Schweiz Med Wochenschr, 2000 Jan 29, 130(4), 122 - 7 {The hospitalized patient with fever and mental status changes}; Guillet EM et al.; The case is discussed of a 74-year-old patient hospitalised with acute colitis, who newly developed headache, fever, and mental status changes on the 14th day after admission . The course of the disease was characterised by rapid progression with loss of consciousness and the development of extensive brain oedema, despite broad-spectrum antibiotic therapy . The patient died on the 17th of hospitalisation. Can J Microbiol, 2000 Apr, 46(4), 333 - 8 Shuttle vectors for genetic manipulations in Ustilago maydis; Kojic M et al.; Shuttle vectors with new or improved features were constructed to enable facile genetic manipulations in the plant pathogen Ustilago maydis . Sets of plasmids selectable in media containing geneticin, carboxin, nourseothricin, or hygromycin, able to replicate autonomously, to transform U . maydis by integration, and to express foreign genes under control of the homologous glyceraldehyde-3-phosphate dehydrogenase promoter, were built upon a common pUC19 vector backbone . This permits a large number of choices for a cloning site, blue/white screening for recombinant plasmids, rapid transfer of a cloned DNA fragment between plasmids, and choice of several dominant drug-resistance markers for selection in U . maydis. Cancer Lett, 2000 May 29, 153(1-2), 51 - 6 Preferential cytotoxicity of caffeic acid phenethyl ester analogues on oral cancer cells; Lee YJ et al.; As part of our previous search for new compounds with improved biological activities including antibiotic, antiviral, anti-inflammatory, and tumor growth inhibition activities, we synthesized some caffeic acid phenethyl ester (CAPE)-like compounds from commercially available caffeic acid . Nine chemicals were tested by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on the growth of buccal mucosal fibroblast (BF), oral submucosus fibroblast (OSF), neck metastasis of Gingiva carcinoma (GNM), and tongue squamous cell carcinoma (TSCCa) cells . CAPE and its ethyl analogue show significant cytotoxicity on OSF, GNM, and TSCCa cells, but not on BF cells . The results suggest that CAPE-like compounds may be potential chemotherapy agents against oral cancer. Exp Toxicol Pathol, 2000 Mar, 52(1), 37 - 42 Hypovolemia in rats increases mortality rates following endotoxin administration; Zurovsky Y et al.; The aim of the present study was to examine whether acute or chronic hypovolemia increase the mortality rates of rats following endotoxin injection . Another aim of this study was to examine whether this increase in sensitivity can be explained by increased leakage of endotoxin from the digestive tract to the blood stream . Chronic hypovolemia was caused by water deprivation for 8 days . Acute hypovolemia was caused by injection of sucrose (300mg/100g) or by hemorrhage of a volume of up to 2.1 ml/100g . The hypovolemia was examined by measuring the plasma volume using Evans Blue (EB) . Endotoxin at various doses was injected to the hypovolemic rats and the lethality of the various treatments was examined . Acute and chronic hypovolemia caused a significant increase inthe mortality rates of rats injected IP with a dose of 1-1.5 mg/100g endotoxin . Endotoxin administration (6mg/100g) by drinking to hypovolemic rats did not cause death at all . In contradistinction, injection of galactoseamine to rats that underwent similar treatments caused 100% mortality . Endotoxin tolerance reduced the mortality rates following galactoseamine injection to the control level of administration of endotoxin without hypovolemia (p < 0.001) . Injection of the antibiotic polymixin B following the galactoseamine injection also decreased mortality rates to 40% (p < 0.05) . Examination of plasma endotoxin concentration exhibited a significant increase following administration of endotoxin by drinking to hypovolemic rats (p < 0.001) compared to rats that received the same amount of endotoxin but without hypovolemia . These results indicate that one possible explanation for the increased mortality rate of the hypovolemic rats after endotoxin injection is due to leakage of endotoxin from the digestive tract. Int J Tuberc Lung Dis, 2000 Apr, 4(4), 350 - 5 Referral times of Vietnamese refugees with tuberculosis in camps in Hong Kong; Taylor WR et al.; SETTING: Two closed camps in Hong Kong for Vietnamese refugees . OBJECTIVE: To determine the referral times by clinicians (doctor's delay) of cases of tuberculosis (TB) from refugee camp clinics to the hospital/chest clinic . DESIGN: Retrospective case-note study of 97 Vietnamese patients receiving treatment for tuberculosis . RESULTS: The sites of TB were pulmonary (n = 61), glandular (n = 15), pleural effusion (n = 15), and other (n = 6) . The median referral time was 18 days (range 0-417) . Median consultations numbered three (range 1-16) . Fifty-three (54.6%) patients were prescribed antibiotics . Thirty-nine (40%) patients were referred within 10 days; of these, 18 were referred the same day . These 39 patients were less likely to have received antibiotics (9/39 {23.1%} vs 44/58 {75.9%}, relative risk {RR} 0.3 95% confidence interval {CI} 0.17-0.55), but were equally likely to have been physically examined (RR 0.66, 95%CI 0.39-1.1) . Sixteen (16.5%) patients were referred after 90 days . They attended the clinic more often (median attendances 6.5 vs 3, P = 0.0002), and were prescribed more antibiotic courses (mean antibiotic prescriptions 1.6 vs 0.7, P = 0.03) . CONCLUSION: Referral times by these clinicians varied widely, with long delays for approximately 60% of patients . Guidelines pertinent to primary care clinicians are needed to heighten their awareness of tuberculosis to prevent referral delays and subsequent TB treatment. Rev Clin Esp, 2000 Feb, 200(2), 60 - 3 {Migratory erythema (Lyme borreliosis) . Clinicoepidemiologic features of 50 patients}; Oteo Revuelta JA et al.; BACKGROUND AND OBJECTIVE: Erythema migrans (EM) is the earliest and most common manifestation of the infection caused by B . burgdorferi (Lyme borreliosis) . The objective of the present work was to report the clinicoepidemiological features in a series of patients . PATIENTS AND METHODS: Retrospective collection of clinicoepidemiological features of the first fifty patients diagnosed of EM at La Rioja Hospital (March 1989-September 1998) . RESULTS: In our series, no differences were observed regarding sex or living in a rural or urban area . Mean age was 41 years (range 9 to 78) . In 70% of patients the antecedent of a tick bite was obtained and the incubation period was 6.48 days (1 to 15 days) . The mean size of the lesions was 14.3 cm (5 to 40) and in 16% of patients satellite cutaneous lesions were observed . The areas where EM appeared were lower limbs and the perineal region (60%), chest (24%), head and neck (10%) and upper limbs (6%) . Forty-eight percent of patients reported extra-cutaneous manifestations . All cases occurred during the spring, summer and autumn months, with a peak in June . The most common referred antecedent was walking in forest areas . All patients responded to antibiotic therapy . CONCLUSIONS: EM is common in the studied environment and presents with a marked polymorphism. Eur J Nucl Med, 2000 Mar, 27(3), 314 - 8 Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft; Fuster D et al.; The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft . We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6+/-12 years) . The mean duration of PFS was 35 days (range 7-122) . Forty-six of the 91 patients underwent steroid therapy (2-10 mg/day) . Platelet labelling was carried out following Thakur's method . Platelet scans were performed 48 h after reinjection of labelled platelets . The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI . The final diagnosis of PFS was established depending on the outcome after treatment . In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy . In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin) . The PUI in patients with immunological PFS was 1.80+/-0.7, while in patients with non-immunological PFS it was 1.12+/-0.1 (P<0.05) . When a PUI of > or =1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively . In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P<0.05) . These results suggest that 111In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft . Therapy with steroids could reduce the sensitivity of 111In-labelled platelet scintigraphy in detecting immunological PFS. Med Clin (Barc), 2000 Mar 4, 114(8), 299 - 301 {Emergency valvular replacement in infective endocarditis: hospital and long term clinical course . Analysis of 45 patients}; Alegret JM et al.; BACKGROUND: To define the evolution of patients with infective endocarditis who require urgent valve replacement in our environment . PATIENTS AND METHODS: We followed 45 consecutive cases of infective endocarditis that require valve replacement during their hospitalization . 32 patients had native valve infective endocarditis, 7 early prosthesis valve endocarditis and 6 late prosthesis valve endocarditis . Patients were followed for a long-term period, clinical and echocardiographycally . RESULTS: In 39 cases valve replacement was performed before ending antibiotic therapy . The main indications for surgery were refractory heart failure (24 patients) and shock (11 patients) . The mortality rate was 24%: 19% in native valve infective endocarditis, 43% in early prosthetic valve endocarditis and 33% in late prosthesis valve endocarditis . The first cause of death was septic shock (46%) . We followed 31 over 34 survivors for a mean time 65 (DS 49) months . We found two relapses and six deaths (1 sudden death, 2 endocarditis) and 72% of patients presented class I NYHA . We detected 17% prosthetic leaks (34% in the prosthetic valve endocarditis group) . CONCLUSIONS: The need of urgent valve replacement in the context of infective endocarditis is associated with a high mortality rate, and should be considered a serious condition . Long term prognosis is, however, acceptable, although 17% of patients had prosthesis leak, specially those with prosthetic valve endocarditis. Indian J Pediatr, 1998 Sep-Oct, 65(5), 717 - 21 Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community acquired pneumonia; Chaudhry R et al.; A prospective one year study was performed on 62 children admitted at the All India Institute of Medical Sciences with community acquired pneumonia (CAP) for the prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae . Diagnosis of infection with M . pneumoniae was based on serological tests viz microparticle agglutination test for detection of IgM antibodies and indirect immunofluorescence test for antigen detection from throat swabs (sensitivity 85.7%, specificity 93.3%) . The indirect solid-phase enzyme immunoassay for detection of IgG antibodies was used to determine the prevalence of C . pneumoniae (sensitivity 88.8%, specificity 75.8%) . Seventeen patients (27.4%) were found to have serological evidence of M . pneumoniae infection whereas only 4 (6.4%) patients were seropositive for C . pneumoniae . Results of this study indicate that M . Pneumoniae plays a significant role in CAP in infants and young children . Thus specialized laboratory testing for these agents should be more widely used thereby affecting empiric antibiotic regimens. Am J Nephrol, 2000 Mar-Apr, 20(2), 138 - 41 Subcutaneous nodules attributed to nocardiosis in a renal transplant recipient on tacrolimus therapy; Wong KM et al.; We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection . The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses . The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction . She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline . We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently 'cold' subcutaneous nodules without any systemic upset . An associated brain lesion should be excluded even in patients without neurological symptoms . Transfusion, 2000 Apr, 40(4), 414 - 9 Functional characteristics of neutrophils collected and stored after administration of G-CSF; Leavey PJ et al.; BACKGROUND: Granulocyte transfusion may be used in neutropenic patients with severe bacterial or fungal infections that are unresponsive to antibiotic therapy . However, the inability to store granulocyte concentrates limits their clinical usefulness . STUDY DESIGN AND METHODS: Neutrophil chemotaxis and NADPH oxidase activity and the integrity of the neutrophil NADPH oxidase system were examined after apheresis collection and during storage to 48 hours . Neutrophils were mobilized in vivo by G-CSF, collected by apheresis techniques, and stored in apheresis bags in the presence and absence of additional G-CSF . For all experiments, cells were further purified by standard techniques of dextran sedimentation and hypotonic RBC lysis . RESULTS: Neutrophil chemotaxis was preserved to 24 hours of storage but was not affected by the G-CSF added to storage units . The NADPH oxidase system was also preserved as a functioning complex, and both cytosolic proteins and membrane-associated proteins were normal to 48 hours . However, there were divergent responses by intact cells to activating stimuli and reduced oxidase activity in the cell-free system . G-CSF did not appear to significantly affect NADPH oxidase activity or NADPH oxidase system integrity during storage . CONCLUSION: Neutrophils collected after the administration of G-CSF retained functional and biochemical characteristics for at least 24 hours of storage, which suggests additional effects of G-CSF mobilization beyond enhancing PMN yields and the possibility of storage of these components after collection. Nucleosides Nucleotides Nucleic Acids, 2000 Jan-Feb, 19(1-2), 283 - 95 Synthesis of biomimetic analogs of neomycin B: potential inhibitors of the HIV RNA Rev response element; Nishizono N et al.; The aminoglycosidic antibiotic, neomycin B, is an inhibitor of the binding of Rev to RRE . This paper reports on the synthesis of analogs of neomycin B as potential anti-HIV compounds designed to function as inhibitors of Rev/RRE binding. Drug Metab Dispos, 2000 May, 28(5), 529 - 37 Rabbit pregnane X receptor is activated by rifampicin; Savas U et al.; Reverse transcriptase-polymerase chain reaction was used to amplify a partial cDNA from rabbit lung mRNA that shared 77% protein sequence identity with the mouse pregnane X receptor (PXR) . Rapid amplification of cDNA ends from a rabbit kidney lambdaZAP expression library resulted in the isolation of overlapping cDNAs spanning the complete coding sequence . The deduced amino acid sequence of 411 residues exhibited 79% overall amino acid identity with human PXR and 77% identity with mouse PXR . Based on this protein sequence relationship and a similar degree of conservation exhibited by the mouse and human PXR orthologs, the cDNA appears to encode the rabbit PXR ortholog . 