Surg Neurol, 1999 Nov, 52(5), 445 - 8 Successful treatment of brainstem abscess with stereotactic aspiration; Nakajima H et al.; BACKGROUND: Brainstem abscess is an uncommon condition associated with a high mortality . We report a case of brainstem abscess in a 51-year-old female with a pulmonary arteriovenous fistula that was cured after appropriate antibiotic therapy following stereotactic aspiration . The value of stereotactic aspiration in the management of brainstem abscess is documented with a review of the relevant literature . CASE REPORT: A 51-year-old female with a pulmonary arteriovenous fistula suffered fever, diplopia and weakness on the right side . Magnetic resonance (MR) imaging of the brain showed a large cystic mass with ring-like enhancement in the brainstem . A diagnosis of brainstem abscess as a complication of pulmonary arteriovenous fistula was made . MR imaging-guided stereotactic exploration was carried out via the suboccipital transcerebellar approach and the pathogen of the brainstem abscess was identified . The brainstem abscess was cured after treatment employing antibiotics to which the pathogen was sensitive . CONCLUSIONS: Stereotactic aspiration is an effective procedure for brainstem abscesses . This procedure is less invasive than open surgery and can be performed even in patients in poor general condition. Int J Antimicrob Agents, 1999 Oct, 13(2), 117 - 25 The MYSTIC (meropenem yearly susceptibility test information collection) programme; Turner PJ et al.; The primary objective of the MYSTIC study is to monitor the performance of meropenem over a period of at least 3 years during which this carbapenem is prescribed in different hospital units thus allowing profiles to be established within individual hospitals . Monitoring is being carried out by assessing the antibiotic susceptibility of bacterial pathogens isolated from patients with a predominate problem of intraabdominal infections (IAI) and/or lower respiratory tract infections (LRTI), treated in specialist centres (haematology wards, the Intensive Care Unit {ICU}, cystic fibrosis units) and non-specialised centres . Samples will be collected over each year and tested against meropenem and a set of comparators . The data obtained from the first year of the study (1997) come from 33 centres spread mainly throughout Europe but also in Israel and Mexico . The results shows that meropenem retains its broad spectrum and potency whilst there is evidence that the activity of comparator antibiotics is being eroded by a variety of resistance mechanisms . Data from subsequent years of the programme will determine whether these trends continue and will allow a series of individual centre profiles to be compiled and presented. Am J Contact Dermat, 1999 Dec, 10(4), 226 - 7 Allergic contact dermatitis to polyethylene glycol and nitrofurazone; Guijarro SC et al.; We report a case of worsening dermatitis after the application of an antibiotic ointment (Furacin) containing furazone and polyethylene glycol . Patch tests to nickel sulfate, potassium dischromate, chloride cobalt, Furacin, nitrofurazone 1% petrolatum, polyethylene glycol mix 4% petrolatum, polyethylene glycol (PEG) 300 4% petrolatum, and PEG 400 as is (ai) were positive . The use of topical agents containing nitrofurazone or polyethylene glycol on damaged skin may predispose to contact allergy . We discuss the sensitizing properties of nitrofurazone and polyethylene glycol. Pediatr Res, 1999 Nov, 46(5), 566 - 75 Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants . Developmental Epidemiology Network Investigators; Leviton A et al.; Echolucent images (EL) of cerebral white matter, seen on cranial ultrasonographic scans of very low birth weight newborns, predict motor and cognitive limitations . We tested the hypothesis that markers of maternal and feto-placental infection were associated with risks of both early (diagnosed at a median age of 7 d) and late (median age = 21 d) EL in a multi-center cohort of 1078 infants <1500 x g . Maternal infection was indicated by fever, leukocytosis, and receipt of antibiotic; fetoplacental inflammation was indicated by the presence of fetal vasculitis (i.e . of the placental chorionic plate or the umbilical cord) . The effect of membrane inflammation was also assessed . All analyses were performed separately in infants born within 1 h of membrane rupture (n = 537), or after a longer interval (n = 541), to determine whether infection markers have different effects in infants who are unlikely to have experienced ascending amniotic sac infection as a consequence of membrane rupture . Placental membrane inflammation by itself was not associated with risk of EL at any time . The risks of both early and late EL were substantially increased in infants with fetal vasculitis, but the association with early EL was found only in infants born > or =1 after membrane rupture and who had membrane inflammation (adjusted OR not calculable), whereas the association of fetal vasculitis with late EL was seen only in infants born <1 h after membrane rupture (OR = 10.8; p = 0.05) . Maternal receipt of antibiotic in the 24 h just before delivery was associated with late EL only if delivery occurred <1 h after membrane rupture (OR = 6.9; p = 0.01) . Indicators of maternal infection and of a fetal inflammatory response are strongly and independently associated with EL, particularly late EL. Br J Orthod, 1999 Dec, 26(4), 295 - 8 Orthodontics and infective endocarditis; Khurana M et al.; Infective endocarditis associated with orthodontics is a rare occurrence . Unfortunately, many orthodontic practitioners do not treat patients potentially at risk of developing endocarditis due to the lack of practical guidelines and fear of precipitating the infection . Additionally, many patients that undergo orthodontic treatment are inappropriately prescribed antibiotic cover for procedures that have a minimal bacteraemic risk . In this paper the literature linking orthodontic treatment and infective endocarditis is examined . Recommendations are made for the appropriate management of patients at risk of infective endocarditis for orthodontic procedures . Refereed Paper ASAIO J, 1999 Nov-Dec, 45(6), 531 - 4 A novel percutaneous barrier device that permits safe subcutaneous access; Yu C et al.; Successful subcutaneous access is important for optimal management of internal artificial organs and treatment of many diseases . However, skin downgrowth and tissue infection are still significant problems in the use of devices that require long-term subcutaneous access . The authors developed a new percutaneous device that provides a unique biologic boundary with surrounding connective tissue while minimizing the risk of complications . This new percutaneous device is made of a circumferential, strong, thin, and flexible mesh collar with millimeter size holes for connecting the structure . It has two distinct functional portions: a connecting zone and a sealing line . The most important features of the structure are: 1) Connective tissue grows through the millimeter size pores of the connecting zone to form a strong bond between the device and healthy tissue . 2) The millimeter size pores of the connecting zone allow capillaries to grow through its entire surface, ensuring sufficient blood supply . 3) The tissue of the connecting zone and the device surface form a biosealed junction (sealing line) . This sealing line is protected by the connecting zone and is free from external forces acting on local skin . 4) The device is generally functional immediately after surgical implantation . The subcutaneous perimeter of the functional dome contains extruded rigid rings of millimeter size holes permitting growth of subcutaneous tissue through the device . This functions as the minor connecting structure of the device . Four of five implanted rabbits have remained healthy 8 months postimplantation without antibiotic administration . The fifth rabbit died 4 months postimplantation for reasons unrelated to the device . Gross or histopathologic inspection revealed no signs of tissue injury or inflammation . Growth of healthy connective tissue was clearly observed . These results indicate this percutaneous device can provide a strong, stable, and effective connection to internal organs without bioboundary damage, skin downgrowth, or tissue infection. J Radiol, 1999 Nov, 80(11), 1569 - 71 {US-guided percutaneous drainage of an infected epidermoid cyst of the spleen in a child}; Blondel C et al.; Epidermoid cyst of the spleen is a rare entity (2.5% of all splenic cysts) and rarely becomes complicated by hemorrhage, rupture or infection . Classically, management consisted of total or partial splenectomy . We report the case of an 8-year-old boy presenting with a splenic abscess complicating an epidermoid cyst . Percutaneous drainage of the abscess was performed under sonographic guidance and completed by intravenous antibiotic therapy . Six weeks later, laparoscopic surgery was performed and the splenic parenchyma could be preserved. Cancer Invest, 1999, 17(8), 586 - 93 A dose-escalation phase II clinical trial of infusional mitomycin C for 7 days in patients with advanced measurable colorectal cancer refractory or resistant to 5-fluorouracil; Anderson N et al.; Chemotherapy for 5-fluorouracil (5-FU)-resistant colorectal cancer is largely ineffective with new and innovative therapeutic strategies needed to benefit patients developing progressive disease while receiving 5-FU or 5-FU-based programs . The tumor antibiotic mitomycin C is an alkylating agent with a broad range of clinical activity in a variety of gastrointestinal malignancies and is therefore a reasonable agent to test for clinical activity in the setting of 5-FU-resistant or -refractory colorectal cancer . The principal goal of this study is to investigate the logistical feasibility and clinical efficacy of a 7-day infusion of mitomycin C, delivering an equitoxic dose to the standard bolus delivery in patients with progressive disease while receiving 5-FU-based chemotherapy . Twenty-five patients with advanced measurable colorectal cancer, resistant or refractory to 5-FU-based chemotherapy, were treated with a 7-day intravenous infusion of mitomycin C . Doses ranged between 1.5 and 3.0 mg/M2/day for total cumulative mitomycin C, ranging between 10.5 and 21.0 mg/M2 per chemotherapy cycle . Forty-four courses of infusional mitomycin C were delivered to 25 patients via surgically implanted venous access devices . The median age of all patients was 63 years (range, 27-83); there were 11 men and 14 women . Eleven patients had received two or more prior chemotherapy combinations, with the average number of prior therapies before mitomycin C being 1.6 . The median number of cycles of mitomycin C administered was two (range, one to six) . Thirty-seven of 44 cycles were administered at the dose range of 2.0-3.0 mg/M2/day . Hematologic toxicity was mild, with only three courses associated with grade III thrombocytopenia and one course with grade III neutropenia . No extrahematologic toxicities were observed . No patient had a complete response; two patients (8%) showed partial responses that lasted for 145 and 190 days . One patient had stable disease for 180 days . Twenty-two of 25 patients (88%) developed progressive disease during mitomycin C administration . Infusional mitomycin C for 7 days, cycled every 42 days, is logistically feasible and associated with minimal clinical toxicity . Used on this schedule and with these doses in 5-FU-resistant/refractory colorectal cancer, however, there is no meaningful clinical activity for this agent, and it cannot be recommended as a salvage or second-line therapy in the treatment of metastatic colorectal cancer. Dermatology, 1999, 199(3), 268 - 70 Skin invasion of Hodgkin's disease mimicking scrofuloderma; Takagawa S et al.; We report a case of direct skin invasion by Hodgkin's disease from a left supraclavicular lymph node . Clinical and pathological presentations mimicked infectious disease such as scrofuloderma . The nodule later developed a fistula following a biopsy that never healed despite numerous antibiotic treatments . Ten months later, other nodules with spontaneous fistula formation appeared on the anterior neck . A diagnosis of Hodgkin's disease was then made . Subsequent COPP cytostatic therapy remarkably improved the skin lesions and lymph nodes achieving complete remission. Eur J Pediatr, 1999 Dec, 158(12), 975 - 7 Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis; de Moor RA et al.; Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy . In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published . In general, these adverse effects will develop after seven to ten days of treatment . We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment . Patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate. Pathologe, 1999 Nov, 20(6), 351 - 4 {Malakoplakia of the colon}; Kruger S et al.; We report on a 62-year-old female patient with melena in which polypoid lesions of the cecum were discovered endoscopically . Histological examination of mucosal biopsies revealed an inflammatory process with lots of histiocytes and so-called Michaelis-Gutmann bodies, leading to the diagnosis of a malakoplakia of the colon . No other organs were found affected . In the course of an antibiotic therapy, there was no melena detectable over a period of six months . Malakoplakia, an inflammation usually affecting the urogenital tract, is rarely found in the colon, with only 35 cases published until now . It is frequently associated with other diseases like neoplastic or inflammatory disorders, immune defect syndromes or heroin abuse . This spectrum is expanded by our report in which a long-standing alcohol abuse was found as an attendant disease. Laryngoscope, 1999 Dec, 109(12), 1924 - 7 Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media; Ruhl