Bacteriological

Vaccine, 1995 Feb, 13(3), 301 - 4
The Brucella abortus RB51 vaccine does not confer protection against Brucella ovis in rams; Jimenez de Bagues MP et al.; The protective efficacy against Brucella ovis of the live vaccine Brucella abortus strain RB51 has been evaluated in rams using the attenuated B . melitensis strain Rev 1 as a reference vaccine . Sixteen Brucella-free rams, 6 months of age, were vaccinated subcutaneously with 4.18 x 10(10) c.f.u . RB51 . Sixteen rams of the same condition and age were vaccinated subcutaneously the same day with 1.1 x 10(9) c.f.u . Rev 1 . Fifteen similar rams were kept unvaccinated as controls . Six months after vaccination all rams were challenged with 3 x 10(9) c.f.u . B . ovis and slaughtered 8 weeks thereafter for bacteriological and pathological studies . The percentage of rams that were found infected was 68% (Rev 1), 100% (RB51) and 100% (controls) . At necropsy, the percentage of organs found to be infected was significantly lower (p < 0.0005) in Rev 1-vaccinated (34%) than in RB51-vaccinated rams (74%) or controls (69%) . In conclusion, the RB51 vaccine did not confer protective immunity against B . ovis in rams.

Vaccine, 1995 Feb, 13(2), 191 - 6
Comparison of the efficacy of Brucella suis strain 2 and Brucella melitensis Rev . 1 live vaccines against a Brucella melitensis experimental infection in pregnant ewes; Verger JM et al.; The comparative efficacy of Brucella suis strain 2 (S2) and Brucella melitensis strain Rev . 1 (Rev . 1) live vaccines in protecting sheep against B . melitensis infection was evaluated by clinical and bacteriological examination of ewes vaccinated conjunctivally with a dose of 1 x 10(9) c.f.u . when 4 months old and then challenged with 5 x 10(7) c.f.u . of the B . melitensis virulent strain 53H38 (H38) at the middle of the first or second pregnancy following vaccination . Animals were considered to be protected when no abortion, no excretion of the challenge strain and no infection at slaughter occurred . The percentages of protection in Rev . 1-vaccinated groups challenged during either first (80%) or second (62%) pregnancy were significantly different (p < 0.001 and p < 0.05, respectively) compared with those of the relevant unvaccinated control groups . In contrast no significant difference in protection was found between the S2-vaccinated and control groups.

Indian J Med Sci, 1995 Feb, 49(2), 28 - 31
Myocarditis in enteric fever; Prabha A et al.; 1 . Myocarditis in the course of enteric fever is a common occurrence . In a series of 100 bacteriologically or serologically proved enteric fever, we found 7 cases with clinical evidence of myocarditis and 46 cases with ECG evidence of myocarditis . 2 . Commonest ECG abnormality was Q-Tc prolongation (29%) followed by ST-T changes (20%) bundle branch block (7%) first degree A-V Block (%) and arrhythmia (2%) . 3 . All the ECG changes were transient except bundle branch block which persisted in 3 cases . 4 . Those with other systemic complications had a higher chance of having myocarditis (P < 0.01) . 5 . Autopsy evidence of myocarditis was found in 2 cases . With our results, it is obvious that ECT must be recorded in all cases of enteric fever . Those with ECG changes must be observed carefully for clinical evidence of myocarditis . All these patients must have absolute bed rest . Judicious use of corticosteroids is indicated in selected cases of selected cases of severe myocarditis . Diuretics are indicated in cases with evidence of congestive cardiac failure.

Med Dosw Mikrobiol, 1995, 47(3-4), 119 - 25
{Characterization of bacteriophage nontypable patterns of S . aureus strains}; Cybulski Z et al.; Out of 195 strains of S . aureus isolated from in and outpatients . 43 were proven not to be lysed by the chosen set of bacteriophages . Of these nontypeable strains 14 were isolated from blood cultures and septic wounds of patients from Poznan University Hospital . 29 strains were derived from the anterior nares or throat swabs of outpatients, who were treated for chronic pharyngitis in the children's clinic in Poznan . S . aureus was identified using standard bacteriological method . Sensitivity tests to antibiotics were performed using the ATB computer system (bioMerieux) . Beta lactamase production was examined using the iodometric method . The intracellular esterases of S . aureus were separated by polyacrylamid gel electrophoresis and stained with Fast Blue using alpha-naphtyhl acetate, beta-naphthyl propionate and indoxyl acetate as substrates . A much higher percentage of S . aureus strains isolated from specimens obtained from the hospital patients showed the ability to produce beta-lactamase than the strains cultured from outpatients . The esterase patterns of S . aureus are helpful in differentiating bacteriophage nontypeable strains.

Med Trop (Mars), 1995, 55(4), 363 - 73
{Mycobacterium ulcerans cutaneous infections: Buruli ulcers}; Josse R et al.; Mycobacterium ulcerans skin infection or Buruli ulcers are common in children in many rural tropical areas . The usual clinical appearance is a deep, rapidly developing chronic ulcer associated with necrosis of subcutaneous fat . Patients are usually seen at an advanced stage . Bacteriologic identification is not always possible because the pathogen, Mycobacterium ulcerans, is an atypical mycobacteria that is difficult to isolate and grows slowly in culture . Medium although of little assistance in tropical regions, the histological features are highly characteristic and can allow diagnosis in areas in which the disease is rare and unsuspected . The pathogenic effects of Mycobacterium ulcerans are due to the production of a necrotizing exotoxin with an immunosuppressive action . Treatment using antituberculosis and antileprosy drugs has been disappointing . Surgery is usually required and causes extensive sequels in many cases, the best technique being an excision/graft procedure . Many epidemiologic characteristics of Buruli ulcers which are andemic in regions with and aquatic ecosystem are still unclear including the mode of infection, transmission and reservoir . Recent outbreaks, particularly in west Africa, may be related to changes in the natural environment.

Ann Med Interne (Paris), 1995, 146(7), 496 - 9
{Value of the stool bacteriological test in Mycobacterium avium complex infections in AIDS}; Bevilacqua S et al.; Incidence of Mycobacterium avium complex (MAC) infection has increased in HIV infected patients . We report a retrospective study of 25 cases of MAC infection occurring in HIV patients . Stools examination was performed in 5 (31%) of the patients without digestive symptoms and in the 9 (100%) patients presenting with diarrhoea . The stools culture are positive in 79% of cases (11/14) . In all the patients with diarrhoea, direct examination of the stools gave the diagnosis of MAC infection . All the patients had profound immunodepression with CD4+ cell count < 5/mm3 . The mean survival time from mycobacteriosis diagnosis was 122 +/- 90 days despite antimycobacteriosis therapy.

Folia Parasitol (Praha), 1995, 42(2), 91 - 6
Amoebic gill infection of turbot, Scophthalmus maximus; Dykova I et al.; Amoebae were found to cause severe gill tissue damage in turbot, Scophthalmus maximus L, from a grow-out facility in northwestern Galicia (Spain) . The nature and extent of lesions along with negative results of bacteriological and virological examination made this agent responsible for mortalities in four turbot stocks supplied with water from a single source . We present our findings, although we failed to isolate amoebae, since there was a clear evidence of their primary role in the development of disease condition and occurrence of mortalities . In addition, this is a record both of a new host endangered by amoebae in intensive cultures and pathogenesis of the gill lesions.

Ann Radiol (Paris), 1995, 38(7-8), 408 - 17
{Primary tuberculous infection . Current aspects in imaging . Apropos of 14 cases}; Ouzidane L et al.; Active pulmonary tuberculosis, a source of contamination, is currently undergoing a recrudescence in developed countries, particularly in clinical contexts of immunodepression . The authors report a retrospective series of 14 cases of primary tuberculosis in a paediatric population (7 girls and 7 boys) with a mean age of 3.5 years (range: 4 months-16 years) observed over a 3-year period . After reviewing the current radiological features of patent primary tuberculosis, the authors emphasize the contribution of chest CT scan in latent forms with a normal chest x-ray and a difficult bacteriological diagnosis . Imaging remains an essential tool in early diagnosis, therapeutic management and active surveillance of this form . The authors propose a decisional flow-chart in the case of suspected primary tuberculosis in children.

Vestn Khir Im I I Grek, 1995, 154(3), 17 - 21
{The interpretation of the data from the ultrasonic examination of patients with acute and chronic suppurative lung and pleural diseases}; Tsurupa DI et al.; Observations were made in 104 patients with acute and chronic lung abscesses and pleural empyema . The endoscopic, bacteriological and ultrasonic methods were used to make full diagnosis and to begin treatment . This article describes the part of the work devoted to the ultrasonic diagnostics . Different forms of lung abscesses were revealed and explained . The method was used to differentiate the collection of pus in the lung and pleural cavity, to reveal the structure of pathologic processes and its development, to learn the character of changes in the lungs and pleural space . The method is rather simple and gives the doctor much information about the condition of the pathologic tissue.

Ann Otolaryngol Chir Cervicofac, 1995, 112(8), 393 - 8
{Peritonsillar abscess . Emergency tonsillectomy?}; Marchal F et al.; The treatment of peritonsillar abcess is still controversial: quincy tonsillectomy, also called tonsillectomy "a chaud" (TC) or interval tonsillectomy, also known as tonsillectomy "a froid" (TF), several weeks after incision and drainage . Of 105 patients presenting with peritonsilar abscess, 53 had tonsillectomy: 27 TC and 26 TF . For each group the following variables were analyzed: age, location of abscess, bacteriology, duration of surgery, amount of per-operative bleeding, post-operative hemorrhage and complications, and length of hospital stay . The location of the abscess was posterior in 33%, and therefore difficult to drain without tonsillectomy . Significant differences in favor of TC were found for: 1) the amount of per-operative bleeding; 2) the occurrence of post-operative hemorrhage; and 3) the duration of hospital stay . We conclude that TC is a safe procedure without increased risks, with less complications, and with a reduced cost . When surgery is indicated in the treatment of peritonsillar abcess, we advocate TC . From our results and the litterature a decision tree for the management of peritonsillar abcess is presented.

Arch Inst Pasteur Madagascar, 1995, 62(1), 45 - 51
{National Laboratory for Mycobacterias . Evolution, missions and activities from 1991 to 1994}; Ramarokoto H et al.; The setting up of a new nationwide tuberculosis control programme allowed the creation of a National Mycobacteria Reference Laboratory . This latter originated from the small bacteriology laboratory of the antitubercular dispensary of the Institut d'Hygiene Sociale (IHS) and its activities increased tenfold within three years . Extension of rooms, a more numerous staff and the acquisition of a modern equipment explained those results . However, to carry out the tasks of such a laboratory a rapid modification of structures and a new job distribution facilitated by a cooperation with the Institut Pasteur de Madagascar are necessary.

Arch Inst Pasteur Madagascar, 1995, 62(1), 18 - 23
{Tuberculosis in the prison milieu at Antananarivo from 1990 to 1993}; Auregan G et al.; Within 42 months, from June 1990 to December 1993, 454 cases of tuberculosis have been recorded in the central remand home of Antananarivo . The tubercular prevalence observed was there eight times superior to that of the global population of Madagascar . Among the 360 pulmonary tuberculosis, only one did not have any bacteriological proof; among the 94 extrapulmonary tuberculosis, 37 have been proved by histology or bacteriology . Among the extrapulmonary tuberculosis, pleurisies were obviously preeminent (79/94) . Association of tubercular localizations could be observed with 21% of the patients . New cases of smear-positive pulmonary tuberculosis (PMT+) represented 81% of all the PMT+, recurrences were 9% and revivals 10% . Since February 1991, the 8 months short course regimen was the standard applied; before, the lack of stock did not allowed any standardization . The PMT+ new cases recovery rate increased from 42.5% in 1990 to 74% in 1993, whereas lethality decreased from 23% in 1990 to 8% in 1993 . Patient dropouts were noted only with released or escaped individuals . Treatment failure rate was 4% . The diminution of cases despite the constancy of prisoners number and the carrying out of activities by the same health team make questionable the explanatory factors of the burst of tuberculosis-diseases in a prison milieu . Because of the importance of prison tubercular foci in terms of public health and the satisfactory results obtained, the Programme proposes to apply the model of partnership developed between the Tonga soa NGO and the prison administration to other prisons in Madagascar.

Acta Gastroenterol Latinoam, 1995, 25(3), 153 - 61
{Colonic ulcer in HIV (+) patients}; Varsky C et al.; A characteristic rectocolonic endoscopic finding is the presence of ulcers, which may correspond to different diagnosis . Between January, 1989 and May, 1993, we performed 28 colonoscopies and 12 rectoscopies in patients with HIV (+) . In all cases, histologic, parasitologic, bacteriologic, virologic, and micrologic studies were practised on tissue biopsies . Eighteen of them presented rectocolonic ulcers (we are not including anal and terminal ileum ulcers) . The studies involved 16 males and 2 females, with an average age of 31, 21 years old (20-47), 14 of which were male homosexuals, 2 intravenous drug abusers, 1 hemophilic and an heterosexual female . Symptoms were as follows: 15 with hematochezia, 7 with proctorrhagia, 6 with enterorrhagia and 2 with both manifestations . All the rest, presented chronic diarrhea, loss of weight, anal secretion, asthenia, fever, constipation and anemia in isolated cases . Diagnosis were 6 rectocolonic cytomegalovirus (all occurred during the current year) . Other related opportunistic pathogens included an intestinal TBC, a rectal Herpes and a Burkitt's lymphoma . Related etiological agents were not found in 9 patients, in spite of systematic quest . Opportunistics found in three of the cases revealed AIDS in those patients . COMMENTS: 1-The indexes of male homosexuals are strikingly higher than the rest of our HIV endoscopy statistics . 2-We observed prevailing idiopathic lesions . 3-The relationship between "CU like" pictures, already described, and the immunocomponents of the idiopathic CU is unknown . 4-All our CMV cases are recent . 5-Hematochezia was the most frequent symptom . 6- Herpetic ulcers correspond to HSV type 1 . 7-Diffuse ulcers may correspond to lymphoma.

Scand J Infect Dis, 1995, 27(5), 463 - 8
Ampicillin plus mecillinam vs . cefotaxime/cefadroxil treatment of patients with severe pneumonia or pyelonephritis: a double-blind multicentre study evaluated by intention-to-treat analysis; Cronberg S et al.; In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil . In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone . When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil . In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups) . The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group . Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis . Of 136 patients with pyelonephritis, 63% were cured in each group . The main reason for failure was bacteriological relapse . Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group . Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.

Ann Fr Anesth Reanim, 1995, 14(4), 320 - 5
{Aseptic meningitis . Demonstration of bacterial DNA in cerebrospinal fluid by gene amplification}; Salord F et al.; OBJECTIVE: To develop a diagnostic tool to recognize whether a postoperative meningitis occurring in neurosurgical patients is of bacteriological origin or not, in detecting in CSF bacterial DNA with the polymerase chain reaction (PCR) technique . STUDY DESIGN: Laboratory study . PATIENTS: Twenty-seven neurosurgical ICU patients associating, in the postoperative period, the CDC criteria of meningitis and a neutrophil polymorphonuclear count over 100 cells.mm-3 were allocated either into the MB+ group (n = 7) when their CSF culture was positive or in the MB- group (n = 20) when the culture was sterile . The CSF of 43 neurosurgical ICU patients without postoperative clinical and biological features of meningitis acted as controls . Sixteen specimens out of the 43 were inoculated with bacteria at a known concentration . METHODS: The CSF specimens of all patients were tested for the presence of eurcaryote DNA using the PCR technique . Beforehand its sensitivity had been assessed using the inoculated CSF of control group: a positive amplification at 20 cycles was equivalent to 10(5) CFU.mL-1 and a positive amplification at 25 cycles to 10(3) CFU.mL-1 . RESULTS: In the 43 sterile control CSF specimens the amplification was negative in all at 20 cycles and in 42 at 25 cycles . In the 16 previously sterile control specimens supplemented with bacteria, as well as in the CSF of all 7 patients of MB+ group the amplification was positive at 20 and 25 cycles . In those of MB- group the amplification was negative in all at 20 cycles, but was positive in 19 out of 20 at 25 cycles . Southern blot with specific procaryote probes was positive with amplification products from CSF of MB+ and MB- groups and negative with control CSFs and human DNA . DISCUSSION: The presence of bacteria in CSF of patients sustaining a meningitis can be accurately detected through their DNA . Postoperative aseptic meningitides may have a bacterial origin . PCR can be used as a routine technique to provide a diagnosis of bacterial meningitis in less than 6 hours . Additionally specific oligonucleotides allow to identify the bacteria in less than 12 hours.

Acta Orthop Belg, 1995, 61(4), 331 - 6
Skin closure in hip surgery: subcuticular versus transdermal . A prospective randomized study; Sakka SA et al.; A randomized parallel-group clinical trial was conducted between March 1991 and December 1993 to compare the effectiveness of subcuticular suture using absorbable material (Dexon) and continuous transdermal blanket suture using nonabsorbable material (silk) in hip surgery . Eighty patients (48 females and 32 males) aged between 19 and 94 years (average 71.4 years) who underwent 97 hip operations were studied . Patients were followed up between 2 and 20 months . The two groups were evaluated with respect to infection rate, patient satisfaction with the scar, extra time and cost in removal of suture and the cosmetic appearance assessed by a plastic surgeon evaluating photos of patients' wounds using a specific scoring method without knowledge of the suturing method used . Five patients died during the study . There was no significant difference in superficial infection rate between the two groups (5% with positive bacteriological swab and 16% requiring extra antibiotics on clinical grounds) . No deep infection was suspected in either group . The average score of patient satisfaction with the scar was 9.6/10 in the subcuticular group and 8.68/10 in the continuous mattress with a significant difference between the two groups (p < 0.05) . Cosmetic evaluation by the plastic surgeon using a 6-category scoring system showed a better cosmetic result in the subcuticular group with a significant difference (p < 0.01) . An average of 17 minutes of extra nursing time was needed for removal of suture material in the nonabsorbable group in addition to the cost of the suture removal set . We conclude that absorbable subcuticular skin closure is an effective method and offers some advantages over the traditional transdermal suturing method in hip surgery.

Med Trop (Mars), 1995, 55(3), 252 - 4
{Autopsy findings in 70 AIDS patients who died in a department of pneumology in Ivory Coast: impact of tuberculosis}; Domoua K et al.; Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast . the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease . in this population . Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%) . In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia . In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement . In 17 cases (54.8%) involvement of more than two organs was observed . Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys . Histologic features were remarkable by the absence of typical tuberculous granulomas . The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.

Hist Philos Life Sci, 1995, 17(1), 81 - 90
Between bacteriology and virology: the development of typhus vaccines between the First and Second World Wars; Weindling P; This paper provides an overview of the development of typhus vaccines between the first and second world wars . It is shown that there was a shift in the classification of the causal Rickettsiae from being classed as bacteria to being conceptualised as a type of virus . This 'paradigm switch' stimulated interest in the possibility of producing an effective medicine.

Gynecol Obstet Invest, 1995, 40(3), 183 - 9
Low birth weight and genital infections . An incident case-referent study; Bique Osman N et al.; In an attempt to elucidate the potential association between genital infections and low birth weight (LBW) births, 51 women with LBW neonates were identified and compared to 51 women with normal birthweight (NBW) neonates . Both groups were matched according to age and parity . All women were subjected to interviews regarding socioeconomic background and obstetric history . The were examined clinical and tested regarding serum haemoglobin, malaria parasitaemia, syphilis and HIV serology . Cultures were taken from the vagina, endocervix, amniotic fluid and from various sites of newborn, including the conjunctivae and the stomach and from the interior of the placenta . Whilst socioeconomic background factors did not differ among cases and referents, previous neonatal death did . Significant differences were also found in mid-upper-arm circumference (OR 3.08) and body mass index (OR 6.00) . The prevalence of alleged risk factors according to the antenatal card was similar among cases and referents . Birthweight < 2,000 g was significantly more often associated with chorioamnionitis than birthweight between 2,000 and 2,499 g (OR 5.46) . Bacteriological findings did not show significant differences in cases and referents . Haemoglobin values and prevalence of malaria parasitaemia were similar as was the neonatal mortality . It is concluded that LBW births is difficult to predict by use of alleged risk factors in existing antenatal cards.

Ann Dermatol Venereol, 1995, 122(4), 206 - 12
{Value of molecular biology methods for diagnosis in bacteriology}; Piemont Y et al.; Progress in molecular biology has led to the development of new tools for bacteriological diagnosis . Sporadic genes coding for virulence factors can be detected with highly specific genetic probes applied to cultured bacteria . Such genetic probes can also be used to specifically identified cultured bacteria whose general taxonomic classification is known . Another advantage of molecular genetics is the possibility that the cell culture step may not be needed, bacteria being identified directly in the sample specimen . Such techniques are particularly interesting to identify bacteria which are difficult to culture (for example: Borrelia burgdorferi, Chlamydia trachomatis) or which grow slowly (mycobacteria) . The bacterial DNA must be isolated and amplified with an enzyme reaction . This is a critical step in the method: several positive and negative controls are required . When performed under optimal conditions, amplification techniques are excellent methods which can offer results similar to culture methods in culturable bacteria . Finally, molecular biology can be used to identify previously cultured bacteria for which there is no taxonomic orientation . Here the ribosome 165 DNA must be amplified and sequenced . The sequence is then compared with a data bank allowing classification . One could image future techniques applied to certain pathology samples for the detection and identification of bacteria without need for a culture step . However, direct microscope examination and bacterial culture remain the basic methods for bacteriologic diagnosis, the advantages and disadvantages of molecular biology leading to its use a complementary method for improving the quality of the diagnosis.

Rev Med Interne, 1995, 16(10), 771 - 4
{Adrenal histoplasmosis in a non-insulin-dependent diabetic patient}; Sert C et al.; Adrenal histoplasmosis is a rare infection that can be misdiagnosed as tuberculosis . We present here a case of adrenal histoplasmosis in a 65 year-old male diabetic with marked weight loss . Laboratory investigations noticed an inflammatory syndrome and the abdominal computed tomography scanner reported an heterogenous left adrenal mass of 6 cm in diameter . Hormonal as well as bacteriological studies were negative . The patient was operated and the histopathological examination proved that the mass was a tuberculoma and an anti-tuberculous treatment was started . Four months later, the patient suffered from recurrence of symptoms and laboratory investigations confirmed the inflammatory syndrome and the abdominal computed tomography scanner showed a right adrenal mass . A surgical biopsy was performed and specific fungal researches proved that the lesion was due to Histoplasma capsulatum . The patient experienced a remarkable improvement under anti-fungal treatment.

Przegl Lek, 1995, 52(7), 338 - 43
{Interpretation of diagnostic data exemplified by tests for identification of Helicobacter pylori in gastric mucosa}; Dabrowiecki S et al.; Seven diagnostic tests were employed to detect the infection of gastric mucosa with the H . pylori bacteria, among patients with epigastric pain and dyspeptic complains . The tests' results were compared to the bacteriologic culture . For each test the following criteria were taken into consideration: sensitivity, specificity, positive and negative predictive values . The tests' accuracy was compared with the agreement expected by chance and beyond chance (kappa) . For each test the likelihood ratio was calculated for its positive and negative results . The construction of so called diagnostic decision tree was presented, which allows on the evaluation of the diagnostic test and its utility . The best result were obtained from the test, in which the identification of bacteria took place in the histopathologic specimen after its Gram staining . The interpretation of clinical significance of diagnostic data is simplified with the use of likelihood ratio calculated for a positive test result.

Med Dosw Mikrobiol, 1995, 47(1-2), 11 - 6
{Diagnostic value of the latex test (Pyloriset) for detection of Helicobacter pylori antibodies in adult patients with upper digestive tract diseases}; Zaremba M et al.; The biopsy specimens and sera from 269 adult patients referred for gastroscopy were examined for Helicobacter pylori infections . The bacteriologic studies included: Gram smears, urease test and culture methods of biopsy specimens, biochemical tests for identification of isolates and their sensitivity testing to 17 chemotherapeutics . The biopsy specimens were examined histopathologically also . For demonstration of specific antibodies the latex test (Pyloriset, Orion Diagnostica, Finland) was used . Biopsy--cultures were positive for H . pylori in 171 (63.6%) cases, biopsy--urease test in 149 (55.4%) and Gram smears in 163 (62.8%) . A total of 193 (71.7%) positive sera with latex were found . The sensitivity and specificity of the latex test as compared with the culture method, biopsy--urease test and Gram smears was 80.7% and 43.9%, 80.5% and 39.2% or 79.8% and 40.6% respectively . All three direct diagnostic methods were positive in 122 (45.4%) patients, 101 (82.8%) of them were positive with the latex test . Only in 33 (19.3%) patients with positive biopsy--culture for H . pylori anti-H . pylori antibodies were not observed . On the other hand, among 75 patients with negative all direct methods for H . pylori infections 39 (52.0%) of them were positive with the latex test . The latex test was also positive in 56 (54.9%) sera among 102 blood donor tested by us but this value was lower, in trems of statistical significance than in patient sera . In conclusion, the latex test may be useful as a screening serological test for the diagnosis of patients with H . pylori infections and for epidemiological studies.

Rev Mal Respir, 1995, 12(1), 5 - 11
{Post-lung transplantation bronchiolitis obliterans}; Fournier M et al.; Bronchiolitis obliterans is an anatomical lesion with multiple aetiologies . In the lung transplant patient the pure forms of bronchiolitis obliterans are probably the consequence of a process of chronic rejection; in fact necropsy tissue or lungs removed which have been transplanted show that the lesions of bronchiolitis obliterans are often associated with parenchymal disorders, vascular and proximal bronchial disease, which are sequelae of phenomena of rejection or infection . The effect of bronchiolitis obliterans on lung function is constant; this may appear progressively or in stages . Increasing immunosuppressive treatment may arrest the progress . This rarely occurs and the development of respiratory failure tends to be the rule . It is exceptional to achieve the diagnosis of bronchiolitis obliterans from the examination of a transbronchial biopsy . It is a combination of features, both clinical and respiratory function, negative bacteriology and virological investigations as well as the absence of any efficacy of conventional treatment for rejection which leads to the diagnosis . In certain cases the question of a pulmonary re-transplantation is raised.

Rev Mal Respir, 1995, 12(1), 13 - 23
{Respiratory toxicity due to atmospheric pollutants . General review and a study of the relation to respiratory infections}; Leduc D et al.; The main primary pollutants released into the atmosphere are sulfur dioxide (SO2), nitrogen monoxide and dioxide (NOx), particulate dust and in a less important part carbon monoxide (CO), hydrocarbons and heavy metals (Pb, Cd) . Sulfur and nitrogen oxides are released from combustion of coals and fuels . Sulfates, nitrates and ozone are secondary pollutants resulting from chemical reactions within the atmosphere . While governmental directives limiting emissions have decreased SO2 and particulate matter levels, air quality in urban regions has improved in the last two decades . The role of air pollution as a risk factor for respiratory infections is difficult to address . Animal experiments demonstrate that air pollutants decrease the efficacy of lung defense mechanisms and increase the sensibility to respiratory infections . Nevertheless, because of difference in sensitivity between animal species and between exposure conditions, these effects are difficult to extrapolate to humans . Moreover, it is obvious that direct exposure studies of the sensibility of humans to respiratory infections are rare for ethical reasons . Epidemiological data addressing the role of air pollutants at usual levels can only suggest that some pollutants (SO2, suspended particulates) constitute a risk factor for respiratory infections . Since most of these studies do not include bacteriologic and virologic confirmation, it is unclear whether this respiratory morbidity is due to respiratory irritation or infection . In conclusion, we think that high concentrations of air pollutants are very likely to increase sensibility to respiratory infections in humans . There are however no sufficient data to clearly establish whether air pollution constitutes a risk factor for respiratory infections at usual ambient concentrations.

Gynecol Obstet Invest, 1995, 39(1), 54 - 9
Immune response characteristics in women with chlamydial genital tract infection; Cunningham DS; Immune responses in women with chlamydial genital tract infection who achieved a bacteriologic cure were prospectively compared to those women who had an incomplete clinical response . Local anti-chlamydia IgA antibody responses were significantly diminished in the outpatient treatment group who had an incomplete response, while circulating IgG responses did not differ significantly between groups . This is in contrast to both specific and non-specific lymphoproliferative responses which were similar between uninfected controls and women with a chlamydial genital tract infection, regardless of treatment outcome . Thus, the kinetics of successful outpatient treatment of chlamydial genital tract infections may have an immunologic component which can be measured at the time of initial evaluation, and may be predictive of the clinical response to adjunctive antibiotics.

Kekkaku, 1995 Jan, 70(1), 67 - 72
{The examination of tuberculosis contacts: the current situations and perspective in Japan}; Ahiko T; Contacts of active tuberculosis cases are the most easily identified high-risk group for tuberculosis in Japan . Thus, examination of the contacts is one of the most useful methods for finding persons with disease or with infection . The purpose of this study is to analyze recent problems in the examination . Program assessment and evaluation for the contact examination were administered by a mail questionnaire to 74 Health Centers (HCs) in Tohoku District . The response rate was 100% . The Service Report of Activities of HCs (1992) was also utilized as the basic data for estimating statistical indices concerning contact examination . Results obtained are as follows: 1 . At a rough estimate, the number of persons who underwent the contact examination accounted for 1.6 per newly diagnosed cases with tuberculosis in Japan . This index remarkably varied according to the region, e.g., maximum was 6.6 in Okinawa and minimum was 0.9 in Yamaguchi . The contacts had a high incidence rate (0.65%) with active tuberculosis . This rate was twenty-five times higher than that by periodic mass X-ray examinations . 2 . In Tohoku District, only 17 HCs (23%) carried out the examination fitting "guidelines" that had been published by the Ministry of Health and Welfare . Results from the program assessment suggested that HCs should give priority of the examination to the contacts because they were risky . The risk of manifestation is mainly influenced by bacteriological severity of source cases . 3 . Main planners of the examination were public health nurses.(ABSTRACT TRUNCATED AT 250 WORDS)

Kekkaku, 1995 Jan, 70(1), 17 - 23
{Shortening of hospitalization period for patients with pulmonary tuberculosis}; Suzuki A et al.; The development of specific chemotherapeutic agents revolutionally improved the prognosis of tuberculosis and markedly shortened the duration of the treatment . Evidence of successful treatment with short-course regimens for pulmonary tuberculosis has been accumulated . But, the duration of hospitalization tends to be determined empirically and varys among hospitals and clinicians . Generally speaking, the duration of hospitalization is longer in Japan than in the United States and Europian countries . We investigated retrospectively the duration of hospitalization, treatment period, and recurrence rate of the disease for patients with pulmonary tuberculosis who admitted to the Tokyo Metropolitan Fuchu Hospital in the years 1984, 1988, and 1991 . Patients who had been previously treated for more than 2 weeks and/or, had severe complications, such as malignancy and miliary tuberculosis were excluded from the study . Cases who died during the hospitalization and discharged without permission were also excluded . Numbers of subjects in each year were 114, 114, and 115 in 1984, 1988, and 1991, respectively . A total of 343 patients (M: 254, F: 89) were enrolled to the study and their average age was 49.4 yr old . A number of patients with both smear and culture positive in sputum bacteriology was 210 (61.2%), and 42 cases (12.2%) were smear negative and culture positive . The results are as follows: (1) Mean duration of hospitalization in the years 1984, 1988, and 1991 were 141, 102, and 72 days, respectively . That is, a mean hospitalization period was shortened to about half during these seven years . (2) According to the chest x-ray classification (Group A: I, II3, B: II1, II2, III3, C: III1, III2), mean durations of hospitalization were 186 days for group A, 143 days for group B, and 108 days for group C in 1984, and 96 days, 76 days, and 59 days in 1991, respectively . (3) According to sputum bacteriology, mean durations of hospitalization were 169 days for (S+/C+) cases, 105 days for (S-/C+) cases, and 90 days for (S-/C-) cases in 1984, and 83 days, 67 days, and 41 days in 1991, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Rev Med Interne, 1995, 16(1), 63 - 6
{Necrotizing hepatic granuloma of brucellosis origin . Apropos of a case}; Debat-Zoguereh D et al.; The authors report on a case of febrile necrotizing brucellosis hepatic granulomatosis in a patient living in brucellosis endemia areas . This hepatic localization of brucellosis is rare: to our knowledge only 28 cases have been described in the literature . The bacteriological diagnosis was not established by blood or abscess pus cultures, but by Brucella serology only . Surgery completed by biantibiotherapy have permitted a complete recovery.

Kyobu Geka, 1995 Jan, 48(1), 67 - 9
{Surgical treatment of infective endocarditis: application of DNA probe method}; Mizuno A et al.; DNA probe method is a new bacteriological method for diagnosis of bacteria . The authors tried to apply the method to diagnosis of bacteremia and treatment of infective endocarditis . We could diagnose the patient's illness as bacteremia with this method even when blood cultures are not positive . We suggest that cardiac surgery should be performed in case bacteria is detected repeatedly with DNA probe method . Therefore it is useful for decision whether cardiac surgery for patients with active infective endocarditis should be done or not.

Int J Syst Bacteriol, 1995 Jan, 45(1), 186 - 7
Taxonomic note: implementation of the provisional status Candidatus for incompletely described procaryotes; Murray RG et al.; The International Committee on Systematic Bacteriology recommended that the category Candidatus, recently proposed by Murray and Schleifer (Int . J . Syst . Bacteriol . 44:174-176, 1994) to record the properties of putative taxa of procaryotes, should be implemented . This category should be used for describing procaryotic entities for which more than a mere sequence is available but for which characteristics required for description according to the International Code of Nomenclature of Bacteria are lacking . In addition to genomic information, such as sequences apt to determine the phylogenetic position of the organism, all information, including structural, metabolic, and reproductive features, should be included in the description of a provisional taxon, together with the natural environment in which the organism can be identified by in situ hybridization or other similar techniques for cell identification.

Ther Umsch, 1995 Jan, 52(1), 75 - 81
{Infections of the hand}; Troeger H; The possibilities of hand injuries lead to the higher incidence of hand infections . The clinical signs of inflammation (pain, swelling, heat, loss of function and red colour) are found in near all cases . The start of pain and its localisation help to find quickly the layer of the inflammatory process . Bites, foreign bodies, puncture wounds and open wounds especially those acquired in slaughterhouse or agriculture are in most cases the predisposing conditions . Treatment of hand infections demands a consequent protocol consisting in: exact diagnostics including clinical picture, laboratory investigation, bacteriology and in some cases X-ray-examination; operative treatment including incision, irrigation, drainage, excision of necrosis and foreign bodies under the rules of hand surgery (i.g . blood--{without exsanguination} and painfree operation field, magnifying lenses, correct incision avoiding scar contractures); immobilisation (dressing or splinting) in intrinsic-plus-position while acute inflammation is going on, early movement combined with ergotherapy and physiotherapy after this . Use of antibiotics is indicated in septic cases or in cases of complications (sepsis, lymphangitis, osteomyelitis) in concordance with bacteriology but it cannot compensate mistakes in treatment . The most common infections are placed around and under nail (paronychia) and in the subcutaneous space of the distal phalanx (felon) . They are treated by incision and spontaneous drainage . More severe are infections of tendon sheath, joint, web space and deep palmar space . If pus is present in such cases there is no place for conservative treatment but operative treatment under clinical conditions is imperative.