5'-rapid amplification of cDNA ends performed on an adaptor-ligated cDNA library from rabbit liver revealed the presence of an alternate mRNA, which differed at the 5'-terminus . RNase protection assays indicated that the alternate mRNA was expressed at >50-fold lower levels in rabbit kidney and liver . Rifampicin treatment of CV-1 cells cotransfected with a rabbit PXR expression plasmid and a luciferase reporter construct containing two copies of the DR3 enhancer from CYP3A23 produced a 6-fold induction of luciferase activity . In contrast, rat PXR was not responsive to this antibiotic under the same conditions . Pregnenolone 16alpha-carbonitrile was an efficacious activator of rat PXR, but failed to significantly activate rabbit PXR at equivalent concentrations . These results indicate that the ligand activation profile of rabbit PXR is distinct from rat PXR and more closely resembles that of human PXR . The rabbit PXR activation profile is consistent with the cytochrome P450 (P450) 3A6 induction profile in rabbits. Antimicrob Agents Chemother, 2000 May, 44(5), 1214 - 22 Identification of the novobiocin biosynthetic gene cluster of Streptomyces spheroides NCIB 11891; Steffensky M et al.; The novobiocin biosynthetic gene cluster from Streptomyces spheroides NCIB 11891 was cloned by using homologous deoxynucleoside diphosphate (dNDP)-glucose 4,6-dehydratase gene fragments as probes . Double-stranded sequencing of 25.6 kb revealed the presence of 23 putative open reading frames (ORFs), including the gene for novobiocin resistance, gyrB(r), and at least 11 further ORFs to which a possible role in novobiocin biosynthesis could be assigned . An insertional inactivation experiment with a dNDP-glucose 4, 6-dehydratase fragment resulted in abolishment of novobiocin production, since biosynthesis of the deoxysugar moiety of novobiocin was blocked . Heterologous expression of a key enzyme of novobiocin biosynthesis, i.e., novobiocic acid synthetase, in Streptomyces lividans TK24 further confirmed the involvement of the analyzed genes in the biosynthesis of the antibiotic. Anesteziol Reanimatol, 2000 Jan-Feb, (1), 36 - 8 {Characteristics of the strategy of intensive care of unconscious children}; Mel'nikova EV et al.; Three major groups can be distinguished among children hospitalized in resuscitation and intensive care wards in a state of unconsciousness: patients with bacterial meningitis and meningoencephalitis, viral meningoencephalitis, and noninfectious involvement of the NCS . Common strategy of treatment of these patients is characterized by some specific features: etiotropic antibiotic therapy in group 1 patients, antiviral drugs in group 2, and mainly symptomatic measures in group 3 . Immunotherapy used in each of these groups is substitute in group 1, immunomodulating and immunostimulating in group 2 and even more so in group 3 . Better results in group 1 are due to highly effective etiotropic antibiotics and drugs. Arch Pediatr Adolesc Med, 2000 Apr, 154(4), 370 - 4 Are signs and symptoms associated with persistent corneal abrasions in children? Rittichier KK, Roback MG, Bassett KE. BACKGROUND: Corneal abrasions are common eye injuries in children . Most are treated with antibiotic drops or ointment, patching of the affected eye, and follow-up within 24 hours to confirm resolution by fluorescein examination . OBJECTIVE: To determine if signs and symptoms at follow-up were associated with the presence of a persistent corneal abrasion or abnormal visual acuity . DESIGN: Retrospective case series . SETTING: A children's hospital . PATIENTS: Children who were aged 4 years or older with the diagnosis of corneal abrasion between May 1992 and December 1996 and who had a follow-up examination . RESULTS: Seventy-seven patients (57% male) were enrolled (median age, 7 years) . The respective sensitivities, specificities, positive predictive values, and negative predictive values of selective signs and symptoms for persistent abrasions were as follows: for pain, 53%, 93%, 80%, and 80%; for photophobia, 57%, 100%, 100%, and 80%; for redness, 100%, 46%, 44%, and 100%; for pain and redness, 40%, 96%, 80%, and 80%; and for at least 1 sign or symptom, 95%, 48%, 47%, and 95% . Twenty-six patients had persistent corneal abrasions at follow-up . Six of these 26 patients were symptom free at follow-up, and 15 patients had only redness as a persistent sign . Five patients had abnormal visual acuity, one of whom was asymptomatic . All 3 patients with complications were symptomatic . CONCLUSIONS: Signs and symptoms are inconsistently associated with persistent corneal abrasions . Asymptomatic patients may have persistent corneal abrasions, suggesting the need for selective follow-ups. Crit Care Clin, 2000 Apr, 16(2), 233 - 49 Pharmacologic issues in the management of septic shock; Jindal N et al.; Despite our increased understanding of the biochemistry and physiology of sepsis, the treatment of septic shock remains a challenge . Initial management of septic shock entails urgent and emergent stabilization of the patient followed by broad-spectrum, empiric antibiotic therapy . After volume resuscitation, vasopressors or inotropic therapy or both may be necessary to restore perfusion . Adjunctive therapies and monitoring strategies may be helpful in preventing complications in the intensive care setting . Additional research and clinical trials are needed to identify supportive interventions that may affect the outcome of the septic patient. Antibiot Khimioter, 2000, 45(3), 7 - 8 {The augmentin (amoxicillin/clavulanate) prophylaxis of postoperative infectious complications in patients with acute surgical diseases of the abdominal cavity organs}; Grinberg AA et al.; Augmentin was used prophylactically in 25 patients with an account of the infectious complication risk according to 4 regimens: ultrashort-term (1.2 g intravenously with initial narcosis), short-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg in 8 and 16 hours), middle-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 2 days) and long-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 3 days) . One complication episode as wound suppuration was recorded . The routine approach to the use of antibiotics in emergency abdominal surgery, when antibiotics are administered every day for several days after the operation, should be revised. Minerva Stomatol, 1999 Nov, 48(11), 559 - 62 {Evaluation of the efficacy of flurbiprofen in subjects undergoing extraction of impacted 3d molar}; Roggia S et al.; INTRODUCTION: In this open controlled study the authors evaluated the anti-inflammatory, antalgic and antipyretic efficacy of flurbiprofen in 200 mg capsules as a complementary treatment to antibiotic therapy following minor oral surgery . METHODS: A total of 100 patients of both sexes, aged between 13 and 65, were monitored after extraction of impacted 3rd molar . Patients were treated with flurbiprofen SR 200 mg/day for five days and were controlled on the 2nd and 5th day after surgery . The following parameters were evaluated: painful symptoms, objective examination of mucosa and fever . RESULTS: The results showed the clear efficacy of flurbiprofen SR in reducing all the parameters examined. Eur J Obstet Gynecol Reprod Biol, 2000 May, 90(1), 67 - 71 Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation; Xiao ZH et al.; OBJECTIVE: To identify factors influencing the outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks' gestation . DESIGN AND POPULATION: All premature infants with gestational age <34 weeks, either inborn or outborn, with history of rupture of membranes before 25 weeks' gestation, admitted to our NICU between January 1992 and July 1997, were eligible for this retrospective study . Collected information included birth weight, gestational age at rupture of membranes and at delivery, duration between rupture of membranes and delivery (latency period), severity of oligohydramnios, pre- and post-natal managements, and follow-up of survivors . RESULTS: A total of 28 neonates fulfilled the inclusion criteria . Despite new strategies of ventilation and optimal management, the overall mortality rate was 43% (12/28) . Nonsurvivors were significantly less mature at rupture of membranes, and had severe oligohydramnios (anamnios) . We also noted less antenatal corticosteroids and antibiotic therapy in this group . Nine of eleven infants (82%) following rupture of membranes before 22 weeks' gestation died shortly after birth . The two remaining infants developed severe bronchopulmonary dysplasia . Nine deaths occurred in thirteen cases (69%) of anamnios . The major death causes were refractory respiratory failure and neurologic complications . Half of all survivors (8/16) developed bronchopulmonary dysplasia . CONCLUSION: The outcome of premature infants following prolonged premature rupture of membranes before 25 weeks' gestation is influenced by gestational age at rupture, severity of oligohydramnios, and antenatal antibiotics and corticosteroids . Neonates with rupture of membranes before 22 weeks have a very low chance of survival at the present time. Scand J Gastroenterol, 2000 Mar, 35(3), 260 - 3 Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus; Gasbarrini A et al.; BACKGROUND: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease . H . pylori eradication appears to be reduced in IDDM patients . The aim of the study was to evaluate the efficacy of the most common H . pylori eradication regimens in a population of IDDM-infected patients . METHODS: One hundred and seventy-two IDDM patients were evaluated . H . pylori infection was assessed through the 13C-urea breath test . Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole . Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole . RESULTS: Thirty-seven per cent of IDDM patients were infected . None of the triple therapies used provided an eradication higher than 62% . Conversely, the quadruple regimen was successful in 88% of the patients . Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P < 0.05) . CONCLUSIONS: IDDM patients show a low H . pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently . The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects. Anticancer Drug Des, 1999 Oct, 14(5), 433 - 42 A DNA binding indolocarbazole disaccharide derivative remains highly cytotoxic without inhibiting topoisomerase I; Qu X et al.; NB-506 is a glucosylated indolocarbazole related to the antibiotic rebeccamycin and is currently under clinical trials as an anticancer drug . This compound is a DNA intercalating agent and a potent topoisomerase I poison . The glucose residue attached to the planar indolocarbazole chromophore plays a significant role in the interaction of the drug with nucleic acids and contributes positively to the stabilization of topoisomerase I-DNA covalent complexes . To investigate further the influence of the carbohydrate moiety, we studied the DNA binding and topoisomerase I inhibition properties of an analogue of NB-506 bearing a disaccharide side chain . Fluorescence and footprinting studies indicate that the replacement of the glucose chain of NB-506 with a maltose residue does not hinder the capacity of the drug to bind to DNA and to recognize GC-rich sequences . The addition of the second sugar residue does not reinforce the interaction with DNA but abolishes the capacity of the drug to inhibit topoisomerase I . Unexpectedly, the disaccharide analogue of NB-506 has totally lost its capacity to stimulate DNA cleavage by topoisomerase I . In addition, like NB-506, the new analogue is not an inhibitor of topoisomerase II . However, despite the absence of topoisomerase poisoning activity, the cytotoxic activity is fully maintained . The maltosyl-indolocarbazole drug proved to be as potent as NB-506 at inhibiting the growth of various human and murine tumour cell lines . The study raises the question as to whether topoisomerase I poisoning is important for the antitumour activity of rebeccamycin analogues. Acad Radiol, 2000 Apr, 7(4), 228 - 31 Is the stat Gram stain helpful during percutaneous image-guided fluid drainage? Ketai L, Washington T, Allen