for example in acquiring the disease and/or in progression of the clinical course . Host defense mechanisms are constituted from mechanical protection such as cough or sneeze, chemical resistance such as complements or lactoferrin, nonspecific cellular defense such as macrophages or neutrophiles and specific immunological defense mechanisms such as immunoglobulins or immunocompetent cells . If there were any complicated disease other than pulmonary tuberculosis, the disease outcome might become different . We examined 44 patients whose sputa culture was continuously positive for one year or more, despite of administration of anti-tuberculous regimens . And we also analyzed clinical outcome of 556 patients with pulmonary tuberculosis (control group) who were discharged after bacteriological negative conversion . Diabetes mellitus is one of the most common complications in patients with pulmonary tuberculosis, 11/44 in continuously positive patients and 101/580 in control group . There was no statistical significance between these two . Next, the control group was divided into four subgroups, those were 1 . no complication, 2 . complicated with diabetes mellitus, 3 . complicated with liver dysfunction, 4 . complicated with the other diseases . Bacteriological negative conversion rate was analyzed in these four subgroups . At the first and the second month, there were significant difference in negative conversion rate between subgroup 1 and 2 . But these differences disappeared as the time goes by.

Scand J Rheumatol, 1996, 25(1), 42 - 6
Helicobacter pylori infection increases the risk of peptic ulcers in chronic users of non-steroidal anti-inflammatory drugs; Li EK et al.; The objective was to study the gastrointestinal complications in chronic NSAID users with Helicobacter pylori infection . Eighty-two Chinese patients on long-term NSAID or aspirin treatment were studied for the occurrence of H . pylori infection and gastroduodenal mucosal injuries by upper endoscopy . H . pylori infection was confirmed by CLO test, histology and bacteriological cultures . Frequency and severity of symptoms of dyspepsia were also assessed . Thirty-three (40%) patients were diagnosed to have H . pylori infection and 49 (60%) patients were not infected . The two groups were comparable in age, sex, smoking and drinking habit and the use of anti-ulcer drags . Twenty-four out of 33 (72.7%) H . pylori-positive patients and 31 out of 49 (63%) of H . pylori-negative patients were found to have macroscopic lesions by endoscopy . The overall incidence of gastroduodenal lesions in the H . pylori positive patients was not significantly different from the H . pylori-negative patients (p = 0.34) . However a higher incidence of duodenal ulcers in the H . pylori-infected group than the H . pylori-negative group (33% vs 6%, p = 0.0001) was found . The difference in severity and frequency of dyspeptic symptoms between the two groups did not reach statistical significance . H . pylori infected chronic NSAID users is associated with a higher rate of duodenal ulcer.

Ter Arkh, 1996, 68(6), 33 - 7
{Changes in the large intestine in patients with chronic kidney failure}; Ryss ES et al.; Clinical and bacteriological examinations performed in 138 patients with chronic renal failure (CRF) have found in the majority of late-stage examinees endogenic chronic colitis (ECC) . This should be taken into consideration when prescribing repeat enteroclysis for correction of some uremia symptoms . Etiologically, ECC may be due to intestinal dysbacteriosis.

Acta Vet Scand, 1996, 37(2), 171 - 85
Prostaglandin F2 alpha metabolite and progesterone profiles in post-partum cows with retained foetal membranes; Bekana M et al.; Post-partum prostaglandin release and resumption of cyclical ovarian activities were studied in 11 Swedish dairy cows with retained foetal membranes (RFM), leaving the RFM untreated . The main PGF2 alpha metabolite, 15-ketodihydro-PGF2 alpha, was measured in blood plasma collected twice daily during the first 50-60 days after delivery . Progesterone was monitored from all morning samples to evaluate the resumption of ovarian activity . The plasma levels of 15-ketodihydro-PGF2 alpha were arbitrarily considered to be significantly elevated between 6-24 days when they exceeded the mean basal value + 2 standard deviations . Comparison between this duration in days of the post-partum PGF2 alpha release and the time required for the completion of uterine involution, placental shedding and last day of post-partum clinical signs showed no significant relations . However, prior to a final decrease below a line of significance of 233-590 pmol/l, pronounced sustained and pulsatile release of PGF2 alpha occurred in relation to the increased frequency of the bacteriological findings . These additional periods of PGF2 alpha release were described as the "total" duration of post-partum release, and were found to be positively correlated with the time required for uterine involution from the stand point of rectal palpation (p < 0.05), while a tendency towards a positive relationship existed for the last day post-partum of clinical signs (p = 0.11) . Progesterone analysis revealed resumption of ovarian activity and the first ovulation occurred between 19-29 days in 70% of the cows . The levels of the PGF2 alpha metabolite were again high at the time of luteolysis, thus terminating the luteal phase in the ovulating animals . Thus, it is seen that non-removal of the RFM or the resultant intrauterine infection do not prolong the duration of the immediate post-partum release of PGF2 alpha as compared to normal animals . However, a second release is associated with the increased frequency of uterine infections, indicating that PGF2 alpha may play a role for the early elimination of the infections.

Khirurgiia (Mosk), 1996, (2), 39 - 42
{Role of Helicobacter pylori in the etiology of duodenal ulcer recurrence after selective proximal vagotomy}; Mitrokhina TV et al.; 126 patients with duodenal peptic ulcer were examined before and in different periods after operation for selective proximal vagotomy (SPV) . Endoscopy was performed and Helicobacter pylori (HP) was detected by the urease, bacteriological, and histological methods . The urease test proved to be the most informative, simple, and available method for revealing infection of the gastric mucosa by HP . The frequency of HP detection by this method made up 97-98% . The frequency of ulcer recurrences after SPV coincided with the degree of contamination of the mucosa with HP and increased to 15% in high contamination . Treatment with agent eliminating HP in the early period after SPV promoted cicatrization of the ulcer.

Probl Tuberk, 1996, (3), 8 - 10
{Characterization of tuberculosis agent in different regions of Russia and its significance in assessment of the epidemiological situation}; Kaliuk AN; The authors analyze M . tuberculosis viability in terms of growth speed and intensity, drug sensitivity; compare bacteriological data with epidemiological (morbidity, primary bacillarity in respiratory tuberculosis, bacillary focus in populations, population with fibrocavernous tuberculosis); range epidemiological and bacteriological indices; determine integral indices of epidemiological and bacteriological situation; calculate Spirman's rate . It is thought possible to use the above bacteriological indices in analysis of epidemiological situation concerning tuberculosis.

Br J Clin Pract, 1996 Jan-Feb, 50(1), 62 - 3
Tuberculous parotitis: two cases in Libyan patients; Adalla SA et al.; Two patients with tuberculous parotitis are described . This condition is rare, and has not previously been recorded in Libya . Unilateral tuberculous parotitis is clinically indistinguishable from a parotid tumour, and imaging techniques may also fail to reveal the true diagnosis . If other features point to tuberculous parotitis, fine needle aspiration allowing bacteriological confirmation is the most useful investigation.

Eur J Cancer, 1996 Jan, 32A(1), 52 - 6
A randomised study comparing granulocyte-colony stimulating factor (G-CSF) with G-CSF plus thymostimulin in the treatment of haematological toxicity in patients with advanced breast cancer after high dose mitoxantrone therapy; Sanchiz F et al.; 54 patients with advanced breast cancer were randomised into a prospective, non-blinded, controlled trial to receive: mitoxantrone 28 mg/m2 intravenous day 1 and granulocyte-colony stimulating factor (G-CSF) 5 micrograms/kg/day subcutaneously days 2 to 16 (n = 27) or the same regimen plus thymostimulin (TS) 50 mg/day intramuscular at days 2 to 16 (n = 27) . The median time to reach a neutrophil count greater than 0.5 x 10(9)/l was lower in the G-CSF+TS treated group (9.13 versus 3.24 days; P < 0.0005) . More patients experienced neutropenic fever in the G-CSF group than in the G-CSF+TS group (59.3% versus 22.2%, P = 0.0119) . The incidence, duration and severity of clinically or bacteriologically documented infection were lower in patients who received TS . 16 patients (59.3%) in the G-CSF group contracted infection, and 4 patients (14.8%) receiving G-CSF+TS (P = 0.0016) . These data indicate that the combination of G-CSF and TS is well-tolerated and may enhance haematological recovery following myelosuppressive chemotherapy in patients with advanced breast cancer.

Schweiz Med Wochenschr Suppl, 1996, 76, 39S - 48S
{Dosing aminoglycosides once a day}; Blaser J; In the past few decades aminoglycosides have usually been administered as multiple daily dosing regimens . However, animal experiments have shown that nephrotoxicity can be reduced if, with the same total daily dose, the dosing interval is spread out . Further, several in-vitro and in-vivo studies suggest that once-daily dosing may be more effective . In 24 randomized, clinical trials, once- vs . multiple daily dosing regimens of amikacin, netilmicin and gentamicin have been compared in a total of 3181 patients . An analysis of these studies revealed significant advantages in favour of once-daily dosing for both clinical efficacy (89.5% vs . 84.7%, p < 0.001) and bacteriological efficacy (88.6% vs . 83.4%, p < 0.01) . In addition, improved but not statistically significant results were obtained with once-daily dosing with regard to nephrotoxicity (4.5% for once-daily vs . 5.5% for multiple daily dosing) and ototoxicity (4.2% vs . 5.8%) . Furthermore, once-daily dosing is cheaper, as less infusions are required and the expense of monitoring serum levels can be reduced . In conclusion, amikacin, netilmicin and gentamicin can be administered once a day.

Pediatr Radiol, 1996, 26(4), 291 - 7
The value of sonography in the detection of osteomyelitis; Riebel TW et al.; PURPOSE: A retrospective study was carried out in order to determine the role of sonography in establishing the diagnosis in extremity osteomyelitis . MATERIALS AND METHODS: The imaging documents of 24 infants and children aged from 2 weeks to 13 years with osteomyelitis (acute 21, chronic 3) were reviewed . Sonograms and conventional radiographs were available in all patients . Additional skeletal scintigraphy had been performed in 13 patients and MRI in only 3 . Special emphasis was put on the different ultrasound findings and their onset in the course of disease . RESULTS: Intra-articular fluid collections (in 15 cases) and/or subperiosteal abscess formation (in 12) were the most frequent early sonographic findings, and preceded any radiographic changes by several days in 11 of these cases . Together with positive clinical signs of inflammation, they were usually sufficient to establish the correct diagnosis . In selected cases, fluid or abscess puncture for immediate microscopic and later bacteriological studies was carried out under sonographic control . In addition, sonography was also able to detect superficial cortical erosion and even an intramedullary focus in a very young patient . CONCLUSION: Ultrasonography is a very helpful tool for establishing the correct diagnosis in osteomyelitis and reducing the frequency of additional imaging studies.

Thorax, 1996 Jan, 51(1), 78 - 81
Scottish national survey of tuberculosis notifications 1993 with special reference to the prevalence of HIV seropositivity; Leitch AG et al.; BACKGROUND: The study sought to determine the contribution of HIV seropositivity to the arrest of decline in tuberculosis notifications in Scotland . METHODS: Survey forms relating to each tuberculosis notification in 1993 were completed by the notifying consultant . Voluntary anonymous HIV testing of tuberculosis cases aged under 65 was requested . Age, sex, ethnic status, country of birth, employment status, occupation, previous tuberculosis, contact status, risk factors for HIV infection, HIV serostatus of cases aged under 65, site, radiological extent, and bacteriological status of tuberculous disease were determined . RESULTS: Five hundred and seventy four cases of tuberculosis were originally notified, of which 77 (14%) subsequently proved to be non-tuberculous and were therefore denotified . Of the 497 cases 423 (85%) were white and 58 (12%) were from the Indian subcontinent . Eighty five per cent of patients from the Indian subcontinent were aged < 55 years whereas 64% of white patients were aged > 55 years . Pulmonary disease was found in 74%, non-pulmonary in 22%, and combined disease in 4% of patients . Of 242 HIV tests performed, three were positive and five other HIV positive patients were known, giving an HIV positivity rate of 1.6% of all tuberculosis notifications in 1993 . Annual notification rates for Scotland were 9.7 per 10(5) before and 8.7 per 10(5) after exclusion of previously treated cases; rates were 8.4 per 10(5) for the white population and 179 per 10(5) for those from the Indian subcontinent . CONCLUSIONS: The study documents the distribution of tuberculous disease in Scotland by age, sex, site, and ethnic group for the first time . Notification practices, with respect to denotification, need to be improved . Infection with HIV is presently uncommon in cases of tuberculosis in Scotland but continued vigilance is essential.

West Afr J Med, 1996 Jan-Mar, 15(1), 1 - 5
Primary peritonitis in previously healthy children--clinical and bacteriological features; Ofori-Kuma FK et al.; A prospective study of cases of primary peritonitis in children at the Korle-Bu Teaching Hospital, Accra, was undertaken to find diagnostic clinical and aetiological features of the disease . Seventeen children, 15 females and two males, diagnosed as primary peritonitis underwent laparotomy with peritoneal toiletting . Peritoneal exudate and high vaginal swabs (HVS) were taken under anaesthesia for bacteriological analysis . Patients were followed up for one month . Thirteen patients (70%) were aged between 6 to 10 years . Presentation was early (65% presented in less than 48hrs of onset of symptoms) . The commonest presenting feature were fever (100%) and abdominal pain (100%) in the absence of headache (100%) . All had classical signs of diffuse peritonitis . There was leucocytosis in 15 cases (88%) . No bacterial growth was obtained in 50% of cases cultured . Pneumococcus was the commonest organism isolated (33.3%) . Of the 7HVS taken, 4 did not yield any bacterial growth and 2 grew escherichia coli but no pneumococcus . There was no correlation between the bacteriological findings of the peritoneal exudate and the HVS . Post-operative complications were few, insignificant and there was no mortality recorded . Sixty five percent (11/17) of cases could be predicted from the clinical symptoms and signs . The results of this study do not support any aetiological theory of causation.

J Wildl Dis, 1996 Jan, 32(1), 94 - 104
Experimental studies on Brucella abortus in moose (Alces alces); Forbes LB et al.; Four moose (Alces alces) were inoculated conjunctivally with B . abortus biovar 1 to determine their susceptibility to brucellosis, and to describe the serology, bacteriology, hematology, clinical chemistry, and pathology associated with infection . All moose became infected . Two moose were killed at day 70 post-exposure, one (83F) died acutely at day 85, and one was killed at day 166 . None of the moose had clinical signs, except for 83F immediately before death . Infected moose were readily detected serologically by the buffered antigen plate test, Brewer card test, standard tube agglutination test, and complement fixation test as used for brucellosis in cattle . With the exception of samples from 83F taken 24 hours before death, clinical chemistry, and hematology results were stable for all moose, and similar to normal values seen in cattle . Lesions seen in all moose were indicative of endotoxemia, and moose 83F died of acute endotoxic shock . Brucella abortus biovar 1 was isolated from several tissues in all moose, most notably from lymph nodes where counts often exceeded 4 x 10(4) colony forming units per g of tissue . Thus infection with B . abortus will kill moose, and progression of the disease is likely rapid under field conditions . Moose appear to be a dead-end host for brucellosis.

Am J Clin Pathol, 1996 Jan, 105(1), 58 - 64
Quality perceptions of microbiology services . A survey of infectious diseases specialists; Peddecord KM et al.; Opinions about the quality of their primary microbiology laboratory were received from more than 500 practicing infectious diseases specialists by a nationally distributed questionnaire . Approximately 92% of the respondents' primary laboratories were hospital-based . These sophisticated users rated the quality of their microbiology laboratories to be generally high, with bacteriology receiving highest scores and parasitology the lowest scores . Fortunately, the serious problems, such as failing to call a critical result and culture mishandled in the laboratory, were experienced rarely . Laboratories directed by pathologists with specialty microbiology training, PHD microbiologists, and infectious diseases specialists were judged to be of highest quality . American Board of Medical Microbiology certification of the laboratory director was related to higher overall quality perceptions . Whereas physician-customer opinions may not directly measure a laboratory's analytic quality, they are an important performance measure on which laboratories can base quality improvement activities in both service and analytical aspects of performance.

J Exp Med, 1996 Jan 1, 183(1), 179 - 86
CD16-mediated p21ras activation is associated with Shc and p36 tyrosine phosphorylation and their binding with Grb2 in human natural killer cells; Galandrini R et al.; The Src homology (SH) 2/SH3 domain-containing protein Grb2 and the oncoprotein Shc have been implicated in a highly conserved mechanism that regulates p21ras activation . We investigated the involvement of these adaptor proteins in the signaling pathway induced by CD16 or interleukin (IL) 2R triggering in human natural killer (NK) cells . Both p46 and p52 forms of Shc were rapidly and transiently tyrosine phosphorylated upon CD16 or IL-2 stimulation with different kinetics . Shc immunoprecipitates from lysates of CD16- or IL-2-stimulated NK cells contained Grb2 and an unidentified 145-kD tyrosine phosphoprotein . Grb2 immunoprecipitates from anti-CD16-stimulated NK cells contained not only Shc, but also a 36-kD tyrosine phosphoprotein (p36) . The interaction between Grb2 and Shc or p36 occurred via the Grb2SH2 domain as indicated by in vitro binding assays using a bacteriologically synthesized glutathione S-transferase-Grb2SH2 fusion protein . We also present evidence that p21ras is activated by CD16 and IL-2R cross-linking . Accumulation of guanosine triphosphate-bound Ras was detected within 1 minute and occurred with kinetics similar to inductive protein tyrosine phosphorylation and Grb2 association of Shc and p36 adaptor proteins.

Gastroenterology, 1996 Jan, 110(1), 232 - 40
Antibiotic treatment improves survival in experimental acute necrotizing pancreatitis; Mithofer K et al.; BACKGROUND & AIMS: It is still unproven whether prophylactic antibiotics can reduce mortality from acute necrotizing pancreatitis (ANP) . The aim of this study was to investigate whether antibiotic therapy can influence long-term outcome in ANP and how appropriate this therapy is . METHODS: ANP was induced in rats by standardized intraductal bile acid infusion and cerulein hyperstimulation . Serum trypsinogen activation peptide levels were used to verify comparable disease severity . Starting 6 hours after induction, animals randomly received saline (n = 60), 20 mg/kg imipenem (n = 62), or 10 mg/kg ciprofloxacin (n = 60) every 8 hours for 7 days . On day 7, half of each group was killed so a quantitative pancreatic bacteriology could be conducted . The other half was analyzed at 21 days for long-term mortality, late bacteriologic changes, abscesses, and pseudocysts . RESULTS: Comparable trypsinogen activation peptide increases confirmed equally severe ANP in each group before treatment . Imipenem and ciprofloxacin significantly reduced the number of infected pancreatic specimens, bacterial counts, and identified species at 1 week . At 3 weeks, pancreatic infection prevalence was lower in animals treated with antibiotics; abscess formation was reduced and pseudocysts were smaller and less frequently infected . Survival was significantly improved by imipenem and ciprofloxacin . CONCLUSIONS: Antibiotic treatment reduces early and late septic pancreatic complications and improves survival from experimental ANP.

J Manag Med, 1996, 10(3), 49 - 58
Cultural conflict in a bacteriology department: Apollo v . Athena; Bignardi GE; Aims to explore the employees' perception of the organizational culture, as well as their cultural preference, and assess what might be the implications of any differences between the two . A questionnaire, largely based on one previously used by Charles Handy, was given to the MLSOs and the medical staff working in a bacteriology department . Analysis of the replies showed that there was a conflict between what was perceived as the existing culture and the preferred culture, and that the intensity of this conflict was associated with either stress or job dissatisfaction . The increased pace of changes affecting this department and the nature of the workforce profile, with many highly qualified and skilled employees, also suggested that a cultural change might be appropriate . Contains a number of recommendations which are budget neutral and which aim to achieve cultural change and increasing motivation.

Cas Lek Cesk, 1995 Dec 6, 134(23), 743 - 5
{Tuberculosis in Central Europe . Comparison of the present situation and development of tuberculosis in the Czech Republic and in Germany 1991-1993}; Trnka L et al.; Comparison of the position as regards tuberculosis in the Czech Republic (CR) and in the Federal German Republic (FRG), two neighbouring countries of the Central European region was made possible by an approximation of systems of health services in the two countries and by the common effort to standardize definitions of indicators of the epidemiological situation as regards tuberculosis according to international recommendations . The relative number of newly assessed diseases of all forms and at all sites was equal in the two countries in 1993 and did not differ significantly during the past three years . No significant differences were found on comparison of indicators of incidence classified by bacteriological confirmation, site and age distribution . In the GRF the position as regards TB during the past three years is considered stabilized without apparent changes; the same applies also to the CR . In the GRF TB in the domestic population (German population) and foreigners is evaluated separately, as foreigners account for 7.3% of the prevalence . Tuberculosis of foreigners influences in a significant way the general incidence in the GRF, in particular in younger age groups . It is due to the adverse situation as regards TB in countries from which immigrants come . Logistic comparison of indicators of the incidence revealed that the traditional stabilized system of health services in the GRF as well as the newly introduced system in the CR are biased by the same error as regards mandatory notification of all new cases of TB . The findings make it possible to assess priorities specific for the Central European area in the amended system of surveillance of TB in the CR.

J Paediatr Child Health, 1995 Dec, 31(6), 495 - 8
The epidemiology, mortality and morbidity of tuberculosis in Australia: 1850-94; Williams HE et al.; The review covers the four major changes in the history of tuberculosis in Australia from 1850 to 1994 . During the first 100 years there was no significant effective treatment . Mass miniature radiological chest screening and effective bacteriological examination of World War II army recruits resulted in reliable diagnosis . The Australian Tuberculosis Campaign 1948-76 utilized the army experience for detection, and the use of specific treatment virtually eliminated the disease . Failure to maintain strict screening of high-risk groups, especially immigrants, has led to a resurgence of tuberculosis as shown by an increase in notifications in adults and prevalence rates in secondary school children.

Zentralbl Bakteriol, 1995 Dec, 283(2), 215 - 23
Prevention of catheter-related infections by silver coated central venous catheters in oncological patients; Goldschmidt H et al.; Catheter-related infection (CRI) is a serious complication of central venous catheterization . We have investigated the efficacy of a silver-coated polyurethane catheter (Pellethane, Fresenius AG, Germany) in preventing CRI in oncological patients receiving chemotherapy in a phase II study . From November 1992 through April 1994, 266 patients were assigned to receive single lumen catheters, either standard uncoated catheters (UC, n = 113) or silver-coated ones (SC, n = 120) . Catheters were inserted into the internal jugular vein after institutional approval and informed consent . Duration of catheterization (UC vs . SC = 13.3 vs . 12.7 days) and leukopenia (< 1.0 x 10(9) WBC/l; 4.3 vs . 3.6 days) were similar in both groups demonstrating a comparable risk for infections . Skin reactions at the catheter entry site were recorded daily . CRI and colonization rates were studied by semiquantitatively culturing intradermal and intravascular segments . CRI were confirmed by blood cultures obtained via catheter and from peripheral veins in cases of suspected sepsis or at the end of catheterization . No adverse effects from the silver-coated catheter could be observed . The bacteriological results showed that SC were colonized (> 15 CFU) in 45.1% and UC in 44.2% . CRI developed in 21.2% of the UC patients but only in 10.2% of the SC patients (p = 0.011) . We conclude that this new silver-coated central venous catheter is biocompatible and effective in reducing the incidence of catheter-related infections in oncological patients.

Zentralbl Veterinarmed A, 1995 Dec, 42(10), 643 - 7
Milk N-acetyl-beta-D-glucosaminidase and serum albumin as indicators of subclinical mastitis in the camel; Abdurahman OA; NAGase activity (NAGase) and serum albumin concentrations were determined in milk from 101 traditionally managed camels in the Sudan . NAGase, a lysosomal enzyme released from damaged epithelial cells as well as other somatic cells in milk, was recorded for quarter milk samples from camels (n = 353) using the fluoroscan method . NAGase activity in major pathogen-infected quarters was significantly (P < 0.05) higher than in minor pathogen-infected and non-infected quarters . Means for minor pathogen-infected quarters were also significantly higher than non-infected quarters . Concentrations of serum albumin, resulting from increased vascular permeability, in quarter milk samples (n = 320) were measured by the radial immunodiffusion test . Serum albumin content in milk was not affected by infection status of the quarter . There were, however, large variations in serum albumin levels and, to a lesser extent, NAGase values between samples in both infected and non-infected quarters . NAGase was more effective in predicting bacteriological status of the quarter than serum albumin.

Eur J Clin Microbiol Infect Dis, 1995 Dec, 14(12), 1029 - 38
Once-daily dosing of aminoglycosides; Blaser J et al.; Since their introduction one or more decades ago, aminoglycosides have generally been administered in multiple daily (i.e . twice- or thrice-daily) dosing regimens . However, nephrotoxicity can be reduced in animal models by administering the same total daily dose as one large dose instead of as multiple small doses . In addition, in vitro and in vivo studies that considered the impact of dosing regimens on efficacy suggest that once-daily dosing is equally or more effective compared to multiple daily dosing . Once-daily versus multiple daily dosing regimens have been compared for amikacin, netilmicin, and gentamicin in 24 randomized, clinical trials including a total of 3,181 patients . An analysis of these studies revealed superior results for once-daily regimens with respect to clinical efficacy (89.5% vs . 84.7%, p < 0.001) as well as bacteriological efficacy (88.6% vs . 83.4%, p < 0.01) . No statistically significant differences were noted for toxicity . Nevertheless, both nephrotoxicity and ototoxicity occurred less frequently during once-daily dosing (4.5% vs . 5.5% and 4.2% vs . 5.8%, respectively) . Finally, once-daily dosing is more economical, since less nursing time and infusion material are required and the efforts for drug monitoring can be reduced . In conclusion, amikacin, netilmicin, and gentamicin can be administered once a day.

J Chemother, 1995 Dec, 7(6), 535 - 42
Open, controlled, randomized study on the efficacy and safety of cefodizime single daily dose versus two daily doses and versus ceftriaxone single daily dose in patients with acute purulent bronchitis and acute purulent exacerbation of chronic bronchitis; Zanussi C et al.; Two hundred and thirty-eight in-patients with signs and symptoms of acute purulent bronchitis or purulent exacerbation of chronic bronchitis at stage 1 and 2 of Anthonisen's classification were enrolled in 11 Centers and randomly assigned to one of the following 3 treatment groups: group A, cefodizime 1 g i.m . qD; group B, cefodizime 1 g i.m . BID; group C, ceftriaxone 1 g i.m . qD . Bacteriological results after treatment were satisfactory in 64 patients (91.4%) of group A, 64 (92.8%) of group B and 74 (94.9%) of group C . Global clinical results after treatment showed satisfactory efficacy in 57 patients (79.2%) of group A, 59 (85.5%) of group B and 63 (80.8%) of group C . There was no statistically significant difference in improvement in single symptoms, global bacteriological or clinical results between the 3 groups . Mild adverse events occurred in only 3 patients (one per group).

Ginekol Pol, 1995 Dec, 66(12), 681 - 4
{An attempt to choose the optimal antibiotic for early treatment of neonates with bacterial sepsis}; Stempniewicz K et al.; Aim of our study was making easier choice of right antibiotic to treatment newborns with sepsis after receiving results of bacteriological test . We analysed antibiograms that were results of first bacteriological test of blood samples taken from 59 neonates, who were admitted in first week of life to the Neonatal Pathology Clinic in Zabrze . On the ground of our analysis we propose applying netilmicin and cephalotin in every case of neonate with symptoms suggesting the sepsis . These two antibiotics have the best effects in treatment the sepsis.

Tuber Lung Dis, 1995 Dec, 76(6), 550 - 4
IS6110 restriction fragment length polymorphism typing of clinical isolates of Mycobacterium tuberculosis from patients with pulmonary tuberculosis in Madras, south India; Das S et al.; SETTING: Madras, India . OBJECTIVE: To explore the utility of a standardized IS6110/PvuII deoxyribonucleic acid (DNA) fingerprinting restriction fragment length polymorphism (RFLP) typing method for distinguishing between isolates of Mycobacterium tuberculosis, and to assess the potential for distinguishing between relapse versus reinfection rates . DESIGN: To assess RFLP heterogeneity in the population, initial isolates, obtained from the sputum of tuberculous 98 patients in diagnosis and follow-up during short-course chemotherapy, were stored and compared . To assess the frequency of disparity between the RFLP type of the initial isolate and one obtained after successful completion of chemotherapy, either during relapse or as an isolated positive culture, 124 isolates comprising 62 such pairs were coded and compared both blind and after decoding . RESULTS: Although a wide variety of DNA band patterns (fingerprints) was present, the isolates from 39 (40%) of the patients showed a single copy of IS6110 . Only 15 pairs of coded initial and follow-up isolates could be identified as having the same band pattern when isolates with zero or single bands were excluded . Nevertheless, after decoding, in a retrospective analysis that included all isolates, those isolates that bacteriologically defined a patient's relapse more often showed RFLP type identity with the initial isolate (19 of 30 comparisons) than did isolates that were obtained as isolated positive cultures (3 of 32 comparisons) (X2 P < 0.001) . Tests of sensitivity to chemotherapeutic drugs, catalase activity and resistance to thiophene-2-carboxylic acid hydrazide were of minimal value in discriminating between isolates . CONCLUSIONS: Despite the high frequency of single- and zero-band isolates in this population, the discriminatory power of RFLP typing with IS6110 is sufficiently high to be useful for clinical and epidemiological studies.

Tuber Lung Dis, 1995 Dec, 76(6), 534 - 9
Incidence of pulmonary tuberculosis in Korean civil servants; Kim SJ et al.; SETTING: Longitudinal epidemiological study based on civil servants in Korea . OBJECTIVE: To estimate the incidence of pulmonary tuberculosis (PTB) for the general population from a reliable sample . DESIGN: New active PTB developing between 1988 and 1990 in civil servants has been determined from (1) the findings of biennial medical examinations and (2) perusal of the medical records of those claiming health insurance for tuberculosis (TB) . RESULTS: A total of 790,204 subjects was available for investigation . Active PTB was diagnosed in 5107 patients over the 2 years of the study . Bacteriological examination of 3847 patients yielded 575 (14.9%) positive smears and 350 (9.1%) smear-negative positive cultures from them . Applying these rates to the 1260 whose sputum was not examined, 702 were smear-positive, and 431 were culture-positive . Overall PTB incidence was 393 per 10(5), with 84 and 53 per 10(5) smear- and culture-positive . Incidence was high in males, and in the age group 20-29 years in both sexes . CONCLUSION: Such high PTB incidence, particularly in the age group 20-29, clearly indicates that TB in Korea remains a serious health problem.