J Comput Assist Tomogr, 1995 Jan-Feb, 19(1), 52 - 5
Pulmonary nocardiosis: CT findings; Yoon HK et al.; OBJECTIVE: To evaluate CT findings of pulmonary nocardiosis in immunocompromised patients . MATERIALS ALND METHODS: Five patients with bacteriologically confirmed pulmonary nocardiosis were evaluated . Four patients were receiving corticosteroids with or without other immunosuppressive drugs for lupus nephritis (two patients), idiopathic thrombocytopenic purpura (one patient), and renal transplantation (one patient), and one patient had long-standing diabetes . Nocardia asteroides was isolated from blood culture, bronchial washing, pleuropulmonary aspirates, or open lung biopsy . Plain chest radiography and CT were performed on all patients, and follow-up CT was performed on one patient . RESULTS: On CT there were pleural effusion (four patients), air-space consolidation with internal low attenuation with or without cavities (four patients), multiple noncavitating pulmonary nodules and subpleural pulmonary nodules (three patients), and chest wall extension (three patients) . Follow-up CT after treatment showed marked improvement of the pleural and pulmonary lesions . CONCLUSION: In the immunocompromised and chronically debilitated host, pulmonary nocardiosis should be included in differential diagnosis if chest CT shows consolidation with low attenuation areas with or without cavitation, multiple pulmonary nodules, pleural effusion, and chest wall extension.

J Nutr, 1995 Jan, 125(1), 92 - 8
Production of large amounts of {13C}leucine-enriched milk proteins by lactating cows; Boirie Y et al.; During protein metabolism kinetic studies, oral tracers are administered as labeled free amino acids and do not necessarily represent the metabolic fate of amino acids ingested as proteins . However, sufficient quantities of 13C-labeled proteins are not currently available . We here present a new methodology for producing large amounts of milk proteins intrinsically labeled with {13C}leucine . After surgical preparation, two lactating cows were infused with 80-90 g of L-{1-13C}leucine for 24-32 h, and milk was collected during and after the infusion . Casein and whey protein fractions were purified by membrane separation techniques . Arteriovenous balance across the udder indicated a very efficient extraction of leucine by the mammary gland . Five batches of pure casein and whey proteins, totaling 3854 g of protein of excellent bacteriological quality, were obtained . Two thirds of these proteins had {13C}leucine enrichments ranging from 10.5 to 19.4% ({13C}leucine atom percent excess) . The overall tracer recoveries were 22 and 27% (cows 1 and 2, respectively) . Thus, pure milk proteins were produced in large amounts with sufficient 13C enrichment to be used in human protein metabolism studies.

Cancer Chemother Pharmacol, 1995, 35(3), 225 - 9
Treatment of advanced hormone-refractory prostate carcinoma with a combination of etoposide, pirarubicin and cisplatin; Naito S et al.; A total of 20 patients with hormone-refractory prostate carcinoma entered a pilot study of combination chemotherapy based on the EAP (etoposide, Adriamycin and cisplatin) regimen, in which Adriamycin was replaced by pirarubicin, a less cardiotoxic derivative of Adriamycin . The response was assessed by criteria modified from those of the National Prostatic Cancer Project: prostate-specific antigen was employed instead of acid phosphatase . Of 18 evaluable patients, 6 achieved a partial response, 5 had stable disease, and in 7 the disease had progressed during therapy; thus, the overall response rate was 33.3% {95% confidence interval (CI) 11.5-55.1%} . Significant pain alleviation and performance status improvement were obtained in 5 of 12 patients (41.7%; CI 13.8-69.6%) and 3 of 13 patients (23.1%; CI 0.2-46.0%), respectively . Although myelosuppression was moderate to severe, no chemotherapy-related deaths or bacteriologically documented sepsis occurred; nor was there any clinical cardiotoxicity . All the responding patients received maintenance chemotherapy with etoposide thereafter . At present, the median duration of response is 33 weeks (range: 23-91 weeks) and the median survival period for all patients is 42 weeks (range: 27(+)-136 weeks), with 12 deaths . In spite of the small number of patients treated, these results suggest that this chemotherapy regimen is active in advanced hormone-refractory prostate carcinoma.

Arch Surg, 1995 Jan, 130(1), 20 - 3
Postoperative T-tube cholangiography: is routine antibiotic prophylaxis necessary? A prospective, controlled study; Sheen-Chen SM et al.; OBJECTIVE: To determine the value of antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography . DESIGN: A prospective, controlled study . SETTING: A tertiary care center . STUDY PARTICIPANTS: The role of antibiotic prophylaxis during postoperative T-tube cholangiography was prospectively evaluated in 164 patients . INTERVENTION: Sixty-two patients were administered antibiotic prophylaxis treatment (1 g of cephalothin sodium was infused intravenously 30 minutes before the procedure and 500 mg of cephalexin was given orally every 6 hours for 3 days after the procedure) . Seventy-one patients were in the control group and did not receive antibiotic therapy . MAIN OUTCOME MEASURES: Complications and adverse reactions following postoperative T-tube cholangiography were recorded and compared between the two groups . RESULTS: There was no significant difference between the groups in regard to age, sex, serum amylase level before T-tube cholangiography, white blood cell count, and liver function . The results of the bacteriologic culture specimens of the bile were also comparable between the groups . One patient who had received antibiotic therapy and one patient in the control group had fever (temperature, > 38 degrees C) and chills after the procedure . Two patients who had received antibiotic therapy and one patient in the control group had mild abdominal pain . These complications were treated conservatively without any event . No significant difference was found in the rates of complications and the success of postoperative T-tube cholangiography between the groups . CONCLUSION: Routine antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography is not necessary under selected conditions.

Bull Soc Pathol Exot, 1995, 88(1), 7 - 10
{Extra-pulmonary tuberculosis and dissemination in patients infected by the human immunodeficiency virus in Bujumbura (Burundi)}; Fagard C et al.; Scattered and extra pulmonary tuberculosis patients coinfected with HIV represent in Bujumbura (Burundi) more than 56% of tuberculosis cases . The high prevalence of these forms could be explained partly by the hospital recruitment, therefore by patients already strongly immunocompromised . Performing further examinations as abdominal echography, ganglionic biopsy (or firstly a puncture sucking procedure) permit to reveal multifocal affections . These examinations provide valuable diagnostic arguments specially among the negative bacteriological forms.

Stomatologiia (Mosk), 1995, 74(1), 38 - 40
{The use of immunoenzyme analysis for the diagnosis of an anaerobic infection of the maxillofacial area}; Tsarev VN et al.; Solid-phase EIA was used to titer antibodies to polysaccharide and ultrasonic disintegrate antigens of the most incident agents of anaerobic infections of the maxillofacial area . Comparison of the results of EIA with polysaccharide antigens of B.melaninogenicus, B.asaccharolyticus, F.nucleatum, P.intermedius, and Str.sanguis and the results of bacteriological detection of these bacteria in a closed pyoinflammatory focus in 283 patients with maxillofacial abscesses and phlegmons brought the authors to a conclusion that the suggested EIA technique may be used to prove the contribution of these bacteria to the development of an inflammatory process in a patient . Data are presented on the frequency of detection of a diagnostically significant level of antibodies in patients with positive results of bacteriological investigation.

Ter Arkh, 1995, 67(3), 7 - 11
{Rovamycin (spiramycin)--a macrolide antibiotic for intravenous administration: a trial in the treatment of pneumonia}; Strachunskii LS et al.; An open non-comparative study of rovamycin (spiramycin produced by Rhone-Poulenc Rorer) for intravenous administration was performed to evaluate its clinical and bacteriological efficacy, safety and tolerance . Thirty patients (adults aged 16-65 years) with community-acquired pneumonia were involved into the study . Two patients were dropped out because of adverse events . Dosage regimen was 1,500,000 I.U . three times a day (intravenous infusion) . The treatment was continued after partial recovery (3,000,000 I.U . per os) . Spiramycin showed a high clinical efficacy . Approximately half of the patients (41.4-55.6%) had positive clinical trends by third day of spiramycin treatment . The overall clinical efficacy by the completion of the drug administration reached 90.0% . Bacteriological activity was observed in 93.4% of the patients treated . Adverse events were observed in 6 (20.0%) patients, including 2 dropouts . Serious side effects were not registered . As rovamycin showed high clinical efficacy and good safety the drug may be recommended for the treatment of adult pneumonia.

Wien Klin Wochenschr, 1995, 107(7), 219 - 24
{Coexistence of infection of the oral cavity and stomach and duodenal mucosa with Helicobacter pylori in patients with ulcer and chronic gastritis}; Kopaanski Z et al.; In a group of 260 patients with a peptic ulcer of the stomach or the duodenum and/or chronic gastritis, bacteriological tests were conducted aiming at the detection of Helicobacter pylori in the mucosa of the stomach and the duodenum and in the gingival pockets . The presence of the infection of the mucosa of the stomach and/or of the duodenum was confirmed in 197 patients (75.8%) . In this group of patients the bacteria occurred simultaneously in the oral cavity in 77 (39.1%) patients . It was found that the frequency of coexistence of Helicobacter pylori infection in the gingival pockets with an infected gastric or duodenal ulcer was not statistically significant . However, there was a statistically significant correlation between the frequency of Helicobacter pylori infection in the oral cavity (83.3%) and the simultaneous occurrence of extensive infection of the gastric mucosa.

J Infect, 1995 Jan, 30(1), 37 - 40
Factors determining ethnic differences in the incidence of bacteriologically confirmed genitourinary tuberculosis in south east England; Grange JM et al.; In South East England, genitourinary (GU) tuberculosis is a much less common manifestation of non-respiratory tuberculosis in patients of Indian subcontinent (ISC) ethnic origin than in those of European ethnic origin . When considered in relation to all bacteriologically confirmed cases of tuberculosis, both respiratory and non-respiratory, the ethnic difference in the occurrence of GU tuberculosis is much less evident, while there is a highly significant excess of other forms of non-respiratory tuberculosis among the ethnic ISC patients . Unlike other forms of non-respiratory tuberculosis, GU disease tends to occur in an older age range in the ethnic ISC population and, when stratified for age, the ethnic difference in the occurrence of this form of tuberculosis is not significant while that of lymph node tuberculosis remains significantly high . Thus, after elimination of the confounding factor of age, the occurrence of GU tuberculosis is very similar in the two ethnic groups while other forms of non-respiratory tuberculosis differ considerably.

Acta Otorrinolaringol Esp, 1995 Jan-Feb, 46(1), 15 - 8
{Efficacy of topical ciprofloxacin in the treatment of chronic otorrhea}; Povedano Rodriguez V et al.; The aim of the present study was to assess the clinical and bacteriological efficacy of ciprofloxacin in the treatment of chronic otitis media . Ciprofloxacin was randomly administered for ten days to two groups of patients . Group A was given 500 mg . orally twice a day . Group B received drops of ciprofloxacin in saline solution locally twice a day . We obtained a favorable clinical and bacteriological response . Bacteriological response observed in group B was statistically higher than that of group A (p < 0.01) . Results obtained in this study suggest that ciprofloxacin locally administered is very effective in the treatment of chronic otitis media.

Vestn Otorinolaringol, 1995 Jan-Feb, (1), 12 - 4
{Suppurative otitis media, bacteriologic study and therapeutic management}; Sako B; The patients of the ENT clinic at the Gabriel Ture hospital (Bomako, Mali) suffering from otitis media purulenta (96 patients under 70) were examined for pathogenetic agents in their purulent exudate . The infection was found in 96.9% of the samples . Monoflora dominated in 74%, mixed flora in 26% of the examinees . The patients received antibiotics . The antibioticograms proved high effectiveness of gentamycin, colistin, sisomicin and cefatoxin in the treatment of acute and chronic otitis media purulenta.

Adv Pediatr Infect Dis, 1995, 10, 1 - 39
Atypical pneumonias in children; Hammerschlag MR; The major agents responsible for atypical pneumonia in children include a wide variety of organisms, one Mycoplasma species, two Chlamydia species, a rickettsia, and one fastidious bacterium . Mycoplasma pneumoniae and C . pneumoniae together may be responsible for over 40% of these infections . Recognition of the role that these agents play in pneumonia is important since many of the diagnostic methods used to detect these organisms are not available in most hospital microbiology laboratories . If you don't look, you won't find . Epidemiologic factors can provide valuable clues, especially with the less frequently encountered infections, since it is almost impossible to make a clinical diagnosis on which to base treatment . A reliable history of avian exposure should suggest psittacosis, exposure to sheep or pregnant cats suggests Q fever, and children with underlying malignancy or immunodeficiency or those receiving systemic steroids may have legionnaires' disease . None of these organisms are susceptible to beta-lactam antibiotics . Sometimes the diagnosis is not considered until after the child has failed to respond to a penicillin or a cephalosporin and routine bacteriology is negative . In view of the role played by M . pneumoniae and C . pneumoniae, a macrolide may be the first-line antibiotic for atypical pneumonia in children.

Vet Med (Praha), 1995, 40(1), 7 - 10
{Association between BoLA antigens and bovine mastitis}; Simon M et al.; The association between BoLA class I antigens and mastitis was studied in Bohemian Pied breed (n = 17) and its crosses--Bohemian Pied x Red Pied Holstein (n = 161), Bohemian Pied x Red Pied Holstein x Ayrshire (37) . The diagnostics of mastitis was followed in the course of two years and two diagnostic parameters were included: 1 . a modified California Mastitis Test (CMT) was performed once a month; 2 . a bacteriological infection was examined once quarterly using biochemical and serological methods . BoLA class I antigens were determined by specific antisera in the standard microlymphocytotoxicity test . During testing the majority of cows had at least one positive reaction of CMT test . The bacterial findings were detected in 31.63% of animals . The antigen A16 was found to be significantly associated with susceptibility to mastitis in both diagnostic tests . Animals A16 positive showed the highest CMT values and repeated bacterial infections (Fig . 1) . The high values observed in A2 positive animals were not significant due to the very low frequency of this allele in the population under study . There was a slight increase of CMT values and the infection frequency in animals with higher parity number (Fig . 2) . However, the order of lactations did not influence the relationship of BoLA A16 and mastitis . This association was not significantly affected by the breed . The increased bacterial infection observed in the Bohemian Pied breed is likely due to relatively high incidence of A16 allele rather than to breed differences (Fig . 3).

Pediatr Infect Dis J, 1995 Jan, 14(1), 51 - 5
Pediatric lung abscess: clinical management and outcome; Tan TQ et al.; Pulmonary abscess is an infrequent but significant problem in children . We retrospectively reviewed the charts of 45 children with documented lung abscesses admitted and treated at Texas Children's Hospital, Houston, over the 11-year period from January, 1982, to December, 1993, and report their presenting symptoms, bacteriology, clinical management and outcome.

Immunol Invest, 1995 Jan-Feb, 24(1-2), 163 - 70
Bacterial contamination of blood products and the value of pre-transfusion testing; Blajchman MA; There has been a dramatic increase recently in the number of reports of septic episodes associated with both red cell and platelet concentrate transfusions . These reports suggest that transfusion-associated septic reactions may occur as often as 1 per 4000 platelet transfusions, however, the true incidence of the bacterial contamination of stored cellular blood components has not yet been established . Recently developed automated techniques for the detection of bacteria are much more rapid than direct plating techniques . Such rapid techniques can be used to monitor the sterility of cellular blood products with greater sensitivity than Gram staining; using a small aliquot of the blood product taken soon after collection . Using such equipment, the incidence of bacterial contamination of 15,838 random donor platelet concentrates collected over a six-month period was determined and evidence of bacterial contamination was found in 32 . Seven were classified as confirmed, 10 as unconfirmed and 12 as non-confirmed positives . The confirmed positivity rate was thus 4.4 per 10,000 . This rate represents the minimum incidence of bacterial contamination of platelet concentrates and the true rate is likely higher, as some of the unconfirmed positives are likely to have been found to be positives, had the original platelet concentrate been available for culture . The true positive rate is therefore estimated to be between 4.4 and 10.7 per 10,000 . Given this rate of bacterial contamination, it is our contention that all platelet concentrate units be monitored for bacteriologic sterility prior to their issue.(ABSTRACT TRUNCATED AT 250 WORDS)

Vet Res, 1995, 26(1), 11 - 20
{Genital Ureaplasma diversum infection: investigations in cattle in France}; Le Grand D et al.; A first bacteriological study of infection by Ureaplasma diversum in cattle was performed in France on 50 bulls and 565 dairy cows . U diversum was isolated in 74% (37/50) of the bull semen and 40% (227/565) of the cows . No significant relationship was found in cows between infection and lesions of granular vulvitis, nor between infection and breeding performances . Serological studies of isolates by membrane filtration dot immunobinding showed a predominance of the serogroups B and C in males, and serogroup B in females.

Can J Vet Res, 1995 Jan, 59(1), 20 - 5
Importance of Escherichia coli in young beef calves from northwestern Quebec; Ganaba R et al.; The objectives of this study were: (i) to investigate the prevalence of Escherichia coli producing F5 (K99), F41, or F165 fimbriae and STa enterotoxin; (ii) to determine serum antibody levels against these fimbriae; (iii) and to examine the association between bacteriological and serological results and the presence of diarrhea, in beef calves from northwestern Quebec . A total of 373 live three to four week old calves and 27 dead calves were sampled between January and March 1991 . No isolates positive for F5 were detected in live calves, and only one E . coli producing STa and F41 was isolated . Escherichia coli producing F41-like surface antigens or F165 fimbriae were isolated from 17.43% and 5.63% of live calves, respectively . Antibodies against F5, F41 and F165 were low . Escherichia coli isolates positive for F41-like surface antigen were most often observed in calves born between January and March . No association was found between bacteriological and serological findings, nor between these findings and diarrhea . Calves born from dams vaccinated against E . coli had higher median antibody levels than those born from unvaccinated dams . No E . coli positive for F5 or F41 fimbriae were isolated from dead calves . Escherichia coli with F41-like surface antigen or F165 were found in 55.56% and 11.11% of ileal samples; 4% and 16% of cecal samples, and 0% and 7.4% of colon samples, respectively . Escherichia coli positive for F41-like surface antigen were detected significantly more frequently in the ileum (chi (2)2df = 31.01, p < 0.001).

Nephrologie, 1995, 16(1), 37 - 44
{Connectology for treatment by peritoneal dialysis for chronic renal insufficiency}; Durand PY et al.; With the exception of the simple Luer or Spike type systems all of the presently used CAPD devices have a system for intraluminal sterilization and/or an handling assist device . The sterilizing process can be chemical (antiseptics), physical (heat or ultraviolet (UV) light) or mechanical (flush effect) . Studies comparing various peritoneal dialysis devices have led to results which diverge greatly, and are not always controlled . Synthesis of these studies shown that disconnect systems (DS) seemed to be not more effective against bacteriological contamination than the last generations of UV non-disconnect (NDS) systems . Efficacy of heat sterilization NDS must be confirmed . The choice of a NDS does not result only from a medical indication.

Pneumonol Alergol Pol, 1995, 63(1-2), 27 - 31
{The role of bronchoscopy and bronchoalveolar lavage in diagnosis of pulmonary tuberculosis in AIDS}; Zajaczkowska J et al.; Bronchoscopy was carried out in 32 HIV seropositive patients, most with AIDS during the period between January 1992 and August 1993 . In 14 patients tuberculosis was diagnosed, in 13 it was bacteriologically confirmed . The mean age of the examined patients was 35.5 years (range 22-49 years) . In 50% of the BAL samples bacterioscopy was positive . Bacteriological examination of the sputum and BAL fluid (bacterioscopy and culture) produced a confirmation of tuberculosis in 99.9% of the cases.

Pneumonol Alergol Pol, 1995, 63(1-2), 21 - 6
{Characterization of patients with treatment failure in the Central Tuberculosis Registry}; Miller M et al.; An analysis was carried out in order to explain the reason of treatment failure in patients with bacteriology confirmed active tuberculosis registered in the Central Tuberculosis Register in the years 1988-1991 . The population of patients is whom failure of treatment was observed is older compared with the population of patients in whom the treatment did not fail . The regimens in both groups were similar although the duration of the regimens was shorter in the group in whom tuberculosis was not eradicated (less than 3 months or the treatment duration could not be established) . In the chronic sputum positive patients severer cases of tuberculosis were observed more often . Tuberculosis coexistent with other diseases was seen twice more often . The result of therapy in patients with bacteriologically confirmed tuberculosis can be effected by coexistency of tuberculosis and alcoholism.

Acta Leprol, 1995, 9(3), 127 - 31
{The frequency of the appearance of perforating foot ulcers in patients with Hansen's disease as a function of treatment with disulone alone or with polychemotherapy}; Mane I et al.; Between 1986 and 1989, in 5 departments of Senegal, 436 new cases of leprosy were detected, of whom 225 were put under dapsone monotherapy and 211 under multidrug therapy (MDT) . Of them, 190 could be followed-up during 2 years by means of annual bacteriological and clinical examination, including neurological assessment . In 2 years, the onset of 10 (5.3%) chronic plantar ulcers (CPU) was observed: 4 (4%) among the 99 patients under dapsone monotherapy and 6 (6.6%) among the 91 under MDT (no significant difference) . Of the 10 CPU, 3 (2%) appeared among the 149 patients without any disability at detection while 7 (17%) were observed among the 41 others who presented a grade 1 disability at detection (p < 0.01) . Of the 6 CPU appeared in the patients under MDT, 5 (22%) were observed among the 23 who presented a grade 1 disability at detection and 1 (1.5%) among the 68 who did not (p < 0.01) . This difference was not noted in the patients under dapsone monotherapy . Our results need to be confirmed by other studies including a higher number of patients followed-up during a longer period of time . Nevertheless, they suggest that MDT could prevent the onset of CPU, but only in patients without any disability at detection . Therefore, they reemphasize the importance of early detection of the disease in leprosy control programmes.

Pediatr Pol, 1995 Jan, 70(1), 59 - 65
{Evaluation of treatment efficacy in gastritis and duodenitis in children with Helicobacter pylori infection}; Ignys I et al.; The efficacy of Ventrisol treatment in gastritis and duodenitis in children infected with Helicobacter pylori was evaluated . Eighty-six children aged 3 to 18 years with chronic abdominal pain were examined . All children underwent gastrofiberoscopic examination . H . pylori infection was diagnosed on the bases of two of three diagnostic tests (urease, bacteriological, histological) . H . pylori was detected in 50 children (56.4%) . After a 4 week course of Ventrisol treatment, H . pylori eradication was obtained in 41 children (82%) . Twenty-one children (42%) were completely cured, whereas in 20 children (40%) elimination of HP was observed although macroscopic and histological inflammatory changes were still present . The drug was well tolerated by 92.5% of children and its accumulation was not observed.

Indian J Lepr, 1995 Jan-Mar, 67(1), 45 - 59
Clinical features and diagnosis of relapses in leprosy; Ramu G; 1 . The definition of relapse as "occurrence of new signs and symptoms of the disease during the period of surveillance or thereafter in a patient who successfully completes an adequate course of multidrug therapy" accommodates the current policy of releasing patients even when there are clinical and bacteriological signs of activity after fixed duration treatment . 2 . The predisposing cause of relapse in the persistence of live M . leprae in various tissues in MB leprosy and in the nerve in PB leprosy . 3 . The precipitating causes of relapse include (a) inadequate therapy due to miscategorization of MB cases as PB when there are solitary or few MB lesions since skin smear examinations for AFB are not routinely done in PB cases . (b) Previously sulphone treated LL cases inactive for more than two years are not included for MDT . Relapses commonly seen in NLEP units are in such cases . (c) Multiple skin and nerve lesions in PB leprosy . (d) Pregnancy and lactation . (e) Mental depression which downgrades immunity . (f) HIV infection . 4 . There may be a change in type on relapsing, PB cases relapsing as MB and MB cases relapsing as PB . 5 . Criteria for diagnosis of relapse are: increase in the extent of lesions, infiltration and erythema, fresh skin and nerve lesions, positive skin smears for AFB in previously negative cases; and in bacteriologically positive cases during surveillance, an increase in BI by two logs at any site over the previous BI in two successive examinations . 6 . Relapses are but too often diagnosed as reversal reactions inspite of the absence of symptoms and signs of acute inflammation to the detriment of patients; a course of steroid therapy which is administered to these patients on the diagnosis of reversal reaction does not halt the progress of the disease especially in the nerve, resulting in disability.

J Gynecol Obstet Biol Reprod (Paris), 1995, 24(3), 253 - 9
{Comparative study of ofloxacin+amoxicillin-clavulanic acid versus doxycycline+amoxicillin-clavulanic acid combination in the treatment of pelvic Chlamydia trachomatis infections}; Judlin P et al.; OBJECTIVE . To evaluate the efficacy and safety of ofloxacin+coamoxiclav versus doxycycline-coamoxiclav in the treatment of chlamydial pelvic infections . DESIGN . An open, comparative, randomised, monocentric study . SUBJECTS . A hundred and eighteen patients (85 endometritis and 33 salpingitis) were included . Clinical, laparoscopic and bacteriological assessments were performed before treatment . 30.4% of salpingitis were considered as severe (COGIT score > 6) . 25.4% of acute pelvic infections were only caused by Chlamydia trachomatis . TREATMENT . A hundred and eighteen patients were treated orally with 3 week combination ofloxacin (200 mg b.i.d.) + coamoxiclav (1 g b.i.d.) (n = 60) or with a 6 week coamoxiclav (1 g b.i.d.) + doxycycline (100 mg b.i.d.) (n = 58) . RESULTS . Oral combination ofloxacin-coamoxiclav is as effective as oral combination doxycycline+coamoxyclav with respectively 96.7% versus 96.6% and 100% versus 98.4% satisfactory clinical et bacteriological results.

J Gastroenterol Hepatol, 1995 Jan-Feb, 10(1), 47 - 50
Survival after a first episode of spontaneous bacterial peritonitis . Prognosis of potential candidates for orthotopic liver transplantation; Altman C et al.; To determine the potential role of orthotopic liver transplantation (OLT) in cirrhotic patients surviving a first episode of spontaneous bacterial peritonitis (SBP), medical records of 79 patients presenting with a first episode of SBP were reviewed . Of these patients, 37 were selected as potential candidates for OLT using the following criteria: absence of hepatocellular carcinoma; no severe organ failure other than the liver; age < or = 66 years; and survival after SBP > 60 days . Survival time was calculated from the day of SBP diagnosis . Prognostic value of clinical, biological and bacteriological data recorded at the time of SBP was determined using univariate and multivariate analysis (Cox's regression model) . Survival rate of the potential candidates for OLT at 3 months, 1 year and 2 years was 94, 46 and 30% respectively . Serum creatinine value (P = 0.001) and Pugh score (P = 0.005) were independently correlated with death . The 1 year survival rate was 80% for the 11 patients with a Pugh score < 10, and 26% for the 26 patients with a Pugh score > or = 10 . Our results suggest that after SBP, OLT should be considered in patients with severe liver disease . Survival of patients with a moderate liver disease (i.e . Pugh score < 10) might be relatively high.

Klin Med (Mosk), 1995, 73(2), 45 - 8
{Spiramycin (rovamycin), a macrolide antibiotic for oral treatment of outpatient pneumonia}; Strachunskii LS et al.; Spiramycin activity against acute pneumonia has been studied in 21 outpatients (15 adults and 6 children) . The drug was administered orally twice daily in a dose 3,000,000 units . The course lasted from 7 to 14 days . All the cases were confirmed roentgenologically . The disease ran a moderate-severity course . The response rate reached 95.2% . Another course of antibiotic therapy was not needed . Side effects were not registered . Bacteriological efficacy of spiramycin made up 71.3% . 14 out of 16 isolated strains of causative agents (S.pneumoniae, S.pyogenes, S.aureus, H.influenzae in 5, 1, 7 and 3 patients, respectively) proved sensitive to spiramycin . 2 patients developed mycoplasma infection diagnosed serologically . The findings confirm high therapeutic efficacy of spiramycin, its good tolerance . Spiramycin may be considered the drug of the priority choice in outpatient treatment of acute pneumonia.

Antibiot Khimioter, 1995 Jan, 40(1), 41 - 4
{Effectiveness of cefmetazole in the treatment of puerperal pyo-septic diseases}; Zharov EV et al.; An open non-comparative clinical trial of cefmetazole in the treatment of 40 females with postnatal purulent septic diseases was performed . Excellent and good clinical efficacy of cefmetazole was observed in 100 per cent of the cases . The bacteriological efficacy also equaled 100 per cent . No severe side effects of cefmetazole were recorded . The use of cefmetazole was shown to be advisable in the treatment of postnatal purulent septic diseases.

Antibiot Khimioter, 1995 Jan, 40(1), 31 - 6
{Effectiveness of cefmetazole in treatment of lower respiratory tract infections}; Strachunskii LS et al.; The efficacy of cefmetazole was studied in an open non-comparative clinical trial comprising 40 patients with infections of the lower respiratory tracts . The clinical efficacy of cefmetazole was excellent and good in 85 per cent of the cases . The bacteriological efficacy amounted to 75 per cent . Adverse reaction due to the treatment with cefmetazole in 6 patients (15 per cent) were recorded . The adverse reactions were not severe, did not require any special treatment or prolongation of the hospitalization term . The use of cefmetazole in the treatment of infections of the lower respiratory tracts was shown to be advisable.

Antibiot Khimioter, 1995 Jan, 40(1), 27 - 30
{Effectiveness of cefmetazole in treatment of wound infection}; Eropkina AG et al.; The cefmetazole efficacy was studied in an open non-comparative clinical trial in the treatment of 40 patients with wound infections . The clinical results were excellent and good in 90 per cent of the cases . In 2.5 per cent of the cases the treatment failed . In 7.5 per cent of the cases the results could not be evaluated . The bacteriological efficacy of cefmetazole was equal to 80 per cent . The drug tolerance was good and only in 3 patients allergic reactions were observed . No hepatotoxic or nephrotoxic effects were recorded . The results were indicative of the advisability of the cefmetazole use in the treatment of wound infections.

Pathology, 1995 Jan, 27(1), 58 - 60
Mycoplasma hominis pneumonia in aboriginal adults; Norton R et al.; Mycoplasma hominis (M . hominis) is a well recognized extragenital pathogen . Its role as a pathogen of the respiratory tract, however, remains difficult to determine . Four cases of pneumonia are presented in which M . hominis was isolated from blood, tracheal aspirates or post-mortem lung tissue . All 4 of these isolates were in young Aboriginal adult males . M . hominis is the least fastidious of the human mycoplasmas and grows well on most blood-containing bacteriological media . The recognition and identification of M . hominis is important as it is commonly resistant to erythromycin which would be the drug of choice in most atypical pneumonias . Early recognition and treatment with tetracycline instead may influence outcome.

Arch Orthop Trauma Surg, 1995, 114(5), 298 - 301
Reactivation of a tuberculous coxitis due to loosening of a total hip endoprosthesis; Fink B et al.; A 45-year-old woman who suffered from juvenile tuberculous coxitis at the age of 4 is presented . Her hip joint replacement lasted for 18 years and then needed replacing . Intraoperatively removed caseous soft tissue and an opalescent secretion histologically resembled a tuberculous focus, and bacteriological culture grew a Mycobacterium tuberculosis strain . Four months after the replacement, the patient suffered from a tuberculosis-induced septic loosening of the newly replaced hip joint endoprosthesis . The tuberculosis relapse was probably due to aseptic loosening of the first hip joint endoprosthesis.

Schweiz Arch Tierheilkd, 1995, 137(7), 297 - 305
{Preliminary results using a combined xylose absorption/hydrogen exhalation test in horses}; Bracher V et al.; In the present study the breath hydrogen (H2) excretion test was combined with the xylose absorption test in 4 normal horses and 9 clinical patients with chronic diarrhea (n = 3) or chronic weight loss without diarrhea (n = 6) . All horses underwent a thorough clinical examination . Laboratory evaluations consisted of haematology and serum biochemistry as well as bacteriological and parasitological examination of feces . In addition, serum electrophoresis and abdominocentesis was performed in all the clinical patients . Gastroscopy was carried out in 6 patients and rectal biopsies were obtained from 4 animals . Two animals were euthanized within 4 weeks after the evaluation . The diagnosis of chronic granulomatous enteritis was confirmed in one of them at necropsy, the cause of weight loss in the other remained unexplained . In the remaining animals, specific causes such as management, parasites, chronic infections and diseases of liver, kidneys and heart were excluded, but no specific diagnosis could be obtained . For the combined xylose absorption/H2 excretion test, the animals were starved overnight and given 0.5/kg/bwt xylose as a 10% solution by stomach tube the next morning . Blood samples were collected for plasma xylose analysis at 30 min intervals for 4 hrs, and breath samples were also collected at 30 min intervals for 8 hrs . With the exception of the animal with granulomatous enteritis, the diseased horses showed only slight alterations in either peak concentrations or times to reach peak levels of plasma xylose . None of the healthy animals showed an increase in breath H2 production after xylose administration, whereas five of the diseased animals showed distinct increases of variable heights . In addition, the diseased horses showed higher fasting breath H2 levels (range 7.5-61.5 ppm) than normal horses (range 0-5 ppm) . It is concluded that gastrointestinal disorders might be influenced or even induced by a change in intestinal microbial composition, as evidenced by an increased hydrogenic metabolism.

Rev Pneumol Clin, 1995, 51(3), 115 - 21
{Mucoviscidosis: comparative analysis of epidemiological data of French and North American registries}; Rault G et al.; A national registry for cystic fibrosis was established in France in 1993 . A questionnaire is sent once a year to different health care units . The first questionnaire was analyzed in 1992: 1,893 patients (53% males) were identified . 28% were over 15 years of age, 13% more than 20, and 1% over 35 . Usually, diagnosis had been suggested by respiratory signs, followed by digestive tract signs and growth impairment and meconial ileus . 13% were diagnosed in screening programmes . Diagnosis was made before 1 year in 66% of the subjects (mean = 7 months) . All the data collected and the functional and bacteriologic data were compared with those observed in the United States and Canada . It should also be noted that 38 patients were grafted during this study year and that it is too early to analyze the general outcome for all subjects . The creation of this registry is an important step towards a better understanding of the epidemiology of cystic fibrosis in the French population.

Rev Laryngol Otol Rhinol (Bord), 1995, 116(3), 187 - 9
{Bacteriology of maxillary sinusitis among members of the 11th parachutist unit}; Wery G et al.; When sinusoscopic examinations of chronic maxillary are made, bacteriological samples are the most often carried out . We report results of thirty one cases among young soldiers 19 to 23 years old . Our bacteriological results are similar to those reported in literature . A bibliographic study reminds the recent bacteriological findings according to countries or type of patients where pathogen germs were researched.