T, Rael J. RATIONALE AND OBJECTIVES: The purpose of this study was to use logistic regression to analyze both Gram stain results and other clinical information to create a decision rule capable of predicting which abdominal or pelvic fluid collections would later prove to be infected and therefore require catheter drainage . MATERIALS AND METHODS: The authors retrospectively collected Gram stain results and clinical data (postoperative status and antibiotic use) regarding 124 abdominal or pelvic fluid drainage procedures performed between 1991 and 1996 . They then analyzed these data by using logistic regression to create an equation that predicted the presence of fluid infection . Finally, they validated this equation by applying it to 39 abdominal or pelvic fluid drainage procedures performed in 1997 . RESULTS: The resulting equation predicted that a fluid collection was likely to be infected if any of the following were present: Gram stain positive for bacteria, Gram stain showing moderate or many white blood cells, and purulent fluid at visual inspection . For the initial data set, the sensitivity of the decision rule was 91%, the specificity was 54%, and the overall accuracy was 77% . For the 1997 data set, the sensitivity of the decision rule was 88%, the specificity was 50%, and the accuracy was 77% . CONCLUSION: When combined with clinical information, Gram stain results are sensitive but nonspecific in the detection of abdominal or pelvic fluid infection . Use of the decision rule could prevent unnecessary catheter placement in a minority of patients with abdominal or pelvic fluid collections. Quintessence Int, 1999 Nov, 30(11), 785 - 90 Early-onset periodontitis in a patient with Ehlers-Danlos syndrome type III; Reichert S et al.; This case history describes the course of disease in a 17-year-old boy with Ehlers-Danlos syndrome type III and early-onset periodontitis . Flow cytometric tests showed a reduced cell count in the specific immune system . Immunoglobulin concentrations in saliva and serum were within normal limits . Infection with T-lymphotropic viruses was excluded . The phagocytic capacity of the peripheral blood polymorphonuclear leukocytes was unimpaired . The anaerobic infection present in the early-onset periodontitis was treated with systemic antibiotic therapy and closed curettage . Following 14 days of this treatment, signs of acute inflammation subsided, and 18 months after therapy ended, a slight gain in clinical attachment was found, and bone growth was visible via radiology . However, a continuing lack of adequate oral hygiene represents a risk to the success of therapy in the long term. Am J Ophthalmol, 2000 Apr, 129(4), 531 - 3 Bilateral orbital hemorrhage in a newborn; Ezzadin EM et al.; PURPOSE: To report a case of severe bilateral proptosis resulting from orbital hemorrhage in a newborn and to discuss the differential diagnoses and management . METHOD: Case report of a 13-day-old male infant with bilateral proptosis since birth . The proptosis was monitored with clinical examinations and computed tomography as well as magnetic resonance imaging (MRI) scans, and it was managed with antibiotic ointment and patching . The MRI scans demonstrated bilateral subperiosteal orbital hemorrhage . RESULTS: Proptosis decreased, and there was successful, complete recovery without untoward sequelae in 14 days; follow-up indicated no late complications at age 1 year . CONCLUSION: Spontaneous orbital hemorrhage, unilateral or bilateral, is uncommon in an otherwise healthy newborn without apparent history of birth trauma . Magnetic resonance imaging scans are helpful in making the diagnosis of subperiosteal hemorrhage, and conservative management is advised. Cancer Lett, 2000 Apr 3, 151(1), 25 - 9 Cells in cryptophycin-induced cell-cycle arrest are susceptible to apoptosis; Kessel D et al.; Exposure of murine leukemia L1210 cells to the antitumor antibiotic cryptophycin 52 (C52) led to cell-cycle arrest at the prometaphase/metaphase interface within 18 h, but apoptotic nuclei did not appear until 36 h later . To determine whether accumulation of cells in early metaphase might have delayed the apoptotic process, cells were treated with C52 for 18 h and a photodynamic process was used to initiate the release of mitochondrial cytochrome c . Apoptosis was observed within 60 min, indicating that the slow apoptotic response was not caused by an impaired ability of genomic DNA to undergo endonucleosomal cleavage during cell-cycle arrest induced by cryptophycin 52. J Am Board Fam Pract, 2000 Mar-Apr, 13(2), 101 - 6 How family physicians distinguish acute sinusitis from upper respiratory tract infections: a retrospective analysis; Little DR et al.; BACKGROUND: The purpose of our study was to examine how physicians diagnose sinusitis in practice . We addressed three specific questions: (1) what clinical factors do physicians look for in evaluating and caring for patients with suspected sinusitis, (2) to what extent do physicians use transillumination and radiograph evaluations in diagnosing sinusitis, and (3) how does the diagnosis of sinusitis influence the decision to prescribe antibiotic therapy? METHODS: We conducted a retrospective review using charts from 25 local family physicians who volunteered to participate in the study . After selecting a random sample of charts of adult patients treated for sinusitis and for upper respiratory tract infection (URI) by each physician, we reviewed the charts to determine the nature of the information collected to differentiate between sinusitis and URI . RESULTS: Rhinorrhea, sinus tenderness, visualization of purulent secretions, and a history of sinusitis were significant predictors of the diagnosis of sinusitis . Antibiotics were prescribed for 98.4% of patients with sinusitis and 13.1% of patients with URI . CONCLUSIONS: This sample of physicians based the diagnosis of sinusitis on three prominent clinical findings, which were also significant factors in diagnosing sinusitis in previous studies . The history of sinusitis might influence patient and physician expectations for the diagnosis. Laryngoscope, 2000 Apr, 110(4), 603 - 7 Calciphylaxis: is there a role for parathyroidectomy? Kriskovich MD, Holman JM, Haller JR. OBJECTIVE: Calciphylaxis, a rare disorder typically affecting renal failure patients, results in vascular calcification with subsequent skin necrosis, gangrene, and often death from sepsis . Parathyroid hormone is thought to act as a tissue sensitizer leading to these soft tissue changes . As such, parathyroidectomy is often advocated to control this complicated condition . A discussion of calciphylaxis does not exist in the otolaryngology literature, and head and neck surgeons performing parathyroidectomy should be aware of this phenomenon . This study evaluates the success of parathyroidectomy in reversing the ill effects of calciphylaxis in both our patient population and the literature . STUDY DESIGN: Retrospective study and review of the literature . METHODS: Five patients with calciphylaxis treated at our institution were evaluated for mortality, surgical and perioperative complications, wound healing, and predictors of patient outcomes . RESULTS: Two patients died from sepsis and infectious complications of their calciphylaxis shortly after surgery . Of the three survivors, two later died (15 and 18 mo after surgery) from causes not directly related to calciphylaxis . The other long-term survivor required partial amputation of a leg for osteomyelitis . There was one operative complication-- wound infection requiring antibiotic therapy, drainage, and packing . Postoperative hypocalcemia required treatment in two patients . Immediate perioperative survival was more likely in patients with leukocyte counts less than 20,000 cells/mL CONCLUSIONS: Calciphylaxis is a serious disease and patients often succumb to sepsis and infectious complications . Patients with extremely high leukocyte counts from coexistent infections may have a worse prognosis . Although a conclusive effective therapy does not exist, parathyroidectomy can be safely performed and may benefit some patients with what is often an otherwise fatal disease . The literature to date generally confirms our findings . Key Words: Calciphylaxis, parathyroid hormone, parathyroidectomy, skin necrosis, chronic renal failure. J Bacteriol, 2000 May, 182(9), 2445 - 52 Efficient targeted mutagenesis in Borrelia burgdorferi; Bono JL et al.; Genetic studies in Borrelia burgdorferi have been hindered by the lack of a nonborrelial selectable marker . Currently, the only selectable marker is gyrB(r), a mutated form of the chromosomal gyrB gene that encodes the B subunit of DNA gyrase and confers resistance to the antibiotic coumermycin A(1) . The utility of the coumermycin-resistant gyrB(r) gene for targeted gene disruption is limited by a high frequency of recombination with the endogenous gyrB gene . A kanamycin resistance gene (kan) was introduced into B . burgdorferi, and its use as a selectable marker was explored in an effort to improve the genetic manipulation of this pathogen . B . burgdorferi transformants with the kan gene expressed from its native promoter were susceptible to kanamycin . In striking contrast, transformants with the kan gene expressed from either the B . burgdorferi flaB or flgB promoter were resistant to high levels of kanamycin . The kanamycin resistance marker allows efficient direct selection of mutants in B . burgdorferi and hence is a significant improvement in the ability to construct isogenic mutant strains in this pathogen. J Clin Pharmacol, 2000 Apr, 40(4), 360 - 9 Acetaminophen controlled-release sprinkles versus acetaminophen immediate-release elixir in febrile children; Wilson JT et al.; Current acetaminophen (APAP) formulations approved for antipyretic use in children require up to five doses/day, which compromise compliance and risk breakthrough fever over 4 hours after dosing . A total of 112 evaluable febrile children received oral APAP-equivalent doses of either one dose of APAP controlled release (CR) as sprinkles on applesauce or one dose q 4 hours x 2 of APAP immediate-release (IR) elixir in an 8-hour, double-blind, double-dummy, randomized, multicenter study . Prior or concurrent antibiotic use did not significantly affect either the magnitude or the pattern of temperature reduction during the 8-hour observation period . Significantly greater aural temperature reductions were found with APAP-CR than with APAP-IR at 4 and 5 hours . However, the 8-hour AUCs of temperature reduction were not significantly different between treatments . Pharmacokinetic/pharmacodynamic modeling of APAP was performed in 8 patients with values in both treatments similar to previous results, except for expected differences in AUC0-infinity . Similar 8-hour temperature reduction for APAP-CR (one dose) and APAP-IR (two doses) demonstrates the efficacy of APAP-CR as an antipyretic in children 2 to 11 years of age . A decrease in the number of APAP daily doses and the prolonged antipyretic effect of APAP-CR may assist those who care for febrile children at home. Plant Physiol, 2000 Apr, 122(4), 1003 - 13 Activation tagging in Arabidopsis; Weigel D et al.; Activation tagging using T-DNA vectors that contain multimerized transcriptional enhancers from the cauliflower mosaic virus (CaMV) 35S gene has been applied to Arabidopsis plants . New activation-tagging vectors that confer resistance to the antibiotic kanamycin or the herbicide glufosinate have been used to generate several tens of thousands of transformed plants . From these, over 30 dominant mutants with various phenotypes have been isolated . Analysis of a subset of mutants has shown that overexpressed genes are almost always found immediately adjacent to the inserted CaMV 35S enhancers, at distances ranging from 380 bp to 3.6 kb . In at least one case, the CaMV 35S enhancers led primarily to an enhancement of the endogenous expression pattern rather than to constitutive ectopic expression, suggesting that the CaMV 35S enhancers used here act differently than the complete CaMV 35S promoter . This has important implications for the spectrum of genes that will be discovered by this method. Clin Exp Obstet Gynecol, 2000, 27(1), 24 - 6 Postpartum ovarian vein thrombosis; Hippach M et al.; OBJECTIVE: Ovarian vein thrombosis (OVT) is known as a rare but serious postpartum complication . The condition is often clinically not distinguishable from endometritis, appendicitis or pyelonephritis . OVT may cause sepsis, septic pulmonary thromboembolism, and thrombosis of the inferior vena cava and the renal veins, and is potentially fatal . The objective of this study was to report the clinical findings and outcome of two patients with diagnosed ovarian vein thrombosis after delivery managed at this institution . METHOD: Two patients fit the study criteria of documented ovarian vein thrombosis after delivery . An imaging diagnosis (CT) of ovarian vein thrombosis was required for final study inclusion . RESULTS: We present two patients with ovarian vein thrombosis . The symptoms of one patient disappeared two days after beginning heparin and antibiotic therapy . The control-CT 93 days after the diagnosis of POVT showed unsuspected ovarian veins . The other patient suffered from POVT 13 days after spontaneous delivery . Because of lethal embolisms she died during the operation for embolectomy . CONCLUSION: On the basis of our series and other recent series, OVT may likely be more common than previously thought and may become