Tuber Lung Dis, 1995 Dec, 76(6), 529 - 33
Incidence of pulmonary tuberculosis among diabetics; Kim SJ et al.; SETTING: Longitudinal epidemiological study based on diabetic and non-diabetic civil servants in Korea . OBJECTIVE: To determine a comparative incidence of pulmonary tuberculosis (PTB) between diabetic and non-diabetic subjects . DESIGN: Investigation of newly developed PTB among diabetics and non-diabetics between 1988 and 1990, on the basis of biennial medical examination and the medical records of those who claimed health insurance for tuberculosis . RESULTS: The 1990 medical examination and investigation of medical records of the health insurance claimants revealed that PTB had developed in 170 patients (including 37 smear and eight culture positives) among 8015 diabetics, and in 4935 patients (including 538 smear and 342 culture positives) among 806,698 control subjects . Estimated annual incidence rates of PTB of (1) all types, (2) smear and/or culture positive versus (3) smear positive cases were 1061, 281 and 231 per 10(5) respectively among diabetics and 306, 55 and 33 per 10(5) among non-diabetic controls . PTB developed in 167 of 7695 male diabetics and in 3 of 320 female diabetics . The greater the age, the more diabetics were found . CONCLUSION: Relative risks (RR) of developing PTB of all types and bacteriologically confirmed cases were 3.47 times and 5.15 times higher in the diabetics than in the matched controls . A greater RR was observed on those at the age of 30-49 than in those of 50 years or more.

Kansenshogaku Zasshi, 1995 Dec, 69(12), 1356 - 64
{Legionella pneumophila serogroup 3 isolated from a patient of pneumonia developed after drowning in bathtub of a hot spring spa}; Shiota R et al.; A 71-year-old Japanese female, was found unconscious by drawing, in a hot spring spa, at around noon of 20 October 1994 . She recovered by emergency cardiopulmonary resuscitation, and admitted to the Takinomiya General Hospital, with adult respiratory distress syndrome (ARDS) . Although she recovered from ARDS within 4 days after her admission, she developed severe pneumonia accompanied with the second attack of ARDS . Ordinary bacteriological culture of her respiratory specimens failed to yield any significant pathogen for her pneumonia, and neither cefazolin nor imipenem/cilastatin was effective . Thus minocyclin was given on the 7th hospital-day and this was effective for blood gas and C-reactive protein (CRP) levels . Intratracheal exsudate inoculated on BCYE alpha agar plate yielded grayish white colonies . Cells of the colonies were clearly agglutinated by anti-Legionella pneumophila serogroup (SG) 3 serum . Antibody titers of patient's paired sera against the strain L . pneumophila SG3 Bloomington-2 and the patient's strain (Y-1) were determined by microplate agglutination test, and a significant rise from 1:20 to 1:320 was demonstrated . Patient recovered by erythromycin treatment and was discharged on the 59th hospital day . L . pneumophila SG3 organisms were again isolated from the spa water where the patient drawn . From these findings described above, we diagnosed the patient as pneumonia due to L . pneumophila SG3, and the spa water was the most probable source of infection.

Pneumologie, 1995 Dec, 49 Suppl 3, 657 - 62
{Tuberculosis and radiologic diagnosis 100 years after W . C . Roentgen}; Felix R et al.; The discovery of the x-rays by W . C . Roentgen 100 years ago significantly improved the diagnosis and follow-up of tuberculosis, therapy control became possible, and the basis for prevention was set by early detection . Within few years, the "Roentgen" rays had been made a triumphant progress around the world, and Roentgenology was established as an independent medical discipline . Even after a century of developments like tomography, ultrasound, conventional/-high resolution and spiral computed tomography, digital radiography, digital subtraction angiography, and magnetic resonance imaging, innovations in the field of medical imaging appear to be unlimited, an evolution, which had been initiated by Roentgen . Today, therapists and radiologists are again challenged by the renaissance of tuberculosis, partially in new "clothes" by increasing numbers of HIV-patients . These specific changes clinically and radiological often appear atypical, and require subtile radiological diagnostics with the use of new imaging modalities . CT and MRI allow for follow-up of chemotherapy in mediastinal lymph node disease, significantly improve pleural diagnosis, and both are methods of choice in vertebral and cerebral tuberculous disease . Digital radiography and digital net-work allow for x-rays at the lowest dose, improved comparison in the follow-up, as well as for "online"-evaluation of images on the department's screen . Today, optimal diagnosis of tuberculosis includes the bacteriologic and clinical diagnosis and radiological imaging . To face the challenge of recurrent tuberculosis in in the second century after after Roentgen successfully, an intensive interdisciplinary cooperation of therapists and radiologists is necessary.

Versicherungsmedizin, 1995 Dec 1, 47(6), 207 - 12
{Clinical studies of the incidence of pulmonary and extrapulmonary tuberculosis}; Schweisfurth H et al.; On the whole 797 patients (mean age 49.5 +/- 18.6 years) with tuberculosis who were hospitalized during 1987 and the first half of the year 1994 were investigated . 148 (18.6%) of these patients were foreigners . Regarding the age, the patients of German origin were mostly above 40 years (70.5%) . Within the group of foreigners, 61.5% were below 40 years . 83.3% of the patients suffered from pulmonary and 11.4% from extrapulmonary and 11.4% from extrapulmonary tuberculosis . 5.3% of these patients had both manifestations . The tuberculin tine test was positive in 95.7% and negative in 4.3% . In 63.9% of all patients the tuberculosis was localized in the upper lobe of the lung . The tuberculosis was established bacteriologically in 56.0% and histologically in 16.5% . Both methods were applied in 13.6% . The tuberculosis was deteriorated by chronic alcoholism . Malignant diseases were recorded in 17 (2.1%) of the patients . 22 (2.8%) died during their stay at the hospital.

J Trop Med Hyg, 1995 Dec, 98(6), 392 - 4
Acute aphasia complicating typhoid fever in an adult; Bansal AS et al.; Motor aphasia complicating bacteriologically confirmed typhoid fever in a 20-year-old adult female is presented . Neither the cause of death nor the aetiology of this isolated neurological deficit could be determined from detailed post-mortem examination . An immune related mechanism is suggested based on the temporal characteristics of this complication and CSF abnormalities.

Appl Environ Microbiol, 1995 Dec, 61(12), 4291 - 5
Effect of point-of-use, activated carbon filters on the bacteriological quality of rural groundwater supplies; Synder JW Jr et al.; The water quality of 24 rural, domestic groundwater supplies treated with point-of-use, powdered activated carbon (PAC) filters was monitored to determine how such treatment might impact the bacteriological quality of private, residential drinking water supplies . Heterotrophic-plate-count (HPC) and total coliform analyses were performed on raw, PAC-treated, and overnight or stagnant (first-draw) PAC-treated water samples . Densities of HPC bacteria were elevated by 0.86 and 0.20 orders of magnitude for spring and well water systems, respectively, in PAC-treated effluents following overnight stagnation compared with levels in untreated treated effluents . Densities of HPC bacteria in PAC-treated effluents were significantly reduced (P < 0.01) below influent levels, however, after the point-of-use device was flushed for 2 min . While PAC significantly reduced the number of coliforms in product waters (P < 0.01), these indicator organisms were still detected in some effluents . Seasonal variations were evident in microbial counts from spring but not well water systems . It appears that aside from periods following stagnant-water use, such as overnight, PAC treatment does not compromise the bacteriological quality of drinking water obtained from underground sources.

Arch Otolaryngol Head Neck Surg, 1995 Dec, 121(12), 1414 - 6
Treatment of chronic ear disease . Topical ciprofloxacin vs topical gentamicin; Tutkun A et al.; OBJECTIVE: To determine and compare the therapeutic efficiency of ciprofloxacin hydrochloride and gentamicin sulfate in the treatment of chronic ear disease . DESIGN: Prospective randomized study . SETTING: Academic tertiary medical center . PATIENTS: Consecutive referred sample of 44 patients with chronic suppurative otitis media randomized into two groups . INTERVENTIONS: Ciprofloxacin hydrochloride (200 mg/mL) was administered to the first group (composed of 24 patients), while the second group (composed of 20 patients) received gentamicin sulfate (5 mg/mL) locally, five drops three times a day for 10 days . RESULTS: In the ciprofloxacin group, 21 (88%) of the 24 patients with suppurative chronic otitis media were cured . On the other hand, only six (30%) of the patients in the gentamicin group were cured . The rest of the patients showed no clinical or bacteriological improvement . CONCLUSIONS: To our knowledge, this is the first study to compare the efficiency of two topical otic preparations in the treatment of chronic ear disease . The results show that topical ciprofloxacin preparation is more efficacious and efficient than topical gentamicin for the treatment of chronic otitis media in the acute stage.

J Am Vet Med Assoc, 1995 Nov 15, 207(10), 1332 - 3
Comparison of serologic tests and bacteriologic culture for detection of brucellosis in swine from naturally infected herds; Ferris RA et al.; OBJECTIVE--To compare results of 6 serologic tests with results of bacteriologic culture for Brucella suis in swine . DESIGN--Prospective study . ANIMALS--Two hundred twenty-one swine from 39 naturally infected herds . PROCEDURE--Blood samples and lymph nodes were collected at slaughter . Serologic tests conducted were the particle concentration fluorescence immunoassay, the automated complement fixation assay, the card test, the buffered acidified plate antigen assay, the standard tube test, and the rivanol test . Lymph nodes were plated on Farrell's medium and serum-enriched agar for bacteriologic culture . RESULTS--Sensitivities ranged from 57 (automated complement fixation assay) to 83% (standard tube test) . Specificities ranged from 62 (standard tube test) to 95% (rivanol test) . Brucella suis was isolated from 46 of the 221 (21%) pigs . For 8 of the 46 culture-positive pigs, results of all 6 tests were negative . CLINICAL IMPLICATIONS--Data illustrate the difficulty of eliminating brucellosis by means of a test-and-removal program and support the policy of slaughtering infected herds.

Skeletal Radiol, 1995 Nov, 24(8), 563 - 71
Imaging the diabetic foot; Gold RH et al.; Early and accurate diagnosis of infection or neuropathy of the diabetic foot is the key to successful management . Angiopathy leads to ischemia which, in combination with peripheral neuropathy, predisposes to pedal skin ulceration, the precursor of osteomyelitis . Chronic hyperglycemia promotes production of glycosylated end products which accumulate on endothelial proteins, causing ischemia of the vasa nervorum . When combined with axonal degeneration of the sensory nerves, the result is hypertrophic neuroarthropathy . Should the sympathetic nerve fibers also be damaged, the resultant loss of vasoconstrictive impulses leads to hyperemia and atrophic neuroarthropathy . Plain radiography, although less sensitive than radionuclide, magnetic resonance (MR), and computed tomographic examinations, should be the initial procedure for imaging suspected osteomyelitis in the diabetic patient . If the radiographs are normal but the clinical suspicion of osteomyelitis is strong, a three-phase 99mTc-MDP scan or MR imaging is recommended . An equivocal 99mTc-MDP scan should be followed by MR imaging . To exclude osteomyelitis at a site of neuroarthropathy, a 111In white blood cell scan is preferable . To obtain a specimen of bone for bacteriological studies, percutaneous core biopsy is the procedure of choice, with the entrance of the needle well beyond the edge of the subjacent ulcer.

Food Addit Contam, 1995 Nov-Dec, 12(6), 759 - 67
Reduction in phosalone residue levels during industrial dehydration of apples; Mergnat T et al.; Dehydrated fruits and vegetables, which may well be used in baby foods, must be of excellent bacteriological quality with an absence of contamination . In order to define the effects of the industrial dehydration process, according to the 'Hatmacker' drying method, on an organophosphorus pesticide, we have studied phosalone in Golden Delicious apples as an example . The technological process undertaken leads to a reduction in phosalone levels on the apples of more than 80%, whatever the initial dose between 0 and 4.29 micrograms/kg . Washing brings about a reduction of 30-50%, probably by the dissolution of the phosalone in the water . The cooking and especially the filtration of the pureed apple mechanically eliminates, without notable deterioration, 40-70% of the phosalone . However, drying, which takes place at the end of the process, does not lead to significant variations in phosalone levels . Consequently, the reduction in phosalone residue levels in dehydrated apple products manufactured by this process provides the consumer with a greater degree of security with respect to this contaminant . In addition, we have presented several possibilities to add to the quality of dehydrated products.

Vet Microbiol, 1995 Nov, 47(1-2), 89 - 98
Genetic characterization of mycobacteria from South American wild seals; Romano MI et al.; Tuberculosis has been recently diagnosed in four wild seals found stranded in the Atlantic coast of Argentina . By bacteriological studies and IS6110 hybridization, these isolates were characterized as belonging to the Mycobacterium tuberculosis complex . A genetic characterization using RFLP (Restriction fragment length polymorphism) and a species-specific probe of M . tuberculosis, called mtp40, showed hybridization with this probe on a single band . A similar band was also found in M . tuberculosis H37Rv . This showed a relationship between M . tuberculosis and the wild seal isolates . However these would also seem to belong to a different genetic group in the M . tuberculosis complex, since they do not grow on glycerol-egg containing medium (Lowenstein-Jensen) as typical M . tuberculosis strains usually do . Repeated sequences pMBA2, pTNB12, DR and IS6110 were used as probes to evaluate the epidemiological relationships between the 4 cases of tuberculosis . A low degree of polymorphism was observed, that suggested that these isolates were epidemiologically related.

Nihon Kyobu Shikkan Gakkai Zasshi, 1995 Nov, 33(11), 1259 - 64
{Sarcoidosis with pulmonary cavitation and calcification}; Yokogawa K et al.; A 38-year-old man was seen at another hospital because of bilateral reticulo-nodular shadows on a chest X-ray film at the time of a regular health check-up . Pulmonary tuberculosis was diagnosed, and the patient was treated with antituberculous chemotherapy . The shadow did not improve, and the patient was transferred to our hospital . Bacteriological studies for pyogenic bacteria, mycobacteria, and fungi were all negative . Serum levels of angiotensin-converting enzyme and lysozyme were abnormally high . Examination of a specimen obtained by transbronchial lung biopsy revealed noncaseating epithelioid-cell granuloma associated with severe hyalinization . Sarcoidosis was diagnosed . Chest CT showed multiple nodular opacities, some of which were calcified . Oral steroids were given because the lesion was progressing rapidly . Cavitary lesions appeared during tapering of steroid therapy . Bacteriological and fungal studies were negative and transbronchial lung biopsy showed noncaseating epithelioid-cell granuloma . Therefore, the cavitation within the granuloma with hyalinization may have developed because of steroid therapy, and the calcification may have been caused by postorganizing dystrophy.

Vestn Otorinolaringol, 1995 Nov-Dec, (6), 11 - 5
{Effectiveness of local magnetic field of the acoustic frequency in the treatment of patients with acute inflammatory diseases of the larynx}; Tarasov DI et al.; The authors have tried alternative magnetic field of sound frequency in patients with acute inflammatory diseases of the larynx . The above modality proved highly efficient in view of its bacteriological, immunomodulating and detoxication actions at cellular level, which make the method promising in physiotherapy of acute inflammation.

Arch Dis Child Fetal Neonatal Ed, 1995 Nov, 73(3), F181 - 3
Autologous umbilical cord blood transfusion; Ballin A et al.; The purpose of this study was to examine some aspects of umbilical cord blood collection for autologous transfusion in premature infants . All 120 microbacterial cultures (aerobic and anaerobic) of cord blood samples as well as 30 cultures of mycoplasma were treated . Cord prothrombin fragment (F 1 + 2) concentrations were quantified at one and 10 minutes after clamping of the cord . F 1 + 2 concentrations assessed on 25 newborn infants were similar and no linear association with time of clamping could be drawn . This means that cord blood thrombosis is not activated for at least 10 minutes following clamping of the cord . As far as is known, the first newborn infant to benefit from this method of transfusion is reported here . The premature infant received two portions of autologous blood (on days 5 and 7) . No untoward effects were noted . Blood, collected from the umbilical cord, is a safe source for autotransfusion, provided that bacteriological testing has been carried out.

Am J Respir Crit Care Med, 1995 Nov, 152(5 Pt 1), 1562 - 9
Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia; Djedaini K et al.; Heat and moisture exchangers (HME) (Dar-Hygrobac II, Peters) can safely be used every 24 h for long-term mechanical ventilation and provide a cost-saving alternative to heated humidifiers . We have prospectively determined whether changing HMEs every 48 h only affects their clinical and bacteriological efficiency in a series of consecutive nonselected ICU patients requiring long-term mechanical ventilation . Two consecutive periods were compared . During period 1, HMEs were replaced every day; during period 2, they were changed every 48 h . Patients from the two periods were similar in terms of age and indication for and overall duration of MV (10 +/- 8.6 versus 10 +/- 9 d, p = 0.9) . Minute ventilation and maximum values for peak airway pressure were identical during the two periods . These values were also identical after 1 and 2 d of HME use during period 2, indicating that HME resistance was not increased by prolonged use . Obstruction of the tracheal tube occurred only once in a period 1 patient . The results of quantitative cultures indicate that the maximum and mean levels of bacterial colonization during the two periods were similar for the pharynx, trachea, Y-connector, patient, and ventilator side of the HME . More importantly, the incidence of nosocomial pneumonia was similar during the two periods (6/61 versus 8/68, p = 0.7) . Thus, prolonged HME use is safe and provides a substantial reduction in the cost of mechanical ventilation.

Rev Med Brux, 1995 Nov, 16(5), 344 - 8
{Pharyngo-tonsillitis: Current clinical, bacteriological, serological and therapeutic aspects}; Sternon J et al.; The authors present the pharyngo-tonsillitis in four fields: clinical, bacteriology, serology and treatment . They insist on the danger of the beta-hemolytic Strep A, the failures of the ASLO detection and stress the execution of the rapid antigenic test at the office . They suggest the limitation of the administration of antibiotics and the prescription of a penicillin which is much better than macrolides or cephalosporins of second or third generation.

Sci Total Environ, 1995 Oct 27, 171(1-3), 29 - 34
Drinking water quality and monitoring in north Africa: the Moroccan experience; Abouzaid H et al.; In Morocco, the water quality standards have been derived from World Health Organization guidelines for all that concerns bacteriological and toxicological parameters; for the rest of the parameters, several other sources have been used especially EEC, US and Canadian standards . Local considerations have dictated, however, the value of the maximum acceptable level adopted for the total dissolved solids (2000 mg/l), instead of the 1500 mg/l generally considered to be the maximum acceptable level . The National Office of Potable Water (ONEP) developed quite an extensive network for water quality monitoring, comprised of a central laboratory conducting all sorts of analytical determinations ranging from parasitological, planktonic and bacteriological examinations, to the determination of trace metals, pesticides, global radioactivity and toxicity tests . The work of the central laboratory is seconded by 34 small branch laboratories spread all over the country . The preparation of reference analytical methodologies has been a subject on the agenda of the next phase of the work of the commission in charge of the preparation of standards dealing with drinking water . A first approach of the Moroccan water quality standards implementation have been made by ONEP . The evaluation of the costs necessary to be in conformity with these standards and the dispensation requests to be presented, where appropriate, to health authorities are on the way.

J Chromatogr B Biomed Appl, 1995 Oct 6, 672(1), 133 - 7
Gas chromatographic-mass spectrometric study of lipids and rapid diagnosis of Mycobacterium tuberculosis; Mayakova TI et al.; The method suggested is based on the identification of tuberculostearic acid as a Mycobacterium tuberculosis marker . Bacterial culture and sputum of patients with pulmonary tuberculosis and lung diseases of non-tuberculous etiology were investigated . A complete coincidence of the results of bacteriological and gas chromatographic-mass spectrometric (GC-MS) methods used in examining a group of patients with pulmonary tuberculosis was found . GC-MS ion monitoring provides a highly sensitive and rapid technique for the diagnosis of pulmonary tuberculosis.

Enferm Intensiva, 1995 Oct-Dec, 6(4), 141 - 8
{Mouth care in intubated patients with nothing-by-mouth diet in an in tensive care unit}; Breton M et al.; The objective of this study is to value the effectiveness of a care plan of mouth care and at the same time, compare the effects of the use of two different solutions: physiologic serum and non-diluted hexetidine (Oraldine) . The sample studied was formed by 40 intubated patients or patients with an absolute oral diet who were in the Intensive Care Unit of the University Clinic . 50% of the patients underwent oral hygiene with physiological serum, following the established protocol and the other 50% were treated with non-diluted hexetidine with a frequency of five times a day . The mouth status was checked at the moment of admission and then daily: lips, tongue, gums, palate, presence of residua and saliva characteristics . Also, a series of factors which could alter the buccal integrity were registered: oxygenotherapy, orotraqueal intubation, anemia, plaquetopenia, medicines, etc . Bacteriological controls of traqueal secretion were performed periodically . From the analysis of the results we can conclude that the care plan established is efficient, although it is not enough for patients with coagulation alterations (plaquetopenia) . From the solutions used for oral hygiene we can say that although there have not been significant differences, the physiologic serum is the chosen product, as it maintains the mouth status better and helps to keep the oral microbiota.

Clin Infect Dis, 1995 Oct, 21(4), 905 - 9
Evaluation of the Duke criteria versus the Beth Israel criteria for the diagnosis of infective endocarditis; Hoen B et al.; New diagnostic criteria for infective endocarditis (IE) have been proposed by the Duke University Endocarditis Service (Durham, NC) to update the widely used Beth Israel (Boston) criteria . We compared the Duke criteria with the Beth Israel criteria in a series of 115 consecutive patients with suspected IE who were hospitalized in a referral center . The diagnosis of IE was histologically and/or bacteriologically confirmed for 27 operated patients . If surgery had not been performed on these 27 patients, 22 vs . 12 would have been classified as having inverted question markclinically definite inverted question mark and inverted question markprobable inverted question mark IE by the Duke vs . the Beth Israel criteria, respectively, whereas 0 vs . 5 would have been inverted question markrejected inverted question mark by the Duke vs . the Beth Israel criteria, respectively . The improvement in sensitivity of the criteria from 44% (Beth Israel) to 82% (Duke) was statistically significant (P < .01) . We confirm that the Duke criteria improve the sensitivity of diagnosis of IE . The specificity of these criteria should be further evaluated.

Toxicon, 1995 Oct, 33(10), 1359 - 64
Fatal mass poisoning in Madagascar following ingestion of a shark (Carcharhinus leucas): clinical and epidemiological aspects and isolation of toxins; Boisier P et al.; In November 1993, 188 people were admitted to hospital after eating the meat from a single shark (Carcharhinus leucas) in Manakara, a medium-sized town on the south-east coast of Madagascar . This shark and its meat had no unusual characteristics . The attack rate was about 100% . The first clinical signs appeared within 5-10 hr after ingestion . The patients presented with neurological symptoms almost exclusively, the most prominent being a constant, severe ataxia . Gastrointestinal troubles, like diarrhoea and vomiting, were rare . The overall case mortality ratio was close to 30% among the 200 poisoned inhabitants . There were no reports of previous similar poisonings in this area, and fishermen in Manakara usually eat this kind of shark without problems . Bacteriological and chemical causes were eliminated . Two liposoluble toxins were isolated from the liver and tentatively named carchatoxin-A and -B, respectively . They were distinct from ciguatoxin in their chromatographic properties.

J Antimicrob Chemother, 1995 Oct, 36(4), 647 - 56
Comparative activity of azithromycin and doxycycline against Brucella spp . infection in mice; Domingo S et al.; The activities of a short therapeutic regimen with azithromycin and the classic treatment doxycycline with streptomycin were compared and evaluated in mice infected with Brucella melitensis . In a chronic model, starting therapy 31 days after challenge, azithromycin (10 days, 50 mg/kg/day) significantly reduced the infection (2.9 logs, day 48 post-infection) . The effectiveness of doxycycline (21 days, 50 mg/kg/12 hourly) was greater than azithromycin (4.1 logs of reduction, day 48 post-infection), and when doxycycline was administered for a period of 45 days, all the animals were bacteriologically cured from day 78 . The combination with streptomycin (14 days, 10 mg/kg/day) did not improve the effect of any of the regimens . In an acute model infection, treatments with doxycycline or doxycycline-streptomycin, for a period of 3 days, starting 1 day after lethal challenge, were able to protect all the mice . In contrast, only 50% of the mice treated with azithromycin survived the challenge . In conclusion, although a short oral treatment with azithromycin was able to reduce the infection significantly, it was not able to cure the animals as effectively as the classic regimen with doxycycline administered for a longer period of time.

Tierarztl Prax, 1995 Oct, 23(5), 497 - 501
{Experiences in diagnosis and therapy of puppy diseases in the fist days of life}; Munnich A et al.; In a survey covering 145 puppies in 60 litters diseases after parturition and within the first week of life are discussed . Problems in the diagnosis and therapy are correlated with further investigations, i.e . bacteriology, sensitivity tests and in some cases necropsy . Neonatal respiratory distress syndrome and bacterial infections have been found to be the most common diseases in the first days of life in puppies.

J Vet Diagn Invest, 1995 Oct, 7(4), 494 - 9
Comparison of diagnostic tests for bacterial kidney disease in juvenile steelhead trout (Oncorhynchus mykiss); White MR et al.; In order to accurately diagnose bacterial kidney disease caused by Renibacterium salmoninarum in steelhead trout, kidney tissue from experimentally infected fish was evaluated using a commercially available enzyme-linked immunosorbent assay (ELISA) test kit, fluorescent antibody (FA) testing, bacteriologic culture, and histopathology . Seventy-five steelhead trout were randomly assigned to 1 of 4 groups and intraperitoneally inoculated with 0.15 ml saline (n = 20), 1 x 10(10) organisms/ml (n = 18), 1 x 10(8) organisms/ml (n = 18), or 1 x 10(6) organisms/ml (n = 19) of R . salmoninarum . ELISA, FA and bacteriologic culture were positive for R . salmoninarum from the kidney tissue of the 2 groups infected with the highest doses . Although the ELISA and FA tests were accurate when compared to the bacteriologic culture from the 2 groups infected with higher doses of the organism, they were less sensitive at the lowest level of inoculum . Histopathology was not specific for this disease; however, all infected fish had a marked proliferative histiocytic interstitial nephritis, characterized by marked expansion of the renal hematopoietic tissue by histiocytes without tissue necrosis . Other microscopic findings included splenitis and myositis (at the injection site) of some fish.

Eur J Nucl Med, 1995 Oct, 22(10), 1118 - 22
Increased accuracy of the carbon-14 D-xylose breath test in detecting small-intestinal bacterial overgrowth by correction with the gastric emptying rate; Chang CS et al.; To date, there is no general agreement as to which test is to be preferred for the diagnosis of small-intestinal bacterial overgrowth . The 1-g carbon-14 D-xylose breath test has been proposed as a very sensitive and specific test for the diagnosis of bacterial overgrowth . However, in patients with severe gastrointestinal motor dysfunction, the lack of consistent delivery of 14C-D-xylose to the region of bacterial contamination may result in a "negative" result . The aim of this study was to determine whether the accuracy of 14C-D-xylose breath test for detecting bacterial overgrowth can be increased by correction with the gastric emptying rate of 14C-D-xylose . Ten culture-positive patients and ten culture-negative controls were included in the study . Small-intestinal aspirates for bacteriological culture were obtained endoscopically . A liquid-phase gastric emptying study was performed simultaneously to assess the amount of 14C-D-xylose that entered the small intestine . The results of the percentage of expired 14CO2 at 30 min were corrected with the amount of 14C-D-xylose that entered the small intestine . There were six patients in the culture-positive group with a 14CO2 concentration above the normal limit . Three out of four patients with initially negative results using the uncorrected method proved to be positive after correction . All these three patients had prolonged gastric emptying of 14C-D-xylose . When compared with cultures of small-intestine aspirates, the sensitivity and specificity of the uncorrected 14C-D-xylose breath test were 60% and 90%, respectively . In contrast, the sensitivity and specificity of the corrected 14C-D-xylose breath test improved to 90% and 100%, respectively . In conclusion, using the gastric emptying rate of 14C-D-xylose as a correcting factor, we found a higher sensitivity and specificity for the 14C-D-xylose breath test in the detection of small-intestinal bacterial overgrowth than were achieved with the conventional method.

Laryngoscope, 1995 Oct, 105(10), 1058 - 60
Bacteriology of sinusitis in human immunodeficiency virus-positive patients: implications for management; Upadhyay S et al.; The bacteriology of sinusitis in human immunodeficiency virus (HIV)-infected patients has been only sporadically reported . In this study, we report the results of cultures taken from 12 HIV patients with refractory chronic sinusitis who underwent surgery . Nine of the 12 patients had positive cultures with 16 isolates and 5 patients having multiple isolates . Five of the 12 patients grew out atypical or opportunistic infections not responsive to standard medical therapy, including 3 patients with cytomegalovirus, 1 with Aspergillus fumigatus, and 1 with Mycobacterium kansasii . These results suggest the need for aggressive medical care for HIV-infected patients with sinusitis and early intervention for tissue cultures in patients who do not respond to standard antibiotic regimens.

Hepatology, 1995 Oct, 22(4 Pt 1), 1171 - 4
Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial; Rolachon A et al.; The aim of this prospective double-blind study was to evaluate the value of long-term antibiotic prophylaxis using ciprofloxacin for the prevention of spontaneous bacterial peritonitis (SBP) in 60 cirrhotic patients with low ascitic fluid protein levels (< 15 g/L) . The patients were assigned to two groups: group I (n = 28) ciprofloxacin 750 mg per os once a week for 6 months, group II (n = 32) placebo . The two groups were similar for clinical and laboratory characteristics . Twelve patients developed an intercurrent disorder, and 10 patients died during the trial . There were no adverse effects in the treated group . There was a significant decrease in the incidence of SBP (3.6 vs . 22%) (P < .05) and duration of hospitalization (9.3 +/- 4.5 vs . 17.6 +/- 6.2 days) (P < .05) in the treated group as compared with the placebo group . The bacteriological study showed no acquired resistance to ciprofloxacin after 6 months' treatment . These results suggest that long-term preventive antibiotic prophylaxis based on the weekly administration of 750 mg of ciprofloxacin is effective in the prevention of SBP in cirrhotic patients.