CM et al.; OBJECTIVE: To assess the success rate of revision tympanoplasty with aerating mastoidectomy in patients with noncholesteatomatous chronic otitis media who had failed at least one prior tympanoplasty . STUDY DESIGN: Retrospective chart review . METHODS: Data were analyzed from 135 patients available for clinical and audiometric studies with a minimum of 18 months' follow-up . All patients had failed at least one prior tympanoplasty and presented with: 1) a persistent tympanic membrane perforation with intermittent drainage, or 2) a wet draining ear, unresponsive to systemic antibiotic and topical management . All patients underwent 1.5-mm, high-density, bone window computed tomography (CT) scanning to assess middle ear, epitympanic, and mastoid air cell pneumatization . All patients underwent revision tympanoplasty with aerating mastoidectomy via a postauricular approach . Patient charts were reviewed for information regarding preoperative radiographic findings, mucosal and ossicular findings at the time of surgery, and success or failure of revision tympanomastoidectomy . RESULTS: The tympanic membrane graft take rate for the entire group of 135 patients was 90.4% (13 grafts failed) . A majority of the patients were found to have radiographic and intraoperative evidence of middle ear/mastoid disease . CONCLUSION: For patients with noncholesteatomatous chronic otitis media who have failed prior tympanoplastic reconstruction, an aerating mastoidectomy may be indicated and may improve the success rate of the surgery. J Antimicrob Chemother, 1999 Dec, 44(6), 735 - 42 Mechanisms involved in the development of resistance to fluoroquinolones in Escherichia coli isolates; Tavio MM et al.; Eighteen quinolone-resistant isolates of Escherichia coli were selected by exposing ten clinical isolates to increasing concentrations of norfloxacin and lomefloxacin . The mutant isolates showed a multiple-antibiotic-resistance phenotype . All of them contained single mutations in gyrA consisting of the substitution of Ser-83-->Leu (n = 14), Val (n = 1) or Ala (n = 1) and the substitution of Asp-87-->Asn (n = 2) . Only one concomitant mutation in parC (Ser-80-->Arg) was detected . Four parent isolates exhibited a single mutation in gyrA which required < or = 12 mg/L of norfloxacin to be inhibited . Fluoroquinolone resistance, in the 18 quinolone-resistant mutants, was a result of mutations affecting DNA gyrase plus decreased fluoroquinolone uptake . This latter mechanism of resistance was a combined effect of an absence of OmpF and an increase in active efflux in eight isolates, or an increased active efflux alone in the remaining ten selected mutants. Biophys J, 1999 Dec, 77(6), 3152 - 5 Orientation of cecropin A helices in phospholipid bilayers determined by solid-state NMR spectroscopy; Marassi FM et al.; The orientation of the insect antibiotic peptide cecropin A (CecA) in the phospholipid bilayer membrane was determined using (15)N solid-state NMR spectroscopy . Two peptide samples, each specifically labeled with (15)N at Val(11) or Ala(27), were synthesized by solid phase techniques . The peptides were incorporated into phospholipid bilayers, prepared from a mixture of dimyristoylphosphatidylcholine and dimyristoylphosphatidylglycerol, and oriented on glass slides . The (15)N chemical shift solid-state NMR spectra from these uniaxially oriented samples display a single (15)N chemical shift frequency for each labeled residue . Both frequencies are near the upfield end of the (15)N chemical shift powder pattern, as expected for an alpha-helix with its long axis in the plane of the membrane and the NH bonds perpendicular to the direction of the magnetic field . These results support a mechanism of action in which CecA binds to and covers the membrane surface, thereby causing a general destabilization and leakiness of the lipid bilayer membrane . The data are discussed in relation to a proposed mechanism of membrane lysis and bacterial killing via an ion channel activity of CecA. Urol Clin North Am, 1999 Nov, 26(4), 829 - 39, x Management of prosthesis infections in urologic surgery; Carson CC 3rd; Prosthetic devices are a cornerstone of urologic surgical care . The most disastrous complication of these surgical procedures is infection . The prevention, identification, and management of infections are critical to maintaining functional urologic prosthetic devices . Although the incidence is low, rapid identification of infections once they occur and proper management with antibiotics, surgical intervention, irrigation, and salvage procedures can maintain the function of urologic prosthetic devices despite clinical infection. Mol Biochem Parasitol, 1999 Oct 25, 104(1), 39 - 53 Expression of foreign proteins in Trypanosoma congolense; Downey N et al.; An expression vector was constructed to express foreign genes in Trypanosoma congolense . The foreign gene and a neomycin phosphotransferase (NPT) gene are flanked by glutamate and alanine rich protein (GARP) gene processing signals and their expression is driven by a ribosomal RNA gene promoter . The plasmid is not maintained as an episome in T . congolense, but the NPT gene permits selection of cells in which the plasmid has integrated into the genome . We used this plasmid to express luciferase, green fluorescent protein and a surface protein of Trypanosoma brucei, glycine-proline-glutamate glutamate threonine procyclic acidic repetitive protein (GPEET PARP) . The plasmid-derived GPEET PARP is expressed on the surface of procyclic T . congolense and comigrates on a polyacrylamide gel with native GPEET PARP from T . brucei procyclic cells . We also attempted to use the plasmid to overexpress a previously identified T . congolense cysteine protease . The plasmid-derived cysteine protease mRNA species occurs in the transfected cells, but we were unable to detect increased levels of protein or protease activity. J Clin Periodontol, 1999 Nov, 26(11), 757 - 63 GCF levels of MMP-3 and MMP-8 following placement of bioresorbable membranes; Said S et al.; Matrix metalloproteinases (MMPs) are responsible for remodeling and degrading extracellular matrix and basement membrane components . MMP-3 and -8 levels were assessed in this study during the early healing phase following a guided tissue regeneration (GTR) procedure . 32 patients, having 2 or 3 walled intrabony defects of PD > or =6 mm, were stratified into 2 groups on the basis of age, sex, smoking status and disease severity . All intrabony defects were treated using the resorbable Guidor membrane but only 1 group of patients was given a pre-operative dosage of antibiotic (3 g amoxycillin) . GCF samples for the quantification of MMP-3 and -8 levels were obtained from the intrabony site where a membrane was placed (membrane site), from the non-adjacent site on the adjacent tooth which was involved in the surgical flap (surgical control site), and from a healthy site (healthy) on the contralateral side . The GCF samples taken at baseline, 1 week, 4 weeks and 3 months after surgery were analyzed using an enzyme linked immunoabsorbent essay (ELISA) for MMP-3 and using a time-resolved immunofluorescence assay (IFMA) for MMP-8 . MMP-3 was detected in a very low % of sites at baseline while relatively high levels of MMP-8 were detected at all 3 types of sites at baseline . MMP-8 levels increased for all sites at week 1, and this was statistically significant for the membrane site, but at week 4, the levels decreased for both the membrane and the surgical sites . There was no statistically significant difference between the levels of MMP-3 and -8 in the antibiotic and non-antibiotic group . Collagen remodelling occurs during the early wound healing period following surgical and regenerative procedures . The levels of MMP-3 and -8 in GCF appear to reflect these processes . Interestingly, the presence of the membranes appeared to increase the levels of MMP-3 and -8 and may relate to the resorption of the resorbable membrane by host systems. J AOAC Int, 1999 Nov-Dec, 82(6), 1316 - 20 Determination of sulfamethazine in milk by biosensor immunoassay; Gaudin V et al.; A biosensor based on surface plasmon resonance (SPR) measurement was developed for use in an immunoassay for detection of sulfamethazine (SMZ) in milk . The biospecific surface was a carboxymethyl dextran-modified gold-surface sensor chip to which SMZ was covalently bound . The assay was based on inhibition of the binding of polyclonal antibodies to immobilized SMZ by SMZ in the sample . The SPR response changed inversely in relation to the antibiotic concentration in the sample . Calibration curves were constructed for SMZ in buffer and in milk at a concentration which included the maximum residue limit (0 to 200 micrograms/kg) . The analysis time per sample varied from 8 to 30 min . Different flow rates and antibodies were modified alternatively during the study to assess their influence on the performance of the assay . The active antibody concentration was calculated at approximately 1880 and 180 nM for the antibody anti-SMZ 1 and the antibody anti-SMZ 2, respectively . No cross-reactivity of antibodies with other antibiotics was found . Under optimal conditions, the detection limits in milk for SMZ were 8 and 1.7 micrograms/kg, respectively, for antibody 1 and antibody 2, at a flow rate of 20 microL/min. Vet Clin North Am Equine Pract, 1999 Dec, 15(3), 623 - 46 Equine infectious keratitis; Hamor RE et al.; Corneal ulcers are one of the most common ocular disease presentations in the horse . With the use of correct diagnostic techniques and selection of an appropriate treatment regimen, most cases result in a satisfactory outcome . The eye does not respond well to inflammation, and in complicated ulcers, this should be managed aggressively using systemic NSAIDs with a high priority assigned to removing the infectious agent . Care needs to be taken to avoid topical or systemic corticosteroid use for the treatment of equine ocular disease, however, unless the clinician is completely sure that the corneal disease is not caused by an infectious process . The use of combination corticosteroid-antibiotic ophthalmic preparations without an appropriate treatment rationale can result in doing more harm than good . It is important to have a treatment plan and to monitor the elected treatment regimen . The clinician should decide on some objective criteria at initiation of treatment so that any changes are made rationally . This approach should also include consideration of early referral of the eye's care to a veterinary ophthalmologist. Arch Esp Urol, 1999 Oct, 52(8), 892 - 5 {Bladder malacoplakia: 14-year follow-up of a case}; Collado Serra A et al.; OBJECTIVE: To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder . METHODS/RESULTS: After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered . The same treatment was repeated 4 years later . During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion . CONCLUSIONS: Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder . The importance of long-term follow-up of the patient is emphasized. J Allergy Clin Immunol, 1999 Dec, 104(6), 1265 - 72 Sensitization to Aspergillus species in the congenital neutrophil disorders chronic granulomatous disease and hyper-IgE syndrome; Eppinger TM et al.; BACKGROUND: Hyper-IgE syndrome (HIE) and chronic granulomatous disease (CGD) are congenital immunodeficiency diseases with increased susceptibility to bacterial and fungal infections . Both carry significant morbidity and mortality rates because of invasive infections by Aspergillus species . We encountered 2 patients, one with HIE and one with CGD, in whom detection of sensitization to Aspergillus species preceded the diagnosis of immunodeficiency . With high-dose systemic corticosteroids for allergic bronchopulmonary aspergillosis (ABPA), an inflammatory disorder caused by sensitization to Aspergillus species, pulmonary abscesses developed in the patient with HIE, and the patient with CGD succumbed to an overwhelming Aspergillus species-induced pneumonia . OBJECTIVE: We sought to assess the prevalence of sensitization to Aspergillus fumigatus and the presence of diagnostic criteria for ABPA in patients with CGD and HIE . METHODS: We measured A fumigatus-specific serum IgE, IgG, and precipitating antibodies as indicators for A fumigatus sensitization in the sera of 18 patients with neutrophil disorders (7 with HIE and 11 with CGD) . Hospital records were reviewed for the presence of other diagnostic criteria for ABPA (asthma, elevated total serum IgE concentration, and radiographic abnormalities) . RESULTS: Twelve (67%) of 18 patients were sensitized to A fumigatus, as evidenced by precipitating A fumigatus-specific antibodies . Six (33%) of 18 patients had serologic evidence of ABPA . Five of those 6 patients had radiologic abnormalities consistent with a diagnosis of ABPA . One patient with HIE also had asthma, thus fulfilling minimal essential criteria for concurrent ABPA . CONCLUSIONS: Patients with HIE syndrome and CGD have a high incidence of sensitization to Aspergillus species . A clinical picture indistinguishable from ABPA may coexist or emerge in patients with CGD or HIE and create a major management dilemma because systemic corticosteroids may accelerate tissue damage and invasive fungal infections . It is important to distinguish individuals with congenital neutrophil disorders from uncomplicated classic ABPA. Pediatr Transplant, 1999, 3 Suppl 1, 45 - 51 Can we make some general recommendations regarding immune recovery after hematopoietic reconstitution preceded by ablative therapy? Trigg ME. Children undergoing marrow transplantation have compromised immune systems for variable periods of time after transplant . A number of methods have been utilized to assess recovery of the immune system . Four recommendations are made in regards to