Acta Otorhinolaryngol Belg, 1994, 48(1), 67 - 70 {Local treatment of otitis media and otitis externa: the role of quinolones}; De Schepper S et al.; Patients suffering from suppurative otitis media and externa, and in whom pseudomonas species are present, were treated twice daily by local instillation of ciprofloxacin 0.2% . Treatment resulted in clinical and bacteriological cure in all 17 patients, including patients resistant to previous therapy, within a mean time of six days . There were no adverse effects except one case of local allergy . Audiograms remained unchanged . Local therapy with ciprofloxacin is a welcome addition but should be reserved for cases resistant to other therapy. Minerva Stomatol, 1994 Jan-Feb, 43(1-2), 7 - 15 {Oral pathology in autologous bone marrow transplantation (ABMT) . Its prevention and local treatment}; Cocchi F et al.; The level of chemo-radiotherapy that patients must undergo in the course of ABMT treatment causes a direct toxic mucous damage and serious medulla aplasia with subsequent neutropenia . Both factors significantly affect the appearance of oral complications . These represent one of the most frequent (congruent to 85%) postoperative problems . Particular attention must be paid to the conditions of the oral cavity during the phase immediately preceding the transplantation, owing to the fact that serious aplasia that patient show, may have potentially lethal consequences . Therefore, the authors of this study followed the patients during the pre-transplantation and post-transplantation phase, putting into practice a whole range of procedures whose aim is the prevention of oral lesions or the limitation of their seriousness and duration . The Hematology Department of San Martino Hospital admitted 30 patients, 22 with LNH and 8 with LLA, 10 men and 20 women . 10 patients represented the control group . The patients were visited approximately one month before the transplantation; they underwent x-ray examination and an objective examination of the oral cavity . On the basis of the results of these first examinations, each patient would be assigned to different therapeutic protocols so that all the patients would be surgically treated only when the state of the oral cavity was sufficiently good . Since admittance to hospital for ABMT, the patients were followed 3 times a week, then different protocols of prophylaxis and local therapy were applied, according to the presence of bacteriological, viral or fungal localized or diffused oral lesions.(ABSTRACT TRUNCATED AT 250 WORDS) Z Geburtshilfe Perinatol, 1994 Jan-Feb, 198(1), 33 - 5 {Results and experiences with the premature labor prevention program}; Charisius J; From August 1992 to August 1993 we used the Prematurity Prevention Programme at 50 Pat . (23 + 1 to 34 + 0 pregnancy week) with premature labour or with a premature rupture of membranes . The results tally for the most part with the results in the literature . The combination of a positive bacteriological cut, of a positive identification of fibronectin and of a CRP-value > or = 2.0 mg/dl indicate and advanced degree of symptoms of premature birth through infection . With the examinations of the Prematurity Prevention Programme we have a simple technical and systematic programme for assessment symptoms of premature birth . The clinical use of this programme is a good help at the medical care of high risk patients. J Gynecol Obstet Biol Reprod (Paris), 1994, 23(1), 39 - 46 {A new therapeutic strategy using a ofloxacin-amoxicillin-clavulanic acid combination in the treatment of upper gynecologic infections . Apropos of 123 cases}; Verhoest P et al.; OBJECTIVE: To evaluate a new antibiotic strategy with a combination of ofloxacin + co-amoxiclav in the treatment of pelvic infectious diseases . DESIGN: An open-non-comparative multicentre (10) study . SUBJECTS: 123 patients (118 salpingitis and 5 endometritis) were included clinical, laparoscopic and bacteriological assessments were performed before treatment and a laparoscopic control was done in 35% of cases . Among positive bacteriological samples before treatment 48.7% C . trachomatis were isolated; 56.1% of salpingitis were considered as severe (COGIT score > 6) . TREATMENT: Patients received at entry oral ofloxacin 200 mg bid in combination with parenteral co-amoxiclav 2 to 4 g following by oral route . Total duration of treatment was 21 days . RESULTS: With respectively 97.2% and 91.6% satisfactory clinical and bacteriological results, this combination should take a major place in the treatment of pelvic infectious diseases. Int J Pediatr Otorhinolaryngol, 1994 Jan, 28(2-3), 149 - 55 Comparison of bacterial culture results in bronchoalveolar lavage and nasal lavage fluid in children with pulmonary infection; Wang D et al.; In this prospective study, bronchoalveolar lavages (BAL) as well as nasal lavages (NL) were performed in 25 consecutive pediatric patients with pulmonary infections . It aimed to study the relevance of bacterial culture results from nasal lavage fluid as compared with bronchoalveolar lavage fluid in children with pulmonary infection . Purulent nasal secretions were observed in 9 out of 10 children presenting with acute unilateral pneumonia within 1-2 days and who had not been treated with antibiotics (Group 1), and in 10 out of 15 children who had been ill for about 1-3 weeks and had not improved, even though antibiotic therapy had been instituted (Group 2) . Potential bacterial pathogens were isolated from the NL of almost all the patients (24/25) . In 6 of the 10 patients in Group 1, BAL cultures were positive; the pathogens present in BAL fluid were also found in the nose in all cases . In 8 of the 15 patients in Group 2, BAL cultures were positive; the pathogens present in BAL fluid were also found in the nose in 7 cases . The total number of bacterial isolates recovered from NL fluid was higher (n = 32) than that from the BAL fluid of the involved lung (n = 17) . Ten patients with a positive NL fluid culture had negative BAL culture . This shows that nasal bacteriological findings were rather poor predictors of the actual bronchoalveolar bacteriology . It is, however, logically accepted that bacterial pathogens from the upper respiratory tract spread to the lower respiratory tract, but that not all bacteria sited in the nose will eventually infect the lung. Am J Perinatol, 1994 Jan, 11(1), 33 - 6 Differential leukocyte count in babies treated with natural surfactant; Amato M et al.; The potential of exogenous replacement therapy in surfactant-deficient states such as neonatal respiratory distress syndrome (RDS) is an area of intense clinical interest today . At present, a fundamental problem with any type of exogenous surfactant is the uncertainty about potential effects on physiological defense mechanisms, such as differentiation and mobilization of peripheral leukocytes . Considering that newborn infants with proven bacterial infections have abnormal values of segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes, we studied 42 placebo- versus Curosurf-treated babies with severe RDS . Differential white blood cell (WBC) count was serially performed before and after treatment during the first days of life . The statistically significant increase in the proportion of bands in surfactant-treated babies did not coincide with clinical and bacteriologic evidence of possible infection . Some molecular interaction mechanisms influencing immature to mature WBC ratio are supposed . Among a variety of influences on the leukocyte count, surfactant replacement therapy needs to be considered for proper interpretation of hematologic data in babies treated for RDS. Eur Respir J, 1994 Jan, 7(1), 114 - 20 Bronchoalveolar lavage during neutropenic episodes: diagnostic yield and cellular pattern; Cordonnier C et al.; Few data are available concerning the relationship between alveolar and blood cell populations during neutropenia . We wanted to compare the value of pulmonary endoscopic procedures with lavage in neutropenic (polymorphonuclear (PMN) count < or = 1,000.mm-3) and non-neutropenic settings . We therefore, retrospectively, reviewed the results of 118 investigations for pneumonia in patients with malignant haematological diseases . All had bronchoalveolar lavage (BAL), and some had additional studies with protected bacteriological samples . Each BAL specimen was studied after cytocentrifugation by cytological examination for opportunistic infections, haemorrhage, virus, legionellae, and bacteriological cultures . The diagnostic yield of all endoscopic procedures (BAL, telescoping plugged catheter and protected specimen brush) was 53% in neutropenic (Group 1) and 61% in non-neutropenic (Group 2) patients . The aetiological pattern of pneumonia was nearly the same in the two groups, except for more alveolar proteinosis in Group 1 and more cytomegalovirus (CMV) in Group 2 . The absolute number of alveolar cells recovered through BAL (total number, macrophages, lymphocytes and PMNs) was significantly lower in neutropenic patients . We conclude that: 1) neutropenic patients with pneumonia require the same investigative approach as non-neutropenic patients; 2) profound neutropenia may be concomitant with a decreased cellularity of alveoli, which may reflect the consequences of marrow aplasia on the pulmonary cell population and/or direct effect of chemotherapy on the lung. Mol Gen Mikrobiol Virusol, 1994 Jan-Feb, (1), 19 - 23 {A polymerase chain reaction method for studying host persistence of pathogenic leptospira}; Samsonova AP et al.; Polymerase chain reaction has for the first time been shown to be applicable to indication of Leptospira interrogans in the organs of infected animals with acute or chronic leptospirosis (on the model of golden syrian hamsters) . Polymerase chain reaction is superior to microscopic and bacteriological analyses in identification of leptospirae in organ suspensions . The sensitivity of the technique is 1-10 cells per sample in studies of kidney or brain suspensions or 100-1000 cells in studies of liver suspensions. Br J Plast Surg, 1994 Jan, 47(1), 24 - 9 Stored skin--stored trouble? Titley OG, Cooper M, Thomas A, Hancock K. Quantitative bacteriology is presented on 102 consecutive split-skin grafts . A sample of graft was cultured whenever skin was taken and whenever stored skin was used . Stored skin unused at 21 days was also cultured . The percentage take of grafts was inversely proportional to number of organisms/g of skin (r = -0.24, p < 0.05) . Commonly used storage conditions facilitated bacterial multiplication . There was no significant difference in organisms/g contaminating grafts for different surgeons, skin preparations, types of grafts, cutting tools or mode of anaesthesia . Male patients had a significantly greater count for initial grafts (p = 0.02), but after 3 weeks storage there was no sex difference. Int J Syst Bacteriol, 1994 Jan, 44(1), 174 - 6 Taxonomic notes: a proposal for recording the properties of putative taxa of procaryotes; Murray RG et al.; The problem that the proposal for recording the properties of putative taxa of procaryotes attempts to redress arises because the International Code of Nomenclature of Bacteria is not able to provide sensible regulation of nomenclature for new taxa defined by very limited data, such as a nucleotide sequence for a