Probl Tuberk, 1995, (5), 8 - 11
{Tuberculous osteitis in infants}; Mushkin AIu et al.; Clinical and diagnostic aspects, surgical outcomes, bacteriological findings were investigated for 72 infants under 3 years old operated for tuberculous ostitis . Tuberculin and seroimmunodiagnosis revealed infection allergy in 1/3 of the cases . The treatment comprises radical surgical reconstruction, drug and functional therapy . Tuberculous ostitis may arise due to vaccinal strain of M . tuberculosis.

Probl Tuberk, 1995, (5), 39 - 41
{Characteristics of nephrotuberculosis in children, adolescents and young persons}; Iagafarova RK; According to the author, urogenital tuberculosis in children and young subjects occurs in 10% of all the cases with this disease . Antituberculosis service registers 71.2% of cases in preschool children, whereas in schoolchildren 70.4% of diagnoses are made by general practitioners . 90% of nephrotuberculosis cases are detected early, in 85% bacteriological examination.

Int Orthop, 1995, 19(3), 151 - 6
{Replacement of infected total hip prosthesis in two stages}; Lenoble E et al.; Since 1975 we have treated 36 infected hip replacements by a two stage procedure in which the prosthesis and cement were first removed . Gentamicin impregnated beads were left at the sites of the prosthesis . Not less than 45 days later a fresh prosthesis was inserted into the hip . In two hips revision was not undertaken because of persistence of infection . The remaining 34 hips received a fresh prosthesis when the site was bacteriologically sterile . Gentamicin impregnated cement was used and antibiotics were given for a further three months . The functional results were satisfactory at an average of five years of follow up . Incomplete removal of methylmethacrylate was a factor in the persistence of infection and of pain in the absence of infection . The bacteriological efficacy of Gentamicin impregnated beads is uncertain, but their use gave a better functional result.

An Otorrinolaringol Ibero Am, 1995, 22(5), 521 - 33
{Multicenter study comparing the efficacy and tolerance of topical ciprofloxacin (0.3%) versus topical gentamicin (0.3%) in the treatment of simple, non-cholesteatomaous chronic otitis media in the suppurative phase}; Lorente J et al.; A multicentre double-blind randomized study was carried out to compare topical ciprofloxacin and topical gentamicin in the treatment of simple non-cholesteatomatous purulent chronic otitis media . Three hundred and eight patients were included in the study, 159 treated with ciprofloxacin and 149 treated with gentamicin . The percentage of clinical success (elimination of otorrhoea) was 95% with ciprofloxacin and 94% with gentamicin (ns) . Likewise, the percentage of bacteriological erradication was 96% with ciprofloxacin and 93% with gentamicin . Both drugs were well tolerated, without changes in the audiometric values . In these patients, topical ciprofloxacin shows the same efficacy as topical gentamicin without any potential ototoxic effect.

Schweiz Arch Tierheilkd, 1995, 137(6), 272 - 8
Suppurative pleuropneumonia and a pulmonary abscess in a ram: ultrasonographic and radiographic findings; Braun U et al.; This report describes a two-year-old White Alpine ram with suppurative pleuropneumonia and a lung abscess . Prior to admission, the ram had been unsuccessfully treated with antibiotics and levamisole . Clinical examination revealed that the general behaviour and condition of the ram were severely disturbed . The rectal temperature and respiratory rate were increased . Auscultation of the lungs revealed increased vesicular sounds . Based on clinical findings, a tentative diagnosis of bronchopneumonia was made . To confirm the diagnosis, blood was taken for serological testing for Maedi-Visna, and endoscopic examination of the respiratory tract and ultrasonographic and radiographic examination of the thorax were performed . Cytologic and bacteriologic examination of tracheal secretions revealed large numbers of neutrophils and Actinomyces pyogenes organisms . A pocket of gas, surrounded by a capsule of soft tissue density, overlying the base of the heart, and a horizontal fluid line were observed on radiographs . Ultrasonographic examination revealed an effusion between the pleura and the lung on the left side of the thorax; an encapsulated abscess was seen on the right side of the thorax . Centesis and aspiration of this accumulation of fluid yielded foul-smelling pus . Post mortem examination confirmed the clinical, radiographic and ultrasonographic findings . The ram had severe chronic suppurative pleuropneumonia with abscess formation between the pleura and lung on the right side.

Adv Ther, 1995 Jan-Feb, 12(1), 62 - 71
Ampicillin/sulbactam compared with cefotaxime in the treatment of lower respiratory tract infections of bacterial etiology; Jauregui L et al.; This was a randomized, prospective, parallel study of the efficacy and safety of ampicillin/sulbactam (2 g/1 g) and cefotaxime (2 g), administered intravenously every 6 hours, in 53 hospitalized patients with lower respiratory tract infections . Thirty-four of the 36 patients treated with ampicillin/sulbactam and 16 of the 17 patients treated with cefotaxime were evaluable . Clinical and bacteriologic effectiveness did not differ significantly between the two groups (P = .828, P = .648, respectively) . Of the ampicillin/sulbactam-treated patients, 21 (61.8%) were cured, 8 (23.5%) were improved, and 4 (11.8%) were treatment failures . In the cefotaxime group, 9 patients (56.3%) were cured, 4 (25%) were improved, and 2 (12.5%) were treatment failures . All primary pathogens were eradicated in 19 (55.9%) ampicillin/sulbactam-treated patients and partially eradicated in 7 (20.6%); in cefotaxime-treated patients, all primary pathogens were eradicated in 10 (62.5%) patients and partially eradicated in 2 (12.5%) . Both study drugs were well tolerated, with the overall incidence of adverse events similarly low in the two groups.

Adv Ther, 1995 Jan-Feb, 12(1), 1 - 10
Cefadroxil in skin and skin-structure foot infections: a retrospective review; Yu GV et al.; The efficacy and safety of cefadroxil in eradicating localized skin and skin-structure infections of the foot were investigated in a retrospective chart review of 222 consecutive patients from two private practices seen over a 10-year period . Of the 189 patients for whom follow-up data were available, 187 (99%) received cefadroxil 500 mg twice daily, and 2 patients (1%) received 250 mg twice daily . The duration of therapy was 2 weeks or less in 87% of patients, with a median duration of therapy of 11.4 days (range, 5 to 35 days) . Of the 189 clinically evaluable patients, 179 (95%) achieved a favorable clinical response to treatment; of the 57 patients with microbiologic cultures, 54 (95%) experienced a satisfactory bacteriologic response to therapy; no adverse events related to cefadroxil therapy were identified during the review . The overall results from this retrospective study suggest that cefadroxil is an effective agent with a favorable safety profile for the treatment of skin and skin-structure infections of the foot.

J Hosp Infect, 1994 Dec, 28(4), 305 - 13
A hospital study of ice-making machines: their bacteriology, design, usage and upkeep; Burnett IA et al.; Ice-making machines have occasionally been implicated in nosocomial infection . We have examined the ice-making machines in our hospital both bacteriologically and for their general state of cleanliness and repair . Results were variable but, in most cases few organisms of significance were found . Some design features are considered and recommendations for the purchase, maintenance, cleaning and use of these machines are included.

Neurosurgery, 1994 Dec, 35(6), 1144 - 9
Idiopathic chronic hypertrophic craniocervical pachymeningitis: case report; Botella C et al.; A 55-year-old woman with a unique form of chronic hypertrophic pachymeningitis involving the posterior fossa and upper cervical spine is reported . Unlike other cases previously described, the clinical picture was dominated by signs of increased intracranial pressure, lower cranial nerve disorders, and a progressive cervical radiculomyelopathy . The diagnosis was made by means of a contrast-enhanced magnetic resonance imaging scan and confirmed by histological examination of the excised dura . Surgical treatment with removal of the hypertrophic dura provided temporary relief, although the natural history of the disease was not modified . Exhaustive bacteriological and histopathological studies failed to identify a specific cause for this diffuse hypertrophy of the cranial and cervical dura . The literature is reviewed, and other histologically documented cases are discussed.

J Clin Microbiol, 1994 Dec, 32(12), 3018 - 25
Restriction fragment length polymorphism Mycobacterium tuberculosis strains isolated from Greenland during 1992: evidence of tuberculosis transmission between Greenland and Denmark; Yang ZH et al.; In order to describe the transmission of tuberculosis (TB) at the clonal level in a defined geographic region during a certain period of time, all isolates of Mycobacterium tuberculosis collected during 1992 from Greenland were subjected to analyses of DNA restriction fragment length polymorphism (RFLP) . The RFLP patterns obtained by probing the genomic DNA with the repetitive insertion segment IS6110 revealed a high degree of similarity among the isolates, indicating a relatively high transmission rate and a close relationship between the individual M . tuberculosis clones . This was further confirmed by reprobing the Southern blots with two more-stable genetic markers, IS1081 and the DR sequence . The RFLP patterns were compared with those of 245 M . tuberculosis strains collected from Denmark during the same period (representing 91% of all new, bacteriologically verified cases of TB in Denmark in 1992) . One of the three prevalent IS6110-defined clusters was traced to a group of immigrants from Greenland living in a small, defined geographical region in Denmark and to a group of Danish citizens either with known contact with these immigrants or, in other cases, with a record of previous travel or working activities in Greenland . The study showed that the present technique is extremely helpful in monitoring the spread of TB and thereby also contributing to improved disease control.

Baillieres Clin Obstet Gynaecol, 1994 Dec, 8(4), 759 - 72
Role of laparoscopy in the management of pelvic adhesions and pelvic sepsis; Henry-Suchet J et al.; Operative laparoscopy in pelvic sepsis is useful in acute cases: (a) for diagnosis, as there are 20-30% false positive and false negative diagnoses based on clinical and laboratory data alone; and (b) for treatment in severe cases and mainly in tubo-ovarian abscesses, laparoscopy allows aspiration of purulent discharge and, in recent cases, removal of fresh adhesions . In most cases, rapid and complete recovery is associated with treatment with an effective polyvalent antibiotic . Fertility is also preserved in most cases as assessed by a small series of bilateral abscesses with long-term follow-up . In CS associated with infertility, laparoscopic treatment is limited to velamentous adhesions or to dense adhesions of small extent . If performed after the completion of the inflammatory episode, laparoscopic surgery can give results comparable to those of microsurgery . A full bacteriological investigation and appropriate antibiotic treatment are necessary in order to stop or reduce the inflammatory condition which is usually associated with the development of adhesions and is a possible cause of their recurrence.

Kekkaku, 1994 Dec, 69(12), 759 - 65
{Analysis of tuberculosis cases among students reported from Osaka prefectural high schools and counter--measures for tuberculosis}; Takatorige T et al.; The number of newly registered cases of tuberculosis has been increasing in the age group 15-19 year-old and over . To investigate the prevention of tuberculosis among young people under 20 years old, a survey was conducted on reported cases of tuberculosis among Osaka Prefectural high school students during the period from April, 1989 to May, 1994 . Altogether 67 cases were reported from their schools during this period . Although there was a decrease in the total number of students since 1990, there was no corresponding decrease in the number of cases of tuberculosis . Of the total number of cases among high school students registered at public health centers in Osaka, only 23% were reported from the high schools . Cases confirmed bacteriologically positive consisted 13% of all cases . Male students accounted for 61% of reported cases . The methods of detection included medical consultation due to symptoms (75%), mass radiography (18%) and pre-employment health checkup (7%) . 46% of cases reported during the first school year were discovered by mass radiography . While 24% of all cases were detected in April, no less than 46% of cases among those in the first school year were detected in April . Compared with those detected in any other school years, cases detected in the first school year showed some characteristic differences with regards to detection and bacteriological results . There has been one tuberculosis epidemic which accounted for six cases during the past five years.(ABSTRACT TRUNCATED AT 250 WORDS)

J Appl Bacteriol, 1994 Dec, 77(6), 631 - 4
Bacteriological evaluation of groups of beef carcasses before the wash at six Alberta abattoirs; Jericho KW et al.; A method has been developed for the bacteriological evaluation of groups of beef carcasses which can be used to measure the degree of control over hygiene during hide removal and carcass dressing in abattoirs . This method, which enumerates aerobic mesophilic bacteria automatically using a hydrophobic grid membrane filter, was applied at six abattoirs . Two hundred excision samples (5 x 5 x 0.5 cm) were taken at 10 sites on the external surface of a group of 20 carcasses (five carcasses were sampled on each of four consecutive daily visits) for group-carcass evaluation at each abattoir . For each abattoir, the mean log10 Most Probable Number of Growth Units (MPNGU) and between-carcass variance component were obtained for each site and the average over sites . Using the average within-abattoir variance of this study and previously published studies involving 76 additional carcasses (Jericho et al . 1993), it was determined that 20 carcasses are more than adequate to estimate the mean log10 MPNGU per cm2 within 0.5 units at a site . The distribution of the log10 MPNGU per cm2 over the 10 sites was compared for the abattoirs, and sites were found to cluster into 2-4 homogenous groups . The means over sites of log10 MPNGU per cm2 for the abattoirs ranged from 1.52 to 2.64 and were unrelated to line speed.

Arch Mal Coeur Vaiss, 1994 Dec, 87(12), 1721 - 9
{Infectious endocarditis induced by Actinobacillus actinomycetemcomitans . 8 new cases}; Grand A et al.; A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France . This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations . One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental . In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC . The echocardiographic appearances are non-specific . The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere . Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%) . Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological . The hospital mortality was 9%; late mortality was 6% . Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms . A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective . The complementary surgical indications are the same as for other forms of infectious endocarditis . Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.

Tuber Lung Dis, 1994 Dec, 75(6), 454 - 9
Cerebral tuberculosis in the immunocompetent host: 8 cases observed in Switzerland; Labhard N et al.; 8 cases of cerebral tuberculosis were observed between January 1985 and June 1993 at the University Hospitals of Lausanne and Geneva, Switzerland . 5 patients were foreigners and 3 were Swiss, 2 of them alcoholics . All patients were HIV seronegative . Mycobacterium tuberculosis was isolated in 7 patients and M . bovis in one patient . All patients had radiological or bacteriological signs of pulmonary tuberculosis, and 3 had miliary tuberculosis . 3 patients died, 5 were cured . The main prognostic factors were age and the degree of neurological impairment at the beginning of treatment . The epidemiological, clinical, diagnostic and therapeutic aspects of this rare and severe form of extrapulmonary tuberculosis are reviewed.

Nucl Med Commun, 1994 Dec, 15(12), 953 - 60
Diagnostic value of 99Tcm-d,l-HMPAO-labelled leukocyte scintigraphy in the detection of vascular graft infections; Krznaric E et al.; Prosthetic vascular graft infection is a relatively uncommon complication of peripheral vascular surgery . We retrospectively analysed technetium-99m-d,l-hexamethylpropylene amine oxime (99Tcm-d,l-HMPAO) labelled leukocyte scans of 21 patients with a suspected vascular graft infection . Operative findings, bacteriological cultures, radiological findings or clinical follow-up were used to confirm the diagnosis . We found eight true-positive and six true-negative cases . There were no false-positive scintigraphic diagnoses . The false-negative rate was 33% (n = 7) . Our results show a sensitivity of 53%, a specificity of 100% and an accuracy of 66% . The conclusion is that a negative 99Tcm-d,l-HMPAO-labelled leukocyte scan is of limited value in ruling out a vascular graft infection . A combination of computed tomography (CT-scan) and a 99Tcm-d,l-HMPAO-labelled leukocyte scan is probably the most efficient way of diagnosing a vascular graft infection.

Int J Food Microbiol, 1994 Dec, 24(1-2), 93 - 102
Evaluation of a predictive model for the shelf life of cod (Gadus morhua) fillets stored in two different atmospheres at varying temperatures; Einarsson H; The shelf life of fish and food in general is difficult to predict especially if stored at varying temperatures . Shelf life models were constructed (Einarsson, 1992) for cod fillets stored at constant temperatures . The aim of this study was to evaluate if these models could be used to predict spoilage and bacterial growth in cod fillets stored in air and modified atmosphere at constant and varying temperatures . Fresh fillets were packed and stored at constant or varying temperatures between -2 degrees C and 5 degrees C . Samples were taken at regular intervals for bacteriological and sensory evaluation . The results showed that fish stored at +0.6 degrees C in air had a shelf life (assessed by sensory analysis) of 11 days which is close to what could be expected and predicted . The increase in bacterial number observed was generally less than predicted . For fish fillets, stored in air at +5 degrees C for 3 days, then at +0.6 degrees C for 3 days and finally at -2 degrees C, the shelf life was found to be 7 days which was in good agreement with the predicted shelf life . The shelf life of fillets stored at same the temperatures in modified atmosphere was found to be 9 days but by prediction 11 to 12 days . The models for predicting changes in sensory score were more accurate than those predicting changes in bacterial numbers.

Cent Eur J Public Health, 1994 Dec, 2(2), 103 - 5
Water as a possible factor of transmission in mycobacterial infections; Slosarek M et al.; Mycobacterium kansasii and Mycobacterium xenopi are the most frequent species occurring in water in the Czech Republic . In the endemic area of M . kansasii in heavy industry and mining areas of North Moravia various mycobacterial species were detected in more than 20% of different water samples and M . kansasii was found in 1.5 to 1.9% of them, frequently in pit bathrooms and in the drinking water as well . Mycobacterium xenopi was detected in 35 and 50% of water samples collected in households of M . xenopi excretors in North Bohemia and in Prague . A nosocomial occurrence of M . xenopi was recorded in an hospital department in North Bohemia and in a rest home in Prague and all samples of water from the afflicted institutions were positive for M . xenopi . In a coal mine in Moravia a case of cutaneous involvement associated with the presence of M . marinum in mine water was also recorded . The incidence of various mycobacterial species (except of M . kansasii and M . xenopi) in spa and swimming pools in West Bohemia reached 35% positivity . Comprehensive reviews of bacteriological investigations for mycobacteria performed in the entire territory of the Czech Republic have been reported in annual reports since 1985 . In the period from 1985 to 1991 a total of 5167 samples of various kinds of water samples were examined and mycobacteria were detected in 8.2 to 47.7% of them.

Mol Biol Cell, 1994 Dec, 5(12), 1281 - 8
Extracellular matrix controls tubulin monomer levels in hepatocytes by regulating protein turnover; Mooney DJ et al.; Cells have evolved an autoregulatory mechanism to dampen variations in the concentration of tubulin monomer that is available to polymerize into microtubules (MTs), a process that is known as tubulin autoregulation . However, thermodynamic analysis of MT polymerization predicts that the concentration of free tubulin monomer must vary if MTs are to remain stable under different mechanical loads that result from changes in cell adhesion to the extracellular matrix (ECM) . To determine how these seemingly contradictory regulatory mechanisms coexist in cells, we measured changes in the masses of tubulin monomer and polymer that resulted from altering cell-ECM contacts . Primary rat hepatocytes were cultured in chemically defined medium on bacteriological petri dishes that were precoated with different densities of laminin (LM) . Increasing the LM density from low to high (1-1000 ng/cm2), promoted cell spreading (average projected cell area increased from 1200 to 6000 microns2) and resulted in formation of a greatly extended MT network . Nevertheless, the steady-state mass of tubulin polymer was similar at 48 h, regardless of cell shape or ECM density . In contrast, round hepatocytes on low LM contained a threefold higher mass of tubulin monomer when compared with spread cells on high LM . Furthermore, similar results were obtained whether LM, fibronectin, or type I collagen were used for cell attachment . Tubulin autoregulation appeared to function normally in these cells because tubulin mRNA levels and protein synthetic rates were greatly depressed in round cells that contained the highest level of free tubulin monomer . However, the rate of tubulin protein degradation slowed, causing the tubulin half-life to increase from approximately 24 to 55 h as the LM density was lowered from high to low and cell rounding was promoted . These results indicate that the set-point for the tubulin monomer mass in hepatocytes can be regulated by altering the density of ECM contacts and changing cell shape . This finding is consistent with a mechanism of MT regulation in which the ECM stabilizes MTs by both accepting transfer of mechanical loads and altering tubulin degradation in cells that continue to autoregulate tubulin synthesis.

Presse Med, 1994 Nov 26, 23(37), 1703 - 7
{Helicobacter pylori gastric infections in children}; Benhamou PH et al.; OBJECTIVES: Numerous reports have established the association of Helicobacter pylori and recurrent abdominal pain in children . We investigated the clinical, bacteriological and therapeutic features of our patients seen over a 1 year period . METHODS: We investigated 121 children during 1992 in Hospital Saint Vincent-de-Paul, Paris . At endoscopy, biopsies were taken and sent for histology and bacteriology and urease testing . A decision regarding treatment by amoxicillin and metronidazol was made after positive results of bacteriology and/or histology . RESULTS: Heliobacter pylori was found in 47 antral biopsies after pathology examination with Giemsa staining alone 16 times, bacterial culture 9 times and both methods 22 times . Abdominal pain was the prominent symptom, occurring in 35.5% of Helicobacter pylori+patients . In 25 of the positive negative patients, a nodular gastritis was observed (53.1%) and in 27.6% of them a weight loss or a delay in weight gain . Few patients became after combined treatment with amoxicillin and metronidazol whereas eradication rates after triple therapy with amoxicillin-metronidazol and H2 antagonist or proton pump blocker were higher . CONCLUSION: Helicobacter pylori related gastritis is a common cause of abdominal complaints in children . The most common symptom is recurrent abdominal pain . Antral nodularity is a peculiar endoscopic finding in children . Two-drug therapy associating amoxicillin-metronidazol is often ineffective to eradicate the bacteria whereas eradication rates after triple therapy amoxicillin-metronidazol and H2 antagonist or proton pump blocker are higher.

Dtsch Med Wochenschr, 1994 Nov 25, 119(47), 1613 - 7
{Esophagomediastinal fistulae as a rare complication of tuberculosis in an HIV-infected patient}; Greten T et al.; A 57-year-old man with an HIV infection, diagnosed a year ago, complained of fever and cough . The haemoglobin level was 7.5 g/dl, white cell count 3800/microliters, T-helper cell count 60/microliters and the CD4-CD8 ratio 0.1 . Erythrocyte sedimentation rate was raised to 21/39 mm . Bacteriological tests were at first negative . The chest radiograph showed slight widening of the upper mediastinum which further increased over the next 10 days, at which time it also revealed a shadow in the right upper lobe . Computed tomography suggested necrotizing mediastinal lymph-nodes . Treatment was begun with rifampicin (600 mg daily) ethambutol (1.2 g daily), pyrazinamide (1.5 g daily) and ciprofloxacin (500 mg twice daily) . Oesophagoduodenoscopy, performed after 3 weeks, revealed several fistulae which, after ingestion of contrast medium, were demonstrated to communicate with the mediastinum, presumably as a result of lymph-node liquefaction . Mycobacterium tuberculosis was demonstrated in gastric juice, sputum and stool only after tuberculostatic drugs had been started.

J Infect Dis, 1994 Nov, 170(5), 1216 - 23
Changing trends in the epidemiology of human brucellosis in California from 1973 to 1992: a shift toward foodborne transmission; Chomel BB et al.; From 1973 through 1992, 426 cases of human brucellosis were reported in California, of which 98% were laboratory confirmed . Brucella melitensis was identified in 185 cases (78.7% of the bacteriologically typed cases) . Hispanics accounted for 81% of the cases from 1983 to 1992 compared with 65% during the previous decade (P < .01) . The population-adjusted average annual incidence was higher in Hispanics, especially in children and teenagers, compared with non-Hispanic whites and African Americans . Slaughterhouse cases decreased from 25% during 1973-1982 to < 3% during the following decade . Changes in case distribution were characterized by a decreasing incidence in the Central Valley and an increasing incidence in the San Francisco Bay area and the southern Coast Range . Hispanics were more likely to report being infected by consumption of milk and cheese in Mexico during 1983-1992 than during the previous 10 years (relative risk, 1.45) . Between 1973 and 1992, human brucellosis in California evolved from an occupational to a foodborne illness.

Am J Gastroenterol, 1994 Nov, 89(11), 2066 - 9
A case of chronic pancreatitis with pseudocysts complicated by infection and obstructive jaundice; Noda T et al.; We report a case of chronic pancreatitis with pseudocysts complicated by infection and obstructive jaundice . A 49-yr-old male was admitted with the complaints of fever and jaundice . Laboratory findings included high biliary tract enzyme values and normal serum amylase value . Ultrasonography and computed tomographic scan demonstrated a cyst, 4 cm in diameter, in the pancreas head . Cholangiography revealed a long, tapered obstruction of the common bile duct which was apparently compressed by the cyst . Although the jaundice improved after percutaneous transhepatic biliary drainage, fever continued, and the cyst was aspirated . Bacteriological examination of the contents revealed infection . The symptoms disappeared rapidly and the cyst decreased in size soon after aspiration . The stenosis of the common bile duct showed improvement for several weeks but then regressed . In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, distinguishing the condition is an important aspect of accurate diagnosis and therapy.

Clin Infect Dis, 1994 Nov, 19(5), 846 - 53
Ceftazidime vs . amoxicillin/clavulanate in the treatment of severe melioidosis; Suputtamongkol Y et al.; An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/{kg.d}) vs . amoxicillin/clavulanate (160 mg/{kg.d}) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand . Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group . The overall mortality rate (47%) was similar for both treatment groups . However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after > or = 72 hours of treatment (P = .004) . The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P = .02) . Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated . Parenteral amoxicillin/clavulanate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.

Spine, 1994 Nov 1, 19(21), 2451 - 5
Magnetic resonance imaging for the diagnosis of tuberculous spondylitis; Kim NH et al.; OBJECTIVES . The purposes of this study were to evaluate the nature of the paraspinal soft tissue mass and the location of the lesion involved using magnetic resonance imaging and to correlate these observations with surgical findings . SUMMARY OF BACKGROUND DATA . In the past, tuberculous spondylitis was diagnosed by plain radiography and since the 1970s, computed tomography has been a useful method for assessing tuberculous spondylitis . In contrast to most imaging methods, MRI has the advantages of improved contrast resolution for bone and soft tissues and versatility of direct imaging in multiple planes . METHODS . Medical records and magnetic resonance imaging studies of 22 patients with bacteriologically and/or histologically proved tuberculous spondylitis were reviewed . In each patient, the numbers of vertebrae involved were evaluated as well as which columns of vertebrae were affected and the signal intensities of lesions . In addition, an attempt was made to determine if granulation tissue differed from the abscess based on magnetic resonance imaging appearance and to compare the outcome with surgical findings . RESULTS . The average number of vertebrae involved per patient was 2.8 and T8 and T9 were the vertebrae most frequently affected . The destruction of vertebrae and discs was easily identified in both sagittal and axial planes . The peripheral margins were exclusively enhanced in all cases . Of particular interest, the posterior aspect of the vertebral body was predominantly involved . Mostly the involvement of both anterior and middle columns was noted . With the aid of intravenous administration of magnetic resonance contrast agents, magnetic resonance imaging was highly accurate in distinguishing the granulation tissue from the cold abscess . CONCLUSIONS . Magnetic resonance imaging demonstrated excellent images of bone destruction and soft tissue mass, and provided information in multiple planes, thereby delineating the extent of involvement in tuberculous spondylitis . Magnetic resonance imaging is most helpful in planning a surgical approach to tuberculous spondylitis.

J Radiol, 1994 Nov, 75(11), 629 - 34
{Ultrasonography in the diagnosis and treatment of psoas abscess . Apropos of a study with 30 patients}; Ousehal A et al.; The abscess of psoas are more often secondary to a loco-regional cause . The authors report a series of 42 abscess of psoas in 30 patients during 3 years . It concerns 16 men and 14 women witch a mean age of 35 years . The abscess was secondary to a spondylodiscis in 25 patients and primary in 5 patients . The size of the abscess was upper 5 cm with a variable ultrasound structure: liquid in 33 cases, hypoechogenic in 9 cases . All patients underwent a percutaneous treatment guided by ultrasonography . A single or multiple evacuation puncture with 16 Gauge needle were performed for 40 abscess . Complementary percutaneous drainage with 14 french drain was used in 3 cases . In 2 other cases, the percutaneous drainage was used firstly . The bacteriological study of puncture liquid isolated the germ in 8 cases . Evaluation has been assessed in only 29 cases . The recovery was reached in 12 abscess on 15 which were treated by a single puncture . In 10 abscess on 13 treated by multiple puncture; and in 4 abscess an 5 managed by drainage . The results demonstrate the accuracy of single or multiple drainage puncture associated with adapted antibiotherapy in the management of abscess.

Kekkaku, 1994 Nov, 69(11), 671 - 80
{Six-month short course chemotherapy containing pyrazinamide for initial treatment of pulmonary tuberculosis}; Wada M et al.; From January 1991 to December 1992, 419 patients with pulmonary tuberculosis were initially treated at Fukujuji Hospital . Among them, 190 patients, who were younger than 80 years old and had pulmonary tuberculosis with cavities or infiltration of extension 2 or 3, and/or were sputum-smear positive, had been treated by 6-month short course regimen containing pyrazinamide, 2HRS(E)Z/4HRE . And were eligible for the evaluation of the clinical usefulness of pyrazinamide-containing regimen for the initial treatment of pulmonary tuberculosis . The dose of pyrazinamide was 1.2 g per day irrespective of body weight . The patients of this treatment group consisted of 151 males and 39 females, and mean age of the males was 45.3 and that of the females was 43.8 years old . At the start of the treatment, 74% of the cases were smear positive, 70% were cavitary, and 6 cases each showed primary resistance to isoniazid and to streptomycin, respectively, and only one case showed resistance to both of isoniazid and streptomycin . There was no primary resistant case to either rifampicin or ethambutol . Bacteriologic negative conversion rates were 95% and 90% after 2 months of treatment by PZA-containing regimen and by the standard regimen, respectively, and treatment durations required to achieve the negative conversion of all cases were 3 and 6 months for respective regimens . Of 90 patients who completed 6-month PZA-containing regimen and could be followed-up, only one bacteriologic relapse (1.1%) was noticed . Elevation of serum GPT level higher than 150 IU/ml during the treatment was noticed in 6.3% of 175 cases under PZA-containing regimen in comparison with 4.0% of 174 cases under the standard regimen (not significant) . The interval between the onset of the treatment and the detection of abnormal liver function was much shorter (mean 31.3 days) in the PZA-containing regimen than in the standard regimens (mean 63.4 days) . Hyperuricaemia (> 10 mg/ml) was noticed in 46.7% of 57 males and 59.4% of 19 females tested, but pyrazinamide was not discontinued in any case due to arthralgia . These results clearly show that pyrazinamide can be used rather safely for Japanese tuberculosis patients . If the pyrazinamide-containing regimen {2HRS(E)Z/4HRE} is adopted as the new standard regimen in place of on-going standard regimen in Japan, 6HRS(E)/3HR, the duration of chemotherapy could be shortened by three months with the same level of both efficacy and safety . We recommended pyrazinamide-containing 6-month regimen, 2HRS(E)Z/4HRE, as the new standard regimen for the initial treatment of pulmonary tuberculosis.

Arch Pediatr, 1994 Nov, 1(11), 998 - 1003
{Ultrasonographic survey of the effect of umbilical arterial catheterization in newborn infants}; Berger C et al.; BACKGROUND--Incidence of aortic thromboses in the neonatal period is significantly increased after umbilicar artery catheterization . POPULATION AND METHODS--Fourty neonates (GA: 34.7 +/- 7.2 wks and birth weight: 2377 +/- 786 g) were prospectively studied in order to assess frequency and natural history of aortic thromboses due to umbilical artery catheterization . Investigation was based on serial real-time ultrasonography (2.3 times/week) . Presence of aortic thrombus was correlated with the existence of clinical complications and the results of biological findings (prothrombin and fibrinogen levels; hematocrit) and platelet number . RESULTS--Aortic thrombosis was found in six patients (15%); it was clinically asymptomatic in two (5%) . A vascular wall-fixed catheter was shown in ten infants (25%); this finding was associated with thrombosis in five cases and preceded thrombosis in one other . The presence of thrombus and/or abnormal position of the catheter was not correlated with gestational age, birth weight, duration of catheterization, blood hemostasis and results of bacteriological cultures of the tip of the catheter . CONCLUSIONS--Ultrasonographic control must be repeated after umbilical artery catheterization . It permits evaluation of renal flux and can lead to removal of catheter and/or peculiar therapeutic measures.

Klin Padiatr, 1994 Nov-Dec, 206(6), 433 - 6
{BCG-vaccination in neonates as a cause of osteomyelitis--an argument against BCG-vaccination?}; Walter S et al.; BCG-osteomyelitis is a rare complication of BCG-vaccination . By means of a case report clinical and immunological findings are discussed . Contrary to the undramatic clinical symptoms the x-ray showed pronounced osteolytic lesions in the sternum . The bacteriological examination demonstrated mycobacteria of BCG-type . Immunological investigations presented normal humoral and cellular immunity . The therapy (curettage, antituberculous drugs) was effective . In spite of this complication the BCG-vaccination is furthermore recommended.

Rev Fr Gynecol Obstet, 1994 Nov, 89(11), 537 - 42
{Acute pelvic pain syndrome . Diagnostic and therapeutic approach in women}; Burlet G et al.; Acute pelvic pain is a common syndrome in women and is an emergency . Management requires rapid diagnostic evaluation to enable immediate treatment . Blood tests (beta-HCG assay, etc.), bacteriological studies and pelvic ultrasonography may be required . Gynecological problems are the commonest etiology: ectopic pregnancy, miscarriage, PID . The possibility nevertheless remains of appendicitis, sigmoid diverticulitis, UTI or renal colic, all of which are medical or surgical emergencies.

Rev Med Chil, 1994 Nov, 122(11), 1307 - 15
{Abdominal actinomycosis}; Bannura G; Actinomycosis is a non opportunistic chronic infection caused by a superior bacteria that forms grains in the pus or affected organs . Fifty four cases have been reported in the last 50 years in the chilean literature, 51% were abdominal actinomycoses, 25.5% pelvic and 18.5% pulmonary . Fourteen cases have been treated in the last 9 years at San Borja Arriaran . Of these 7 were abdominal (1 parietal and 6 visceral forms) and four involved the rectosigmoid; two were ileocecal and occurred after an appendicectomy . The presenting picture was of a giant abdominal mass in two cases (one with a colocutaneous fistula), rectal stricture in one case, tubo-ovarian abscess with colonic involvement in one case, parietal mass in one case and a fistula after an appendicectomy in two cases . Actinomyces Israelli was found in the histopathological study in three cases and in the bacteriological study in two . All visceral forms were treated with penicillin plus tetracycline or amoxicillin during 6 to 12 months with complete and permanent recovery . Two patients required a colonic resection due to a iatrogenic damage and an associated diverticular disease . Three patients required a colostomy to overcome the obstruction, all of them are asymptomatic and without colostomy 18 months to 8 years later . Due to its different presentation forms, actinomycosis has been called "the great pretender" and in several occasions the histological or bacteriological diagnosis is not achieved.