Br J Obstet Gynaecol, 1995 Oct, 102(10), 773 - 9
The chronically symptomatic vulva: aetiology and management; Fischer G et al.; OBJECTIVE: To determine the causes and management of chronic vulval symptoms and to compare the findings in patients first presenting to a gynaecologist with those in patients first presenting to a dermatologist . DESIGN: A prospective study of 144 patients, approximately half each being referred to a gynaecologist and a dermatologist . Diagnosis was based on clinical history, vulvoscopy, vulval biopsy and bacteriology . Biopsies were examined by a histopathologist experienced in dermatopathology and gynaecological pathology . RESULTS: The two patient groups were similar in both range and frequency of conditions . The commonest cause of chronic vulval symptoms was dermatitis, which was found in 64% of our patients . Dermatitis occurred alone in 55% and was found in association with histological evidence of human papilloma virus (HPV) in a further 9% . These patients responded to simple dermatological methods, mainly topical corticosteroids . Histopathological evidence of HPV was encountered in only 23% of our patients, and of these 36% also demonstrated dermatitis on biopsy . Most responded to topical corticosteroids . Another 7% had lichen sclerosus, and all responded to potent topical corticosteroid . The remaining 15% demonstrated a range of diagnoses, including psoriasis, dysaesthetic vulvodynia, vulval intraepithelial neoplasia (VIN) and chronic candidiasis . The majority of patients had a corticosteroid responsive dermatosis rather than a gynaecological condition . CONCLUSIONS: The majority of patients with a chronically symptomatic vulva who present to either a gynaecologist or a dermatologist have a dermatological condition that responds to simple dermatological treatments . We believe that the presence or absence of the human papilloma virus is not relevant to most patients with a chronically symptomatic vulva and treatments should not be aimed at eradicating this virus . Histopathologists and gynaecologists who have focused on gynaecological disorders have often missed simple dermatological conditions that are easily treatable.

Gaoxiong Yi Xue Ke Xue Za Zhi, 1995 Oct, 11(10), 552 - 6
Bacteriology of maxillary sinuses in rabbits; Juan KH et al.; To study whether normal sinus flora exist in normal sinus, we used 40 sinuses from 20 New Zealand white rabbits as the animal model . The histological examination was performed on sinus mucosa from each sinus and bacteria from these sinuses were cultured . Surprisingly, 70% of them (28 sinuses) were found to have sinusitis . These sinuses not only contained bacteria in culture but also showed various degree of histological inflammatory reaction in mucosa examination . Of the other 12 normal or near normal sinuses, only two showed positive bacterial culture, and ten of them showed negative bacterial culture either from discharge or mucosa studies . Accordingly, these data suggest that these two studies (bacterial culture and histological mucosa examination) are consistent . Thus, from this study it was concluded that there is no bacteria or few bacteria in normal sinus.

J R Soc Health, 1995 Oct, 115(5), 310 - 3
Surveillance of tuberculosis caused by Mycobacterium bovis in Slovakia; Badalik L et al.; The elimination of tuberculosis (TB) among cattle was claimed in Czecho-Slovakia in the middle of the sixties . Experiences from some countries which eliminated TB among cattle earlier than Czecho-Slovakia indicated a sporadic occurrence of TB caused by M . bovis . A long-term investigation of the occurrence of this 'diminishing zoonosis' has been carried out by a special group of experts (epidemiologists, clinicians, bacteriologists, epizootiologists and veterinary surgeons) on the whole territory of Slovakia . During the period of years 1972-1990 there were discovered 68 new cases of TB in humans caused by M . bovis . This paper analyses the results of the epidemiological investigation of this group of patients from several aspects: eg age, sex, occupation and geographical distribution.

Tidsskr Nor Laegeforen, 1995 Sep 10, 115(21), 2656 - 8
{Diagnostic evaluation of suspected reactive arthritis}; Glennas A et al.; On the basis of an epidemiological study on recently onset, possible reactive arthritides in Oslo we propose a programme for diagnostic evaluation . Disease symptoms and signs provided little help for an ethiological diagnosis . Therefore a variety of diagnostic tests and examinations are recommended in order to obtain a correct diagnosis; such as clinical examination, chemical and serological blood tests, bacteriological examinations from throat, of stools and of specimens from urethra-cervix, examination of synovial fluid and synovial tissue and X-ray examination of affected joints, sacroiliacal joints and lungs . About one third of the recently onset arthritides in the Oslo study were diagnosed as reactive arthritis, one third as possible reactive arthritis and another third as inflammatory arthritides.

Ann Soc Belg Med Trop, 1995 Sep, 75(3), 201 - 10
{Epidemic of bacillary dysentery in the Rwanda refugee camps of the Goma region (Zaire, North Kivu) in August 1994}; Milleliri JM et al.; The authors describe the extension of an outbreak of bacillary dysentery among the Rwandese populations seeking refuge in the region of Goma, Zaire in august 1994 . Analysis of the epidemiological surveillance data and of the bacteriological laboratory results of the Bioforce, show that this epidemic was probably facilitated by the preceding cholera outbreak . In such circumstances, rapid sterilization of the virus reservoir, by short course treatments, might be beneficial in limiting the extension of the epidemic.

Antibiot Khimioter, 1995 Sep, 40(9), 30 - 4
{Cefpiramide (Tamicin) in the treatment of purulent complications of abdominal surgery}; Iakovlev VP et al.; Fifty patients with purulent infection of the abdominal cavity were treated with cefpiramide (Lek, Slovania) . The analysis of the results showed that the clinical effect was favourable in 92 percent of the patients . The bacteriological efficacy amounted to 65.2 percent . The index of the isolates susceptibility was high (72 percent at the average) . The concentration of cefpiramide in the bile from the bile common duct was low (23 micrograms/ml) as a result of its partial or complete obstruction . The adverse reaction (diarrhea) was stated in 1 patient.

Mem Inst Oswaldo Cruz, 1995 Sep-Oct, 90(5), 623 - 8
Low occurrence of arthritic manifestations in patients with pulmonary tuberculosis . T cell subsets and humoral studies; Dlugovitzky D et al.; Given the suspected role of mycobacteria in the establishment of disorders with an autoimmune background and joint damage, a study was conducted to analyze whether rheumatic symptoms were likely to be present in tuberculosis (TB) patients . To this end, 330 patients with a bacteriologic confirmation of tuberculosis were investigated for the presence of arthritic complaints . The latter were recorded in five of them with rheumatic symptoms mostly involving interphalangeal and metacarpophalangeal joints, and preceding the clinical manifestations of the TB illness . Three out of these five patients remained arthritic by the time of the bacteriologic conversion and fulfilled the criteria for the diagnosis of rheumatoid arthritis . In the two remaining patients sputum negativization was accompanied by a disappearance of rheumatic manifestations . These patients were also assessed for their peripheral levels of major T cell subsets as well as for the presence of autoantibodies . Comparisons with a series of non-arthritic TB cases, rheumatoid arthritis patients, and controls revealed that presence of rheumatic manifestations was associated with a different profile of autoantibody formation and T cell subset changes . Evidence recorded in the present study indicates that joint affectation in TB is a rare event, being rather the exception than the rule.

Burns, 1995 Sep, 21(6), 437 - 40
Serum cytokine levels (IL-4, IL-6, IL-8, G-CSF, GM-CSF) in burned patients; Struzyna J et al.; The presence and concentration of selected cytokines (interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were evaluated in the sera of 12 burned patients (6-90 per cent body surface area) . The presence of cytokines in the sera of 20 healthy volunteers (control group) was always undetectable (< 2 pg/ml) . In sera of the burned patients the concentrations of IL-4 or GM-CSF were also below the test sensitivity levels, while G-CSF and IL-6 were present throughout all the observation period and IL-8 was detectable at the onset of massive infections . The serum concentrations of G-CSF and IL-6 increased during the episodes of clinically and bacteriologically detectable infections . Their increases were, however, observable 12-24 h later than the other infection symptoms . Similar increases in G-CSF and IL-6 levels have been detected during corrective surgery (covering of granulation tissue with skin grafts) . It may be concluded that serum G-CSF and IL-6 levels in burned patients may be considered as diagnostic factors, but the delays in the reaction to the massive infection do not allow us to use them for predicting the time of onset of the infection.

Kekkaku, 1995 Sep, 70(9), 561 - 6
{Assessment of effectiveness of BCG vaccination against childhood tuberculosis}; Takamatsu I et al.; We performed a retrospective analysis of the history of BCG vaccination of 367 childhood patients who were treated for active tuberculosis (TB) in our hospital from 1976 to 1994 . Fifty-eight percent of 367 cases, 83.1% of cases under 5 years of age and 92% of tuberculous meningitis had not received BCG . To investigate the effectiveness of BCG vaccination against TB, we carried out case-control studies using 59 patients with TB and 118 controls without TB . The cases were patients treated for TB in our hospital from 1988 through Nov . 1994 . Two controls were chosen for every case with matching for sex, age at admission, year of admission and place of residence . Based on whole 59 pairs, BCG vaccination was shown to have protective efficacy of 78% (95% confidence interval {CI}, 57-89%) . For 34 pairs of under 5 years of age, estimated efficacy was 92% (95%CI, 80-97%), for primary pulmonary disease (27 pairs) it was 92% (95%CI, 78-97%) . For bacteriologically confirmed TB (27 pairs), it was 84% (95%CI, 58-94%), while for bacterilogically negative TB (32 pairs) 71% (95%CI, 27-89%) . Our results indicate that BCG vaccination with multipuncture methold protected considerably against TB in infants including primary pulmonary TB.

Kekkaku, 1995 Sep, 70(9), 505 - 9
{Management of nontuberculous mycobacteriosis in health centers and tuberculosis surveillance system}; Shigeto E; Nontuberculous Mycobacteriosis (NTM) is a different disease from tuberculosis, but in Japan most of them are still obliged to be treated as tuberculosis under medical insurance scheme and included statistically in the number of tuberculosis . In this investigation, patients of NTM who were at first registered as tuberculosis and diagnosed later as NTM or found to be positive for nontuberculous mycobacteria were analysed from the standpoint of tuberculosis statistics and activities at health centers . Out of 1207 newly registered tuberculosis in 1993 at 23 health centers (HCs) or its branches in Hiroshima Prefecture, 482 cases were bacteriologically positive, and among them 40 cases were found to be NTM later . Under the current tuberculosis surveillance system, 4 cases from 1 HC were omitted from the tuberculosis registry, 10 cases from 4 HCs were kept on the tuberculosis registry as 'culture positive for nontuberculous mycobacterium', 15 cases from 7 HCs were registered as 'tuberculosis with nontuberculous mycobacteriosis as a complication' and in 11 cases no informations on NTM were entered into the registry . Only 6 smear positive cases which were registered as 'culture positive for nontuberculous mycobacteria' were excluded from the number of smear positive tuberculosis under the surveillance system . In other investigation made by hospitals in the same area on NTM, 59 patients with definite NTM were reported in 1993 . At least 52 were registered first as tuberculosis, thus NTM occupies at least 4.3 percent of all newly reported tuberculosis and 10.8 percent of new smear positive cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Laryngoscope, 1995 Sep, 105(9 Pt 1), 949 - 57
The fate of the skin graft in laryngoplasty; Gordon NA et al.; In laryngoplasty procedures, laryngotracheal soft tissue defects are often repaired using skin grafts . While stenting is necessary to approximate and immobilize the graft, prolonged stenting causes increased bacterial counts, granulation tissue formation, tissue ischemia, and graft failure . Optimal time for stent removal has not been experimentally defined . Using the ferret animal model, 24 laryngoplasty procedures were performed . The subjects were stented by group for 0, 3, 7, 14, or 28 days . Analysis consisted of quantitative bacteriology, dye perfusion, and quantitative histologic assessment of graft viability . Tissue culture results revealed that by 3 days after the procedure all groups had 10(5) CFU of bacteria per gram of tissue . Graft viability in successful procedures was maximal in the 7-day group and statistically significant from the 3-day to the 28-day groups . In conclusion, while stenting is necessary for graft adherence, prolonged exposure to local tissue sepsis leads to progressive graft destruction.

J Clin Oncol, 1995 Sep, 13(9), 2272 - 7
Escalated MVAC with or without recombinant human granulocyte-macrophage colony-stimulating factor for the initial treatment of advanced malignant urothelial tumors: results of a randomized trial; Logothetis CJ et al.; PURPOSE: Hematopoietic growth factors have been shown to ameliorate the side effects of chemotherapy . Here we assess the ability of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) to increase the dose-intensity and reduce the side effects of escalated methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy . PATIENTS AND METHODS: A prospective randomized trial to compare escalated MVAC versus escalated MVAC with rhGM-CSF was conducted . All patients were treated at The University of Texas M.D . Anderson Cancer Center (UTMDACC) and had a metastatic or unresectable urothelial tumor . Forty-eight patients were randomized (25 to MVAC with rhGM-CSF and 23 to escalated MVAC alone) . The clinical characteristics of the study populations were similar (ie, degree of tumor dissemination and performance status) . RESULTS: The dose-intensity in the two arms of the study did not differ significantly . No difference in the frequency of bacteriologically documented infections occurred between the two study arms . CONCLUSION: The use of the hematopoietic growth factor rhGM-CSF did not result in an increased dose-intensity of escalated MVAC . The inability to increase the dose-intensity of MVAC further was a result of nonhematologic side effects of the chemotherapy . Escalation of treatment delivered at its median-tolerated dose is unlikely to result in additional therapeutic benefit for patients with common solid tumors . Future development of therapy may require the development of new agents or concepts, rather than modification of existing therapies.

Fertil Steril, 1995 Sep, 64(3), 657 - 60
Spermoculture: improvement of the bacteriological quality of samples by direct verbal counseling before semen collection; Boucher P et al.; OBJECTIVE: To compare the bacteriologic quality of samples after direct verbal or written counseling for semen collection . DESIGN: Prospective randomized comparative study . SETTING: Laboratories of biology of reproduction and microbiology in university hospitals . PATIENTS: Male partners of infertile couples on their first attempt to collect semen were assigned randomly into two groups . INTERVENTION: In one group (n = 52) the patients were given direct verbal instruction by one of the investigators on how to avoid bacterial contamination during semen collection . In the other group (n = 52) the patients were asked to follow the usual written instructions . MAIN OUTCOME MEASURE: Bacterial count, number of species, classification of the samples in positive, negative, and noninformative cultures . RESULTS: Direct verbal teaching significantly reduced the bacterial count (2.06 +/- 1.6 versus 3.29 +/- 1.6 log cfu/mL; mean +/- SD) and number of species (1.44 +/- 2.02 versus 3.25 +/- 2.25), increased the percentage of sterile cultures (59.6% versus 23.1%), and decreased the percentage of noninformative cultures (29.9% versus 50%) . CONCLUSION: Direct verbal counseling on how to avoid bacterial contamination during semen collection significantly improves the bacteriologic quality of the samples.

Can J Anaesth, 1995 Sep, 42(9), 801 - 4
Propofol emulsion and bacterial contamination; McHugh GJ et al.; Package insert information provided with propofol advises prompt administration following its drawing-up . This study has examined the delays which occur between drawing-up and administration of propofol in clinical practice and the incidence of bacterial contamination occurring under such conditions . Two hundred and fifty-four clinical uses of propofol were examined . Mean elapsed times (range) from drawing-up to induction were 28.8 min (1-172), and 11.6 min (1-65) from induction to culture inoculation . The delay to induction exceeded ten minutes in 68.5% of propofol uses . Sixteen cultures (6.3%) grew bacteria . Delay to induction was not associated with increased chances of bacterial growth in any of the samples . Increasing delay between induction and culture inoculation was associated with greater odds of bacterial growth, which is consistent with contamination occurring at or after induction . Whilst the manufacturers advise prompt administration, our findings show that when inadvertent delays occur, propofol remains bacteriologically safe to use under standard clinical conditions . Microbial contamination can occur at any stage, thus attention to asepsis remains important throughout the administration period.

Epidemiol Mikrobiol Imunol, 1995 Sep, 44(3), 104 - 6
{Selection of criteria for evaluation of septic conditions}; Michalkova L et al.; In a prevalence study of septicaemia at a surgical clinic 645 patients were followed up . The assembled data were compared with data from a similar study made in 862 patients which was implemented in different departments of Ostrava hospitals . In the two studies different criteria of sepsis were used . In the study conducted at the surgical clinic these criteria were more precisely specified and extended . This trebled the assessed number of sepses . From comparison of results of these studies ensues that more frequent bacteriological monitoring of patients in necessary.

APMIS, 1995 Sep, 103(9), 651 - 4
Proposed new bacterial taxa and proposed changes of bacterial names published during 1994 and considered to be of interest to medical and veterinary bacteriology; Frederiksen W et al.; At the recent meeting of the International Committee on Systematic Bacteriology (ICSB) in 1994 it was decided to establish an ad hoc committee within the ICSB with the task of formulating an approach to communication of new names to users in medical and veterinary bacteriology . This is the first list which includes 61 names.

Jpn J Antibiot, 1995 Sep, 48(9), 1093 - 118
{Comparative clinical study of azithromycin with tosufloxacin tosilate in the treatment of acute odontogenic infection}; Sasaki J et al.; To objectively assess azithromycin (AZM) for its clinical efficacy, safety and usefulness in the treatment of acute odontogenic infections (periodontitis, pericoronitis and osteitis of the jaw), a double-blind, randomized, multi-center trial was conducted in which tosufloxacin tosilate (TFLX) was used as the control drug . AZM was administered to 90 patients at a once-daily 500 mg dose for 3 days, while TFLX was given to 90 patients at a 150 mg t.i.d . dose for 7 days . 1 . The clinical efficacy rates calculated according to evaluation at an endpoint set on the 3rd day of treatment by a committee of experts were 85.9% (73/85) in the AZM group and 78.9% (71/90) in the TFLX group . No statistically significant difference between the treatment groups was detected, and clinical equivalence was verified (p = 0.002) . 2 . The clinical efficacy rates according to evaluations made by investigators at the end-of-tail point was 87.1% (74/85) in the AZM group and 73.3% (66/90) in the TFLX group . The efficacy rate in the AZM group was higher than that in the TFLX group, and the difference was statistically significant (p = 0.006) . 3 . The bacteriological elimination rate in the AZM group was 97.5% (39/40) and that in the TFLX group was 85.7% (30/35), but the difference was deemed statistically not significant . 4 . Adverse reactions were observed in 11 of 88 cases (12.5%) in the AZM group and 5 of 90 cases (5.6%) in the TFLX group . Six of 85 cases (7.1%) in the AZM group and 5 of 85 cases (5.9%) in the TFLX group showed laboratory abnormalities . However, neither adverse reactions nor laboratory abnormalities showed any differences in statistical significance between the treatment groups . 5 . The safety rates, expressed as percentages of cases with no adverse events and no laboratory abnormalities, was 84.1% (74/88) in the AZM group and 90.0% (81/90) in the TFLX group . The difference between the two groups was found to be statistically insignificant . 6 . The usefulness rates, the ratio of cases rated as either "Very useful" or "Useful", was 83.9% (73/87) in the AZM group, and it was statistically higher (p = 0.025) than 72.2% (65/90) obtained for TFLX group . Judging from the above results, it has been concluded that AZM is as useful as TFLX in the treatment of acute dental infections.

J Dairy Sci, 1995 Aug, 78(8), 1684 - 92
Analysis of associations between major histocompatibility complex (BoLA) class I haplotypes and subclinical mastitis of dairy cows; Aarestrup FM et al.; The associations between BoLA class I haplotypes and subclinical mastitis were investigated using information on 333 cows from three different breeds and crossbreeds from 14 dairy herds in Denmark . Somatic cell count and bacteriological status were used as markers for subclinical mastitis . Associations between BoLA class I haplotypes and IMI status were also determined . The association between BoLA class I haplotypes and subclinical mastitis was weak . The A10(W50), A11, A12(A30), A16, A19(A6), A21, A26, and A31(A30) alleles were associated with different markers of subclinical mastitis . Susceptibility or resistance to the two bacteria categories was associated with different alleles . This study indicated that BoLA antigens may be involved in resistance to mastitis and that resistance may be specific for a particular pathogen.

J Chemother, 1995 Aug, 7(4), 371 - 9
Once-daily tobramycin therapy in lower respiratory tract infections; Grassi C et al.; In a multicenter Italian study of 104 adult patients with severe bacterial lower respiratory tract infections, the safety and efficacy of a regimen of high dose, once-daily tobramycin alone or in combination with antipseudomonas betalactams was assessed . The overall bacteriological response was an elimination of the original pathogen in 70% of the patients while the overall clinical response mirrored the bacteriological results with a successful clinical outcome in 78% of patients . Adverse experiences were, in general, few and mild without oto- or nephrotoxicity . The once-daily, high dose regimen of tobramycin proved to be a safe and efficacious therapy for severe lower respiratory tract infections in adult patients.

Clin Infect Dis, 1995 Aug, 21 Suppl 1, S66 - 71
Tuberculosis as an opportunistic disease in persons infected with human immunodeficiency virus; Castro KG; Tuberculosis, a bacterial disease caused by the Mycobacterium tuberculosis complex, is becoming an increasingly common opportunistic disease in persons infected with the human immunodeficiency virus (HIV) . M . tuberculosis is transmitted from person-to-person by airborne droplet nuclei . Persons who are exposed to these droplet nuclei in poorly ventilated environments are at risk of becoming infected with M . tuberculosis . HIV infection is probably the most significant risk factor associated with progression from latent M . tuberculosis infection to active disease . Thus, HIV-infected persons should avoid exposure to M . tuberculosis, they should be screened for evidence of latent infection with the tuberculin skin test, and they should be offered preventive therapy . Because many severely immunosuppressed anergic HIV-infected persons have been found to have an increased risk of developing active tuberculosis, decisions to use preventive therapy should be individualized on the basis of the local prevalence of tuberculosis and drug-resistance patterns . Persons with active tuberculosis should receive at least 6 months of treatment with recommended regimens, preferably with directly observed therapy, to ensure adequate bacteriologic response, completion of therapy, and cure . Chronic suppressive therapy after completion of therapy is currently not recommended.

Dig Dis Sci, 1995 Aug, 40(8), 1798 - 804
Intestinal transit and bacterial translocation in obstructive pancreatitis; Moody FG et al.; Pancreatic infection from gut-derived bacteria has emerged as the major cause of death in necrotizing pancreatitis . Bacterial overgrowth of indigenous enteric organisms as a consequence of guts stasis (ileus) represents a potential initial event in this process . The present study was designed to examine the interrelationships between intestinal transit, enteric bacteriology, and the translocation of bacteria from the gut lumen to mesenteric lymph nodes and splanchnic viscera during experimentally induced acute pancreatitis . Male rats underwent pancreaticobiliary duct ligation (PBDL) or sham surgery and were sacrificed after 24, 48, or 96 hr . Severity of pancreatitis was assessed with histology, tissue water content, and amylase and lipase levels . Intestinal transit was measured with fluorescent tracers . Blood, mesenteric lymph nodes (MLNs), splanchnic organs, and gut luminal contents were subjected to bacteriologic analysis . PBDL was followed by biochemical and histologic evidence of progressive pancreatic injury at each time interval . Enteric bacteria within the gut and in adjacent MLNs increased as intestinal transit decreased after PBDL-induced pancreatic inflammation . Surprisingly, all parameters returned to control levels by 96 hr in spite of progression of pancreatic inflammation.

Am J Respir Crit Care Med, 1995 Aug, 152(2), 550 - 6
Pulmonary infection during the acute respiratory distress syndrome; Sutherland KR et al.; Pulmonary infection is thought to be a common complication of ARDS . We undertook this prospective study to determine the incidence of pulmonary infection in patients with ARDS, and to evaluate the impact of nosocomial pneumonia on severity of ARDS and on survival . Two hundred one bronchoscopies were performed in 105 patients with ARDS with retrieval of distal airway secretions by bronchoalveolar lavage (BAL) and protected specimen brush (PSB) . Whenever possible, bronchoscopy was performed at predetermined times: Day 3, Day 7, Day 14, and Day 21 after the onset of ARDS . The majority of patients were receiving antibiotics at the time of study . Changes in bacterial flora over time were determined by quantitative cultures of BAL and PSB . Bacterial growth was common, but usually at small concentrations . Only 16 patients met quantitative culture criteria for pneumonia (PSB > or = 10(3) cfu/ml or BAL > or = 10(4) cfu/ml) . Correlation was poor between clinical evidence of pneumonia and pneumonia by quantitative culture criteria: clinical criteria had a very low sensitivity (24%) for predicting positive quantitative culture results, and a low specificity (77%) for predicting negative quantitative culture results . There was no correlation between total colony counts on BAL or PSB and severity of ARDS as judged by Pao2/FIo2 ratios, days receiving ventilation, or compliance . Furthermore, there was no correlation between bacterial growth and survival . We conclude that pneumonia defined by quantitative bacteriology is uncommon in ARDS . The potentially confounding role of broad-spectrum antibiotics should be studied further.

Infect Immun, 1995 Aug, 63(8), 2840 - 5
Characterization of a Legionella micdadei mip mutant; O'Connell WA et al.; The pathogenesis of Legionella micdadei is dependent upon its ability to infect alveolar phagocytes . To better understand the basis of intracellular infection by this organism, we examined the importance of its Mip surface protein . In Legionella pneumophila, Mip promotes infection of both human macrophages and freshwater protozoa . Southern hybridization and immunoblot analyses demonstrated that mip sequences were present and expressed within a panel of virulent L . micdadei strains . Using allelic exchange mutagenesis, we then constructed an L . micdadei strain that completely and specifically lacked Mip . Although unimpaired in its ability to grow in bacteriologic media, this Mip mutant was defective in its capacity to infect U937 cells, a human macrophage-like cell line . Most significantly, the Mip- organism displayed a 24-fold reduction in survivability immediately after its entry into the phagocyte . Similarly, the mutant was less able to parasitize Hartmannella amoebae . Taken together, these data argue that Mip specifically potentiates intracellular growth by L . micdadei.

Tuber Lung Dis, 1995 Aug, 76(4), 300 - 10
Atypical mycobacteria in extrapulmonary disease among children . Incidence in Sweden from 1969 to 1990, related to changing BCG-vaccination coverage; Romanus V et al.; SETTING: In April 1975, the general BCG vaccination of newborns in Sweden was replaced by selective vaccination of groups at increased risk of tuberculosis . OBJECTIVE: To relate the incidence of atypical mycobacterial disease in children to BCG vaccination . DESIGN: A nationwide survey in Sweden during the period 1969-90 disclosed 390 children under 15 years of age with bacteriologically confirmed atypical mycobacteria from extrapulmonary lesions . RESULTS: The average, annual incidence of atypical mycobacterial disease per 100,000 children under 5 years of age increased from 0.06 during the period 1969-74 to a maximum level of 5.7 during 1981-85 . Among the cohorts born in Sweden in the period 1975-85, the cumulative incidence rate before 5 years of age was estimated at 26.8 per 100,000 non-BCG-vaccinated children and at 4.6 among those BCG-vaccinated, ratio 5.9 (95% confidence limits 1.6, 48.5) . Mycobacterium avium-intracellulare was found in 83% . Disseminated, fatal disease developed in 3 children . The remaining ones suffered from local infections, most often lymph-node or soft-tissue lesions . The observed incidence of bacteriologically confirmed diagnosis was estimated to represent approximately 40% of the 'true' number, if patients with diagnosis based on histological, clinical and epidemiological findings only were included . CONCLUSION: The present study indicates that BCG vaccination plays a role in protection against localized disease caused by atypical mycobacteria in children.

J Clin Pathol, 1995 Aug, 48(8), 719 - 24
Simple method for quantifying viable bacterial numbers in sputum; Pye A et al.; AIMS--To establish a simple method of quantitative culture for determining the viable bacterial numbers present in expectorated sputum samples . METHODS--Sputum samples were homogenised with dithiothreitol, sterile saline or glass beads to determine which method recovered the greatest number of viable bacteria . Culture broths were also incubated with dithiothreitol and sampled over time to determine its effect on bacterial viability . Sputum samples homogenised with dithiothreitol were diluted in sterile saline and sampled using either standard bacteriological loops or a precision pipette to determine which method resulted in the least variation . RESULTS--Homogenisation of sputum using dithiothreitol increased the recovery of viable bacteria compared with sterile glass beads and/or saline, with no apparent effect on bacterial viability when incubated with culture broths . By inoculating agar plates with 10(-3), 10(-4) and 10(-5) dilutions of the homogenised sputum sample, all potential pathogens could easily be identified . A 10 microliter sample volume dispensed by precision pipette and spread with a "hockey stick" resulted in the least variation between plates (less than 16%) and an even distribution of bacterial colonies . Numbers of viable bacteria recovered from different aliquots of individual sputum samples were generally of the same order of magnitude . CONCLUSIONS--This method represents a relatively quick and simple technique for accurately quantifying viable bacteria present in sputum samples . The use of a small portion appears to be representative of the sample as a whole.

J Clin Microbiol, 1995 Aug, 33(8), 2077 - 81
Molecular epidemiology of tuberculosis in Denmark in 1992; Yang ZH et al.; The incidence of tuberculosis (TB) is increasing all over the world, including in countries with a high standard of living and good social security . Denmark represents such a region . Furthermore, it is a small country (5 million inhabitants) with a long tradition in TB control, including a centralization of the bacteriological diagnostic facility . The present study was intended to analyze the transmission of Mycobacterium tuberculosis in a country in which TB has low endemicity by a combination of conventional epidemiological approaches and DNA fingerprinting techniques, whereby individual bacterial strains can be traced . M . tuberculosis isolates from 92% of all new cases of bacteriologically verified TB in Denmark during 1992 were subjected to IS6110 DNA fingerprinting to visualize the DNA restriction fragment length polymorphism (RFLP) patterns of the isolated strains . The data obtained from the RFLP analyses were interpreted by using demographic data, such as age, sex, ethnicity, and residence, for the patients . The risk factors among the patients for being part of an active chain of transmission, as opposed to demonstrating reactivation of a previously acquired latent infection, were estimated by statistical analyses . The magnitude of TB transmission in 1992 in Denmark was determined, and transmitted infections were shown to comprise at least one quarter of the total number of cases . Almost half of the TB cases involved patients of foreign origin . However, most of these isolates showed unique DNA fingerprint patterns and were rarely part of an active chain of transmission . The major chains of recent transmission were localized to distinct geographical regions in the country . TB is frequent among immigrants, especially from Asia and Africa, but it is apparently readily suspected, diagnosed, and treated by the health care system . Danish patients with pulmonary symptoms are not primarily suspected to have TB and, therefore, play an important role in recent TB transmission in Denmark.