the testing that should be done, when the testing should be done, when immunizations should be provided and when antibiotic and other infection prophylaxis can be reduced. J Vet Intern Med, 1999 Nov-Dec, 13(6), 507 - 15 Gastric function in dogs with naturally acquired gastric Helicobacter spp . infection; Simpson KW et al.; The association of Helicobacter pylori with gastritis, peptic ulcers, and gastric neoplasia has led to fundamental changes in the understanding of gastric disease in humans . The relationship of Helicobacter spp . infection to gastric disease in dogs is unclear . The objective of this study was to determine if Helicobacter infection affects the gastric secretory axis of dogs . Eight Beagle dogs with naturally acquired Helicobacter spp . infection were studied before and after (4 and 29 days) the attempted eradication of Helicobacter spp . with a combination of amoxicillin, metronidazole, and famotidine (AMF) . Six specific-pathogen-free, Helicobacter-free Beagle dogs served as controls . The electron microscopic appearance of spiral organisms in infected dogs indicated coinfection with Helicobacter felis- and H bizzozeronii-like organisms . Unstimulated gastric pH and fasting, postprandial, and bombesin-stimulated plasma gastrin were similar in both infected and uninfected dogs, although a trend (P = .09) toward higher meal-stimulated gastrin was observed in infected dogs at 60 minutes . Pentagastrin-stimulated maximal acid output (mmol HCI/kg0.75/hour) and titratable acidity (mmol HCl/mL) were similar in both infected and uninfected dogs, but gastric pH during maximal acid output was lower (P < .01) in uninfected dogs . Mild gastric inflammation was present in both infected and uninfected dogs . Gastric spiral organisms were undetectable in 6/8 infected dogs 4 days after AMF but had recurred in 8/8 dogs 29 days after AMF . Analysis of gastric DNA with Helicobacter-specific primers indicated persistence of Helicobacter DNA at 4 and 29 days after antibiotic therapy . Acid secretion, plasma gastrin, and mucosal inflammation were not affected by the transient suppression of Helicobacter spp . by AMF . These findings suggest that gastric secretory function in dogs is not markedly perturbed by naturally acquired Helicobacter spp . infection and that treatment with amoxicillin, metronidazole, and famotidine causes suppression rather than eradication of gastric Helicobacter spp . in dogs. Ren Fail, 1999 Nov, 21(6), 635 - 45 Co-administration of co-trimoxazole does not augment tacrolimus-induced impairment in kidney function in rats; Agarwala S et al.; Co-trimoxazole is an antibiotic that is frequently used in organ transplant patients . Our objective was to determine the effect of co-trimoxazole on tacrolimus-mediated functional impairment of the kidney in rats . Sprague Dawley rats were divided into three groups . Group 1 (dextrose) received 5% dextrose and Group 2 (tacrolimus) received tacrolimus (1 mg/kg/day) as a continuous intravenous infusion for seven days . Group 3 (combination) received tacrolimus as above and co-trimoxazole (30 mg/kg/day trimethoprim and 150 mg/kg/day sulfamethoxazole) intraperitoneally for six or seven days . Biochemical and functional parameters were measured pre- and post-drug infusion . On day 7, glomerular filtration rate (GFR) was evaluated using 3H-inulin while the effective renal plasma flow (ERPF)/cationic tubular secretion was assessed using 14C-tetraethylammoniumbromide(TEA) . GFR (mL/min/kg) as measured by inulin clearance was higher (p < or = 0.05) in the dextrose (12.0 +/- 1.4) group as compared to tacrolimus group (6.0 +/- 1.3) and combination group (6.4 +/- 1.6), but there was no difference between the tacrolimus and combination group . ERPF/cationic tubular secretion (mL/min/kg) was also significantly higher in the dextrose group (62.6 +/- 10.3) as compared to the other two groups . ERPF/cationic tubular secretion was not different between the combination (33.3 +/- 5.9) and the tacrolimus (35.1 +/- 6.7) groups when there was no co-trimoxazole in the body . However, in the presence of co-trimoxazole ERPF/cationic tubular secretion was significantly reduced in the combination (23.1 +/- 3.5) group as compared to the tacrolimus group (35.1 +/- 6.7) . These results indicate that co-trimoxazole does not further potentiate tacrolimus induced impairment in kidney function but is likely to further inhibit cationic tubular secretion in patients on tacrolimus therapy. Ann Thorac Surg, 1999 Nov, 68(5), 1648 - 51 Adjuvant treatment of deep sternal wound infection with collagenous gentamycin; Leyh RG et al.; BACKGROUND: The treatment of deep sternal wound infections remains controversial . Currently advocated procedures carry the risk of reinfections . The significance of local antibiotic-releasing systems as an adjuvant therapy to avoid reinfections is the subject of the presented study . METHODS: Forty-two patients with deep sternal wound complication were treated with radical wound debridement, sternal refixation, retrosternal suction drainage, bilateral pectoralis major muscle flaps, and placement of collagenous drug carrier loaded with gentamycin (Sulmycin Implant) underneath, above, and between the sternal edges . RESULTS: No treatment failure and death were observed in our patients . Side effects after adjuvant treatment with collagenous gentamycin were not detected . CONCLUSIONS: The preliminary results of adjuvant therapy with collagenous gentamycin in combination with surgical debridement leads to excellent results in the treatment of early deep sternal wound infections with no death and no primary treatment failures . This technique is easy to perform, reliable, and safe . For final judgment controlled randomized trials are mandatory. Spectrochim Acta A Mol Biomol Spectrosc, 1999 Oct, 55A(12), 2547 - 58 NMR study of pradimicin derivative BMY-28864 and its interaction with calcium ions in D2O; Hu M et al.; The dynamic structure of the antifungal antibiotic pradimicin BMY-28864 in D2O and its interaction with calcium ions were analyzed using one- and two-dimensional 1H nuclear magnetic resonance (NMR) . Spectra indicate extensive self-association of molecules in the solution . Two-component spectra were observed simultaneously in a very dilute solution, suggesting equilibrium of two aggregative states . The addition of CaCl2 caused a number of changes in NMR spectra . Therefore we concluded that pradimicin BMY-28864 could form a complex with the Ca2+ ion, causing a movement of the equilibrium . The position of the bound calcium ion is determined indirectly by observing how the NMR shift affects protons that are close to the binding site . The stoichiometry of Ca2+ ion to the Pradimicin molecule for the Ca(2+)-saturated complex is verified to be 1:2 . Signal broadening and changes in chemical shift in the 1H NMR spectroscopy of BMY-28864 are assumed to be related to changes in the molecular aggregate conformation. Hum Reprod Update, 1999 Sep-Oct, 5(5), 421 - 32 Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis; Weidner W et al.; Infections of the male genitourinary tract may contribute to infertility to a various extent depending on the site of inflammation . Especially in prostatitis, the exact classification of the infection contributes to its impact on changes in the ejaculate . Similarly, in urethritis, epididymitis and orchitis, only a clear clinical diagnosis allows a rational approach to altered sperm parameters . Several inflammatory and reactive alterations of sperm quality seem to be proven; nevertheless, the impact of these findings on male fertility remains in many cases unclear . Even therapeutic trials do not provide more insights into the association of male genital infections and impaired fertility, although the efficacy of antibiotic trials seems to be proven . For the future, it may be decisive to evaluate inflammatory changes in the ejaculate not only on the basis of standard but also on functional parameters, thus providing new definitions of the interactions between male urogenital tract infection and disturbances of male fertility. Vestn Oftalmol, 1999 Sep-Oct, 115(5), 14 - 7 {The prevention and treatment of recurrences after dacryorhinostomies}; Beloglazov VG et al.; A total of 1206 dacryorhinostomies carried out from January, 1991 to December, 1997 at Institute of Ocular Diseases of the Russian Academy of Medical Sciences are analyzed . The main causes of relapses were underevaluation of the data of examinations and improper choice of operative access and method of surgery, errors in the technique of operation, and wrong postoperative treatment . For improving the efficacy of surgery, the authors developed a comprehensive method for preventing and treating relapses . X-ray and rhinological data are decisive for the choice of the access and method of operation . Unfavorable rhinogenic factors are removed and measured aimed at suppression of the cicatricial process at the site of anastomosis are carried out in primary dacryorhinostomy . For this purpose the authors for the first time in Russia applied a cytostatic antibiotic mitomycin C to the site of dacryostoma (44 cases) and a polymeric film Diplen with hemostatic and wound-healing effects (87 cases) with good results . Thorough follow-up after surgery detected a threatened relapse sufficiently early to carry out adequate treatment promoting cure. Complement Ther Med, 1999 Sep, 7(3), 132 - 5 A randomized comparison of homoeopathic and standard care for the treatment of glue ear in children; Harrison H et al.; OBJECTIVE: To pilot a model for determining whether homoeopathic treatment of children suffering from glue ear is more effective than standard GP care at producing a return to normal hearing (a hearing loss of less than 20 dB) within 12 months . DESIGN: Non-blind, randomized controlled trial . SETTING: General practice in two locations in southern England . SUBJECTS: Thirty-three children aged 18 months to 8 years with otitis media with effusion, hearing loss > 20 dB and an abnormal tympanogram . OUTCOME MEASURES: Hearing loss, tympanogram, referrals to specialists and number of courses of antibiotics at 12 month follow-up . RESULTS: A higher proportion of children receiving homoeopathic care had a hearing loss less then 20 dB at follow-up (64 vs 56%), though this difference did not reach statistical significance (95% confidence interval for the difference between means of -25 and 42%) . More homoeopathy patients than controls had a normal tympanogram (75 vs 31%, P = 0.015) . Referrals to specialists and antibiotic consumption was lower in the homoeopathy group, though differences between groups did not reach statistical significance . CONCLUSION: Further research comparing homoeopathy to standard care is warranted . Assuming recovery rates of 50 and 30% in homoeopathy and standard care groups respectively, 270 patients would be needed for a definitive trial. Microbios, 1999, 100(396), 117 - 27 Correlation of actinomycin X2 to the lipid profile in static and shaken cultures of Streptomyces nasri strain YG62; el-Naggar MY et al.; Streptomyces nasri strain YG62 produces a broad-spectrum antibiotic designated actinomycin X2 . The influence of static and shaken incubation on the production of actinomycin X2 and lipid profiles of S . nasri strain YG62 was investigated . It was found that shaken incubation was superior to the static process for both actinomycin X2 (2-fold) and total lipids (1.6-fold) . Triglyceride and phospholipid levels paralleled the actinomycin X2 production with an increase in the triglyceride (2.8-fold) and phospholipid (1.2-fold) concentrations in the shaken culture over the static incubation . Analysis of fatty acid patterns revealed the occurrence of a wide range of fatty acids (C10-C22) . The mean percentage of total saturated fatty acids in shaken culture was higher than those of the static culture . The mean percentage of mono-unsaturated fatty acids was almost the same in both cultures . The mean percentage of the total polyunsaturated fatty acids in the static culture was slightly higher than that of the shaken culture . The polyunsaturated/saturated fatty acid ratio (P/S) was higher in the static culture compared with the shaken culture . A positive correlation was recorded between triglycerides, phospholipids and actinomycin X2 . A negative correlation on the other hand, was found between fatty acids and actinomycin X2. J Antibiot (Tokyo), 1999 Aug, 52(8), 721 - 9 Melithiazols, new beta-methoxyacrylate inhibitors of the respiratory chain isolated from myxobacteria . Production, isolation, physico-chemical and biological properties; Sasse F et al.; New antibiotic compounds, melithiazols, were isolated from the culture broth of strains of the myxobacteria Melittangium lichenicola, Archangium gephyra, and Myxococcus stipitatus . The compounds belong to the group of beta-methoxyacrylate (MOA) inhibitors and are related to the myxothiazols . The melithiazols show high antifungal activity, but are less toxic than myxothiazol A and its methyl ester in a growth inhibition assay with mouse cell cultures . The melithiazols inhibit NADH oxidation by submitochondrial particles from beef heart . Melithiazol A blocks the electron transport within the bc1-segment (complex III) and causes a red shift in the reduced spectrum of cytochrome b. Cell Calcium, 1999 Jun, 25(6), 429 - 38 Functional characterization of thapsigargin and agonist-insensitive acidic Ca2+ stores in Drosophila melanogaster S2 cell lines; Yagodin S et al.; The role of acidic intracellular calcium stores in calcium homeostasis was investigated in the Drosophila Schneider cell line 2 (S2) by means of free cytosolic calcium ({Ca2+}i) and intracellular pH (pHi) imaging together with measurements of total calcium concentrations within intracellular compartments . Both a weak base (NH4Cl, 15 mM) and a Na+/H+ ionophore (monensin, 10 