small portion of the genome . The constructors of the original code (1957) and the Judicial Commission considering the 1976 and 1990 revisions did not foresee or act upon the possibilities for molecular description and typification of procaryotes that were not yet cultivable . As a result, formal names are being proposed for uncultivated procaryotes whose uniqueness is defined only by very limited characteristics, such as differences in a molecular sequence . As the editors of two journals concerned with the systematics of procaryotes, we recognize that the problem will increase as the available technology gains wider use and becomes easier to apply . Accordingly, this note is presented in advance of discussions by the International Committee on Systematic Bacteriology at the forthcoming congress (July 1994) so that there may be discussions and reaction by colleagues. Clin Orthop, 1994 Jan, (298), 202 - 11 Osteolysis around uncemented acetabular components of cobalt-chrome surface replacement hip arthroplasty; Buechel FF et al.; Ten cases of major osteolysis were identified in patients with hemispherical cobalt chrome acetabular components of cementless resurfacing total hip prostheses at follow-up examinations ranging from two to five years . All components were porous coated with cobalt chrome spheres and were stabilized initially with screws . Five patients were women and five were men, with ages ranging from 20 to 59 years . The radiolucent cystic lesions with peripheral rims of reactive bone formation appeared one to five years after the operation . They measured from 1.5 to 6 cm in the largest diameter and were most often found adjacent to the screws used to secure the acetabular components to the skeleton . On the radiographs, none of the components appeared to be loose . Three patients had revision surgery . In two of the three cases, the implants were found to be firmly fixed . There was no clinical or bacteriologic evidence of infection . The polyethylene articulating surface showed signs of wear in all three cases and in one of the three it dislocated from the metal shell . Granulation tissue was found in the regions of osteolysis, and the diseased tissue contained numerous macrophages and giant cells . Lymphocytes and plasma cells were rare . Numerous small particles of phagocytosed polyethylene and metal in the cells were noted in two cases, whereas only polyethylene was found in the third.(ABSTRACT TRUNCATED AT 250 WORDS) Nihon Kyobu Shikkan Gakkai Zasshi, 1994 Jan, 32(1), 90 - 4 {A case of tuberculous pleural effusion diagnosed by polymerase chain reaction (PCR)--with reference to tuberculous pleurisy using polymerase chain reaction}; Hayashi M et al.; A 38-year-old man was admitted to hospital because of chest pain and for the evaluation of a right pleural effusion on his chest X-ray film . Pleural effusion was characterized as exudative lymphocyte-predominant fluid with elevation of adenosine deaminase (ADA) . Bacteriologic examination of pleural fluid was negative in both smear and culture of the fluid . PPD was positive and ESR was elevated . Mycobacterial DNA was detected in the pleural effusion using polymerase chain reaction (PCR) with primers which amplified a fragment of Is6110 . Following treatment (INH, RFP and EB), the right pleural effusion disappeared . We conclude that PCR technique may be very useful in the rapid diagnosis of tuberculous pleurisy. Clin Exp Obstet Gynecol, 1994, 21(2), 99 - 102 Clinical significance of amniotic fluid bacteriological cultures taken at caesarean section; Poka R et al.; To predict postoperative infection after Caesarean section by bacteriological examination of amniotic fluid samples a prospective analysis was performed on amniotic fluid bacteriological results and infectious morbidity in 266 consecutive Caesarean sections . Culture and sensitivity results were analysed in relation to postoperative febrile complications and their antibiotic treatment . One hundred and twelve samples grew bacteria . There was a significantly higher frequency of postoperative pyrexial complications among those patients with a positive amniotic fluid culture (22.3% vs 14.2%) . Eighty per cent of amniotic fluid samples with significant bacterial growth provided useful information when antibiotic treatment had been required . Routine amniotic fluid sampling for bacteriology at Caesarean section is of clinical value in the prediction and management of postoperative pyrexial complications. Biol Neonate, 1994, 65(5), 310 - 6 Is the piglet a useful animal model of sudden infant death syndrome? Lavoue S, Dagorne M, Morvan H, Madec F, Durigon M. A prospective study of early death was conducted in a large population of piglets in order to investigate the causes of mortality and determine whether this species could be useful as an animal model of the sudden infant death syndrome (SIDS) . 1,921 live-born piglets were closely monitored from birth to 2 months of age . The cause of death was analyzed in all the animals which died during this period . Complete histological, bacteriological and virological examinations of all sudden death animals were compared to identical examinations performed in age-matched control animals . 384 animals (20%) died during the study period and 8 sudden deaths were observed (0.4%) . The principal causes of nonsudden death were overlaying (9.4%), hypotrophy (6%), infection (2%) and acute fetal suffering (1.4%) . Bacterial infection was found in 6 of the sudden deaths . There was 1 case of suffocation and 1 unexplained sudden death . Compared to controls, there was a significantly greater prevalence of pathology (p < 0.01) and of positive tissue bacteriology (p < 0.05) in sudden death animals . The 6 sudden deaths due to bacterial infections were clearly different from the human syndrome . Suffocation is a known cause of sudden infant death . In the final analysis, only 1 animal (0.5/1000) had an outcome which could be assimilated with SIDS . It is concluded that although there probably exists a syndrome in the piglet equivalent to SIDS, its incidence is very low and major obstacles related to the high level of early mortality in this species hinder investigation. Arch Orthop Trauma Surg, 1994, 113(3), 157 - 8 Bacteriological study of surgical knives: is the use of two blades necessary? Ramon R, Garcia S, Combalia A, Puig de la Bellacasa J, Segur JM. Scalpel blades used in 115 operations were studied bacteriologically . In each case the knife used for skin incision was discarded immediately after the incision and a fresh knife was used to complete the operation . The scalpel blades were cultured in enriched thioglycolate and incubated at 37 degrees C . Readings were taken at 24 and 48 h . From positive cultures, colonies were isolated directly in solid media, and the germ was identified using routine tests . Results showed that there was no bacteriological evidence to justify the use of different blades for skin incision and deep dissection. Rev Mal Respir, 1994, 11(3), 271 - 6 {Treatment with clarithromycin of 173 HIV+ patients with disseminated Mycobacterium avium intracellulare infection}; Dautzenberg B et al.; No treatment was established for disseminated M . avium intracellulare (MAC) infection, a common disease of end stage of AIDS . An open study was conducted to assess in 173 AIDS patients, the activity of clarithromycin . Initial bacteriologic eradication from blood was observed in 136/147 evaluable patients (93%) . Acquired resistance to clarithromycin associated with relapse appeared to develop after 2 to 7 months of drug treatment in 31/136 patients with initial success . Early bacteriological relapse was associated with clinical deterioration . Side effects of drug treatment were elevated liver enzymes (26%) and impaired hearing (4%) . Side effects conducted to stop treatment in 14 cases (8%) to modified treatment in 8 cases (5%) . Our study gave new argues for activity of clarithromycin in disseminated MAC infection. Vet Res, 1994, 25(2-3), 213 - 8 Farming practices associated with the 'udder infection' complex; Faye B et al.; A total of 4,129 dairy cows from 47 dairy farms were submitted each year after calving to a milk sampling for bacteriological examination . Six criteria defined the udder infection complex: frequency of minor, major and rare pathogens; rate of clinical and subclinical mastitis; and index of gravity of mastitis . Forty-seven variables described practices and their associations with the type of farms (defined by the above 6 criteria) were studied . The associated variables were dipping practices, covering of the milking parlour, disinfection practices, housing cleanliness and milk production. Vasa, 1994, 23(2), 138 - 44 {(123 I)-anti-NCA95 antibodies in diagnosis of bacterial wound infections after prosthetic vascular replacement . Comparison with computerized tomography}; Venz S et al.; Immunoscintigraphy (IS) with {123I}-anti-NCA95 labelled autologous granulocytes and computer-tomography (CT) examinations were performed in 21 patients with clinical suspicion of a vascular graft infection . The results of both IS and CT were compared with bacteriological and surgical findings . In this study the sensitivity was higher for IS compared with CT (92% and 67%, respectively) . However, specificity was lower in IS compared with CT (89% and 100%, respectively) . No false positive results have been found in CT . False positive results were observed in IS within 30 days after vascular surgery and may be due to a unspecific accumulation of granulocytes in perivascular hematomas . In later infection of a vascular graft (i.e . more than 30 days after surgery) no false positive findings were made by IS . In contrast, CT was false negative in two cases . IS with {125I}-anti-NCA95 labelled autologous granulocytes represents a useful tool for the detection of vascular graft infection, since granulocyte accumulation in infected tissue can be visualized with high sensitivity and specificity. Akush Ginekol (Mosk), 1994, (2), 20 - 3 {The complex diagnosis of certain forms of uterine pathology after labor as the prevention of late puerperal complications}; Usanov VD; Two groups of puerperae, group 1, n = 1000 and group 2, n = 860, were examined on days 3-4 and 5-6 after spontaneous delivery . Echography, hysteroscopy, bacteriological studies, local thermometry, measurements of the level of medium-sized molecules were used to diagnose postpartum endometritis and uterine subinvolution . In group 1 subinvolution of the uterus was diagnosed in 10.5% and postpartum endometritis in 4.8% of puerperae, in group 2 in 11 and 5.1% of examinees, respectively . In group 1 surgical treatment of the uterus was carried out in patients with uterine involution or postpartum endometritis, in group 2 such treatment was administered only to patients with postpartum endometritis on the basis of material substrate . Findings of local thermometry and levels of medium-sized molecules in patients with uterine subinvolution indicate a catabolic trend of metabolic processes . Surgical treatment of the uterus in subinvolution helped reduce the incidence of postpartum complications by 3.4 times. Probl Tuberk, 1994, (4), 27 - 8 {Differential-diagnostic value of detecting L-forms of Mycobacterium tuberculosis}; Golanov VS et al.; A clinical and bacteriological study was made of 144 patients