An Med Interna, 1994 Nov, 11(11), 557 - 60
{Spontaneous bacterial peritonitis in the cirrhotic patient}; Moro Alvarez MJ et al.; Spontaneous bacterial peritonitis in cirrhotic patients is a severe complication which frequently decompensate the underlying disease and which is associated, even in our days, to a 50% mortality . Hence, the relevance of an adequate exploration, as weil as an early treatment . The acknowledge of several variants, as are the concepts of bacterascites and neutrocytic ascites with negative culture required the use of updated diagnostic criteria . In addition to the already known clinical and bacteriological characteristics of the ascitic fluid infection, we have also intended to review new aspects of this entity referred to in the literature published in the past years, as are the followings; study of possible predictive factors of this complication and factors which have an influence on its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive and curative therapeutics.

Arkh Patol, 1994 Nov-Dec, 56(6), 57 - 62
{Reparative processes in peptic ulcer (clinico-morphologic study)}; Sklianskaia OA et al.; 475 patients with stomach ulcer (1984-1993) were studied using various methods: endoscopical, immunological, biochemical, bacteriological and morphological . Morphology of exacerbation and type of reparative processes in normal scarring and torpid course of disease are presented . Under adequate regeneration there is an activation of immune system, first that of T-cell compartment . Torpid course is characterized by a grave regeneration disturbance and depression of the immune system . The interpretation of the so-called "red scar" is given: it reflects different stages of the epithelial regeneration, however in 4.8% of duodenal ulcers and in 11.2% of stomach ulcers it masks a torpid course . Helicobacter pylori has no influence on the reparative processes . Adequately chosen therapy improves and accelerates ulcer scarring.

Schweiz Rundsch Med Prax, 1994 Oct 18, 83(42), 1170 - 2
{Differential diagnosis of diarrhea}; Gerok W; Diarrheal disease should be differentiated into acute and chronic forms . Acute diarrhea can most commonly be referred to infectious pathogens and is usually self-limiting . To establish a firm diagnosis is important for patients with special professions, e.g . food-handlers, cooks, etc . In patients with chronic diarrheal disease, the individual case history (e.g . abdominal operations, length and frequency of diarrhea, body weight, medications, etc.) is of paramount importance to differentiate between functional and organic illness . At least half of the patients in general practice suffer from functional, not from organic disease . Endoscopy of the gastrointestinal tract and tests of small bowel function are first-line procedures in patients with chronic diarrhea, followed by additional investigations (hormonal analysis, bacteriological tests, etc.), if indicated in a given patient.

Obstet Gynecol, 1994 Oct, 84(4 Pt 2), 654 - 5
Orogenital contact: a cause of chorioamnionitis?
Dixon NG, Ebright D, Defrancesco MA, Hawkins RE.
BACKGROUND: Fusobacterium nucleatum and Capnocytophaga species are common oral pathogens and infrequent causes of systemic infection in patients with compromised immunity or disrupted mucosal integrity . The isolation of both organisms from a clinical specimen suggests an oral source of infection . CASE: A 23-year-old black woman was admitted at 24 weeks' gestation in preterm labor . She subsequently developed signs of clinical chorioamnionitis, including fever, fetal tachycardia, and uterine tenderness . Bacteriologic studies of the amniotic fluid and subchorionic placental cultures yielded F nucleatum and Capnocytophaga species . On review of the patient's history, a temporal relation was noted between orogenital contact and the onset of clinical infection . Thorough evaluation of the patient, including dental examination, did not reveal an obvious source of infection . However, significant periodontal disease was identified in her partner . CONCLUSION: The concomitant finding of these two organisms in the patient's amniotic fluid and a history of periodontal disease in her partner suggests that chorioamnionitis may have been due to an ascending infection after orogenital contact.

Mem Inst Oswaldo Cruz, 1994 Oct-Dec, 89(4), 581 - 6
Helicobacter pylori in dyspeptic children and adults: endoscopic, bacteriologic and histologic correlations; Solari CA et al.; Using different bacteriological (urease test, Gram staining and culture) and histological (Steiner staining and modified Giemsa staining) techniques, we searched for the presence of Helicobacter pylori in the gastric antrum of 200 dyspeptic Brazilian patients (106 females and 94 males aged 19 days to 81 years) . The presence of bacteria was then correlated with the endoscopic and histological findings . H . pylori was present in 59.5% of the population studied . In Brazil, colonization occurs early, involving 37% of the dyspeptic population by 20 years of age . The presence of H . pylori in the gastric antrum was strongly associated with duodenal ulcer (P < 0.001) and a normal endoscopic examination did not exclude the possibility of colonization of the gastric antrum by H . pylori . The most sensitive test was the preformed urease test (89%) . We conclude that more than one diagnostic method should preferably be used for the detection of H . pylori and that the presence of H . pylori is closely correlated with active chronic gastritis (P < 0.001).

HNO, 1994 Oct, 42(10), 643 - 6
{Initial clinical experience with taurolidin instillation into the area of the middle area}; Reisser C et al.; In this pilot study 2% taurolidin solution was used for irrigation of infected ears and instillation topically in 10 patients with severe purulent otitis media . The main purpose of the study was to find out whether the application of the taurolidin solution into the middle ear would cause significant pain or not . A slight increase in local pain was found sporadically but was not reason for withdrawing the drug . Twelve of 13 bacterial species isolated prior to treatment were eliminated during the trial, with the otorrhea of most patients stopping after just the first instillation . Audiometric evaluations during and 30 months after therapy did not reveal any ototoxic side effects . Tinnitus was not experienced by any patient during therapy . Overall findings demonstrated that local therapy with taurolidin for patients with severe purulent otitis media was very well tolerated and effective bacteriologically . There were also no therapy-related complications or ototoxic side effects.

Burns, 1994 Oct, 20(5), 409 - 15
Haematology reports of routine blood films in patients with burns; Topley E et al.; A retrospective pilot study of 99 peripheral blood films from 27 patients with burns is reported . Abnormalities of the granular leucocyte series were more common in the more extensive burns and usually preceded bacteriological evidence of wound pathogens or a clinical decision to take a blood culture . The evidence suggests that a prospective study is needed to determine the possible clinical value of reporting such granulocyte abnormalities . Abnormalities of the myelo-monocytic and lymphocyte cell lines were sufficiently frequent to permit fundamental research of possible relevance not only to patients with burns but in other host responses such as in sepsis, malaria or AIDS.

Eur J Clin Microbiol Infect Dis, 1994 Oct, 13(10), 851 - 6
Efficacy and safety of cefprozil versus other beta-lactam antibiotics in the treatment of lower respiratory tract infections; Ball P; Cefprozil was evaluated in four multicentre comparative studies in the treatment of acute respiratory tract infections . In two studies, cefprozil 500 mg q . 12 hours was compared to cefaclor 500 mg q . eight hours for ten days of therapy . Randomization was on a 2:1 (cefprozil:cefaclor) basis in the European centres and 1:1 in North America . The clinical efficacy in acute bronchitis was 88% (284 out of 324 patients) for cefprozil and 88% (183 out of 208) for cefaclor, with successful bacteriological eradication of the causative pathogen in 86% and 82% of the patients, respectively . Amongst the patients with acute exacerbations of chronic bronchitis, the clinical response rate of 80% (59 out of 74) for cefprozil appeared superior to that of cefaclor at 62% (p = 0.067), whilst the bacteriological response rates were 62% (36 out of 58) for cefprozil and 74% (20 out of 27) for cefaclor . In pneumonia, the clinical response rates for cefprozil and cefaclor therapy were similar, 82% vs . 79%, although bacteriological eradication rates were better for cefprozil at 82% than for cefaclor at 71% . In the comparison of cefprozil with cefuroxime axetil, a total of 170 patients were evaluable . The clinical and bacteriological response rates for cefprozil of 95% and 100% were better than those for cefuroxime axetil 500 mg q . 12 hours of 84% and 75%, respectively . In the cefprozil vs . amoxicillin-clavulanate, 500 mg q . eight hours comparative study, the two antibiotics displayed no significant difference in clinical or bacteriological responses.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1994 Oct, 34(4), 565 - 77
Piperacillin/tazobactam compared with ticarcillin/clavulanate in community-acquired bacterial lower respiratory tract infection; Shlaes DM et al.; The efficacy and safety of a new combination parenteral antibiotic, piperacillin/tazobactam, was compared with that of parenteral ticarcillin/clavulanate in the treatment of adult patients with community-acquired lower respiratory tract infections . A total of 299 patients were enrolled in this multicentre, double-blind, comparative study; 177 received piperacillin/tazobactam and 122 received ticarcillin/clavulanate . Of these, 119 met the evaluability criteria (69, piperacillin/tazobactam and 50, ticarcillin/clavulanate) . The study drugs (piperacillin/tazobactam 3 g/375 mg or ticarcillin/clavulanate 3 g/100 mg) were given every 6 h by slow iv infusion for a minimum of 5 days . The favourable clinical response (cured and improved) rates of evaluable patients were 84% and 64% at endpoint (P < 0.01) for piperacillin/tazobactam and ticarcillin/clavulanate, respectively . The favourable bacteriological response at the early follow-up (eradicated and presumed eradicated) were 91% and 67% for piperacillin/tazobactam and ticarcillin/clavulanate, respectively (P < 0.01) . At endpoint, 84% and 64%, respectively (P = 0.02) had a favourable response . The most common adverse experiences involved the gastrointestinal tract and occurred in 31.6% of the piperacillin/tazobactam group compared with 20.5% in the ticarcillin/clavulanate group (P = 0.02) . These events were mild and generally did not affect therapy . Piperacillin/tazobactam appears to be more effective than ticarcillin/clavulanate in this patient population and is generally well tolerated.

J Chemother, 1994 Oct, 6(5), 322 - 7
Therapeutic efficacy and tolerability of brodimoprim in comparison with doxycycline in acute sinusitis in adults; Arndt J et al.; OBJECTIVE: To compare efficacy and tolerability of brodimoprim tablets with doxycycline tablets in adults with acute sinusitis . DESIGN: Open, randomized, controlled phase III study, with parallel groups . PATIENTS: Of the 70 enrolled patients, 56 adults of both sexes with a mean age of 33 years were evaluable . STUDY DRUGS: One brodimoprim 200mg tablet or one doxycycline 100mg tablet was administered once daily for 8 to 12 days (on the first treatment day all patients received the loading dose consisting of 2 tablets of the corresponding compound) . CLINICAL OUTCOME: In the brodimoprim group 96.4% of the patients were judged cured/improved; in the doxycycline group 96.2% . BACTERIOLOGICAL OUTCOME: Eradication of the causative pathogen/s was achieved in 87.5% of the patients treated with brodimoprim and in 60% of the doxycycline group . SAFETY OUTCOME: Tolerability was judged as very good/good in 89.7% of the patients treated with brodimoprim and in all patients receiving doxycycline . Gastrointestinal skin, CNS and various other reactions were reported by 13 patients; 3 of them had to discontinue treatment . Discontinuation of therapy: 8 more patients withdrew from the study due to inactivity of the compound or reasons unrelated to the drugs . CONCLUSION: Brodimoprim was shown to be effective in the treatment of acute sinusitis in adults, its efficacy being equal to that of doxycycline . The assessments showed a positive clinical response to the medication in 96.4% of the patients treated with brodimoprim and 96.2% of the patients taking doxycycline . Both compounds were well tolerated and all side effects were of mild nature and reversible.

Indian J Med Res, 1994 Oct, 100, 167 - 71
Evaluation of PCR based test for the detection of Mycobacterium tuberculosis in coded sputum specimens; Khandekar P et al.; A test based on amplification of 169 bp DNA specific to Mycobacterium tuberculosis was evaluated in a trial, on 50 coded samples which included 25 sputum specimens from radiologically, clinically and bacteriologically proven patients of pulmonary tuberculosis and 25 control specimens . At the end of the trial the code was broken and the results of PCR test were compared with those obtained with Ziehl Neelsen staining and culture test . The test appeared highly sensitive reacting 100 per cent in either of the hands with concordance rate of 76 per cent; 3 of 25 control samples gave false positive results.

Tuber Lung Dis, 1994 Oct, 75(5), 341 - 7
Rifabutin for the treatment of newly-diagnosed pulmonary tuberculosis: a multinational, randomized, comparative study versus Rifampicin . Rifabutin Study Group; Gonzalez-Montaner LJ et al.; SETTING: Patients with newly-diagnosed drug-sensitive, radiographically active and bacteriologically confirmed pulmonary tuberculosis recruited at 6 centres in Argentina, Brazil and Thailand . OBJECTIVE: To assess the efficacy, tolerability and toxicity of two regimens containing different daily dosages of rifabutin in comparison with rifampicin . DESIGN: Multicentred, randomised, comparative study . In each group, study medications were administered daily for 6 months combined with isoniazid (6 months), and with pyrazinamide and ethambutol (both stopped after 2 months) . Treatment success patients were followed-up for up to 2 years . RESULTS: A total of 520 patients were enrolled and randomly assigned to receive either rifampicin (n = 175), or rifabutin 150 mg (n = 174) or rifabutin 300 mg (n = 171) . Considering all patients with positive baseline culture, the success rates at the last valid observation for each patient were 89%, 94% and 92% in the rifampicin, rifabutin 150 mg, and rifabutin 300 mg groups, respectively . The median time to culture conversion was comparable in the 3 groups and was 34 days for rifampicin and 37 days for each of the rifabutin groups . During the drug-free follow-up period, one relapse occurred in the rifampicin group, and two in each of the rifabutin groups . The 3 treatment schedules appeared well tolerated . No patients had to discontinue therapy because of an adverse event in the rifabutin 150 mg group, compared to one in the rifampicin and 5 in the rifabutin 300 mg group . CONCLUSION: All 3 regimens proved effective and well tolerated . Rifabutin at 150 mg/d showed the best risk-to-benefit ratio, in that this group had the highest proportion of patients completing treatment, the highest bacteriological conversion rates and the lowest incidence of adverse events.

Lab Anim, 1994 Oct, 28(4), 313 - 9
Diarrhoea and increased intestinal permeability in laboratory beagles associated with proximal small intestinal bacterial overgrowth; Morris TH et al.; Repeated episodes of diarrhoea were seen in 4 laboratory beagles after experimental renal surgery and feeding a modified diet . Small intestinal bacterial overgrowth (SIBO) was suspected by exclusion of other causes and measurement of plasma folate . SIBO was confirmed by quantitative duodenal bacteriology . Beagles with SIBO can show no clinical signs, experimental stress and dietary change may have been reasons why these 4 beagles exhibited clinical signs with SIBO . Despite normal gut histology an increase in gut permeability was found using sugar absorption tests . This increased permeability had the potential to cause variations in drug absorption during experimental studies.

Indian J Gastroenterol, 1994 Oct, 13(4), 139 - 40
Evaluation of culture techniques for detection of spontaneous bacterial peritonitis in cirrhotic ascites; Pawar GP et al.; This prospective study was done in cirrhotic patients to evaluate ascitic fluid culture techniques by the conventional method and by an alternate method of bedside ascitic fluid inoculation into blood culture bottles, with an aim to improve bacteriological diagnosis of spontaneous bacterial peritonitis (SBP) . Of the 300 patients who were evaluated, 43 who had a total leukocyte count greater than 500/mm3 or a polymorphonuclear cell count greater than 250/mm3 in ascitic fluid were included . There were 30 episodes of SBP in 28 patients and another 15 patients had culture-negative neutrocytic ascites (CNNA) . Escherichia coli was the commonest organism cultured, being found in 60% . There was significantly greater (p < 0.001) ascitic fluid culture positivity with direct inoculation into blood culture bottles, i.e . 66.7% compared to 31.1% by conventional method at 48 hours, and this was evident even 24 hours after inoculation i.e . 33.3% positivity compared to 4.4% . Bacteremia was present in 53.3% of patients with SBP and 33.3% with CNNA . Ascitic fluid inoculation directly into blood culture bottles leads to a significantly increased percentage of culture positivity and reduces the time needed for detection of SBP from 48 to 24 hours.

Minerva Pediatr, 1994 Oct, 46(10), 429 - 36
{High incidence of Helicobacter pylori infections in an endoscopic pediatric patient series}; Bonamico M et al.; We evaluated in children with abdominal complaints the prevalence of Helicobacter pylori gastric and duodenal colonization and the histological features of gastric and duodenal mucosae . Fifty patients, aged 1-17 years, underwent upper endoscopy for recurrent abdominal pain, vomiting and/or gastrointestinal bleeding . With serological, bacteriological and/or histological methods twenty-eight children were demonstrated to be Helicobacter pylori-positive . No statistically significant differences were observed with regard to age, sex and indication to perform endoscopy . Eighty-two percent of Helicobacter pylori-positive patients had gastritis and/or duodenitis . The Helicobacter pylori-positive children had higher Helicobacter pylori specific IgG levels than the Helicobacter pylori-negative ones (p < 0.001) . No statistically significant differences were found between Helicobacter pylori-positive and Helicobacter pylori-negative subjects, for gastrin and pepsinogen I . Since the frequency of Helicobacter pylori infection in children with gastrointestinal complaints is high, in patients undergoing upper endoscopy, the sistematical examination of bioptic samples for bacteriological and histologic procedures is of great importance.

Jpn J Antibiot, 1994 Oct, 47(10), 1318 - 28
{A comparative study of imipenem/cilastatin sodium BID vs QID in the treatment of infections associated with hematopoietic disorders}; Sawae Y et al.; Using the envelope method, we allocated 125 patients with infections accompanied by hematopoietic disorders into two groups treated with imipenem/cilastatin sodium (IPM/CS) at a daily dose of 1 g/1 g b.i.d . (group BID) or 0.5 g/0.5 g q.i.d . (group QID), and obtained the following results . 1 . In group BID, ANLL was observed in 25 patients; ALL in 6; and NHL in 12 . In group QID, ANLL was observed in 27 patients; ALL in 7; and NHL in 13 . 2 . In group BID, efficacy rates were 54.5% (6/11) in sepsis, 63.0% (17/27) in fever of undetermined origin and 50.0% (4/8) in pneumonia, thus the overall efficacy was 61.8% (34/55) . In group QID, efficacy rates were 66.7% (4/6) in sepsis, 76.0% (19/25) in fever of undetermined origin and 35.7% (5/14) in pneumonia, thus the over all was 61.1% (33/54) . No significant difference in response rates were observed between the two groups . 3 . Bacteriologically, 22 bacterial strains were isolated in group BID and 21 21 strains, in group QID . The eradication rates after treatment with IPM/CS was 100% in group BID and 66.7% in group QID . 4 . Side effects were observed in 8 patients in group BID and 3 in group QID . Laboratory examination revealed abnormal values in 9 patients in group BID and 6 in group QID . However, all of the side effects disappeared after the suspension or discontinuation of IPM/CS . The efficacies of IPM/CS therapy for severe infections in patients with hematopoietic disease were similar between 1 g/1 g b.i.d . and 0.5 g/0.5 g q.i.d . groups.

Kekkaku, 1994 Oct, 69(10), 621 - 5
{A case of pulmonary tuberculosis developed immediately after a chest wall injury}; Koga H et al.; A 75-year-old female was admitted to our hospital for further examination of the cause of blood-stained sputum and abnormal shadow on chest radiogram which had developed immediately after an injury of right chest wall . The bacteriological examination of sputum on admission revealed negative Gaffky score, but positive PCR, and Mycobacterium tuberculosis was isolated by culture . Her symptoms and chest radiogram were improved by the administration of isoniazid, ethambutol and rifampicin . Although development of pulmonary tuberculosis induced by chest wall injury is rare, in case of the aged persons such possibility should be considered . PCR may be useful for rapid diagnosis of tuberculosis, even in such case.

Khirurgiia (Mosk), 1994 Oct, (10), 12 - 5
{Anaerobic paraproctitis}; Koplatadze AM et al.; The authors had 80 patients, most of them (90%) of an old age, with anaerobic paraproctitis . Delayed hospitalization was encountered in 62 cases, in 16 of these cases an erroneous diagnosis had been established . Severe concomitant diseases complicated the course of anaerobic paraproctitis in 80% of cases (in each group of three patients one had diabetes mellitus) . The authors describe characteristic clinical manifestations and the course of various forms of anaerobic paraproctitis, the results of bacteriological examination, and the order in which the surgical treatment is applied . They suggest a scheme of drug therapy which is maximally approximated to cleansing of a microbial cenosis, including ultraviolet irradiation of the blood . All these measures allowed the mortality rate to be decreased from 33.3% to 17.7%.

Zentralbl Veterinarmed B, 1994 Oct, 41(7-8), 492 - 503
{Detection of Chlamydia psittaci in vaginal discharge of cows: a necessary enlargement of bacteriologic diagnosis for the etiologic clarification of fertility disorders in the female cow}; Wittenbrink MM et al.; Vaginal discharge from 119 dairy cows from 59 herds was examined bacteriologically, including application of the IDEIA Chlamydia test, to detect genus-specific chlamydial LPS-antigen . A putrid quality of specimens was closely correlated with isolation of Actinomyces pyogenes (p < 0.001) . The IDEIA was positive for 39 of 65 (60.0%) non-putrid specimens and for 16 of 54 (29.6%) putrid specimens; a non-putrid quality of specimens was closely correlated with the detection of chlamydial antigen (p < 0.01) . IDEIA-positive results were confirmed by a blocking-antibody assay and by polymerase chain reaction (PCR) using a set of primers based on the 16S rRNA sequences of Chlamydia psittaci . Chlamydia-positive non-putrid specimens generally yielded no other bacterial pathogens . The clinical history of repeat breeding and endometritis, as well as failure to isolate other bacterial pathogens on routinely used non-living media, were strongly suggestive of primary chlamydial involvement in these cases.

Wiad Lek, 1994 Oct, 47(19-20), 756 - 62
{Evaluation of the effectiveness of cefazolin++ (Kefzol) in preventing infections in patients after abdominal surgery}; Chaber A et al.; The purpose of the work as an assessment of the effectiveness of cefazolin (Kefzol) in preventing infections in patients after abdominal surgery . The prospective studies included 200 patients, out of whom in 100 patients in the studied group Kefzol was administered prior to and for 24 hours after operation, while in 100 patients in the control group no prevention was used . The percent of infections in the studied group was lower in comparison to the control group (9% vs 25%, p < 0.01) . A statistically significant reduction was obtained of wound infection per cent from 19% in the control group to 7% in the studied group, including a reduction from 14.3% to 3.1% after operations on the gall bladder and bile ducts, and from 18.2% to 11.1% after gastroduodenal operations . The per cent of wound infections after appendectomy was 5.9% in the patients from the studied group receiving prophylactically Kefzol with metronidazole, and 20.6% in the patients from the control group . Bacteriological investigations, demonstrated that 87.5% bacterial strains were susceptible to cefazolin . In the authors' opinion cefazolin (Kefzol) is effective in the prevention of purulent complications, and the reduction of the per cent of infections causes lowering of treatment cost.

Ugeskr Laeger, 1994 Sep 12, 156(37), 5276 - 8
{Should the presence of Mycobacterium tuberculosis be demonstrated before the treatment of patients with suspected pulmonary tuberculosis?}; Norregaard J et al.; In Denmark, treatment of tuberculosis is generally only recommended if the diagnosis is confirmed bacteriologically, which may cause a delay in treatment . We investigated the duration of the treatment delay, and if the delay would cause any serious health problems for the individual or risk of contact infections by a retrospective examination of 324 cases of pulmonary tuberculosis . The mean treatment delay was longer in older age groups . Regarding death due to delay, we found no risk for the patients who are not weakened by old age or another disease . Only 11 (3.6%) above the age of ten years were treated without bacteriological confirmation (1% for Danes) . The infection risk from the smear negative, but culture positive patients was minimal, as only one subject was definitely infected from a smear negative subject . In conclusion, we find the epidemiologic and individual risk sufficiently low to continue our rather restrictive treatment policy.

Vet Rec, 1994 Sep 10, 135(11), 254 - 6
Brucella ovis infection in two flocks of sheep; Marco J et al.; Brucella ovis infection could not be eradicated from two flocks of sheep despite serologically testing and culling the infected rams for four years . The hypothesis that the ewes played a major role in the maintenance of the infection in both flocks was investigated by using serological, bacteriological and pathological criteria . Specific antibodies against B ovis were demonstrated in 71 ewes in the two flocks . Forty-four of the seropositive ewes were slaughtered for bacteriological and pathological studies and B ovis was isolated from 16 of them; the uterus was the target organ of the infection, although extrauterine infection was also demonstrated in some of the infected ewes.

Curr Opin Ophthalmol, 1994 Oct, 5(5), 78 - 83
Lacrimal disease; Wesley RE; Several authors have investigated the success of nasolacrimal duct intubation in children as well as the length of time for tubes to remain in place . The treatment of congenital amniocele with potential for life-threatening septicemia has been investigated . Other topics have included the bacteriology of dacryocystitis emphasizing the risk of endophthalmitis after intraocular surgery, balloon treatment for functional nasolacrimal duct obstruction, anatomical measurements of the lacrimal system relative to intracranial space, and new procedures for punctal stenosis . Diagnostic tests for epiphora and methods of punctal occlusion are evaluated.

Lepr Rev, 1994 Sep, 65(3), 222 - 30
The role of antiperipheral nerve antibodies in nerve damage in leprosy; Desikan P et al.; The objective of this study was to determine the role of antineural antibodies in leprosy . Indirect ELISA using antigen prepared from normal human peripheral nerves was carried out on the sera from 100 leprosy patients and 18 normal controls . In total, 9% of the patients had demonstrable levels of IgG antineural antibodies and 11% had demonstrable levels of IgM antibodies . There was no correlation with the type of leprosy, bacteriological index, treatment taken, the presence of a reactional state, the presence of enlarged nerves or active neuritis.

Lepr Rev, 1994 Sep, 65(3), 181 - 9
Ofloxacin-containing combined drug regimens in the treatment of lepromatous leprosy; Rao PS et al.; A total of 26 clinically diagnosed adult patients, with active untreated lepromatous leprosy, with a Bacteriological Index of 4+ or more, were admitted to the hospital of the Central Leprosy Teaching and Research institute, Chengalpattu, India, between 1989 and 1991 . After prescribed investigations, the patients were randomly allocated in groups of 3 to 3 treatment regimens, namely: 1, clofazimine 50 mg daily and 300 mg once in 4 weeks + dapsone 100 mg daily (AA); 2, (AA)+ofloxacin 400 mg daily (BB); and 3, (AA)+ofloxacin 800 mg daily (CC) . The drugs were administered for 56 days continuously under supervision . Sequential biopsy results on day 0, 7, 14, 28 and 56 in normal mouse footpad revealed no growth by day 28 and 56 in all patients treated with CC and BB regimens, respectively . Calculation of the proportion of viable Mycobacterium leprae through analysis of median infectious dose (ID50) showed significant differences on day 7 in the percentage of kill between the ofloxacin-containing regimens and the other . Moderate to marked clinical improvement has been observed in a significantly higher proportion of patients treated with ofloxacin-containing regimens . All the 3 regimens were well tolerated . No severe complications or side-effects to the drugs were noticed with any of the regimens that required any suspension of treatment or the administration of steroids . Addition of ofloxacin to the standard WHO recommended MDT regimen for multibacillary patients may reduce the present duration of therapy . Ofloxacin may also be considered as an alternative drug in rifampicin-resistant cases or where rifampicin is contraindicated.

Am J Respir Crit Care Med, 1994 Sep, 150(3), 776 - 83
Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill; Rouby JJ et al.; The incidence of infectious maxillary sinusitis (IMS) and its clinical relevance was prospectively studied in 162 consecutive critically ill patients who were mechanically ventilated for a period longer than 7 d . All had a paranasal computed tomographic (CT) scan within 48 h of admission and were divided into three groups according to the radiologic aspect of their maxillary sinuses: Group 1 = normal maxillary sinuses (n = 40), Group 2 = maxillary mucosal thickening (n = 26), Group 3 = radiologic maxillary sinusitis (RMS) defined as the presence of an air fluid level and/or opacification of maxillary sinuses (n = 96) . Group 1 patients were randomized between nasal and oral endotracheal intubation with a gastric intubation performed via the same route and had a second paranasal CT scan 7 d later . Endotracheal and gastric tubes were left in their original position in Group 2 patients and a second paranasal CT scan was performed 7 d later . All patients of Group 3 underwent a transnasal puncture for bacteriologic analysis of maxillary sinus content . Forty-five spontaneously breathing patients served as a control group . In all patients with RMS, the occurrence of bronchopneumonia (BPN) was prospectively assessed for 7 d following the initial CT scan . Upon inclusion, only 25% of the patients had normal maxillary sinuses whereas all patients in the control group had normal paranasal CT scans . After 7 d, 46% of Group 2 patients had evidence of RMS . Risk factors for RMS were nasal placement and duration of endotracheal and gastric intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Monaldi Arch Chest Dis, 1994 Sep, 49(4), 327 - 45
Treatment of tuberculosis and tuberculosis infection in adults and children . American Thoracic Society; Long-term evaluation of immune status in leprosy patients undergoing multiple drug therapy; Department of Immunology, National Institute of Hygiene and Epidemiology, Hanoi, VietnamA long-term survey of leprosy patients of all clinical types, starting at the time of diagnosis, was carried out to monitor clinical, bacteriological and immunological parameters at regular intervals during multiple drug therapy (MDT) . The patients were assigned to two groups for treatment following WHO guidelines: paucibacillary (PB) and multibacillary (MB) . Immunoglobulin levels, specific antibodies, skin-test responses to different soluble mycobacterial antigens (new tuberculins), and in vitro proliferative responses to mitogens and to antigens were measured during treatment, as were clinical changes, the bacterial index, and clinical improvement . No exact relations between disease activity and IgM antibody levels, both IgM immunoglobulin and specific IgM antibody to a species-specific antigen (ND-O-BSA), could be seen for MB patients . Changes in in vitro cell-mediated immunity and skin-test response seemed to be more directly related to the bacterial load and could reflect the improvement of bacteriological and clinical parameters during MDT.

Nippon Koshu Eisei Zasshi, 1994 Sep, 41(9), 938 - 44
{Analysis of prevalence over-estimates for tuberculosis in Okayama Prefecture}; Mouri Y; In order to clarify the over-estimates in prevalence rates of tuberculosis, patients originally registered as having tuberculosis and later cancelled from the registration due to change of diagnosis were analyzed . The results were as follows: 1) The patients reclassified due to a change in diagnosis accounted for 6.3% of all reclassified patients . Of all the patients cancelled by the change of diagnosis, the proportion diagnosed as having atypical mycobacteriosis was largest . 2) The patients cancelled due to a change in diagnosis accounted for 6.0% of the patients newly registered as having tuberculosis . 3) The prevalences of all tuberculosis, pulmonary tuberculosis, infectious pulmonary tuberculosis and of bacteriologically positive pulmonary tuberculosis were significantly reduced by corrective adjustments . 4) Analysis for method by which diagnosis was obtained showed that there was a larger proportion of those patients who were reclassified due to change in diagnosis who were diagnosed by mass screening, compared to those reclassified due to correction of disease . The prevalence of cavities was less among the former group than the latter.

Arch Pediatr, 1994 Sep, 1(9), 813 - 5
{Stomatococcus mucilaginosus meningitis in immunocompromised child}; Ben Salah H et al.; BACKGROUND--Opportunistic infections are responsible for significant morbidity and mortality in patients with malignancy developing granulocytopenia as a result of therapy . A case of Stomatococcus mucilaginosus meningitis is reported . CASE REPORT--A 2 year-old boy was admitted because he had developed fever and neutropenia during chemotherapy given for neuroectodermal tumor . He was previously treated for a Stomatococcus mucilaginosus septicemia with vancomycin given for 15 days through an intravenous catheter which has subsequently been left in place . At admission, fever was associated with severe degree of aplasia (70 WBC/mm3) . The patient was given IV ceftazidime plus amikacin . Two days later, the boy developed acute meningitis due to Stomatococcus mucilaginosus; he was then given IV vancomycin (40 mg/kg/d) and imipenem (100 mg/kg/d) . Persistence of abnormal clinical and bacteriological findings required subsequent intrathecal administration of vancomycin (1.5 mg/d) for 5 days . CSF cultures were negative 2 days later, leading to stop IV antibiotics after 3 weeks . The catheter was removed 1 week later . CONCLUSION--This patient represents the third reported case of Stomatococcus mucilaginosus meningitis . Combined intrathecal and systemic administration of vancomycin seems to have been useful in our case.

Nippon Geka Gakkai Zasshi, 1994 Sep, 95(9), 669 - 77
{The role of intestinal flora in the pathogenesis of infection and aggravation of experimental acute pancreatitis in rats}; Iwasaki G et al.; This study was undertaken to determine the role of bacterial translocation in the pathogenesis of infection and aggravation of the course of experimental acute pancreatitis in rats . Acute pancreatitis was induced by the injection of 3% sodium taurocholate . The rats were divided into following 3 groups: acute pancreatitis only (AP), total colectomy + pancreatitis (TCAP), acute pancreatitis with ED preparation (EDAP) . The positive rate of bacteriological culture of pancreatic tissue was 40.7% at 24 hours in AP group and 50.0% in EDAP group, but in TCAP group, pancreatic tissue was sterile at 6.12 hours and at 24 hours positive rate was only 6% . There was a significant reduction of bacterial contamination in TCAP group compared with AP and EDAP groups . In the bacteriological culture of the liver, spleen and MLN, bacterial contamination was reduced in TCAP group . Blood endotoxin level elevated gradually compared to the level before induction of acute pancreatitis . At 24 hours, there was a significant difference between TCAP group and EDAP group . In TCAP group, survival rate was improved at 24 hours compared to AP group and EDAP group . Infectious complication during the experimental acute pancreatitis in rats can be explained by the bacterial translocation of intestinal flora, especially colonal bacteria, which may result in aggravation of pancreatitis.

J Pharm Biomed Anal, 1994 Sep, 12(9), 1063 - 8
Determination of thymidine, uracil and p-aminobenzoic acid in bacteriological cultures by capillary zone electrophoresis; Richards RM et al.; A capillary zone electrophoresis assay has been developed which simultaneously separates and quantifies the bacterial metabolites thymidine, uracil and p-aminobenzoic acid present at bacteriologically relevant concentrations in a supplemented minimal bacteriological medium . Sulphadiazine was used as the internal standard.

Am J Med, 1994 Aug 15, 97(2A), 9 - 13
Secondary bacterial infections in HIV-infected patients: an alternative ambulatory outpatient treatment utilizing intravenous cefotaxime; Morales JO et al.; The purpose of this study was to determine the safety and efficacy of home intravenous antibiotic therapy in treating secondary bacterial infections in patients infected with the human immunodeficiency virus (HIV) . This study was a subset analysis of 22 patients with HIV, enrolled in two centers of a multicenter, open-label, prospective study . When necessary, patients were stabilized as inpatients, followed by home therapy . Enrolled patients had diagnoses of pneumonia, skin and soft-tissue infections, bacteremia/septicemia, or other infections requiring parenteral therapy . A third-generation cephalosporin, cefotaxime, 1-2 g every 8 hours, was delivered intravenously using an ambulatory delivery system (ADS) . Home therapy with cefotaxime/ADS produced a clinical response rate of 95% and bacteriologic response of 88.2% . The requirement for and duration of inpatient therapy was markedly reduced compared with diagnosis-related group (DRG) allotments . In conclusion, home intravenous antibiotic therapy with cefotaxime in patients infected with HIV is effective and safe . It may improve quality of life by reducing the length of hospital stay.