clinically apparent only when complicated by infection, expansion of the thrombus or pulmonary embolism . POVT is a potentially fatal condition most commonly seen as a complication of pelvic surgery or inflammatory disease. Can J Gastroenterol, 2000 Mar, 14(3), 188 - 98 From bench to bedside to bug: an update of clinically relevant advances in the care of persons with Helicobacter pylori- associated diseases; Chiba N et al.; In-depth meetings of the XIth International Workshop on Gastroduodenal Pathology and Helicobacter pylori led to the presentation and discussion of extensive new data on H . pylori and its diseases . The mode of transmission of H . pylori remains unclear, and it remains unknown why only a small proportion of infected individuals develop duodenal or gastric ulcer disease and even fewer develop gastric cancer . The role of H . pylori eradication in persons with uninvestigated dyspepsia remains controversial . New clinical trials of H . pylori treatment show symptom relief and improvement in the quality of life of persons with functional dyspepsia, especially in those with ulcer-like or reflux-like dyspepsia . Clearly the move is toward symptom-based management of persons with dyspepsia, with fewer endoscopies being needed in the otherwise healthy young dyspeptic patients . It remains controversial whether eradicating H . pylori in duodenal ulcer or functional dyspepsia increases the risk of subsequent development of gastroesophageal reflux disease . The one-week proton pump inhibitor-based triple regimens remain the gold standard of H . pylori therapy, but some of the ranitidine bismuth citrate plus two antibiotic regimens also achieve an 80% H . pylori eradication rate on an intention-to-treat basis . While the urea breath test remains the noninvasive test of choice, interesting new data are available on the use of stool antigen testing to diagnose H . pylori infection . The number of H pylori-associated gastroduodenal diseases grows to include possible liver, vascular, immune and skin conditions. Neurotoxicol Teratol, 2000 Mar-Apr, 22(2), 213 - 20 Exacerbation of iminodipropionitrile-induced behavioral toxicity, oxidative stress, and vestibular hair cell degeneration by gentamicin in rats; Al Deeb S et al.; This study describes the effect of gentamicin, an aminoglycoside antibiotic on iminodipropionitrile (IDPN)-induced abnormal neurobehavioral syndrome in female Sprague-Dawley rats . The animals were exposed to IDPN in the dose of 100 mg/kg/day intraperitoneally for 7 days . Gentamicin (GM) was administered intraperitoneally daily 1 h before IDPN in the doses of 10, 40, and 80 mg/kg body weight in three different groups of rats . One more group of animals received gentamicin alone (80 mg/kg) and served as the gentamicin-alone group . The intensity of IDPN induced characteristic excitation with choreiform, and the circling movement (ECC) syndrome was examined using an observational test battery including dyskinetic head movements, circling, tail hanging, air righting reflex, and contact inhibition of the righting reflex on days 6, 8, 10, 12, 19, 26, and 33 . The animals for histopathological observation were sacrificed on day 10, whereas the remaining animals that were used for long-term behavioral studies were sacrificed on day 35 for biochemical observations . The blood and brain samples were collected for the analysis of blood urea nitrogen (BUN), serum creatinine, cerebral malondialdehyde (MDA), conjugated dienes, and lipid hydroperoxides, whereas temporal bones were collected for inner ear histopathology . Our results showed that gentamicin significantly and dose dependently exacerbated the incidence and the severity of the IDPN-induced behavioral syndrome . The histopathology of the inner ear demonstrated more severe loss of sensory hair cells in the crista ampullaris of the rats treated with IDPN plus gentamicin compared to the IDPN-alone treated animals . Concomitant treatment with gentamicin also potentiated IDPN-induced increase in free radical indices, suggesting a possible role of oxidative stress in gentamicin-induced aggravation of IDPN toxicity . Further studies are warranted to determine the role of aminoglycosides in nitrile toxicity and drug-induced movement disorders. Oncol Res, 1999, 11(7), 319 - 29 Establishment of a quantitative mouse dorsal air sac model and its application to evaluate a new angiogenesis inhibitor; Funahashi Y et al.; We have developed an improved mouse dorsal air sac model for quantifying in vivo tumor-induced angiogenesis . In our improved model, tumor angiogenesis is determined by measuring the blood volume in an area of skin held in contact with a tumor cell-containing chamber, using 51Cr-labeled red blood cells (RBC) . The blood volume induced by murine B16-BL6 melanoma cells increased linearly with the cell number in the range from 2 x 10(5) to 5 x 10(6) . Ten of 11 human tumor cell lines examined induced a significant increment in blood volume . For three representative human tumor cell lines (A549, WiDr . and HT1080 cells) that showed different angiogenic potencies, the levels of vascular endothelial growth factor (VEGF) produced by the tumor cells cultured under conditions of hypoxia and high cell density were correlated with the degree of in vivo angiogenesis . Using the improved model, it was confirmed that TNP-470, a well-known inhibitor, and borrelidin, an antibiotic from Streptomyces rochei, significantly inhibited the WiDr cell-induced angiogenesis . Borrelidin also inhibited spontaneous lung metastasis of B16-BL6 melanoma at the same dose that inhibited angiogenesis . Our results suggest that the improved mouse dorsal air sac model can be used for simple and quantitative measurement of tumor-induced angiogenesis and its inhibition. J Chromatogr A, 2000 Mar 24, 873(2), 149 - 62 Novel simulated moving-bed method for reduced solvent consumption; Jensen TB et al.; Simulated moving-bed (SMB) chromatography is attractive for reducing sorbent and solvent consumption relative to fixed-bed systems . In this contribution, we describe a novel and versatile method for further reducing solvent consumption in the case of reversed-phase chromatography . The method is based on the variation of the distribution coefficients of solutes to be separated upon varying the composition of a multi-component mobile phase . If the solvent strength of the desorbent is set higher than the solvent strength of the feed, the components will have smaller distribution coefficients in the extraction section of the SMB and hence will be more easily eluted . This will result in a lower desorbent flow and possibly also in a shorter desorbent zone, and, ultimately, in more concentrated products . The so-called "Triangle-method" by Storti et al . {AIChE J., 39 (1993) 471} to obtain the region of complete separation, is extended for this novel SMB method . Theoretical evaluation of the proposed methodology supports the anticipated solvent reduction relative to fixed-bed RP-HPLC for the cases of the purification of the polyketide antibiotic nystatin and the separation of bovine insulin from porcine insulin. In Vivo, 1999 Nov-Dec, 13(6), 503 - 6 Inhibitory action of roxithromycin on tumour necrosis factor-alpha production from mast cells in vitro; Shimane T et al.; This study was designed to evaluate the effects of roxithromycin (RXM), a newly synthesized macrolide antibiotic, on cytokine production from mast cells . Mast cells, induced by long-term culture of spleen cells from BALB/c mice, were stimulated with 2.5 micrograms/ml concanavalin A in the presence or absence of various concentrations of RXM . The culture supernatants were obtained 24 h after stimulation . RXM caused a reduction in TNF-alpha levels in culture supernatants in a dose dependent manner and was first detected at a concentration of as little as 0.5 microgram/ml . Metabolized RXM (RU 39001, RU 44981, and RU45179) also suppressed TNF-alpha production in a dose dependent fashion with a minimum concentration of 0.5 microgram/ml . However, metabolized RXM, RU 28111, scarcely affected TNF-alpha production from cultured mast cells . These results strongly suggest that RXM inhibits mast cell function, especially inflammatory cytokine production and may result in favorable modification in inflammatory diseases. J Mol Biol, 2000 Apr 21, 298(1), 95 - 110 Aminoglycoside binding in the major groove of duplex RNA: the thermodynamic and electrostatic forces that govern recognition; Jin E et al.; We use a combination of spectroscopic, calorimetric, viscometric and computer modeling techniques to characterize the binding of the aminoglycoside antibiotic, tobramycin, to the polymeric RNA duplex, poly(rI).poly(rC), which exhibits the characteristic A-type conformation that is conserved among natural and synthetic double-helical RNA sequences . Our results reveal the following significant features: (i) CD-detected binding of tobramycin to poly(rI).poly(rC) reveals an apparent site size of four base-pairs per bound drug molecule; (ii) tobramycin binding enhances the thermal stability of the host poly(rI).poly(rC) duplex, the extent of which decreases upon increasing in Na(+) concentration and/or pH conditions; (iii) the enthalpy of tobramycin- poly(rI).poly(rC) complexation increases with increasing pH conditions, an observation consistent with binding-induced protonation of one or more drug amino groups; (iv) the affinity of tobramycin for poly(rI).poly(rC) is sensitive to both pH and Na(+) concentration, with increases in pH and/or Na(+) concentration resulting in a concomitant reduction in binding affinity . The salt dependence of the tobramycin binding affinity reveals that the drug binds to the host RNA duplex as trication . (v) The thermodynamic driving force for tobramycin- poly(rI).poly(rC) complexation depends on pH conditions . Specifically, at pH< or =6.0, tobramycin binding is entropy driven, but is enthalpy driven at pH > 6.0 . (vi) Viscometric data reveal non-intercalative binding properties when tobramycin complexes with poly(rI).poly(rC), consistent with a major groove-directed mode of binding . These data also are consistent with a binding-induced reduction in the apparent molecular length of the host RNA duplex . (vii) Computer modeling studies reveal a tobramycin-poly(rI) . poly(rC) complex in which the drug fits snugly at the base of the RNA major groove and is stabilized, at least in part, by an array of hydrogen bonding interactions with both base and backbone atoms of the host RNA . These studies also demonstrate an inability of tobramycin to form a stable low-energy complex with the minor groove of the poly(rI).poly(rC) duplex . In the aggregate, our results suggest that tobramycin-RNA recognition is dictated and controlled by a broad range of factors that include electrostatic interactions, hydrogen bonding interactions, drug protonation reactions, and binding-induced alterations in the structure of the host RNA . These modulatory effects on tobramycin-RNA complexation are discussed in terms of their potential importance for the selective recognition of specific RNA structural motifs, such as asymmetric internal loops or hairpin loop-stem junctions, by aminoglycoside antibiotics and their derivatives . Eur J Med Res . 2000 Mar 27;5(3):125. Extrinsic allergic alveolitis in domestic environments (Domestic allergic alveolitis) caused by mouldy tapestry Schwarz H, Wettengel R, Kramer B. Extrinsic allergic alveolitis often occures as bird fancier's lung or is caused by occupational treatment with antigenic materials . In housing environments antigens of allergic alveolitis are also found, especially mould fungi . lf a source of antigens is absent in the anamnesis and the clinical picture as well as the clinical findings are ambiguous, the diagnosis of extrinsic allergic alveolits is delayed or unobtained . The following example shows that in spite of a detailed allergic anamnesis the source of antigens may remain occult and only an inspection of the dwelling rooms leads to an elucidation . - A sixty-one year old non-smoking women was twice admitted to hospital with a temperature of more than 39 degrees C, intense dyspnea on exertion and a strong dry cough under the persumed diagnosis pneumonia . The laboratory values showed nonspecific signs of inflammation, the blood gas analysis was changed to a heavy hypoxemia (pO subset2 49.2 mmHg) and in the chest x-ray there were seen miliary and partly reticular alterations . The chest computed tomography showed extensive densities in both upper and lower parts of the lungs and the pulmonary function test corresponded with a low-grade to middle-grade restriction (VC subsetin = 67%, TLC = 69%) . A high dose of corticosteroids produced an improvement of the radiological findings and of the pulmonary function . Also the specialized diagnostic in a hospital for pulmonary diseases yielded no new knowledge, and an interstitial pneumonia was diagnosed . Only the new formation of an acute pneumonic clinical picture on the day of returning to the patients own habitation suggested a noxious substance in the domestic environment . The inspection of the rooms finally showed the source of antigen to be from a condensation water soaked, moulded tapestry on the embrasure of a small unopenable window in the bedroom just on the head of the bed . The nutritive mediums left in the rooms furnished evidence of the mould-species Penicillium, Cladosporium and Botrytis, in the bedroom however mostly Penicillium . The RAST of specific IgG proved a positive result of all three mould species (Penicillium sp . 