microM) evoked cytosolic alkalinization followed by Ca2+ release from acidic intracellular Ca2+ stores . Pretreatment of S2 cells with either thapsigargin (1 microM), an inhibitor of endoplasmic reticulum Ca(2+)-ATPases, or with the Ca2+ ionophore ionomycin (10 microM) was without effect on the amplitude of Ca2+ release evoked by alkalinization . Application of the cholinergic agonist carbamylcholine (100 microM) to transfected S2-DM1 cells expressing a Drosophila muscarinic acetylcholine receptor (DM1) emptied the InsP3-sensitive Ca2+ store but failed to affect the amplitude of alkalinization-evoked Ca2+ release . Glycyl-L-phenylalanine-beta-naphthylamide (200 microM), a weak hydrophobic base known to permeabilize lysosomes by osmotic swelling, triggered Ca2+ release from internal stores, while application of brefeldin A (10 microM), an antibiotic which disperses the Golgi complex, resulted in a smaller increase in {Ca2+}i . These results suggest that the alkali-evoked calcium release is largely attributable to lysosomes, a conclusion that was confirmed by direct measurements of total calcium content of S2 organelles . Lysosomes and endoplasmic reticulum were the only organelles found to have concentrations of total calcium significantly higher than the cytosol . However, NH4Cl (15 mM) reduced the level of total calcium only in lysosomes . Depletion of acidic Ca2+ stores did not elicit depletion-operated Ca2+ entry . They were refilled upon re-exposure of cells to normal saline ({Ca2+}o = 2 mM), but not by thapsigargin-induced {Ca2+}i elevation in Ca(2+)-free saline. J Otolaryngol, 1999 Oct, 28(5), 260 - 5 New method for packing the external auditory canal, middle ear space, and mastoid cavities after otologic surgery; Wiesenthal AA et al.; Since its introduction in 1945, an absorbable gelatin sponge, Gelfoam, has long been a staple used for packing in otologic surgery . The present method commonly employed at the University of Manitoba teaching hospitals requires that operating room nurses carefully prepare extremely small pieces of both compressed and noncompressed Gelfoam . These pieces are then selectively soaked in an antibiotic solution and carefully placed, one by one, into the appropriate position . We describe a new paste preparation of Gelfoam powder, Thrombostat, acetic acid, and Bacitracin ointment, which can very quickly be injected from a syringe into the operated cavity . Our preliminary study indicates that this preparation reduces operating time, while making the process of packing easier for the surgeon . In addition, it ensures a more evenly packed cavity while still fulfilling the requirements of middle ear packing . Postoperatively, it was found to be easier to debride from the operative cavity in the office, decreasing patient discomfort and procedure time . Reported below is a preliminary clinical patient series report comparing this new method to the old method. Bone Marrow Transplant, 1999 Nov, 24(10), 1089 - 93 Itraconazole oral solution as antifungal prophylaxis in children undergoing stem cell transplantation or intensive chemotherapy for haematological disorders; Foot AB et al.; This was an open study of oral antifungal prophylaxis in 103 neutropenic children aged 0-14 (median 5) years . Most (90%) were undergoing transplantation for haematological conditions (77% allogeneic BMT, 7% autologous BMT, 6% PBSC transplants and 10% chemotherapy alone) . They received 5.0 mg/kg itraconazole/day (in 10 mg/ml cyclodextrin solution) . Where possible, prophylaxis was started at least 7 days before the onset of neutropenia and continued until neutrophil recovery . Of the 103 who entered the study, 47 completed the course of prophylaxis, 27 withdrew because of poor compliance, 19 because of adverse events and 10 for other reasons . Two patients died during the study and another five died within the subsequent 30 days . No proven systemic fungal infections occurred, but 26 patients received i.v . amphotericin for antibiotic-unresponsive pyrexia . One patient received amphotericin for mycologically confirmed oesophageal candidosis . Three patients developed suspected oral candidosis but none was mycologically proven and no treatment was given . Serious adverse events (other than death) occurred in 21 patients, including convulsions (7), suspected drug interactions (6), abdominal pain (4) and constipation (4) . The most common adverse events considered definitely or possibly related to itraconazole were vomiting (12), abnormal liver function (5) and abdominal pain (3) . Tolerability of study medication at end-point was rated as good (55%), moderate (11%), poor (17%) or unacceptable (17%) . Some patients had poor oral intakes due to mucositis . No unexpected problems of safety or tolerability were encountered . We conclude that itraconazole oral solution may be used as antifungal prophylaxis for neutropenic children. Ann Intern Med, 1999 Nov 2, 131(9), 668 - 72 Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis; Annibale B et al.; BACKGROUND: Iron deficiency anemia is the most common form of anemia worldwide . Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency . OBJECTIVE: To investigate the effects of eradicating H . pylori with combination antibiotic therapy on iron deficiency anemia in patients with H . pylori-associated gastritis . DESIGN: Case series . SETTING: University hospital . PATIENTS: 30 patients with a long history of iron deficiency anemia in whom H . pylori-associated gastritis was the only pathologic gastrointestinal finding detected . INTERVENTION: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy . MEASUREMENTS: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H . pylori status . RESULTS: At 6 months, 75% of patients had recovered from anemia (P<0.001), ferritin values increased from 5.7+/-0.7 microg/L to 24.5+/-5.2 microg/L (95% CI, 8.85 to 29.97) . After 12 months, 91.7% of patients had recovered from anemia . CONCLUSIONS: Cure of H . pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia. Int J Pediatr Otorhinolaryngol, 1999 Oct 5, 49 Suppl 1, S173 - 8 Otitis media in Australian Aboriginal children: an overview; Leach AJ; Remote and rural Australian Aboriginal children achieve lower standards of numeracy and literacy than their non-Aboriginal peers . The reasons are complex, but extraordinarily high rates of conductive hearing loss (> 50%) are, in part, responsible for poor classroom success . In addition to the burden of acute bacterial respiratory illness (highest rates of invasive pneumococcal disease in the literature), chronic disease affects virtually every young child . In the Aboriginal community studied, otitis media commenced within 3 months of birth for all infants, progressed to chronic suppurative otitis media in 60% and did not resolve throughout early childhood . Our findings, supported by mathematical modelling, show that the vicious cycle of endemic chronic otitis media is perpetuated by high carriage rates of multiple species and multiple types of respiratory bacterial pathogens, by high cross-infection rates and thus, by early age of pathogen acquisition and prolonged carriage . Long-term damage to respiratory mucosa, possibly linked to later chronic bronchitis and bronchiectasis, follows a constant series of infections by each of the concurrently held pathogens, without periods of recovery . Overcrowding and poor hygiene promote this vicious cycle . Medical and social options for intervention are limited by poor resources, low expectations for health and a complex biology that includes antibiotic resistant pneumococci. Arch Esp Urol, 1999 Sep, 52(7), 792 - 4 {Squamous carcinoma of the male urethra, its presentation as a scrotal abscess}; Medina Perez M et al.; OBJECTIVE: To report a case of urethral carcinoma presenting as scrotal abscess . METHODS: A 53-year-old man presented with swelling, redness and pain in the scrotum . He had a history of urethral stricture and multiple scrotal abscesses . Incision and drainage were performed and the patient was treated with antibiotics without improvement . Incision and drainage were repeated and a biopsy of the tissue edges of the abscess were performed . RESULTS: Histopathological analysis disclosed a squamous cell carcinoma arising from the urethra . CONCLUSION: Patients with a history of urethral stricture should be followed closely . A scrotal biopsy should be performed in patients who do not improve with antibiotic therapy. Can Fam Physician, 1999 Oct, 45, 2397 - 404 Diagnosing and treating asymptomatic tuberculosis infection; Wang CT; OBJECTIVE: To summarize relevant parts of the guidelines recommended by the Canadian and American Thoracic Societies for diagnosis and management of asymptomatic tuberculosis (TB) infection . QUALITY OF EVIDENCE: The latest guidelines published by the Canadian and American Thoracic Societies were reviewed . Unfortunately, neither of these guidelines state explicitly how recommendations were derived . The references accompanying each set of guidelines, however, suggest that they were developed by extensive literature review of the subject and consensus among expert panels . MAIN MESSAGE: Only higher-risk patients should receive a TB screening test (Mantoux test) to minimize the possibility of false-positive test results . The cutoff points for positive tests vary to reflect the pretest likelihood of TB infection . An induration 5 mm or greater is considered positive in patients at highest risk of TB infection, that is, HIV-infected patients, close contacts of active TB cases, and patients with chest x-ray abnormalities suggestive of previous untreated TB . All other patients are considered positive if they have induration greater than 10 mm according to the Canadian guideline . A 15-mm cutoff point, however, is used for patients without risk factors in the American guideline . All patients with positive Mantoux test results should be considered infected with TB . Infected patients should be offered 6 to 12 months of isoniazid prophylaxis if they have HIV infection, if they have medical conditions that increase the risk of TB activation, or if they are younger than 35 years . CONCLUSIONS: Prophylactic treatment of infected individuals effectively prevents the spread of TB infection . Family physicians, who most often see patients in the asymptomatic stage of TB infection, are uniquely situated to prevent secondary cases of TB by offering appropriate patients prophylactic treatment . Patients should be counseled about the risk and benefit of prophylactic treatment so they give informed consent for it. Hepatogastroenterology, 1999 Sep-Oct, 46(29), 2986 - 90 Severe acute pancreatitis associated with hyperlipidemia: report of two cases and review of the literature in Japan; Ohmoto K et al.; Two cases of severe acute pancreatitis associated with type V hyperlipoproteinemia are reported . A 39-year-old obese woman was hospitalized with continuous severe abdominal pain . The diagnosis was made on the day of admission to our hospital, and treatment using continuous regional arterial infusion of a protease inhibitor and an antibiotic was performed with good results . The other patient was a 35 year-old woman in the 35th week of pregnancy, and a diagnosis of gestational hyperlipidemic pancreatitis was made on the day of onset . She was treated supportively using intravenous hyperalimentation, protease inhibitors, and antibiotics . She recovered from the acute pancreatitis and delivered a healthy term infant . It is difficult to diagnose acute pancreatitis in patients with type V hyperlipoproteinemia, because even when serum amylase levels are high, the value is reduced by high serum triglycerides . Early diagnosis was achieved in both of the present cases, and early intensive therapy was performed, which may be of the utmost importance in saving the life of a patient. Scand J Infect Dis, 1999, 31(5), 475 - 80 Helicobacter pylori infection in Ethiopian children: a cohort study; Lindkvist P et al.; Risk factors for infection with Helicobacter pylori (HP) were investigated in a cohort study of 121 seronegative children in Ethiopia aged 2-4 y, who had previously participated in a case-control study . Blood samples were drawn at inclusion in the cohort study and again after 12 and 30 months . At 12 months the parents were also interviewed about putative risk factors for infection, using a structured questionnaire . Analyses were made by comparing risk factors in seropositive and seronegative children . The seroconversion rate during the first year was 31% (27/87) and during the following 18 months 34% (17/50; corresponding to an annual incidence of 24%) . After a period of 30 months, 58% (14/24) of the children who were 24-29 months old at inclusion in the study had seroconverted, compared with 40% (4/10) of those who were 30-35 months old, 73% (22/30) of those who were 36-41 months old and 31% (4/13) of those who were 42 months old or more . These results indicate that peak age for HP infection is below 6 y in this cohort in Ethiopia, and might also reflect a pattern of repeated seroconversion and sero-reversion in early childhood . Independent predictors of HP-seroconversion were the variables 'drinking-water', comparing water from a well with water from rivers or pipes (RR = 1.46, 95% CI 1.0-2.15) and 'antibiotic treatment' (RR = 1.84, 95% CI 1.16-2.92). An Esp Pediatr, 1999 Sep, 51(3), 235 - 40 {Neutropenia as early manifestation of X-linked agammaglobulinemia . Report on 4 patients}; Plo Rodriguez F et al.; OBJECTIVE: The aim of this study was to determine the frequency of neutropenia associated to X-linked agammaglobulinemia (XLA) and to describe the clinical characteristics of the children diagnosed in our unit . PATIENTS AND METHODS: A revision of the medical records registered in our unit during a 28 year period (1970-1998) according to the diagnostic criteria of XLA was performed . We included in the