with new-onset pulmonary tuberculosis who had been treated within the first 3-4 weeks in the out- and in-patient settings for non-specific lung disease . Detailed studies found changed variants of the pathogen as L-forms in 28 (19.4%) patients, bacterial forms being undetectable . The paper shows how difficult to diagnose tuberculosis. Arch Virol, 1994, 137(1-2), 69 - 79 Virus production and viral antigen expression in porcine blood monocytes inoculated with pseudorabies virus; Nauwynck HJ et al.; Interactions of pseudorabies virus (PRV) with peripheral blood mononuclear cells (PBMC) were studied . T-lymphocytes, B-lymphocytes and monocytes were selected or depleted from the PBMC fraction by means of several separation techniques . After inoculation with virulent PRV in vitro, the percentage of cells that expressed viral antigens was determined in the different subpopulations by immunofluorescence . The susceptibility of monocytes depended on the method of isolation . When plasma-coated polystyrene culture grade dishes were used, 17 to 26% of the monocytes showed expression of viral antigens . However, PRV antigens were detected in only 2% of the monocytes when the cells had first been labelled with monoclonal antibodies against a monocyte marker and subsequently separated on polystyrene bacteriological Petri disches coated with anti-mouse monoclonal antibodies . In subpopulations of unstimulated T- and B-lymphocytes only 0.4 to 0.7% of the cells were found positive by immunofluorescence . Viral antigens appeared in the cytoplasm and on the cell membrane of monocytes isolated on plasma-coated dishes starting 5 h after inoculation and the expression was found in a maximal number of monocytes, 7 to 8 h after inoculation . The intracellular and extracellular virus progeny titers obtained in monocyte cultures were low, ranging from 10(4.3) to 10(5.2) TClD50 per 10(6) inoculated monocytes . The percentage of inoculated monocytes which produced infectious PRV was 0.1% in two experiments and less than 0.01% in one experiment . The results indicate that although monocytes are the most susceptible subpopulation of unstimulated PBMC to a PRV infection in vitro, replication is clearly restricted . Only a subset of monocytes expresses viral antigens and an even smaller fraction produces infectious virus. Ann Dermatol Venereol, 1994, 121(2), 194 - 6 {Study of erythema nodosum leprosum}; Nguyen VU; Erythema nodosum leprosum usually occurs after specific treatment of lepromatous disease or borderline leprosy but may be observed in patients who have not been treated . It is an immune complex vasculitis . Since it is extremely difficult to identify the histological features and the bacteriological study is often negative, this diagnosis relies on clinical examination . Although many authors emphasize the role of reaction to dapsone, there is no one cause of erythema nodosum leprosum which may be triggered by infections, drugs, treatment errors and stress . As a rational treatment of erythema nodosum leprosum may be quite difficult, the clinician must determine the bacteriological and morphological indexes . Anti-inflammatory and anti-allergic treatment should be used before specific drug therapy which should be started after the acute episode triggering the reaction . Finally long-term follow-up of erythema nodosum leprosum is required to avoid recurrence. Rev Mal Respir, 1994, 11(4), 385 - 91 {Diagnostic and therapeutic strategies in acute pneumopathies in urban practice}; Taytard A et al.; The consensus conference of the French Language Society of Infectious Disease convened at Lille in 1991 stressed the fact that "in the management of pneumonia, neither the clinical features nor the bacteriological information would enable a prediction of the responsible and effective agent with sufficient accuracy" and that antibiotic therapy should be empirical, based on the probabilities linked to the epidemiology and locality . The object of this study was to ascertain the diagnosis and therapeutic attitude of the general practitioner (GP) dealing with an acute infectious pneumonia in a 40 year old adult, previously well without any critical signs, which was the model taken for the consensus conference . One hundred GPs were selected at random from the general medical list in the city of Bordeaux and registered with the local medical council in Gironde . They were invited to answer a questionnaire containing 69 questions . The results were analysed for the two phases of the enquiry . The strategy of first intention and the method of re-evaluating for treatment instituted . Secondly the strategy used when faced with a patient who did not improve with the initial treatment . Eighty eight GPs answered the questionnaire and thus we are able to give the following information: the differential diagnosis was not clearly made between bronchial and pulmonary pathology when faced with a lower respiratory tract infection; two thirds of the GPs had a diagnostic and therapeutic approach which was in agreement with the recommendations of the consensus.(ABSTRACT TRUNCATED AT 250 WORDS) Zentralbl Neurochir, 1994, 55(2), 120 - 4 Reoperation in the management of post-operative disc space infection; Bongartz EB et al.; Post-operative intervertebral disc space infection had been recognised as a clinical entity with its own characteristics . Various treatments have been described . During the last six years 3127 open lumbar intervertebral disc operations were performed of which 15 (0.5%) showed a post-operative discitis . We treated our patients by reoperation of the infected intervertebral disc space . The reason of reoperation consists of acquiring material for bacteriological culture and removing loose fragments . It appears to us that reoperation is facilitating early mobilisation of patients . Also attention is paid to new diagnostic possibilities. Ter Arkh, 1994, 66(12), 74 - 7 {Current aspects in the clinical picture and diagnosis of gluten enteropathy in children}; Rimarchuk GV et al.; Clinical, biochemical, bacteriologic, instrumental and morphological investigations were performed in 52 children with celiac disease (15 patients with the acute phase and 37 ones during incomplete remission proved by clinical and laboratory data) . Incidence of secondary gastroenterological affections presenting as chronic gastroduodenitis, chronic pancreatitis or alterations in the small intestinal mucosa was monitored . Therefore, follow-up of the children with the above diseases was found to be mandatory as was a long-term pathogenetically substantiated treatment with gliadin-free diet. Rev Pneumol Clin, 1994, 50(5), 240 - 6 {Bacteriological diagnosis of tuberculosis}; Truffot-Pernot C et al.; Microscopic examination and culture are still today essential elements of the bacteriological diagnosis of tuberculosis . Microscopic examination of a Ziehl fuchsin or auramine stained specimen allows detection of most strains in less than an hour . Culture on Lowenstein-Jensen medium is more sensitive than the microscopic examination and is required for identification and to measure sensitivity to antibiotics . Mycobacterium colonies, generally the causal agent in tuberculosis, usually grow within 28 days and are easily recognized by their "cauliflower" aspect . The niacin test is used for formal identification . Currently, radiometric respirometry allows detection of M . tuberculosis growth and provides antibiotic sensitivity results more rapidly, usually within 10 days . Use of this technique is however limited because the culture medium contains radioactive carbon . Genetic probes are on the other hand quite easy to use and allow identification of cultured bacteria in only a few hours . After polymerization chain reaction gene amplification, M . tuberculosis strains can be detected directly in the specimen within 2 or 3 hours, but in practice, this method has not become a routine laboratory technique, particularly due to lack of sufficient specificity and sensitivity . No other serologic tests are currently reliable enough for the diagnosis of tuberculosis . For cases with low-count specimens, there still is no reliable "on-the-spot" diagnostic test. Eur J Cardiothorac Surg, 1994, 8(11), 585 - 8 Video-assisted thoracoscopic treatment of pleural empyema . A new therapeutic approach; Striffeler H et al.; Pleural empyema is a disease which is not always recognized . Despite consecutive treatment and antibiotics its mortality rate is still high, especially in older patients with concomitant disease or in the case of delayed treatment . We report our experience with early video-assisted thoracoscopic surgery of pleural empyema in 13 patients, where chest tube drainage had failed . The clinical symptoms of empyema did not exceed 14 days, bacteriologic cultures were positive in 62% . In all patients the fever disappeared within 1 to 5 days (mean 3.5) post-operatively and they remained in hospital for an average of 11.5 days after video-assisted thoracoscopic surgery . Pulmonary function tests 6 months later revealed normal values without a substantial loss of lung volumes . No relapse of empyema occurred. Akush Ginekol (Mosk), 1994, (6), 27 - 30 {Diagnosis of bacterial amnionitis}; Tsvelev IuV et al.; Results of complex clinical laboratory diagnosis of bacterial amnionitis are analyzed . General clinical, bacteriological, cytological, immunological, and pathomorphological methods of investigation were used . The incidence of amnionitis was 29.8% . Changes in the amniotic fluid and fetal membranes, associated with bacterial amnionitis, were revealed . The authors come to a conclusion on the desirability of profound clinical laboratory monitoring of pregnant patients with infectious inflammatory diseases of the genitals, with habitual abortions, and preterm escape of the amniotic fluid. Med Trop (Mars), 1994, 54(3), 231 - 3 {Aspects of sexually transmissible diseases in young children in Burundi: gonorrhea caused by sexual abuse}; Baribwira C et al.; The purpose of this study was to demonstrate the existence of sexually transmitted diseases secondary to sexual abuse inflicted on young infants in Black Africa . A total of 230 files involving infants presenting leucorrhea or urethral discharge were reviewed in Bujumbura (Burundi) to select only cases with bacteriologically documented gonorrhea . A total of 2 such cases were identified during the period from 1987 to 1992 . There were 20 girls and 5 boys with a mean age of 6.4 years . In 4 cases, rape was proven . In 9 cases the contaminator could not be identified, but in 12 cases medical and legal evidence showed that the alleged authors of sexual abuse was a domestic employee at the child's home . These findings indicated that sexual abuse in children is not an uncommon occurrence in Black Africa and often leads to gonorrhea . The consequences of such abuse are aggravated by the epidemic of human immunodeficiency virus . The authors recommend a practical approach that should be taken whenever sexual abuse is suspected in these countries. Probl Tuberk, 1994, (5), 45 - 6 {Identification of cultures of Mycobacteria cultivated using sodium salicylate medium}; Lazovskaia AL et al.; Sodium salicylate test is used in bacteriological practice to distinguish M . tuberculosis and M . bovis from other mycobacterial species . The species of the strains growing in sodium salicylate media are not as a rule identified . This was done using gas chromatography with cultures which had grown in Lowenstein-Jensen media with sodium salicylate and isolated from the patients admitted to the Tuberculous hospital in 1991-1993 . Only 20% of the strains belonged to human mycobacteria, the others were opportunistic or saprophyte mycobacteria (M . avium, M . fortuitum, M . phlei, M . flavescens, M . vaccae, M . smegmatis), some of the cultures were not of the Mycobacterium genus, but belonged to other Actinomycetales . It is evident that with sodium salicylate test one cannot be absolutely sure of Mycobacteria isolation . The strains growing in sodium salicylate medium call for further investigations. Probl Tuberk, 1994, (5), 30 - 2 {Surgical tactics in bilateral destructive pulmonary tuberculosis}; Andrenko AA et al.; 43 patients with pulmonary tuberculosis (mean age 36.8 years) were treated surgically . All the patients had disseminated bilateral disease with destruction . Preoperative bacteriological examination identified M.tuberculosis in 67.5% of the examinees . In two-thirds of them x-ray evidenced total pulmonary lesion . 