Am J Med, 1994 Aug 15, 97(2A), 43 - 9
Outpatient antibiotic therapy for elderly patients . HIAT Study Group; Angel JV; The purpose of this study was to determine the safety and efficacy of outpatient intravenous (IV) therapy with a third-generation cephalosporin, cefotaxime, in patients > or = 60 years of age and to determine its effect on length of hospital stay . Subset analysis was performed with 62 patients with various infections who had been enrolled in a prospective, multicenter, open-label trial of IV cefotaxime delivered through a computerized ambulatory delivery system (ADS) . Initial treatment was given in hospital if required, followed by home therapy . The overall clinical response rate among evaluable patients was 98%, and the overall bacteriologic response rate was 93% . The mean duration of inpatient therapy was 3.6 days less than the mean of 8.2 days allowed under diagnosis-related group (DRG) allotments . Outpatient therapy with cefotaxime via infusion pump is safe and effective and may reduce hospitalization requirements.

Am J Med, 1994 Aug 15, 97(2A), 34 - 42
Treatment of serious infections with cefotaxime utilizing an outpatient drug delivery device: global analysis of a large-scale, multicenter trial . HIAT Study Group; Poretz DM; The primary objective of this multicenter, prospective trial was to determine the safety, efficacy, and cost effectiveness of cefotaxime delivered via an ambulatory delivery system (ADS) in the treatment of patients with a variety of bacterial infections . The secondary objective was to determine the safety and efficacy of cefotaxime/ADS treatment of infections in a diabetic subgroup . A total of 238 patients (> or = 18 years) in five infection categories were enrolled from 10 sites . All patients received cefotaxime/ADS . Both global analysis and analysis of a subpopulation with diabetes mellitus were performed . Of the 211 patients who completed the study, 201 patients (95.3%) exhibited a satisfactory or improved clinical response following cefotaxime/ADS . Bacteriologic response, evaluable in 134 of 211 patients, was satisfactory in 125 of these patients (93.3%) . Within the diabetes mellitus subpopulation, a satisfactory or improved clinical response was identified in 30 of 32 patients (93.8%) . In conclusion, administration of cefotaxime via ADS is a well-tolerated, safe, and clinically effective treatment of serious infection and may be less expensive than inpatient intravenous antibiotic therapy.

Am J Med, 1994 Aug 15, 97(2A), 28 - 33
Efficacy and safety of intravenous cefotaxime for treating pneumonia in outpatients; Morales JO et al.; The treatment of bacterial pneumonia commands a large segment of hospital resources, and economic concerns are dictating shorter hospital stays . This study was designed to determine whether outpatient therapy with intravenous (IV) antibiotics (a third-generation cephalosporin, cefotaxime, delivered via an ambulatory delivery system {ADS}) is as effective as traditional hospital management of pneumonia . A subgroup of 62 patients from three centers, with bacterial pneumonia, were enrolled in a multicenter, open-label study of outpatient IV cefotaxime therapy . Doses of cefotaxime were 1 g IV every 12 hours, 1 g IV every 8 hours, or 2 g IV every 8 hours, based on severity of infection . Of 62 patients, 53 (85%) completed the study . All 22 bacteriologically evaluable patients showed eradication of pathogen or clinical cure with no obtainable follow-up culture; no relapses, reinfections, or superinfections were reported . Overall clinical success rate was 94.8% (satisfactory 75.9%; improved 19.0%, n = 58) . Average length of hospital stay was 2.3 +/- 4.83 days . In conclusion, clinical success rates with outpatient IV cefotaxime therapy were comparable to previous studies with IV cefotaxime for pneumonia treatment in the hospital . Outpatient IV antibiotic therapy has the potential to significantly reduce length of hospital stay for pneumonia without sacrificing clinical efficacy.

Am J Med, 1994 Aug 15, 97(2A), 23 - 7
Treatment of skin and soft-tissue infections utilizing an outpatient parenteral drug delivery device: a multicenter trial . HIAT Study Group; Poretz DM; The purpose of this study was to examine the safety and efficacy of outpatient intravenous antibiotic therapy for skin and soft-tissue infections and determine its effect on length of hospital stay . In this open-label, multicenter, prospective study, 130 adult patients with skin and soft-tissue infections requiring parenteral antibiotic therapy were enrolled as a subgroup . Initial therapy was delivered to hospital inpatients or in outpatient treatment centers, followed by home infusion therapy . Cefotaxime was delivered intravenously using a programmable ambulatory infusion pump . The clinical response rate was 97.5% (n = 118), while the bacteriologic response rate was 94.0% (n = 83) . Only 32.2% of patients required hospitalization, and the mean duration of inpatient care for all evaluable patients was only 1.5 days . The mean duration of hospitalization for patients receiving inpatient care was 4.7 days . In conclusion, home intravenous cefotaxime therapy is safe, effective, and may reduce healthcare costs for many patients with skin and soft-tissue infections.

Vet Rec, 1994 Aug 13, 135(7), 154 - 6
A field study of ovine bacterial meningoencephalitis; Scott PR et al.; Bacterial meningoencephalitis most commonly affected lambs two to four weeks old (median three weeks, range three days to six months) with clinical signs of episcleral congestion, lack of suck reflex, weakness, altered gait and depression extending to stupor, but hyperaesthesia to auditory and tactile stimuli . Opisthotonos was observed during the agonal stages of the disease . Analysis of lumbosacral cerebrospinal fluid revealed a highly significant increase in protein concentration (P < 0.01) with a neutrophilic pleocytosis, but bacteriological culture yielded organisms in only a few cases . A response was achieved with high doses of dexamethasone and chloramphenicol in only one of 20 cases . Polyarthritis and liver abscesses in a number of lambs provided evidence of a previous bacteraemic or septicaemic episode but no definite source of the central nervous system infection was identified . In common with other infectious bacterial conditions which are prevalent during the early life of sheep, control measures should ensure an adequate transfer of passive antibody, repeated treatments of the navel, and hygienic conditions in the lambing and rearing environments.

Schweiz Med Wochenschr, 1994 Aug 9, 124(31-32), 1381 - 4
{Helicobacter pylori resistance against metronidazole in Switzerland: implications for eradication therapy?}; Sieber CC et al.; Gastroduodenal ulcers are strongly associated with Helicobacter pylori (HP) infection . Successful eradication drastically diminishes ulcer recurrence . Most of the eradication schemes include metronidazole (Flagyl) . The present study was designed to establish the metronidazole resistance rate in Switzerland . Antral biopsies were taken in 153 patients with suspected ulcers (115 men, 38 women, mean age 46 +/- 16 {SD} years) during upper endoscopy for bacteriological testing . Metronidazole resistance (> 8 micrograms/ml) was found in 47/153 (31%) of the isolates . Resistance was found in no case to amoxicillin (Clamoxyl) (0/104 = 0%) and only in 3% (2/66) to clarithromycin (Klazid) . Metronidazole resistance of HP in a third of the isolates studied is comparable to numbers found in other European countries . These findings raise the question whether eradication schemes including metronidazole without prior sensitivity testing are justified . Amoxicillin and clarithromycin appear to be valid alternatives.

Intensive Care Med, 1994 Aug, 20(7), 496 - 9
Malassezia furfur-related colonization and infection of central venous catheters . A prospective study in a pediatric intensive care unit; Sizun J et al.; OBJECTIVE: To determine the incidence of Malassezia furfur-related colonization and infection of central venous catheters . DESIGN: Prospective clinical study . SETTING: A paediatric intensive care unit at a University Hospital . PATIENTS: 66 newborns with central venous catheters for parenteral nutrition including lipid emulsions (Intralipid) . METHODS: When a central venous catheter was removed, it was rinsed with 1 ml of physiological saline, transported at ambient temperature to the clinical laboratory and cultured on Dixon's medium . The tip of the central venous catheter was used for a bacteriological study using Maki's technique . In case of suspected sepsis, blood cultures were obtained using an Isolator tube . RESULTS . 74 central venous catheters were included: mean duration of use of a central venous catheters and infusions of lipid emulsion (Intralipid) were 19.3 +/- 10 days and 8.6 +/- 8 days respectively . Only 2 central venous catheters (2.7%) were colonized by Malassezia furfur: (Mf) one in an asymptomatic newborn, and the other in an infected newborn with signs of sepsis, who most probably died at 4 months of age from refractory hypoxia due to pulmonary hypoplasia, but not from Mf sepsis . CONCLUSIONS: The incidence of Malassezia furfur-related colonization of central venous catheters appears to be low but not negligible, which warrants the use of specific culture techniques.

J Clin Microbiol, 1994 Aug, 32(8), 1835 - 40
Evaluation of allergic and serological tests for diagnosing Brucella melitensis infection in sheep; Blasco JM et al.; A total of 291 unvaccinated sheep from Brucella melitenesis-infected flocks were examined for delayed-type hypersensitivity (DTH) responses with Brucellergene commercial allergen and with cold saline extract and cytosol from rough B . melitensis 115, and their sera were tested in the rose bengal test (RBT), complement fixation test (CFT), and enzyme-linked immunosorbent assay (ELISA) with lipopolysaccharide . DTH reactions were maximal after 72 h, with no intensity differences among allergens, inoculation sites (eyelid and tail), and doses tested . There were no differences in the results recorded by visual inspection and palpation of inoculation sites, by measuring skin thickness with a caliper, or by microscopic examination of samples taken at necropsy . Six days after DTH testing, energy was observed in 100% of the animals, and 100% reactivity was recovered only after 24 days . All animals were necropsied, and thorough bacteriological searches were performed . The sensitivities found with the 140 animals from which B . melitensis was isolated were ELISA, 100%; DTH, 97.1%; RBT, 92.1%; and CFT, 88.6% . Those results put into question the value of RBT and CFT as screening and confirmatory tests for sheep brucellosis and at least indicate that their standardization should be modified . For 151 tested sheep from which B . melitensis was not isolated, the percentages of positive animals were ELISA, 100%; DTH, 94.0%; RBT, 57.6%; and CFT, 53.6% . All tests were negative for 100 tested sheep from Brucella-free flocks . The different results of bacteriological and immunological tests suggest the usefulness of developing indirect tests able to distinguish truly infected animals from those that have developed an immunological response.

Clin Nucl Med, 1994 Aug, 19(8), 731 - 7
Diagnosis of osteomyelitis . Accuracy and limitations of antigranulocyte antibody imaging compared to three-phase bone scan; Scheidler J et al.; Thirty-seven patients with suspected osteomyelitis in conjunction with diabetic gangrene (N = 14, group 1), arthroplasty (N = 8, group 2), and various diseases (N = 15, group 3) were examined . Three-phase bone scans, followed by granulocyte imaging using I-123 labeled anti-NCA 95 monoclonal antibodies, were performed to evaluate and compare the diagnostic accuracy of both procedures . Final diagnosis was established histologically, bacteriologically, or by both methods either through the clinical course or by long-term follow-up in patients in group 1 . Osteomyelitis was proven in 17 out of the 37 patients . Bone and antigranulocyte imaging demonstrated positive results in all patients with osteomyelitis (sensitivity 100% for each method) . No signs of skeletal infection were found in 20 patients . Fifteen of these patients had no antigranulocyte antibody accumulation, resulting in 75% specificity . Ten patients without infection had normal three-phase bone imaging results (specificity 50%) . Antigranulocyte imaging results were negative in 6 out of 10 patients without osteomyelitis in groups 2 and 3 whose bone imaging results were questionable . However, because of identical bone and granulocyte imaging results, no increase of diagnostic accuracy could be obtained by additional granulocyte imaging in patients with diabetic gangrene . Final diagnoses of false-positive antigranulocyte studies were aseptic osteonecrosis (N = 2), loosening of prostheses, gouty arthritis, and pain after arthrolysis . In summary, antigranulocyte antibody imaging offered high sensitivity and acceptable specificity for the diagnosis of osteomyelitis . Diagnostic accuracy can be improved through the adjuvant use of antigranulocyte imaging for patients with suspected osteomyelitis, especially when radiographic and scintigraphic results are questionable or unreliable.

Kekkaku, 1994 Aug, 69(8), 527 - 33
{Commemorative lecture of receiving Imamura Memorial Prize . I . Studies on bacteriological diagnostic methods for mycobacteria}; Abe C; Two systems, radiometric BACTEC and biphasic MB-Check, based on liquid media proved to be significantly better than the egg-based solid media for the isolation of mycobacteria from clinical specimens . The difference in the rates of isolation of mycobacteria between two groups of media was more remarkable with smear-negative specimens . The time to the detection of the Mycobacterium tuberculosis complex with MB- Check was shorter than that with the 3% Ogawa egg method but longer than that with BACTEC . The polymerase chain reaction (PCR) using oligonucleotides based on the repetitive sequence (IS986) of M . tuberculosis as a primer and the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD), which combines an M . tuberculosis rRNA amplification method with the hybridization protection assay format, were evaluated for detection of M . tuberculosis in clinical samples . Although the sensitivities of the PCR and MTD appeared to be similar to that of culture with the MB-Check system, the two methods based on nucleic acid amplification should be very useful for rapid detection of M . tuberculosis infections without the long time required for culture of M . tuberculosis . Epidemiological studies with techniques which allow differentiation of strains within M . tuberculosis groups are important for limiting the dissemination of the disease . We analyzed six groups of small outbreaks of M . tuberculosis infections by restriction fragment length polymorphism (RFLP) analysis . Five showed identical fingerprints within each group, but one which as also suspected to have a common source of infection showed different banding patterns, emphasizing that RFLP analysis using IS986 as a probe is useful in epidemiological studies of tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aust N Z J Obstet Gynaecol, 1994 Aug, 34(4), 398 - 402
Risk factors for wound infection following caesarean section; Beattie PG et al.; A prospective study was performed between April 1, 1991 and April 30, 1992 to determine factors involved in the development of post-Caesarean section wound infection . During this period there were 4,857 deliveries, 428 by Caesarean section (8.8%) . Complete data were available on 328 (76.6%) patients . Wound infection occurred in 25.3% of women and was confirmed by positive bacteriology in 77.1%; 36% of wound infections were diagnosed following the patients' discharge from hospital . A negative correlation was found between maternal age and development of wound infection up to age 40 (p = 0.03) . Maternal weight was a highly significant indicator of subsequent wound infection development (p = 0.0001), the relationship between increasing maternal weight and infection appearing linear . Antibiotic prophylaxis was found to be the most significant protective factor (p = 0.0007) in the reduction of postoperative wound infection . This relationship was independent of maternal weight.

Zentralbl Hyg Umweltmed, 1994 Aug, 196(2), 153 - 69
Chemical, bacteriological and biological examination and evaluation of sediments from drinking water reservoirs--results from the first sampling phase; Schreiber H et al.; Between September 1992 and April 1993, samples of sediment were taken from a total of 16 drinking water reservoirs from seven water suppliers . Five different types of raw water were examined, samples being taken with varying frequency . The comparison of surface reservoir water and ground water constituted a central aim in this first series of investigations . The composition of the sediment was determined in terms of its chemical, bacteriological and biological characteristics . It was established that the deposits that normally accumulate in the course of an operating period contain, in addition to the familiar mass-determinant inorganic constituents such as iron, manganese and calcium compounds, in some cases considerable quantities of organic substances . Total organic carbon (TOC) contents of up to 11 weight-% were found . Besides an increased concentration of heavy metals, in particular cadmium, nickel and zinc, were measured in some sediments . The bacteriological examination of the sediments, in accordance with the German drinking water regulation (TrinkwV) showed, in part, very high colony counts . However, there was apparently no influence on the effluent water as the reservoir was emptied . The microscopical examination showed independent of the raw water source the sediments being colonized by invertebrates . Up to 9000 organisms per litre of fresh sediment were recorded . The predominant group of animals, in terms of numbers, was the rotifers followed by threadworms . The comparison of water from impounding reservoirs and ground water made evident that the presence of organisms in reservoir sediments is not restricted to the use of surface water.

Rev Med Chil, 1994 Aug, 122(8), 955 - 7
{Celebration of the 50th anniversary of the School of Public Health of the University of Chile}; Medina E; The joined initiative of the University of Chile, the Health institutions, the Bacteriological Institute and the Rockefeller Foundation support allowed the creation of the School of Public Health . A group of skilled and talented young specialists gave rise to the School, as an expression of the need to refurbish the medical care of the forties . The aim of the School was to communicate the scientific basis of sanitary practice, to study national problems and to group people that can contribute to improve the health status of the country . During fifty years, the number of Chilean and foreign students expanded considerably . During these five decades the School has trained 1588 specialists (459 foreigners) in Public Health . The School was awarded by WHO in 1988 in recognition of its outstanding contributions to Public Health . It is difficult to make adequate decisions at the present time, due to the complexity of Chilean health situation, that is going through an epidemiological and demographic transition . A systematic effort to investigate and to train people in public health and health administration is mandatory . These are the principal tasks of the School, that maintains its fifty years tradition left by its founders.

Presse Med, 1994 Jul 2-9, 23(25), 1166 - 71
{Tuberculosis: a new priority}; Molimard M et al.; Tuberculosis is one of the most widespread diseases affecting more than 8 million subjects . The death toll has been estimated at 3 million persons annually . In France, the incidence in 1991 was 15 per 100,000 inhabitants with wide regional variation (37 per 100,000 in Paris and surrounding areas) . It is difficult to interpret variations in incidence which would appear to be on the rise since 1993 . (The increase may be a real rise in incidence or simply due to better registration as a result of reports of HIV infection.) In industrialized countries, economic factors, movements in populations, restrictive policies in antituberculosis health care and HIV infection are all factors leading to an increased incidence in tuberculosis . These observations strongly suggest the need for reorganizing our health care policy in the fight against tuberculosis, improving modern techniques in bacteriological identification and imagining new modalities of prevention and treatment . Special emphasis must be placed on research still required before this curable disease can be eradicated.

Br Vet J, 1994 Jul-Aug, 150(4), 377 - 84
Evaluation of the risk of potential bacteraemia in carcasses from very young slaughter calves with localized navel ill; Biss ME et al.; In the absence of gross pathological and bacteriological indicators, histopathology was used as the most sensitive technique to determine the risk of potential bacteraemia in the very young slaughter calves with and without lesions of localized navel ill (omphalophlebitis) . The positive predictive value (ability to detect truly diseased cases) of routine post-mortem meat inspection for the detection of localized navel ill was 87.4% and the negative predictive value (ability to detect truly non-diseased cases) was 98.1% . The probability of histopathological lesions suggestive of bacteraemia in the kidneys and/or liver of calves with localized navel ill (319 cases) was 0.29 {0.24, 0.34} whereas that in control carcasses (319 cases) was 0.21 {0.17, 0.25} . There was no statistically significant difference in the proportion of cases graded as having severe compared with moderate periportal hypercellularity of the liver in each group . The risk of potential bacteraemia in carcasses passed at routine post-mortem meat inspection according to two different judgement regimes for localized navel ill (condemnation vs trimming of localized lesions) was virtually identical (251 vs 254 per 1000 carcasses passed respectively) and was not sensitive to changes in the prevalence of localized navel ill.

Surgery, 1994 Jul, 116(1), 28 - 35
Clindamycin plus amikacin versus clindamycin plus aztreonam in established intraabdominal infections; Barboza E et al.; BACKGROUND . A prospective, randomized, single-blind study evaluated the efficacy and safety of clindamycin plus amikacin versus clindamycin plus aztreonam (Cl-Az) in treating intraabdominal infections in adults . METHODS . Patients were treated intravenously for 7 to 10 days, clindamycin 900 mg plus amikacin 5.0 mg/kg three times a day or clindamycin 900 mg plus aztreonam 2.0 gm three times a day . All 67 patients enrolled were evaluated for safety and 31 in each group for clinical and microbiologic response . Both groups were similar in initial diagnosis, perforated appendicitis or intraabdominal abscess . In each group 24 patients (77%) were admitted in serious condition and three (10%) in critical condition . Twenty-five patients (80.6%) in each group had aerobic and anaerobic pathogens; the remainder had either aerobic or anaerobic pathogens . RESULTS . On therapy completion, clinical and bacteriologic responses were as follows: clindamycin plus amikacin group, 26 (84%) cured, 3 (9.7%) improved, and 2 (6.3%) failed; Cl-Az group, 25 (80.7%) cured, 6 (19.3%) improved, and 0 failed . Rapid temperature decrease occurred in Cl-Az group (p = 0.007) . Forty-one mild adverse medical events reported were evenly distributed, but no patients were removed as a result . CONCLUSIONS . Both combinations were highly effective in managing intraabdominal sepsis . Clindamycin aztreonam showed a slight advantage because of absence of renal toxicity and shorter time to apyrexia.

Chest, 1994 Jul, 106(1), 28 - 32
Tuberculosis in young adults and the elderly . A prospective comparison study; Korzeniewska-Kosela M et al.; OBJECTIVES: To compare the clinical, bacteriologic, and radiologic features of pulmonary and pleural tuberculosis in young adults and the elderly and determine if any differences exist between both groups . DESIGN: Prospective recruitment of all patients diagnosed as having pulmonary and pleural tuberculosis in British Columbia, Canada . SETTING: A population-based sample from a provincial control program TB registry . PATIENTS: A total of 218 consecutive patients whose conditions were diagnosed between January 1990 and May 1991 . We excluded 15 HIV-positive patients whose conditions were diagnosed during this study . INTERVENTION: Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical and epidemiologic data . MAIN RESULTS: There were 142 young adult patients and 76 elderly patients . The young adults had a mean age of 41.2 years and the elderly group had a mean age of 75 years of age . Fever (p = 0.002) and night sweats (p = 0.02) were more common in young adults . In culture-proven disease, hemoptysis, fever, and cough were more common in young adult (p = 0.03, 0.02, and 0.01, respectively) . There was no difference in the duration of symptoms between the two groups . The odds ratio for cancers other than lung cancer, 3.98 (confidence interval, 1.49, 10.65) in the elderly group was the only significant risk factor to differ between the two groups . Skin test responses to 5TU PPD were positive in 86.2 percent of young adults and 67.6 percent of elderly patients tested (p = 0.03) . A total of 79.6 percent of young adults and 88.15 percent of the elderly patients (not significant) were culture positive . Comparison of radiologic findings in young adults vs elderly patients showed no significant differences apart from those with miliary TB 0.7 percent vs 6.7 percent (p = 0.04) . CONCLUSIONS: In this population-based study, young adults were more likely to have hemoptysis, fever, and cough and to have a positive PPD response . Cancer was significantly associated as a risk factor in the older age group . There was no difference in bacteriologically proven disease or radiologic findings between the two groups, apart from the more common occurrence of miliary TB in the elderly.

Am Surg, 1994 Jul, 60(7), 490 - 4
Idiopathic necrotizing fasciitis: recognition, incidence, and outcome of therapy; McHenry CR et al.; Early recognition and treatment of necrotizing fasciitis (NF) is essential for survival . The diagnosis of primary or idiopathic NF may be particularly challenging because it occurs in the absence of a known causative factor or portal of entry for bacteria . Patients with NF treated between 1989 and 1993 were reviewed to determine the incidence, clinical features, bacteriology, and results of treatment in patients with idiopathic NF . Idiopathic NF occurred in nine (18%) of 51 patients, five men and four women, ranging in age from 21 to 67 years . Associated conditions included diabetes mellitus (4), alcoholism (3), remote infection (3), and pregnancy (2) . NF affected the lower extremity in eight and the perineum in one patient . Pain and tenderness occurred in all patients, soft tissue gas was recognized in two, and the presence of erythema and edema was variable . Idiopathic NF was monomicrobial in seven (78%) patients, compared to 21 per cent of patients with secondary NF (P = 0.003) . S . pyogenes was the causative organism in five of seven monomicrobial infections . Time from admission to operation was significantly longer (62.3 +/- 54.8 hours) in patients with idiopathic NF compared to patients with secondary NF (17.0 +/- 16.6 hours) (P = 0.001) . Treatment included operative debridement (means = 3.3) and limb amputation (n = 1) to control infection . Three patients (33%) with idiopathic NF died . Primary or idiopathic NF is principally a monomicrobial infection usually caused by S . pyogenes that most commonly occurs in the extremities . Mortality is high but is comparable to secondary NF . It is important to recognize that NF may occur spontaneously, and it should be suspected in patients with unexplained soft tissue pain and tenderness.

Pediatrics, 1994 Jul, 94(1), 1 - 7
Clinical features, diagnosis, and treatment of tuberculosis in infants; Vallejo JG et al.; OBJECTIVE . Despite the recent resurgence of tuberculosis among children in the United States, no series of infants < 1 year of age with tuberculosis has been reported in the last 20 years . This study was undertaken to describe the epidemiology, clinical, and radiographic manifestations, and response to therapy in infants < 1 year of age with tuberculous disease . METHODS . The medical records were reviewed for all infants age 12 months or less with a diagnosis of tuberculosis and cared for at the Children's Tuberculosis Clinic at Ben Taub General Hospital in Houston, Texas between January 1, 1985 and June 30, 1992 . RESULTS . Of the 47 infants identified, 51% were female . The median age at diagnosis was 8 months (range 3.5 to 12 months) . Fifty-one percent of the infants were African-American and over one-third were Hispanic . All patients were born in the United States . Diagnosis resulted from the examination of an ill infant in 79% of cases, a case contact investigation of an adult suspected of having tuberculosis in 19%, and routine tuberculin skin testing in 2% . An adult with infectious tuberculosis who had contact with the infant was identified in 68% of cases . Intrathoracic disease alone was present in 70% of cases . Fourteen (30%) infants had extrapulmonary tuberculosis (11 central nervous system disease, 2 disseminated disease, and 1 cervical adenitis) . Gastric aspirate cultures yielded Mycobacterium tuberculosis from 75% of the infants with isolated intrathoracic disease . Forty-five infants successfully completed therapy and only one death was directly related to tuberculosis . Forty-eight percent of the infants with pulmonary tuberculosis were treated with a 6-month regimen consisting of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide . Eighteen infants received some twice weekly directly observed therapy mainly due to documented or suspected nonadherence . Treatment was well-tolerated; one patient (2%) developed hepatotoxicity due to isoniazid . No infant had a relapse or recurrence of disease in 6 months to 7 years follow-up for a median of 3 years (range, 6 months to 7 years) . CONCLUSION . Most infants with tuberculosis are symptomatic at the time of diagnosis, and bacteriologic confirmation was obtained in 70% of cases . A contact investigation of the household should be initiated immediately when an infant is suspected of having tuberculosis because valuable information needed to establish the diagnosis and guide therapy in the infant may be obtained . Intensive 6-month and twice weekly directly observed therapy appear to be well-tolerated and effective for the treatment of pulmonary tuberculosis in infants.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Jul-Aug, (4), 55 - 8
{An evaluation of the effectiveness of laboratory diagnostic methods for brucellosis}; Gandara B et al.; The diagnostic value of bacteriological and serological methods for the laboratory diagnosis of brucellosis was studied . In the analysis of milk and cheese specimens Brucella cultures were isolated and differentiated as B.melitensis, biovar I, and B.abortus, biovar 4 . In 25.6% of cases B.melitensis culture, biovar 1, was isolated from the blood of persons suspected for brucellosis . The isolation of B.melitensis culture from milk showed that this infective agent migrated from small animals to cattle, which was indicative of a high risk of human infection in the state of Zacatecas, Mexico . The comparative evaluation of serological diagnostic methods (the agglutination test in test tubes, Huddleson's slide test, the acidic rose bengal test and the 2-mercaptoethanol test) showed high sensitivity of rapid tests (Huddleson's test and the rose bengal test in 93.7% and 87.9% of cases respectively) . The 2-mercaptoethanol test which gave positive results in 63.8% of cases provided additional information characterizing the course of infections process.

Clin Ther, 1994 Jul-Aug, 16(4), 653 - 61
Controlled study of brodimoprim and cephalexin in the treatment of patients with acute sinusitis in general practice; Bockmeyer M et al.; Brodimoprim, a new dehydrofolate reductase inhibitor, was compared with cephalexin in the treatment of patients with acute sinusitis . A total of 49 patients were randomly assigned to receive either brodimoprim 200-mg tablets once a day (400 mg on the first day as a loading dose) or cephalexin 500-mg tablets three times a day for 8 to 12 days . Nearly all patients treated were judged clinically cured/improved; in fact, only one failure (in the cephalexin group) was noted . In the 45 assessable patients, the time until disappearance of the symptoms and the duration of treatment did not differ significantly between the two groups . A bacteriologic examination was performed in all patients at baseline as well as at the end of therapy . Bacteriologic eradication was obtained in 88% of the patients treated with brodimoprim and in 76% of those receiving cephalexin . Both compounds were generally well tolerated (one patient in the brodimoprim group complained of skin reactions) . These results suggest that once-daily treatment with brodimoprim represents safe and effective therapy for adults with acute bacterial sinusitis.

Clin Exp Rheumatol, 1994 Jul-Aug, 12(4), 381 - 8
Takayasu's arteritis in Mexico: a clinical review of 44 consecutive cases; Robles M et al.; OBJECTIVES . To review our experience in clinical diagnosis of the non-specific arteritis called Takayasu's arteritis (TA), and to assess its possible relationship with previous mycobacterial infections as judged by delayed hypersensitivity skin test . METHODS . We examined 44 consecutive patients in Mexico City . All of them fulfilled the ACR criteria for the classification of TA and had a characteristic panaortogram in the absence of any other arterial or systemic disease . RESULTS . Forty-three of our patients were Mexican mestizos; only one had a Caucasian appearance . 38 were women, and the age at diagnosis ranged from 15 to 64 years with a mean of 32 and a median of 35 . Age at onset of the symptoms was under 30 years in most cases . Five patients had type I disease, and 4 had type II . Most had a diffuse arteritis (type III), and in seven cases involvement of the pulmonary artery (type IV) was recognized . All patients showed abnormal peripheral pulses and blood pressure differences, 35 had systemic arterial hypertension and 7 pulmonary hypertension . A noisy vascular auscultation was very common and cardiac ailments were also found in many cases . Systemic complaints such as fever, weight loss and malaise were present in the active stages of the disease . Arthritis did occur in a single case, arthralgia was frequent and inflammatory nodules involving the shin, perimalleolar area, and the antero-external surface of the distal leg were also common . Polyclonal hypergammaglobulinemia was a frequent finding in active and inactive cases; leukocytosis with neutrophilia, accelerated ESR and high fibrinogen, however, did occur when the disease was active . Eight of our patients had a previous diagnosis of tuberculosis, and 81% developed a delayed skin reactivity to PPD (2U old tuberculin) . None had a bacteriologic diagnosis of tuberculosis or mycobacterial disease . CONCLUSION . Non-specific arteritis, or Takayasu's disease, frequently affects young women of colored race in Mexico . Late diagnosis is common and cardiovascular features dominate the clinical picture . Arterial compromise is widespread and may involve the pulmonary artery and its branches . Most cases are inactive and morbidity results from systemic arterial hypertension and heart disease; active cases have systemic complaints and laboratory abnormalities suggestive of ongoing inflammation . The close relationship between Takayasu's arteritis and previous contact with Mycobacterium tuberculosis was again confirmed in our series, although further studies are necessary to clarify this probable relationship.

Jpn J Antibiot, 1994 Jul, 47(7), 882 - 8
{Clinical studies on biapenem (L-627) in the pediatric field}; Watanabe A et al.; Biapenem (L-627) was given intravenously to 17 children with acute bacterial infections including 3 with purulent tonsillitis, 1 with bronchitis, 4 with pneumonia, 2 with sepsis, 3 with pyelonephritis, 2 with SSSS . (2 cases are omitted from evaluation because of Mycoplasma pneumonia and infectious mononucleosis) . Daily dosages per kg bodyweight ranging from 18.3 to 60 mg were given in 3 divided doses per day for 4 to 6 days . Clinical responses were excellent in 12 (80%), good in 2 (13.3%), fair in 1 (6.7%) and poor in 0 (0%), with an overall efficacy rate of 93.3% . Good bacteriological responses were obtained in all of the 9 cases from which pathogens were identified . A side effect is observed in only 1 case with mild diarrhea . The above results suggest that L-627 is a useful new carbapenem derivative for the treatment of bacterial infections in children.

Rev Lat Am Enfermagem, 1994 Jul, 2(2), 73 - 85
{Agents of nursing in São Paulo health practices: from the bacteriological model to the health program (1889-1983)}; Villa TC et al.; The historical roots of the nursing profession in public health in the state of Sao Paulo from 1900-1980 have been identified . Nurses have effectively participated to implement a new public health program--"Programacao em Saude", having the assignment to train, coordinate, supervise/manage other nurses who lacked specialized training . The nurse's understanding of her role in the health process was limited to individual performance with emphasis on technical ability, without understanding the purpose of her actions in the overall model.

Indian J Lepr, 1994 Jul-Sep, 66(3), 307 - 14
Anticardiolipin antibodies in leprosy; Thawani G et al.; Eighty-four leprosy patients were studied clinically and for IgG and IgM anticardiolipin (aCL) antibodies . Following WHO criteria, 41 patients could be classified as multibacillary (MB) and 43 as paucibacillary (PB) . Baseline levels of IgG and IgM antibodies were 27 +/- 4.8 GPL and 20 +/- 3.4 MPL per ml respectively . Comparing with these, 60.9% of MB and 39.5% of PB cases showed rise in IgG and IgM anticardiolipin antibodies; 19.5% of MB and 4.6% of PB sera showed rise in only IgG antibodies, while 4.8% of MB and 13.9% of PB cases showed rise only in IgM antibodies . Rise in aCL antibodies had no correlation with cardiovascular involvement, bacteriological index, reactive state and duration or regularity of treatment.

Indian J Pathol Microbiol, 1994 Jul, 37(3), 275 - 9
Transrectal fine needle aspiration cytology of granulomatous prostatitis; Mondal A et al.; Transrectal fine needle aspiration cytology by Franzen technique was carried out from January, 1985 till January, 1992 on 567 patients having prostatomegaly which were suspicious of malignancy by clinical per rectal examination . Granulomatous prostatitis was diagnosed in 56 cases . Analysis showed 34 cases were tuberculous prostatitis and 22 cases were nonspecific granulomatous prostatitis . Comparison of aspiration cytology with bacteriological study of the aspirated material and histopathology showed correct diagnosis of granulomatous prostatitis by fine needle aspiration . The findings indicate that transrectal fine needle aspiration cytology is a reliable procedure for diagnosis of granulomatous prostatitis which can clinically mimic prostatic malignancy when it presents as a diffuse or nodular enlargement with firm to hard consistency.