study group those patients that expressed a neutropenia . Immunological studies by standard techniques were performed . RESULTS: Of the 37 patients fulfilling the diagnostic criteria of XLA, 4 cases had experienced episodes of neutropenia (10.81%) . The frequency of neutropenia within the group without familiar antecedents was 15% and within the group with familiar antecedents 5.88% . In all cases, the neutropenia was present during a serious acute infectious disease . The neutropenia was transient and resolved promptly after the onset of antibiotic therapy in all patients . None of the patients experienced neutropenia while under therapy with intravenous gammaglobulin . CONCLUSIONS: The association of XLA and neutropenia seems to be sufficiently frequent as to include it in the differential diagnosis of neutropenia during infancy . It is important to consider a primary immunodeficiency diagnosis when a child presents neutropenia and a serious acute infectious disease . Quantification of serum immunoglobulin levels and enumeration of lymphocyte subpopulations can lead to an early diagnosis. Rev Chir Orthop Reparatrice Appar Mot, 1999 Oct, 85(6), 640 - 5 {Traction-mobilization in 2-stage treatment of infected total knee prosthesis . Apropos of 12 cases}; Lecuire F et al.; INTRODUCTION: A two stages reimplantation is advised by most authors in salvage of infected total knee arthroplasty . This treatment is more difficult, but seems more successful in controlling infection . It set the problem of the attitude between the two operative stages: an antibiotic cement spacer is usually used, but articular mobilization is not possible, except with an articulating spacer . MATERIAL AND METHODS: Since 1989, we use traction-mobilisation between the two operative stages, with mobilization under traction up to 50 degrees, and on edge of bed up to 70-90 degrees, till the reimplantation . We used this method on 12 cases of chronic infection in total knee arthroplasty . The reimplantation was done 34 to 47 days later . The reimplantation was more easy and more comfortable in approach and exposition, and post operative mobilisation easier . RESULTS: We did not have any recurrence of infection in this patients, but the follow up is too short for some of them . One prosthesis was removed for mechanical failure . The mean range of motion is 86 degrees at two months, 96 degrees at one year . DISCUSSION: The antibiotic cement spacer presents the disadvantage of leaving material in a potentially infected environment . It does not allow mobilisation, except using an articulating spacer . Traction-mobilisation keep articular flexion, allows mobilization, and does not leave any material in articulation . But this method has the disadvantage of requiring an hospital care between the two stages: that is reasonable if the delay is short . CONCLUSION: Traction mobilization seems to be an alternative to cement spacer . It makes the reimplantation easier, facilitates post operative recovery of mobility, and does not seem to increase recurrence of infection. Nutrition, 1999 Nov-Dec, 15(11-12), 968 - 71 The Second International Scientific Symposium on Tea & Human Health, September 14th, 1998; Phipps RP; It is fascinating to reflect that tea, the world's most widely consumed beverage next to water, began in Chinese antiquity not as a beverage but as a medicine . Several millennia later, modern scientific research is confirming that such ancient intuition has relevance to contemporary health concerns including cancer, heart disease, and antibiotic-resistant bacteria . The timeliness of this message as the 20th century concludes could not be better . The importance of a balanced diet has been recognized and studied throughout this century . The concept that we are what we eat has become a part of popular culture . If tea's health message, which future scientific research will continue to articulate, is creatively presented and embraces the romantic image that tea affords the industry, there is every reason to expect a rebirth and reinvigoration of this ancient beverage as a new millennium commences. Structure Fold Des, 1999 Nov 15, 7(11), 1365 - 72 Crystal structure of colicin E3 immunity protein: an inhibitor of a ribosome-inactivating RNase; Li C et al.; BACKGROUND: Colicins are antibiotic-like proteins of Escherichia coli that kill related strains . Colicin E3 acts as an RNase that specifically cleaves 16S rRNA, thereby inactivating the ribosomes in the infected cell . The producing organism is protected against colicin E3 by a specific inhibitor, the immunity protein Im3, which forms a tight 1:1 complex with colicin E3 and renders it inactive . Crystallographic studies on colicin E3 and Im3 have been undertaken to unravel the structural basis for the ribonucleolytic activity and its inhibition . RESULTS: The crystal structure of Im3 has been determined to a resolution of 1.8 A . The structure consists of a four-standard antiparallel beta sheet flanked by three alpha helices on one side of the sheet . Thr7, Phe9, Phe16 and Phe74 form a hydrophobic cluster on the surface of the protein in the vicinity of Cys47 . This cluster is part of a putative binding pocket which also includes nine polar residues . CONCLUSIONS: The putative binding pocket of Im3 is the probable site of interaction with colicin E3 . The six acidic residues in the pocket may interact with some of the numerous basic residues of colicin E3 . The involvement of hydrophobic moieties in the binding is consistent with the observation that the tight complex can only be dissociated by denaturation . The structure of Im3 resembles those of certain nucleic acid binding proteins, in particular domain II of topoisomerase I and RNA-binding proteins that contain the ribonucleoprotein (RNP) sequence motif . This observation suggests that Im3 has a nucleic acid binding function in addition to binding colicin E3. JPEN J Parenter Enteral Nutr, 1999 Nov-Dec, 23(6), 363 - 5 Tunneled right atrial catheter infection presenting as renal failure; Yared G et al.; We report two cases of progressive renal failure secondary to membranoproliferative glomerulonephritis associated with subclinical septicemia from a tunneled right atrial catheter used for home parenteral nutrition administration . Although the occurrence of line infection and septicemia is a common complication of central venous catheters, a review of the literature reveals only one case report of renal failure secondary to an infected implanted central venous device . Both patients presented with azotemia and had biopsy-proven membranoproliferative glomerulonephritis, accompanied by leukocytoclastic vasculitis . In both cases, removal of the right atrial catheter and prolonged antibiotic therapy was effective in resolving the ongoing infection and resulted in marked improvement in renal function . A high index of suspicion for catheter sepsis should be maintained in patients with tunneled right atrial catheters presenting with subacute renal failure. J Chromatogr B Biomed Sci Appl, 1999 Oct 29, 734(1), 7 - 14 Determination of flumequine and doxycycline in milk by a simple thin-layer chromatographic method; Choma I et al.; Tetracycline and quinolone antibiotics have for many years served as important classes of veterinary drugs . Two representatives of both classes: doxycycline from tetracyclines and flumequine from quinolones are often administered together . When the withdrawal periods are not obeyed, the antibiotic residues may be present in edible products, e.g., in meat, eggs or milk . In the present paper a simple thin-layer chromatography (TLC) screening method is established for determining these drugs in milk . Only two developments of the plate with concentrating zone are needed: one as a clean-up procedure, the other as a proper analysis . The spots were detected both by UV lamp with dual wavelength (254 and 366 nm) and by densitometry. Rev Med Interne, 1999 Oct, 20(10), 869 - 74 {Systemic reaction induced my minocycline treatment: a report of four patients and a review of the literature}; Piette AM et al.; We report four cases of the side effects of minocycline seen during the last two years in our department . There was one case of drug-related lupus and three cases of hypersensitivity reactions, including one eosinophilic pneumopathy with pericarditis, one nephropathy and one severe, pseudo-infectious episode of high fever, rash, lympadenopathy, hepatitis and eosinophilia . Minocycline is a tetracycline agent widely used for acne therapy in France and all over the world . During the last few years, there has been an increasing number of reports concerning systemic adverse reactions to minocycline, with on the one hand auto-immune disorders (lupus, autoimmune hepatitis, vascularitis with ANCA), occurring after a prolonged course of therapy and reported recently in the last few years, and on the other hand, hypersensitivity reactions (eosinophilic pneumopathies, hepatitis, nephropathies, myocarditis, serum sickness or pseudo-infectious reactions), occurring precociously in the course of therapy, and potentially severe . Although these side effects are uncommon in the context of the high number of patients who have been prescribed the drug, the first-line antibiotic therapy in acne must probably be reconsidered. Dig Dis Sci, 1999 Nov, 44(11), 2295 - 302 H . pylori-negative duodenal ulcer prevalence and causes in 774 patients; Gisbert JP et al.; The prevalence of H . pylori infection has been reported to be very high in duodenal ulcer (DU) disease, but the precise frequency and causes of H . pylori-negative DU are not well known . In some geographical regions, however, a relatively low prevalence of the infection has been described . Our aim was to study the frequency and causes of H . pylori-negative DU and to evaluate whether empirical H . pylori eradication therapy without confirmation of the infection is justified . In all 774 consecutive patients with an endoscopic diagnosis of DU were studied prospectively . Exclusion criteria were associated diseases and previous gastric surgery . The use of NSAIDs, antibiotics (during the last month), and proton pump inhibitors (during the last month) was evaluated by means of a specific questionnaire . At endoscopy, two biopsies from both antrum and corpus were obtained in all 774 patients for histologic study (H&E stain) . One sample from the antrum for rapid urease test, one sample each from the antrum and corpus for culture, and two duodenal biopsies for histologic study were also obtained in the first 307 patients . A {13C} urea breath test was carried out in the remaining 467 patients . Patients were considered infected if any of the diagnostic tests were positive and noninfected when all tests performed were negative . Age (mean +/- SD) was 46+/-12 years, 70% were males . NSAID, antibiotic, and proton pump inhibitor use was described, respectively, in 8.9%, 5.8%, and 6.3% of the cases . H . pylori infection was demonstrated, overall, in 95.3% (95% CI: 93.6-96.6%) of the patients . H . pylori prevalence increased up to 99.1% (98.1-99.6%) if patients taking NSAIDs and/or antibiotics were excluded . Among the 36 H . pylori-negative patients, 20 (55%) were taking NSAIDs, 9 (25%) were taking antibiotics, and 1 (3%) both of them . Therefore, in only 6/774 patients (0.8%) could DU disease be considered truly "idiopathic." Differences were demonstrated between H . pylori-positive and -negative patients (univariate study; chi2) with regard to NSAID intake (7% vs 58%; P < 0.0001) and previous antibiotic use (5% vs 28%; P < 0.0001) . In the multivariate analysis (logistic regression), NSAID use (OR: 0.06; CI: 0.03-0.13; P < 0.001) and antibiotic use (OR: 0.23; CI: 0.09-0.59; P < 0.01) were the only variables that correlated with H . pylori infection . The most important factors associated with H . pylori-negative DU are NSAIDs and prior antibiotic use, and if these agents are excluded, the prevalence of infection in our area is as high as 99% . Therefore, in DU patients not taking NSAIDs and living in areas where previous studies have shown the prevalence of the infection in DU disease to be very close to 100%, empirical H . pylori eradication therapy without confirmation of the infection may be justified. Int J Pharm, 1999 Dec 1, 192(1), 63 - 75 The use of MTDSC to assess the amorphous phase content of a micronized drug substance; Guinot S et al.; Mechanical treatments such as grinding, milling or micronization applied to crystalline drug substances may induce changes such as the occurrence of crystal defects and/or amorphous regions . These changes are likely to affect the chemical and physical properties of the material as well as the corresponding drug product performances . Various analytical techniques such as standard differential scanning calorimetry, isothermal and solution microcalorimetry as well as dynamic vapour sorption can be used to characterise and possibly quantify the amorphous phase content of these materials . These techniques have been applied for the development of analytical methods based on temperature- or solvent-induced (including water) recrystallization of the amorphous phase in semi-crystalline drug substances and excipients and have sometimes allowed for detecting low amounts of amorphous phase . We have developed an alternative MTDSC method for the quantitation of the amorphous content in samples of a micronized drug substance co-crystal (form A), an antibiotic drug substance which does not recrystallize even when exposed to temperature or solvent vapours . This is performed through measurement of the heat capacity jump associated with the amorphous phase glass transition . The MTDSC parameters and experimental conditions were optimised for this system . The amorphous content calibration curve was established using pure crystalline and amorphous drug substance samples and their known mixtures . Limits