40 subjects of all surgical patients underwent operation for bilateral fibrous-cavernous tuberculosis with caverns location in the upper lobe or upper lobe and 6 segment . The disease was diagnosed to be 1-3 years in duration . The interventions developed in the Novosibirsk Research Institute of Tuberculosis included: osteoplastic thoracoplasty, resection following osteoplastic thoracoplasty, atypical extrapleural resection with limited thoracoplasty, open treatment of the caverns . The surgery resulted in marked improvement (abacillation, cavernous healing) in 42 patients . Long-term follow-up recorded cure in 41 patients (95.3%). Pneumonol Alergol Pol, 1994, 62(9-10), 456 - 62 {The role of pleural needle biopsy and determination of Carcinoembryonic antigen in pleural fluid for diagnosing the etiology of pleural effusion}; Traczyk K et al.; Results of histopathological and bacteriological examinations of specimens taken in 213 patients with pleurisy by Abrams' needle biopsy of parietal pleura were presented . Malignant cells were found in histological survey of excisions from pleura in 48/128 patients with final diagnosis of cancer (37.5%) . The same examination accompanied by bacteriological survey led to establish proper diagnosis in 41/60 patients with pulmonary tuberculosis (68.3%) . In 31 patients with cancer pleural fluid was searched for concentration of the carcinoembryonic antigen (CEA) . In this group, in 7/19 patients with negative histological results of pleural biopsy CEA concentrations were markedly increased . This finding strongly supported further searching for malignancy in those cases . Finally, the diagnosis was established due to the pleural needle biopsy in 89/213 patients (41.8%). Trop Geogr Med, 1994, 46(5), 275 - 9 Development of a serological test for tuberculosis . Problems and potential; Verbon A; The secreted antigens of 24K and 38K and the hsp of 12K and 16K are valuable as reagents in a serodiagnostic assay for tuberculosis . A combination of the TB72 assay with either the 16K or 24K antigen gives the best sensitivity and specificity . Antigens isolated from mycobacterial cultures are valuable in a serological test . Peptides cannot be used as antigens . The value of antigens obtained with recombinant DNA techniques remains to be determined . In HIV-seronegative patients with TB serodiagnosis is a valuable test both in pulmonary and extrapulmonary TB . Unfortunately, the results in HIV-seropositive patients are rather disappointing . The use of likelihood ratios seems to increase the potential of serodiagnostic assays . The value of serodiagnosis should be judged in context with other diagnostic methods such as direct microscopy, bacteriological culture or skin tests . A serological test is especially valuable in cases where direct microscopy, polymerase chain reaction or skin testing is negative and allows antituberculous therapy to be started before results of culture are known. Langenbecks Arch Chir, 1994, 379(6), 361 - 7 {An intestinal neosphincter attained by circumscribed muscle proliferation . Technical development and functional evaluation in the dog}; Ecker KW et al.; In an experimental study an intestinal neosphincter (INS) was constructed by modifying the principle of the ileocolic nipple-valve anastomosis by means of ultrasonic tissue fragmentation of the contacting serosa of the ileum and the corresponding mucosa of the ileum and colon . The healing of the muscle layers was studied histologically . The function of the INS was investigated in six dogs and compared intraindividually with that of the ileocecal valve and conventional end-to-end anastomosis . Morphologically the neospincters healed within 3 months without major fibrosis . The reference values of the aerobic and anaerobic bacterial counts in the terminal ileum were more than 2 logs lower than in the colon with the normal ileocecal valve, and after ileo-colonic end-to-end-anastomosis bacterial colonization of the terminal ileum was found both qualitatively and quantitatively . Subsequent interposition of the INS led to bacterial clearance of the terminal ileum . The median aerobic bacterial counts were lower by six logs and the an aerobic bacterial counts by 3 logs than in the colon . However, differences were not statistically significant owing to the wide variation in the individual values . Nevertheless, the demonstrable clearance of the terminal ileum could be explained by the orthograde passage with absolutely no stagnation and the relative competence of the INS in resisting retrograde pressure competence . In conclusion, ultrasonic fragmentation of the serosa and mucosa of the bowel allows construction of an INS from three muscle layers, which acts as a bacteriological barrier . Before it is introduced into the clinical setting its integration into the intestinal motility should be evaluated by further studies. Injury, 1994, 25 Suppl 3, S - C8-14 Experience with the pinless fixator in the treatment of fractures of the lower leg; Winkler H et al.; This is a report of the experience we have gathered in the application of the pinless fixator in cases of tibial fracture with soft tissue damage . In the Berufsgenossenschaftlichen Unfallklinik Ludwigshafen (Clinic for Trauma Surgery) 12 diaphyseal fractures of the tibia were stabilized with the pinless fixator in 1991 . In all cases, conversion to an intramedullary nail was intended from the very beginning and was performed in 11 cases . In one case, a conventional external fixator had to be selected instead . The injuries included first and second degree open and closed fractures, mostly from group A of the AO classification . At conversion four bacteriological smear tests from the medullary cavity proved positive . In four cases, transitory peroneal deficiencies were diagnosed . When investigating their cause, it seemed that the present geometry of the pinless arms might be responsible for pressure damage to the soft tissues . Possibly this difficulty could be solved by altering the configuration of these arms . The pinless external fixator has definitely proved its usefulness when later conversion to an intramedullary nail is intended since the final fixation can be performed with the pinless device still in place. Annu Rev Microbiol, 1994, 48, 1 - 24 A charmed life; Magasanik B; Boris Magasanik was born in Kharkoff, Ukraine, on December 19, 1919 . He received his preliminary and secondary education in Vienna, Austria, and studied chemistry at the University of Vienna in 1937 . He continued his studies at City College, New York (BS, 1941) and after one semester of graduate study at Pennsylvania State University, served in the US Army in England and France from 1942-1945 . He obtained his PhD degree in biochemistry from Columbia University in 1948 . A faculty member in the Department of Bacteriology and Immunology at Harvard Medical School from 1951 to 1960, he then continued his career as Professor of Microbiology at MIT where he served as head of the Department from 1967 to 1977 . He became a member of the National Academy of Sciences USA in 1969 and received the Selman A Waksman Award in 1993 . He is currently the Jacques Monod Professor Emeritus at MIT and is the author of over 240 publications dealing with microbial physiology and the regulation of gene expression in bacteria and yeast. Rev Belge Med Dent, 1994, 49(2), 9 - 17 {Bacteriological aspects of periodontal disease}; Sauvetre E; Periodontal diseases are caused by specific bacteria in the periodontal pocket . Despite the vast complexity of the flora on the teeth and the more than 300 types of bacteria that may be found in the mouth, studies have been able to narrow the list of pathogens to a small group of suspected bacteria . It is not clear, however, how much of the destruction of periodontal tissue is caused by the direct effects of the bacteria and how much by indirect effects mediated by the host's reaction to the bacteria. Br J Neurosurg, 1994, 8(4), 447 - 55 The management of cerebellar abscess since the introduction of CT scanning; Brydon HL et al.; Sixteen patients with surgical infection of the posterior fossa are presented . There were 14 patients with cerebellar abscess, one patient with a solitary posterior fossa subdural empyema, and another with a combined cerebellar abscess and subdural empyema . Two of the cerebellar abscess patients also had supratentorial infections . The presenting features, aetiology, radiology and bacteriology are discussed with particular reference to differences in abscess re-accumulation, and outcome between those managed by aspiration and excision . We have been unable to show that either method of treatment is superior to the other . An overall mortality rate of 19% was achieved; however, for those with parenchymal cerebellar abscesses this was reduced to 13% . We conclude that burr hole aspiration with regular CT is a satisfactory method of treatment for cerebellar abscess. Acta Vet Hung, 1994, 42(1), 25 - 33 Bacteriologically confirmed cases of ovine epididymo-orchitis caused by Brucella ovis in Sub-Carpathia; Denes B et al.; During the eradication of Brucella ovis infection from five large breeding ram flocks of Sub-Carpathia (The Ukraine), the genital organs of 55 rams culled because of seropositivity in the agar-gel precipitation (AGP) test and ELISA were subjected to gross pathological, histopathological and bacteriological examination . The results of these examinations, as well as the properties of B . ovis strains isolated for the first time in the region are reported . Thirty-three out of the 55 pairs of epididymides and testicles (60%) showed gross lesions (chronic epididymitis associated with the formation of spermatocele, sperm granuloma or abscess) . From the 55 pairs of epididymides and testicles examined, a total of 26 B . ovis strains were isolated: of them, 24 (92.3%) originated from breeding rams while 2 (7.7%) from ram hoggets kept together with the breeding rams . Seven out of the 26 B . ovis strains (26.9%) were cultured from the epididymides of rams which did not show palpable epididymal and/or testicular lesions . It is emphasized that chronic inflammatory processes were observed in both