Pneumoftiziologia, 1994 Jul-Dec, 43(3-4), 173 - 7
{The possibilities for improving the serological diagnosis of active tuberculosis by using new mycobacterial antigens and immunoblot and ELISA technics}; Banica D et al.; The study concerns 264 cases among which: 119 active lung tb . eliminating and 11 cases not-eliminating M . Tuberculosis; 17 cases of extrarespiratory tb . confirmed by bacteriology and/or by anatomopathology; 18 cases of bone-joint non-tb disease; 38 cases of chronic lung disease other than tb; 61 healthy persons (controls) . Sera from these cases were collected before treatment and submitted concomitantly to two different methods: (1) Mycodot test (immunoblot) with lipoarabinomannan (LAM) as antigen, on nitrocellulose discs (Dynagen, Cambridge, MA, USA); (2) ELISA test with antigen 60 (A60) (ANDA-Biologicals, Strasbourg, France) and with antigen I.C . (Cantacuzino Institute, Bucharest) . The results were estimated on terms of sensitivity and specificity . As for sensitivity the results show 74-90% . the highest values were reached in ELISA with A60 IgA . The specificity of the Mycodot test was highest: 90-100% in the two successive experiments . The active tb diagnosis discrimination capacity of the studied methods allows the following classification: 1 . Mycodot test with LAM antigen 2 . ELISA with A60-Ig G complex 3 . ELISA with I.C . antigen The Mycodot test is more advantageous being more rapid and more simple to perform.

Pneumoftiziologia, 1994 Jul-Dec, 43(3-4), 147 - 61
{The incidence of tuberculosis in Romania in the first 3 trimesters of 1994}; Corlan E; Using information from the TB notification forms completed during the first 9 months of the 1994 year and demographic data (the number of inhabitants by sex and age groups in various districts at 1 July 1994), epidemiometric indicators like TB incidence by disease localization, sex and bacteriologic confirmation for whole country and each of its 41 districts have been calculated . The absolute fingers and the rates are presented in a series of 11 successive tables . These data, revealing the magnitude of "TB problem" in Romania, are presented with the aim to support planning and optimization of TB control activities at the central and intermediate levels.

Rev Sanid Hig Publica (Madr), 1994 Jul-Aug, 68(4), 521 - 8
{The evolution of the incidence of tuberculosis in the La Coruña health area}; Castro Lareo I et al.; BACKGROUND: Tuberculosis represents a major public health problem . In Spain, the incidence of tuberculosis is among the highest in the European Community, and shows an increasing trend . The aim of this study is to determine the incidence and temporal trends of tuberculosis in the catchment area of the "Hospital Juan Canalejo" (La Coruna, Spain), between 1982 and 1991 . METHODS: Revision of all case records of tuberculosis with positive bacteriology and detected by the Epidemiological Vigilance System of the Preventive Medicine Unit of the "Hospital Juan Canalejo", diagnosed between January 1982 and December 1991 . The incidence of tuberculosis as a function of age, sex, period, and county, was modeled with Poisson regression . RESULTS: 1120 cases were studied . The relative risk of tuberculosis in females with respect to males was 0.50 (95% confidence interval 0.44 to 0.56; p < 0.001) with a peak of increased risk between 15 and 35 years of age in both genders . With respect to temporal trends, the risk of tuberculosis increased from 1986 in females and from 1987 in males . CONCLUSIONS: Over the last decade, the incidence of tuberculosis has increased in the study area, with higher risk in males and young adults.

J Am Med Inform Assoc, 1994 Jul-Aug, 1(4), 328 - 38
Information retrieved from a database and the augmentation of personal knowledge; de Bliek R et al.; OBJECTIVE: To assess the degree to which information retrieved from a biomedical database can augment personal knowledge in addressing novel problems, and how the ability to retrieve information evolves over time . DESIGN: This longitudinal study comprised three assessments of two cohorts of medical students . The first assessment occurred just before student course experience in bacteriology, the second occurred just after the course, and the third occurred five months later . At each assessment, the students were initially given a set of bacteriology problems to solve using their personal knowledge only . Each student was then reassigned a sample of problems he or she had answered incorrectly, to work again with assistance from a database containing information about bacteria and bacteriologic concepts . The initial pass through the problems generated a "personal knowledge" score; the second pass generated a "database-assisted" score for each student at each assessment . RESULTS: Over two cohorts, students' personal knowledge scores were very low (approximately 12%) at the first assessment . They rose substantially at the second assessment (approximately 48%) but decreased six months later (approximately 25%) . By contrast, database-assisted scores rose linearly: from approximately 44% at the first assessment to approximately 57% at the second assessment, to approximately 75% at the third assessment . CONCLUSION: The persistent increase in database-assisted scores, even when personal knowledge had attenuated, was the most remarkable finding of this study . While some of the increase may be attributed to artifacts of the design, the pattern seems to result from the retained ability to recognize problem-relevant information in a database even when it cannot be recalled.

Wiad Lek, 1994 Jul, 47(13-14), 547 - 8
{A case of kidney and ureter tuberculosis causing diagnostic difficulties}; Ogrodnik J et al.; A case is presented of tuberculosis of the kidney and ureter with negative bacteriological examination, suspected of malignant tumour . The diagnosis was based on histological examination of ureteral specimen taken intraoperatively.

Ugeskr Laeger, 1994 Jun 27, 156(26), 3876 - 80
{Septic arthritis in intravenous drug abuse}; Andersen K et al.; Septic arthritis (SA) in intravenous abusers is reviewed in the English literature from 1966-1992 with the purpose of registration of the bacteriological development, localization of the infected joints, clinical information and laboratory data . Eighty-three publications are available for the review . We have registered 270 joint infections caused by 264 bacteria in 257 intravenous drug abusers with SA . Since 1985 there has been a change in joint localization and bacteriology . A possible explanation is considered . Diagnosis and treatment is difficult, because of the unstable life-style and frequent compliance problems in intravenous drug abusers . SA should be considered in patients with known intravenous drug abuse, uncharacteristic pain and symptoms of osteoarticular infection . SA is often accompanied by fever, leucocytosis and elevated sedimentation rate . Bacteriological diagnosis is achieved by joint aspiration and/or blood culture . Tc-99m-MDP-(technetium-99m-methylene diphosphonate)-bone scintigraphy should be performed on joints suspected of infection which are difficult to aspirate . With adequate antibiotic treatment the prognosis is good, and the mortality is insignificant.

Schweiz Med Wochenschr, 1994 Jun 25, 124(25), 1083 - 9
{Infectious endocarditis}; Schaffner A; The diagnosis of infective endocarditis remains a challenge to physicians providing primary care . On one hand this type of infection will be rarely encountered in primary care, but on the other hand this disease carries an enormous detrimental potential . Furthermore infective endocarditis, particularly in its initial phase, often has an uncharacteristic presentation with findings and symptoms shared with many much more frequent and often harmless diseases . To confront these difficulties, which are responsible for the often delayed diagnosis of infective endocarditis, strict rules must be applied . In patients at risk for infectious endocarditis no antibiotic therapy should be instituted without prior cultures . Also, in all other patients aimless, "blind" antibiotic therapy without diagnosis of a bacterial infection should be avoided . In patients with uncharacteristic symptoms and findings compatible with the diagnosis of infective endocarditis that persist for more than 5 days, blood cultures prior to any antibiotic therapy are warranted in addition to other clinical exams and tests . The sensitivity of echocardiography in detecting infective endocarditis is frequently overestimated . Furthermore, transesophageal echocardiography in endocarditis high-risk patients requires antibiotic prophylaxis which would obscure bacteriological diagnosis . For these reasons echocardiography should not be used as first test method when considering the diagnosis of infective endocarditis.

Semin Arthroplasty, 1994 Jul, 5(3), 137 - 41
One-stage exchange in the treatment of the infected total hip arthroplasty; Elson R; One-stage exchange for deep infection of a joint arthroplasty has a valuable place in our range of techniques but should be utilized with great care . Bacteriological facilities must be of an especially high quality . If the operator lacks experience, it is wise to revert to a more conventional two-stage procedure . I believe that for one-stage exchange, heavily antibiotic-loaded acrylic cement should be used . In this account, results from my hospital show that useful survival can be achieved as well as an acceptable rate of control of the infection.

Adv Ther, 1994 Jul-Aug, 11(4), 183 - 91
A comparison of ampicillin/sulbactam and cefoxitin in the treatment of bacterial skin and skin-structure infections; Weigelt JA; Seventy-six hospitalized patients with complicated skin/soft-tissue infections were enrolled in this randomized, prospective, third-party-blinded, comparative study of the effectiveness and safety of intravenous or intramuscular administration of ampicillin/sulbactam (1.0 to 2.0 g ampicillin plus 0.5 to 1.0 g sulbactam every 6 hours) and cefoxitin (1.0 to 2.0 g every 6 hours) . Twenty-five of 36 ampicillin/sulbactam patients and 33 of 39 cefoxitin patients were evaluable . Clinical and bacteriologic effectiveness did not differ significantly between the two treatment groups (P = .674, P = .118, respectively); neither did duration of hospitalization (P = .894) . Twenty-one (84%) ampicillin/sulbactam patients were cured, 2 (8%) were improved, and 2 (8%) were treatment failures . Twenty-eight (85%) cefoxitin patients were cured, 4 (12%) were improved, and 1 (3%) was a treatment failure . All primary pathogens were eradicated in 6 (24%) ampicillin/sulbactam patients; partial eradication occurred in 9 (36%) . Primary pathogens were eradicated in 15 (47%) cefoxitin patients and partially eradicated in 8 (25%) . Both treatments were well tolerated, with a small number of adverse reactions in each group . The overall incidence of adverse events was similar in the two groups.

Circulation, 1994 Jun, 89(6), 2728 - 35
Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis; Koh KK et al.; BACKGROUND: Adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) have been measured in pleural fluid to help distinguish malignant from benign effusions, especially in tuberculous pleurisy . We investigated ADA and CEA levels in patients with moderate to large pericardial effusions of different etiologies . METHODS AND RESULTS: We performed diagnostic and therapeutic pericardiostomy with drainage and biopsy . We measured ADA and CEA levels in the pericardial fluid in 26 patients with moderate to large pericardial effusion and 19 control patients . Patients were included in a prospective protocol from August 1991 to August 1993 . Patients were grouped as follows: group 1, 9 patients with tuberculous pericarditis (TP) confirmed by bacteriologic culture or histology of pericardial biopsy; group 2, 5 patients with clinically strongly suspected TP; group 3, 12 patients with malignancy (8) and acute pericarditis (4); group 4, 19 control patients without pericardial disease . We treated patients with TP with isoniazid, rifampin, and either streptomycin or ethambutol for 12 months and pyrazinamide for 2 months . We observed for symptoms and signs of recurrent pericarditis or constrictive pericarditis on follow-up . In group 1 the ADA activity was significantly higher (101 +/- 14 U/L) than that in group 3 (22 +/- 5 U/L) or that in group 4 (17 +/- 2 U/L) (P < .05) . There was no significant difference between ADA activity in group 1 (101 +/- 14 U/L) and that in group 2 (100 +/- 26 U/L) . With a cutoff value for ADA activity of 40 U/L, sensitivity was 93% and specificity 97% in the diagnosis of TP . In benign diseases, the CEA level was significantly lower (1.0 +/- 0.3 ng/mL) than that in malignant diseases (135.1 +/- 79.7 ng/mL) (P < .05) . With a cutoff value for CEA level of 5 ng/mL, sensitivity was 75% and specificity 100% in the diagnosis of malignant pericarditis . Follow-up study (mean, 12.9, 19.8, and 11.8 months in groups 1, 2, and 3, respectively, showed no symptoms or signs of constrictive pericarditis, except for 1 patient . CONCLUSIONS: Pericardial fluid ADA and CEA are useful for the differential diagnosis of pericardial effusion of various causes . They also have great value in early diagnosis of TP, particularly when the results of other clinical and laboratory tests are negative.

Ann Otol Rhinol Laryngol, 1994 Jun, 103(6), 434 - 8
Preliminary report on L-forms: possible role in the infectious origin of secretory otitis media; Ataoglu H et al.; Infection and inflammation of the middle ear cleft are important factors in the pathogenesis of secretory otitis media . Although high percentages of negative cultures are confronted in many studies, strong evidence pointing to the infectious nature of this disease could not be overlooked . Many authors agree about the failure of conventional culture methods in identifying the responsible pathogen or pathogens . Besides, some agents, such as some kinds of antibiotics, lysozyme, and perhaps some undetected materials, are capable of changing bacterial behavior and consequently the clinical course . Effusions taken from 40 ears with secretory otitis media were cultured by means of conventional brain-heart infusion broth and special hypertonic thioglycollate broth . Strikingly, bacterial L-forms were detected in 6 specimens in thioglycollate broth, with no growth in the conventional broth . We concluded that these atypical forms of bacteria, the L-forms, may play an important role in the bacteriologic aspect of secretory otitis media.

J Bone Joint Surg Am, 1994 Jun, 76(6), 848 - 53
The usefulness of C-reactive protein levels in the identification of concurrent septic arthritis in children who have acute hematogenous osteomyelitis . A comparison with the usefulness of the erythrocyte sedimentation rate and the white blood-cell count; Unkila-Kallio L et al.; Thirty-six children who had bacteriologically confirmed acute hematogenous osteomyelitis but did not have concurrent septic arthritis, and ten children who had confirmed acute hematogenous osteomyelitis and concurrent septic arthritis, were followed for one year to compare the changes in the C-reactive protein level in the blood, the erythrocyte sedimentation rate, and the white blood-cell count . In both groups, the mean C-reactive-protein values were high (eighty-four milligrams per liter in the children who had septic arthritis and osteomyelitis and sixty-five milligrams per liter in those who had osteomyelitis only) at the time of admission to the hospital . However, in the group that had septic arthritis, the increase was significantly higher (p < 0.01) as early as the second day and a normal level (less than twenty milligrams per liter) was reached significantly later (p < 0.001) than in the group that had osteomyelitis only (11 +/- 7 days compared with 6 +/- 3 days {mean and standard deviation}) . The erythrocyte sedimentation rate showed the same tendency, but the difference in the rates between the groups did not become evident until the fifth to fourteenth days after admission . A normal erythrocyte sedimentation rate (less than twenty millimeters per hour) was reached in 25 +/- 12 days in the children who had septic arthritis and in 17 +/- 10 days in those who did not (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1994 Jun, 169(6), 1297 - 305
Pertussis in Massachusetts, 1981-1991: incidence, serologic diagnosis, and vaccine effectiveness; Marchant CD et al.; Massachusetts provides diphtheria-tetanus toxoid-pertussis (DTP) vaccine, and since 1980 has monitored pertussis with a statewide diagnostic service . The incidence of bacteriologically confirmed pertussis was 104.5 per 100,000 person-years in 1-month-old infants and declined progressively thereafter . Infants < 6 months old experienced disproportionate morbidity: 44% of bacteriologically confirmed pertussis, 64% of hospitalizations, and 71% of hospital days . Most children with pertussis had received < 3 DTP doses during childhood, whereas 87% of adolescents with pertussis had received > or = 4 doses . Serodiagnosis by single serum anti-pertussis toxin antibody ELISA increased the incidence of confirmed pertussis in persons 11-19 years old from 3.0 to 12.9 per 100,000 and in persons > or = 20 years old from 0.16 to 0.56 per 100,000 . Bacteriologic methods underestimate pertussis incidence, but a single serum anti-pertussis toxin antibody ELISA is a practical method for population-based diagnosis in adolescents and adults.

Antimicrob Agents Chemother, 1994 Jun, 38(6), 1320 - 4
Effect of dexamethasone on therapy of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis; Paris MM et al.; Treatment of pneumococcal meningitis has become problematic because of the emergence of penicillin- and cephalosporin-resistant strains and because of the concern that dexamethasone therapy might reduce penetration of antibiotics into the cerebrospinal fluid (CSF) . We addressed these issues with our rabbit meningitis model by studying two pneumococcal isolates that were resistant to penicillin and ceftriaxone and susceptible to vancomycin and rifampin . Ceftriaxone, vancomycin, and rifampin were given alone or in combination, with or without coadministration of dexamethasone . Treatment was started 12 to 14 h after intracisternal inoculation of approximately 10(4) CFU of one of the organisms . Rifampin concentrations in serum and CSF were similar, regardless of whether dexamethasone was given, whereas those of ceftriaxone were somewhat lower at each time point in animals given dexamethasone . The penetration of vancomycin into CSF was consistently and substantially reduced with dexamethasone treatment, which resulted in a delay in CSF sterilization not observed in non-dexamethasone-treated animals . When rifampin was used with ceftriaxone for treatment of meningitis caused by the more resistant strain, bacteriologic cure occurred promptly, with or without dexamethasone therapy . In areas with high rates of occurrence of resistant pneumococcal strains, we believe initial empiric therapy of bacterial meningitis should include two antibiotics: ceftriaxone and either rifampin or vancomycin . When dexamethasone is used, the combination of ceftriaxone and rifampin is preferred for therapy.

Arch Bronconeumol, 1994 Jun-Jul, 30(6), 297 - 300
{Study of primary resistance to antitubercular drugs in Galicia}; Alvarez D et al.; The primary resistance of 100 specimens of Mycobacterium tuberculosis isolated in patients with active tuberculosis confirmed bacteriologically was studied prospectively over a period of 15 months . Strains resistant to 1 or more drugs were found in 5 patients . Three patients presented resistance to 2 drugs (isoniazide and streptomycin in 2 and rifampicin and isoniazid, streptomycin and ethambutol); and the fifth was resistant only to pyrazinamide . Owing to the few instances of primary resistance found, it was impossible to establish whether any of the factors analyzed in each patient was related to a higher index of resistance, although 4 of the 5 resistant strains came from respiratory specimens . We conclude that the index of primary resistance in our area is low and this allows us to do without prescribing a fourth drug in the first two months of anti-tuberculosis therapy, and makes routine sensitivity tests unnecessary for patients with no history of prior treatment for tuberculosis.

Ther Drug Monit, 1994 Jun, 16(3), 238 - 47
Challenges in comparing treatment outcome from a prospective with that of a retrospective study: assessing the merit of gentamicin therapeutic drug monitoring in pediatric oncology; Ho KK et al.; The objectives of this study were: (a) to assess whether treatment outcome with gentamicin in pediatric oncology patients could be improved by a pharmacy based therapeutic drug monitoring (TDM) service that included pharmacokinetic interpretation; and (b) to describe the challenges in comparing treatment outcome from a prospective to a retrospective study when the merit of gentamicin therapeutic drug monitoring (TDM) was assessed in pediatric oncology patients . Two groups of pediatric oncology patients, aged 1-18 years, received empiric gentamicin therapy for fever and for confirmed or suspected infection, with the same inclusion and exclusion criteria . Group 1 consisted of patients from a prospective gentamicin pharmacokinetic study with a formalized pharmacy-based TDM service (n = 52) . Group 2 consisted of patients admitted to the oncology units who had gentamicin levels analyzed in the TDM Laboratory without the formalized TDM Service (n = 25) . Gentamicin dosage adjustments were recommended based on three blood samples (one pre- and two postdose concentrations) collected between the third and sixth doses from each patient in the TDM group, utilizing pharmacokinetic principles and the Sawchuk-Zaske method . In the non-TDM group, dosage adjustments based on two routine blood samples (one pre- and post-gentamicin dose) were performed by physicians without the help of the formalized TDM Service . Multiple regression analysis showed that time periods (TDM, non-TDM), duration of neutropenia, intravenous methotrexate, and types of cancer, e.g., hematologic malignancy vs . solid tumor, had significant effects on duration of fever . Initial absolute neutrophil count, insertion of central venous line, intravenous cloxacillin administration, bacteriologic cultures, and initial post gentamicin levels > or = 5 mg/ml had no significant effects on the duration of fever . Mean duration of fever in the TDM group (2.8 +/- 2.4 days) was significantly shorter than that in the non-TDM group (9.0 +/- 8.8 days) (p < 0.001) . Therapeutic serum concentrations were achieved more promptly in the TDM group, with significantly fewer patients requiring dose changes and fewer sets of serum concentrations required . One patient from each group had a > 100% increase in serum creatinine on day 5 compared to baseline . No apparent nephrotoxicity was observed in other patients . Although there was an association of shorter duration of fever with prompt achievement of therapeutic gentamicin serum concentrations with the TDM Service, there were several unresolved factors that affected duration of fever . A randomized prospective and controlled study would be required to substantiate the merit of TDM in shortening the duration of fever in pediatric oncology patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Aust Vet J, 1994 Jun, 71(6), 179 - 81
Strategies for mastitis control: dry cow therapy and culling; Browning JW et al.; The effects of three selection strategies for dry cow therapy on prevention of new infections and rate of antibiotic usage were compared . Quarter infection status of 1044 cows in 12 herds was determined by bacteriological methods at drying off, calving and three to five months into the following lactation . Cows that were uninfected at drying off were randomly allocated to treatment (whole udder, dry cow therapy) and non-treatment groups . Infected cows were randomly allocated to whole udder or infected quarter only treatments . The strategies compared were blanket treatment (treat all quarters of all cows), selective cow treatment (treat all quarters of any cow infected in one or more quarters) and selective quarter treatment (treat infected quarters only) . Selective cow treatment was identified as the preferred strategy . Blanket treatment resulted in increased antibiotic usage (15.5 vs 6.4 tubes per infection eliminated) with no additional benefit, and selective quarter treatment resulted in a higher new infection rate (6.4% vs 3.9% quarters) in the dry period . The prevalence of infection within a herd at drying off had no influence on new infection rates in the dry period or early lactation . The cure rate after dry cow treatment (mean of 66%) decreased significantly with increasing age (P < 0.001) . Cows infected in the previous lactation contributed over 76% of infections at calving and nearly 70% at mid-lactation . To lower the incidence of mastitis in a herd, a greater emphasis on culling of older infected cows and prevention of new infections during lactation is needed.

Jpn J Antibiot, 1994 Jun, 47(6), 837 - 43
{Clinical effect of arbekacin on MRSA infections after gastrointestinal surgery}; Ochiai M et al.; From January 1991 to July 1993, 58 patients with MRSA infections in our clinic at Wakayama Medical College and six affiliated hospitals were administered with arbekacin (ABK) . The clinical results were as follows: 1 . The clinical efficacy rates of ABK were 84% in pneumonia, 100% in both wound infections and hepatobiliary tract infections, and 85% in total . The bacteriological efficacy rate was 83% . 2 . Regarding the administration route, the clinical efficacy rates were 60-79% by the intravenous treatment and inhalation therapy . Especially by the local administration with ABK, MRSA was eradicated in all cases . 3 . The sufficient efficacy was obtained by the treatment of ABK alone (89%) and by the combined treatment with ABK (82%) and another antibiotics . From these results, it is concluded that ABK is useful for the treatment of MRSA infections after gastrointestinal surgery.

Jpn J Antibiot, 1994 Jun, 47(6), 751 - 62
{An evaluation study on arbekacin for MRSA-infectious diseases including pneumonia, septicemia and others}; Odagiri S et al.; Availability of arbekacin (ABK) was analyzed in the chemotherapy of 24 MRSA-infected patients with symptoms of pneumonia (12), sepsis (6) and others (6) . Most patients had background diseases such as malignant tumors or cerebrovascular disorders . 47% (7/15) of them were immunologically abnormal . 17 of them had been previously treated with cephems, imipenem, minocycline or fosfomycin . The ABK therapy was performed with doses ranging 50-400 mg a day, divided into 1-3 times (mostly 100 mg x 2), and for 5-24 days . (18 patients were treated between 5 and 14 days) . 14 patients (58%) received combined therapy with other antibiotics (mostly with beta-lactams, 12) . The clinical efficacy rate of the ABK therapy was 62% (good, 13; fair, 4; ineffective, 4; unknown, 3) . The bacteriological efficacies were: eradicated, 7 (44%); decreased, 4; no change, 5; unknown, 8 . Side effects were found in 3 patients (oliguria, 2; eruption due to drug, 1) and one case resulted in serious renal disorder . Abnormal laboratory data were found in 7 cases . Above results have indicated that ABK is a useful antibiotic in chemotherapy of MRSA-infections.

Jpn J Antibiot, 1994 Jun, 47(6), 595 - 605
{Nationwide investigation in Japan of the status of MRSA infections and usefulness of arbekacin}; Hayashi I et al.; A clinical investigation on MRSA infections, and the determination of the efficacy and usefulness of arbekacin (ABK) were performed an "MRSA Forum" composed of 18 groups including 115 institutions in Japan . Patients with infectious diseases clearly related with MRSA, a total of 348 (males: 237, females: 111), were evaluated, 74/274 patients were treated with ABK alone/combination with ABK . Most of them (94.6%/96.4%) had underlying diseases and they had pneumonia (38/175), sepsis (6/35) or other infections (30/64) . Infections by MRSA alone were noted in 41/159 and polymicrobial infections including with MRSA were in 33/115 . 53.6%/56.4% of MRSA were eradicated and bacteriological clinical efficacies were 75.6%/67.9% in single infections and 63.6%/71.3% in polymicrobial infections . The clinical efficacies were obtained in 70.3%/69.3% of total and in 60.5%/72.0% of pneumonia and in 90.0%/80.8% of the patients pretreated with other drugs within 3 days previously . Efficacy rates were 78.6%/71.4% in 30 minute's div and 63.2%/66.4% in 60 minute's div . Adverse effects were found in 4.76%/5.70% including renal function disorder (2/11) but no case was serious . Abnormal laboratory test results were noted in 15.4% . ABK is effective against MRSA infections.

Int J Lepr Other Mycobact Dis, 1994 Jun, 62(2), 215 - 9
Rate of relapse in multibacillary patients after cessation of long-course dapsone monotherapy supplemented by a final supervised single dose of 1500 mg of rifampin; Cartel JL et al.; When multidrug therapy was implemented in Senegal, 406 multibacillary (MB) patients who had been treated for more than 10 years by dapsone alone, and who had become clinically inactive and skin-smear negative, were released from treatment . Of these 406 patients, 298 were given a supervised single dose of 1500 mg of rifampin . Subsequently, 302 of them (229 who had been given rifampin and 73 who had not) were followed up by means of annual clinical and bacteriological examinations . Of the former 229 followed up for a mean period of 4.9 years, 34 patients relapsed (22 males and 12 females), giving a crude relapse rate of 15% and an overall risk of relapse of 3.1 per 100 patient-years . Of the latter 73 followed up for a mean period of 2.4 years, 5 relapsed (4 males and 1 female), giving a crude relapse rate of 6.8% and an overall risk of relapse of 2.9 per 100 patient-years . Such results, which are in agreement with those of a similar study conducted recently in Mali, indicate that the intake of a single dose of 1500 mg of rifampin by MB patients when they are released from long-course dapsone monotherapy does not result in a decrease of the relapse rate . Therefore, MB patients who have been treated with dapsone alone, even for long periods, should be put under multidrug therapy prior to their release from control.

Arch Esp Urol, 1994 Jun, 47(5), 445 - 8
{Is urogenital tuberculosis a current disease still?}; Cabezudo Hernando IA et al.; In 1991, the epidemiology service of the health department of La Rioja announced that the number of deaths and new cases were higher than the national average (45/100,000 in 1991) . Our service detected 16 new cases of urogenital tuberculosis during 1990-1991 . The most common clinical symptoms being urgency and frequency . The bacteriological diagnosis using the Lowenstein-Jensen culture medium was positive in 87.50% of the cases . Anomalies were detected in 87.50% of the urographic analyses, the more frequently observed being infundibular involvement . Polychemotherapy consisting of rifampicin, ethambutol and isoniazid was administered for a period of 9 months in all of the cases, which resulted in negative cultures in 100% of the patients . Control evaluation was performed every 3 months, including CBK and serial bacilloscopy, biochemical assays, renal ultrasound, examination of eye grounds (1st trimester), chest X-ray and sputum bacilloscopy . Only endourological methods were utilized, except in one patient with coexisting congenital stricture of the pyeloureteric junction.

Harefuah, 1994 Jun 1, 126(11), 651 - 4, 691
{Cervical necrotizing fasciitis}; Peled M et al.; Necrotizing fasciitis of the head and neck is a rare infection caused by a mixed bacterial flora with anaerobic predominance . Mortality is due to misdiagnosis which results in late and inadequate treatment . The natural course of this serious infection involves spreading necrosis of the soft tissues of the neck with erosion of major blood vessels . A 33-year-old man and a 66-year-old woman are presented to demonstrate the usual etiological factors of cervical necrotizing fasciitis, mainly dental and pharyngeal infections . Diagnosis is by bacteriological culture and CT-scan; a high degree of clinical suspicion is necessary . Treatment included aggressive surgery, appropriate antibiotic coverage and hyperbaric oxygen, and resulted in successful outcomes in our 2 cases.

Comput Appl Biosci, 1994 Jun, 10(3), 329 - 34
A bacterial identification teaching exercise revisited; Bryant TN; Bacterial Identification, first described by Bryant (1986), is a program that provides a novel way of enhancing the teaching of systematic bacteriology and numerical identification procedures . A student is assigned an unknown isolate from a list of bacteria . The student's objective is to identify the unknown isolate using the least number of tests from the set of tests available . Simultaneously the computer tries to identify the unknown using optimised and random selection of tests . A student can compare their progress against that of the computer . The program has been improved and the data matrix on which it was based has been revised by the addition of 14 more species, an additional test and by updating the original probability matrix . The program, Bacterial Identification, is available as 'freeware' and has been placed with organisations that distribute such software.

J Spinal Disord, 1994 Jun, 7(3), 185 - 205
Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation; Jeanneret B et al.; External skeletal fixation is a well-known tool in the management of infection of long bones . However, the application of external skeletal fixation in the treatment of spinal infection has not been previously reported . We have used percutaneous external spinal fixation (PESF) for the treatment of osteomyelitis of the spine in 23 patients since 1981 . The treatment consists of percutaneous vertebral biopsy for bacteriologic diagnosis, installation of a suction/irrigation system into the intervertebral disk space, and posterior stabilization (and reduction if indicated) with an external fixator placed percutaneously . This treatment was conceived in 15 patients as definitive treatment . One patient died due to pulmonary embolism . In 12 patients, the infection healed without further operative treatment . Preoperative kyphosis averaged 15 degrees (range 0-30 degrees) . At follow-up, kyphotic deformity also averaged 15 degrees (range 0-30 degrees) . Two patients required anterior debridement and bone grafting because of progression of bony destruction . In eight patients, PESF was performed emergently, followed by planned anterior debridement and interbody grafting . The treatment was successful in all patients . All fusions healed . Preoperative kyphosis averaged 18 degrees (range 0-40 degrees) . At follow-up, kyphotic deformity averaged 10 degrees (range 0-22 degrees) . Our present indications are listed below and comprise pyogenic and tuberculous osteomyelitis of the spine localized between T3 and S1 . The procedure is an alternative to conservative or more invasive operative treatment modalities in the following conditions: (a) painful lesions of the spine with minimal bone loss, not amenable to efficient orthotic stabilization (thoracic spine from T3 to T9, lumbosacral junction, elderly patients, or presence of deleterious general conditions); (b) osteomyelitis of the spine from T3 to S1, when emergency decompression of the spine is mandatory because of neurologic deterioration due to the kyphotic deformity or to a noncapsulated epidural abscess and anterior decompression is not possible emergently; (c) pyogenic osteomyelitis of the spine at L5/S1, when operative treatment is indicated . In addition, percutaneous insertion of external skeletal fixation is indicated in the presence of infected wounds, making internal posterior stabilization unsuitable (e.g., after open decompression of epidural abscess, postoperative infections).

Braz J Med Biol Res, 1994 Jun, 27(6), 1317 - 20
Abortion due to equine herpesvirus in southern Brazil; Weiblen R et al.; We report an outbreak of abortion due to equine herpesvirus (EHV) in 5 mares between 9 and 11 months of gestation, from a herd of 22 Thoroughbred mares . Equine herpesvirus was isolated from extracts of the liver, spleen and thymus but not from the lungs of a 9-month fetus grown in Rabbit Kidney (RK13) cells . The virus was identified by electron microscopy, where virus particles could be seen in the nucleus of infected cells, and by the fluorescent antibody technique with polyclonal antibodies against the whole virus . Anamnesis, necropsy, histopathology, bacteriology, and virology data suggest that the abortions reported in this paper were due to equine herpesvirus.

Eur J Epidemiol, 1994 Jun, 10(3), 291 - 7
The evolution of pulmonary tuberculosis in coal miners in Asturias, northern Spain . An attempt to reduce the rate over a 15-year period, 1971-1985; Mosquera JA et al.; A prospective study of 53,753 coal miners was undertaken at the Instituto Nacional de Silicosis (INS) in Asturias, Spain, during the period 1971 to 1985 . This included a complete medical history, physical examination, pulmonary function tests, and intensive search for pulmonary tuberculosis . A total of 1,136 new cases of active pulmonary tuberculosis were found, all of which were confirmed by bacteriology . The average incidence was 150 +/- 31 cases per 100,000 miners year-1 . Annual analysis revealed that this figure remained fairly stable during the period of study . Only a reduction of the prevalence in the subgroup of miners with massive pulmonary fibrosis was seen in later years . The risk of tuberculosis among miners was three times greater than that for the general population of the same area . Our inability to reduce the incidence of pulmonary tuberculosis in a large group of coal miners, in spite of the fact that the treatments given were effective and that in the last eight years chemoprophylaxis was given to close contacts, should be emphasized.

Cent Eur J Public Health, 1994 Jun, 2(1), 60 - 1
Detection of serum antibodies in tuberculosis patients; Jarosikova T et al.; Sera of 14 bacteriological confirmed pulmonary tuberculosis and 16 non-tuberculotic or healthy controls were sampled in Ignace Deen University Hospital in Conakry, Quinea . Samples were examined for IgG and IgM antibodies by means of enzyme-linked immunosorbent assay (ELISA) using sonicated M . bovis BCG and M . avium antigens and were tested for antibodies to HIV-1/HIV-2 as well . Median of IgG antibody titres to M . bovis BCG antigen was 1:445 and differed significantly from that of the control group (1:149) . The median of IgM antibody titres was 1:79.1 and did not differ statistically from that of control group (1:69.3) as well as the antibody titres against M . avium antigen in the IgG and IgM classes for both analyzed serum groups . Seven of tested TB patients sera were positive for antibodies against HIV-1 . The median of IgG antibody titres against M . bovis BCG antigen was 1:442 not differing significantly from values of remaining TB patients as well as the IgM antibody titre (1:109).

J Am Vet Med Assoc, 1994 May 15, 204(10), 1571 - 2
Results of using histologic examination and acid-fast staining to confirm a diagnosis of swine mycobacteriosis made on the basis of gross examination; Margolis MJ et al.; Overall, 74% of the tissue specimens that meat inspectors at a large Pennsylvania packing plant identified as lesions of swine mycobacteriosis yielded Mycobacterium avium on bacteriologic culture . Histopathologic lesions compatible with mycobacteriosis were identified in 83% of the specimens; only 12% of the specimens had acid-fast staining organisms.