Neuroimaging Clin N Am, 1995 Aug, 5(3), 401 - 25
Inflammatory and infectious processes of the cervical spine; Ruiz A et al.; This article discusses infectious and inflammatory processes of the cervical spine . Major emphasis is placed on infectious discitis/osteomyelitis and epidural abscess, particularly the epidemiologic, bacteriologic, pathophysiologic, and clinical aspects, as well as the major role played by magnetic resonance imaging and other imaging modalities used in the detection and diagnosis of these processes.

Jpn J Clin Oncol, 1995 Aug, 25(4), 168 - 72
Leukemoid reaction resulting from multiple cytokine production in metastatic mucoepidermoid carcinoma with central necrosis; Chen YM et al.; We report a male patient with metastatic high-grade mucoepidermoid carcinoma and associated leukemoid reaction . The patient was transferred to our hospital due to persistent spiking fever, marked granulocytosis, and suspected liver abscess . After thorough bacteriological studies, including cultures of blood and material aspirated from the "liver abscess", no evidence of infection was documented . The patient suffered from persistent spiking fever for more than 4 weeks in spite of empirical antibiotic treatment, and repeated aspiration of the presupposed liver abscess . He underwent exploratory laparotomy for intended surgical evacuation of the liver abscess and bacteriological diagnosis . The operative findings were compatible with metastatic carcinoma with multiple liver and retroperitoneal lymph node involvement and tumor necrosis . The pathology report indicated high-grade mucoepidermoid carcinoma . Immunohistochemistry showed positive staining for interleukin-1 alpha (IL-1 alpha) and IL-6 . Elevation of cytokine levels in the necrotic tumor fluid, including IL-1 alpha, IL-6, granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor was confirmed by ELISA test . This case shows that multiple cytokine production from a metastatic tumor and its central necrotic area in the liver can produce a febrile leukemoid reaction mimicking a pyogenic liver abscess.

J Hosp Infect, 1995 Aug, 30(4), 245 - 52
Survey of operating theatres in Great Britain and Ireland; Humphreys H et al.; A survey of operating theatres in Great Britain and Ireland by postal questionnaire was undertaken to determine the number of non-ventilated theatres in use, the number of designated theatres for specialist surgery and how and when bacterial sampling is conducted . Replies were received from 147 centres covering 438 operating theatre suites . Eighty-seven (59%) centres contained three or fewer suites and only 32% did not have a designated theatre for any specialist surgery . One hundred and seventy-three (40%) theatre suites were built over 20 years ago and 28 non-ventilated theatres were identified, mainly used for minor surgery (e.g . removal of 'lumps') . Four percent of plenum and 9% of ultraclean theatres are never monitored bacteriologically and settle plates are used in 72 (49%) centres . This survey suggests there is some confusion over the indications for bacteriological monitoring and what constitutes acceptable standards . The use of non-ventilated theatres, except for the most minor of procedures, is of some concern and should be phased out.

Int J Syst Bacteriol, 1995 Jul, 45(3), 507 - 14
A taxonomic study of the genus Streptomyces by analysis of ribosomal protein AT-L30; Ochi K; The ribosomal AT-L30 proteins from 81 species of the genus Streptomyces as listed by Williams et al . in Bergey's Manual of Systematic Bacteriology were analyzed . My results provided further evidence that the genus Streptomyces is well circumscribed . On the basis of levels of AT-L30 N-terminal amino acid sequence homology, the strains were classified into four groups (groups I to IV) and a nongrouped category, whose members contained amino acid sequences characteristic of each species . A phylogenetic tree constructed on the basis of the levels of similarity of the amino acid sequences revealed the existence of six clusters within the genus . The first cluster contains the members of groups I and II together with several other species; the second cluster contains the members of groups III and IV and several other species; the third cluster contains Streptomyces ramulosus and Streptomyces ochraceiscleroticus; the fourth cluster contains only Streptomyces rimosus; the fifth cluster contains Streptomyces aurantiacus and Streptomyces tubercidicus; and the sixth cluster contains Streptomyces albus and Streptomyces sulphureus . Considerable agreement between the results of the AT-L30 analyses and the results of numerical phenetic classification was found, although there were numerous disagreements in details . For example, four groups (groups I to IV) defined by the AT-L30 analysis data did not correlate with the aggregate groups defined by numerical classification . In general, but not always, the species classified in a particular cluster in the numerical classification system had the same or similar AT-L30 terminal amino acid sequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Rev Argent Microbiol, 1995 Jul-Sep, 27(3), 115 - 22
{Bacteriological study of seawater for recreational use}; Cabezali CB et al.; A study was conducted at the request of the authorities of the Municipality of Bahia Blanca city, in order to decide whether the sea-water of a swimming pool was suitable for recreational purposes . The characterization of the water was performed through bacteriological indicators and the following groups of bacteria were studied: marine and terrestrial viable aerobic heterotrophic bacteria; total coliforms; Escherichia coli and fluorescent Pseudomonads . Salinity, temperature and pH were registered together with meteorological parameters . In every case, the bacteriological values obtained were lower than those of the most strict international standards used worldwide for bathing waters . In this way, the particular dynamic processing of the water entering the swimming pool from Blanca Bay becomes important, since previous studies conducted on the water of its Principal Channel had yielded high bacteriological values which rendered it unsuitable for bathing . This work shows that in this tidal-flats system, extrapolation of results is not valid . These conditions will remain the same if other factors do not change in the tidal-flats that surround the swimming pool.

Indian J Lepr, 1995 Jul-Sep, 67(3), 301 - 8
Bacterial clearance with WHO--recommended multidrug regimen for multibacillary leprosy; Kishore BN et al.; Sixty multibacillary leprosy patients with an average initial bacteriological index (BI) of 2.5 were followed up after they had completed the WHO--recommended multidrug therapy regularly till attaining bacteriological negativity . The minimum duration of treatment was two years as stipulated by WHO and the maximum duration for reaching negativity was seven years (mean 4.25 years) . The minimum time for the attainment of bacteriological negativity was one year and the maximum was 6.75 years (mean 3.75 years) . The higher the initial BI the longer was the time taken for the attainment of bacteriological negativity . The average fall of BI per year was 0.67 . Dapsone monotherapy received before the commencement of MDT, prednisolone received during therapy and the type of leprosy did not have any effect on the time taken for bacteriological clearance . There was no relapse during the period of observation (mean 2.83 years) . The site to attain negativity last was the ear lobe, in 95% of the cases.

Indian J Lepr, 1995 Jul-Sep, 67(3), 293 - 300
Role of antineural antibodies in perpetuation of a pre-existing peripheral nerve damage in leprosy; Desikan P et al.; This study was carried out in order to find out whether antineural antibodies had a role to play in perpetuating pre-existing nerve damage in leprosy . Indirect ELISA was carried out on sera from 20 leprosy patients and five normal controls using antigen prepared from peripheral nerves of a cured bacteriologically negative leprosy patient . None of the patients had significant levels of IgG antibodies whereas eight of them (40%) had significant levels of IgM antibodies . However, there was no correlation with duration of disease, treatment received, nerve enlargement or active neuritis . The nature of these antibodies is discussed.

J Antimicrob Chemother, 1995 Jul, 36 Suppl A, 99 - 108
Safety and efficacy of meropenem in hospitalised children: randomised comparison with cefotaxime, alone and combined with metronidazole or amikacin . Meropenem Paediatric Study Group; Schuler D; In this multicentre, randomised study of 170 children hospitalised with bacterial infections, meropenem (10 to 20 mg/kg every 8 h) was found to be as effective and as well tolerated as cefotaxime (100 to 150 mg/kg/day), with or without amikacin or metronidazole . Most drug-related adverse events were mild and self-limiting . Neither regimen was associated with seizures . The overall incidence of clinically significant laboratory changes was similar in the two treatment groups . Satisfactory clinical responses were obtained in 94/96 (98%) patients treated with meropenem monotherapy and 43/46 (93%) children treated with cefotaxime regimens, while satisfactory bacteriological responses were obtained in 25/28 (89%) and 9/10 (90%) patients, respectively . Meropenem monotherapy appears to be a well-tolerated and effective drug for paediatric infections.

J Antimicrob Chemother, 1995 Jul, 36 Suppl A, 191 - 205
Meropenem versus imipenem/cilastatin in intra-abdominal infections requiring surgery . Meropenem Study Group; Geroulanos SJ; In a multicentre, open, randomised study, the efficacy and tolerability of intravenous meropenem (1 g every 8 h, infusion or bolus) was compared with that of intravenous imipenem/cilastatin (1 g every 8 h, infusion) in 232 hospitalised patients with moderate to severe intra-abdominal infections . At the end of therapy, a satisfactory clinical response (cure or improvement) was seen in 79/82 (96%) evaluable meropenem patients and 83/88 (94%) imipenem/cilastatin patients; this was still seen at follow-up (57/63; 90% and 58/66; 88%, respectively) . A satisfactory bacteriological response (elimination or presumed elimination) was seen in 69/82 (84%) meropenem patients and 71/88 (81%) imipenem/cilastatin patients at the end of therapy and in 52/62 (84%) and 55/70 (79%), respectively, at follow-up . There was a high level of clinical cure or improvement (95% for both treatment groups) in the 120 patients (60 in each group) who had polymicrobial infections . A similar incidence of adverse events was seen in each group: 45/116 patients in the meropenem group (72 events) and 42/116 patients in the imipenem/cilastatin group (65 events); the adverse event profiles were also similar, with injection site inflammation and elevated transaminases the most frequent in both groups . The results of this study indicate that monotherapy with meropenem was as effective and as well tolerated as the combination of imipenem/cilastatin in the treatment of moderate to severe intra-abdominal infections.

J Antimicrob Chemother, 1995 Jul, 36 Suppl A, 179 - 89
Antibiotic monotherapy with meropenem in the surgical management of intra-abdominal infections; Huizinga WK et al.; In an open, multicentre, randomised study, the efficacy and safety of meropenem monotherapy as adjuvant antibiotic therapy in the surgical management of intra-abdominal infection was compared with that of the combination of cefotaxime and metronidazole . A total of 160 hospitalised adult patients with intra-abdominal infection requiring surgery were treated intravenously with either meropenem 1 g every 8 h (by bolus injection or infusion; n = 77) or cefotaxime 2 g and metronidazole 500 mg every 8 h (n = 83) . Clinical and bacteriological responses to antibiotic therapy were assessed at the end of treatment and at 2-4 weeks' follow-up after treatment . The clinical response rates at the end of treatment and follow-up were 91% and 96%, respectively, for meropenem and 100% and 97%, respectively, for cefotaxime plus metronidazole . The bacteriological response rates were 90% and 93%, respectively, for meropenem and 92% at both time points for cefotaxime plus metronidazole . Both treatments were well tolerated . In this study, meropenem monotherapy was effective and as well tolerated as cefotaxime plus metronidazole . Meropenem monotherapy should, therefore, prove a useful alternative to standard combination therapy for the empirical treatment of intra-abdominal infections.

Am J Surg, 1995 Jul, 170(1), 44 - 50
Classification and treatment of local septic complications in acute pancreatitis; Howard TJ et al.; BACKGROUND: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA) . Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined . The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis . PATIENTS AND METHODS: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups . Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission . Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed . RESULTS: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score > 15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days, P = 0.02), required necrosectomy with drainage (65% versus 4%, P < 0.001) rather than simple drainage (3% versus 86%, P < 0.001), more reoperations (2.3 versus 1.1, P < 0.05), and had a significantly higher mortality rate (35% versus 4%, P < 0.05) . In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than either patients with SN or PA (P < 0.05) . CONCLUSIONS: We conclude that this classification system allows for the stratification of patients into three distinct groups--infected necrosis, sterile necrosis, and pancreatic abscess--and has both therapeutic and prognostic usefulness.

J Urol, 1995 Jul, 154(1), 89 - 92
Outcome prediction in patients with Fournier's gangrene; Laor E et al.; We treated 30 patients with Fournier's gangrene during a 15-year period . Data were collected on demographics, medical history, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology . The timing and degree of surgical debridement as well as antibiotic therapy were also reviewed . The extent of disease was calculated from body surface area nomograms . Data were stratified according to the outcomes of death (13 patients) or survival (17) . Patients who survived were significantly younger (53 years old, range 23 to 90) than those who died (71 years old, range 53 to 83, p = 0.004) . Admission laboratory parameters that were statistically related to outcome included hematocrit, blood urea nitrogen, calcium, albumin, alkaline phosphatase and cholesterol levels . White blood count, platelets, potassium, bicarbonate, blood urea nitrogen, total protein, albumin and lactic dehydrogenase levels 1 week following hospitalization were also associated with outcome . The greater mean extent of body surface area involved among patients who died was not statistically different from that of those who lived (7.16 and 4.32%, respectively, p = 0.1) . The number of surgical debridements did not seem to influence outcome . To assess better the physiological profile of the patients in both outcome categories, the acute physiology and chronic health evaluation II severity score was modified to create a Fournier's gangrene severity index . The mean Fournier's gangrene severity index for survivors was 6.9 +/- 0.9 compared to 13.5 +/- 1.5 for nonsurvivors . Regression analysis demonstrated a strong correlation between Fournier's gangrene severity index and death rate (correlation coefficient = 0.934, p = 0.005) . Using a Fournier's gangrene severity index threshold value of 9, there was a 75% probability of death with a score greater than 9, while a score of 9 or less was associated with a 78% probability of survival (p = 0.008) . In conclusion, Fournier's gangrene is an infectious disease affecting an ever aging population of patients . Deviation from homeostasis is the most important parameter predictive of outcome and not the extent of disease or performance of surgical debridement . The Fournier's gangrene severity index is an objective and simple method to quantify the extent of metabolic aberration that may be used to predict outcome . We recommend the use of the Fournier's gangrene severity index when evaluating therapeutic options and reporting results.

J Urol, 1995 Jul, 154(1), 19 - 24
Rufloxacin once daily versus ciprofloxacin twice daily in the treatment of patients with acute uncomplicated pyelonephritis; Bach D et al.; PURPOSE: We compare the bacteriological and clinical efficacy of rufloxacin and ciprofloxacin in patients with acute uncomplicated pyelonephritis . MATERIALS AND METHODS: A total of 110 outpatients was enrolled in a randomized, double-blind multicenter study and treated for 10 days with 200 mg . rufloxacin daily (after a loading dose of 400 mg . on day 1) or 500 mg . ciprofloxacin twice daily . Bacteriological and clinical efficacy was based on the accumulated outcomes assessed at the end of treatment, and at 2 and 4 to 6 weeks . RESULTS: The bacteriological and clinical success rates of rufloxacin and ciprofloxacin were comparable: 55.6% versus 58.8% and 74% versus 71%, respectively (95% confidence interval -28% to +22% and -20% to +25%, respectively) . Both study medications were well tolerated . CONCLUSIONS: Rufloxacin once daily is a good alternative in the outpatient treatment of acute uncomplicated pyelonephritis.

Bol Oficina Sanit Panam, 1995 Jul, 119(1), 1 - 10
{Analysis of restriction fragment length polymorphism (RFLP) in epidemiology of tuberculosis}; Gomez Marin JE et al.; The purpose of this study was to determine the polymorphism of insertion segment 6110 (IS6110) in strains of Mycobacterium tuberculosis isolated from Colombian patients as well as the current status of resistance to antituberculosis drugs in the department of Quindio, Colombia . To this end, a prospective study was performed with a consecutive sample of 59 patients who sought care at local health centers and hospitals in rural and urban areas of Quindio from March to July 1993 . The patients in the sample had symptomatic pulmonary tuberculosis confirmed by bacteriologic inspection of sputum, with and without a history of treatment, and were participants in the Tuberculosis Control Program of the Sectional Health Institute of Quindio in Armenia, Colombia . Sputum cultures and drug sensitivity tests were done . Later, restriction fragment length polymorphisms (RFLP) of IS6110 were analyzed in accordance with the protocols of van Soolingen et al . (1992) . Cases were classified by treatment history, applying the criteria of WHO (1991) . The results showed 44 cultures positive for M . tuberculosis and one positive for M . africanum . Primary drug resistance was found in 4 of 42 cultures, or 9.5% (CI 95%: 0.6 to 18); 4.8% were resistant to isoniazid (INH) and 4.8% to isoniazid and streptomycin (INH-SM) . Acquired resistance was found in two of three cultures, or 66% (to isoniazid, rifampicin, and streptomycin {INH-RM-SM} and to isoniazid, ethambutol, rifampicin, and streptomycin {INH-EMB-RM-SM}) . In 27 strains submitted to RFLP analysis, the number of copies of IS6110 varied from 6 to 17 . Similarity coefficients revealed five distinct groups.(ABSTRACT TRUNCATED AT 250 WORDS)

J Bone Joint Surg Br, 1995 Jul, 77(4), 654 - 6
Eosinophilic synovitis . A new entity?
Tauro B.
The appearance and the biochemical, cytological and bacteriological findings were studied in synovial fluid obtained from the knees of 72 patients from south-west India . We report a group of 12 patients with 'eosinophilic synovitis' . In these patients, all below the age of 20 years with an acute onset of severe pain in the knee, there was a large effusion with painful limitation of movement . Their blood leucocyte count averaged 11,200 per mm3 with a mild eosinophilia of 6% . Biochemical examination of synovial fluid was normal, but cytology showed an increase in leucocytes ranging from 1200 to 20,500 (mean 9525) with between 75% and 90% of eosinophils in eight patients and 60% to 75% in four . All the patients responded well to a course of diethylcarbamazine.

Am J Ophthalmol, 1995 Jul, 120(1), 47 - 54
Extensive lamellar keratectomy for treatment of nontuberculous mycobacterial keratitis; Hu FR; PURPOSE: To determine the efficacy of using extensive lamellar keratectomy for treating patients who have nontuberculous mycobacterial keratitis that is unresponsive to medical treatment . METHODS: Nine patients with bacteriologically proven nontuberculous keratitis, who had poor response to medical treatment and whose corneal infiltrate was not deeper than 80% of corneal thickness, were selected for extensive lamellar keratectomy . This procedure was performed freehand to remove all the corneal infiltration visible by operation-microscopic examination, to have a clean stromal bed . RESULTS: Corneal infection was eradicated in seven patients by a single procedure . In the other two patients, the condition was controlled by a second operation . Epithelialization was rapid and complete in all cases within ten days (mean, 4.8 days) . Pain relief was dramatic after surgery . Visual acuity after surgery was improved in seven patients, but remained the same in two . There were no complications as a result of the lamellar keratectomy . CONCLUSIONS: Lamellar keratectomy should be considered as a treatment option for patients with nontuberculous mycobacterial keratitis who are unresponsive to medical therapy.

J Dairy Sci, 1995 Jul, 78(7), 1629 - 36
The visual appearance and somatic cell count of mammary secretions collected from primigravid heifers during gestation and early postpartum; Hallberg JW et al.; Mammary secretions, obtained before and after calving, were examined for visual appearance, SCC, and bacteriology as part of a larger study determining the prevalence of IMI in 1588 primigravid heifers . Appearance of secretions was categorized into five groups: thin and watery, honey-like, serumy, milky, or thickened colostrum . Precalving secretions were further characterized as low viscosity (thin and watery, serumy, or milky) or high viscosity (honey-like and thickened colostrum) . Postcalving secretions were further characterized as normal (milky, thickened colostrum) or abnormal (thin and watery, serumy, or honey-like) . Infected precalving quarters (81%) had low viscosity secretions . Quarters that were uninfected precalving (75%) had high viscosity secretions . Greater than 90% of all postcalving milk samples appeared to be normal, regardless of geographic location, season, or bacterial infection status . Only 77% of the samples from quarters infected with contagious and noncontagious mastitis pathogens had normal appearance . Precalving SCC from bacteriologically negative quarters were lower than SCC from infected quarters . Similarly, postcalving SCC were lower from the bacteriologically negative quarters than from the infected quarters . Infected quarters had higher mean SCC than the uninfected quarters during both pre- and postcalving periods.

Eur J Clin Microbiol Infect Dis, 1995 Jul, 14(7), 655 - 61
Experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA; Tice AD; The experience with 538 patients who received outpatient parenteral antibiotic therapy (OPAT) in 1993 in a private institute in Tacoma, Washington, USA, is reviewed here . Clinical outcomes suggested a successful resolution of infection in 99% of cases . Bacteriological outcomes showed that eradication of the organism had occurred in 92% of patients by the end of therapy . The success of the program indicates that 91% of properly selected patients can be treated without adverse events . Antibiotics were changed in 45 (8%) instances, but only half of these changes were made because of an adverse event . The development of rash was the most frequent adverse event and resulted in hospitalization in only 1 instance . Hospitalization was necessary before the OPAT program was completed in 42 cases--20 of those were for surgery and 13 for medical reasons unrelated to the infection or antibiotic therapy . In 8 cases, patients were hospitalized because of failure of home care or inability to administer the antibiotics effectively . Three patients were taken off the program because of failure to comply . Patient satisfaction surveys suggested that 99% of patients were satisfied with the program . With careful patient selection and a well-developed program, OPAT can be safe, effective and beneficial to patients and can save costs in healthcare services.

J Heart Lung Transplant, 1995 Jul-Aug, 14(4), 761 - 73
Transbronchial biopsy in heart and lung transplantation: clinicopathologic correlations; Pomerance A et al.; BACKGROUND AND METHODS: We reviewed and correlated the histologic and clinical records for the 1027 transbronchial biopsies performed, as clinically indicated, in 313 heart and lung transplant recipients in the Harefield Transplant Unit from 1988 through 1991 . Three pieces of lower lobe or radiologically abnormal lung were routinely sent for histologic diagnosis . Clinical diagnoses of rejection and infection were based on symptomatologic, radiologic, and bacteriologic findings and response to appropriate therapy . Standard histopathologic technology and diagnostic criteria were used, including the Working Formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection grading . RESULTS: Rejection was the most common finding (22.2%) and showed good clinicopathologic correlation . With unequivocal histologic features of rejection (Working Formulation grade A1 or above), specificity (clinical agreement with biopsy diagnosis) was 93.1% and sensitivity (clinical rejection confirmed by transbronchial biopsy) was 61% . Sensitivity increased to 77% if unsatisfactory specimens were excluded . Possible/probable rejection only was reported in 83 specimens; there were technically unsatisfactory, showed only minimal perivascular infiltrates, or had infiltrates limited to one vessel; 71% of these did have clinical rejection . Infection, excluding opportunistic, was reported in 18.5% of biopsy specimens; specificity was 70.5% and sensitivity 51.3% (both rising by 9%), with unsatisfactory specimens excluded . Histologic features of both rejection and infection were seen in 47 transbronchial biopsy specimens (4.7%) . Where both components appeared definite specificity was 66.7%, but where either had been doubtful the clinical diagnosis was most often rejection . Sensitivity was also 66.7% . Cytomegalovirus inclusions were identified in 12.1% of biopsy specimens, with specificity of 91% and sensitivity of 83.5% . Sensitivity (88%) and specificity (100%) were both high for the 17 cases with pneumocystis infections . Sensitivity for the 25 transbronchial biopsy specimens from fungal infections was only 20% . Sensitivity was also poor (27.7%) in obliterative bronchiolitis, although specificity was 75% . Almost a third of transbronchial biopsy specimens from patients with obliterative bronchiolitis were unsatisfactory . Pneumonitis was the only change noted in 68 biopsy specimens . Most correlated with clinical status, but 26.5% were from patients with active rejection . Nonspecific changes or no significant pathologic condition was seen in 278 transbronchial biopsy specimens; over a third of these were from patients with clinical rejection (17.7%) or infection (18%) and 6.5% were from obliterative bronchiolitis cases . Excluding 78 technically unsatisfactory specimens reduced the proportion of false negative findings in rejection and infection by 6% and 4%, respectively . CONCLUSIONS: We found that transbronchial biopsies consisting of three adequate pieces of lung parenchyma correlated well with clinical rejections and infections other than fungal but was of limited value in confirming a diagnosis of obliterative bronchiolitis or fungal infection.

Vet Microbiol, 1995 Jul, 45(2-3), 185 - 9
Evaluation of a potassium chloride extract of Brucella abortus in an ELISA for detecting Brucella antibodies in bulk tank milk samples from cows; Thoen CO et al.; An enzyme-linked immunosorbent assay (ELISA) was developed using as antigen a potassium chloride extract of Brucella abortus strain 1119-3 for detecting Brucella antibodies in bulk tank samples of cow's milk . Three-hundred-thirty-four Milk Ring Test (MRT) suspicions milk samples originating from cattle herds in 13 states and 106 BRT negative milk samples were analyzed . Fifty-four of 334 MRT suspicious milk samples were positive on ELISA; bacteriologic examinations revealed B . abortus field strain was isolated from cows in 15 herds, B . abortus strain 19 was isolated from cows in 16 herds and serologic suspects were reported in 6 of the other 23 herds . Two-hundred-fifty-eight (85.6%) of the 301 MRT suspicious samples were negative on ELISA; field investigations and/or serologic tests on cattle failed to disclose Brucella infection in these herds . Suspicious ELISA reactions were detected in 22 MRT suspicious bulk tank milk samples; serologic suspects were reported in 8 of the 22 herds . No false positive ELISA reactions were detected in the 106 MRT negative bulk tank milk samples collected from dairy herds in 7 states.

Jpn J Antibiot, 1995 Jul, 48(7), 942 - 8
{Clinical efficacy of sulbactam/cefoperazone for the treatment of geriatric patients with respiratory tract infections}; Takaki K et al.; We performed clinical studies on sulbactam/cefoperazone (SBT/CPZ) for the treatment of geriatric patients with respiratory tract infections . Seven patients with pneumonia, 7 with acute bronchitis, 6 with chronic respiratory tract infections were treated with SBT/CPZ . The patients were administered with a daily dose of 2.0 g or 4.0 g for 4-14 days . The clinical responses were excellent in 3, good in 13, fair in 3, and poor in 1 patients . The efficacy rate was 80.0% . No side effects were observed in any patients, but elevations of GOT, GPT were observed in two cases . Causative organisms were E . coli (2 strains), P . aeruginosa (2), MSSA (1), MRSA (1), S . pneumoniae (1), H . influenzae (1), K . oxytoca (1), and E . aerogenes (1) . The bacteriological effect rate was 60% . One strain of MRSA and one of two strains of P . aeruginosa persisted in 2 patients.

Chemotherapy, 1995 Jul-Aug, 41(4), 306 - 15
Initial treatment of sepsis in non-neutropenic patients: ceftazidime alone versus 'best guess' combined antibiotic therapy; Extermann M et al.; We conducted a prospective, randomized, multicentric study in community hospitals . Patients with clinical sepsis, rectal temperature > or = 38 degrees C and pulse rate > or = 100 bpm were randomized to receive ceftazidime (group CAZ) or a combination of antibiotics freely chosen by the clinician following his 'best guess' (group COMB) . On specified grounds, the clinician could also treat patients in an open group with a free combination of antibiotics (group OPEN) . The severity of disease at study admission was assessed by a clinical estimation and an Apache II score . There were 128 patients included: 56 randomized in group CAZ, 50 in group COMB, and 22 in the OPEN group . Ninety-one patients were evaluable: 41 in group CAZ, 30 in group COMB, 20 in OPEN group . At the end of the period of empirical treatment (48-72 h), the clinical success rates (improvement of status) were 93, 93 and 75% (p for group OPEN vs . groups CAZ or COMB: 0.10) . The bacteriological success rates (sterile blood cultures) were 91, 88 and 80% (p not significant) . mean Apache II score was 16.7 and the score correlated significantly with outcome, as did clinical evaluation . In conclusion, ceftazidime alone was a safe antibiotic therapy in this study and we could not demonstrate a superiority of a combined antibiotic therapy chosen by the clinician following his 'best guess' over ceftazidime.

Contracept Fertil Sex, 1995 Jul-Aug, 23(7-8), 457 - 9
{Study of a new lactic acid and pH 5.2 lactoserum emulsion for feminine hygiene . Results of a clinical study}; Jacquet A et al.; A new solution intended for use in feminine hygiene, and composed of a lactic acid base and of lactoserum at pH 5.2, was tested for a period of 8 weeks on 40 women . This test focused on its influence on the pH and the flora, as well as on the tolerance of the mucous membrane . Successive measurements of the vulvar and vaginal pH revealed no statistically significant variation between the beginning and the end of the trial . At the study inclusion thirty patients had a normal flora; of these, twenty-eight showed no change during the eight weeks of the trial . A candidiasis appeared in two patients in the middle of the trial; one of these patients received no treatment, while the other was given a five-day treatment due to similar occurrences in her past medical history . The product under study was continued throughout the trial, at the conclusion of which the flora was found to have returned to normal . At the study inclusion ten patients had either a candidiasis or a vaginitis . Their lack of symptoms and the absence of any previous problems resulted in no treatment being made in five of the ten cases, while in four cases the presence of such prior problems led to the immediate carrying out of short-length treatments . In every case, the product under study was used until the end of the trial . Bacteriological studies showed that in all the patients--whether or not they had been treated--the flora rapidly returned to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesteziol Reanimatol, 1995 Jul-Aug, (4), 17 - 9
{Features of the treatment of suppurative complications of limb injuries in prolonged crush syndrome}; Zvezdina MV et al.; The results of treatment of 42 patients with prolonged crush syndrome complicated by suppuration are analyzed . The results of bacteriological studies are presented, which helped monitor the treatment efficacy . Surgical treatment of the injured limbs is described, as is the combined application-adsorption method of local detoxifying therapy of suppurative wounds, which, combined with staged necrosectomy, helped cope with purulent complications, prepare the wounds of the limbs to repair plastic surgery within 35 to 55 days after the injury, and rule out lethal outcomes.