epididymides even if the clinically palpable epididymo-orchitis occurred unilaterally . Three out of the 26 B . ovis strains were derived from AGP-positive but ELISA-negative, while 5 from ELISA-positive but AGP-negative rams . The remaining B . ovis strains were isolated from the genital organs of rams found seropositive both by the AGP test and by ELISA . The cultural, morphological and most important biochemical properties of the 26 sub-Carpathian B . ovis strains were identical with those of the reference strain designated Weybridge 63/290 (NCTC 10512). Rocz Panstw Zakl Hig, 1994, 45(4), 371 - 8 {Evaluation of water sanitation and hygiene in swimming pools in the town of Biała Podlaska}; Czeczelewski J; The purpose of the study was the characteristic of physico-chemical and bacteriological features of water quality in three swimming pools of standard type accepted for most pools in the country, and it was tried to assess their sanitary-hygienic state in relation to the accepted sanitary standards . The study was carried out in the years 1991-1992 taking water samples from each pool twice in a month during water removal, and once in the whole study during pool filling . The physico-chemical and bacteriological studies were carried out by the methods evolved at the National Institute of Hygiene, and the results were compared with the obligatory standards . It was found that physico-chemical parameters of water quality different only slightly between the tested pools . Most evident differences were observed in chloride concentrations . It was noted that falling free chlorine concentration in a pool was associated with increasing bacterial contamination of water . The degree of bacterial contamination of water in that pool was above the permissible value in 18% of the studied samples . The obtained results point out water quality depends, in the first place, on correct performing of disinfection, which was not always adequate in these pools. Rocz Panstw Zakl Hig, 1994, 45(4), 337 - 46 {The occurrence of keratinolytic fungi in the polluted environment of the Labedy District in Gliwice}; Ulfig K; This study was undertaken to find relationships between the degree of bacteriological contamination with qualitative composition of potentially pathogenic keratinolytic fungal population in soil, sediment and air samples from the Labedy district in Gliwice (Poland) . The examined soil samples were characterized by the predominance of Botryotrichum piluliferum, Chrysosporium anamorph of Arthroderma curreyi, Myceliophthora anamorph of Ctenomyces serratus, Chrysosporium pannicola and Trichphyton ajelloi . These species are typical for keratinolytic mycoflora in moderate climate soils, and their abundance was certainly resulted from the assembly of keratin remains in the soil environment . In the light of the weak bacteriological and mycological differentiation of the examined soil samples, however, it is difficult to determine categorically the extent to which the remains were originated from sewage via soil flooding by sewage or air transportation, or from the local human and animal population . Subsequently, the population of keratinolytic fungi in sediments was found to be clearly dependent of the degree of water contamination with sewage . In badly polluted sediments, Chrysosporium pannicola, Chrysosporium anamorph of Aphanoascus fulvescens, Chrysosporium keratinophilum, Trichophyton ajelloi and Microsporum cookei were prevalent species . Keratinolytic fungi were only a small part of airborne fungal population in sewage bioaerosoles . Geomyces pannorum, a soil species better known by its celullotytic than keratinolytic properties, predominated in air samples . Some pathogenic species, such as Aspergillus flavus, Aureobasidium pullulans, Chrysporium anamorph of Aphanoascus fulvescens, Candida spp., Geotrichum candidum, Microsporum canis, Sporothrix schenckii and Trichosporon beigelii, were recovered in the present study . This confirms that the sewage-contaminated environments in an important storage place of pathogenic fungi, mostly from the opportunistic subgroup. Ann Dermatol Venereol, 1994, 121(8), 550 - 2 {Aseptic adenitis in pyoderma gangrenosum}; Costa I et al.; INTRODUCTION . Extra-cutaneous manifestations of neutrophilic dermatosis are rare . Symptomatic cases are usually multiform and confusing . We report a case with an aseptic lymph node abscess associated with pyoderma gangrenosum . CASE REPORT . A 28-year-old woman with past history of pyoderma gangrenosum was seen for abdominal symptoms and fever related to an epigastric mass . Due to signs indicating abscess formation, surgery was performed and led to total regression of the symptomatology . Recurrence was evidenced 3 months later with skin lesions which were negative on bacteriological examinations . The diagnosis of lymph node manifestations of pyoderma gangrenosum was retained . General corticotherapy was very effective . Relapse occurred again 6 years later and was treated with thalidomide . DISCUSSION . Lymph node involvement has been described in Sneddon-Wilkinson's disease associated with pyoderma gangrenosum . In neutrophilic dermatosis, pulmonary manifestations appear to be the least exceptional of the extra-cutaneous lesions . The pathophysiology has not been elucidated although recent hypotheses suggest that G-CSF could be involved . Corticotherapy is remarkably effective in most cases but thalidomide could be an interesting alternative treatment. Ann Otolaryngol Chir Cervicofac, 1994, 111(5), 292 - 4 {Actinomycosis in otorhinolaryngology . Apropos of a case with localization in the nasal cavity}; Chobaut JC et al.; The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery . Treatment by penicillin and surgical excision gave a good result . Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity . A trauma is often found in the previous history . Diagnosis with tumors and abscess may be difficult . The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain . Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time . The literature is reviewed without finding such a case. Neurochirurgie, 1994, 40(4), 233 - 41 {Prevention of infections of cerebrospinal fluid shunts for hydrocephalus}; Lorenzetti C et al.; Two consecutive series of patients operated for insertion or revision of a shunt for hydrocephalus have been followed for at least 18 months . The series are comparable . The first series (84 cases) did not receive antibiotic prophylaxis, whereas the second series (59 cases) received a unique dose of intravenous Vancomycin immediately before the operation . In the first series (168 operations), there were 18 infections, 8 in the group of 34 children and 10 in the group of 50 adults . In the second series, only one infection happened in the group of 27 adults (41 operations) and none among the 22 children (44 operations) . The difference was significative . Bacteriological samples were taken during these operations . The positive cultures, mostly for sta . epidermidis, were as frequent among the cases of the first series than among those of the second series . The antibiotics are considered effective in protecting the shunting device against contamination during the surgical procedure by germs from the skin of the patient. Arch Anat Cytol Pathol, 1994, 42(6), 289 - 96 {Bacillary angiomatosis related to Rochalimaea quintana . Anatomoclinical and ultrastructural study of cutaneous localizations in AIDS}; Bost F et al.; We report a case of bacillary angiomatosis in a 53-year-old homosexual man with acquired immunodeficiency syndrome (AIDS) . Pathological and bacteriological studies of cutaneous nodules led to the identification of a rickettsia: Rochalimaea quintana . This observation prompted us to relate the clinical presentation of cutaneous and visceral forms of this disease . Histopathological patterns are also considered . They usually consist in a lobular proliferation of capillaries with plump and sometimes epithelioid endothelial cells . Polymorphonuclear cells, histiocytes and necrotic areas may be present . The most characteristic feature is the presence of interstitial, granular and amorphous clusters of bacteria . Diagnostic problems can be raised with Kaposi's angiosarcoma which can be associated with bacillary angiomatosis . Two types of Rochalimaea have so far been isolated in this disease i.e., R . henselae which is the most frequently involved, and R . quintana . The usefulness of making such a diagnosis resides in the sensitivity of bacillary angiomatosis to antibiotics, emphasing the need to carefully look for the presence of bacterial clusters when atypical angioproliferative lesion appears in patients with AIDS. Cell Biophys, 1994, 24-25, 99 - 107 Use of technetium antigranulocyte monoclonal antibody Fab' fragments for the detection of osteomyelitis; Harwood SJ et al.; Accurate early diagnosis of osteomyelitis is critical for optimal clinical management . Conventional radiology (X-rays, CT) and nuclear medicine scans (bone, gallium, and technetium/indium white blood cell {WBC}) have limitations and drawbacks . The monoclonal antibody (MAb) ImmuRAID-MN3 (Immunomedics Inc., Morris Plains, NJ), a 99m-Tc Antigranulocyte Fab' fragment, recognizes a surface glycoprotein NCA-90/95 shared by granulocytes, carcino-embryonic antigen (CEA), and meconium antigen (MA) . Intravenous injection of radiolabeled MAb enables in vivo labeling of human granulocytes and targets infected lesions in the bone and throughout the body . Technetium labeled Fab' fragments rapidly clear the blood pool and high-quality images can be obtained the same day, as early as 1 h postinjection . Results at our institution on 13 patients with clinically suspected osteomyelitis of infected long bones, prostheses, and diabetic foot ulcers were compared with the surgical/bacteriological verification of the presence or absence of infection . The MAb scan showed six true positives, six true negatives, and one false negative (very low grade infection) . The procedure was safe, no clinical or laboratory adverse reactions were encountered . The MAb fragments are markedly less immunogenic than whole IgG, resulting in lower induction of human antimouse antibody (HAMA) titers . No HAMA to this MAb fragment has been detected in 24 patients (data from multiple institutions) . Our preliminary results suggest that 99m-Tc ImmuRAID-MN3 is highly accurate for detection of osteomyelitis . This study is part of an ongoing multiinstitutional project sponsored by Immunomedics, Inc . to evaluate the efficacy and safety of this radiopharmaceutical. Pneumoftiziologia, 1994 Jan-Jun, 43(1-2), 9 - 22 {The incidence of tuberculosis in Romania in 1993}; Corlan E; The situation of tuberculosis in Romania has been progressively deteriorated since 1986 . Using the data from the TB notification forms and demographic data for the number of inhabitants by sex and age groups in various districts in 1993, there have been calculated the main TB epidemiometric indicators for 1993 . TB notification rate in 1993 in Romania (89.4%000) is plotted against values in other countries of the Europe Region WHO in figure 1 and against the mean values for in the six WHO regions in figure 2; the dynamic of the annual values 1991-1994 in the 41 districts of Romania are presented in figure 3 and a comparison of the annual values 1985-1993 