Arch Surg, 1994 May, 129(5), 489 - 93
Rigid internal fixation of the sternum in postoperative mediastinitis; Gottlieb LJ et al.; OBJECTIVE: The current standard treatment of mediastinitis following median sternotomy is radical sternal debridement and obliteration of anterior mediastinal dead space with muscle or omental flaps . This report describes and reviews our experiences with a new technique of sternal salvage based on osseous quantitative bacteriologic assessment and rigid fixation in patients with postoperative mediastinitis . DESIGN: A retrospective review of 29 patients treated with sternal rigid internal fixation . SETTING: Two tertiary care academic medical centers in Chicago, Ill, and Ann Arbor, Mich . PATIENTS: Patients with postoperative mediastinitis following median sternotomy who underwent rigid internal fixation of retained sternum . INTERVENTION: Following debridement, quantitative bacteriologic assessment and sternal vascularity were assessed . Sternal segments with good vascularity and in bacteriologic balance were anatomically reduced and rigidly fixed to each other with titanium miniplates in 24 patients with postoperative mediastinitis . Five of the 29 patients, at high risk for mediastinitis, underwent rigid internal fixation immediately after their cardiac procedure . MAIN OUTCOME MEASURES: Resolution of infection, wounds remaining closed, and stable sternums . RESULTS: Bony union was obtained in 27 (93%) of 29 patients . The postoperative hospital stay ranged from 5 to 84 days, with a mean stay of 17 days and a median stay of 7 days . Length of stay was directly related to pulmonary function, which correlated with preoperative intubation status . CONCLUSIONS: Radical sternal debridement may not be necessary in all patients with postoperative mediastinitis following median sternotomy . Sternal salvage can safely and reliably be performed with a combination of clinical assessment of vascularity and osseous quantitative bacteriologic assessment . Anatomic reduction of the viable sternal segments is possible even in severely osteoporotic bone.

Am J Respir Crit Care Med, 1994 May, 149(5), 1359 - 74
Treatment of tuberculosis and tuberculosis infection in adults and children . American Thoracic Society and The Centers for Disease Control and Prevention; Bass JB Jr et al.; Treatment of Tuberculosis . 1 . A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment . Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (i.e., there is less than 4% primary resistance to isoniazid in the community, and the patient has had no previous treatment with antituberculosis medications, is not from a country with a high prevalence of drug resistance, and has no known exposure to a drug-resistant case) . This four-drug, 6-mo regimen is effective even when the infecting organism is resistant to INH . This recommendation applies to both HIV-infected and uninfected persons . However, in the presence of HIV infection it is critically important to assess the clinical and bacteriologic response . If there is evidence of a slow or suboptimal response, therapy should be prolonged as judged on a case by case basis . 2 . Alternatively, a 9-mo regimen of isoniazid and rifampin is acceptable for persons who cannot or should not take pyrazinamide . Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should also be included until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (see Section 1 above) . If INH resistance is demonstrated, rifampin and ethambutol should be continued for a minimum of 12 mo . 3 . Consideration should be given to treating all patients with directly observed therapy (DOT) . 4 . Multiple-drug-resistant tuberculosis (i.e., resistance to at least isoniazid and rifampin) presents difficult treatment problems . Treatment must be individualized and based on susceptibility studies . In such cases, consultation with an expert in tuberculosis is recommended . 5 . Children should be managed in essentially the same ways as adults using appropriately adjusted doses of the drugs . This document addresses specific important differences between the management of adults and children . 6 . Extrapulmonary tuberculosis should be managed according to the principles and with the drug regimens outlined for pulmonary tuberculosis, except for children who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Clin Infect Dis, 1994 May, 18(5), 736 - 43
Rifampin-resistant Mycobacterium kansasii; Wallace RJ Jr et al.; We identified 36 rifampin-resistant Mycobacterium kansasii isolates, including 17 (4%) of 464 isolates recovered in Texas between 1989 and 1992 . Of 29 patients infected with rifampin-resistant M . kansasii whose history of medication was known, 90% had previously received rifampin, and 58% of these patients had been treated with one or two effective drugs . Thirty-two percent of rifampin-resistant isolates recovered since 1989 were from patients who were seropositive for human immunodeficiency virus (HIV) infection . Twenty courses of therapy with a four-drug regimen determined on the basis of in vitro susceptibilities were administered to 16 patients from whom rifampin-resistant isolates were recovered; the therapy did not include surgery . Sputum cultures converted to negative as the result of 90% of treatments (time to conversion: mean, 11 weeks; range, 4-20 weeks) . Bacteriologic relapses occurred in four of five patients who withdrew from therapy after being culture negative for < or = 6 months of therapy and in one of 12 patients who were culture negative for at least 12 months of therapy (mean, 16.3 months) . This study suggests that the prognosis for cure of infection due to rifampin-resistant M . kansasii with chemotherapy alone is excellent, although the number of cases appears to be increasing, in part because of the HIV disease epidemic.

Arch Androl, 1994 May-Jun, 32(3), 213 - 8
Alteration of semen characteristics and regulatory factors in human semen with bacterial infection; Gopalkrishnan K et al.; Semen samples (n = 40) obtained from males attending an infertility clinic were subjected to bacteriological culture and categorized as bacteriologically negative (group I) and bacteriologically positive (group II) depending on the culture positivity . Semen samples from both groups were simultaneously analyzed for routine parameters such as volume, count, motility, viability, morphology, pH, and hypoosmotic swelling . Seminal plasma was assayed for levels of prolactin (PRL), prolactin-suppressing factor (PSF), prostatic inhibin peptide (PIP) and zinc (Zn) . Patients in group II (n = 25) showed statistically significant alteration (p < .01) in semen parameters such as motility, percent normal morphological forms, and percent normal HOS test as compared to group I (n = 15) . There was a negligible change in the sperm concentration between the two groups . The semen volume, viability, and pH did not show any variation . Among the regulatory factors assayed, there was a significant change in the Zn, PSF (p < .05), and PIP (p = .01), while no such alterations were seen for PRL . The results suggest that bacterial infection affects fertility either by affecting the seminal characteristics directly or by acting on the regulatory systems.

Vet Microbiol, 1994 May, 40(1-2), 53 - 63
Post mortem diagnosis of Mycobacterium bovis infection in cattle; Corner LA; A tentative diagnosis of bovine tuberculosis can be made following the macroscopic detection at necropsy of typical lesions . Histo-pathological examination of the lesion may increase the confidence of the diagnosis but bacteriological isolation of Mycobacterium bovis from the lesion is the only way to make a definitive diagnosis . The sensitivity of gross post mortem examination is affected by the method employed and the anatomical sites examined . Careful examination of as few as 6 pairs of lymph nodes, the lungs and the mesenteric lymph nodes can result in 95% of cattle with macroscopic lesions being identified . Although during post mortem inspection of carcases at abattoir all the principle sites where lesions are to be found were examined, this procedure was found to be insensitive for the detection of lesions . To determine the significance of cattle that give a positive reaction in diagnostic tests but do not have visible lesions (NVL), a bacteriological examination is necessary . NVLs may be due to early infection, poor necropsy technique or infection with mycobacteria other than M . bovis . M . bovis was found to survive best in frozen tissue and the tissue preservative, sodium tetraborate, was found to have adverse effects on viability . It was found desirable to use two different culture media for the primary isolation of M . bovis; agar media for rapid growth and egg media for control of contamination . Additional control of contamination was achieved without adversely affecting the viability by treating the specimen before culture with 0.075% hexadecylpyridinium chloride . The addition of CO2 to the incubation atmosphere did not enhance the recovery of M . bovis . Conventional identification of isolates of M . bovis is by biochemical tests and cultural characteristics, but methods employing monoclonal antibodies and DNA probes may be used to obtain a rapid identification.

J Card Surg, 1994 May, 9(3), 353 - 6
The use of cyanoacrylate adhesive (Krazy Glue) in cardiac surgery; Robicsek F et al.; The authors report four cases of patients in desperate clinical situations where cyanoacrylate adhesive (Krazy Glue) was successfully used to control hemorrhage . Clinical observations were supplemented with bacteriological studies which showed that commercially available cyanoacrylate adhesive showed lack of bacteriological contamination.

Australas Radiol, 1994 May, 38(2), 112 - 4
Bacteriological studies of open versus closed contrast medium delivery systems in angiography; Tress BM et al.; The aim of this study was to evaluate the safety of the 'open' method of contrast medium delivery in the angiographic theatre, in which contrast medium is decanted into open galley pots on sterile trolleys . The air bacterial load within the angiographic theatre was sampled before and during angiographic procedures . The relationship of staff and patient activity to bacterial load was assessed . Samples of Iopromide (Ultravist 370; Schering Pty Ltd, Sydney, NSW, Australia) decanted into galley pots were taken for bacterial culture at the end of seven patient procedures . Air bacterial loads were comparable with operating theatre levels and were heaviest during staff activity . Three of seven samples taken at the end of angiographic procedures from air-exposed galley pots yielded contaminants, but the number of bacteria was below that required to produce septicaemia under normal conditions . These results suggest that the open system of contrast medium delivery can be safely used, providing that bacterial checks of room contamination are performed and personnel entry into the theatre is strictly limited.

J Prosthet Dent, 1994 May, 71(5), 473 - 7
How severe is the threat of caries to old teeth?
MacEntee MI.
Caries is a bacterial infection caused by a complex interaction of biologic and behavioral factors . It is believed that caries is a major threat to teeth in old age, yet little information is available on the incidence and progress of carious lesions in elderly teeth . All too often caries is diagnosed after a visual and tactile examination of tooth structure without thought for the other factors essential to the initiation and support of an active lesion . Prospective studies have been conducted recently in Vancouver to quantify associations between the incidence of caries and many of the behavioral, bacteriologic, and physiologic factors potentially influencing oral health in old age . The results indicate that improvements in hygiene may hold the most promise for controlling this infection in an elderly population.

Infection, 1994 May-Jun, 22(3), 226 - 30
Flurithromycin ethylsuccinate in the treatment of lower respiratory tract bacterial infections; Bariffi F et al.; Efficacy and tolerability of flurithromycin ethylsuccinate were evaluated in lower respiratory tract infections . One hundred and ten patients (38 women, 72 men; age range 18-87 years) were treated with on 375 mg tablet 12-hourly for a mean duration of 8.7 days . One hundred and five patients were evaluable for efficacy . Overall clinical cure rate was 62.9%; improvement was recorded in 19% of patients for a total satisfactory clinical response rate of 81.9% . Sputum production decreased in most patients, being absent after treatment in 47% (only one patient was negative at baseline); sputum was purulent or mucopurulent in 80% of subjects before and in 20% after treatment . Bacteriological evaluation was possible in 72 patients: pathogen eradication was achieved in 80.2% of cases . Eight patients out of 110 reported adverse reactions, mainly gastrointestinal; in one case treatment had to be discontinued . These results demonstrate that flurithromycin ethylsuccinate is safe and effective in the treatment of lower respiratory tract infections.

J Formos Med Assoc, 1994 May, 93(5), 368 - 73
Prospective, randomized study of H2-blocker and triple therapy for duodenal ulcer treatment and the eradication of Helicobacter pylori; Lin JT et al.; The efficacy of H2-blocker and triple therapy in curing duodenal ulcer was compared and the contribution of the eradication of Helicobacter pylori on ulcer remission was assessed . Forty-two duodenal ulcer patients infected with H . pylori were randomized to receive either H2-blocker therapy with famotidine (n = 21) or triple therapy with bismuth, amoxicillin, and metronidazole (n = 21) . All patients received treatment for four weeks . Endoscopic evaluation of ulcer status and bacteriologic identification of H . pylori were performed at two, six and 12 months after therapy . Triple therapy had a similarly high healing rate to H2-blocker therapy (100% vs 90.5%) at two months of follow-up . However, at 12 months of follow-up, the ulcer remission rate in the triple therapy group (94.4%) was significantly higher than that of the H2-blocker therapy group (38.9%) (p < 0.05), resulting in the former therapy having a significantly lower rate of H . pylori infection compared to the latter (5.6% vs 100%, p < 0.005) . Patients with persistent H . pylori infection at two months of follow-up had a significantly higher ulcer recurrence rate (64.7%) at 12 months than those without infection (5.3%) (p < 0.05) . The success of triple therapy in ulcer remission may be attributed to the high eradication rate of H . pylori.

Encephale, 1994 May-Jun, 20(3), 351 - 4
{Acute catatonia and neuroleptic malignant syndrome . A case of infantile psychosis}; Revuelta E et al.; Similar clinical and biological features in lethal catatonia (LC) and neuroleptic malignant syndrome (NMS) suggest a relationship between both affections and common physiopathologic mechanisms . Pharmacological effects of several drugs--dopaminergic agonists, benzodiazepines, carbamazepine--suggest an impairment of several systems of neurotransmitters . We report the case of a young woman with infantile psychosis who developed catatonic syndrome worsened by neuroleptic treatment, arising the problem of the chronology of both affections . The evolution with treatment may partially explain the physiopathology . A 18-year old woman with an history of infantile psychosis, experienced insomnia, anorexia, paradoxical agitation developed after affective traumatism (mother's hospitalization) . Chlorazepate (150 mg) remained inefficient and hospitalization was necessary . The patient was dumb, prostate in bed . She presented negativism, rigidity of the four limbs, catalepsia and hyperpyrexia (38.5 degrees C) . Hepatic transaminases were increased (SGOT: 71 UI/l; N < 30) . After cumulated dose of levomepromazine (100 mg) profuse sudation, thermic and cardiovascular instability, alteration of consciousness, major rigidity of limbs appeared . (Blood) hepatic transaminases and muscular enzymes increased . Bacteriological samples, cerebrospinal fluid analysis, CT-scan and EEG were normal . Within 48 hours after rehydratation and bromocriptine (30 mg per day) alteration of consciousness and autonomic disorders decreased but hyperpyrexia (38 degrees C) persisted . Biological parameters were normalized 10 days later . Negativism and psychomotor inertia remained . Lorazepam (3 mg per day) failed to be clinically beneficial . On carbamazepine (600 mg per day) she started speaking and moving spontaneously . Catalepsia disappeared but rigidity and anorexia persisted . Electroconvulsivotherapy (ECT) was necessary . After 2 shocks she started standing up, walking, taking food and speaking fluently.(ABSTRACT TRUNCATED AT 250 WORDS)

Vet Rec, 1994 Apr 2, 134(14), 351 - 2
Lymphocytic-plasmacytic enterocolitis in a cow; O'Leary M et al.; A White Park cow with enterocolitis suffered chronic weight loss and diarrhoea . An examination of rectal biopsies revealed an inflammatory infiltrate in the lamina propria, but the aetiology of the condition was not determined despite haematological, bacteriological and parasitological tests . On post mortem examination the inflammatory infiltrate was found throughout the large and small intestine.

Surg Endosc, 1994 Apr, 8(4), 326 - 8
Childhood abdominal tuberculosis . The role of echo-guided fine-needle aspiration in its management; Liu KW et al.; Two children presented with abdominal tuberculosis . Because of the nonspecific clinical features, the diagnosis required a high index of clinical suspicion . Fine-needle aspiration (FNA) under ultrasonographic guidance allowed an early definitive diagnosis and bacteriological confirmation to guide chemotherapy . Both patients responded well to antituberculous chemotherapy.

Spine, 1994 Apr 1, 19(7), 855 - 7
Percutaneous discectomy for the treatment of bacterial discitis; Gebhard JS et al.; METHODS . Percutaneous discectomy was successfully used to diagnose and treat bacterial discitis . CONCLUSIONS . This technique was successful in obtaining a bacteriologic diagnosis, relieving the patient's symptoms and assisting in the eradication of the infection . With percutaneous discectomy, there is lower morbidity and cost than with open treatment . Any comments on the overall effectiveness of this technique will need to be based on additional cases.

J Dairy Sci, 1994 Apr, 77(4), 1132 - 40
Evaluation of a prototype on-line electrical conductivity system for detection of subclinical mastitis; Lansbergen LM et al.; A prototype on-line system for measurement of electrical conductivity of quarter milk was evaluated for accuracy in detection of subclinical mastitis compared with that of bacteriological culture and SCC of sampled quarters . Because of the low quarter prevalence of mastitis, quarters were sampled conditionally from the signals of the on-line system . All signaled quarters and a random selection of the nonsignaled quarters were sampled . To calculate sensitivity and specificity, the total number of non-signaled quarters was extrapolated . The system identified correctly 18 out of 23 subclinical quarters and 521 out of 555 healthy quarters . Quarter prevalence was about 1% . Predictive value of a positive test (35%) and the predictive value of a negative test (99%) were calculated, as well as sensitivity (25%) and specificity (99%), after extrapolation of the total number of nonsignaled quarters . Because of repeated measurements, sensitivity may be underestimated . When signaled quarters were defined by repeated signals within 14 d, predictive value positive increased to 48% . The prototype on-line system did not detect subclinical mastitis very accurately because of suboptimal test characteristics.

Unfallchirurgie, 1994 Apr, 20(2), 94 - 110
{Local antiseptics in surgery--rebirth and advances}; Willenegger H; The history of antisepsis is marked by names such as Pringle, Lister, Billroth, Koch, Kocher, von Volkmann, von Nussbaum, Schloffer and Carrel . The revolutionary initial success of Lister's method was followed by severe setbacks because persisting biological intolerance of the chemical and physical antiseptics prevented the main purpose of application: killing bacteria without damaging cells . Until the discovery of penicillin the predominantly used antiseptics were perubalsam (balsamum peruvianum), azo-dyes (Rivanol), and sulphonamides (Cibazol) . The dawn of the "antibiotic age" demonstrated once more the limits of locally applied therapeutic effectiveness of these substances (antiseptics, antibiotics) and was often outweighed by the damage caused . For the same reason systemicly applied substances frequently lack satisfactory effectiveness in the area of tissue damage . Experiences with intraoperative and postoperative wound lavage have shown that favourable results achieved by this surgical procedure are more likely due to the mechanical cleaning process than to the effectiveness of the locally applied substances being limited by the restricted duration of influence and the restricted depth of tissue penetration . Taking into account earlier studies and long-term experiences, antiseptic solutions were tested in view of their tissue compatibility, their biologic availability, and their effectiveness in close cooperation of clinic, bacteriology and laboratory medicine . The coordinated investigations resulted in a solution of biguanid (Lavasept) which is free from iodine, quicksilver, PVP and aldehyde . It can be applied for local treatment of wounds liable to infection, as an adjuvant for wound treatment in cases of acute tissue infections, as well as in the surgival practise to take care of acute and chronic infections of soft tissue . Sofar locally applied antiseptics in surgery have proved to be less satisfactory than considered in the course of their history due to side effects, e.g . tissue damage . Coordinated investigations now present an antiseptic solution of biguanid which can be used in various cases of wound treatment to prevent or counteract infections.

J Periodontol, 1994 Apr, 65(4), 364 - 71
Clinical, bacteriological, and immunological examinations and the treatment process of two Papillon-Lefèvre syndrome patients; Ishikawa I et al.; Papillon-Lefevre Syndrome (PLS) is a rare disease associated with the early onset of periodontal breakdown in deciduous and permanent dentition . The etiology of the destruction has not been completely clarified . Two female patients (ages 4 and 7 years) with severe destruction of the periodontal structures were examined . Except for palmar and plantar hyperkeratosis, dermatologic examination revealed no other medical disorders . On immunological analysis, measurement of serum antibody titers to 7 periodontopathic bacteria including Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was performed by enzyme-linked immunosorbent assay (ELISA) . Further immunoblot analysis of A . actinomycetemcomitans and microbial culture of samples collected from deep periodontal pockets and mouthrinse solution were performed . The serum of the two patients showed high IgG titer against A . actinomycetemcomitans . Immunoblot results of the two patients against sonicated extract of A . actinomycetemcomitans Y4 strain exhibited a similar pattern . The band pattern differed from that observed in other forms of early onset periodontitis patients or periodontally healthy subjects . Moreover, A . actinomycetemcomitans colonies were cultured in high percentages from the pocket samples . Antibiotic therapy was instituted in addition to conventional periodontal therapy . In the younger patient, all deciduous teeth were extracted as part of the treatment and A . actinomycetemcomitans was no longer detected . All four permanent first molars and 8 permanent incisors subsequently erupted with healthy periodontium . However, the older patient did not improve after periodontal and antibiotic (minocycline and erythromycin) treatments and A . actinomycetemcomitans was consistently detected . Ofloxacin medication finally eliminated A . actinomycetemcomitans from the periodontal pockets . This antibiotic was also associated with reduced gingival inflammation and probing depth.(ABSTRACT TRUNCATED AT 250 WORDS)

J Laryngol Otol, 1994 Apr, 108(4), 348 - 9
Unusual association of secondary tonsillar and cerebral tuberculosis; Adiego MI et al.; The patient was a 50-year-old alcoholic man with a left palatine tonsillar ulcer . Histopathological and bacteriological studies established the diagnosis of tonsillar tuberculosis with asymptomatic advanced pulmonary tuberculosis and multiple cerebral supra- and infratentorial tuberculomas previously unnoticed.

J Egypt Soc Parasitol, 1994 Apr, 24(1), 93 - 105
The value of ascites adenosine deaminase activity and interferon gamma level in discriminating tuberculous from non-tuberculous ascites; Soliman AA et al.; The diagnosis of tuberculous ascites is often difficult because of the subtle clinical clues, poorly discriminative biochemical assays, delayed results of bacteriological studies and hazards of laparoscopy . Therefore, the role of ascites adenosine deaminase (ADA) activity and interferon-gamma (IFN-delta) level in distinguishing tuberculous from other causes of ascites was examined in 50 patients with ascites . Following bacteriologic culture, seventeen (34%) patients were found to have tuberculous ascites; nine (59.9%) of them had also schistosomal hepatic fibrosis (SHF) . Therefore, 36% (9 out of 25) of all patients with SHF included in the study, had coexistent peritoneal tuberculosis despite the presence of transudative ascites and unrecognized clinical features . Ascites ADA activity was significantly higher in tuberculous than in other causes of ascites (P < 0.001) regardless of the presence of an underlying liver disease . A cut-off of 28 U/L reached a sensitivity of 94.4% and a specificity of 100% . A direct correlation was found between ascites ADA activity and total proteins in the tuberculous group (r = 0.613) and the only false-negative result occurred in a patient with SHF and low-ascites protein . Ascites IFN-delta level was also significantly higher in tuberculous ascites with or without SHF than in other causes of ascites (P < 0.05) . A cut-off of 26 pg/ml reached a sensitivity of 81% and a specificity of 100% . There was no correlation between ascites ADA activity and IFN-delta level in the tuberculous group (r = 0.329) . Based on the results of the present study, it can be concluded that tuberculous ascites should be considered as an important cause of ascites particularly in patients with underlying liver disease . Ascites ADA activity was more sensitive than ascites IFN-delta in diagnosing tuberculosis (TB) . It has proved to be an easy, rapid, safe and reliable method for routine use in the early diagnosis of tuberculous ascites.

Nutr Clin Pract, 1994 Apr, 9(2), 69 - 72
Femoral venous catheters: a safe alternative for delivering parenteral alimentation; Friedman B et al.; Femoral vein catheterization is an alternative method of obtaining central venous access . Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion . We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs . Fifty-two patients were followed from a hospital-wide population including patients in the critical care units . Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation . Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures . If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally . The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%) . Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found . On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

Wei Sheng Wu Xue Bao, 1994 Apr, 34(2), 89 - 95
{New species of Haloarcula}; Zhou P et al.; Three strains of pleomorphic halobacteria (A5, B2 and B-B2) were isolated from salt lakes of Xinjiang, China . Based on the Bergey's Manual of Systematic Bacteriology, Volume 3 (1989) and the analytical results of polar lipids, the three strains could be included in the genus Haloarcula . But since they differ from normally accepted two species of this genus in cell shape and physiological and biochemical features, it is suggested that the three strains belong to a new species, called Haloarcu la aidinensis sp . nov.

J Vet Diagn Invest, 1994 Apr, 6(2), 182 - 7
Comparison of particle concentration fluorescence immunoassay to card and complement fixation tests using isolation of Brucella abortus as the standard; Greenlee MT et al.; Serologic test data and bacteriologic culture results from 816 cattle were evaluated . Brucella abortus (field strain or strain 19) was isolated from 27.3% of the cows . Results of the card test, particle concentration fluorescence immunoassay (PCFIA), and complement fixation (CF) test were compared . Antibody titers were directly associated with B . abortus isolation, with the majority (64.7%) of field strain isolations having a PCFIA value of < or = 0.300 and a CF test result of at least 1+ at a 1:160 dilution . The specificity of the CF test was significantly higher than that of the PCFIA (at CF > or = 1:40 and PCFIA < or = 0.300).

Aust Vet J, 1994 Apr, 71(4), 106 - 8
Veterinary education in the era of information technology; Whithear KG et al.; A major innovation in the delivery of the veterinary curriculum is being implemented at The University of Melbourne using the subject of systematic bacteriology and mycology as a pilot project . Students receive course information as interactive, multimedia databases . These consist of text and an associated library of catalogued digital images, movies and sounds . The databases employ a hypermedia information system to achieve efficient integration within and between subjects . The new delivery method encourages greater autonomy and more active learning roles for students than occurs in traditionally taught courses . Students will use their databases as the principal resource of information for undergraduate studies . A unique feature of this system for delivering the curriculum is that students will modify and expand their databases during the course . The ultimate aim is for students at graduation to receive, on disc, a copy of their own databases, adapted by themselves to their particular future professional needs . As graduate veterinarians they will continue to use their databases as a major resource for information and learning, thus providing continuity from undergraduate to continuing postgraduate education.

Allerg Immunol (Paris), 1994 Apr, 26(4), 148, 151 - 3
{Ansatipine: only preventive treatment available for opportunistic MAI infections in AIDS . From an interview with Dr . Agnes Mignon}; Mignon A; Ansatipine, the international name of which is rifabutine, is a new specialty that was licensed in February 1993 and marketed in France in June 1993 . It is an antibiotic of the rifamycin family, the result of research by Farmitalia Carlo Erba and is now presented by the Laboratoire Pharmacia . Today, rifabutine is the only molecule in the world that has been shown to be efficacious in preventative treatment for infections by the Mycobacterium avium complex (MAC) and to be officially recognised as such . Rifabutine (Ansatipine) was developed for prophylaxis of infections by MAC, because of its bacteriological activity on mycobacteria and especially on the Mycobacterium avium complex, the small number of the MAC which are naturally resistant, its high degree of tissue and intracellular penetration and its long half-life that allows a single daily dose . Clinical tests on more than 1,000 patients have shown the benefit of Ansatipine in the prophylactic treatment of MAC infections: reduction by half on the frequency of surveillance, prolongation of the delay in appearance, significant improvement in general condition and quality of life of the patients . Ansatipine is now dispensed to town pharmacies, which can only ease the daily lives of patients and reinforce the co-operation between hospital teams and general practitioners who specialize in the care of AIDS.

Allerg Immunol (Paris), 1994 Apr, 26(4), 141 - 4
{A new prophylactic agent in AIDS: Ansatipine . Disseminated Mycobacterium avium complex infection is now the most frequent of the opportunistic bacterial infections in AIDS}; Dautzenberg B; Otherwise infrequent, infections by non-tuberculous or atypical mycobacteria are now rising in AIDS . Infection with the Mycobacterium avium complex (MAC) is now the most frequent opportunistic bacterial infection, because of better detection of HIV positive patients . The incidence, which is probably underestimated, is now 14-33% in France . The Mycobacterium avium complex is responsible for 96% of infections by atypical mycobacteria in AIDS patients . Diagnosis of infection by MAC is bacteriological . The clinical picture is non-specific and associates high fever, profuse sweating, weight loss and asthenia, all of which make a severe alteration to the general condition . This infection persists in AIDS patients to a late phase of evolution where Immunodeficiency is profound, that is when the level of CD4 lymphocytes is low . Because of this, it is an increasing and preoccupying problem in patients, since it involves the prognosis of life . This shows the importance of prophylactic treatment for this pathology.

Artif Organs, 1994 Apr, 18(4), 322 - 4
Fibrin sheet covering subclavian or femoral dialysis catheters; Hombrouckx R et al.; The existence of a sheet around a single lumen dialysis catheter tip, which provokes a valve mechanism, is proved by the observation that several times during the replacement procedure of a dialysis catheter, a sheet surrounding the surface of the catheter is removed with the dialysis catheter . This sheet is grey, approximately 1 mm thick and 30 mm long and consists of fibrin and thrombocytes . Bacteriological examinations were always negative . The existence of the sheet in vivo is demonstrated by digitalized angiography during the removal procedure for single lumen dialysis catheters . Rarely, only the sheet is removed with the catheter . It all other instances, the sheet is stripped off and remains in the subcutaneous tunnel or in the vascular bed without causing much clinical discomfort in most patients . Occasionally an episode of cough, dyspnea, hypotension, retrosternal oppression or hemoptae after removing the single lumen dialysis catheter, suggest pulmonary embolism or lung infarction.

Can J Vet Res, 1994 Apr, 58(2), 87 - 92
Attaching and effacing and enterotoxigenic Escherichia coli associated with enteric colibacillosis in the dog; Drolet R et al.; The objective of this study was to describe observations from cases of enteric colibacillosis in the dog . Thirteen cases of canine enteric colibacillosis were diagnosed from routine necropsy submissions to our diagnostic laboratory from 1980 to 1992 . In all cases there was a clinical history of gastrointestinal disease associated with histological and bacteriological evidence of either attaching and effacing Escherichia coli (AEEC) or enterotoxigenic Escherichia coli (ETEC) infection . Of these 13 cases of enteric colibacillosis, 12 were associated with AEEC and one with ETEC . Eight of the 12 AEEC isolates were available for study . They were of various serogroups, non-hemolytic, and negative for the genes coding for fimbrial antigens F4, F5, F6, F41 and F165; enterotoxins STap, STb and LT; and verotoxins VT1 and VT2 . These eight isolates were EAE-positive (E . coli attaching and effacing) by colony hybridization; six of these were also EAF-positive (EPEC adherence factor), and six were BFP-positive (bundle-forming pilus) . The ETEC isolate was negative for the EAE, EAF and BFP determinants and for the fimbrial antigens tested but was positive for the STap and STb genes . Most of the dogs affected with enteric colibacillosis originated from kennels and pet shops and were aged between 1.5 and 3 months . Coinfection with other enteric pathogens was identified in eight of these 13 cases . This study showed that Escherichia coli should be considered of causal significance when investigating diarrheal disease in dogs, particularly in puppies.

Klin Oczna, 1994 Apr-May, 96(4-5), 163 - 7
{Amebic keratitis-keratitis acanthamoeba}; Gieryng R et al.; In seventeen patients who suffered of corneal ulcer, and were negative in bacteriological and mycological examinations, parasitological tests were performed between 1990-1992 . Acanthamoeba keratitis was diagnosed in one patient with characteristic corneal changes of right eye following trauma . The patient was not a contact lens wearer . The amoeba found in direct smears of scraping from corneal ulcer and isolated and cloned in in vitro conditions (isolate-clone-No . 2961) belonged to Acanthamoeba polyphaga species . The trophozoites showed a low degree of invasiveness and high virulence when tested in BALB/c mice . The authors discussed the epidemiology of Acanthamoeba keratitis and pointed out to the necessity of accurate laboratory diagnosis and discerning interpretation of the results to prevent an Acanthamoeba-phobia among the potential patients and most of all among the medical staff.

Zhonghua Liu Xing Bing Xue Za Zhi, 1994 Apr, 15(2), 117 - 20
{Studies on the detection of Legionella pneumophila by the application of polymerase chain reaction (PCR)}; Yu C et al.; DNA fragment of Legionella pneumophila, the PCR was performed with a pair of artificial synthesized primer . Results of agarose electrophoresis and EB staining showed that there was a 870 bp band shared by serogroups 1-14 of L.pneumophila . The sensitivity of PCR in detecting Legionella from water was 350cfu/ml, however, the specific DNA probe labeled with 32P was .43cfu/ml by blot hybridization . The positive rate of tissue specimens from infected guinea-pigs with Legionella pneumophila was 83.3% by PCR detection, and only 26.6% by bacteriological culture method . An outbeak caused by Lp10 was verified by PCR . The result showed that the PCR could detect the infection of Legionella rapidly, specifically and sensitively.

Antibiot Khimioter, 1994 Apr, 39(4), 37 - 9
{Use of a new drug, lomefloxacin (maxaquin), from the fluoroquinolone group in the treatment of patients with wound infection}; Blatun LA et al.; A clinicolaboratory study on the efficacy of lomefloxacin (maxaquin, Searle, USA) was carried out in the treatment of 31 patients with wound infections . In the complex therapy the clinical efficacy of the drug amounted to 96.7 per cent and its bacteriological activity reached 64.6 per cent . The drug tolerance in the majority of the cases was good . Only in one patient an allergic reaction in the form of multiple skin eruption on the 6th day of the treatment was recorded . One patient showed an insignificant increase in the level of alanine aminotransferase not accompanied by any signs of hepatic insufficiency.

Arch Intern Med, 1994 Mar 28, 154(6), 640 - 5
Tuberculosis among patients with AIDS and a control group in an inner-city community; Given MJ et al.; BACKGROUND: Tuberculosis, the largest single cause of death of any infectious disease worldwide, has undergone a startling resurgence in the United States, partially related to the acquired immunodeficiency syndrome (AIDS) epidemic . METHODS: To compare the clinical, roentgenographic, and bacteriologic characteristics of patients with AIDS and the general population, we retrospectively analyzed the clinical records of all patients with tuberculosis in an inner-city population over a 4-year period . Forty-six patients with AIDS (including 38 injecting drug users {83%}) were identified and matched with a control group of 46 patients with tuberculosis who did not have AIDS . RESULTS: Forty-one patients with AIDS (89%) had pulmonary tuberculosis; 10 (22%) had disseminated disease and 13 (28%) had concurrent extrapulmonary disease . Among the patients without AIDS, two (4%) had disseminated disease and four (9%) had extrapulmonary disease . Patients with AIDS were far more likely to be black . Thirty-seven patients with AIDS (80%) had negative purified protein derivative skin test results compared with eight controls (17%) . Seventeen (41%) of 41 patients with AIDS presented with classic post-primary upper-lobe disease compared with 32 (73%) of 44 patients in the control group . Primary tuberculosis features occurred predominantly in the AIDS group . Four (10%) of 41 patients with AIDS presented with clear chest films despite positive smears and cultures . Nine patients with AIDS (20%) were drug-resistant compared with three controls (7%) . Seven patients with AIDS with drug resistance were born in the United States (78%), while all controls with drug resistance were foreign-born . CONCLUSIONS: We found vast differences in the clinical, roentgenographic, and drug susceptibility characteristics of patients with tuberculosis who did and did not have AIDS.