Scand J Gastroenterol, 1995 Jul, 30(7), 681 - 5
Bacteriologic analysis of mucosal biopsy specimens for detecting small-intestinal bacterial overgrowth; Riordan SM et al.; BACKGROUND: Although culture of luminal secretions is regarded as the most accurate diagnostic test for small-intestinal bacterial overgrowth, obtaining an aspirate is often difficult owing to the sparseness of luminal secretions present at the time of aspiration . Obtaining a mucosal biopsy specimen for bacteriologic analysis would overcome this problem . METHODS: Culture of small-intestinal and gastric aspirates and unwashed small-intestinal mucosal specimens was performed in 51 adult subjects investigated for small-intestinal overgrowth . RESULTS: Highly significant (r = 0.85-0.90; p < 0.0005) correlations were found between viable bacterial counts in small-intestinal luminal secretions and biopsy specimens . Small-intestinal bacterial overgrowth was present in 60.8% of subjects . When specimens weighing 4.0-84.0 mg were suspended in diluent, total aerobic and/or anaerobic bacterial counts > or = 10(2) CFU/ml were found to have 90.3% sensitivity and 100% specificity for small-intestinal bacterial overgrowth . CONCLUSION: Culture of an unwashed small-intestinal mucosal biopsy specimen is a useful alternative to culture of a small-intestinal aspirate for detecting subjects with small-intestinal bacterial overgrowth, especially when luminal secretions are scanty at the time of aspiration.

Presse Med, 1995 Jun 24, 24(23), 1062 - 6
{Clinical and bacteriological aspects of nocardiasis . 9 cases}; Bani-Sadr F et al.; OBJECTIVES: Nocardial infection is usually localized in the immunocompetent patient and occurs as an opportunistic disseminated infection in about half of the cases in immunoincompetents patients . METHODS: We report a retrospective assessment of 9 cases of nocardial infection diagnosed between January 1991 and February 1994 . RESULTS: Six of the patients were immunodepressed: 3 had a disseminated infection with pulmonary (n = 2), brain (n = 2), skin (n = 3) and/or ocular (n = 1) localizations . There were 3 immunocompetent patients with an isolated local infection: skin and bone mycetoma, knee joint and lung . Diagnosis was made on samples obtained invasively in 7 patients . Nocardia asteroides was isolated in 5 patients, N . farcinica in 3 and N . caviae in 1 . These organisms showed in vitro sensitivity to amoxicillin-clavulanic acid 5/9, cefotaxime 5/9 (0/3 for N . farcinica), imipeneme 7/9, amikacin 8/8, minocyclin 5/8, pefloxacin 0/8 and trimethoprime-sulfamethoxazol (TMP-SMX) 3/9 . Clinical outcome was favourable in all cases and was not always correlated with laboratory sensitivity . CONCLUSION: TMP-SMX remains the reference antibiotic . For one patient, only TMP-SMX (resistant in vitro) was effective; with all the other antibiotic tried (sensitive in vivo) treatment failed.

Malays J Pathol, 1995 Jun, 17(1), 35 - 7
A review of the serological results obtained in a routine diagnostic laboratory for Mycoplasma pneumoniae infections; Tay ST et al.; The results of a Mycoplasma pneumoniae serology test performed routinely at the Bacteriology Division, Institute for Medical Research were reviewed . A total of 1402 patients were screened over a period of 4 years (January, 1990-December, 1993), of which 327 (23.3%) were seropositive . The seropositivity rates among Malays, Chinese and Indians were 25.2, 25.4 and 17.8% respectively . The male to female ratio was 1:1 . The age specific rate was highest amongst patients of the 6-12 years (35.1%) followed by the 13-20 years age groups (35.0%) . In general, infection with M . pneumoniae appears to be relatively common in this country.

J Chemother, 1995 Jun, 7 Suppl 2, 95 - 101
A randomised comparison of isepamicin and amikacin in the treatment of bacterial infections in paediatric patients; Vigano A et al.; The efficacy and safety of isepamicin 7.5 mg/kg of body weight twice daily or amikacin the same dosage regimen for the treatment of various infections in neutropenic and non-neutropenic paediatric patients were compared in a prospective randomised trial . In total, 306 patients were enrolled and received at least one dose of randomised treatment (204 isepamicin, 102 amikacin: intent-to-treat population); 181 patients satisfied all criteria for evaluability (120 isepamicin, 61 amikacin: efficacy population) . Clinical cure or improvement rates in the isepamicin and amikacin groups were: intent-to-treat population, 188/204 (92%) and 94/102 (92%), respectively; efficacy population, 117/120 (98%) and 58/61 (95%), respectively . The bacteriological elimination rate (efficacy population) in the isepamicin and amikacin treatment groups was 75/76 (99%) vs 35/38 (92%) . Nephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dL or > or = 44.2 mumol/L from baseline, occurred in 4/187 (2%) and 1/191 (1%) children treated with isepamicin and amikacin, respectively . Definite ototoxicity at the > or = 20 dB threshold occurred in 3 (1 isepamicin and 2 amikacin) out of 56 children evaluated with at least two audiograms . Thus isepamicin was as effective and as well tolerated as amikacin in the treatment of various infections in paediatric patients.

J Chemother, 1995 Jun, 7 Suppl 2, 143 - 8
The efficacy and safety of isepamicin compared with amikacin in the treatment of intra-abdominal infections; Leal del Rosal P; This multicentre, randomised, open-label, parallel group study compared the efficacy and safety of isepamicin (15 mg/kg once daily) and amikacin (7.5 mg/kg twice daily) when given intravenously in combination with metronidazole to 267 hospitalised adults with intra-abdominal infections . Clinical cure or improvement was achieved in 96.3% (130/135) evaluable patients (efficacy population) in the isepamicin group and 94.3% (66/70) patients in the amikacin group . Bacteriological elimination occurred in 93.3% (126/135) evaluable isepamicin patients and 95.7% (67/170) amikacin patients . there was not statistically significant differences between the groups . Adverse events were reported by 9% of patients in the isepamicin group (16/178) and 10% of patients in the amikacin group (9/89) . Events considered to be related to treatment occurred in 6% of patients in both groups . The most frequent adverse events were diarrhoea, nausea and vomiting . Renal problems caused three patients (2 isepamicin, 1 amikacin) to withdraw from the study . Ototoxicity (detected by audiometric testing) occurred in one patient (treated with isepamicin) . In conclusion, isepamicin at a dose of 15 mg/kg once daily was shown to be as effective as amikacin (7.5 mg/kg twice daily) in the treatment of intra-abdominal infections in hospitalised adults also treated with metronidazole . Both treatments were well tolerated.

Zhonghua Nei Ke Za Zhi, 1995 Jun, 34(6), 381 - 4
{Lactulose hydrogen breath test in small intestinal bacterial overgrowth}; Wang J et al.; Lactulose hydrogen breath test (LHBT) was evaluated in 21 patients suspected of having small intestinal bacterial overgrowth syndrome and 10 healthy volunteers as control . After dietary preparation and a 12-hour fast, subjects received 15g of lactulose mixed with 40% barium sulfate . The purpose of the barium meal was to reveal the position of lactulose in the intestines . End-expiratory samples of breath were taken at 15 minutes intervals at least for 4 hours . Breath hydrogen was measured with gas chromatography . A positive LHBT was defined as increase of hydrogen concentration in the breath more than 10 x 10(-6) above the baseline value before barium reached the sixth group of small intestine . Cultures were considered positive for bacterial overgrowth when anaerobic counts > or = 10(6) CFU/ml of aspirate . The procedure was carried out under sterile condition . Compared with the bacteriologic culture, LHBT has a sensitivity of 71.4%, specificity of 88.2% and accuracy of 80.6% . These results show that the LHBT is a simple, non-invasive and relatively reliable method for diagnosis of small intestinal bacterial overgrowth.

J Am Dent Assoc, 1995 Jun, 126 Suppl, 1S - 24S
Caries diagnosis and risk assessment . A review of preventive strategies and management; Intraocular bacterial contamination during cataract surgery in dogs; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USAPrevalence of intraoperative contamination of the eyelids, conjunctival sac, and aqueous humor of 50 canine eyes that underwent elective cataract surgery was determined, and the short-term outcomes for contaminated and noncontaminated eyes were compared by scoring media clarity, pupil size and shape, and behavioral evidence of vision during the initial 30-day postoperative period . Results of bacteriologic culture of anterior chamber samples were positive for 12 of the 50 (24%) eyes, but anterior chamber contamination was unrelated to results of bacteriologic culture of eyelids or conjunctival sac swab samples . Eyes undergoing phacoemulsification were less likely to be contaminated than were eyes undergoing intra- or extracapsular extraction . Eyes undergoing intra- or extracapsular extraction and eyes with anterior chamber contamination had a greater likelihood of developing glaucoma postoperatively . We did not detect an association between intraocular contamination and the surgeon performing the operation, the need for postoperative administration of tissue plasminogen activator, or the presence or absence of diabetes mellitus . Also, we did not detect any differences in outcome between eyes with and without intraocular contamination . Despite intraoperative bacterial contamination of the anterior chamber, bacterial endophthalmitis did not develop in any of the eyes.

Chest, 1995 Jun, 107(6), 1621 - 30
Prednisone as adjunctive therapy in the management of pulmonary tuberculosis . Report of 12 cases and review of the literature; Muthuswamy P et al.; A retrospective chart review was conducted over a 5-year period (1988 to 1993) in a tertiary inpatient care center on the effects of the addition of prednisone to the treatment regimens of 12 patients with pulmonary tuberculosis who continued to spike high temperatures and lose weight while showing bacteriologic response to effective antituberculosis therapy . After exclusion of other causes of fever, all patients were treated with 20 to 60 mg of prednisone daily until normalization of temperature and clinical improvement . Analyzed data included twice weekly sputum bacillary count, temperature record every 4 h, weekly patient weight, serum albumin level, liver function tests, and chest roentgenogram . The patients continued to spike temperatures of 38.3 degrees C to 40.5 degrees C (mean +/- SD = 39.6 degrees C +/- 0.6 degrees C) even after 18 to 53 days (mean +/- SD = 33.9 +/- 9.8 days) of antituberculosis therapy . Within 24 h after the addition of oral prednisone, temperature decreased in all 12 patients from a daily highest spike mean of 39.6 degrees C +/- 0.6 degrees C (SD) to 38.1 degrees C +/- 0.6 degrees C (SD) (p = 0.0022) . The duration of required prednisone therapy was 20.1 +/- 9 days (mean +/- SD) . During this period patients' appetites improved, and their weight increased from a mean (+/- SD) of 53.6 +/- 5.7 kg to 58.1 +/- 6.4 kg (p = 0.0022) . The serum albumin level increased from a mean (+/- SD) of 2.51 +/- 0.4 g/dL to 3.21 +/- 0.4 g/dL (p = 0.0033) . All the patients also showed clinical evidence of a decrease in toxic reactions associated with tuberculosis . There were no side effects from the addition of prednisone . This study shows the need for randomized controlled clinical trials to clarify the role of prednisone as adjunctive therapy in the management of pulmonary tuberculosis.

Can Fam Physician, 1995 Jun, 41, 1030 - 6
Tuberculosis in the 1990s . Issues for primary care physicians; Fitzgerald JM; After declining for many years, tuberculosis rates have begun to level off in Canada . Groups at particularly high risk include aboriginal Canadians, immigrants from high-prevalence countries, HIV-infected people, and elderly men . If disease is suspected, appropriate investigations, including sputum tests for bacteriology and chest x-ray examinations, should be done . Response to treatment is excellent . Chemoprophylaxis is recommended for certain patients . Vaccination with BCG has a limited but important role, especially for aboriginal Canadians.

Am J Gastroenterol, 1995 Jun, 90(6), 906 - 9
The role of Helicobacter pylori in children with recurrent abdominal pain; Heldenberg D et al.; OBJECTIVES: Our major goals in this study were to determine the prevalence of Helicobacter pylori among Israeli children with recurrent abdominal pain and to establish whether a link exists between eradication of Helicobacter pylori and the recovery from abdominal pain . The alternative target was to examine whether the serological test can replace endoscopy in children . METHODS: Upper gastrointestinal endoscopy was performed in 80 children with recurrent abdominal pain . During endoscopy, antral biopsies were taken and sent for histological and bacteriological examination . RESULTS: The prevalence of H . pylori, which was indicated by Gram stain and urease test, was 54% . The positive cases were treated with bismuth combined with amoxycillin and metronidazole . Two months after completion of the treatment, 34 patients were reexamined . Twenty-nine of them (85%) became symptom free, and five (15%) remained symptomatic . These five children were retreated, and they also became symptom free . Eight months after completion of treatment, all 34 patients were reexamined and found to be asymptomatic . CONCLUSIONS: We found a high prevalence of H . pylori (54%) among Israeli children with recurrent abdominal pain; we also found that symptoms were effectively and significantly reduced by the eradication of H . pylori . The endoscopic examination cannot be replaced by serological test.

Gastroenterology, 1995 Jun, 108(6), 1835 - 41
Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites; Garcia-Tsao G et al.; BACKGROUND/AIMS: Cirrhotic patients are predisposed to develop spontaneous bacteremias and/or peritonitis, mainly caused by enteric bacteria . The aim of this study was to investigate if bacterial translocation, which is the passage of bacteria from the intestinal lumen to regional lymph nodes and/or the systemic circulation, is increased in a rat model of cirrhosis . METHODS: Rats were studied after 12-16 weeks of CCl4 inhalation, when samples of mesenteric lymph nodes, blood, liver, and spleen for standard bacteriologic cultures and a fragment of colon and liver for histology were obtained . Immunostaining of the cecum was performed using a polyclonal anti-Escherichia coli antibody . RESULTS: A significantly greater proportion of rats with cirrhosis and ascites (5 of 9; 56%) had positive mesenteric lymph node cultures compared with cirrhotics without ascites (0 of 9) and normal controls (0 of 12) (P < 0.01) . In one cirrhotic rat, E . coli was isolated from both mesenteric lymph nodes and ascites . Rats with cirrhosis and ascites had significantly greater cecal submucosal edema and inflammation than rats with no ascites and controls . Immunoreactivity with E . coli was present in the cecal wall in 3 of 5 animals with E . coli translocation to mesenteric lymph nodes . CONCLUSIONS: In cirrhotic rats, bacterial translocation is increased after the development of ascites and may be a major factor in the development of spontaneous infections in cirrhosis.

Int J Epidemiol, 1995 Jun, 24(3), 630 - 6
Predictive factors of Mycobacterium tuberculosis infection and pulmonary tuberculosis in prisoners; Martin Sanchez V et al.; BACKGROUND . Tuberculosis currently represents a serious problem in prison populations . METHODS . With the aim of studying the predictive factors for, and the prevalence of, Mycobacterium tuberculosis infection and pulmonary tuberculosis in a Spanish prison, all those admitted during 1991 and 1992 were included (N = 1314) . The tuberculin skin test, HIV serology, chest X-ray and bacteriological examination of sputum were carried out . Statistical analysis was done by univariant tests, stratified analysis and logistic regression . RESULTS . The prevalence of M . tuberculosis infection was 55.5% (95% confidence interval {CI} 52.5-58.5) . An association was found with sex, imprisonment more than once, HIV infection and age . The co-infection rate (tuberculosis plus HIV) was 9.2% . Logistic regression showed a greater risk with age (4.4% per year), time spent in prison and for males . The prevalence of pulmonary tuberculosis was 1.26% and an association was found with M . tuberculosis infection, HIV infection (odds ratio {OR} = 13.7), intravenous drug users (OR = 17.2) and imprisonment more than once (OR = 7.3) . Logistic regression showed an association with HIV co-infection (OR = 20.2) . CONCLUSIONS . The prevalence of M . tuberculosis infection and pulmonary tuberculosis is high when compared with similar studies . The influence of age, time spent in prison and co-infection with HIV is relevant to recommendations for specific tuberculosis prevention programmes in correctional facilities.

Pediatr Infect Dis J, 1995 Jun, 14(6), 471 - 7
Mycoplasma pneumoniae and Chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithromycin vs . erythromycin ethylsuccinate; Block S et al.; We evaluated 260 previously healthy children ages 3 through 12 years who had clinical signs and symptoms of pneumonia, radiographically confirmed . Patients were randomized 1:1 to a 10-day course of either clarithromycin suspension 15 mg/kg/day divided twice a day or erythromycin suspension 40 mg/kg/day divided twice a day or three times a day . Evidence of infection with Chlamydia pneumoniae was detected in 28% (74) of patients: 13% (34) by nasopharyngeal culture and 18% (48) by serology with the microimmunofluorescence assay . Evidence of infection with Mycoplasma pneumoniae was detected in 27% (69) of patients: 20% (53) by nasopharyngeal culture or polymerase chain reaction and 17% (44) by serology with the use of enzyme-linked immunosorbent assay . Serologic confirmation of infection was observed in 23% (8) and 53% (28) of patients with bacteriologically detected C . pneumoniae and M . pneumoniae, respectively . Treatment with clarithromycin vs . erythromycin, respectively, yielded the following outcomes: clinical success 98% (121 of 124) vs . 95% (105 of 110); radiologic success 98% (109 of 111) vs . 94% (92 of 110); and eradication by pathogen, C . pneumoniae 79% (15 of 19) vs . 86% (12 of 14) and M . pneumoniae 100% (9 of 9) vs . 100% (4 of 4) . Adverse events were primarily gastrointestinal occurring in almost one-fourth of patients in both groups, and were mild to moderate in severity . Clarithromycin and erythromycin were similarly effective and safe for the treatment of radiographically proved, community-acquired pneumonia in children older than 2 years old.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS, 1995 Jun, 9(6), 577 - 83
Tuberculosis and HIV infection: a cohort study of incidence and susceptibility to antituberculous drugs, Bordeaux, 1985-1993 . Groupe d'Epidémiologie Clinique du SIDA en Aquitaine; Dupon M et al.; OBJECTIVES: To assess the temporal trends in incidence of tuberculosis (TB) in HIV-infected patients, to evaluate the impact of pulmonary TB on the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition and to assess the frequency of Mycobacterium tuberculosis strain resistance . DESIGN: A retrospective study within a cohort . SETTING: The Bordeaux University Hospital and three general hospitals in Aquitaine, southwest France . SUBJECTS: Since 1985, HIV-infected in- and outpatients aged > 13 years have been included in the Aquitaine cohort . Reported cases of pulmonary and extrapulmonary TB were investigated and records cross-referenced with the files of the TB reference laboratory . RESULTS: As of 30 June 1993, the Aquitaine cohort (3119 patients) accounted for 6409 person-years (PY) of follow-up . TB was diagnosed in 139 patients (average annual incidence, 2.17 per 100 PY) of whom 79 had bacteriological diagnosis, 13 histological diagnosis and 47 clinical and/or radiological diagnosis . Extrapulmonary TB accounted for 40% of the cases . Intravenous drug use was more frequent in the group who developed TB (50%) than in the rest of the cohort (40%) (P = 0.009) . There was an increase in the incidence rate of TB in the cohort between 1985 (0.45 per 100 PY) and 1989 (2.67 per 100 PY) and a stabilization around 1.5-2.0 per 100 PY until 1993 . Pulmonary TB was estimated to increase the AIDS cumulative incidence by 0.4% when performing a simulation with the 1993 AIDS case definition . Single drug resistance was documented in 3.4% of the cases and a multiple drug resistance in 5.1% . CONCLUSION: TB incidence has stabilized since 1990 in the Aquitaine cohort with a limited increase of the number of AIDS cases (1993 CDC criteria) . Drug resistance was rare.

Radiol Med (Torino), 1995 Jun, 89(6), 769 - 75
{Pulmonary tuberculosis in non-immunocompromised patients . Current radiologic features}; Polverosi R et al.; Sixty-four non-immunocompromised and adult patients with proved tuberculosis were examined . Twenty-three of them had bacteriologic confirmation with sputum examination, 7 with biopsy, 8 with bronchoscopy and bronchial lavage, 3 with pleural effusion examination and 3 with specific ex-juvantibus therapy . Fifteen patients had positive Mantoux skin tests . Thirty-nine patients had primary and 25 postprimary tuberculosis . All patients underwent chest radiography and 37 underwent also CT scans of the chest . The radiographic findings in primary tuberculosis were: 33 parenchymal consolidation patterns (in 24 patients), more frequent in the upper (20/33) than in the lower (13/33) lobes, with cavitations in 16 cases; 2 miliary patterns; 4 atelectasis cases; 4 intrathoracic adenopathies and 11 pleural effusions . The radiographic findings in postprimary tuberculosis were: 32 parenchymal consolidation patterns (in 19 patients), more frequent in the upper (27/32) than in the lower (5/32) lobes, with cavitations in 7 cases; 2 tuberculomas; 1 miliary pattern; 1 atelectasis; 5 pleural effusions and 1 pericardial effusion . Thus, we can conclude that in our series both primary and postprimary tuberculosis appear mostly as upper lobe consolidation, with cavitations especially in the primary form, often with pleural effusion and sometimes with intrathoracic adenopathies . Primary tuberculosis is most frequent in adult men . Finally, lower lobe consolidations or less typical radiographic patterns are observed, e.g., atelectasis, adenopathies or pleural effusion with no parenchymal changes, which can mimic other diseases and thus delay the diagnosis.

Gastroenterol Clin North Am, 1995 Jun, 24(2), 353 - 84
Radiologic investigation of acute inflammatory and infectious bowel disease; Gore RM et al.; Definitive diagnosis of infectious or idiopathic inflammatory bowel disease ultimately rests on histologic and bacteriologic documentation . Nevertheless, radiologic studies play an important role in the evaluation and management of patients with acute enterocolitis . Plain abdominal films can give a gross estimate of disease extent in the colon and detect complications, such as perforation or toxic megacolon . Double-contrast barium enema allows visualization of the mucosal pattern and the overall configuration of the bowel, which are important for determining the extent and severity of disease and its most likely cause . Cross-sectional imaging depicts the mural and mesenteric involvement as well as intraperitoneal complications of inflammatory bowel disease, thus providing a critically important perspective that complements the information afforded by endoscopic and conventional radiographic techniques.

Arch Pediatr, 1995 Jun, 2(6), 548 - 50
{A rare complication of multiple exostoses: hemothorax}; Dendale J et al.; BACKGROUND--Hemothorax is a rare complication of hereditary multiple exostosis . CASE REPORT--A 12 year-old boy suffered from abrupt thoracic pain, firstly attributed to pleural effusion . He had hereditary multiple exostosis known since the age of 9 years . The patients was given anti-inflammatory drugs and erythromycin but the pleural effusion became more abundant 6 days later requiring thoracentesis which showed hemothorax . All bacteriological and cytologic investigations were negative . X rays, ultra-sonography and CT scan showed several costal exostoses developing into the thoracic cavity . The hemothorax disappeared within 12 days and the patient was well 4 months later, without pleural sequelae . CONCLUSIONS--Hemothorax may be due to internal costal exostosis . It may be cured with thoracentesis; more aggressive therapy should be performed in exceptional cases with severe and/or recurrent bleeding.

Arch Dis Child, 1995 Jun, 72(6), 516 - 7
Bacteriologically confirmed non-tuberculous mycobacterial lymphadenitis in south east England: a recent increase in the number of cases; Grange JM et al.; The annual numbers of cases of non-tuberculous mycobacterial lymphadenitis in south east England has increased over the period 1973 to 1993, most notably during the last few years . The most frequent cause is the Mycobacterium avium complex, followed by M malmoense . The reason for the increase is unknown but it could be due to an increased awareness in mycobacterial disease, an external factor such as pollution, or both.

Tuber Lung Dis, 1995 Jun, 76(3), 205 - 9
Disease due to Mycobacterium kansasii in the Czech Republic: 1984-89; Kaustova J et al.; SETTING: Endemic area of North Moravia, Czech Republic . OBJECTIVE: Evaluate the incidence of human disease due to Mycobacterium kansasii . The follow-up of some bacteriological and clinical features . DESIGN: A retrospective analysis of M . kansasii patients . RESULTS: M . kansasii was isolated from the sputum, tissue and other specimens obtained from 650 persons during the period 1984-89 . In only 471 of them was this mycobacterium deemed to be the causative agent, predominantly of lung disease . The most typical radiographic finding in these patients was lung infiltration and/or thin-walled cavity . CONCLUSION: As in previous years the highest incidence of disease remains in an endemic area of North Moravia . The effects of treatment in follow-up patients were influenced not only by the antituberculosis regimen but also by a high frequency of associated diseases . Sputum conversion within 30 days was not affected by the presence or absence of a cavity . Authors consider water to be the source of infection.

Minerva Pediatr, 1995 Jun, 47(6), 249 - 60
{Efficacy and tolerance of azithromycin in respiratory tract infections in children}; Toscano MA et al.; This study was carried out to determine the clinical efficacy and the clinical safety of azithromycin in a group of children with acute respiratory tract infections . The study involved 82 children treated with a single daily 10 mg/kg dose of azithromycin for three consecutive days . 7 days later, the overall clinical response was 100% (cure and improvement): bacteriological cure was achieved in 97.5% of the patients treated . Recurrences were never observed . Side effects not requiring interruption of therapy were observed in 3 patients (3.6%) . The side effects were gastrointestinal disturbances . In conclusion azithromycin showed a remarkably clinical efficacy for treatment of acute respiratory infections in children . Tolerability and therapeutic compliance were excellent.

J Radiol, 1995 Jun, 76(6), 347 - 52
{Thoracic standard radiology and x-ray computed tomography in mediastino-pulmonary tuberculosis in infants}; Bourliere-Najean B et al.; Primary mediastino pulmonary tuberculosis in infancy is increasing in France . Bacteriological diagnosis is difficult . The aim of the study is to assess the value of chest radiograph and CTscan for diagnosis of tuberculosis . We studied 15 infants, 3 month old to 18 month old, between November 1990 and June 1992 . On plain film, lymphadenopathies were present in 13 cases and parenchymal disease in 10 cases, parenchymal nodular densities in 6 cases and pleural effusion in one case, displacement of the trachea in 6 cases . We found CTscan to be useful in delineating the lymphadenopathies and parenchymal changes . In 2 cases lymphadenopathies and in 2 cases alveolar condensation were discovered on CTscan as plain film was normal . In all cases lymphadenopathies were present in CTscan, often in right side and in all cases, lymphadenopathies were hypodense with peripheral enhancement . In conclusion, the association of right paratracheal nodes with displacement of trachea and alveolar consolidation is common in tuberculosis in infants . These findings when seen on chest radiographs must lead to perform a CTscan and suggest the diagnosis.

JPEN J Parenter Enteral Nutr, 1995 May-Jun, 19(3), 193 - 8
Malabsorption and villous atrophy in patients receiving enteral feeding; Cummins A et al.; BACKGROUND: The purpose of this study was to assess the structure and function of the small intestine before and after enteral feeding given via a percutaneous feeding gastrostomy (PEG) . It is not known whether this method of feeding provides a good luminal drive to the small intestine . METHODS: Studies were performed of patients at the time of PEG placement, in a cross-sectional group after a period of feeding and in a smaller longitudinal subgroup . Enteral feeds were adjusted in volume and caloric content for each patient . Duodenal biopsies were taken during endoscopy for quantitative morphometry, and lactulose-rhamnose permeability tests were performed during the next day . Duodenal fluid was cultured quantitatively in the first study, and disaccharidases determined in the second study . RESULTS: The first study of 15 patients, who had enteral feeding for a median (range) period of 13 (8 to 104) weeks, showed partial villous atrophy with normal crypt length, no increase in duodenal bacteriology, and abnormal lactulose-rhamnose sugar permeability due to rhamnose malabsorption . These changes were also present in 38 similar patients before enteral feeding . A second study before enteral feeding showed lowered maltase activity (24 patients), and similar intestinal permeability findings (22 patients) . Twelve of these patients were followed longitudinally for 3 months of enteral feeding that maintained but did not improve nutrition, as assessed by body mass index and mid-arm muscle circumference, and there was no change in duodenal morphometry (11 patients), rhamnose malabsorption (4 patients), or disaccharidases (11 patients) . CONCLUSIONS: These studies suggest villous atrophy was not due to an inflammatory enteropathy but resulted from a poor luminal "drive" associated with the enteral feeding . Enteral feeding maintained but did not improve nutrition status.

Pathol Biol (Paris), 1995 May, 43(5), 401 - 6
{Use of the Bactec TB 460 method for the bacteriological diagnosis of tuberculosis . Results of a multicenter study}; Carbonnelle B et al.; Isolation of Mycobacteria on Loewenstein-Jensen medium lasts many weeks . The use of Radiometric method (Bactec TB 460) reduces the delays . Results of 79,064 cultures are reported from a multicentric study associating 16 laboratories . The average was 4.8% of positivity and 2.51% of contamination . The comparison of the results with conventional method previously obtained shows that radiometric method is more sensitive and contaminations are less numerous . Concerning hemocultures the Bactec method is very usefull . Among 11,277 tests performed 907 were positive (8.04%) . Mycobacterium avium was identified in 89% of the cases . Identification test utilizes Biochemical and NAP tests, but also more and more Nucleic probes . The antibiotic sensitivity is performed in five days . The mean delay of analysis is about 25 days, lessening by half the conventional method delays . Nevertheless, Bactec method has the following inconveniences: syringe inoculation, use of radiolabelled products, expensive cost.