1 : 100, Cladosporium sp . 1 : 200 and Botrytis sp . 1 : 200) . The diagnosis of an extrinsic allergic alveolitis caused by mould was confirmed by a controlled re-exposure test, which promptly gave rise to a relapse and forced the patient to change habitation with the result of no further ailments . - Characteristic for the extrinsic allergic alveolitis in the described case is the inefficiency of antibiotic therapy, the immediate recovery by corticosteroids and furthermore the outbreak of relapses caused by re-exposure . If the source of antigens is unclear, the inspection of the habitation by an experienced allergologist may lead to success. Int J Antimicrob Agents, 2000 Feb, 13(4), 243 - 8 A comparison of the activities of three amphotericin B lipid formulations against experimental visceral and cutaneous leishmaniasis; Yardley V et al.; The polyene antibiotic, amphotericin B, the gold standard for systemic fungal infections is also a recommended second line treatment for visceral, cutaneous and mucocutaneous leishmaniasis . Acute toxicity has limited the use of amphotericin B but less toxic lipid formulations, AmBisome, Amphocil and Abelcet, have shown potential for the treatment of clinical visceral and mucocutaneous leishmaniasis . This study compares the in vitro and in vivo anti-leishmanial activity of Fungizone and the three lipid formulations . AmBisome and Amphocil were more active (ED50 values 0.3 and 0.7 mg/kg, respectively) than Abelcet (ED50 2.7 mg/kg) against L . donovani in a mouse model . Against L . major in vivo, AmBisome at a dose of 25 mg/kg was the most successful at reducing lesion size, with Amphocil also showing activity while Abelcet was inactive . In the L . donovani--peritoneal macrophage (PEM) model Fungizone and Amphocil were significantly more active (ED50 values 0.013 and 0.02 microg/ml, respectively) than AmBisome and Abelcet (ED50 values 1.5 and 2.6 microg/ml) . This trend was similar in the L . major--PEM model (Fungizone > Amphocil > AmBisome > Abelcet) . THP-1 macrophages infected with L . donovani amastigotes showed a different profile with Amphocil = Abelcet > AmBisome > Fungizone . Differences could be due to the interaction of the formulations with the biological milieu and uptake into different cell types. Spine, 2000 Mar 1, 25(5), 626 - 8 Mycobacterium xenopi infection of the spine: a case report and literature review; Danesh-Clough T et al.; STUDY DESIGN: A case report of Mycobacterium xenopi . OBJECTIVES: To present a case report of a vertebral osteomyelitis caused by M . xenopi and to review the world literature on the subject . SUMMARY OF BACKGROUND DATA: M . xenopi is most commonly a pulmonary pathogen in immunosuppressed patients or those with underlying lung disease . Infection of the spine is very rare, with only four cases reported . Three of these cases occurred in immunosuppressed patients, and the fourth in a patient with previous tuberculosis osteomyelitis of the spine . METHODS: The information was obtained from a review of the patient's clinical notes and follow-up appointments . RESULTS: The patient was a 73-year-old woman with an M . xenopi osteomyelitis of T6-T7, confirmed by magnetic resonance imaging and a computed tomography-guided biopsy . She was treated with surgical decompression and stabilization before a 2-year antibiotic regimen was begun . At follow-up assessment 1 year after the antibiotics were finished, she still had some ongoing back pain, but no evidence of relapse . CONCLUSIONS: This is the first reported case of an M . xenopi infection of the spine in a patient with no predisposing factors . This type of infection can be difficult to treat, with a high relapse rate reported despite prolonged courses of antibiotics. Med Pregl, 1999 Nov-Dec, 52(11-12), 505 - 7 {A quiet clinical course in an otogenic brain abscess}; Deric D et al.; INTRODUCTION: The occurrence of otogenic intracranial complications has been significantly diminished by introduction of antibiotic therapy, improved diagnostic methods and surgical treatment of chronic otitis . Meningitis is still the most frequent otogenic intracranial complication, otogenic brain abscesses are following, while other complications occur rarely (1,2,3) . Otogenic meningitis and brain abscesses are often associated, which makes the on time diagnosis of each complication harder . Mortality from otogenic brain abscesses is still relatively high, despite diagnostic and therapeutic achievements (4.5) . CASE DESCRIPTION: The aim of this study is to present a patient with brain abscess, which arose quietly, as a consequence of chronic suppurative otitis and to point at possibilities of diagnostics and treatment of this complication . The diagnosis of brain abscess by clinical methods of examination is not always reliable . It is often accompanied by most severe form of meningitis, so that neurological examination, in most cases, reveals only signs of meningitis . In our patient, the abscess has been detected by computerized tomography, in its late stage, when it already had completely formed a capsule and had shown clinically manifesting focal signs . This case is interesting because of quiet and unperceived evolution of brain abscess . In the active phase of chronic suppurative otitis, the patient was receiving antibiotic therapy, which has most likely hidden the early symptoms of evolution of intracranial infections . The appearance of signs of focal intracranial infection (photophobia) required applying computerized tomography revealing brain abscess, which was clearly bounded, with a developed capsule, pointing at its late stage (about two months) . These findings lead to a conclusion that an otologist should always keep in mind and check whether there is an intracranial infection in cases of active phase chronic otitis. Eur J Clin Microbiol Infect Dis, 2000 Feb, 19(2), 146 - 8 Evaluation of the E test for antifungal susceptibility testing of Candida glabrata; Favel A et al.; The E test was compared to the reference NCCLS broth macrodilution method for susceptibility testing of Candida (Torulopsis) glabrata . The MICs of amphotericin B, flucytosine, fluconazole and itraconazole were determined using the appropriate culture media (RPMI 1640 agar with 2% glucose, Casitone agar or Antibiotic Medium 3 agar) according to the drug tested . Agreement between the two methods was within plus/minus two dilutions for 77-100% of test results, according to the drug/medium combination . The study revealed problems in determining the MICs of azoles using the E test, and confirmed the suitability of Casitone agar for susceptibility testing of fluconazole even if results were read within 24 h. Rozhl Chir, 1999 Nov, 78(11), 587 - 9 {Drainage of the abdominal cavity using a simple and reliable system}; Serclova Z et al.; Experience with drains is more than 2000 years old, but instructive . In abdominal surgery nowadays indications for prophylactic drainage are diminishing as peroperative antibiotic administration has a similar effect . Therapeutic drainage is however still important and drainage is also useful after extensive operations, surgery of the lesser pelvis and operations with major bacterial contamination . The authors present their practical experience with a simple system of wrapped drains (Medisillen-Rubena, Brno) and a cover with an adhesive plate (B-Braun-Biotrol) which they used in 660 abdominal drainages with a very good effect. Int J Hematol, 2000 Feb, 71(2), 136 - 43 Efficacy of a new formulation of lenograstim (recombinant glycosylated human granulocyte colony-stimulating factor) containing gelatin for the treatment of neutropenia after consolidation chemotherapy in patients with acute myeloid leukemia; Takeshita A et al.; The efficacy and safety of a new formulation of lenograstim (recombinant glycosylated granulocyte colony-stimulating factor) prepared by switching the stabilizer from human serum albumin (HSA) to gelatin was investigated for the treatment of neutropenia after consolidation chemotherapy in patients with acute myeloid leukemia (AML) . The results obtained in the study using the gelatin-containing formulation (gelatin-lenograstim) were retrospectively compared to those obtained from a placebo-controlled double-blind randomized study (AML-DBT) using the HSA-containing formulation (HSA-lenograstim) . The median time of neutrophil recovery to > or = 1000/mm3 was significantly shorter in the gelatin-lenograstim group (14 days) than in the placebo group (21 days, P = .0001), and there was no significant difference between the gelatin-lenograstim group and the HSA-lenograstim group (14.5 days of AML-DBT, P = .5462) . The incidences of febrile neutropenia were significantly reduced in the gelatin-lenograstim group (24/43, 55.8%) compared to the placebo group (58/64, 90.6%, P < .0001) . The incidence of fever and antibiotic use was also significantly lower in the gelatin-lenograstim group (69.8% and 83.7%, respectively) than in the placebo group (92.2%, P = .0034, and 96.9%, P = .0285, respectively) . However, between the 2 groups there were no differences in the number of patients who had infectious episodes . No serious adverse drug reactions ascribed to gelatin-lenograstim were encountered . These results demonstrate that gelatin-lenograstim exerted beneficial effects in the acceleration of neutrophil recovery and in the reduction of fever, febrile neutropenia, and antibiotic use, and its efficacy was equivalent to HSA-lenograstim . Therefore, we concluded that the gelatin-lenograstim formulation, which offers no risk of virus contamination and can be stored at room temperature, is more beneficial than the HSA-lenograstim formulation. Oral Oncol, 2000 Mar, 36(2), 242 - 7 Induction of apoptosis in KB cells by pingyangmycin; Tai KW et al.; Pingyangmycin (PYM; Bleomycin A(5)), an antitumour antibiotic is currently used during anticancer therapy . Previous experiments demonstrated that the therapeutic efficiency of PYM for treatment of malignant tumours is considered to be related to its ability to cause DNA strand breaks in vitro . However, very little is known about the interaction of PYM with the target cells, and it is still unclear how PYM enters the cells . In this study, cell death induced by PYM was studied in a human squamous cell carcinoma cell line (KB cells) . In order to determine if cell death occurred by necrosis (reproductive cell death) or apoptosis (programmed cell death), KB cells were exposed to different concentrations of PYM and evaluated by biochemical and morphological criteria . Our results indicate that KB cells displayed an arrest in the G(2)-M phase of the cell cycle and became enlarged and polynucleated before dying at the low concentrations of PYM . In contrast, when cells were exposed to high concentrations of PYM, morphological changes identical to those usually associated with apoptosis were observed as well as internucleosomal digestion of genomic DNA . In conclusion, we demonstrate that PYM is able to induce two distinct modes of cell death depending on the doses of PYM. Magn Reson Imaging, 2000 Apr, 18(3), 255 - 62 The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis; Umans H et al.; The objective of the study was to evaluate the diagnostic utility of contrast enhanced magnetic resonance imaging (MRI) for distinguishing between acute medullary bone infarct and osteomyelitis . There were 11 patients (age 6-34 years) presented to our institution between December 1994 and February 1998 with a clinical differential diagnosis of acute bone infarct versus osteomyelitis and inconclusive radiographs were imaged using MRI . All but one received i.v . gadolinium . Nine of the patients had homozygous Sickle Cell disease (SCD) and two had Systemic Lupus Erythematosus (SLE), the latter requiring chronic methylprednisolone . Osteomyelitis was confirmed either by biopsy alone or by the combination of Gallium(67) scan in conjunction with positive blood cultures and clinical resolution following antibiotics . Infarcts without osteomyelitis were confirmed either by biopsy or resolution of symptoms without antibiotic therapy . All patients had at least six months clinical follow-up . The results found that seven of nine patients with SCD had acute infarct only . One patient with SCD had osteomyelitis only . Three patients (two SLE and one SCD) had both acute-on-chronic infarcts and superimposed osteomyelitis, one with an adjacent soft tissue abscess . Accurate distinction between infarct and osteomyelitis was impossible for one patient with SLE who did not receive contrast . All other cases were correctly diagnosed prospectively based on distinct patterns of MRI contrast enhancement . In all adult patients, acute infarcts demonstrated thin, linear rim enhancement on MRI while osteomyelitis revealed more geographic and irregular marrow enhancement . Two of four cases of osteomyelitis also demonstrated subtle cortical defects with abnormal signal traversing marrow and soft tissue . The single pediatric patient demonstrated elongated, serpiginous central medullary enhancement with periostitis . We concluded that the pattern of MR contrast enhancement may allow accurate distinction between acute infarct and osteomyelitis, or recognition of osteomyelitis superimposed on bone infarction. Obes Surg, 1994 Aug, 4(3), 232 - 237 Clinical Benchmark for Gastric Stapling Procedures; Graves HA Jr; To help answer the call to cut costs of surgical care, hospitals and physicians have joined to compare methods of care for the more common Diagnosis Related