of detection and quantification of 0.9 and 3.0% (w/w) respectively were obtained for specimen mass less than 5 mg. Nippon Geka Gakkai Zasshi, 1999 Oct, 100(10), 683 - 8 {Shock and acute organ dysfunction}; Murata A et al.; Multiple trauma, hemorrhage, and sepsis may produce various kinds of shock, and such a host as shock could not be controlled and may easily fall into multiple organ dysfunction . Although those mechanisms on the pathogenesis of these sequential inflammatory responses have been clarified recently, the clinical outcome of such patients suffering from severe sepsis and multiple organ dysfunction is still very low . This inflammatory response against the insult shows a sequential manner; cardiovascular system failure, renal system failure, respiratory system failure, central nervous system failure, and finally, hepatic failure . However, the host response to the insult is a kind of defense against the invasion, and the clinical goal might be to stabilize hemodynamic system, metabolic system, and immunologic system . To achieve hemodynamic homeostasis, we use catecholamines and blood transfusion to improve the oxygen supply to important organs and enhance tissue repair . For metabolic homeostasis, early administration of hyperalimentation may be needed, either parenterally or enterally . Enteral feeding may also provided a route for bacterial translocation . To achieve immunologic homeostasis, prophylactic antibiotic administration and metabolic support may be required and should also protect against infection as a secondary invasion . This review explains these mechanisms in terms of the relationship between shock and organ dysfunction and the general features of clinical management. Australas J Dermatol, 1999 Nov, 40(4), 204 - 7 Pustular vasculitis of the hands; Hall AP et al.; A case of pustular vasculitis of the hands with evidence of systemic involvement is described . A 64-year-old woman presented with a 2-day history of large, tense bullae arranged symmetrically over the dorsum of the three radial digits and extending on to the radial aspect of the dorsum of each hand . The bullae caused some discomfort and prevented normal use of her hands . There was no response to antibiotic therapy initiated prior to referral to hospital . Initial investigations revealed a raised white cell count with a neutrophilia, a raised erythrocyte sedimentation rate and a raised C-reactive protein . Abnormalities of liver function were detected . Aspirates from the bullae and blood cultures were sterile . The histology of debrided tissue demonstrated a florid neutrophilic dermal infiltrate with many blood vessels associated with prominent fibrin . A diagnosis of pustular vasculitis of the hands was made . The bullae were surgically debrided and treatment with oral corticosteroids was started . Two days after commencement of oral prednisolone, a crusted pustule appeared on her upper cutaneous lip . There was rapid resolution of both the vasculitis of the hands and the pustule on her upper lip following an increase in the dose of oral prednisolone . The patient was discharged on the seventeenth day following admission. Mol Pharmacol, 1999 Dec, 56(6), 1329 - 39 The orphan human pregnane X receptor mediates the transcriptional activation of CYP3A4 by rifampicin through a distal enhancer module; Goodwin B et al.; Cytochrome P-450 3A4 (CYP3A4), the predominant cytochrome P-450 expressed in adult human liver, is subject to transcriptional induction by a variety of structurally unrelated xenobiotics, including the antibiotic rifampicin . The molecular mechanisms underlying this phenomenon are poorly understood . We transfected a human liver-derived cell line (HepG2) with various CYP3A4-luciferase reporter gene constructs containing a nested set of 5'-deletions of the CYP3A4 5'-flanking region . Rifampicin-inducible transcription of the reporter gene was observed only with the longest construct, which encompassed bases -13000 to +53 of CYP3A4 (3-fold induction) . The responsive region was functional regardless of its position or orientation relative to the proximal promoter of CYP3A4 and was capable of conferring rifampicin-inducible expression on a heterologous promoter . Further deletion mutants localized the induction to bases -7836 to -7607 . In vitro DNase I footprint analysis of this region revealed four protected sites (FP1, FP2, FP3, and FP4) . Two of these sites, FP3 (bases -7738 to -7715) and FP4 (bases -7698 to -7682), overlapped binding motifs for the orphan human pregnane X receptor (hPXR) . Cotransfection of responsive constructs with a hPXR expression vector substantially increased the rifampicin-inducibility to approximately 50-fold . In addition, the rifampicin-responsive constructs were strongly activated by a range of CYP3A inducers . Finally, we demonstrate cooperativity between elements within the distal enhancer region and cis-acting elements in the proximal promoter of CYP3A4 . Our results provide evidence for the existence of a potent enhancer module, 8 kb distal to the transcription start point, which mediates the transcriptional induction of CYP3A4 by activators of hPXR. Infect Immun, 1999 Dec, 67(12), 6583 - 90 Escherichia coli msbB gene as a virulence factor and a therapeutic target; Somerville JE Jr et al.; A mutation in the msbB gene of Escherichia coli results in the synthesis of E . coli lipopolysaccharide (LPS) that lacks the myristic acid moiety of lipid A . Although such mutant E . coli cells and their purified LPS have a greatly reduced ability to stimulate human immune cells, a minor reduction in the mouse inflammatory response is observed . When the msbB mutation is transferred into a clinical isolate of E . coli, there is a significant loss in virulence, as assessed by lethality in BALB/c mice . When a cloned msbB gene is provided to functionally complement the msbB mutant, virulence returns, providing direct evidence that the msbB gene product is an important virulence factor in a murine model of E . coli pathogenicity . In the genetic background of the clinical E . coli isolate, the msbB mutation also results in filamentation of the cells at 37 degrees C but not at 30 degrees C, a reduction in the level of the K1 capsule, an increase in the level of complement C3 deposition, and an increase in both opsonic and nonopsonic phagocytosis of the msbB mutant, phenotypes that can help to explain the loss in virulence . The demonstration that the inhibition of msbB gene function reduces the virulence of E . coli in a mouse infection model warrants further investigation of the msbB gene product as a novel target for antibiotic therapy. Dig Surg, 1999, 16(5), 420 - 4 Complicated diverticulitis of the sigmoid: a prospective study concerning primary resection with secure primary anastomosis; Hoemke M et al.; BACKGROUND: The Hartmann procedure remains the standard concerning the surgical treatment of acute complicated sigmoid diverticulitis . The aim of this study was to prove the possibility of performing a secure primary anastomosis without colostomy in patients with complicated acute diverticulitis . METHODS: From June 1988 to October 1996, 113 patients suffering from acute complicated sigmoid diverticulitis were included in this prospective study . Within 24-48 h of hospital admission, when symptoms of the illness persisted despite the use of antibiotic therapy, the patients underwent primary resection of the sigmoid . In all patients primary anastomosis was performed, using CEEA staplers, avoiding colostomy and intraoperative colon irrigation . RESULTS: During the observation period of 19 days, there was no anastomotic leakage found either by radiological methods or clinical parameters . Two patients died of early septic complications, 1 of therapy-resistant endocarditis . CONCLUSION: The results of this study demonstrate the safety of primary anastomosis after primary resection of the sigmoid under antibiotic conditions, avoiding the disadvantages associated with two-stage procedures . Copyright Arch Dermatol, 1999 Nov, 135(11), 1317 - 26 Solitary erythema migrans in Georgia and South Carolina; Felz MW et al.; OBJECTIVE: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states . DESIGN: Prospective case series . SETTING: Family medicine practice at academic center . PATIENTS: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease . INTERVENTIONS: Patients underwent clinical and serologic evaluation for evidence of B burgdorferi infection . All lesions underwent photography, biopsy, culture and histopathologic and polymerase chain reaction analysis for B burgdorferi infection . Patients were treated with doxycycline hyclate and followed up clinically and serologically . MAIN OUTCOME MEASURES: Disappearance of EM lesions and associated clinical symptoms in response to antibiotic therapy; short-term and follow-up serologic assays for diagnostic antibody; growth of spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly II media; special histopathologic stains of tissue for spirochetes; and polymerase chain reaction assays of tissue biopsy specimens for established DNA sequences of B burgdorferi . RESULTS: The EM lesions ranged from 5 to 20 cm (average, 9.6 cm) . Five patients (22%) had mild systemic symptoms . All lesions and associated symptoms resolved with antibiotic therapy . Overall, 7 patients (30%) had some evidence of B burgdorferi infection . Cultures from 1 patient (4%) yielded spirochetes, characterized as Borrelia garinii, a European strain not known to occur in the United States; 3 patients (13%) demonstrated spirochetallike forms on special histologic stains; 5 patients (22%) had positive polymerase chain reaction findings with primers for flagellin DNA sequences; and 2 patients (9%) were seropositive for B burgdorferi infection using recommended 2-step CDC methods . No late clinical sequelae were observed after treatment . CONCLUSIONS: The EM lesions we observed are consistent with early Lyme disease occurring elsewhere, but laboratory confirmation of B burgdorferi infection is lacking in at least 16 cases (70%) analyzed using available methods . Genetically variable strains of B burgdorferi, alternative Borrelia species, or novel, uncharacterized infectious agents may account for most of the observed EM lesions. J Biol Chem, 1999 Nov 26, 274(48), 34072 - 82 Regulation of the biosynthesis of N-acetylglucosaminylpyrophosphoryldolichol, feedback and product inhibition; Kean EL et al.; The assembly of the core oligosaccharide region of asparagine-linked glycoproteins proceeds by means of the dolichol pathway . The first step of this pathway, the reaction of dolichol phosphate with UDP-GlcNAc to form N-acetylglucosaminylpyrophosphoryldolichol (GlcNAc-P-P-dolichol), is under investigation as a possible site of metabolic regulation . This report describes feedback inhibition of this reaction by the second intermediate of the pathway, N-acetylglucosaminyl-N-acetylglucosaminylpyrophosphoryldolichol (GlcNAc-GlcNAc-P-P-dolichol), and product inhibition by GlcNAc-P-P-dolichol itself . These influences were revealed when the reactions were carried out in the presence of showdomycin, a nucleoside antibiotic, present at concentrations that block the de novo formation of GlcNAc-GlcNAc-P-P-dolichol but not that of GlcNAc-P-P-dolichol . The apparent K(i) values for GlcNAc-P-P-dolichol and GlcNAc-GlcNAc-P-P-dolichol under basal conditions were 4.4 and 2.8 microM, respectively . Inhibition was also observed under conditions where mannosyl-P-dolichol (Man-P-dol) stimulated the biosynthesis of GlcNAc-P-P-dolichol; the apparent K(i) values for GlcNAc-P-P-dolichol and GlcNAc-GlcNAc-P-P-dolichol were 2.2 and 11 microM, respectively . Kinetic analysis of the types of inhibition indicated competitive inhibition by GlcNAc-P-P-dolichol toward the substrate UDP-GlcNAc and non-competitive inhibition toward dolichol phosphate . Inhibition by GlcNAc-GlcNAc-P-P-dolichol was uncompetitive toward UDP-GlcNAc and competitive toward dolichol phosphate . A model is presented for the kinetic mechanism of the synthesis of GlcNAc-P-P-dolichol . GlcNAc-P-P-dolichol also exerts a stimulatory effect on the biosynthesis of Man-P-dol, i.e . a reciprocal relationship to that previously observed between these two intermediates of the dolichol pathway . This network of inhibitory and stimulatory influences may be aspects of metabolic control of the pathway and thus of glycoprotein biosynthesis in general. Am J Gastroenterol, 1999 Nov, 94(11), 3181 - 3 Successful recovery of H . pylori from rapid urease tests (CLO tests); Windsor HM et al.; OBJECTIVE: Culture of Helicobacter pylori (H . pylori) and the determination of its antibiotic susceptibility is of increasing importance with the rise in numbers of antibiotic-resistant strains . The aim of this study was to determine whether H . pylori could be successfully isolated from antral biopsies used in Rapid Urease Tests (CLOtests) in clinical practice . METHODS: Antral biopsies from patients undergoing endoscopy were inserted into the gel of CLOtests to determine the H . pylori status of the patients . If the CLOtest was positive at the end of the endoscopy session, it was kept at ambient temperature until processed . In the laboratory, biopsies were removed from the gel and cultured on selective and nonselective media . In an attempt to enhance the recovery rate of H . pylori, a subset of positive CLOtests were kept at 4 degrees C from the time that the color change was noted until the removal of the biopsy . RESULTS: One hundred and forty-one positive CLOtests were studied at times between 1 h and 6 h postendoscopy . Culture success was 93% in the 1st hour but fell off sharply after 2 h (p < 0.001) . Isolation was also improved if positive CLOtests were stored at 4 degrees C and plated out within 4 h (p < 0.001) . CONCLUSIONS: H . pylori can be successfully cultured from biopsies in CLOtests kept at room temperature within 2 h or within 4 h if kept at 4 degrees C . Thus the antral biopsy in the CLOtest can be usefully retrieved when, in the light of the CLOtest result, the physician wishes to obtain both culture and antibiotic sensitivity results. Proc AMIA Symp . 