Addiction, 1995 May, 90(5), 711 - 6
Mortality among HIV-infected intravenous drug addicts in Stockholm in relation to methadone treatment; Fugelstad A et al.; The aim of the study was to estimate the mortality rate and evaluate the causes of death in all diagnosed HIV-positive IDUs in the Stockholm area, 1986-90, and to compare the risk of death of those who received methadone treatment with that of those never admitted to or discharged from the programme . Data were collected from the Swedish National Bacteriological Laboratory, the Methadone Maintenance Programme (MMTP) and the Department of Forensic Medicine, as well as from hospitals in the Stockholm region . In Sweden 90% of all IDUs are HIV-tested . Most deceased IDUs are examined forensically . This examination always includes HIV-testing . During the observation period, 472 HIV-infected IDUs were reported from the Stockholm area . Of these addicts 135 participated in the methadone maintenance programme for a shorter or longer time during the study period . Most of them had received the HIV-diagnosis more than 1 year before first entering the programme . Sixty-nine subjects died during the observation period . A majority, 52 persons, died from violence or poisoning . Seventeen died from somatic complications of drug abuse . Nine of them were diagnosed as suffering from AIDS . Eight of the deceased had participated in the MMTP . The relative risk of death from external violence and poisoning was 0.25 (95% confidence interval 0.1-1.0) when participants in the MMTP were compared with HIV-infected IDUs never attending the programme . When all causes of death are compared the relative risk was 0.8 . Those patients discharged from the programme have a higher mortality rate than those who never participated.(ABSTRACT TRUNCATED AT 250 WORDS)

Enferm Infecc Microbiol Clin, 1995 May, 13(5), 292 - 6
{Evaluation of Mycobacterium fortuitum acyltrehaloses in the serologic diagnosis of pulmonary tuberculosis}; Sempere M et al.; BACKGROUND: Several glycolipids of Mycobacterium tuberculosis are antigenic and their use in the serodiagnosis of pulmonary tuberculosis has been postulated . Acyltrehaloses (SL-IV) are among the strongest antigenic glycolipids of M . tuberculosis; similar compounds have been found in M . fortuitum . The aim of the present study was to evaluate the usefulness of the acyltrehaloses of M . fortuitum in the serodiagnosis of pulmonary tuberculosis . METHODS: Two glycolipids, identified as triacyl- (TAT-MF) and diacyl- (DAT-MF) trehaloses, were studied by an ELISA method . Two independent analyses were carried out . In the first one, IgG and IgM were determined in sera from patients with pulmonary tuberculosis (84-24 bacteriologically not confirmed--), healthy individuals (46) and patients with respiratory pathologies other than pulmonary tuberculosis (38), using TAT-MF . In the second one, IgG was determined in sera from pulmonary tuberculosis patients (34) and from healthy individuals (20), using DAT-MF . RESULTS: The sensitivity of the IgG ELISA using TAT-MF varied, according to the cut-off point, between 79.8 and 39.3%; the specificity values ranged between 83.3 and 98.8% . In sera from bacteriologically not confirmed pulmonary tuberculosis patients the sensitivity was 87.5-45.8% . The sensitivity for IgM was very low using TAM-MF (10.7-2.3%), with specificity values ranging from 77.4 to 100% . The sensitivity and specificity values of IgG using DAT-MF were, respectively, 34.3-9.3% and 90-100% . CONCLUSIONS: The IgG ELISA using TAT-MF has similar values of sensitivity and specificity to those reported for the acyltrehaloses of M . tuberculosis, although this antigen, by itself, can not be used in the serodiagnosis of pulmonary tuberculosis . DAT-MF has no value in the serodiagnosis of pulmonary tuberculosis.

Can Vet J, 1995 May, 36(5), 291 - 4
Porcine colonic spirochetosis: a retrospective study of eleven cases; Girard C et al.; This retrospective study of porcine colonic spirochetosis was done in order to characterize the clinical signs, the macroscopical and microscopical changes, and the bacteriological results of cases observed in Quebec . Necropsy records of all cases of colitis were reviewed . Eleven cases with filamentous bacteria colonizing the colonic epithelium were selected . This condition was only observed in weaned piglets, and was associated with mild persistent diarrhea and growth retardation . Macroscopic changes were generally limited to the presence of soft to liquid colonic contents . Adherence of filamentous helicoidal bacteria to the apical surface of the colonic epithelium and mild diffuse infiltration of the colonic lamina propria by mononuclear cells were the main histological findings . Weakly beta-hemolytic spirochetes were isolated in 6 cases . This condition seems to be underestimated for various reasons, and it is possible that some cases diagnosed as nonspecific colitis or superficial colitis, in fact, represent later stages of porcine colonic spirochetosis.

J Trauma, 1995 May, 38(5), 705 - 12
Hemodynamic changes and gut barrier function in sequential hemorrhagic and endotoxic shock; Turnbull RG et al.; Multisystem organ failure (MSOF) is the major cause of late death following trauma . The gut is hypothesized to be the source of an ongoing systemic inflammatory response that drives MSOF . It has also been suggested that while a single physiologic insult might not reliably cause MSOF, the addition of a delayed second stress will . This is known as the "two-hit" theory . The purpose of this study was to investigate the two-hit theory by observing the hemodynamic and bacteriologic response to a second stress in a subacute pig model of hemorrhagic and endotoxic shock . Swine (n = 18, 30-40 kg) were fed an antibiotic-free diet for 14 days . During instrumentation and experimentation on days 1 and 3, all animals were anesthetized (ketamine, isofluorane) . On day 1, all animals had placement of central venous and arterial catheters, a portal venous catheter, and superior mesenteric artery flow probe . Group E (n = 6) underwent instrumentation on day 1, then infusion of endotoxin (25 mcg/kg E . coli lipopolysaccharide) on day 3 . Group HE (n = 7) underwent instrumentation then hemorrhagic shock (mean arterial pressure = 40 mm Hg for 4 hours) on day 1, then infusion of endotoxin on day 3 . Group H (n = 5) were instrumented and hemorrhaged on day 1, and underwent anesthesia only on Day 3 . Between periods of anesthesia the animals were allowed food and water ad lib and systemic blood was sampled for culture every 12 hours . On day 5, the animals were euthanized prior to organ sampling for bacterial culture . One animal from group HE died during endotoxic shock on day 3.(ABSTRACT TRUNCATED AT 250 WORDS)

J Lab Clin Med, 1995 May, 125(5), 581 - 7
Characterization of mycobacterial antigens and antibodies in circulating immune complexes from pulmonary tuberculosis; Raja A et al.; Circulating immune complexes (CICs) in serum samples from patients with pulmonary tuberculosis (bacteriologically positive {S+C+} and bacteriologically negative {S-C-}) and controls (NHC) have been measured by using C1q binding assay (C1qBA) and 3.5% polyethylene glycol precipitation and measurement of absorbance at 280 nm (PEG-OD 280) . Although C1qBA did not show any difference between tuberculous and normal serum samples, PEG-OD 280 was significantly elevated in tuberculous samples . The effect of chemotherapy on CIC levels was studied . During the treatment, initially (for up to 2 months) there was a rise in CIC levels and later a fall, coinciding with bacterial clearance . Anti-purified protein derivative antibodies of class immunoglobulin G (IgG) and immunoglobulin M were measured in the serum samples and PEG precipitates . Anti-mycobacterial antibody measurement in CICs was more discriminatory between the groups than serum antibody . For characterization of the complexed antibody, the PEG precipitates were used in the Western blot and the patterns were compared . S+C+ CICs contained antibodies for a wide range of antigens ranging from 100 Kd to 10 Kd . However, none of the NHC-CICs contained antibodies for antigens < 70 Kd . Thus, when using the criterion of positivity for antibodies to antigens < 70 Kd as a marker for pulmonary tuberculosis, 24 of 24 (100%) of the S+C+ CICs were positive . Similarly, 11 of 16 (70%) of the S-C- CICs contained antibodies for antigens < 70 Kd.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatology, 1995 May, 21(5), 1303 - 7
Diagnostic value of fine-needle puncture of the gallbladder: side effects, safety, and prognostic value; Tudyka J et al.; Bile sampling without the risk of contamination by pancreatic and duodenal secretions and avoiding unpredictable influences of general anesthesia during biliary surgery on biliary analytics are feasible with percutaneous puncture of the gallbladder . In 207 patients with gallstones, gallbladder puncture was performed under local anesthesia with a 22-gauge spinal needle under continuous real-time ultrasound guidance . Bile samples were investigated for biliary lipids and nucleation time . Complete aspiration of gallbladder bile could be achieved in all patients without complications such as bleeding, bile leak, or inflammation . Of these patients, 11.6% reported mild abdominal problems, 3.4% required analgetics, and in 1.0% biliary colics were observed . Elective cholecystectomy was performed in 1 patient . Of the bile samples, 10.1% were contaminated with bactobilia . Biliary lipids, cholesterol saturation index (CSI), total lipid concentration (TLC), and bacteriological contamination were independent of gallstone number, whereas patients with solitary gallbladder stones exhibited a significantly longer nucleation time (NT) in comparison with those with multiple stones . In patients with gallstones, fine-needle puncture of the gallbladder represents an important diagnostic procedure and can be performed within minutes without major side effects if performed by an experienced sonographer.

Am J Respir Crit Care Med, 1995 May, 151(5), 1486 - 90
Comprehensive tuberculosis control for patients at high risk for noncompliance; Schluger N et al.; The current tuberculosis epidemic in the United States is marked, in many areas, by high rates of noncompliance with antituberculous regimens . In response to this, a comprehensive program of medical, nursing, social services, and supervised therapy was developed at Bellevue Hospital . Most patients were referred to the on-site directly observed therapy program (DOT) located in the hospital . Patients on DOT received daily or twice weekly therapy, and were given incentives to enhance compliance . Outreach was used to track patients who missed appointments . From November 1992 through July 1993, 113 patients were referred . HIV infection, homelessness, illicit drug use, and alcoholism were common . Follow-up revealed that 11 patients were noncompliant and completely lost to follow-up; of the remaining 102, 99% achieved bacteriologic cure . Of the 102 patients who received therapy, 74 attended the Bellevue DOT clinic, 16 attended other DOT programs in the city or received medication at home, and three died of HIV-related, nontuberculous illness . Nine patients were self-medicated and judged treatment successes . We conclude that a comprehensive hospital-based tuberculosis control program is capable of achieving a high degree of success, even in a population at high risk for noncompliance.

Am Surg, 1995 May, 61(5), 397 - 402
Jejunoileal bypass-induced liver dysfunction and bacterial translocation: effect of intraluminal glutamine-infusion; Rodriguez JA et al.; We tested the effect of long-term intraluminal administration of glutamine on jejunoileal bypass (JIB) induced abnormalities in the plasma-liver profile in rats . Male Sprague Dawley rats (200-250 g) were subjected to an end to side JIB followed by daily intraluminal infusions of either 8 ml saline (n = 5), infused over a 4-hour period, or 8 ml saline containing 1g/Kg body weight glutamine (n = 7) for 3 weeks . Thirteen unoperated rats and four JIB rats without infusions served as controls . At the conclusion of the experiment, a cardiac blood sample was removed and analyzed for plasma cholesterol, albumin, total protein, gamma glutaril transferase, lactic dehydrogenase, glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, and bilirubin . Tissue samples from various segments of bowel, liver, mesenteric lymph nodes, and spleen underwent histopathologic examination . Bacteriological cultures were prepared from jejunum, ileum, mesenteric lymph nodes, liver, and spleen . Bacterial translocation occurred in both JIB-saline and JIB-glutamine infused rats . Glutamine-infused rats developed a significant decrease in the plasma cholesterol levels . However, glutamine did not prevent the JIB-induced alterations in the plasma-liver profile and bowel histopathology . It is suggested that experimental JIB procedure can be used as a model of bacterial translocation consequent to mucosal permeability and intestinal inflammatory diseases.

Pediatrics, 1995 May, 95(5), 664 - 9
Use of C-reactive protein in differentiation between acute bacterial and viral otitis media; Tejani NR et al.; OBJECTIVES . The objectives of this investigation were: (1) to determine degree of elevation of serum C-reactive protein (CRP) in uncomplicated acute otitis media (AOM); (2) to compare serum CRP levels in bacterial and viral otitis media; and (3) to determine whether a single serum CRP level, obtained early in the course of AOM, could be used to differentiate between viral and bacterial otitis media . DESIGN AND METHODS . Sera were obtained from otherwise healthy infants and children with AOM who were 3 months to 7 years of age between 1989 and 1991 . Tympanocentesis, bacterial and viral studies of the middle ear fluids, virologic studies of nasal wash specimens, measurements of serum antibody titers to respiratory viruses, blood counts, and quantitation of serum CRP concentrations were performed . After the initial tympanocentesis, an oral antibiotic was given for the next 10 days . The patients were clinically reevaluated over next 4 weeks . OUTCOME MEASURES . Serum CRP concentrations were compared among subjects with AOM who were divided into four groups based on the results of bacteriologic and virologic studies: group I, Bacterial infection (n = 82); group II, bacterial and viral infections (n = 69); group III, viral infection (n = 12); and group IV, no identifiable pathogen (n = 22) . RESULTS . There was no statistical difference in serum CRP values among the four groups . The ranges of CRP were less than 0.6 to 22.8, less than 0.6 to 17.8, less than 0.6 to 2.0, and less than 0.6 to 6.8 mg/dL in groups I through IV, respectively . However, when CRP values in bacteria-positive cases were compared with CRP concentrations in bacteria-negative cases (1.58 +/- 3.16 vs 0.64 +/- 1.24 mg/dL), the difference was statistically significant . Furthermore, a significantly higher proportion of bacteria-positive cases had serum CRP concentrations greater than 2 mg/dL, compared with those in bacteria-negative cases . There was no correlation between initial CRP values and clinical findings and/or the clearance of bacteria from the middle ear . After 10 days of antibiotic treatment, CRP values returned to normal (< 0.6 mg/dL) in all cases . CONCLUSION . In AOM, the range of serum CRP varied from less than 0.6 to 22.8 mg/dL . High CRP values (> 2.0 mg/dL) were associated with 22% of cases of bacterial AOM but only with 6% of nonbacterial AOM . High levels of serum CRP were found to be very specific in detecting bacterial AOM, and no cases of viral AOM without a concurrent bacterial infection were found to exhibit high serum levels of CRP.

J Vasc Interv Radiol, 1995 May-Jun, 6(3), 397 - 403
Evaluation of a second-generation tantalum biliary stent in a canine model; Cardella JF et al.; PURPOSE: To evaluate the safety and feasibility of use of a balloon-expandable tantalum (Tantaflex) stent in the biliary tree in a canine model . MATERIALS AND METHODS: In this prospective, randomized trial, 10 tantalum stents were placed in eight dogs (two telescoping stents in two dogs), and six Wallstents were placed in six dogs as controls . Stents were deployed into the common bile duct via a cholecystostomy at laparotomy under fluoroscopic and cholangiographic guidance . Two dogs from each stent group were killed at 4, 12, and 26 weeks; the two dogs with telescoping stents were killed at 12 weeks . Premortem patency was confirmed cholangiographically . Postmortem stent explants were inspected grossly, and tissues were examined histologically . Bacteriologic evaluation of bile was performed . RESULTS: All 14 dogs survived until they were scheduled to be killed without clinical complication or evidence of jaundice . Patency was demonstrated at terminal cholangiography in 12 of 14 dogs and at explantation in 13 of 14 dogs . One Wallstent placed across the ampulla in a dog killed at 26 weeks became obstructed . In another dog, the presence of a cholelith in the cystic duct precluded filling of the common bile duct from the cholecystotomy . Only mild inflammatory changes were present in the bile ducts . CONCLUSION: The tantalum stent can be used safely and effectively in the common bile duct in normal dogs . Performance of a clinical trial in humans is supported finding of this study.

Arch Kriminol, 1995 May-Jun, 195(5-6), 166 - 76
{Errors in treatment of soft tissue phlegmon : expert assessment and forensic evaluation}; Pedal I et al.; In ten cases of soft part phlegmons resulting in death (8) and amputation (2) respectively, various types of medical malpractice were evident . The diagnosis was missed, or the disease was correctly diagnosed but underestimated . Typical therapeutic mistakes were the omission of bacteriological investigations and of the proper antibiotical therapy, a delayed hospital admission, or a delayed or insufficient surgical intervention . These errors however could never be proved to have caused the unfavorable outcome in view of the doubtful prognosis of soft part phlegmons even under proper treatment . Thus, evident malpractice never resulted in a condemnation for bodily injury or involuntary manslaughter.

Minerva Pediatr, 1995 May, 47(5), 171 - 4
{Diagnostic considerations on sinusitis in childhood}; Visca A et al.; The presence of a radiographic sinusal opacification without any other clinical sign or symptom cannot lead to the diagnosis of "Sinusitis", if considered alone . In a previous paper we observed a high prevalence of patients with both clinical and radiographic signs of sinusitis and a high prevalence of neutrophils in the nasal secretions, now we tried to discover which clinical signs and symptoms are more likely to indicate an acute sinusitis . We compared cough, headache, bacteriological culture of nasal secretions with a sinusal CT scan, without finding any relationship . On the contrary, neutrophils in the nasal secretions and Rx are strictly inter-related with CT scan, with a sensitivity of 77% and a specificity of 100%.

Nippon Igaku Hoshasen Gakkai Zasshi, 1995 May, 55(6), 369 - 74
{High-resolution CT findings of Pneumocystis carinii pneumonia}; Tsukada H et al.; High resolution CT (HRCT) was performed on 7 patients with pneumocystis carinii pneumonia (PCP) . Six cases were proven bacteriologically by bronchoalveolar lavage; one case was proven by autopsy . Three patients were re-scanned after specific treatment and symptomatic relief . All the CT scans were abnormal, usually showing bilateral diffuse ground-glass opacity, through which the pulmonary vessels remained visible . Chest X-ray, on the other hand, showed a normal pattern in one patient . Other changes such as air space consolidation (in 4 cases) and thickening of peripheral pulmona vessels (in 2 cases) were also seen . Air space consolidation was found in three cases with mixed infection (cytomegalovirus pneumonia in 2 cases, aspergillosis in one case) . No patient showed significant mediastinal or hilar lymph node enlargement, pleural effusion or cystic pulmonary change . HRCT findings such as ground-glass opacity and air space consolidation were shown to disappear in some cases of PCP after specific treatment . HRCT is useful to evaluate the sequential pulmonary changes after the specific therapy.

Nihon Kyobu Shikkan Gakkai Zasshi, 1995 May, 33(5), 533 - 7
{A case of sarcoidosis with right pneumothorax and multiple cavities in both lung fields}; Yamaguchi M et al.; A 26-year-old man was admitted to our hospital for evaluation of cavitary lesions on his chest X-ray film . Chest CT and conventional tomograms showed multiple cavities in both lung fields, as well as hilar and mediastinal lymphadenopathy . He had uveitis and the laboratory data showed a high level of angiotensin converting enzyme in the serum . Histological findings of the specimen obtained by transbronchial lung biopsy showed non-caseating epithelioid cell granuloma, consistent with sarcoidosis . Corticosteroid therapy (prednisolone 40 mg/day) resulted in reduction of the cavitary lesions and the lymphadenopathy . Negative bacteriological studies and the clinical course strongly suggested primary cavitation, a relatively rare form of pulmonary parenchymal involvement in sarcoidosis.

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 163 - 6
Retrospective analysis of the efficacy of cefotaxime sodium dosed twice daily . The Swedish experience; Bergquist SO et al.; In a Swedish multicenter, comparative, retrospective study, patients with different types of infections--bacteremia-septicemia, genitourinary, intra-abdominal, central nervous system, and lower respiratory tract infections--were randomly selected from the hospital records . Patients treated with cefotaxime twice or three times a day as monotherapy (excluding metronidazole) for at least 1 day (240 cases) were analyzed in terms of clinical and bacteriologic outcome, these results were correlated with the dosing regimen . Similarly high success rates (cure and improvement) at hospital discharge were observed in both group initially treated with cefotaxime 1 g twice daily and 2 g twice daily (97 and 96%, respectively) . A total of 73% of patients were initially treated with cefotaxime for only 3 days at most before changing to a lower dose regimen, an alternate intravenous treatment, or oral drug follow-up . Clinical evaluation at hospital discharge revealed a clinical success rate between 87 and 100%, depending on the type of infection.

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 155 - 7
Cefotaxime twice daily versus ceftriaxone once daily . A randomized controlled study in patients with serious infections; Simmons BP et al.; We randomized 365 patients with serious infections to treatment with either 2 g intravenously (IV) cefotaxime every 12 h or 2 g IV ceftriaxone once daily . Clinical response rates were similar in both treatment groups, with success defined as satisfactory or improved response in 107 of 124 (86.3%) evaluable patients in the cefotaxime group compared with 103 of 114 (90.4%) evaluable patients in the ceftriaxone group . Bacteriologic cure rates were also similar in the two groups (86.4%) in the cefotaxime group compared with 87.0% in the ceftriaxone group) . There was no statistically significant difference in the incidence of drug-related adverse events in the two groups . These results indicate that 2 g cefotaxime twice daily is as effective, both clinically and bacteriologically, as 2 g ceftriaxone once daily in serious infections caused by susceptible pathogens.

Clin Ther, 1995 May-Jun, 17(3), 413 - 24
Single daily dose of cefodizime in patients with community-acquired pneumonia: an open-label, controlled, randomized study . The Italian Multicentre Community-Acquired Pneumonia Group; De Palma M et al.; The objective of this study was to compare the clinical and bacteriologic efficacy and safety of cefodizime 1 g intramuscularly (IM) once daily (group A) versus cefodizime 1 g IM twice daily (group B) and versus ceftriaxone 1 g IM once daily (group C) in patients with community-acquired pneumonia . A total of 298 patients, affected by bronchopneumonia or pneumonia with known or suspected bacterial cause, new focal signs on examination of chest, and radiographic evidence of a recent infiltrate, were randomized in three comparable groups . The infection was rated as mild, moderate, or severe . A total of 283 patients were assessable for efficacy: 95 in group A, 94 in group B, and 94 in group C . Mean (+/- SD) duration of treatment was 5.96 +/- 1.39 days in group A, 6.24 +/- 1.57 days in group B, and 6.66 +/- 1.95 days in group C . Symptoms such as purulent sputum, cough, and dyspnea improved significantly after treatment in all groups; temperature normalized by about day 3 . Clinical efficacy was rated good in 94.74% of patients in group A, in 92.55% in group B, and in 87.23% in group C . Positive bacteriologic cultures were obtained before treatment from 144 patients: bacteriologic responses were rated good in 98.11%, 98.08%, and 92.80% in groups A, B, and C, respectively . No significant differences were found between the three treatment groups for any measures of clinical efficacy . No serious adverse event occurred in any of the groups . We conclude that cefodizime 1 g IM once daily is an effective dosing regimen in the treatment of patients with community-acquired pneumonia.

Rev Fr Gynecol Obstet, 1995 May-Jun, 90(5-6), 275 - 80
{Premature rupture of membranes at term . Retrospective study of 88 cases}; Dreyfus M et al.; A retrospective study enabled us to evaluate the "wait-and-see" attitude adopted in our department in case of premature rupture of the membranes at term . The series included 88 patients (9.74%) who delivered spontaneously or after induction . The following maternal parameters were studied:time between rupture and delivery, pyrexia and chorioamnionitis number of vaginal digital examinations, histology and placental bacteriology . Neonatal criteria were based upon an infection assessment . Our results showed that approximately 80% of patients were in labor within 24 hours following rupture . Cesarean section rate remained stable (13%) in comparison with the overall rate for the department . Neonatal infectious morbidity (5.7%) showed no increase . The incidence of chorioamniotitis did not vary (7 cases) but appeared to be related to the number of vaginal examinations before labor . In conclusion, our attitude of temporization did not result in any increase in the number of cesarean sections nor of neonatal infections in comparison with the general population in the department . Prostaglandins might be useful in unfavorable obstetric situations.

Rev Latinoam Microbiol, 1995 Apr-Jun, 37(2), 161 - 9
Antibody response to Mycobacterium tuberculosis antigens in children with pulmonary tuberculosis and in BCG vaccinated non tuberculous pediatric patients; Lopez de Arcila C et al.; In this work we look for the antibody response to M . tuberculosis antigens in 38 children with pulmonary tuberculosis: 18 bacteriologically and 20 clinically diagnosed as compared to the response of 52 children with other respiratory illnesses in which tuberculosis was definitively ruled out . In this control group 24 had been BCG vaccinated and 28 had not . Antibodies were detected by ELISA and immunoblot using a crude extract of M . tuberculosis as antigen . All 38 tuberculous diagnosed children tested positive, by ELISA, to the bacterial extract as did previously vaccinated controls (18/24), while all 28 non vaccinated controls gave negative results (sensitivity = 1.0, specificity = 0.68) . By Western blot, tuberculous patients recognized a 12 kDa protein that was not recognized by the control vaccinated group . This partially purified protein which was used in an ELISA resulted positive in all 18 bacteriologically, in 17/20 clinically diagnosed patients, and in only 6/24 vaccinated controls . Specificity increased to 0.86, with a sensitivity of 0.93.

Indian J Lepr, 1995 Apr-Jun, 67(2), 161 - 6
A clinico-epidemiological study of leprosy in arid north-west Rajasthan, Jodhpur; Salodkar AD et al.; A detailed clinical, bacteriological and histopathological study of 1373 patients of leprosy who sought medical advice at the Department of Skin, STD and Leprosy of Dr . Sampurnanand Medical College, Jodhpur, during 1975-1993 is reported . The disease was observed in 1.54 patients per 1000 cases attending in the skin department out-patients . More than 50% of them had polar type of lepromatous leprosy . The disease was found 2.42 times more often in males than in females and was found mainly in the age group 11-70 years . Family history of leprosy was obtained in 130 (9.5%) of the cases . Lepra reactions were seen in 151 (11%) cases, of which 30 had type 1 reaction (19.2%) and 121 type 2 reaction (80.1%) . The majority of leprosy cases (966 or 70.4%) were from Jodhpur district, followed by 109 (7.9%) from Nagaur district and then from, Barmer, Jaisalmer and Jalore etc . All cases of leprosy responded well to the WHO regimens of multidrug therapy . The reactional cases were satisfactorily managed with higher doses of clofazimine along with oral prednisolone.

Int Surg, 1995 Apr-Jun, 80(2), 147 - 51
Intra-abdominal tuberculosis in acquired immunodeficiency syndrome . Diagnosis and management; Schanaider A et al.; Tuberculosis (TB) in human immunodeficiency virus (HIV) immunosuppressed patients is characterized by extra-pulmonary disease in as many of 70% of them . If intestinal or lymph node involvement occurs, the differential diagnosis between an acute abdomen and other non surgical conditions may be a challenging problem . The authors analyzed eight double infected patients (TB and acquired immunodeficiency syndrome AIDS), who were admitted to the University Hospital (HUCFF) of the Federal University of Rio de Janeiro . This association should be considered when abdominal pain, anemia, fever, weight loss and abdominal lymph node enlargement are present . Bacteriology of body fluids, abdominal ultrasound (US) and computed tomography scans (CT) combined with guided needle aspiration biopsies, barium examination, colonoscopy and laparoscopy, can not only elucidate the diagnosis but also be helpful in assessing an appropriate management . Thus a systematic evaluation often yields an etiology and a correct therapeutic indication reducing the high mortality rate.

J Arthroplasty, 1995 Apr, 10(2), 185 - 9
Optimal timing of wound drain removal following total joint arthroplasty; Drinkwater CJ et al.; Closed suction drains reduce postoperative hematoma formation, but create an entry portal for bacteria and thus increase the risk of infection . This study attempts to establish when the risks of wound drainage outweigh the benefits . In a prospective clinical trial, wound drains were used in all patients having a total knee or total hip arthroplasty . Timing of drain removal and amount drained were recorded . Drain-site swabs were sent with drain tips for bacteriology . Results suggest that the likelihood of bacterial colonization increases while wound drainage decreases with time . The authors conclude that the optimal time to remove drains is 24 hours after total joint arthroplasty.

J Cardiovasc Surg (Torino), 1995 Apr, 36(2), 143 - 5
Non-infective high fever after replacement of thoracic aorta using collagen-impregnated Dacron prosthesis; Ishikawa S et al.; We present three patients who were complained of a high fever without infective signs clinically and bacteriologically after the implantation of a woven Dacron prosthesis impregnated with collagen for thoracic aortic aneurysm . High fever appeared on the third on fourth day after surgery, and continued for three to seven days . The maximum fever ranged 39.1 to 39.9 degrees C . There was a close relationship between the value of C-reactive protein and the duration of a high fever . There were no differences between patients with and without a high fever in white blood cell counts, and other hematological and biochemical examinations . Non-infective high fever may be encountered in the postoperative acute phase following the implantation of a Hemashield prosthesis.

Clin Invest Med, 1995 Apr, 18(2), 131 - 8
Clarithromycin versus cefaclor in lower respiratory tract infections . The Canadian Bronchitis Study Group; Fong IW et al.; A randomized study was done to compare the efficacy of clarithromycin 250 mg or 500 mg b.i.d., vs . cefaclor 250 mg or 500 mg t.i.d . for 7-14 d in 197 evaluable patients with lower respiratory tract infection . Ninety-five patients received clarithromycin, 88 with acute bronchitis or exacerbation of chronic bronchitis, and 7 with pneumonia . One hundred and two patients received cefaclor, 86 with bronchitis and 16 with pneumonia . Ten patients (10.5%) in the clarithromycin group did not complete the trial, 5 (5.3%) because of adverse event, and 3 (3.2%) because of clinical failure . Similarly, 11 patients (10.8%) did not complete cefaclor, 2 (2%) because of adverse event, and 7 (6.9%) because of clinical failure . Clinical cure or improvement was observed in 90 (94.7%) of patients on clarithromycin vs . 92 (90.2%) on cefaclor, p = 0.66 . Bacteriologic cure was seen in 26/36 patients (72.2%) on clarithromycin vs . 28/40 patients (70%) on cefaclor, p = 0.28 . Clarithromycin is just as effective as cefaclor for lower respiratory tract infections and is well tolerated.

Am J Vet Res, 1995 Apr, 56(4), 415 - 9
Comparison of the sensitivity of the caudal fold skin test and a commercial gamma-interferon assay for diagnosis of bovine tuberculosis; Whipple DL et al.; A study to determine and compare the sensitivity of the caudal fold tuberculin test (CFT) and a commercial gamma-interferon (gamma-IFN) assay for diagnosis of bovine tuberculosis was conducted . A dairy herd with approximately a third of the cattle infected with Mycobacterium bovis was chosen for this study . All cattle from this herd were slaughtered, and tissue specimens for bacteriologic culturing and histologic examination were collected . Results of the CFT and gamma-IFN assay were compared with results of bacteriologic culturing and histologic examination to determine test sensitivity . Results were analyzed, using each of the following 4 standards to classify cattle as infected: positive test result by bacteriologic culturing only; histologic examination only; bacteriologic culturing and histologic examination; and bacteriologic culturing or histologic examination . Sensitivity of the CFT ranged from 80.4 to 84.4%, depending on the standard of comparison . Sensitivity of the gamma-IFN assay ranged from 55.4 to 97.1%, depending on the standard of comparison and on the method of interpretation . The CFT was significantly (P < 0.001) more sensitive than the gamma-IFN assay for diagnosis of bovine tuberculosis when the gamma-IFN assay was conducted and interpreted as instructed by the manufacturer . Maximum overall sensitivity was achieved when results of the CFT and gamma-IFN assay were interpreted in parallel.