Group (DRG) diagnoses to form a Benchmark . Since many bariatric surgeons are the only ones performing this surgery in their primary hospitals, they do not have two or more surgical routines for comparison . This presentation compares data for the preoperative work-up, operating-room, and methods of postoperative care used by 29 members of the American Society for Bariatric Surgery (ASBS) . There was representation of both academic and private surgeons and hospitals . To target areas for possible savings, the hospital bills of 16 patients without complication were compared . The synthesis of this information revealed significant differences in the extent and cost of preoperative work-up, antibiotic coverage, other postoperative care, and length of stay . These differences are examined under the assumption that patient outcome was the same. Eur J Gastroenterol Hepatol, 2000 Feb, 12(2), 183 - 6 An audit of percutaneous endoscopic gastrostomy in a general hospital in Singapore; Yim HB et al.; OBJECTIVE: We conducted an audit on 50 percutaneous endoscopic gastrostomies (PEGs) performed by physician endoscopists from January 1996 up to November 1997 . DESIGN: A retrospective cohort study was conducted . RESULTS: The mean age of the patients was 68.5 years (range 20-101) and the main indications were cerebrovascular accident in 40 (80%), neurological dysphagia in six (12%) and head injury in three (6%) . The interval between the diagnosis of dysphagia and PEG was > 60 days in 19 patients (38%), 31-60 days in eight (16%) and < or = 30 days in 23 (46%) . The commonest reason for PEG insertion was intolerance to nasogastric tube in 49 patients (98%) . Twelve patients had antibiotics given concurrently for other infections and two had antibiotics given specifically to cover PEG insertion . There was evidence of post-PEG infection in two of 14 patients given antibiotics (14%) and in 14 of 36 patients not given antibiotics (39%) . By Cox regression, the adjusted relative risk of infection in patients receiving antibiotics versus those not receiving was 0.6927 (95% CI 0.3396-1.4130; not significant) . The 30-day mortality was 7/48 patients (15%), with two patients lost to follow-up before 30 days . There were no deaths directly attributable to PEG . CONCLUSIONS: PEG is still not adequately requested by doctors for patients needing enteral feeding for more than 30 days . The use of antibiotics in this retrospective cohort study failed to show any benefit in reducing the rate of infective complications. Int Orthop, 1999, 23(6), 348 - 50 Total hip arthroplasty for tuberculous coxitis; Caparros AB et al.; We report a case of tuberculous arthritis of the hip in a 22 year old male patient, treated with arthrotomy and antituberculous antibiotic therapy for 9 months; the joint deteriorated and 2 years later he underwent uncemented total hip arthroplasty . He received antibiotic therapy for 3 months preoperatively and for 6 months postoperatively . At 5 year follow-up there was no evidence of recurrent infection. J Biochem (Tokyo), 2000 Apr, 127(4), 585 - 9 Mutational analysis of tyrosine-191 in the catalysis of Cephalosporium acremonium isopenicillin N synthase; Loke P et al.; Isopenicillin N synthase (IPNS) is a key enzyme responsible for the catalytic conversion of delta-(L-alpha-aminoadipoyl)-L-cysteinyl-D-valine (ACV) to isopenicillin N in the beta-lactam antibiotic biosynthetic pathway . The Aspergillus nidulans IPNS crystal structure implicated amino acid residues tyrosine-189, arginine-279, and serine-281 in the substrate-binding of the valine carboxylate portion of ACV via hydrogen bonds . In previous reports, we provided mutational evidence for the critical involvement of the corresponding arginine-281 and serine-283, which constitute a conserved R-X-S motif, for the catalysis of Cephalosporium acremonium IPNS (cIPNS) . In this study, we report the site-directed mutagenesis of the corresponding tyrosine-191 in cIPNS to four amino acids from different amino acid groups, namely, phenylalanine, serine, histidine, and aspartate . The mutants Y191F, Y191H, and Y191R respectively yielded specific activities at levels of 3, 8.6, and 18.8% relative to the wild-type when enzyme bioassays were performed using purified protein fractions . These results were surprising, as previous mutational analyses involving arginine-281 and serine-283 resulted in non-measurable specific activities, thus suggesting that tyrosine-191 is important but not critical for the activity of cIPNS due to its involvement in ACV binding . Hence, it is likely that tyrosine-191 is the least critical of the three residues involved in binding the ACV valine carboxylate moiety. Lakartidningen, 2000 Feb 16, 97(7), 688 - 91 {Help to children and adolescents with malnutrition or eating disorders . Percutaneous endoscopic gastrostomy with button: simple, safe and cost-effective}; Casswall T et al.; Percutaneous endoscopic gastrostomy (PEG) has gained great popularity for children with malnutrition and eating disorders secondary to chronic illness . However, the procedure is not without risks . We report on 62 infants and children, median age 4 years (1 month-20 years), who underwent PEG placement . Cerebral palsy with or without mental retardation was the most common diagnosis (50%) . No complications related to the PEG procedure itself occurred, but postoperative pneumonia was seen in 10% . Late complications were few: intraperitoneal migration of the button in one child and prolapse of the stoma in another . At the time of button placement, after median 14 weeks, mean weight had increased from a standard deviation score of -2.7 to -2.2 (P < 0.001) . We consider PEG to be a safe procedure for children with malnutrition requiring enteral feeding . Due to potential risks and complications related to this method, a multidisciplinary approach, as found in a "nutritional support team", is recommended. J Pediatr Orthop, 2000 Mar-Apr, 20(2), 163 - 5 Pin site care during external fixation in children: results of a nihilistic approach; Gordon JE et al.; We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997 . A simple pin care system with no physical pin cleansing except that provided by daily showers was used . Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days . Pin sites were graded according to the system of Dahl et al . on a 0 to 5 scale . A total of 4,473 observations was made . Patients developed 178 pin tract infections (4.0% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections . No pin was removed because of infection . Diaphyseal half pin sites were less commonly infected (1.6%) than periarticular wire or half pin sites (4.5%) . We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures. Laryngorhinootologie, 2000 Feb, 79(2), 77 - 80 {Bilateral malfunction of peripheral vestibular organs . Observations of 20 cases of Dandy syndrome}; Lange G et al.; BACKGROUND: Dandy's Syndrome initially provokes dizziness and vertigo . Later on patients suffer from motion unsteadiness especially in dark surroundings and from oscillopsies . Gentamicin is ototoxic mostly for the vestibular part of the inner ear, and it is nephrotoxic . It may cause transitory renal dysfunction . Chronic or acute renal insufficiencies inhibit gentamicin clearance . PATIENTS: Among 20 cases we found 15 who had previously been treated with aminoglycosides (13 with gentamicin and two with streptomycin) . Ten of our patients showed symptoms of preexistant chronic nephrosis or of transitory renal insufficiency caused by gentamicin therapy . In all 13 cases, peripheral vestibular function was destroyed or severely damaged by antibiotic . The same patients had no hearing loss . CONCLUSIONS: The different reactions of the cochlear and the vestibular end organs support the theoretical basis for transtympanic gentamicin treatment of Meniere's disease.--Other reasons for Dandy's Syndrome were bilateral Meniere's disease, skull fractures, and bilateral vestibular disorders. Aliment Pharmacol Ther, 2000 Mar, 14(3), 299 - 303 Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease; Malekzadeh R et al.; OBJECTIVE: Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking . AIM: A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H . pylori infection in duodenal ulcer patients . METHODS: Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d . (RABM) for 2 weeks . Compliance and side-effects were monitored and recorded by table diary . H . pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C-urea breath test . RESULTS: A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 +/- 11 years) completed the study . Endoscopic findings and demographic data were comparable in both groups . Intention-to-treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0 . 006) in the RABF and RABM groups, respectively . Side-effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0 . 04) . CONCLUSION: Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H . pylori eradication rate in Iranian duodenal ulcer patients. Theriogenology, 1999 Nov, 52(7), 1117 - 22 Effect of clavulanic acid-potentiated amoxycillin on semen quality in dogs; England GC; Two different doses of clavulanic acid-potentiated amoxycillin were evaluated for their effect upon semen quality and libido in dogs . There was no significant difference in either parameter between control dogs and dogs treated with clavulanic acid-potentiated amoxycillin at either 12.5 mgkg-1 or 25 mgkg-1 orally twice daily for 28 d . Despite the marked effect of certain antibiotic agents upon spermatogenesis, it appears that clavulanic acid-potentiated amoxycillin can be used in dogs at up to twice the therapeutic dosage recommended by the manufacturer without a deleterious effect upon semen quality. Eur J Cardiothorac Surg, 2000 Feb, 17(2), 184 - 6 Multiple mycotic arch-thoraco-abdominal aortic aneurysms: a successful case of in situ graft replacement; Kuki S et al.; Mycotic aortic aneurysms are an uncommon yet still life-threatening pathology . We report on a 67-year-old male who had a persistent fever and back pain . Contrast enhanced computed tomography (CT) showed multiple aortic aneurysms located in the aortic arch, the descending thoracic aorta and the supraceliac abdominal aorta . After 2 months of antibiotic therapy, a staged operation was carried out with 2-week interval, which includes a graft replacement of aortic arch with elephant trunk technique and a graft replacement of thoraco-abdominal aorta with omental transfer . The postoperative course was uneventful . This case seems to be quite rare in terms of multiplicity and location of mycotic aneurysms . Surgical strategy for this pathology is discussed. Int J Parasitol, 2000 Apr 10, 30(4), 427 - 39 Impact of a plastid-bearing endocytobiont on apicomplexan genomes; Sato S et al.; Both the chromosomal and extrachromosomal components of the apicomplexan genome have been supplemented by genes from a plastid-bearing endocytobiont: probably an algal cell . The sequence of the apicomplexan plastid's vestigial genome indicates that a large number (>100) of genes of endocytobiotic origin must have transferred laterally to the host cell nucleus where they control maintenance of the plastid organelle and supply its functional components by means of post-translational protein trafficking . Should the nuclear genes prove to be less divergent phylogenetically than those left on the plastid genome, they might give better clues than we have at present to the origin of the plastid-bearing endocytobiont . Most of these nuclear genes still await discovery, but the on-going genome sequencing project will reveal the function of the organelle, as well as many "housekeeping" processes of interest on a wider front . The plastid's own protein synthetic machinery, being cyanobacterial in origin, offers conventional targets for antibiotic intervention, and this is discussed here using a structural model of elongation factor Tu . Uncovering the vital function(s) of the plastid organelle will provide new drug targets. Theriogenology, 1998 Apr 1, 49(5), 933 - 42 In vitro maturation of domestic dog oocytes cultured in advanced preantral and early antral follicles; Bolamba D et al.; Initial studies in our laboratory demonstrated that a large proportion of domestic dog advanced preantral (APAN) and early antral (EAN) follicles contained grown oocytes that had acquired the dense cytoplasmic lipid characteristic of preovulatory oocytes . The objective of this study was to assess nuclear maturation of those oocytes after in vitro culture . Both APAN and EAN follicles (152 to 886 microns in diameter) were isolated from ovaries by treatment with collagenase and DNase . The follicles were cultured in Dulbecco's Modified Eagle's medium/nutrient mixture F-12 Ham culture medium supplemented with 20% (v/v) fetal bovine serum (FBS), 2 mM L-glutamine, 1% (v/v) antibiotic-antimycotic, 1 microgram FSH/ml, 10 IU hCG/ml and 1 microgram estradiol/ml . Within each group (APAN or EAN), control follicles were not cultured (0 h), and 2 to 12 follicles per well were incubated under a humidified atmosphere of 5% CO2 in air at 37 degrees C for 24, 48 or 72 h . After 24 h of culture, significantly more (5.3%, 20/374; P < 0.05) oocytes from APAN follicles reached the metaphase I to metaphase II stages (MI to MII) than the percentage of control follicles observed at 0 h (0.9%, 3/318) . Continued culture resulted in a further increase (P < 0.05) in the percentage of oocytes reaching MI to MII by 48 h (11.5%, 47/407), which remained unchanged at 72 h (9.9%, 