in Romania versus other countries with rising values (USA, Denmark and Lithuania) in figure 4 . Data concerning TB notification rate in children (20.7%000 in 1993) and its dynamic during the last 8 years is presented in table II, high values districts in table III, the prevalence of sources in tables IV and the TB mortality (10.1%000 in 1993) and its trend during the last 11 years in table V . A series of 8 annexes presents 1993 data on TB notification number and rate by disease localisation, bacteriologic confirmation and sex, for each of the 41 districts of the country . All data are meant to reveal the magnitude of "TB problem" in Romania, to allow optimisation of the main control actions and planning of the necessary means. Ann Fr Anesth Reanim, 1994, 13(5), 647 - 53 {Value of D(-) lactate determination for the fast diagnosis of meningitis after craniotomy . An initial study}; Salord F et al.; The early diagnosis of postoperative bacterial meningitis (BM) may be difficult . CSF cultures may remain sterile . Clinical features and routine laboratory data often fail to give an evidence . As early antibiotic therapy is essential in such patients, a rapid diagnosis is required . Different authors proposed the D(-) isomer of lactic acid as an early and effective marker of infection in the body fluids (including CSF) . D(-) lactate is produced by bacteriae and fungi; L(+) lactate may be produced also by human tissues in anaerobic situations . We conducted a prospective study in a neurosurgical intensive care unit to evaluate this technique for the diagnosis of meningitis following craniotomy . Fifty-four patients were included, 40 in group A (not infected or infected out of the CNS), 4 in group B (suspected BM), 10 in group C (BM with positive CSF cultures) . No patient suffered from septicemia, haemodynamic or ventilatory instability, nor metabolic disorder . Clinical data, CSF and blood samples (cytology, conventional biochemistry, D(-) and L(+) lactate, bacteriology) were collected at inclusion and, in group B and C patients, at day 2, 5 and at clinical recovery . D(-) lactate measurements were performed with an enzymatic method adaptated from a Boehringer Mannheim kit (for determination in foodstuff) . Statistics were based on the comparison of group A vs C patients . D(-) and L(+) lactate concentrations in the CSF were significantly higher in group C patients, and blood concentrations were similar.(ABSTRACT TRUNCATED AT 250 WORDS) J Fr Ophtalmol, 1994, 17(11), 634 - 9 {Interleukin-6 and other cytokines in the aqueous humor in uveitis and endophthalmitis}; Feys J et al.; We studied aqueous humour and serum level of 4 cytokines during uveitis and endophthalmitis: Interleukin 6, Gamma interferon, tumor necrosis factor and Granulocyte-macrophage colony stimulating factor . High levels of IL-6 were found in aqueous humour during ocular inflammation and infection . This elevation of IL-6 level was more constant and more important in the endophthalmitis group (mean level 2.992 pg/ml) than in the uveitis group (mean level 1.480 pg/ml) . During endophthalmitis no evident relation was found between IL-6 level and clinical course or aspect, or bacteriological results of anterior chamber tapes . In the uveitis group, no relation was found between IL-6 level and clinical aspect or aetiology. Arch Inst Pasteur Madagascar, 1994, 61(2), 81 - 3 {Fatal ichthyosarcotoxism after eating shark meat . Implications of two new marine toxins}; Boisier P et al.; A fish poisoning involving 188 hospitalizations occurred in November 1993, in Manakara, a middle-sized town on the south-east coast of Madagascar, following the ingestion of shark . A single shark was involved in this poisoning and was identified as Carcharinus leucas . There was no unusual characteristic of this shark or its meat . The attack rate was about 100% . First clinical signs appeared within five to ten hours after ingestion . The patients presented neurological symptoms almost exclusively, the most prominent being a constant, severe ataxia . Gastrointestinal troubles, like diarrhoea and vomiting were rare . The overall case-fatality ratio was close to 30% among the 200 poisoned inhabitants . Search for similar poisoning previously reported in this area was negative, and fishermen in Manakara usually eat that kind of shark without mistrust . Bacteriological and chemical origins were eliminated . Two liposoluble toxins were isolated from the shark liver and tentatively named carchatoxin-A and -B respectively . They were distinct from ciguatoxin in chromatographic properties. Med Pregl, 1994, 47(9-10), 362 - 4 {Whipple's disease . Case report}; Golubovic G et al.; This is a case report on a 42 years old patient suffering from Whipple's disease . The patient had characteristic symptoms: high temperature, frequent bowel movement, melanoderma, arthralgia and enlarged lymph nodes . After detailed clinical researches, x-ray and endoscopic examination, bacteriology examination of faeces, absorptional tests, the diagnosis was made thanks to pathohistologic analysis of biopsy samples of the small intestine by light and electron microscopy . The differential diagnostic similarity with AIDS, especially at the early phase of the illness, required excluding HTLV III . We examined the aetiophathogenesis of the illness and discussed the clinical and laboratory presentation of the patient considering contemporary ideas regarding this disease. Ann Trop Paediatr, 1994, 14(1), 25 - 30 Immunodiagnosis of childhood pulmonary and extrapulmonary tuberculosis using Mycobacterium tuberculosis ES antigen by penicillinase ELISA; Bhaskar A et al.; The diagnostic potential for detection of IgG to Mycobacterium tuberculosis excretory secretory (ES) antigen in childhood pulmonary and extrapulmonary tuberculosis was explored . IgG antibody to M . tuberculosis ES antigen was detected by indirect penicillinase ELISA . Twenty (80%) out of 25 pulmonary tuberculosis cases (clinically diagnosed and/or AFB-positive), five of nine tuberculous pleural effusion cases and only six of 69 cases in the control group were positive for IgG antibody to M . tuberculosis ES antigen . All CSF and sera were positive for IgG antibody in 12 cases of clinically diagnosed tuberculous meningitis (TBM) . Out of 35 cases in the control group for TBM, all five cases of pyogenic meningitis but none of the 13 cases of viral encephalitis, five cases of enteric encephalopathy and 12 cases with no CNS infection were positive for anti-tubercular IgG antibody in CSF samples . Only two of them, i.e . one case of pyogenic meningitis and the other with no CNS infection, were positive for antibody in sera . The study demonstrated the potential of this assay in the diagnosis of tuberculosis in children where bacteriological confirmation is very difficult. J Dairy Sci, 1994 Jan, 77(1), 64 - 74 Influence of pulsationless milking on teat canal keratin and mastitis; Capuco AV et al.; Twenty-four Holstein cows, producing at least 21 kg of milk/d, were used in two replicate experiments to determine the effect of presence or absence of pulsation on loss of teat canal keratin during machine milking . Left quarters were milked without pulsation and right quarters were milked with pulsation . On d 0 and 10, keratin was collected from one left and from one right teat canal of each cow prior to milking and from the remaining two teat canals after milking . Milk was collected for assessment of SCC and bacteriological status on d 0 and approximately every 3 d until d 18 . Quantity of keratin recovered before milking on d 10 did not differ between teats milked with or without pulsation, but loss of keratin because of milking was greater from teats milked with pulsation . By d 7, 30% (12 of 43) of quarters milked without pulsation had become infected, but no (0 of 47) quarters milked with pulsation were infected . By d 14 to 16, new infections had increased to 68% (28 of 41) of quarters milked without pulsation and 2% (1 of 43) in quarters milked with pulsation; mean SCC in pulsationless quarters increased sevenfold relative to pulsation quarters . Protein and water content of keratin did not differ because of treatment, and changes in lipid composition were minor . Histological analysis of the teats of 4 cows indicated that the mean diameter of the teat canal, within 2 h after milking, was greater without pulsation than with pulsation (680 vs . 483 microns). Kekkaku, 1994 Jan, 69(1), 7 - 14 {Efficacy of the "Gen-Probe Mycobacterium Tuberculosis Direct Test (MTD)" for detection of Mycobacterium tuberculosis in clinical specimens--comparison between the MTD and the test by culture on Ogawa's egg medium or in the MB Check System}; Aoyagi T et al.; Three or more weeks are usually required for detecting Mycobacterium tuberculosis by the known culture methods, and therefore, the development of a rapid bacteriological diagnostic method for M . tuberculosis has been urgently awaited . Recently, Gen-Probe Inc . has developed the "Gen-Probe Mycobacterium Tuberculosis Direct Test (MTD)", which is based on amplification of the ribosomal RNA (rRNA) of M . tuberculosis in clinical specimens and hybridization of the amplified rRNA with a M . tuberculosis-specific DNA probe, as a rapid direct diagnostic method for tuberculosis . We therefore compared the sensitivity and specificity of the MTD in detecting M . tuberculosis with the culture methods on Ogawa's egg medium and in the MB Check System, using 107 clinical specimens as test material . The results obtained are as follows: 1 . Of the 61 clinical specimens which were negative when cultured on Ogawa's egg medium, 13 (21.3%) were positive for M . tuberculosis using the MTD, and of the 48 clinical specimens which were negative when cultured in the MB Check System, 8 specimens (16.7%) were positive for M . tuberculosis using the MTD . 2 . All of the specimens which yielded growth of M . tuberculosis (identified by the DNA probe) either on Ogawa's egg medium or in the MB Check System, except one, were positive for M . tuberculosis in the MTD . The only one exception was a specimen which was positive for M . tuberculosis in both Ogawa's medium and the MB Check System.