Jpn J Antibiot, 1995 Apr, 48(4), 482 - 513
{A comparative study of tazobactam/piperacillin and piperacillin in chronic respiratory tract infections}; Oizumi K et al.; The efficacy, safety and usefulness were evaluated for a combined antibiotic tazobactam/piperacillin (TAZ/PIPC) consisting of a new beta-lactamase inhibitor, tazobactam (TAZ), and a broad spectrum penicillin antibiotic, piperacillin (PIPC), in chronic respiratory tract infections with PIPC as the control in a multi-institutional comparative study . The drugs used were a preparation containing 0.5 g of TAZ and 2.0 g of PIPC per vial (TAZ/PIPC group) and a preparation containing 2.0 g of (PIPC group) . The drugs were intravenously injected one vial at a time twice a day for 14 days as a rule . The following results were obtained: 1 . Clinical effect There was no significant difference between TAZ/PIPC (86% or 76/88) and PIPC (81% or 69/85) . 2 . Bacteriological effect There was no significant difference between TAZ/PIPC (93% or 42/45) and PIPC (88% or 36/41) in terms of bacterial eradication rates . In 34 patients with beta-lactamase-producing pyogenic bacteria, there was no significant difference between TAZ/PIPC (77% or 10/13) and PIPC (88% or 15/17) . 3 . Degrees of improvement in clinical symptoms, signs and laboratory findings The TAZ/PIPC group was likely to show reductions in fever and the amount of sputum soon after administration . 4 . Side effects Incidences of side effects were 7% (7/96) in the TAZ/PIPC group and 3% (3/89) in the PIPC group, showing no significant difference between the two groups . The main symptoms were allergic reaction and gastrointestinal symptoms . 5 . Abnormal clinical laboratory test values The incidence was 17% (15/89) in the TAZ/PIPC group and 21% (18/87) in the PIPC group . The main symptoms were eosinophilia and hepatic dysfunction, and most of these symptoms were mild . 6 . Usefulness The usefulness rates in the TAZ/PIPC group were 80% (71/89) and 78% (66/85) in the PIPC group, showing no significant difference . Thus, TAZ/PIPC exhibited excellent clinical effects and presented no troubles with safety . When comprehensively evaluated, TAZ/PIPC appears to be a very useful drug for the treatment of chronic respiratory tract infections.

Jpn J Antibiot, 1995 Apr, 48(4), 449 - 81
{A comparative study of tazobactam/piperacillin and piperacillin in bacterial pneumonia}; Oizumi K et al.; The efficacy, safety and usefulness of tazobactam/piperacillin (TAZ/PIPC), in bacterial pneumonia and lung abscess were determined with PIPC as the control in a multi-institutional comparative study a penicillin antibiotic for injection prepared by combining a newly developed beta-lactamase inhibitor, tazobactam (TAZ), with a broad spectrum penicillin antibiotic, piperacillin (PIPC), at a ratio of 1:4 . TAZ/PIPC was intravenously injected at a dose of 2.5 g (titer) twice a day, and PIPC at a dose of 2.0 g (titer) twice a day as a rule for 14 days . The following results were obtained: 1 . The efficacy rates for bacterial pneumonia and lung abscess were 94% (80/85) in TAZ/PIPC group and 89% (70/79) in PIPC group, showing no significant difference between the two groups . 2 . In a comparison of degrees of improvement in clinical symptoms, signs and laboratory findings, there were no significant differences between the two groups except for results on thoracic rales after three days of administration . 3 . As for bacteriological effects, the elimination rates of causative organisms were 98% (40/41) in the TAZ/PIPC group and 80% (28/35) in the PIPC group . Thus, the TAZ/PIPC group was significantly superior to the PIPC group . The TAZ/PIPC group showed significantly better eradication of bacteria as well . Bacteria considered to be pyogenic were detected in 80 patients (43 administered TAZ/PIPC and 37 administered PIPC), but beta-lactamase production was confirmed in only 11 patients of each group . There were no significant differences in bacteriological effects among these patients . Minimum inhibitory concentrations of TAZ/PIPC against beta-lactamase producing organisms were distinctly superior to those of PIPC . 4 . Side effects occurred in 10% (10/96) of the TAZ/PIPC group and 7% (7/95) of the PIPC group . Abnormal clinical laboratory test values were observed in 22% (20/92) of the TAZ/PIPC group and 18% (17/93) of the PIPC group . Thus, there were no significant differences between the two administration groups . 5 . The usefulness rate in the TAZ/PIPC group was 87% (75/86) and it was 85% (67/79) in the PIPC group, showing no significant difference between them . The results suggest that TAZ/PIPC administered at a dose of 2.5 g (titer) twice a day is more useful than PIPC administered at a dose of 2.0 g (titer) twice a day in the treatment of bacterial pneumonia.

Arch Pediatr, 1995 Apr, 2(4), 339 - 42
{Intraosseous infusion in children}; Carbajal R et al.; BACKGROUND--Intravenous access in critically ill patients may be very difficult to obtain . The intraosseous route is an alternate way to administer fluids and drugs . CASE REPORT--A five month old infant was brought to the emergency department in profound hypovolemia requiring immediate tracheal intubation . A peripheral venous access was established and 35 ml of colloid were rapidly infused . Unfortunately, fluid extravasated and the intravenous line had to be removed . As further attempts to gain intravenous access were unsuccessful, an intraosseous needle was inserted into the left tibia 1 cm below the tibial tuberosity, and colloid and human albumin solution were infused rapidly, followed by 1.4% sodium bicarbonate . After ninety minutes of intraosseous rehydration, 2 peripheral venous lines were inserted, and the intraosseous needle was removed . Bacteriological and viral cultures were negative . Four days after admission, the child was discharged in good condition . CONCLUSIONS--Intraosseous infusion provides safe, rapid and reliable access to the circulation for administration of fluids and drugs in the critically ill child or during cardiac arrest.

Arch Pediatr, 1995 Apr, 2(4), 310 - 6
{Helicobacter pylori gastritis in children}; Lamireau T et al.; BACKGROUND--The role of Helicobacter pylori in chronic gastric and duodenal ulcer disease has now been proven in adults as well as in children . MATERIAL AND METHODS--H pylori has been looked for during endoscopy in 130 children suffering from recurrent abdominal pain (78 patients) or other symptoms (52 patients) . Biopsy samples were taken from the antrum and the fundus, and were examined for histology and bacteriology (Gram staining, urease test, culture) . RESULTS--H pylori was found in 30 cases (H pylori+ group, medium age: 12 years) and was absent in the 100 other cases (H pylori- group, medium age: 6 years) . H pylori was present in 27% of children suffering from recurrent abdominal pain and 17% of children with other symptoms . Epigastric location of the pain and vomiting were equally frequent in both groups . Endoscopic gastritis, often nodular, was noted in 60% of the cases in the H pylori+ group and in 46% in the H pylori- group (NS) . Chronic gastritis was noted in 90% of the cases in the H pylori+ group, and in 32% of the cases in the H pylori- group (p < 0.01) . Culture was positive in 27 out of 28 cases (97%) in the H pylori+ group, including 3 cases with negative histologic examination . Twenty-two children in the H pylori+ group were treated with amoxicillin and metronidazole . Endoscopy performed about 2 months later showed eradication of H pylori in 63% of the cases, associated with disappearance of histologic lesions in 6 out of 14 cases and of symptoms in 5 out of 7 cases . CONCLUSIONS--H pylori is associated with some pediatric cases of antral gastritis . Further studies are needed to determine the influence of its eradication on symptoms and the interest to search this pathology (by serology) in children suffering from chronic abdominal pain.

Unfallchirurg, 1995 Apr, 98(4), 241 - 7
{In vitro and in vivo studies of a temporary absorbable dressing}; Jurgens C et al.; The major advantage of biodegradable synthetic wound dressings compared to other synthetic materials and biological tissue derivatives is avoidance of the necessity to change the dressing . The copolymer films used in this study were made of lactic and caproic acid . They pose no problems concerning immunology or transmission of diseases . Moreover, the substances released by degradation may possibly influence the process of wound healing . The material proved to be non-toxic and was used successfully as a carrier for cell culture with keratinocytes . The permeability for bacteria is determined by degradation . Evaluation of the bacteriological studies indicates secure protection against secondary contamination of the films for at least 15 days, however . Concerning application, dressing properties, wound healing and wound retraction, no disadvantages were found in comparison with the results of the competition's film Opsite . Based on these findings, the films are now used in a clinical study as a wound dressing for split-skin donor sites.

Rofo, 1995 Apr, 162(4), 282 - 7
{Pulmonary manifestations in HIV patients: role of thoracic radiography, CT and HRCT}; Kauczor HU et al.; AIM: To determine the prevalence of pulmonary changes on chest radiographs and computed tomography (CT/HRCT) in HIV patients and their relation to pulmonary symptoms . MATERIAL AND METHOD: 64 HIV patients were examined prospectively . 15 had no respiratory symptoms (group I), 30 had non-specific respiratory symptoms (group II), 19 complained of dyspnoea (group III) . Chest radiographs and CT were performed within a week . In patients with positive findings, bronchoscopy was carried out with bacteriological and histological examinations . RESULTS: In group 1, 13% of chest radiographs and 40% of CTs showed infiltrative changes . In group II, the figures were 27% and 57% respectively . In group III, abnormalities were found in all cases by both examinations . CONCLUSIONS: In the absence of pulmonary symptoms, imaging is not indicated since it has no clinical consequences . In the presence of pulmonary symptoms, CT/HRCT should be performed whether the chest radiograph is normal or not, since it may reveal additional information.

Arch Bronconeumol, 1995 Apr, 31(4), 157 - 61
{Pleural thickening in tuberculous pleural effusion . The associated factors}; Soler JJ et al.; We aimed to determine which factors were related to the development of residual pleural thickening (RPT) after completion of prescribed treatment . Sixty-two patients with pleural tuberculosis (PTB) were assigned to 2 groups according to the presence or absence of RPT > 2 mm in the side and lower portion of a chest film after completion of prescribed treatment . No patient had been given corticoids . Thickening developed in 72.6%, more often in men (OR, 4.06; p = 0.034), in older patients (36 +/- 21 versus 27 +/- 12 years; p = 0.05) . Smoking, size of effusion, duration of symptoms, encapsulation, PPD, pleural biopsy, bacteriology and pH, glucose, proteins and cholesterol in pleural fluids, as well as their respective pleura/serum coefficients, were similar in both groups . Pleural LDH (LDHp) and its pleura/serum coefficient (LDHp/LDHs) were 454.3 +/- 234.6 U/l and 3.21 +/- 1.67 U/l in the group with RPT and 306.0 +/- 137.2 U/l and 2.00 +/- 1.16 in the group with no sequelae (p = 0.004 and p = 0.016, respectively) . Using 2.10 as the cutoff for LDHp/LDHs, sensitivity was 78.9% and specificity was 71.4%, giving a positive predictive value of 88.2% and a negative predictive value of 55.5% . We conclude that RPT a) is a frequent complication, b) is mainly found in men, c) is age-related and d) can be fairly safely predicted using 2.10 as the cutoff for LDHp/LDHs.

J Surg Res, 1995 Apr, 58(4), 351 - 8
Bacterial translocation and intestinal capillary permeability following major liver resection in the rat; Wang X et al.; Bacterial infections constitute a major cause of morbidity and mortality after major liver resection and mechanisms of this type of complication have been poorly understood . The present study evaluated the translocation of enteric bacteria to mesenteric lymph nodes, viscera, and the systemic circulation and gut capillary permeability of a fine ultrastructural tracer in rats subjected to sham hepatectomy or 70% hepatectomy . Furthermore, the preventive effects of water-soluble ethylhydroxyethyl cellulose (EHEC) were studied . Cultures of all samples from rats subjected to sham hepatectomy or 70% hepatectomy with preoperative intravenous administration of EHEC were bacteriologically negative . The incidence of bacterial translocation from the gut to the systemic circulation and mesenteric lymph nodes was 30 and 80%, respectively (P < 0.01), and to the liver and kidneys 50 and 40%, respectively (P < 0.05), 12 hr after 70% hepatectomy . Intestinal capillary permeability and endothelial cell membrane permeability increased with the development of bacterial translocation . Translocating bacteria appeared within the cytoplasm of capillary endothelial cells . EHEC restored the changes in gut capillary permeability induced by major liver resection . These results indicate that gut capillary permeability may play an important role in maintaining the integrity of the gut barrier function and that increased permeability may be associated with the development of gut barrier failure.

J Trop Med Hyg, 1995 Apr, 98(2), 126 - 30
Impact of chlorination of water in domestic storage tanks on childhood diarrhoea: a community trial in the rural areas of Saudi Arabia; Mahfouz AA et al.; During the period September 1991 to February 1992 standard chlorination packages of calcium hypochloride were provided for the first time to 171 families residing in the catchment area of the Sabt-Bany Bishr Primary Health Care Centre in the rural areas of the Asir region, south-western Saudi Arabia . The villagers added the packages to their home storage water tanks each time they added water from the 220 nearby wells . Analysis of the water samples taken from these wells showed that all of them were bacteriologically unfit for human use . By the end of the study period there were no bacteriologically unfit water samples taken from the tanks of the participating families . Children under 5 years of age whose families were not using chlorinated water had twice the risk of diarrhoea compared to children from the participating families (odds ratio = 1.98, P = 0.047) . The use of chlorinated water was associated with a 48% reduction in diarrhoea . These results indicate that the chlorination of water can be successfully carried out locally in rural areas to improve the health of the population.

Chest, 1995 Apr, 107(4), 1035 - 40
Clarithromycin in the treatment of Mycobacterium avium lung infections in patients without AIDS . Clarithromycin Study Group of France; Dautzenberg B et al.; Mycobacterium avium complex infections, common in patients with AIDS as either pulmonary or disseminated disease, are infrequent in patients without AIDS . Participants were 45 HIV-negative patients with lung disease and positive sputum cultures for M avium; 10 had documented immunocompromise, and 24 had preexisting lung disease . Clarithromycin dosage was 500 to 2,000 mg daily (mean +/- SD = 1,633 +/- 432 mg) . The drug was administered either alone (n = 14) or in combination with rifampin (n = 8), aminoglycoside (n = 1), quinolone (n = 10), clofazimine (n = 18), isoniazid (n = 5), ethambutol (n = 9), pyrazinamide (n = 1), or minocycline (n = 6) . At 3 months, 36 patients among 39 bacteriologically assessed had negative sputum cultures, 3 had positive culture, 3 were dead, and 3 discontinued treatment . At the end of treatment, 32 patients remained negative, 7 were positive . The success rate was 15 of 22 (64%) in patients previously treated with antimycobacterial drugs for M avium disease and 17 of 23 (74%) in new patients . Adverse effects included mild hearing loss (n = 4), increase in liver enzyme levels (n = 5), and gastrointestinal pain (n = 10, two of whom had to stop treatment) . Patients stopped treatment after 300 +/- 186 days due to side effects (3), death (4), or the patient's (5) or physician's decision (33) . During the follow-up, one patient suffered a relapse with peripheral lymph nodes . A daily dose of 30 mg/kg of clarithromycin in the treatment of M avium infections appears to be effective and safe . Concomitant drug therapy should be assessed for its ability to prevent relapse.

J Chemother, 1995 Apr, 7(2), 153 - 6
A comparison of ampicillin/sulbactam versus cefotaxime in the therapy of lower respiratory tract infections in hospitalized patients; Jauregui L et al.; Fifty-three hospitalized patients suffering from lower respiratory tract infections were evaluated in a randomized, comparative trial studying the safety and efficacy of ampicillin/sulbactam (2 g ampicillin plus 1 g sulbactam intravenously every 6 h) versus cefotaxime (2 g intravenously every 6 h) . Thirty-four of the 36 and 16 of the 17 patients treated with ampicillin/sulbactam and cefotaxime, respectively, were evaluable . Clinical and bacteriologic efficacy did not differ significantly between the two treatment groups (p = 0.828 and p = 0.648, respectively) . Twenty-one (61.8%) of the ampicillin/sulbactam-treated patients were cured, eight (23.5%) improved and four (11.8%) were treatment failures . Nine (56.3%) of the cefotaxime treated patients were cured, four (25.0%) improved and two (12.5%) failed therapy . All primary pathogens were eradicated in 19 (55.9%) of the ampicillin/sulbactam group and were partially eradicated in seven (20.6%) patients . In the cefotaxime treatment group bacteriologic eradication occurred in 10 (62.5%) and partial eradication in two (12.5%) patients . Both study drugs were well tolerated, as the number of adverse reactions in each treatment group was small and similar between the two groups . Ampicillin/sulbactam appears to be as safe and effective as cefotaxime in the therapy of hospitalized patients with lower respiratory tract infections caused by beta-lactamase positive and beta-lactamase negative pathogens.

Zhonghua Liu Xing Bing Xue Za Zhi, 1995 Apr, 16(3), 147 - 9
{Epidemiologic investigation on the occurrence of brucellosis in a rabbitry family}; Wang SY et al.; This article reports epidemiologic investigations on the occurrence of brucellosis in a rabbitry family in Laoting County, Hebei Province . Three persons of this family were all examined . The results of examinations by serology, bacteriology, clinical observations, and epidemiological history showed that: Two of the three cases were suffering from Brucellosis . Domestic animals in this house and the domestic animals and feeders in the neighborhood were investigated by serology and bacteriology . The results demonstrated that the source of infection was the dog fed by the family and infected by Brucella sheep biotype.

Int J Clin Pharmacol Ther, 1995 Apr, 33(4), 204 - 7
Oral therapy with flurithromycin in ear, nose and throat infections; Galioto GB et al.; In this study efficacy and tolerability of flurithromycin ethylsuccinate (FE) were evaluated in ear, nose and throat infections . One hundred and three patients were treated with FE tablets 375 mg 12-hourly for a mean duration of treatment of 8.2 days and they were divided into groups according to the pathology: pharyngitis/tonsillitis (chronic 7, acute 38), rhinosinusitis (chronic 7, acute 12), otitis (chronic 6, acute 32) and sialadenitis (acute 1) . Patients evaluable for clinical efficacy were 101, among them a complete recovery was registered in 88.2%, an improvement in 9.9% and a treatment failure in 1.9% . Bacteriological evaluation was possible in 95 patients, showing the eradication of the pathogen in 94.7% . Tolerability was judged to be excellent in 81.6%, good in 15.5% and discrete in 2.9% . These results demonstrate that FE is safe and effective in the treatment of infections established on acute or chronic inflammatory states.

Nippon Kyobu Geka Gakkai Zasshi, 1995 Apr, 43(4), 515 - 8
{A case of extirpation of the extrapleural plombs}; Kadokura M et al.; A 75-year-old male, who had undergone left extrapleural plombage for left pulmonary tuberculosis 46 years before, was admitted because of cough and sputum . The Chest X-ray and CT-scan films on admission show fluid collection in plombs . Left postero-lateral thoractomy was performed on January 14, 1994 . There were thickness of the parietal pleura and no findings of empyema or fistulas . Extrapleural plombs and partial part of the vegetation were removed safely . There were two damaged plombs and fluid collection in another two plombs . No findings of residual tuberculosis were found on postoperative pathological and bacteriological examinations . He has been well for 8 months postoperatively.

Eur J Nucl Med, 1995 Apr, 22(4), 302 - 7
Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy for the diagnosis of bone and joint infections: a retrospective study in 116 patients; Devillers A et al.; The aim of this study was to evaluate the diagnostic value of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (HMPAO-LS) by means of a retrospective review of 116 patients divided into three groups of bone and joint infection . One hundred and thirty-one LS examinations were performed, and 143 sites analysed . The final diagnosis of infection was based on surgical, histological and bacteriological data and follow-up . Ninety-four suspected localizations were examined in group 1, which included 74 patients with an infection suspected to involve orthopaedic implants . In this group, there were 38 true-positives, 1 false-negative, 49 true-negatives and 6 false-positives . Surgical confirmation was obtained in 34 cases . In group 2 (24 patients with suspected osteomyelitis), there were 27 localizations of which 14 were true-positives and 13 were true-negatives (including seven surgical confirmations) . In group 3 (18 patients suspected of septic arthritis) there were eight true-positives, two false-negatives, ten true-negatives and two false-positives . Overall sensitivity of 99mTc-HMPAO-LS for the detection of bone and joint infection was 95%, with a specificity of 90% (group 1: sensitivity 97%, specificity 89%; group 2: 100% and 100%; group 3: 80% and 83%) . It may be concluded that HMPAO-LS is an effective tool for the diagnosis of both bone infection involving implants and chronic osteomyelitis.

Artif Organs, 1995 Apr, 19(4), 289 - 94
An outbreak of pyrogenic reactions in chronic hemodialysis patients associated with hemodialyzer reuse; Rudnick JR et al.; In February 1992, 22 patients undergoing chronic hemodialysis at an outpatient dialysis center experienced pyrogenic reactions (PR) . The PR rate was significantly greater (p < 0.001) during the epidemic (February 3-5) than the pre-epidemic period (November 1, 1992-February 1, 1992) . All patients with PR used dialyzers that had been manually reprocessed either on February 1 or 3 . These dialyzers contained up to 120.8 EU/ml of endotoxin in the blood compartment . The only dialyzer reprocessed before February 1 that was available for analysis was found to contain no detectable endotoxin, while dialyzers reprocessed during the epidemic period contained a median endotoxin concentration of 52.8 EU/ml . The bioburden of water used to prepare dialysate was in excess of the Association for the Advancement of Medical Instrumentation (AAMI) standard for water, < or = 200 colony forming units (CFU)/ml . Samples of treated water collected in the reuse area were within AAMI standards at the time of the investigation (February 11 and February 26), but before the investigation, water samples were assayed with a culture method that could not detect microbial concentrations below 10(3) CFU/ml . In addition, the treated water feed line to the disinfectant container may never have been disinfected . However, no samples were collected from this line during the investigation . This outbreak emphasizes the need to use water that meets the AAMI bacteriologic and endotoxin standards of < or = to 200 CFU/ml and/or 5 EU/ml, respectively, for reprocessing hemodialyzers nad to ensure that appropriate culture techniques are used for treated water dialysate.

Eur J Ophthalmol, 1995 Apr-Jun, 5(2), 82 - 7
Ciprofloxacin ophthalmic solution versus rifamycin ophthalmic solution for the treatment of conjunctivitis and blepharitis; Adenis JP et al.; The efficacy and safety of ciprofloxacin (0.3%) ophthalmic solution and rifamycin (1%) ophthalmic solution for the treatment of bacterial conjunctivitis and blepharitis was compared in this randomized, double-masked, parallel-group study . Forty-one patients, 19 on ciprofloxacin and 22 on rifamycin, were culture-positive on admission and evaluated for efficacy . There was clinical improvement in more than 90% of patients in each group at the end of the seven-day treatment period . However, clinical cure rates on day 7 appeared to be higher with ciprofloxacin (53%) than rifamycin (23%; p = 0.061, Mann-Whitney test) . Bacteriological eradication rates were comparable: the infecting organisms were eradicated in 68% of patients on ciprofloxacin and 77% with rifamycin . There were no serious adverse reactions to either treatment . One patient in each group was withdrawn on account of a mild allergy . In conclusion, topical ciprofloxacin was effective and well tolerated and would be a particularly useful agent for the treatment of bacterial conjunctivitis and blepharitis.

West Afr J Med, 1995 Apr-Jun, 14(2), 112 - 5
Seroprevalence of HIV infection among patients with pulmonary tuberculosis in Yaounde-Cameroun; Kuaban C et al.; To determine the seroprevalence of infection with the human immunodeficiency virus (HIV) in pulmonary tuberculosis patients, we conducted an HIV serosurvey in 162 inpatients with pulmonary tuberculosis, in Yaounde Cameroon . HIV seroprevalence in hospitalized pulmonary tuberculosis patients was found to be 9.9% as compared to the seroprevalence rate of 2.2% for Yaounde, the area from which the patients we studied came . No differences were observed in the clinical, radiological and bacteriological features between HIV seropositive and seronegative patients with pulmonary tuberculosis.

Med J Aust, 1995 Mar 20, 162(6), 287 - 90
Tuberculosis in Australia, 1989-1992 . Bacteriologically confirmed cases and drug resistance; Dawson DJ et al.; OBJECTIVE: To collate statistics, including drug susceptibility, of patients with bacteriologically confirmed tuberculosis in Australia during 1989-1992 . DESIGN: Collaborative project among the five Australian mycobacterial reference laboratories . STUDY POPULATION: 2509 Australian residents with bacteriologically confirmed tuberculosis . OUTCOME MEASURES: Patient and specimen data, and drug susceptibility results recorded for isolates of Mycobacterium tuberculosis and Mycobacterium bovis . RESULTS: The annual incidence during 1989-1992 was about 3.6 per 100,000 . The male-to-female ratio was 1.4:1 and about half the patients were under 50 . Older men had high rates of disease . Lymphatic disease was significantly more common in females; the converse was true for pulmonary and pleural disease . Resistance to at least one of the common antituberculosis drugs was detected in 14.4% of isolates, and usually involved streptomycin (7.6%) and isoniazid (8.4%) . Fewer than 1% of isolates were resistant to isoniazid and rifampicin in combination . CONCLUSIONS: By international standards, Australia remains a "low-incidence" country for tuberculosis, with a static annual incidence . Multiple drug resistance is uncommon and most patients should respond to the standard four-drug regimen . Nevertheless, because clinical data confirm that the pool of infected persons is being supplemented through immigration, and that certain population subgroups have high rates of disease, it is essential that Australia maintain effective control programs.

Presse Med, 1995 Mar 18, 24(11), 531 - 3
{Justification of routine puncture of ascites in cirrhotic patients admitted to emergency hospital units}; Lafond P et al.; OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent, serious, recurrent complication, occurring in 10 to 30% of cirrhotic patients hospitalized with ascites . The key to diagnosis of SBP is ascites paracentesis and polymorphonuclear count in ascitic fluid . The purpose of our study was to evaluate sensitivity and specificity of clinical and biological criteria in diagnosis of 5 BP . METHODS: We prospectively reviewed 30 adult cirrhotic patients admitted in our emergency department with ascites . Ascites paracentesis was performed in each patient, and SBP diagnosis was based on either positive bacteriological culture or polymorphonuclear count above 250/mm3 in ascitic fluid . Classical criteria for SBP were recorded: blood pressure under 90 mm of Hg, abdominal pain, temperature above 38.5 or under 36.5, jaundice, encephalopathy, increased serum bilirubin or creatinine, leukocyte blood count about 12 G/l . We evaluated sensitivity and specificity of those criteria in SBP, and compared their frequency in patients with SBP or sterile ascitic fluid . RESULTS: Thirty patients were included in our series, and in 14 of them a SBP was diagnosed . A significant difference was observed between spontaneous bacterial peritonitis and sterile ascitic fluid for abdominal pain and temperature abnormalities, but specificity and sensitivity of these criteria were very low . Moreover, SBP was asymptomatic in 7% . CONCLUSION: Due to the high rate of mortality in patients with SBP we recommend diagnostic procedures for this frequent complication as soon as patient is admitted in emergency department . This diagnosis must be based on ascitic fluid paracentesis, which has to be performed, in the emergency department, in every cirrhotic patient admitted with ascites . Indeed, SBP is often asymptomatic, and no clinical or bacteriological criteria can be considered as completely reliable for the diagnosis of spontaneous bacterial peritonitis.

JAMA, 1995 Mar 15, 273(11), 859 - 64
Risk factors for primary invasive pneumococcal disease among children in Finland; Takala AK et al.; OBJECTIVE--To study risk factors for invasive pneumococcal disease among children . DESIGN--A population-based, case-control study of 149 cases and 284 controls matched for age, sex, and place of residence . SETTING--Finland, November 1986 through November 1989 . PATIENTS AND CONTROLS--Patients were identified from a prospective nationwide surveillance for invasive bacterial diseases among children (0 to 15 years of age) through a network of bacteriologic laboratories . Two matched controls were selected for 135 of the cases and one matched control for 14 of the cases from the respective cases' child health center or school . Questionnaires evaluating potential risk factors were mailed to families of cases and controls . RESULTS--An increased risk for invasive pneumococcal disease among children younger than 2 years was associated with day care center attendance (odds ratio {OR} = 36; 95% confidence interval {CI}, 5.7 to 233), family day care (OR = 4.4; 95% CI, 1.7 to 12), and history of frequent otitis media (OR = 8.8; 95% CI, 2.5 31) . For those at least 2 years of age, existence of siblings younger than school-age indicated increased risk for invasive pneumococcal disease (OR = 2.2; 95% CI, 1.1 to 4.4) . CONCLUSIONS--Day care center attendance is a major risk factor for invasive pneumococcal disease for children younger than 2 years, with significantly higher risk than the risk associated with family day care.

J Am Geriatr Soc, 1995 Mar, 43(3), 256 - 60
Clinical spectrum of tuberculosis in older patients; Liaw YS et al.; OBJECTIVE: To investigate the clinical differences between old and young patients infected with Mycobacterium tuberculosis in a developing country . DESIGN: Retrospective chart and chest radiograph review . SETTING: A university-affiliated teaching hospital . PATIENTS: The medical records of patients with documented tuberculosis (TB) from January 1990 through December 1991 were analyzed . Clinical assessment included sex, age, diagnosis at first visit, past history, symptoms and signs, laboratory data, X-ray findings, bacteriological examinations, outcome, time elapsed from first visit to initiation of anti-TB therapy and the major determinants for starting anti-TB therapy . Statistical significances were analyzed by Student's t test and chi 2 tests . RESULTS: Among 205 patients with culture-proven TB, 57 were 65 years of age and older (range, 65 to 91; mean, 73) and 148 under 65 years of age (range, 16 to 64; mean, 41) . There was a higher incidence of previous TB (26.3% vs . 16.2%) and diabetes mellitus (24.5% vs . 14.3%) in the elderly patients . Initial diagnosis of TB at first visit was less frequent in the elderly than in the young group (38.6% vs . 47.3%), although symptoms and signs at first visit were similar in each of the age groups . Radiographic presentation with mass lesions was more frequently encountered in elderly patients (10.5% vs . 2.1%, P < .05) . Elapsed time from the first visit to suspicion of TB and the initiation of anti-TB therapy was frequently delayed in elderly patients (22 +/- 23 vs . 13 +/- 20 days, P < .05) . The incidence of drug-resistance (39% vs . 16%, P < .05) and unfavorable response to anti-TB therapy (17.5% vs . 3.4%, P < .05) were significantly higher in the older patients . CONCLUSIONS: Although clinical presentation of TB in the elderly did not differ significantly from that in younger patients, this study showed that diagnosis and treatment were more often delayed in the elderly, and there was a higher incidence of treatment failure.