40/404) . The percentage of oocytes from EAN follicles reaching MI to MII did not significantly increase after 24 h of culture . However, there was an increase (P < 0.05) by 48 h of culture (8.7%, 11/126), which remained unchanged at 72 h (7.5%, 8/106) . These results show that dog oocytes cultured within advanced preantral and early antral follicles in vitro are competent to resume meiosis to the metaphase stage. J Am Anim Hosp Assoc, 2000 Mar-Apr, 36(2), 111 - 4 The effects of sodium ampicillin, sodium cefazolin, and sodium cefoxitin on blood pressures and heart rates in healthy, anesthetized dogs; Morgan MR et al.; This study determined the effects of intravenous ampicillin, cefazolin, and cefoxitin on blood pressures and heart rates in healthy, anesthetized dogs . Forty dogs were each randomly assigned to a control, ampicillin, cefazolin, or cefoxitin group . Antibiotics or saline was delivered by intravenous bolus prior to surgical stimulation . Heart rate; systolic, mean, and diastolic arterial pressures; oxygen saturation; end-tidal halothane; and end-tidal carbon dioxide (CO2) were recorded before and every minute for 10 minutes after the test drug was administered . No significant differences were recorded between the antibiotic and control groups . The prophylactic use of these antibiotics should be considered safe in healthy, anesthetized dogs. Obes Surg, 1996 Oct, 6(5), 416 - 420 Complications of Biliopancreatic Diversion Surgery as Proposed by Scopinaro in the Treatment of Morbid Obesity; Michielson D et al.; BACKGROUND: This study concerns 33 patients treated for morbid obesity with the procedure proposed by Scopinaro . Results are reviewed retrospectively in terms of complication rates . METHODS: The group consisted of ten men and 23 women with a mean age of 34 years (range 20-51 years), and a mean BMI of 49.5 kg/m(2) (range 37-77) . Adequate attempts at medical management had failed repeatedly . The operative procedure involved a 2/3 partial gastrectomy and biliopancreatic diversion by Roux-en-Y reconstruction 50 cm before the ileocecal valve . In one patient, a cholecystectomy was added . RESULTS: The mean weight loss after 6 months was 18.9% of the initial weight, with mean BMI 41 kg/m(2) (range 29-60) . Early complications included four wound infections (15%), while two patients complained of an early dumping syndrome (6%), treated by dietary measures . There were no respiratory infections and no pulmonary embolism, likely as a result of the thoracic epidural anesthesia and high doses of prophylactic heparin used . There was no mortality . As to late complications, nine patients complained of diarrhea due to bacterial overgrowth (27%) and were treated with antibiotic therapy . There were five incisional hernias (15%) . Five patients had a peptic ulcer (15%) and required medical treatment . Two patients had acute cholecystitis (6%) . One patient had an afferent loop obstruction (3%), requiring reoperation . CONCLUSIONS: Overall, this series of intestinal diversion procedures by the method of Scopinaro had a larger complication rate than generally accepted. Spectrochim Acta A Mol Biomol Spectrosc, 2000 Jan, 56A(1), 181 - 91 NMR, UV-vis and CD study on the interaction of pradimicin BMY-28864 with divalent cations of alkaline earth metal; Hu M et al.; In order to clarify the mechanism of the calcium-activated anti-fungal action of pradimicin derivatives, we investigated the compatibility of four divalent metal cations, Ca2+, Mg2+, Sr2+ and Ba2+, when combined with pradimicin BMY-28864 in an aqueous solution . The 1H NMR studies suggest that all the tested cations can induce a chemical exchange between two types of aggregation of BMY-28864 in an aqueous solution . The exchange rate, however, varies according to the cation species . In descending order they are: Ba2+ > Sr2+ > Ca2+ > Mg2+ . The differences in the binding ability of BMY-28864 to the cations and the solubility of the chloride salts are explained by the electronegativity of these cations . The UV-Vis and CD spectra of these solutions show isosbestic points that correspond to an exchange process in the cations' binding to BMY-28864 . The results provide experimental support for the hypothesis that there is a common mechanism underlying their cations interactions with the antibiotic . The CD study also provided evidence about the stoichiometric relation of the divalent metal ions to the antibiotic, 1:2, which was obtained by NMR analyses. Postgrad Med, 2000 Mar, 107(3), 69 - 70, 73-6, 79-80 Topical therapy for acne vulgaris . How do you choose the best drug for each patient? Johnson BA, Nunley JR. Although management of acne is sometimes difficult, primary care physicians can offer a number of treatment plans to patients with this skin condition . Comedonal acne usually responds to topical keratolytics, such as salicylic acid, benzoyl peroxide, adapalene, and tretinoin . Inflammatory acne is usually treated with topical therapy plus a systemic antibiotic . Nodulocystic acne generally requires an 8-week course of systemic antibiotics . If the nodulocystic acne does not improve, minocycline or isotretinoin may be needed . Topical therapy is often helpful in the long-term management of nodulocystic acne . New products are available that deliver topical agents in novel ways that decrease skin irritation . With the proper tools and instructions in use, most patients have significant improvement in their acne. Biochem J, 2000 Apr 1, 347 Pt 1, 205 - 9 Novel inhibitors of the condensing enzymes of the type II fatty acid synthase of pea (Pisum sativum); Jones AL et al.; The type II fatty acid synthases (FASs) of higher plants (and Escherichia coli) contain three condensing enzymes called beta-ketoacyl-ACP synthases (KAS), where ACP is acyl-carrier-protein . We have used novel derivatives of the antibiotic thiolactomycin to inhibit these enzymes . Overall de novo fatty acid biosynthesis was measured using {1-(14)C}acetate substrate and chloroplast preparations from pea leaves, and {1-(14)C}laurate was used to distinguish between the effects of the inhibitors on KAS I from those on KAS II . In addition, the activities of these enzymes, together with the short-chain condensing enzyme, KAS III, were measured directly . Six analogues were tested and two, both with extended hydrocarbon side chains, were found to be more effective inhibitors than thiolactomycin . Incubations with chloroplasts and direct assay of the individual condensing enzymes showed that all three compounds inhibited the pea FAS condensing enzymes in the order KAS II > KAS I > KAS III . These results demonstrate the general activity of thiolactomycin and its derivatives against these FAS condensation reactions, and suggest that such compounds will be useful for further detailed studies of inhibition and for use as pharmaceuticals against Type II FASs of pathogens. Bioconjug Chem, 2000 Mar-Apr, 11(2), 219 - 27 Sequence-recognition and cleavage of DNA by a netropsin-phenazine-di-N-oxide conjugate; Helissey P et al.; We report the synthesis, DNA-binding and cleaving properties, and cytotoxic activities of R-128, a hybrid molecule in which a bis-pyrrolecarboxamide-amidine element related to the antibiotic netropsin is covalently tethered to a phenazine-di-N-oxide chromophore . The affinity and mode of interaction of the conjugate with DNA were investigated by a combination of absorption spectroscopy, circular dichroism, and electric linear dichroism . This hybrid molecule binds to AT-rich sequences of DNA via a bimodal process involving minor groove binding of the netropsin moiety and intercalation of the phenazine moiety . The bidentate mode of binding was evidenced by linear dichroism using calf thymus DNA and poly(dA-dT).(dA-dT) . In contrast, the drug fails to bind to poly(dG-dC).poly(dG-dC), because of the obstructive effect of the guanine 2-amino group exposed in the minor groove of this polynucleotide . DNase I footprinting studies indicated that the conjugate interacts preferentially with AT-rich sequences, but the cleavage of DNA in the presence of a reducing agent can occur at different sequences not restricted to the AT sites . The main cleavage sites were detected with a periodicity of about 10 base pairs corresponding to approximately one turn of the double helix . This suggests that the cleavage may be dictated by the structure of the double helix rather than the primary nucleotide sequence . The conjugate which is moderately toxic to cancer cells complements the tool box of reagents which can be utilized to produce DNA strand scission . The DNA cleaving properties of R-128 entreat further exploration into the use of phenazine-di-N-oxides as tools for investigating DNA structure. J Antibiot (Tokyo), 1999 Sep, 52(9), 809 - 14 Enzymatic 1-N-acetylation of paromomycin by an actinomycete strain #8 with multiple aminoglycoside resistance and paromomycin sensitivity; Sunada A et al.; An actinomycete strain #8 with multiple aminoglycoside (AG) resistance and paromomycin (PRM) sensitivity was examined for its capability of enzymatic modification of AGs . Cell free extracts from the strain converted all of the examined AGs including PRM in the presence of acetyl CoA . PRM was completely modified to at least two products (major and minor spots upon TLC) without significant reduction of the antibiotic activity of the reaction mixture . The structure determination and antibiotic assay of the purified major product revealed l-N-acetylPRM and its antibiotic activity (12% activity of PRM), indicating the existence of AAC(1) . It was thus obvious that the 1-N-acetylation of PRM did not cause PRM resistance . Apramycin, the substrate of the known AAC(1), was not readily acetylated, suggesting that the AAC(1) of strain #8 is a new type . Two diacetylated products (1,2'-di-N-acetylPRM and 1,6"'-di-N-acetylPRM) were found in the minor spot, suggesting the existence of additional AACs. J Drug Target, 2000, 7(5), 393 - 406 Synthesis, characterisation and in vivo behaviour of a norfloxacin-poly(L-lysine citramide imide) conjugate bearing mannosyl residues; Gac S et al.; With the aim of promoting the targeting of macrophage mannose receptors and the internalisation of the norfloxacin antibiotic, which is active against some intracellular bacteria, a macromolecular prodrug was synthesised where the antibiotic and mannosyl moieties were coupled to a polymeric carrier, namely poly(L-lysine citramide imide) . This carrier, which derived from two metabolites, citric acid and L-lysine, is known to be biocompatible and slowly degradable under slight acidic conditions . Norfloxacin was coupled onto the acid groups present along the polymer chains, and conjugates were characterised by UV, TLC and SEC . The mannosyl groups selected to promote the targeting of the mannose-specific lectin present on the outer membrane of macrophages were incorporated through a biodegradable glycolic spacer arm . Two different strategies were considered to synthesise the full conjugates, namely coupling norfloxacin onto mannosylated conjugates, and coupling mannose onto PLCAI/Nflx conjugates . The second pathway led to better results regarding mannosylation . The presence of norfloxacin and mannose caused chain aggregation, especially for conjugates with a high content of mannosyl residues . The targeting ability of the prodrug was investigated using a method based on the competition between the mannosylated macromolecules and glucose oxidase, a mannosyl-bearing non-human protein . This method showed that prodrug macromolecules competed effectively with glucose oxidase and thus should be able to bring the drug up to the mannosyl receptor-bearing membranes of macrophages infected by intracellular bacteria. Aust Fam Physician, 2000 Jan, 29(1), 19 - 23 Acute sinusitis . Who should we be treating? Beavis M. BACKGROUND: The diagnosis of acute sinusitis has been regarded as a serious condition that requires the use of antibiotics . However the increasing incidence of resistant organisms means antibiotics need to be used carefully . OBJECTIVE: To look at the evidence available regarding antibiotic use for sinusitis, and to discuss its application to general practice . DISCUSSION: There have been surprisingly few randomised double blind placebo controlled trials for sinusitis, and fewer still have been based in a representative population of primary care patients . This article discusses studies relevant to general practice . Several practical clinical symptoms and signs have been shown to increase the likelihood of a patient having acute bacterial sinusitis, and therefore benefit from antibiotics . When antibiotics are used, comparative data suggest that amoxycillin should be used first line . The issue of patient experience, expectations and satisfaction is also raised. J Infect Dis, 2000 Mar, 181(3), 1185 - 8 Soluble CD14 levels in the serum, synovial fluid, and cerebrospinal fluid of patients with various stages of Lyme disease; Lin B et al.; Levels of circulating soluble CD14 (sCD14) in patients with various stages of Lyme disease (LD) were examined . Patients with early or untreated late LD had significantly higher levels of sCD14 than did healthy controls (P=.0001 and .0007, respectively); levels returned to normal within 3 months after antibiotic therapy . Patients with persistent posttreatment symptoms of LD had sCD14 levels equivalent to those of healthy controls . Differences in the serum sCD14 levels in patients with various stages of LD are likely to be directly correlated with differences in bacterial burden, suggesting