Prehospital Disaster Med, 1994 Apr-Jun, 9(2 Suppl 1), S25 - 8
Improvised purification methods for obtaining individual drinking water supply under war and extreme shortage conditions; Kozlicic A et al.; BACKGROUND: Supplying an adequate amount of drinking water to a population is a complex problem that becomes an extremely difficult task in war conditions . In this paper, several simple methods for obtaining individual supplies of drinking water by filtration of atmospheric water with common household items are reported . METHODS: Samples of atmospheric water (rain and snow) were collected, filtered, and analyzed for bacteriological and chemical content . The ability of commonly available household materials (newspaper, filter paper, gauze, cotton, and white cotton cloth) to filter water from the environmental sources was compared . RESULTS: According to chemical and biological analysis, the best results were obtained by filtering melted snow from the ground through white cotton cloth . CONCLUSIONS: Atmospheric water collected during war or in extreme shortage conditions can be purified with simple improvised filtering techniques and, if chlorinated, used as an emergency potable water source.

Ann Gastroenterol Hepatol (Paris), 1994 Mar-Apr, 30(2), 43 - 52
{Ultrasonographic data of the solid organs of the abdomen in stage IV human immunodeficiency virus infection . A prospective study of 101 cases in central Africa}; Aubry P et al.; A systematic abdominal study of the solid organs of the abdomen (liver, spleen, pancreas, kidneys) carried out in one hundred patients from Central Africa suffering from full blown AIDS revealed disseminated hyperechoic liver in 37 cases and hypoechoic nodules of the spleen in 10 cases . The combination with abdominal adenopathy and/or serous exudates (peritoin, pleura, pericardium) suggested disseminated tuberculosis . Twenty of the 37 patients with diffusely hyperechoic liver presented within tuberculosis which was confirmed by bacteriological data (AARB present in the sputum) in 13 cases . Of the 10 patients presenting with hypoechoic nodules of the spleen, 5 presented with confirmed tuberculosis . These 10 patients were all considered to have disseminated tuberculosis . In view of the current high incidence of extrapulmonary or disseminated tuberculosis occurring in a context of AIDS and the relative infrequency of positive tests for Mycobacterium, abdominal ultrasound must be coupled with chest X-rays in screening and prompt follow-up for TB instigated in HIV-positive adult Africans.

Respir Med, 1994 Mar, 88(3), 213 - 7
Tuberculosis case-finding in Western Australia; Pang SC et al.; The records of a total of 497 patients notified to have active tuberculosis (TB) in Western Australia from 1986 to 1990 inclusive have been reviewed in relation to case-finding . Of these, 276 (55.5%) were Asian migrants, 92 (18.5%) Europeans and 110 (22.1%) Australians . The disease was confirmed bacteriologically in 247 (49.7%) . The most common mode of diagnosis was symptomatic presentation (39.8%), followed by migrant health surveillance (36.8%), incidental finding (7.5%), regular follow-up (3.8%) and pre-employment chest radiography (1.8%) . Contact examination in the non-Asians accounted for only 0.4% while diagnosis after death 2.6% . There was no statistical difference in the detection of TB disease and infection among contacts of index patients with diseases at different sites or of different bacteriological status . The results of the study justify the present strict surveillance over the Asian migrants but do not support the overcautious policy of the contact examination procedures in the non-Asians, for which changes are proposed . Twelve patients whose confirmed TB was diagnosed only at autopsy had a mean age of 75.4 (range 41-86) years . Six of them had miliary or disseminated TB, three co-existing serious medical conditions and none a past history of the disease . The pattern has been well described and clinicians should keep a high index of suspicion for TB in this group of patients.

Med Tekh, 1994 Mar-Apr, (2), 12 - 4
{Development and use of antitubercular biocompatible implants for the treatment of tuberculous spondylitis}; Lavrov VN et al.; The paper deals with the experimental and clinical study of a new implantable therapeutical means based on biocompatible implants containing the antituberculous agent benemycin . The developed implantant having 4 coatings releases within 10 days as high as 37% of the applied drug benemycin . Then within further 30-70 days, release of the drug is 0.7% a day . The parallel bacteriological studies with the operative material placed in agar made 30-60 days after surgery have indicated that growth retardment in rabbits is 17-30 mm, which corresponds to the levels of rifandin (0.125-1.0 microgram/g tissue . The developed implantant has been used in 130 cases of the surgical treatment of tuberculous spondylitis in order to replace a defect of the body of a vertebra and to make a depot for the antituberculous drug just in the focus . Formation of the pulley at the site of intervention was noted in 57 (43.8%) cases within 5 months and in 62 (47.7%) cases within 10 months . The developed implantant has no toxicity and produces no allergic reactions . The position results of the treatment allows it to be recommended for use in clinical practice.

Jpn J Antibiot, 1994 Mar, 47(3), 272 - 9
{Pharmacokinetic and clinical studies on fluconazole in the pediatric field}; Sato Y et al.; Pharmacokinetic, bacteriological and clinical studies on intravenous fluconazole (FLCZ) in deep seated mycoses were performed involving 4 pediatric patients . Clinical and bacteriological assessments were made on 4 patients; clinical improvements were good in 3 patients and bacteriological efficacies were rated as "eradicated" in 3 patients . No side effects nor abnormal laboratory values were observed . The pharmacokinetics were investigated in 2 patients . Good serum FLCZ concentrations were obtained at an intravenous dose of 3-6 mg/kg daily . These results indicate that FLCZ is a useful drug in the treatment of pediatric patients with systemic deep-seated mycosis.

Dig Dis Sci, 1994 Mar, 39(3), 490 - 3
Effect of human bowel wall distension on translocation of indigenous bacteria and endotoxins; Schoeffel U et al.; The effect of colonic distension on the translocation of indigenous bacteria and endotoxins was prospectively assessed in 50 consecutive patients undergoing colonoscopy . Semiquantitative bacteriologic cultures, chromogenic LAL testing for endotoxemia, and serial determinations of inflammatory markers were used . At the end of the endoscopic procedure, true bacteremia was found in only two patients with obstructing colorectal cancer . There was no evidence of systemic endotoxemia either being induced or increased during the observation period . The endotoxin detoxifying plasma capacity was elevated in patients with preexisting inflammation and did not change within this period . Levels of TNF-alpha, interleukin-6 (IL-6), and elastase (E alpha 1PI) did not differ from baseline values . C3 alpha levels increased in 20% of the patients, whereas fibrinopeptide A values rose by up to 10(2) during colonoscopy . However, since neither endotoxin, TNF alpha, nor IL-6 levels were found to be elevated in this study, the excessive activation of the coagulation system must be related to the distension of bowel wall vessels rather than to an effect of endotoxins escaping from the lumen.

Clin Orthop, 1994 Mar, (300), 259 - 63
Sensitivity and negative predictive value of swab cultures in musculoskeletal allograft procurement; Veen MR et al.; Seventy-five fibular specimens were obtained from postmortem donors using aseptic surgical techniques . All specimens were swabbed following the same technique as routinely used for retrieved musculoskeletal grafts . After swabbing, the specimens were placed in BHI-culture medium . Three different protocols were subsequently followed: (1) culture of the entire bone specimen in BHI-culture medium, (2) culture of the swab incubated on blood agar and chocolate plates, and (3) culture of the swab in BHI-culture medium . A control group included 20 sterilized bone specimens that were cultured entirely in BHI-culture medium according to Protocol 1 . The sensitivity and negative predictive value were found to be 10% and 9% in Protocol 2 and 13% in Protocol 3 . These findings imply that swab cultures are inadequate to detect bacterial contamination of musculoskeletal allografts in all cases . However, the instances of infection after transplantation of allografts bacteriologically screened according to Protocols 1 and 2 do not exceed those reported in other similar series . This suggests an acceptable bioburden.

Am J Respir Crit Care Med, 1994 Mar, 149(3 Pt 1), 625 - 9
Risk factors for nosocomial Legionella pneumophila pneumonia; Carratala J et al.; Over a 5-yr period, from January 1985 to January 1990, we prospectively studied 300 episodes of nosocomial pneumonia in a 1,000-bed teaching hospital . All cases had an accurate bacteriologic diagnosis obtained by means of highly reliable techniques . Legionella pneumophila caused a total of 36 episodes; 22 were endemic and 14 occurred during an epidemic outbreak . No patient with Legionella pneumonia had been intubated before infection . To identify risk factors for nosocomial L . pneumophila pneumonia, we compared the 22 endemic cases of nosocomial pneumonia due to L . pneumophila with the 264 cases due to other bacteria . After adjusting for other variables by means of logistic regression analysis, cytotoxic chemotherapy (OR = 5.2; 95% CI, 1.5 to 17.9) and use of corticosteroids (OR = 4.6; 95% CI, 1.5 to 14.1) were positively associated with L . pneumophila pneumonia, whereas previous antibiotic therapy (OR = 0.2; 95% CI, 0.1 to 0.8) and lowered consciousness (OR = 0.2; 95% CI, 0.07 to 0.8) were negatively associated . The major risk factors for Legionella pneumonia delineated in this study should be considered in the clinical approach to and empiric therapy of patients with suspected nosocomial pneumonia.

J Bone Joint Surg Br, 1994 Mar, 76(2), 311 - 4
Fine-needle bone biopsy to diagnose osteomyelitis; Howard CB et al.; In 30 patients in whom osteomyelitis was suspected fine-needle bone biopsies (FNBB) were taken at the same time as bone was aspirated for bacteriological examination . The diagnosis of osteomyelitis was eventually confirmed in 15 patients; the other 15 had myositis (3), arthritis (3), trauma (2), microgeodic phalangeal syndrome (2), haematoma in a non-ossifying fibroma (1), and Ewing's sarcoma (1) . In three patients no pathology was found . The temperature, WBC and ESR at presentation did not help to distinguish osteomyelitis from other conditions . FNBB, however, proved to be a useful additional investigation with a sensitivity for osteomyelitis of 87% and a specificity of 93%.

Exp Toxicol Pathol, 1994 Mar, 46(1), 63 - 9
Dynamics of connective matrix deposition in acute experimental E . coli pyelonephritis in rats; Santos WL et al.; Adult male rats were subjected to pyelonephritis by direct kidney intramedullary injection of 0.1 ml saline suspension of 10(5) E . coli . Animals were killed at intervals of 4, 10, 15, 30 and 60 days . Half of each kidney and bladder were cultured in proper bacteriologic media to demonstrate the existence of infection . The other halves were submitted to light microscopy and ultrastructural studies . Immunofluorescence methods were used for the study of connective matrix components, at the initial stage of the inflammatory process (4, 10 and 15 days) . Infection was documented by bacteriologic, gross and microscopic findings in all groups following inoculation, and it lasted up to two months . Following the acute inflammatory reaction, fibronectin and type III collagen were deposited in the interstitium of kidneys . Small amounts of type I collagen were found later . Type IV collagen appeared in small quantities, associated with collapse of structures containing basement membranes . Fibronectin became concentrated in re-activated foci . The subsequent scarring and associated focal renal atrophy depended upon the extension of the acute lesion.

G Chir, 1994 Mar, 15(3), 115 - 8
{Pyogenic liver abscess: a caseload contribution}; Morone G et al.; Pyogenic hepatic abscesses have been recognized since the time of Hippocrates, but an understanding of their etiology, bacteriology, diagnosis and treatment is an event of the twentieth century . Fortunately mortality rate has declined due to improvements in diagnosis, intensive care, medical and surgical management . In particular, the use of CT and ultrasound scanning has reduced the incidence of unrecognized and therefore untreated liver abscesses . Considering nine patients operated on for liver abscess, the Authors affirm that laparotomic surgical drainage is still the most effective therapy in the majority of cases.

Ann Clin Biochem, 1994 Mar, 31 ( Pt 2), 134 - 9
Neonatal screening for phenylketonuria: evaluation of an automated enzymatic method; Keffler S et al.; An enzymatic assay for phenylalanine using phenylalanine dehydrogenase is available in kit form (Quantase) for use with dried blood spot specimens and microtitre plates . The method has been automated by use of a sample processor and its performance and suitability for neonatal screening for phenylketonuria has been evaluated by comparison with the Guthrie bacteriological inhibition assay . The enzymatic method performed well with regard to precision and accuracy . It was able to differentiate between normal and raised phenylalanine concentrations for the purpose of screening, thus greatly reducing the repeat rate for equivocal results . There were, however, some concerns about its robustness for screening and its detection limit . The Quantase assay has the potential to be used as a large-scale routine neonatal screening method, if its use can be shown to be cost-effective.

Med J Malaysia, 1994 Mar, 49(1), 62 - 7
Evaluation of the bacteriological contamination of a closed feeding system for enteral nutrition; Chan L et al.; A closed enteral delivery system consisting of a cardboard tetrapack containing the sterile ready-to-use liquid feed and an independent sterile administration set, has been devised . We found bacterial contamination within 24 hours in this system in patients on ventilatory support in intensive care . This emphasises the need for meticulous care in handling enteral feeding systems to prevent environmental contamination.

J Infect, 1994 Mar, 28(2), 131 - 9
A comparative study of dirithromycin and erythromycin in bacterial pneumonia; Liippo K et al.; Dirithromycin, a new once-daily macrolide, was studied in a multicentre, randomised, double-blind trial in community-acquired bacterial pneumonia . A total of 591 patients received either a single daily dose of dirithromycin, 500 mg, or erythromycin, 250 mg, four times daily . Clinical response rates were similar in both treatment groups (127 dirithromycin-treated and 118 erythromycin-treated patients): at the time of the final consultation, the clinical and bacteriological response rates for dirithromycin-treated patients were 94.5% and 93.0%, while for erythromycin-treated patients, they were 92.1% and 90.3%, respectively . The nature and frequency of treatment-emergent events were comparable . We conclude that dirithromycin, 500 mg, once daily, is safe and effective in the treatment of community-acquired bacterial pneumonia . The once daily dose is likely to improve compliance, making it preferable to erythromycin.

Z Geburtshilfe Perinatol, 1994 Mar-Apr, 198(2), 72 - 6
{Puerperium after threatened premature labor--effects of infection screening in pregnancy}; Winkler M et al.; Subclinical intrauterine infection is one of the causes of preterm birth . Adjuvant antibiotic treatment can improve the prolongative effects of tocolysis in patients with preterm labour . This study was conducted to evaluate the effectiveness of screening for infection and of antibiotic treatment in reducing postpartal infectious complications in patients with so called idiopathic preterm labour being treated with tocolysis intravenously . At the time of admission, we obtained cervical swabs of 138 patients for bacteriological investigation . 23 of the 37 patients with pathologic cervical colonisation were treated with antibiotics in addition to tocolysis . In women in preterm labour with pathologic cervical microbial colonisation, the frequencies of infectious complications in the puerperium were markedly increased compared to women without cervical colonisation . Adjuvant antibiotic therapy during pregnancy significantly reduced such complications . Additional antibiotic treatment of patients in idiopathic preterm labour with indicators of silent intrauterine infection seems beneficial not only for prolongation of gestation, but also for the reduction of postpartal infectious morbidity.

Cell Transplant, 1994 Mar-Apr, 3(2), 147 - 51
Low-pressure aspiration abortion for obtaining embryonic and early gestational fetal tissue for research purposes; Nauert GM et al.; Successful transplantation of cadaver embryonic neural tissue is highly dependent on the method used to obtain the tissue . It is important that the tissue not be contaminated bacteriologically by vaginal flora during the procedure, and that it not be disrupted mechanically . A low-pressure aspiration abortion technique has been developed that allows for the safe, effective obtainment of embryonic tissue and reduces the risk of transmitting infection . Tissue was cultured in vitro in 102 cases with minimal evidence of contamination by vaginal flora . Transplants of neural tissue into over 300 rodents have resulted in no intracranial abscesses, even in the setting of immunosuppression . The suction apparatus and low-pressure aspiration minimize disruption of the embryonic tissue . Use of low pressure adds no significant additional risk to the patient . In over 300 cases, there have been no medical complications specifically attributable to the technique . Because local anesthetic is used and sonography is not routinely required, the procedure can easily be performed in an outpatient setting during routine elective abortions, with minimal slowing or disruption of the clinic's surgical schedule . In conclusion, the low-pressure aspiration abortion technique can be safely and effectively used to obtain embryonic and early gestational fetal tissue that is almost always free from bacterial, fungal, and yeast contamination and that is frequently structurally intact . It requires no significant alteration in indications for abortion, risks, methodology, timing of the abortion, or patient management.

Baillieres Clin Gastroenterol, 1994 Mar, 8(1), 121 - 31
Endoscopic features of chronic inflammatory bowel disease in childhood; Williams CB et al.; Flexible endoscopy, performed after oral bowel preparation and under moderate intravenous sedation, proves to be well tolerated, safe and highly effective in the diagnosis and management of children with IBD . At St Bartholomew's Hospital it is performed as the investigation of first choice, on the basis that it supplies colour documentation, histopathological and (where relevant) bacteriological evidence, which achieves certain confirmation or exclusion in almost every case and in the shortest possible time . Biopsies must always be taken, as mucosa of normal appearance can show either microscopic ulcerative colitis or Crohn's disease . When there are the characteristic 'aphthoid' ulcers, visual diagnosis of Crohn's disease is reasonably certain, particularly in early-stage disease, although amoebic and other infective causes of colitis can give misleadingly similar appearances . The endoscopist can usually inspect (and almost always biopsy) the terminal ileum, and can expect many children to show the prominent 'nodular lymphoid hyperplasia' which is essentially a normal finding-though sometimes misdiagnosed radiologically as being Crohn's deformity . However, it is important that radiological assessment by barium follow-through complements colonoscopy in view of the not infrequent cases of intestinal Crohn's disease in children where the proximal small intestine is involved, even if the colon and terminal ileum are spared.

Lik Sprava, 1994 Mar-Apr, (3-4), 118 - 22
{The contribution of Prof . I . G . Savchenko to the development of medical science and public health}; Chernobrov IV; I . G . Savchenko is an outstanding scientist-pathologist, microbiologist and immunologist . He dedicated all his life to the cause of protecting and promoting the health of the people and combating the infectious diseases . He made a valuable contribution to the development of medical science . He displayed selflessness having carried out an experiment in himself to confirm observations on building up artificial immunity to cholera . He was an organizer of the bacteriological institutes of Kazan and Krasnodar, chairs of pathology and microbiology at the Krasnodar Medical Institute . He founded scientific schools in Krasnodar and Kazan . In spite of his immense services to science and the population he was subjected to repression in 1932 . 60 years have passed since his decease but the scientist-innovator, physician and citizen will always be held in remembrance.

Surgery, 1994 Feb, 115(2), 170 - 5
Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?--A prospective randomized study; Sheen-Chen SM et al.; BACKGROUND . Postoperative choledochoscopy-related infection has been reported in the literature . We performed a prospective randomized trial to investigate the value of antibiotic prophylaxis for the prevention of such endoscopy-related infection . METHODS . In a 2-year period from 1990 to 1991, 84 patients with biliary lithiasis were included in the study and randomized . Forty-four patients received antibiotic prophylaxis (1 gm cephalothin intravenously 30 minutes before the procedure and 500 mg cephalexin orally every 6 hours for 3 days afterward) . Forty patients in the control group did not receive any antibiotics . RESULTS . There was no significant difference between the groups in age, sex, preprocedure liver function, serum amylase level, white cell count, and duration of the procedure . The results of bacteriologic studies of the bile were also comparable in the two groups . One patient in the control group had transient chill and fever after the procedure . Two patients in the antibiotic group and one patient in the control group had mild abdominal pain . Mild hemobilia was noted in one patient in the antibiotic group . These complications were treated conservatively without any event . No difference was evident in the complications and the success of postoperative choledochoscopy between the two groups . CONCLUSIONS . This prospective randomized study showed that routine antibiotic prophylaxis for postoperative choledochoscopy may be not necessary in selected conditions.

Dis Colon Rectum, 1994 Feb, 37(2), 185 - 9
Liver abscess after hemorrhoidectomy . Report of two cases; Parikh SR et al.; PURPOSE: Pyogenic liver abscess after hemorrhoidectomy is extremely rare . Only two such cases have been previously reported; the diagnosis in each was made intraoperatively . We report two additional cases of hepatic abscess after hemorrhoidectomy, both treated nonoperatively with a successful outcome . METHODS: The two cases were analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology . RESULTS: In both cases, the patients presented within one week of the hemorrhoidectomy . Treatment with broad-spectrum intravenous antibiotics was successful in achieving significant clinical improvement . The liver function test values reverted back to normal and follow-up computed tomography (CT) scans of the liver revealed marked improvement of the abscesses . Laparotomy was avoided in both of the patients . CONCLUSIONS: Increased awareness of this serious complication will afford earlier diagnosis . In addition, proper aerobic and anaerobic bacterial isolation techniques will allow appropriate nonoperative therapy, decreasing the high morbidity and mortality rates associated with this complication.

An Med Interna, 1994 Feb, 11(2), 62 - 6
{The study of contacts of tuberculosis patients}; Fernandez Revuelta A et al.; The study and follow-up of contacts is one of the main goals of the battle against tuberculosis . We studied 640 contacts of 141 patients diagnosed of active pulmonary tuberculosis (PT) in our center between 1985 and June 1990 . The average per index case (IC) was 4.5 . Contacts were classified according to the IC bacteriology (positive bacilloscopy and culture: 448 cases; negative bacilloscopy and positive culture: 126 cases; and both tests negative: 66 cases) . PPD was positive in 342 cases (53.4%) and the number of infected contacts was significant when IC showed positive bacilloscopy and culture (251 cases), cough (328 cases) . Twelve new cases of tuberculosis (1.9%) were detected, with an average age of 29.6 years . Chemoprophylaxis was completed during one-year period by 121 contacts (43.5%) . The systematic study of contacts allow us to detect new patients and infected cases, helping to break the epidemiological chain of transmission of the disease.

Aust Dent J, 1994 Feb, 39(1), 4 - 10
Conservative management of erosion-abrasion: a system for the general practitioner; Bevenius J et al.; This final article in a series of three covering general practice aspects of erosion-abrasion presents a three-phase system for clinical management of erosive-abrasive damage . The first phase comprises pre-restorative case evaluation, initial measures to control factors predisposing to continued erosion-abrasion and where necessary the provision of acrylic overlays to restore facial height . In the second phase the teeth are systematically restored using an acid-etch composite resin technique; guidance for comfortable occlusion is provided by the patient acceptance method . The third phase comprises follow-up, including monitoring of salivary and bacteriological parameters, maintenance of the restorations and modifications of preventive measures necessary to preserve the dentition restored by multiple composite therapy . Modern oral physiological concepts and recent developments in multiple composite therapy and erosion control are discussed.

Tuber Lung Dis, 1994 Feb, 75(1), 44 - 8
Tuberculous meningitis in France in 1990: characteristics and impact of BCG vaccination; Schwoebel V et al.; SETTING: France, 1990 . OBJECTIVE: To measure the incidence and describe the characteristics of bacteriologically-confirmed tuberculous meningitis (TBM) and to estimate the protective efficacy of BCG vaccination in children aged less than 5 years . DESIGN: An active surveillance of TBM cases confirmed by positive cerebrospinal fluid (CSF) culture was conducted through a network of microbiology laboratories serving 99.8% of regional and district general hospitals and other large private hospitals . RESULTS: A total of 70 cases were reported: 61% were adults over 44 years, 64% were males and 77% were born in France . 7 patients were known to be infected with HIV . 6 cases were observed in children aged less than 5 years, 2 of whom had been vaccinated with BCG . 3 of the 6 children died (one had been BCG-vaccinated) . Given the 80% coverage of BCG in this age group, the protective efficacy of BCG vaccination was estimated to be 87.5% (95% CI: 30-98), which indicates that 14 TBM cases may have been prevented by BCG vaccination in 1990 . CONCLUSION: Results are consistent with the number of TBM cases expected on the basis of a 0.04% annual risk of infection . Current BCG vaccination policy in France still has a measurable impact on the incidence of tuberculous meningitis in children under 5 years of age . Given the probable continuous decrease of the annual risk of infection in future years, alternative policies should be considered.

Jpn J Antibiot, 1994 Feb, 47(2), 170 - 80
{Clinical evaluation of combination therapy of sulbactam/cefoperazone and aminoglycoside in respiratory tract infections}; Sukoh M et al.; We compared clinical efficacy and safety of sulbactam/cefoperazone (SBT/CPZ) with those of SBT/CPZ combined with aminoglycoside (amikacin (AMK), tobramycin (TOB), etc.) in treatment of respiratory tract infections in patients with underlying respiratory diseases, with cancer, or with acute exacerbation of chronic respiratory infections . Clinical evaluations of monotherapy with SBT/CPZ in a total of 30 patients showed excellent results in 5, good results in 17 . Clinical effects of combined therapy of SBT/CPZ plus different aminoglycosides in a total of 33 patients were excellent in 18, good in 5 . The efficacy rates (excellent plus good) were 73.3% in the monotherapy and 69.7% in the combined therapy . AMK was used concomitantly with SBT/CPZ in 16 of 33 patients . Clinical effects of SBT/CPZ plus AMK were excellent in 10, good in 3, and the efficacy rate was 81.3% . Bacteriological effects were evaluable against 11 strains in the monotherapy group, and against 17 strains in the combined therapy group . The eradication rates were 54.5% in the monotherapy group, and 81.3% in the combination therapy group . Diarrhea was observed in a patient who received the monotherapy . Abnormal laboratory test results were observed on in 5 patients who received the monotherapy, and in 4 patients who received one of the combined therapies . All abnormalities disappeared after the completion or discontinuation of therapies . We considered SBT/CPZ combined with an aminoglycoside is a useful chemotherapy for respiratory tract infections in patients with underlying diseases and acute exacerbation of chronic respiratory tract infections.

Intern Med, 1994 Feb, 33(2), 74 - 6
Fever of unknown origin: a review of 80 patients from the Shin'etsu area of Japan from 1986-1992; Shoji S et al.; In this survey involving 10 hospitals, we analyzed data on 80 Japanese patients from the Shin'etsu area (Nagano-ken and Niigata-ken) who were observed for fever of unknown origin (FUO) . Our objectives were to identify the underlying causes and the relevant diagnostic methods . Fourteen of the patients died of the underlying illness . The cause of the FUO was infection in 43 patients, allergic or autoimmune disease in 13, neoplasm in 7, miscellaneous causes in 3, and undetermined in 14 . FUO was self-limited in 13 patients and persistent in one patient . Methods successfully used to establish the final diagnosis in 66 patients were: evaluation of the clinical course or response to treatment in 16, serologic tests in 12, bacteriologic studies in 10, biopsy in 9, cytologic examination in 6, conventional radiology in 6, necropsy in 3, endoscopy in 2, and biochemical testing in 2.

Arch Pediatr, 1994 Feb, 1(2), 166 - 9
{Brain abscess complicating dental caries in children}; Vallee L et al.; Brain abscess following dental or periapical infection is rare in childhood . This report describes brain abscesses found in two children with dental caries . Case 1.--A 12 year-old boy was admitted because he had suffered from acute meningitis for 3 days . Clinical examination showed symptoms of meningitis plus palsy of the right third and fourth cranial nerves and of the left facial nerve, and a defect in the left temporal field . Funduscopic examination showed papilledema; CT scan and MRI showed a ring-shaped lesion in the right occipital area . The patient was given cefotaxime and thiamphenicol . The abscess was drained; bacteriological examination showed Actinomyces viscosus and Peptostreptococcus magnus . The neurological condition and the CT scan lesion improved, but intracranial pressure increased again on the 17th day after the onset, requiring replacement of the antibiotics by rifampicin and ampicillin plus clavulanic acid for 2 months . This brain abscess appeared to be metastatic, derived from the infection of a large dental cyst due to a dental infection that had been treated 6 months earlier . Case 2.--A 8 1/2 year-old girl was admitted because she was suffering from palsy of the left facial nerve and left arm . She had had headaches and fever for a few days . Clinical examination showed the palsies and drowsiness . CT scan showed two brain abscesses . The patient was given ceftriaxone, fosfocin and metronidazole . She had been treated for a gingival abscess 1 month earlier, and had two infected teeth extracted . Improvement of the intracranial pressure was transient and the antibiotics were changed on the 12th day of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Lett Appl Microbiol, 1994 Feb, 18(2), 117 - 9
Membrane filtration method for bacteriological testing of water: enhanced colony visualization and stability on purification of phenol red indicator; Hay J et al.; Commercially-available phenol red indicator, purified by adsorption chromatography was incorporated into lauryl sulphate broth (LSB) used in the membrane filtration method for the detection of Escherichia coli and other coliform bacteria . Relative to LSB containing the impure dye or its major contaminant, the purified phenol red provided clear visualization of discrete yellow colonies observed against a white background . The colonies remained stable for at least 24 h at 25 degrees C under standard laboratory lighting conditions . This simple procedure will enhance the detection of coliforms in samples.

Eur Respir J, 1994 Feb, 7(2), 240 - 6
Clinical evaluation of a serological assay using a monoclonal antibody (TB72) to the 38 kDa antigen of Mycobacterium tuberculosis; Bothamley GH et al.; We examined an enzyme-linked immunosorbent assay (ELISA) modification of a radioimmunoassay, using the TB72 monoclonal antibody, as a serological test for tuberculosis in a clinical setting . Sera were obtained from 238 patients with suspected pulmonary tuberculosis, 30 patients treated for tuberculosis, 28 contacts, and 480 random samples from inpatients . Antibody levels were measured as the dilution of serum causing 50% inhibition of binding of the TB72 monoclonal antibody, which binds to an epitope of the 38 kDa antigen specific to the Mycobacterium tuberculosis complex, a positive titre being > 3 . Positive antibody titres were present in 21 out of 25 (84%) patients with smear-positive and 22 out of 27 (82%) patients with smear-negative, culture-positive tuberculosis, and 37 out of 41 (90%) patients successfully treated for tuberculosis but without bacteriological confirmation of disease . Three out of 82 (4%) patients with a firm alternative diagnosis to tuberculosis gave a positive result . Serological tests were negative within 2.5 yrs of successful treatment . Patients without a definite diagnosis one year after tuberculosis had been suspected, and those who had received inadequate treatment for tuberculosis, were frequently positive (21 out of 31 and 21 out of 32, respectively) . Positive tests concurred with tuberculin reactivity in 8 out of 11 contacts given chemoprophylaxis . Screening of 480 random serum samples gave 22 positive titres, 16 of which were not associated with tuberculosis; none of these 16 had an antibody titre > 10 . We conclude that the TB72 test provides additional information in the diagnosis and treatment of tuberculosis . Antibody titres > 10 suggests active tuberculosis; titres of 3-10 merit observation.

Tidsskr Nor Laegeforen, 1994 Jan 30, 114(3), 311 - 2
{The TORCH study . A reevaluation}; Holtmon LW et al.; The TORCH panel is used to screen for congenital infection . The purpose of this study was to evaluate the use of TORCH by pediatricians and pediatric trainees in a university pediatric department . The patient charts corresponding to the 109 samples submitted to the Institute of Bacteriology from 1987-91 were reexamined for evidence suggestive of congenital infection . Generally, the charts contained little information that might explain the reason for ordering a full TORCH panel . None of the submitted samples yielded conclusive evidence of congenital infection . TORCH studies appeared to have been requested on very liberal indications . We conclude that the TORCH panel as used at present creates a lot of work for microbiologists, but yields little information . A more targeted approach to testing for congenital infection seems called for.

J Med Liban, 1994, 42(4), 190 - 5
Medical treatment of sinusitis; Baroody FM; Sinusitis is a very common and increasingly recognized disorder affecting patients of all ages and genders . It is most commonly due to infection of the paranasal sinuses with symptoms varying from cough and anterior nasal drainage in children to headache and post nasal drip in adults . Diagnosis relies heavily on medical history with corroboration by careful physical examination including nasal endoscopy . The most accurate imaging technique to evaluate sinusitis and to delineate the extent of involvement of individual sinuses and identify possible anatomic abnormalities is computerized tomography scanning in the coronal plane . The mainstay of medical treatment of sinusitis is antibiotics with adjuvant treatments such as saline irrigation, decongestants, mucolytics and antiinflammatory agents playing a more secondary role . The use of these agents will be discussed in detail after an introduction about the risk factors, diagnosis and bacteriology of the disease . Surgical treatment of sinusitis will be the subject of another article.

J Med Liban, 1994, 42(4), 184 - 9
The diagnosis of sinusitis; Salman SD; The diagnosis of sinusitis is usually based on evidence obtained from history taking and physical examination . The making of the diagnosis has been made easier recently by CT scanning and by the availability of the rigid Hopkins endoscopes . However, the diagnosis remains basically a clinical one . Radiologic and bacteriologic evidence may also help, but should be considered neither necessary nor required . Minor radiologic abnormalities are not infrequently seen in normal asymptomatic people and require no medical or surgical attention . Fungal sinusitis is on the increase . Sinusitis in children is briefly reviewed.

Int Arch Allergy Immunol, 1994, 103(2), 209 - 13
Sinus aspirates and radiographic abnormalities in severe attacks of asthma; Rossi OV et al.; We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma . Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses . An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates . A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected . Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding . There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.

Acta Otorrinolaringol Esp, 1994 Jan-Feb, 45(1), 25 - 9
{Amoxycillin-clavulanic acid and cefuroxime axetil in the treatment of acute sinusitis . A clinical, radiological and bacteriological evaluation}; Olmo A et al.; Cefuroxime axetil (CAE), an orally absorbed product of cefuroxime, and amoxycillin/clavulanate (AAC), were evaluated for their efficacy and safety in the treatment of acute sinusitis . A total of 47 patients were enrolled in a randomized study to compare cefuroxime axetil 500 mg . b.d . for 8 days (25 patients) with amoxycillin/clavulanate 500 mg . t.d.s for 8 days (22 patients) . All patients were evaluable for clinical, radiological and bacteriological response . Of 25 clinically assessable patients treated with CAE, 24 were cured, 1 improved and 1 relapsed (96% success rate) . Of 22 assessable patients given AAC, 14 were cured and 8 improved (100% success rate) . Two out of 25 (8%) patients treated with CAE experienced drug-related adverse events, including 4% with diarrhoea . In the AAC group, 3 out of 22 (13%) patients had a drug-related adverse event, including 13% with diarrhoea . In conclusion, CAE appears to be as safe and effective as AAC in the treatment of acute sinusitis.

Eur J Cardiothorac Surg, 1994, 8(2), 106 - 7
Cardiac tamponade secondary to intrapericardial rupture of a hepatic amoebic abscess; Perna AM et al.; We report the case of a patient who underwent an emergency subxiphoid pericardiectomy with evacuation of 1700 cc of anchovy sauce-like fluid . On pericardial inspection a fistulous communication was seen with a cavity in the left hepatic lobe . No loculi or adhesions were found in the pericardial sac and no further surgical procedure was advised . The hepatic cavity and pericardium were drained: bacteriological investigation of the fluid yielded entamoeba histolytica and chloroquine was administered . Apart from the rarity of the observation in western countries, we discuss surgical approaches in cases of unknown purulent pericardial effusions, stressing the possibility of achieving a good surgical result even with a minor surgical procedure such as subxiphoid pericardiectomy and drainagePublication Types:

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