Ann R Coll Surg Engl, 1995 Mar, 77(2), 131 - 4
Management of small fragment wounds in war: current research; Bowyer GW et al.; The majority of war wounds are caused by antipersonnel fragments from munitions such as mortars and bomblets . Modern munitions aim to incapacitate soldiers with multiple wounds from very small fragments of low available kinetic energy . Many of these fragments may be stopped by helmets and body armour and this has led to a predominance of multiple wounds to limbs in those casualties requiring surgery . The development of an appropriate management strategy for these multiple wounds requires knowledge of the contamination and extent of soft tissue injury; conservative management may be appropriate . The extent of skin and muscle damage associated with a small fragment wound, the way in which these wounds may progress without intervention and their colonisation by bacteria has been determined in an experimental animal model . Results from 12 animals are presented . There was a very small (approximately 1 mm) margin of nonviable skin around the entrance wound . The amount of devitalised muscle in the wound tract was a few hundred milligrams . Some muscles peripheral to the wound track also showed signs of damage 1 h after wounding, but this improved over 24 h; the proportion of fragmented muscle fibres in the tissue around the track decreased as time went on . There was no clinical sign or bacteriological evidence of the track becoming infected up to 24 h after wounding . This preliminary work suggests that, in the absence of infection, the amount of muscle damage caused by small fragment wounds begins to resolve in the first 24 h after injury, even without surgical intervention.

Intensive Care Med, 1995 Mar, 21(3), 270 - 6
The fluidised bed; Ryan DW; The process of fluidisation involves blowing warm air through small solid microspheres thus creating a liquid, without wetness . The warmth provides some important properties including reducing the metabolic rate in thermal injury which has a beneficial effect on mortality, modifying catabolism after surgery, providing gradual vasodilation in shock and core temperature stability in illness . The fluidisation ensures prevention and successful treatment of pressure sores, a comfortable and less stressful environment than conventional care, a reduction in pain, ease of wound care, discourages a bacterial persistence and reduces the work of the nurse . The importance of proper fluid balance, bacteriological care and limitations of posture must be appreciated in using the bed.

Vestn Otorinolaringol, 1995 Mar-Apr, (2), 31 - 3
{Diagnosis of pharyngeal and laryngeal diphtheria in adults}; Grigorev GM et al.; 142 adults with pharyngeal and laryngeal diphtheria were registered in Yekaterinburg in 1993 . Of them, 136 patients recovered and 6 died . The analysis of the clinical features and diagnostic errors showed that subjects with chronic visceral diseases and alcoholics are more likely to have poor prognosis of diphtheria . Diphtheria manifested primarily with edema followed by infiltration of the mucosa, with appearance of thin transparent furs, tenderness of cervical regional lymph nodes . The typical greyish-brown thick and firm false membranes occurred only in the late stage of the disease . The features of the diphtheric croup in the adults complicated the diagnosis . These were, unlike croup in children, the vagueness of the stages of this syndrome, rapid involvement of the trachea and bronchi, mixed type of dispnea and delirious state in alcoholics . It is necessary to set up the duty of ENT specialists in the diagnostic departments of the infectious hospitals for repeated endoscopic and bacteriologic examinations of the diphtheria suspects.

Mil Med, 1995 Mar, 160(3), 97 - 100
New studies disputing allegations of bacteriological warfare during the Korean War; Rolicka M; In the television series Korea the Unknown War produced jointly by Thames Television (London) and WGBH (Boston) in 1990, General Matthew Ridgway, Commander in Chief of United Nations forces during the Korean War, called the accusations that the United States waged bacteriological warfare "black propaganda." The charges discredited the United States and, despite denials and many international discussions, have not been completely refuted until new . Following studies in archives previously not available for research and after uncovering new sources, many specific examples of black propaganda were discovered that contained false information and lies discrediting the United States . The mechanism of lies, which convinced the Korean population that bacteriological warfare was going on and that the only way not to become victims of the United States' inhuman cruelty was to fight, are shown in this paper.

Can Vet J, 1995 Mar, 36(3), 150 - 4
Systemic necrotizing vasculitis and glomerulonephritis in grower pigs in southwestern Quebec; Helie P et al.; This purpose of this study was to describe the clinical features and the pathological findings of an unusual condition observed in pigs of a fattening unit in southwestern Quebec . Two of these pigs were submitted for complete postmortem examination . The disease was characterized by a systemic necrotizing vasculitis and an exudative and proliferative glomerulonephritis . In the skin, the vascular lesions produced a conspicuous papular dermatopathy with a characteristic distribution . Bacteriological and virological results were inconclusive . In the glomeruli, there were extensive granular complement deposits with scattered immunoglobulin M . Transmission electron microscopy did not reveal any dense deposits in glomerular basement membrane . The cause of this newly recognized and potentially lethal condition remains unknown, although histological and immunopathological observations suggest an immune-mediated process.

J Clin Microbiol, 1995 Mar, 33(3), 706 - 12
Specific bovine brucellosis diagnosis based on in vitro antigen-specific gamma interferon production; Weynants V et al.; In order to improve the specificity of the diagnosis of bovine brucellosis, we developed a test which can be regarded as an in vitro correlate of the delayed-type hypersensitivity test (DTH) . A mixture of cytoplasmic proteins from Brucella melitensis B115 was used as a specific antigenic stimulus in bovine whole blood culture . Supernatants harvested at 18 to 24 h after the in vitro antigenic stimulus were assayed for their gamma interferon (IFN-gamma) content by using a commercial sandwich enzyme-linked immunosorbent assay kit . The IFN-gamma assay was evaluated with 10 heifers during the course (80 days) of an experimental infection and with 14 cows from an ongoing brucellosis outbreak . All of these animals were slaughtered, and pertinent organs were subjected to classical bacteriological analyses . In addition, we analyzed 23 field cases in which false-positive serological reactions occurred . The IFN-gamma results were compared with those of the standard DTH and a battery of serological assays, and they were correlated with bacteriological data . Both for the experimental infection and for the field brucellosis outbreak, the IFN-gamma assay detected infection in more animals than any combination of the serological tests, and it detected infection earlier than these tests . Finally, none of the samples from cows showing false-positive serological reactions was classified as positive by the IFN-gamma assay, attesting to its specificity and to its usefulness in interpreting ambiguous serological results . A rapid and convenient alternative to the DTH, the IFN-gamma assay appears to be an ideal method that is complementary to the serological diagnosis protocols.

J Pediatr Orthop, 1995 Mar-Apr, 15(2), 144 - 7
Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children; Mazur JM et al.; A 30-month prospective study was conducted on 43 children who presented with clinical findings suggestive of acute hematogenous musculoskeletal infection . Magnetic resonance imaging (MRI) was found to be extremely sensitive (0.97) and specific (0.92) in helping to diagnose these infections, with only one false positive and one false negative study . Bone scans are more likely to yield false positive and negative examinations . MRI is particularly useful in difficult cases in which there are conflicting clinical data or infection involving the spine or pelvis . After MRI demonstrates the location of the disease process, histologic and/or bacteriologic confirmation of the etiology is still mandatory.

Arzneimittelforschung, 1995 Mar, 45(3), 267 - 72
Clinical effectiveness of a combination of bromhexine and amoxicillin in lower respiratory tract infection . A randomized controlled trial; Roa CC Jr et al.; A multicenter double-blind randomized trial was performed in 22 teaching hospitals to compare the clinical effectiveness of the combination of amoxicillin (CAS 26787-78-0) plus bromhexine (CAS 3572-43-8) versus amoxicillin alone given 4 times a day for 5 to 7 days in the treatment of clinically diagnosed community-acquired bacterial lower respiratory tract infections . 392 adult patients diagnosed clinically to have acute bronchitis or pneumonia of bacterial etiology were recruited for the study with 192 subjects given amoxicillin (250 mg) plus bromhexine (8 mg) (Drug AB) and 200 receiving amoxicillin (250 mg) (Drug AA) alone 4 times a day for 5 to 7 days . Clinical response, improvement in symptom scores using a visual analogue scale, and bacteriologic response were monitored at Days 3, 5 and 7 of treatment . Results showed that although 180/192 (94%) given Drug AB and 185/200 (93%) given Drug AA had favorable clinical response at the end of treatment, the infection was completely resolved for 89/192 (46%) among the Drug AB group and in 67/200 (34%) of patients on Drug AA (p = 0.022) . Also, patients given Drug AB had significantly greater reduction of their symptom scores at Day 3 for symptoms of cough discomfort, cough frequency, ease of expectoration and sputum volume . Among the subset of patients with pneumonia, the cure rates for Drug AB and Drug AA were 24/50 (47%) and 11/50 (22%), respectively (p = 0.008) . A respiratory pathogen was cultured in only 72/392 (18%) of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Zh Mikrobiol Epidemiol Immunobiol, 1995 Mar-Apr, (2), 42 - 5
{Pseudomonads as a marker of the sanitary-epidemiological state of maternity institutions}; Stavertii LV et al.; In the process of the epidemiological supervision of 4 maternity hospitals in Tyumen 453 Pseudomonas strains, classified with 9 species, were isolated and studied . The overwhelming majority of the strains isolated from nursing articles and medical equipment were classified with P . aeruginosa (86.75 +/- 1.68%) and P . putida (7.11 +/- 1.27%) . In the structure of Pseudomonas isolated from humans these species constituted 51.11 +/- 7.45% and 26.67 +/- 6.69% respectively . High occurrence of Pseudomonas contamination of nursing articles and medical equipment in postnatal wards (11.48 +/- 0.82%) and in infants wards (6.92 +/- 0.58%) was established . Sinks of wash-stands (3.76 +/- 1.3-28.5 +/- 2.15%), compressors for the reanimation of infants (11.1 +/- 10.47%), faucets (1.69 +/- 0.7-5.29 +/- 0.92%), etc . were found to be the most contaminated objects which could be the factor of Pseudomonas transmission . The inclusion of bacteriological control into the system of epidemiological supervision in maternity hospitals facilitates the timely detection of unfavorable epidemiological situation and makes it possible to take the necessary measures with a view to decrease the functioning of mechanisms of Pseudomonas transmission well in advance.

Bull Assoc Anat (Nancy), 1995 Mar, 79(244), 11 - 3
{Analysis of restraint of the femur head . Experimental study of allograft of cold bone and autoclaved bone to kill the HIV virus}; Allogo JJ et al.; The retrovirus S.I.A.D . grown in marrow bone and iatrogenic infections may be possible after bone graft in following total hip arthroplasties . Previous investigators proposed several methods to kill the virus, but without bacteriological safety . They found 20 to 55% of loss on mechanical properties . The present study reports the response of autoclaved femoral heads compression testing on material machine Model 1026 Instron . The stress response of marrow bone to stains showed a classic peak and with linear regression study we saw a relationship between autoclaved bone and cold bone . The cortical bone resists to strains highly 12% of load.

Klin Lab Diagn, 1995 Mar-Apr, (2), 43 - 5
{The design of bacteriological preparations for the diagnosis of legionellosis}; Gal'tseva GV et al.; The technique of making legionellosis diagnostic preparations is described, making use of traditional methods and new modified procedures for isolation and purification of the components of serological biosystems . Results of using bacteriological preparations in studies of legionellosis are presented.

J Wound Care, 1995 Mar, 4(3), 129 - 33
Microbiology and immunology in patients with leg ulcers; Hayes M et al.; Aspects of the bacteriological and immunological status of patients with leg ulcers who also need podiatric treatment have been examined . Qualitative and quantitative bacteriological analyses of 52 patients have provided values for the numbers and types of bacteria present . A simple survey of the immunological status of 11 of the patients was also undertaken . The results of the bacteriological survey are consistent with those of other workers, while the results of the immunological studies are sufficiently heterogeneous to warrant a further dedicated study of a longitudinal nature . Because of the numbers of bacteria isolated, the range of bacterial species identified and uncertainties about the immunological status of the patients and others attending multi-clinic sites, it is suggested that in order to safeguard all patients, personnel and the immediate environment, clearly defined special procedures for infection control should be in place.

Acta Otorrinolaringol Esp, 1995 Mar-Apr, 46(2), 91 - 2
{Bacteriological study of serous otitis}; Valles Fontanet J et al.; The bacteriological study of the middle ear effusion of one hundred cases of serous otitis media was performed . Results are discussed and compared to those reported in the literature.

Schweiz Med Wochenschr, 1995 Feb 4, 125(5), 163 - 70
{The traveler returning from the tropics in clinical practice}; Markwalder K et al.; Travellers returning from the tropics frequently consult a physician even if they have no actual symptoms . Physical check-ups in asymptomatic returnees rarely detect dangerous conditions . The most common laboratory finding is intestinal parasites . Blood eosinophilia may indicate helminthic infections, such as strongyloidosis, filariasis, schistosomiasis and others . If there are no diagnostically suggestive symptoms a systematic, step-by-step workup is recommended (stool parasitology, serology, and special methods to demonstrate parasites in blood or tissues) . The most common symptom of returnees from the tropics is diarrhea, or other disorders of intestinal motility . Appropriate investigations include parasitological and bacteriological tests, and--if the course is more chronic--endoscopy . If diarrhea is associated with fever, systemic infections (e.g . falciparum malaria) must be considered . Fever as a leading sign may mask a number of potentially dangerous infections . If there are no other obvious signs or symptoms indicating a particular etiology, the diagnostic approach should consider first of all those systemic infections, which are potentially life-threatening and can be cured by specific therapy, i.e . bacterial meningitis, falciparum malaria, septicemia (including typhoid fever), extraintestinal amebiasis, and African trypanosomiasis.

Br J Dermatol, 1995 Feb, 132(2), 296 - 9
Eosinophilic pustular folliculitis in infancy: report of two affected brothers; Dupond AS et al.; We describe two brothers with eosinophilic pustular folliculitis . Both had recurrent crops of papules and pustules, primarily affecting the scalp . The eruption began in the neonatal period . Both children had a leucocytosis with eosinophilia . Histology revealed folliculitis, with an infiltrate in which eosinophils were predominant . Bacteriological and fungal cultures of pustules were negative . There was a good clinical response to treatment with a topical corticosteroid and dapsone . We review the 28 previously reported cases of eosinophilic pustular folliculitis in infancy . The occurrence of this disorder in brothers suggests that an inherited or contagious factor may be involved in its aetiology.

Am J Obstet Gynecol, 1995 Feb, 172(2 Pt 1), 553 - 62
Genital ulcer disease in women infected with human immunodeficiency virus; LaGuardia KD et al.; OBJECTIVE: The purpose of this study was to determine the prevalence and microbiologic characteristics of genital ulcer disease in a population of human immunodeficiency virus-infected women . STUDY DESIGN: A retrospective cohort study was performed in university-affiliated, hospital-based women's human immunodeficiency virus clinics . A total of 307 women with human immunodeficiency virus infection were followed up during 20 months . There were no interventions . Age, race, CD4+ cell counts, bacteriologic and virologic analyses in cases of ulcers, serologic testing for syphilis, and histopathologic examination in selected cases (n = 6) . RESULTS: Among 307 women followed up over a 20-month period, 43 ulcers were detected with a prevalence of 14% . Among the ulcer cases the average absolute CD4+ lymphocyte number was 210/mm3 . Diagnostic evaluation yielded no proven etiologic agent in 26 (60%) of the cases . Twelve of the 43 cases (28%) were positive for herpes simplex-2 . Five cases (12%) yielded unusual or mixed bacteriologic types . No cases were attributable to primary syphilis infection . One case each of an ulcer infected with cytomegalovirus, Chlamydia trachomatis, and Gardnerella vaginalis, as well as three unusual presentations of herpetic ulcers, is analyzed in detail . CONCLUSION: These cases exemplify the often dramatic presentation of human immunodeficiency virus-related genital ulcers and the clinical complexity of both diagnosis and management . The frequent lack of an infectious or neoplastic cause in human immunodeficiency virus-infected women with genital ulcer disease suggests that human immunodeficiency virus may play a local role in causation or exacerbation . Biopsies of atypical genital ulcers should be considered to aid diagnosis . Further studies are needed to elucidate the pathogenesis of genital ulcer disease in human immunodeficiency virus-infected women.

Chest, 1995 Feb, 107(2), 447 - 52
Outbreak of tuberculosis in a church; Dutt AK et al.; A 48-year-old white man (index case) with an abnormal chest radiograph remained undiagnosed for tuberculosis for 4 years . Investigation by purified protein derivative (PPD) tuberculin test revealed positive tuberculin reactions (> or = 10 mm induration) in seven of eight (88%) initial close contacts, and in 12 of 46 (26%) coworkers . On the suspicion that transmission had also occurred among members of the index case's church congregation, a PPD tuberculin test survey of 184 of 200 of the members revealed 77 (42%) positive reactors . Thirty percent of the members under the age of 35 years were infected, suggesting transmission of infection . Eight cases of active tuberculosis (including the index case) were detected, yielding a high case rate (4.3%) among the parishioners . Three of the cases were confirmed recent PPD converters . Although bacteriologic findings were available in only three of the eight cases, two cases had phage typing of organism identical to the index case; the third had recrudescent tuberculous disease . Of the remaining five cases without bacteriologic confirmation, two had pleural tuberculosis, one child had progressive primary tuberculosis, and two persons had localized pulmonary nodules suggestive of primary infection progressing to disease . Because transmission of tuberculous infection may occur in any closed environment, including a church, physicians must be conversant with tuberculosis control measures and preventive therapy guidelines to preclude unforeseen transmission of disease.

Zhonghua Nei Ke Za Zhi, 1995 Feb, 34(2), 113 - 5
{Early diagnosis of tuberculosis after kidney transplantation by determining serum anti-PPD-IgG}; Wei D et al.; Tuberculosis is a common complication after kidney transplantation and is not easy to diagnose in the early stage . Determination of serum anti-PPD-IgG level in our laboratory indicated that it was positive in patients with active tuberculosis . The mean time (20.5 days) required to diagnose with this method was obviously shorter than that (66.8 days) required with bacteriology, pathology or imaging . There was no obvious rise in the serum level of anti-PPD-IgG in fever caused by other infections and rejection and the serum anti-PPD-IgG level in patients with tuberculosis controlled returned to normal . It is shown that determination of serum specific antibody is a better index for early diagnosis of tuberculosis complicating kidney transplantation.

Berl Munch Tierarztl Wochenschr, 1995 Feb, 108(2), 58 - 60
{The significance of FeLV infection for diseases in necropsied cats}; Reinacher M et al.; Persistent FeLV infection was demonstrated in more than 3000 necropsied cats by an immunohistological method . The findings were associated with the diagnoses established by means of post-mortem examination, histopathological, bacteriological, virological, and parasitological investigations . Statistically significant differences between FeLV-positive and FeLV-negative cats in the relative risk for certain lesions could be demonstrated for the first time . As a consequence, the importance of FeLV infection for the development of certain lesions in cats is to be seen under new aspects for some diagnoses . The relative risk for development of anemia, e.g., is only slightly increased in FeLV-positive animals whereas the relative risk for focal myocardial necrosis and coccidiosis is elevated tremendously in these cats . The relative risk for some lesions and diagnoses is much higher in FeLV-negative cats than in FeLV-positive animals . This is true, e.g., for myocardiopathy and hemorrhagic cystitis.

Arch Pediatr, 1995 Feb, 2(2), 143 - 6
{Primary psoas abscess in children: 6 cases}; Golli M et al.; BACKGROUND--Primary psoas abscess is very rare in childhood; its diagnosis and treatment can be improved by the use of recent imaging techniques . PATIENTS--Six children, aged 11 months to 10 years (mean: 51 months) were admitted from January 1987 to 15 December 1993 because they suffered mainly from fever, lumbar pain and/or homolateral flexed hip . Examination showed a painful inguinal mass in five patients and hyperleucocytosis in all . X-rays showed disappearance of the external limit of psoas in two patients; ultrasonography showed enlarged psoas in all, associated with hypoechogenic mass in two and without echo in four patients . CT scan showed the abscess in all cases, permitting a needle aspiration for bacteriological studies: Staphycococcus aureus was present in five cases . Drainage of the abscess by CT-guided percutaneous catheter was performed in two patients . Surgical drainage was performed in three including one for whom percutaneous catheter drainage did not succeed . The two other patients were only given antibiotics . CONCLUSION--CT-guided needle aspiration to establish presence and nature of fluid collection is a well established technique that may be extended to treatment of psoas abscesses.

Ryumachi, 1995 Feb, 35(1), 9 - 14
{Three cases with systemic rheumatic diseases who developed pulmonary lesions suggestive of bronchiolitis obliterans organizing pneumonia}; Nakamura K et al.; Three cases with systemic rheumatic diseases who developed lung diseases compatible with BOOP were reported . Underlying diseases of these patients were: RA (1 case), SLE (2 cases) . Respiratory symptoms were observed in one case such as dry cough at the time of diagnosis of BOOP . Chest radiography showed multiple infiltrates in 2 cases, bilateral reticular shadow in one case . In one case characteristic finding described as wandering shadow was observed . TBLB was done in 3 cases . Pathohistological findings were compatible with BOOP . Repeated Bacteriological examinations failed to demonstrate specific organisms implicated for lung lesions . Cytological studies of sputum and TBLB specimens were all negative for malignancy . Antibiotic agents including anti-tuberculosis drugs were not effective for pulmonary diseases . Moderate doses of prednisolone were effective in 3 cases . Although the open lung biopsy has been recommended for establishment of diagnosis of BOOP, in patient with systemic rheumatic diseases this invasive procedure is not always easily performed . Further characterizations of clinical and laboratory features are indicated for noninvasive diagnosis of BOOP.

Rev Fr Gynecol Obstet, 1995 Feb, 90(2), 73 - 6
{Painful pelvic adhesion syndrome}; D'Ercole C et al.; Pelvic adhesions may be responsible for pelvic pain, at least partially, in the following conditions: sequelae of past infection, chronic active inflammatory state, endometriosis, post-operative adhesions . The problem in the presence of adhesions is to determine whether pain is mechanical, inflammatory and/or linked to associated ovarian dystrophy, and what is the psychological component . The postulate "adhesion = pain" is far from constant and there is no systematic relationship between clinical picture and anatomical findings . After careful clinical and laboratory evaluation, celioscopy is the key diagnostic procedure . It should include thorough examination of all pelvic organs, of the abdomen in general and the peri-hepatic region in particular . A diagnosis of psychosomatic pain can be made only in the absence of any macroscopic, histological and bacteriological lesion, though bearing in mind that this term certainly covers failure to recognise other causes.

J Small Anim Pract, 1995 Feb, 36(2), 77 - 8
Focal cystic endometrial hyperplasia in a bitch; Cockcroft PD; Rapid abdominal enlargement and weight gain occurred in a four-year-old Rhodesian ridgeback bitch in late oestrus . The bitch was nulliparous . Severe cardiovascular dysfunction followed and an exploratory laparotomy was performed . A large, single, spheroid mass weighting 17 kg was located in the middle section of the left uterine horn . A diagnosis of sterile, focal, cystic endometrial hyperplasia was made from gross pathology, histopathology and bacteriology . The bitch made a complete recovery following an ovariohysterectomy.

Tuber Lung Dis, 1995 Feb, 76(1), 59 - 64
Dysregulation of homeostasis of blood T-lymphocyte subpopulations persists in chronic multibacillary pulmonary tuberculosis patients refractory to treatment; Bose M et al.; DESIGN: The dysregulation of homeostasis of blood-T lymphocyte subpopulations was studied in 21 cases of chronic, multibacillary pulmonary tuberculosis refractory to treatment . The clinico-bacteriological and immunological parameters studied in these cases (Gr A) were compared with those of a group of 10 newly-diagnosed drug sensitive cases of pulmonary tuberculosis (Gr B) at the beginning of the study and after 3 months of chemotherapy for tuberculosis . The chronic cases were treated with drugs selected from a reserve line . 10 normal healthy individuals were included in this study as a control group . RESULTS: At the beginning of the study the mean CD4/CD8 lymphocyte ratios in the refractory cases (0.69) and the newly diagnosed cases (0.81) were significantly lower than those of the normal control subjects (1.84) . After 3 months of chemotherapy all but 3 of the newly-diagnosed cases showed clinical improvement, and all became sputum-negative . Their CD4/CD8 ratio recorded a rise to near normal (1.54) . On the contrary, following 3 months of reserve-line regimen, only 7 of the 21 group A cases showed sputum conversion . In all of the refractory cases, irrespective of sputum conversion, the CD4/CD8 ratio remained low (1.05) . CONCLUSION: This probably indicates that due to a long-standing bacillary load in drug resistant pulmonary tuberculosis patients the dysregulation of homeostasis of blood-T lymphocytes becomes persistent . This in turn delays their clinical and immunological recovery, even when therapy is adequate.

Tuber Lung Dis, 1995 Feb, 76(1), 17 - 9
Trend of HIV infection in patients with pulmonary tuberculosis in south India; Solomon S et al.; SETTING: Tuberculosis is life threatening, transmissible and pandemic especially among millions of HIV infected persons . In developing countries like India where HIV infection is becoming prevalent and where tuberculosis infection has long been endemic, its incidence is increasing . OBJECTIVE: The aim of the study was to find out the trend of HIV infection in patients with pulmonary tuberculosis in south India . DESIGN: HIV seropositivity was assessed in 1430 radiologically and/or bacteriologically confirmed pulmonary tuberculosis patients attending major tuberculosis institutions in Madras by the AIDS Cell, Institute of Microbiology, Madras Medical College, Madras from January 1991 to May 1993 . RESULTS: HIV seropositivity was found to rise significantly from 0.77% in 1991 to 3.4% in 1993 (P < 0.05) . 22 (91.67%) of a total of 24 HIV seropositive pulmonary tuberculosis patients had pulmonary cavities and 21 patients (87.5%) had bacteriological confirmation of tuberculosis . CONCLUSION: The findings of this prospective study suggest that pulmonary tuberculosis patients with HIV infection are an in early phase of immunosuppression . This study reveals the rising trend of HIV infection; all persons with tuberculosis should therefore be questioned about the risk factors for HIV infection and urged to have an HIV testPIP: Bacteriologically and/or radiologically confirmed pulmonary tuberculosis (TB) patients were screened for the possible association of HIV infection at 4 major centers of Thoracic Medicine in Madras by the AIDS Cell of the Institute of Microbiology, Madras Medical College, India, from January 1991 to May 1993 . All the patients were subjected to chest roentgenography and their sputa were examined for the presence of Mycobacterium TB by smear and culture methods . Blood samples were tested for HIV antibodies by the ELISA technique . The blood samples, which proved seropositive twice by ELISA, were also confirmed by the Western Blot method . 1430 pulmonary TB patients were selected . There was a definite rising trend in the selection of patients over the succeeding years . While there was no significant difference in the pattern of age groups selected during 1991, 1992, and 1993, there was a noticeable increase in the admission of female patients from 25.77% in 1991 to 32.3% in 1993 . HIV infection was detected in 24 (1.68%) of the 1430 pulmonary TB patients screened . There was a significant rise of HIV infection among TB patients, from 0.77% in 1991 to 3.35% in 1993 (p 0.05) . 20 (83.33%) of the 24 HIV seropositive patients were 40 years or younger . In 1993 the number of young seropositives (20 years or younger) was a great deal higher than in the previous years . The HIV detection rate was high (7.14%) during 1993 among female patients, as opposed to the figures of 0.99% and 0.5% obtained during 1991 and 1992, respectively . Pulmonary cavitary lesions were seen in 22 (91.67%) of the total of 24 patients and bacteriological confirmation was obtained in 21 patients (87.5%) . Heterosexual intercourse was the major risk factor among 16 pulmonary TB patients with HIV infection . In India an estimated 1,753,000 people were infected with HIV during 1993 and 87,650 new cases of TB with HIV are likely to emerge . In view of the rising trend of HIV infection among pulmonary TB patients all persons with TB should be urged to have an HIV test .

Arch Microbiol, 1995 Feb, 163(2), 79 - 86
Repeated DNA sequences in mycobacteria; Poulet S et al.; In tuberculosis, it is often important to establish the source of infection and to determine whether disease is due to a new strain of Mycobacterium tuberculosis or to relapse . To cope with the resurgence of tuberculosis and atypical mycobacterioses in AIDS patients, on the one hand, and to overcome the limitations of classical bacteriological procedures on the other, the development of rapid, sensitive, and reliable diagnostic and epidemiologic tools is highly desirable . Molecular typing methods are often based on repeated genes such as those for rRNA . Ribotyping is of limited use with pathogenic mycobacteria, as the slow-growers possess a single rRNA operon, while the fast-growers have two . This problem has been overcome by the discovery and study of repeated DNA elements in mycobacterial genomes, as these provide an alternative pathway for diagnostic and epidemiological investigations.

Kekkaku, 1995 Feb, 70(2), 117 - 20
{A case of tuberculous mesenteric lymphadenitis and peritonitis with symptoms of acute abdomen}; Konishi H et al.; Both of tuberculous mesenteric lymphadenitis and tuberculous peritonitis are now rather rare in parallel with the decrease of the incidence of tuberculosis as a whole . Here, we report a case of tuberculous mesenteric lymphadenitis complicated with tuberculous peritonitis . A 28-year-old man was admitted to our hospital with pulmonary tuberculosis . Antituberculous chemotherapy was started and his chest X-ray findings were improved . After 11 weeks of the treatment, high fever of 39.0 degrees C developed suddenly and he complained right lower abdominal pain . During laparotomy performed on suspicion of acute appendicitis, swelling of mesenteric lymph-nodes, numerous miliary tubercles on mesentery and turbid ascites were noticed . Diagnoses of tuberculous mesenteric lymphadenitis and tuberculous peritonitis were confirmed by bacteriological and histological examinations of lymph-nodes and tubercles . Ileocecal resection was performed and clinical course after the surgery was favourable.

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