that posttreatment symptoms may not require continued presence of the organism . sCD14 levels in the cerebrospinal fluid (CSF) of patients with any stage of LD were no different from those of control subjects . Levels of synovial fluid sCD14 from patients with Borrelia burgdorferi in their joints were elevated, compared with levels in normal serum, and may play a role in the pathogenesis of arthritis. Jpn J Clin Oncol, 1999 Nov, 29(11), 571 - 5 Surgical management of primary lung cancer in an elderly patient with preoperative empyema; Harada M et al.; A 74-year-old man with primary lung cancer developed preoperative empyema but was successfully managed surgically . The patient was given a diagnosis of c-T2N1M0, stage IIB, moderately differentiated squamous cell carcinoma, but before surgery pneumothorax and empyema developed, resulting from rupture of the carcinoma . Thoracic drainage, lavage and systemic administration of antibiotics improved his empyema . As there were no malignant cells in the drainage fluid, right middle-lower bilobectomy, empyemal cavity resection and lymph node dissection were performed . The bronchial stump was covered with an intercostal muscle flap . Thoracic drainage, lavage and systemic administration of antibiotics were performed for 6 days following the operation . The patient was discharged on the 27th postoperative day without any complications having developed . The pathological diagnosis of the tumor was p-T4N2(#7)M0, stage IIIB, br(-), ly(+), v(+), p3(pleura), pm1 and d0 . He died of recurrence at home 18 months after the operation . We believe the following to be the minimum requirements for surgical management of such patients: (1) immediate thoracic cavity drainage and lavage with systemic antibiotic therapy, aiming at infection control before surgery; (2) prophylactic lavage of the thoracic cavity during and after surgery and (3) coverage of the bronchial stump with an adequate flap . Six reported cases of primary lung cancer with preoperative empyema are also discussed. Semin Neurol, 1999, 19(2), 201 - 11 Neurologic manifestations of toxoplasmosis in AIDS; Cohen BA; Central nervous system (CNS) toxoplasmosis is the most common cause of cerebral mass lesions in AIDS patients . Toxoplasma gondii is commonly acquired through ingestion of contaminated meats resulting in latent infection . With the onset of immunosuppression, it may preferentially infect the CNS, resulting in a wide range of clinical presentations . Effective antibiotic therapy is available and capable of producing rapid remission of active infection but must be continued throughout life to prevent recurrence . Characteristic presentations and rapid therapeutic response permit presumptive diagnosis and initiation of specific antibiotics in many cases; however, appropriate clinical and radiographic monitoring to detect alternative or mixed pathologies is necessary . Unusual presentations may hinder rapid diagnosis and should be considered in AIDS patients with cryptic CNS symptoms . Despite increasing attention to primary prophylaxis, the worldwide distribution of this parasite, its potential to be the presenting illness in previously unidentified human immunodeficiency virus-infected individuals, and failures of prophylaxis are likely to make toxoplasmosis an important continuing source of neurologic morbidity in AIDS. Proc Natl Acad Sci U S A, 2000 Mar 14, 97(6), 2674 - 9 The genetics of ivermectin resistance in Caenorhabditis elegans; Dent JA et al.; The ability of organisms to evolve resistance threatens the effectiveness of every antibiotic drug . We show that in the nematode Caenorhabditis elegans, simultaneous mutation of three genes, avr-14, avr-15, and glc-1, encoding glutamate-gated chloride channel (GluCl) alpha-type subunits confers high-level resistance to the antiparasitic drug ivermectin . In contrast, mutating any two channel genes confers modest or no resistance . We propose a model in which ivermectin sensitivity in C . elegans is mediated by genes affecting parallel genetic pathways defined by the family of GluCl genes . The sensitivity of these pathways is further modulated by unc-7, unc-9, and the Dyf (dye filling defective) genes, which alter the structure of the nervous system . Our results suggest that the evolution of drug resistance can be slowed by targeting antibiotic drugs to several members of a multigene family. Perit Dial Int, 2000 Jan-Feb, 20(1), 76 - 9 A retrospective study of seven cases of Candida parapsilosis peritonitis in CAPD patients: the therapeutic implications; Wong PN et al.; BACKGROUND: Candida peritonitis accounts for the majority of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida species were not routinely subtyped in previous studies.The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear . OBJECTIVE: To study the clinical course and outcome of C . parapsilosis peritonitis in CAPD patients . SETTING: Peritoneal dialysis unit in a regional hospital . PATIENTS AND DESIGN: A retrospective study on seven cases of C . parapsilosis peritonitis occurring in a single center over 3 years . RESULTS: The 7 patients included 4 males and 3 females . Their mean age was 62 +/- 11.5 years . Two (29%) were diabetic . Three (43%) had a history of preceding peritonitis and 5 (71 %) had received broad spectrum antibiotic within the previous 1 month . All presented with cloudy dialysate, abdominal pain, and fever . The mean dialysate white cell count was 300 +/- 168/mm3 with a predominance of neutrophils (81.4% +/- 13.1%).The mean time from onset of symptoms to diagnosis was 5.7 +/- 3.1 days . All had been treated with immediate catheter removal within 24 hours of diagnosis and antifungal therapy, including oral fluconazole, intravenous (IV) amphotericin, or their sequential combination . Environmental samplings were negative for C . parapsilosis . The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one peritoneal adhesion (14%), and one mortality (14%) . In the end, only two (29%) could resume CAPD . CONCLUSIONS: The outcome of this study group appeared worse than those previously described in the literature, and the optimal treatment for this group of patients remains unclear. J Dairy Sci, 2000 Feb, 83(2), 338 - 44 The influence of long-term supplementation with biotin on the prevention of lameness in pasture fed dairy cows; Fitzgerald T et al.; In a double-blind study, the influence of biotin supplementation on lameness in dairy cows was investigated over a 13-mo period . The experimental site was a tropical upland environment and involved over 2705 Holstein and Friesian cows on 20 participating farms . Cows on 10 farms received biotin at a rate of 20 mg/head per day in the concentrate, and cows on 10 other farms received feed without the biotin supplement . Premixes with or without biotin were incorporated into a grain concentrate that was fed at a constant rate to cows at milking . Farmers maintained accurate records of the nature of hoof problems and any treatment applied . Each herd was evaluated for locomotion scores at 8-wk intervals . Locomotion scores were significantly correlated with the number of days with measurable rainfall per month (r = 0.88) . The biotin-supplemented herds exhibited better locomotion scores than the unsupplemented herds . In the wet summer period the number of lame cows, as observed by the farmer, were significantly fewer during the rainy period for the biotin-supplemented herds and required fewer antibiotic treatments than unsupplemented herds . Most hoof lesions were most commonly observed in the outer claws of the hind limb . Daily milk production (17.3 vs . 18.5 L) was not affected by biotin supplementation . Reduced milk fat percentage and somatic cell counts of bulk milk were recorded in the biotin supplemented herds during the wet, summer period. Physiol Behav, 2000 Feb, 68(4), 533 - 41 Temporal modulation of nephrotoxicity, feeding, and drinking in gentamicin-treated rats; Julien N et al.; Gentamicin-induced nephrotoxicity varies temporally, with a peak being observed when this antibiotic is administered during the resting period and a trough when given during the activity period of rats . These nychthemeral variations are modified by fasting and by restricted feeding schedules . In this study, food and water intakes of adult female Sprague-Dawley rats were measured during pretreatment (Days 1 to 5) and during treatment (Days 6 to 10) with gentamicin (80 mg/kg/day, i.p.) injected at 1300 or 0100h . A significantly higher level of serum creatinine was observed when gentamicin was administered at 1300 h compared to 0100 h, and a significantly lower creatinine clearance was found in rats treated with gentamicin at 1300 h compared to those treated with saline at the same time . Gentamicin treatment at 1300 or 0100 h resulted in a decrease in the 24-h food intake . In addition, in the gentamicin-treated group at 0100 h, the maximal food intake observed at late dark during the pretreatment period decreased during treatment, and early dark rather than late dark maximal intake occurred . Our data demonstrate that gentamicin induces a nephrotoxicity that varies temporally, and that gentamicin treatment inhibits food intake and alters its nocturnal variations. Chest, 2000 Mar, 117(3), 734 - 7 Errors in the treatment of tuberculosis in Baltimore; Rao SN et al.; BACKGROUND: Incomplete or incorrect antibiotic therapy, especially in the initial phase of antituberculosis (anti-TB) treatment, is a major cause of acquired drug resistance and treatment failure . We determined the extent of errors in anti-TB treatment regimens by way of nonadherence to recommended treatment protocols among patients with TB in Baltimore, MD, a city with declining rates of disease . An error was defined as using too few drugs or the wrong drugs, giving inadequate doses of drugs, or prescribing an inadequate duration of treatment . METHODS: We reviewed the records of all patients with culture-positive, pulmonary TB reported in the city of Baltimore from January 1, 1994, to December 31, 1995 . We determined demographic information, initial anti-TB regimen, doses and duration of therapy, history or presence of resistance to anti-TB drugs, injecting-drug or alcohol abuse, HIV status, and whether treatment was given by a private physician or by the Tuberculosis Clinic of the Baltimore City Health Department (BCHD) . RESULTS: Of the 110 cases of active pulmonary TB, 17 cases (15.4%) had errors in treatment for control of their current disease . Thirteen of 34 privately treated patients (38%) had some error in their initial anti-TB regimen, compared with 4 of 76 patients (5.2%) treated by the Tuberculosis Clinic of the BCHD (p < 0.0001) . Patients were otherwise similar as determined by age, sex, HIV status, drug-resistance characteristics, and injecting-drug use, regardless of whether they had erroneous anti-TB regimens . CONCLUSION: In a low-prevalence area, private physicians make frequent errors in prescribing anti-TB therapy . Additional educational resources for physicians and increased use of expert consultation may contribute to improved TB control. Mutat Res, 2000 Feb 16, 459(1), 29 - 41 Cellular and molecular effects of bleomycin are modulated by heat shock in Saccharomyces cerevisiae; Keszenman DJ et al.; To study some mechanisms underlying the stress responses in eukaryotic cells, we investigated the effect of heat shock (HS) on the induction of DNA double strand breaks as well as on potentially lethal and mutagenic events induced by the radiomimetic antibiotic bleomycin (BLM) in Saccharomyces cerevisiae . Haploid wild-type yeast cells in the logarithmic phase of growth were exposed to different concentrations of BLM (0-30 microg/ml, 1.5 h) without and with a previous HS (38 degrees C, 1 h) . Immediately after treatments, survival as well as mutation frequency were determined, and quantitative analysis of chromosomal DNA by laser densitometry were performed both immediately after treatments and after incubation of cells during different time intervals in liquid nutrient medium free of BLM . Our results indicate that HS induces resistance to potentially lethal and mutagenic effects of BLM . Quantitative analysis of chromosomal DNA performed immediately after treatments showed the same DNA fragmentation, either upon BLM as single agent or preceded by HS . However, HS pretreated cells incubated during 4 h in liquid nutrient medium free of BLM repaired DNA double strand breaks more efficiently as compared to non-pretreated cells . On this basis, we propose that the observed HS-induced resistance to BLM depends on a regulatory network acting after DNA-induced damage, which includes genes involved in DNA repair, HS response and DNA metabolism. J Spinal Disord, 2000 Feb, 13(1), 42 - 5 Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management; Picada R et al.; The authors reviewed 817 instrumented lumbosacral fusions in adults and found an incidence of 3.2% deep wound infections . The primary focus of this study was the management of these infections, with particular attention to whether the implants needed to be removed . A consulting infectious disease specialist indicated that an acute infection of a low back fusion wound could not be healed without removal of the metallic implants . This opinion was in contrast to the authors' daily experience and prompted this study . The authors identified and reviewed 817 cases of instrumented posterior lumbosacral arthrodeses in adults . A detailed analysis of any case with a deep wound infection was pe