1999;:696-700. Development of a Web-based clinical information system for surveillance of multiresistant organisms and nosocomial infections; Bouam S et al.; To optimize the surveillance and control of infections at our hospital, we have developed a clinical information system (CIS) linked to a server providing three kinds of patient-oriented data reports: 1/an automated alert for multiresistant bacteria from a data-driven mechanism; 2/the relevant data for surveillance of hospital-acquired infections; 3/some clinical and educational data for antibiotic prescribing . The new CIS is a Web-based one and now integrated to the Hospital Information System (HIS) . In a close collaboration with the experts, we have, first, specified the relevant information for each report . Then, we have linked the system to those HIS DBs containing this information . Finally we have developed a well-secured intranet Web site, on which the concerned practitioners can instantaneously review the latest alerts and/or the summarized/detailed reports . The preliminary results shows that the system is reliable in medical practice and the response time is satisfying. Ann Ital Med Int, 1999 Jul-Sep, 14(3), 202 - 4 Acute cholecystitis and pancreatitis in a patient with biliary sludge associated with the use of ceftriaxone: a rare but potentially severe complication; Famularo G et al.; Ceftriaxone may precipitate in the bile leading to the formation of biliary sludge . Biliary complications, even serious ones, have rarely been described in patients treated with this antibiotic . A 71-year-old woman presented to the emergency room with biliary sludge complicated by acute cholecystitis and pancreatitis after 10 days of treatment with ceftriaxone (2 g, 40 mg/kg per day) . There had been no evidence of sludge or gallstones on a transabdominal ultrasonography performed 6 months earlier . The patient underwent open cholecystectomy and recovered fully . Ceftriaxone should be kept in mind as a potential cause of biliary sludge . In most cases, resolution of sludge occurs after interruption of ceftriaxone . Young subjects, patients receiving a prolonged course and a daily dose > or = 40 mg/kg, and subjects with impaired gallbladder emptying have a greater risk of ceftriaxone-associated sludge . Cholecystectomy is the definitive therapy for severe complications. J Clin Microbiol, 1999 Dec, 37(12), 4048 - 50 Comparison of a nonradiometric liquid-medium method (MB REDOX) with the BACTEC system for growth and identification of mycobacteria in clinical specimens; Liu YC et al.; Early identification of tuberculosis in the clinical setting is of great importance in order for specific therapy to be swiftly initiated . MB REDOX (Heipha Diagnostika), a growth-based medium without radioactive materials, was evaluated and was compared to the BACTEC system for detection of mycobacteria, including the Mycobacterium tuberculosis complex and atypical mycobacteria . MB REDOX consists of a Kirchner medium enriched with growth-promoting additives, antibiotic compounds, and a redox indicator which can be monitored to detect growth of mycobacteria with the naked eye . MB REDOX only detects growth and cannot differentiate the M . tuberculosis complex (M . tuberculosis, M . bovis, and M . africanum) from other species of Mycobacterium . Therefore, PCR-restriction fragment length polymorphism analysis (PRA) was used in this investigation to identify to the species level organisms showing positive growth with MB REDOX . Our data demonstrate the usefulness of MB REDOX for the detection of mycobacteria in clinical specimens . The rate of detection of M . tuberculosis complex with MB REDOX (84 . 3%) was higher than that with the BACTEC system (68.6%) . When combined with PRA for species identification, MB REDOX is easy to perform and is suited to most clinical laboratory settings for the detection and identification of mycobacteria. J Clin Microbiol, 1999 Dec, 37(12), 3946 - 51 Microdilution susceptibility testing of amphotericin B, itraconazole, and voriconazole against clinical isolates of Aspergillus and Fusarium species; Arikan S et al.; We compared the activities of amphotericin B, itraconazole, and voriconazole against clinical Aspergillus (n = 82) and Fusarium (n = 22) isolates by a microdilution method adopted from the National Committee for Clinical Laboratory Standards (NCCLS-M27A) . RPMI 1640 (RPMI), RPMI 1640 supplemented to 2% glucose (RPMI-2), and antibiotic medium 3 supplemented to 2% glucose (AM3) were used as test media . MICs were determined after 24, 48, and 72 h . A narrow range of amphotericin B MICs was observed for Aspergillus isolates, with minor variations among species . MICs for Fusarium isolates were higher than those for Aspergillus isolates . MICs of itraconazole were prominently high for two previously defined itraconazole-resistant Aspergillus fumigatus isolates and Fusarium solani . Voriconazole showed good in vitro activity against itraconazole-resistant isolates, but the MICs of voriconazole for F . solani were high . RPMI was the most efficient medium for detection of itraconazole-resistant isolates, followed by RPMI-2 . While the significance remains unclear, AM3 lowered the MICs, particularly those of amphotericin B. Mikrobiol Z, 1999 Jul-Aug, 61(4), 22 - 7 {The isolation and characteristics of mutant Streptomyces globisporus 1912 defective for landomycin E biosynthesis}; Matseliukh BP et al.; Mutants defective in the synthesis of antitumor angucycline antibiotic landomycin E were obtained from the asporogenic and initial sporulating strains of Streptomyces globisporus 1912 by means of nitrosoguanidine treatment and UV-irradiation of the mycelium fragments and protoplasts . The frequency of induction of LanE mutants in the protoplasts of strain 3-1 was 3 times higher (0.55%) as compared to mycelium fragments (0.17%) . After mutagenic treatment of spores the yield of such mutants was lower (0.044-0.071%) . It was shown, that izoflavon daidzein was an effective and necessary regulator of the landomycin E synthesis . The collection of 53 landomycin defective mutants was divided into three groups on the basis of their ability to produce antibiotic and regulator: 1) mutants LanE-Dai+ (45 strains), which did not synthesize landomycin E, but produced daidzein; 2) mutants LanE+Dai- (4 strains), which could restore landomycin E synthesis after adding exogenic daidzein to the medium and 3) mutants LanE- Dai- which did not synthesize landomycin E in the presence of daidzein. Int J Antimicrob Agents, 1999 Sep, 13(1), 41 - 6 Effects of aztreonam on natural immunity in mice; Ortega E et al.; The influence of the dose and the duration of treatment with aztreonam, a monocyclic beta-lactam antibiotic, on the natural immune response of mice has been investigated . The results show the effects induced by the antibiotic on several immune parameters were affected by the duration of treatment . Thus, treatment with 28 mg/kg per day of aztreonam over 14 days increased every immune parameter tested, while treatment with 57 mg/kg per day of aztreonam for 7 days only enhanced the natural killer (NK) activity of splenocytes . Since aztreonam does not apparently impair the innate immune response, it might be a suitable therapy for the treatment of patients who are immunosuppressed. Vet Clin North Am Small Anim Pract, 1999 Nov, 29(6), 1291 - 301 Mycobacterial dermatitis; Lemarie SL; Mycobacterial skin disease in cats associated with atypical mycobacteria is an uncommon disease in small animal practice, and the disease is rarely encountered in dogs . A mycobacterial etiology should be considered in cases of chronic nodular dermatitis, draining tracts, and panniculitis . Cats and dogs affected with atypical mycobacterial infections are usually otherwise healthy, and systemic illness is unusual . In most cases, a diagnosis is made based on histopathological findings and growth of a causative organism . Group IV atypical mycobacteria can usually be grown following submission of affected tissue . Treatment should be based on antibiotic sensitivity test results . Treatment is prolonged and is unsuccessful in many cases . In cases of feline leprosy and canine leproid granuloma syndrome, organisms are difficult if not impossible to grow, and clinical and histopathological findings should be used to make a diagnosis . Spontaneous resolution of disease has been reported in atypical mycobacteriosis, feline leprosy, and canine leproid granuloma syndrome. Vet Clin North Am Small Anim Pract, 1999 Nov, 29(6), 1281 - 90 Feline herpesvirus 1-associated facial and nasal dermatitis and stomatitis in domestic cats; Hargis AM et al.; Feline herpesvirus-associated dermatitis has rarely been reported . Recently we documented a unique ulcerative and often persistent facial dermatitis or stomatitis syndrome associated with feline herpesvirus 1 . We believe this syndrome is relatively common, with the 10 cases in our series diagnosed between 1996 and 1997 . The syndrome is associated with epithelial cell necrosis, eosinophilic inflammation, and intraepithelial herpesvirus inclusion bodies . The prevalence of eosinophilic inflammation and low number of inclusion bodies may lead to the misdiagnosis of allergic dermatitis or a lesion within the eosinophilic granuloma complex group of disorders . Feline herpesvirus 1 can be identified in lesional tissue by PCR methodology . Most of our cases developed under circumstances suggesting reactivation of latent herpesvirus infection, and previous glucocorticoid therapy or stress from overcrowding may have played a role in lesion development . Cats with ulcerative dermatitis, especially of the face and nose, and cats with stomatitis should be evaluated for the presence of feline herpesvirus . Treatment options include surgical excision, topical or systemic antibiotic therapy to treat secondary bacterial infection, and oral alpha interferon. Nurs Manage, 1999 Jun, 30(6), 44 - 9; quiz 50 VRE & MRSA . Putting bad bugs out of business; Sheff B; Are you unwittingly contributing to the spread of these dangerous antibiotic-resistant organisms? Learn to protect your patients--and yourself--from out-of-control infections. Ann Acad Med Singapore, 1999 Jul, 28(4), 476 - 80 A prospective study of infections with atypical pneumonia organisms in acute exacerbations of chronic bronchitis; Goh SK et al.; The objective of this paper was to study the incidence of 6 atypical pneumonia pathogens or atypical organisms in local patients admitted for acute exacerbation of chronic bronchitis . This is a prospective observational study . Over a period of 3 years (1995 to 1997), 90 patients admitted to a large general hospital in Singapore for acute exacerbation of chronic bronchitis were tested for the following infections: Legionella, Mycoplasma, Chlamydia, influenza A, influenza B and parainfluenza viruses, using paired serological examination . The antibiotic prescribing pattern by the attending physicians in these cases were also examined . Positive serologies were found in 31 patients (34%), of whom 26 patients (28%) had viral infections . The most common organism was influenza A with 18 positive serologies (20%) . Five patients were tested positive for Legionella . There was no evidence of acute infections by Mycoplasma pneumoniae or chlamydia using serological tests. J Clin Oncol . 1999 Apr;17(4):1227. Effect of CD34(+) cell dose on resource utilization in patients after high-dose chemotherapy with peripheral-blood stem-cell support; Schulman KA et al.; PURPOSE: The mean time to neutrophil and platelet recovery for patients receiving high-dose chemotherapy (HDC) supported with peripheral-blood stem cells (PBSCs) is related to the dose of CD34(+) cells infused . The effect of cell dose on resource utilization after transplantation has not been previously reported . MATERIALS AND METHODS: We assessed CD34(+) cell dose and resource utilization for 1,317 patients undergoing transplantation with PBSCs from April 1991 to June 1997 . PBSCs were collected after mobilization with chemotherapy and recombinant human granulocyte colony-stimulating factor (rhG-CSF) . Daily measurement of the CD34(+) content of the PBSC collection was performed by a central laboratory using a single CD34(+) analysis technique . Resource utilization included engraftment parameters, length of stay, and transfusion requirements for 100 days posttransplantation . Analysis included descriptive statistics and multiple regression . RESULTS: Mean patient age was 47 years, and 86% of patients were female . Median cell dose was 3.6 x 10(6)/kg and 13.2 x 10(6)/kg for patients receiving less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) or more CD34(+) cells/kg, respectively . Patients receiving less than 5 . 