(ABSTRACT TRUNCATED AT 250 WORDS) BMJ, 1993 Dec 18-25, 307(6919), 1582 - 4 Multicentre randomised double bind crossover trial on contamination of conventional ties and bow ties in routine obstetric and gynaecological practice; Biljan MM et al.; OBJECTIVE--To assess level of contamination of neckwear worn by gynaecologists and obstetricians during routine working week . DESIGN--Multicentre randomised double blind crossover trial . Participants wore the same conventional ties for three days in one week and bow ties for the same period in second week . SETTING--Two teaching and three district general hospitals in the midlands, Wales, and north England . SUBJECTS--15 registrars and senior registrars . INTERVENTIONS--A swab soaked in sterile saline was taken from specific area on ties at end of first and third working days and sent in transport medium for culture on chocolatised blood and MacConkey agar for 48 hours . MAIN OUTCOME MEASURES--Level of bacteriological growth assessed semiquantitatively (0 for no contamination; for heavy contamination) after swabs had been cultured . At end of study the participants completed a questionnaire to assess their attitude toward wearing different types of necktie . RESULTS--12 doctors (80%) completed the study . Although bow ties were significantly less contaminated at end of first working day (z = -2.354, p = 0.019), this difference was not maintained; there was no difference in level of contamination on third day . Level of contamination did not increase between first and third day of wearing the same garment . One of the 10 doctors who returned the questionnaire found the bow tie very uncomfortable . All participants would consider wearing a bow tie if it proved to be less contaminated than a conventional tie . CONCLUSIONS--Although a significant difference in contamination was established between conventional and bow ties on first day of study, this difference was not confirmed on third day and there is unlikely to be any real association between tie type and bacterial contamination . Because of its negative image and difficulty to tie, the bow tie will probably remain a minority fashion. Br J Surg, 1993 Dec, 80(12), 1579 - 82 Pancreatic necrosis: assessment of outcome related to quality of life and cost of management; Fenton-Lee D et al.; Ten patients with necrotizing pancreatitis admitted consecutively between August 1990 and August 1991 were studied . They comprised eight men and two women of median age 63 (range 29-73) years . One patient died . The median length of hospital stay was 74 (range 40-150) days . The median number of operations and endoscopic procedures performed per patient was 4 (range 2-7) . Investigations performed included multiple bacteriological, radiological, haematological and biochemical tests . The mean cost of management was 18,441 pounds (range 9,296 pounds-33,796 pounds), of which hospitalization accounted for 65 per cent, operations and endoscopic procedures 20 per cent and investigations 16 per cent . Cost-utility analysis demonstrated a mean benefit per patient of 8.55 quality-adjusted life years gained at a cost of 2,157 pounds each . The management of pancreatic necrosis is expensive but justified by the excellent outcome in terms of quality of life. Radiol Med (Torino), 1993 Dec, 86(6), 820 - 5 {Computerized tomography in the study of tuberculosis}; Valentini G et al.; Twenty-five HIV-negative patients with proven tuberculosis were studied; 10 of them had had bacteriologic confirmation, 1 tuberculin conversion, 2 biopsy confirmation and in 12 cases ex juvantibus criteria had been followed . All patients underwent X-ray and CT exams of the chest which were useful for diagnosis, prognosis and treatment in 22/25 patients . CT yielded better results than conventional radiography in the following cases: miliary cases (1 CT-positive case vs no positives at conventional X-rays), cavities (12 CT-positive cases vs 6 at conventional X-rays), bronchogenic spread (10 CT-positive cases vs 7 at conventional X-ray), nodules (4 CT-positive cases vs 2 at conventional X-rays), consolidations (5 CT-positive cases vs 1 at conventional X-rays), adenopathies (10 CT-positive cases vs 7 at conventional X-ray), extrapulmonary lesions (3 CT-positive cases vs no case at conventional X-ray) . In 13 patients with negative sputum CT helped the diagnosis to be made . Chest radiography is currently the major exam for the first approach to tuberculosis . Nonetheless, CT yields valuable information when clinical signs or bacteriologic information are poor. Nippon Rinsho, 1993 Dec, 51(12), 3081 - 6 {Bacteriological status, serotypes, and biotypes of Helicobacter pylori}; Ishii E; To divide H . pylori strains into subgroup for an etiological survey, some attempts have been made to determine serotypes or biotypes . A variety of serogroups was observed with a slide agglutination test between S . aureus sensitized with antisera and cells of H . pylori (Danielson et al, 1988) . Three or more serotypes were obtained by using antisera absorbed with heterogeneous strains (Tanaka et al, 1990) . Furthermore, the possible existence of serological subgroups or subtypes by ELISA was observed (Inouye et al, 1991) . H . pylori strains were biotyped with preformed enzyme profiles (APIZYM) . The strains were predominantly biotype II, and 4 subsets of the organisms were defined on a combination of motility and cytotoxin production, followed by further detailed types (Owen et al, 1991). Genitourin Med, 1993 Dec, 69(6), 431 - 3 Prevalence of syphilis infection in Mozambican women with second trimester miscarriage and women attending antenatal care in second trimester; Lindstrand A et al.; OBJECTIVES--To elucidate whether recent syphilis infection is significantly more prevalent among women with mid-trimester miscarriage than among antenatal care attenders in midtrimester pregnancy . DESIGN--Two categories of pregnant women were compared regarding serological signs of syphilis . Rapid Plasma Reagin (RPR) analyses were done in Mozambique and Veneral Disease Research Laboratory (VDRL) tests in Sweden . In case of RPR and/or VDRL positivity, Treponema pallidum haemagglutination (TPHA) and Captia Syphilis-M were performed . SETTING--A suburban antenatal care clinic and the emergency ward at the Department of Obstetrics and Gynecology at the Central Hospital in Maputo, Mozambique, were studied June-August 1991 . SUBJECTS--Randomly selected women seeking antenatal care in midtrimester pregnancy (N = 202) were compared with 114 women consecutively entering with clinical signs of midtrimester miscarriage . RESULTS--Among antenatal care attenders, 37/202 (18.3%), and among women with midtrimester miscarriage, 37/114 (32.5%), had syphilis confirmed with the Treponema pallidum haemagglutination test (p < 0.01) . Significant titres of IgM antibodies tended to be more prevalent among women with miscarriage (7.0%) than among women attending antenatal care (4.5%), though the difference only approached statistical significance . CONCLUSION--The findings suggest a potential association between syphilis seropositivity and midtrimester miscarriage . Present findings justify more extensive studies to establish whether or not recent syphilis infection is a risk factor for midtrimester miscarriagePIP: During June-August 1991 in Mozambique, obstetricians and bacteriologists compared the results of laboratory tests for Treponema pallidum of 114 women entering Maputo Central Hospital with clinical signs of second trimester spontaneous abortion with those of 202 pregnant women in the second trimester who sought prenatal care at a suburban prenatal clinic (Primeiro de Maio) . They wanted to learn whether a recent syphilis infection was much more common among women with second trimester miscarriage than among pregnant women in the second trimester who seek prenatal case . 4.5% of the prenatal care group and 7% of the miscarriage group had immunoglobulin M (IgM) antibodies, indicating a recent syphilis infection . The difference between the 2 groups was not significant . The Treponema pallidum hemagglutination test detected a higher prevalence of syphilis in the miscarriage group than in the prenatal care group (32.5% vs . 18.3%; p 0.01), however . All but 1 of the seronegative women had normal pregnancy outcomes . 27% of the women with locally diagnosed seroreactive syphilis did not receive treatment . The findings indicate a possible link between syphilis seropositivity and midtrimester spontaneous abortion . Ann Surg, 1993 Dec, 218(6), 748 - 53 Drainage after elective hepatic resection . A randomized trial; Belghiti J et al.; OBJECTIVE: This prospective randomized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection . SUMMARY BACKGROUND DATA: Routine drainage is no longer advocated after several intra-abdominal surgical procedures . METHODS: A series of 81 patients who underwent elective hepatic resection were randomly allocated to either a nondrainage group (n = 39) and a drainage group with closed-suction drainage (n = 42) . Indications for resection were 42 benign lesions and 39 malignant tumors, including 19 with cirrhosis . Major hepatic resection was performed in 25 patients and minor resection, in 56 . All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collections within the first 5 postoperative days . RESULTS: One patient died in each group . Ultrasonography found a significantly higher rate of subphrenic collections in the drainage group compared with the nondrainage group (respectively, 36% vs . 15%, p < 0.05) . These collections were more frequently infected in the drainage group (n = 6) than in the nondrainage group (n = 2) . After major liver resection, the rate of intra-abdominal postoperative complications (i.e., subphrenic fluid collections, hematomas, and bilomas) was similar between the two groups . CONCLUSIONS: Minor liver resection is safer without drainage . Major liver resection can be performed with or without abdominal drainage. J Am Geriatr Soc, 1993 Dec, 41(12), 1301 - 4 Serum erythropoietin levels in elderly inpatients with anemia of chronic disorders and iron deficiency anemia; Joosten E et al.; OBJECTIVE: To analyze the relationship between serum erythropoietin levels and hemoglobin levels in elderly patients with anemia of chronic disorders related to cancer or acute infection when compared with anemic patients with iron deficiency . DESIGN: Prospective survey with comparison groups . SETTING: Tertiary care center . PATIENTS: An elderly group aged 70 and above (mean 84, range 70-96) was divided into subgroups of 45 with anemia of chronic disorders (23 with cancer and 22 with acute infection), 24 with iron-deficiency anemia, and 27 with no anemia . Thirty non-anemic younger adults were also studied . MEASUREMENTS: Serum erythropoietin (radioimmunoassay), complete blood count, serum iron, B12, folate and ferritin, liver and kidney function tests, blood gas analyses, and bacteriological and radiological tests . RESULTS: The serum erythropoietin levels were significantly lower in the elderly non-anemic hospitalized group than in the healthy younger group . A significant negative relationship between the log serum erythropoietin and hemoglobin levels was found in patients with iron deficiency, but not in the other groups . For any given hemoglobin level, the response of erythropoietin was significantly higher in anemic patients with iron deficiency when compared with the neoplastic and infectious group . CONCLUSION: Erythropoietin response to anemia is blunted in elderly patients with anemia of chronic disorders related to cancer or acute infection . Erythropoietin level is lower in non-anemic elderly inpatients than in healthy younger persons. J Chemother, 1993 Dec, 5(6), 526 - 8 Brodimoprim in maxillary sinusitis; Munzel MA; Recent studies on bacteriological findings in chronic maxillary sinusitis show a great variety of aerobic as well as anaerobic germs . For these reasons adequate chemotherapy has to support the necessary surgical procedure . In this study, the author reports about 60 adult patients suffering from chronic maxillary sinusitis . All of them had to undergo surgical treatment by the Caldwell-Luc procedure . Postoperatively, 30 of them were treated with brodimoprim, the others with doxycycline for 7 days . Bacteriological investigations have been performed during and at several days after surgery . At the same time, a number of laboratory data and the complications observed were registered . In this way, a comparative study of the two antibiotic