0 x 10(6) CD34(+) cells/kg were more likely to have metastatic breast cancer or non-Hodgkin's lymphoma and required more platelet and RBC transfusions, 3.3 more hospital days, and increased antibiotic and antifungal use . In univariate analysis, the cost of care was $41,516 (+/-$20,876 SD) and $32,382 (+/-$16,353 SD) for patients with less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) or more CD34(+) cells/kg, respectively . In multivariate analysis, patients with less than 5.0 x 10(6) CD34(+) cells/kg had an increase in costs of $5,062 (+/- $1,262 SE) . CONCLUSION: Infusion of more than 5.0 x 10(6) CD34(+) cells/kg was associated with a reduction in resource utilization . Achieving a target of 5.0 x 10(6) CD34(+) cells/kg should have important clinical and economic benefits for patients. Sex Transm Dis, 1999 Nov, 26(10), 556 - 63 Evaluation of the use of calendar blister packaging on patient compliance with STD syndromic treatment regimens; Wright JM et al.; BACKGROUND: Good compliance with antibiotic therapy is critical for successful management of sexually transmitted diseases (STDs) . GOAL OF THIS STUDY: To evaluate the use of user-friendly drug packaging as a means of improving patient compliance with STD therapy and the acceptability of the packaging . STUDY DESIGN: Compliance of patients with STDs with treatment regimens for three different STD syndromes, using antibiotics packed in standard medicine packaging (SP), was compared to that of patients using calendar blister packaged drugs . Compliance was measured by counting the remaining pills at two return visits . Questionnaires were used to evaluate acceptability of the packs . RESULTS: Compliance was significantly better among patients using the calendar blister packs than among those using standard packs, irrespective of dosing frequency . The degree of poor compliance increased with increasing dosing frequency . There was a high level of satisfaction with the blister pack among patients and health care workers . CONCLUSION: Compliance can be improved by the introduction of user-friendly drug packaging, especially for more complex dosing regimens. Mycopathologia, 1999, 145(1), 43 - 56 Production of mycotoxins on artificially and naturally infested building materials; Nielsen KF et al.; In this study, the ability to produce mycotoxins during growth on artificially infested building materials was investigated for Penicillium chrysogenum, Pen . polonicum, Pen . brevicompactum, Chaetomium spp., Aspergillus ustus, Asp . niger, Ulocladium spp., Alternaria spp., and Paecilomyces spp., all isolated from water-damaged building materials . Spores from the different isolates of the above mentioned species were inoculated on gypsum board with and without wallpaper and on chipboard with and without wallpaper . Fungal material was scraped off the materials, extracted, and analyzed using high performance liquid chromatography-diode array detection and thin layer chromatography . All six isolates of C . globosum produced the toxic chaetoglobosins A and C, at levels of up to 50 and 7 microg/cm2 respectively . The quantities of secondary metabolites produced by Penicillia were generally low, and no toxin production was detected from any of the five isolates of Pen . chrysogenum . Both isolates of Pen . polonicum produced 3-methoxy-viridicatin, verrucosidin, and verrucofortine . Two of five isolates of Pen . brevicompactum produced mycophenolic acid . From five out of six isolates of Alternaria spp., altenariol and alternariol monomethyl ether were detected . From Ulocladium spp., Paecilomyces spp., and Asp . ustus no known mycotoxins were detected, although the latter two are known mycotoxin producers . Asp . niger produced several naphtho-gamma-pyrones and tetra-cyclic compounds . All investigated species, especially Asp . ustus and Asp . niger produced many unknown secondary metabolites on the building materials . Analyses of wallpaper and glass-fibre wallpaper naturally infested with Asp . versicolor revealed sterigmatocystin and 5-methoxysterigmatocystin . Analyses of naturally infested wallpaper showed that C . globosum produced the chaetoglobosins A and C, and Pen . chrysogenum produced the antibiotic meleagrin. J Bacteriol, 1999 Nov, 181(22), 7131 - 5 Inactivation of the tricarboxylic acid cycle aconitase gene from Streptomyces viridochromogenes Tü494 impairs morphological and physiological differentiation; Schwartz D et al.; The tricarboxylic acid (TCA) cycle aconitase gene acnA from Streptomyces viridochromogenes Tu494 was cloned and analyzed . AcnA catalyzes the isomerization of citrate to isocitrate in the TCA cycle, as indicated by the ability of acnA to complement the aconitase-deficient Escherichia coli mutant JRG3259 . An acnA mutant was unable to develop aerial mycelium and to sporulate, resulting in a bald phenotype . Furthermore, the mutant did not produce the antibiotic phosphinothricin tripeptide, demonstrating that AcnA also affects physiological differentiation. Fed Regist . 1999 May 17;64(94):26657. Conforming regulations regarding removal of section 507 of the Federal Food, Drug, and Cosmetic Act; confirmation of effective date . Food and Drug Administration, HHS . Direct final rule; confirmation of effective date; "Guidance for Industry: On the Content and Format of Chemistry et al.; The Food and Drug Administration (FDA) is announcing the availability of a document entitled "Guidance for Industry: On the Content and Format of Chemistry, Manufacturing and Controls Information and Establishment Description Information for an Allergenic Extract or Allergen Patch Test." The guidance document is intended to provide guidance to applicants on the content and format of the chemistry, manufacturing and controls (CMC) and establishment description sections of the "Application to Market a New Drug, Biologic, or an Antibiotic Drug for Human Use" (revised Form FDA 356h) for an allergenic extract or allergen patch test . This action is part of FDA's continuing effort to achieve the objectives of the President's "Reinventing Government" initiatives and the FDA Modernization Act of 1997, and is intended to reduce unnecessary burdens for industry without diminishing public health protection. Fed Regist, 1999 Mar 8, 64(44), 11023 - 4 "Guidance for industry: content and format of chemistry, manufacturing and controls information and establishment description information for a biological in vitro diagnostic product;" availability . Food and Drug Administration, HHS . Notice; Effect of surgical adhesion reduction devices on the propagation of experimental intra-abdominal infection; Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA . atzianabos@channing.harvard.edu HYPOTHESIS: The use of certain surgical adhesion reduction devices where there is a risk of concomitant bacterial contamination potentiates intra-abdominal infection . DESIGN: Evaluation of adhesion reduction devices in an experimental model of intra-abdominal infection . SETTING: Experimental animal model . INTERVENTIONS: Adhesion reduction devices were administered at the time of bacterial challenge . MAIN OUTCOME MEASURES: Animal mortality rate, abscess formation, and bacterial counts in peritoneal fluid and blood cultures . RESULTS: The use of bioresorbable membrane adhesion reduction devices in the presence or absence of antibiotic therapy did not alter the disease process as compared with appropriate control groups . However, adhesion reduction gels prepared from sodium hyaluronate and carboxymethylcellulose chemically modified with carbodiimide or ferric ion complexed sodium hyaluronate increased the incidence of peritonitis in treated animals . Gel formulations containing diimide-modified carboxymethylcellulose did not have this effect . CONCLUSIONS: The use of certain adhesion reduction devices resulted in the propagation of intra-abdominal infection in an experimental rat model . This outcome was dependent on the composition of the device employed . The use of adhesion reduction devices should be tested in appropriate models of infection where there is the risk of concomitant bacterial contamination. Curr Opin Pediatr, 1999 Oct, 11(5), 447 - 56 Minocycline and autoimmunity; Eichenfield AH; Minocycline is the most widely prescribed systemic antibiotic for the management of acne . In the past several years, increasing attention has been paid to the drug, both for its potential use as a disease-modifying antirheumatic agent and for its propensity to engender untoward autoimmune reactions, including serum sickness-like disease, drug-induced lupus, and autoimmune hepatitis . This paper reviews the evidence for minocycline as an anti-inflammatory and immunomodulatory agent, its utility in the treatment of rheumatoid arthritis, and the spectrum of adverse reactions that have been ascribed to the drug in the past 5 years. Eur J Cardiothorac Surg, 1999 Sep, 16(3), 362 - 3 Do not snog the dog: infective endocarditis due to Capnocytophaga canimorsus; Ngaage DL et al.; We present a case of prosthetic valve endocarditis and paravalvular abscess caused by the canine bacteria Capnocytophaga canimorsus in a 63-year-old man, who made a habit of snogging his pet dog . Capnocytophaga canimorsus can cause culture-negative endocarditis, therefore a high level of clinical awareness and the appropriate isolation techniques are important for making the diagnosis . Antibiotic therapy and properly timed excision of the infected focus are recommended. Hautarzt, 1999 Oct, 50(10), 739 - 42 {Periorbital lipogranuloma following endonasal sinus surgery}; Weidmann E et al.; A 60-year-old woman developed a periorbital lipogranuloma after endonasal surgery on her paranasal sinuses . The granulomatous inflammation was caused by nonabsorbable lipids introduced by the postoperative nasal tamponade which was soaked in antibiotic ointment . These lipids were transported into the periorbital tissue by the postoperative hemorrhage . Since the course of the inflammatory process is chronic, surgical removal is the best treatment. J Biol Chem, 1999 Nov 12, 274(46), 32829 - 34 Disruption of an aromatase/cyclase from the oxytetracycline gene cluster of Streptomyces rimosus results in production of novel polyketides with shorter chain lengths; Petkovic H et al.; Oxytetracycline is a polyketide antibiotic made by Streptomyces rimosus . From DNA sequencing, the gene product of otcD1 is deduced to function as a bifunctional cyclase/aromatase involved in ring closure of the polyketide backbone . Although otcD1 is contiguous with the ketoreductase gene, they are located an unusually large distance from the genes encoding the "minimal polyketide synthase" of the oxytetracycline gene cluster . A recombinant, disrupted in the genomic copy of otcD1, made four novel polyketides, all of shorter chain length (by up to 10 carbons) than oxytetracycline . All four novel structures contained the unusual carboxamido group, typical of oxytetracycline . This implies that the carboxamido group is present at the start of biosynthesis of oxytetracycline, a topic that has been debated in the literature . Loss of the cyclase protein has a profound influence on the length of polyketide chain assembled, implying that OtcD1 plays a greater role in the overall integrity of the quaternary structure of the polyketide complex than hitherto imagined. J Hosp Infect, 1999 Oct, 43(2), 85 - 100 Mopping up hospital infection; Dancer SJ; Hospital cleaning is a neglected component of infection control . In the UK, financial constraints have forced managers to re-evaluate domestic services and general cleaning has been reduced to the bare minimum . Services have been contracted out in some hospitals, which has further lowered standards of hygiene . Control of infection personnel believe that cleaning is important in preventing hospital-acquired infections but they do not manage domestic budgets and have failed to stop their erosion . It is difficult to defend high levels of hygiene when there is little scientific evidence to support cleaning practices . This review examines the common micro-organisms associated with hospital-acquired infection and their ability to survive in the hospital environment . It also describes studies which suggest that comprehensive cleaning disrupts the chain of infection between these organisms and patients . It is likely that restoring hygienic standards in hospitals would be a cost-effective method of controlling hospital-acquired infection . Furthermore, good cleaning is achievable whereas the enforcement of hand washing and good antibiotic prescribing are not. Nutr Hosp, 1999 May, 14 Suppl 2, 129S - 140S {Drug-food interactions}; Cardona Pera D; Pharmacological interaction is identified among other aspects when the effects of a drug are significantly altered clinically by the presence of food . The most important clinical significance in the history of drug-food interactions occurred in the fifties, the vitamin B6 deficiency when administering the tuberculostatic isoniazide, but there is no doubt that the interaction in the sixties between drugs that were inhibitors of the enzyme mono-amine oxidase and the biogenic amines tyramine and histamine had an important clinical significance due to the increase in hypertension and deaths due to cerebro-vascular accidents . In the seventies the types of interactions were due to the chelation between tetracyclines and the calcium of milk products, influencing the bioavailability of the antibiotic, and from this point on, studies explore in depth the interaction of foods with the different steps in the pharmacokinetics of the drugs (absorption, distribution, metabolization, and excretion), and these have helped to explain the metabolization interactions of drugs like the clinical significance between grapefruit juice whose naringenine flavonoid is a powerful inhibitor of cytochrome 450, particularly the CYP3A4 family, and terfenadine (antihistamine), with an increase in the plasma levels of the drug and patient death due to ventricular arrhythmia . In the USA the Joint Commission on Accreditation of Health Care Organization (JCAHO) has recommended monitoring of the possible drug and food interactions since 1985, and recommends that patients be informed of this . Despite the recommendations of the JCAHO, few American hospitals have protocolized these interactions and even fewer comply with these, and according to some authors, this is due to the lack of motivation caused by the lack of clinical significance . In this chapter we will study the effect of foods on drugs in two aspects: at the pharamcokinetic level with the possible alterations in absorption, distribution, metabolization, and excretion, and at the pharamcodynamic level, by alterations in the action of the drug . Also, based on a study by