drugs concerning the therapy of chronic maxillary sinusitis was established. Pathol Biol (Paris), 1993 Dec, 41(10), 927 - 30 {Estimation with bacteriology of the evolution of nosocomial infections between 1989 and 1991 in an university hospital}; Feldmann L et al.; The bacteriological laboratory data base was studied with an original software (Bacterio) and an appropriate method ("doubles" and early samples are not taken in account) to estimate the nosocomial infections . The incidence rates for 100 hospitalizations at the University hospital of Nancy are 9.2, 8.2 et 8.2 for respectively 1989, 90 et 91 . These values are corrected while taking into account a method's sensibility of 65% . The 1000 days of hospitalization's rates allow a better comparison between the medical departments . For the whole hospital, the results are respectively of 7.9, 7.2 and 7.5% . Even if the many bias described cannot always been checked, the method gives some evolutivity indicators which are very useful for the hygienists. Oral Microbiol Immunol, 1993 Dec, 8(6), 361 - 9 Factors influencing the growth and viability of Actinobacillus actinomycetemcomitans; Sreenivasan PK et al.; The metabolic requirements for the routine growth of Actinobacillus actinomycetemcomitans were investigated by the addition of nutrients to conventional bacteriological and tissue culture media . Commonly used tissue culture media required fetal bovine serum as an additive to sustain bacterial growth rates comparable to those obtained with bacteriological media . The addition of increasing concentrations of yeast extract to bacteriological medium increased the growth rate of several A . actinomycetemcomitans strains . In an attempt to identify the components of yeast extract that enhanced the growth of A . actinomycetemcomitans, a number of vitamins, essential and non-essential amino acids were tested for their role in promoting growth . The addition of L-cystine resulted in bacterial growth rates comparable to those with yeast extract . Thiamine increased the growth of several A . actinomycetemcomitans strains but did not result in growth rates comparable to those with yeast extract . The addition of physiological concentrations of steroid hormones to bacteriological medium enhanced the growth of A . actinomycetemcomitans . Additional iron compounds and fat-soluble vitamins had no influence on A . actinomycetemcomitans growth . However, the requirement of iron for bacterial growth remains unclear . The optimal pH range for growth of A . actinomycetemcomitans was between pH 7.0-8.0 in a medium containing 0.5-1% NaCl . Several interesting observations on the viability of A . actinomycetemcomitans were made . A rapid reduction of A . actinomycetemcomitans viability occurred following suspension in distilled water . The presence of the detergent Triton X-100 at concentrations above 2% (v/v) also decreased the viability of A . actinomycetemcomitans within 10 min. Pneumologie, 1993 Dec, 47(12), 670 - 7 {Reliability of bacteriologic diagnosis of tuberculosis . Results of external quality control 1991-1992}; Kuchler R; A report on the results of three proficiency-tests is presented . They were performed to test the efficiency of mycobacteriological laboratories . The incidence of false test-results varied between samples from 2 to 20% . In each survey between 10 and 20% of the participating laboratories arrived at unacceptably poor total assessments . The proportion of institutes where lack of expert competence can be suspected due to repeated failure in external quality tests, was between 3% (microscopy) and 13% (differentiation between tuberculosis bacteria and environmental mycobacteria) . Reproducibility of good and poor total assessments in more than 80% of the laboratories indicates even if a laboratory participates in a survey only once, this will already supply quite reliable information on the efficiency of that laboratory . Even though many laboratories with poor performance in surveys try to improve their standards on their own, it is evident from the large number of institutes with repeated poor results, as well as from the irregular participation by many institutes in external quality tests, that external quality assurance of bacterio-logical tuberculosis diagnostics cannot be achieved by proficiency tests alone . Since the provisions of the Federal law on epidemics do not bestow sufficient legal competence on the health authorities in respect of control of the laboratories, and also because eventual sanctions imposed by the sickness insurance bodies cannot be effective in all cases, it is at present imperative that treating physicians take particularly great interest in the efficiency of the laboratories commissioned by them, for their patients' sake. Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Dec, 31(12), 1507 - 14 {Clinical features of pulmonary Mycobacterium kansasii infection: comparison with M . tuberculosis and M . avium complex infection}; Matsushita Y et al.; Six cases of pulmonary M . kansasii infection were studied . The ages of the patients ranged from 26 to 51, with a mean of 39.6 years . All the patients were male . None had any underlying systemic or lung diseases . On chest X-ray and CT scan, the majority of cases showed a solitary thin-walled cavitary lesion with little satellite or scattered lesions, which were predominantly located in S1 or S2 . The strains of M . kansasii isolated from the 6 patients showed a certain pattern of antibiotic sensitivity being highly sensitive to TH, CS, EB and RFP . In 5 out of the 6 patients, chemotherapy with RFP combined with 2 or 3 other antituberculous drugs for 12 months was successful . In another patient, chemotherapy with RFP, EB and INH for 12 months was unsuccessful and surgical resection was required . Comparison of patients with M . kansasii (n = 6), M . tuberculosis (n = 112) and M . avium complex infection (n = 51) revealed that the former two had some common clinical features: predominance in males, younger age than the patients with M . avium complex infection, predominant involvement of S1, S2 and S6, and involving a single rather than multiple lung lobes . Even in cases clinically suspected of having M . tuberculosis infection, bacteriological examination should be carried out routinely to rule out M . kansasii infection. J Epidemiol Community Health, 1993 Dec, 47(6), 464 - 8 Health effects of attending a public swimming pool: follow up of a cohort of pupils in Paris; Momas I et al.; OBJECTIVES--This study aimed to determine the health effects of attending a well-kept school swimming pool maintained according to French public health regulations . METHODS--This prospective month long study was carried out on a randomised sample of pupils aged 5 to 18 years who attended a private French school with two swimming pools . The children surveyed, helped by their parents, had to fill in questionnaires about their bathing habits and symptoms during the survey period . Inspections of the pool complex were made and these included physicochemical and bacteriological analyses of the pools' water . PARTICIPATION--The response rates achieved were 70% at primary and middle school levels but only 25% in the high school pupils . Because of this older teenagers were excluded from the final analysis (of 246 children) . RESULTS--Compared with non-bathers, bathers experienced fatigue and eye irritation significantly more often (p < 0.001) . The eyes were red (38% of bathers) and/or watery (16%) after swimming but this resolved spontaneously within 24 hours . Bathing behaviour (bath duration, head immersion, wearing swimming goggles) did not affect these incidence rates noticeably . There were no differences between bathers and non-bathers with regard to other symptoms, especially otolaryngological ones . This survey does not allow definite conclusions to be made about verrucas because 22% of non-bathers were exempted from swimming because of verrucas that they might have caught previously in a pool . CONCLUSIONS--Except for verrucas, the methodology was adequate and daily self reporting of symptoms was feasible . This college largely recruits pupils from higher social classes and is not therefore representative of schools in Paris. Hepatogastroenterology, 1993 Dec, 40(6), 563 - 8 Surgical strategies in acute pancreatitis; Buchler M et al.; The most important diagnostic step in the management of patients with acute pancreatitis is to discriminate between interstitial-edematous and necrotizing pancreatitis . Measurement of C-reactive protein or PMN-elastase is useful in detecting the necrotizing course of acute pancreatitis . While patients with acute edematous pancreatitis can be treated on a regular ward, patients with a necrotizing course should be treated in the ICU . Surgical decision-making in necrotizing pancreatitis should be based on the extent of necroses found by contrast-enhanced CT, and on the development of septic signs due to bacterial infection of the necroses . Information about the latter can be obtained by a bedside ultrasound-guided fine needle aspiration and bacteriological examination of the aspirate . Patients with no organic complications and with focal necrosis should be treated conservatively, while patients with persistent organic insufficiencies or progressive multiple organ failure despite maximum intensive care are candidates for surgical therapy . The procedure of choice in necrotizing pancreatitis is the careful removal of necrotic tissue (necrosectomy) followed and supplemented by a postoperative regimen for the continuous evacuation of further necrotic debris . Hospital mortality rate has been reduced to less than 20% by this procedure. Hepatogastroenterology, 1993 Dec, 40(6), 556 - 62 Indications for surgical treatment of acute pancreatitis; Farthmann EH et al.; The clinical spectrum of acute pancreatitis ranges from mild, self-limiting symptoms to fulminant illness that may rapidly lead to multiple organ failure and death . Differentiation between acute interstitial pancreatitis, necrotizing pancreatitis, pancreatic abscess and acute pseudocyst is mandatory for the choice of surgical treatment . If morphological evaluation by dynamic pancreatography reveals pancreatic or peripancreatic necrosis, bacteriological evaluation by CT-guided fine-needle aspiration is the mainstay of further decision-making, and should be performed if general signs of inflammation are not improved by conservative therapy . Basically, operative treatment may be directed against underlying pathology (e.g . cholelithiasis), or may aim to manage complications . Infected necrosis is the only clear indication for surgery . Whether the choice should be debridement and gravity drainage, continuous closed lavage of the lesser sac, staged relaparotomies, or open packing, depends on the extent of the process and the individual situation . Peripancreatic fluid collections and pancreatic pseudocysts without major ductal pathology rarely need operative treatment in the early stages, whereas abscesses resulting from infected necrosis should be dealt with by surgery rather than by percutaneous drainage. Jpn J Antibiot, 1993 Dec, 46(12), 1114 - 21 {Clinical studies of S-1108, a new oral cephem, in pediatric patients}; Yokoo T et al.; Clinical studies of S-1108, a new oral cephem, in pediatric patients were conducted and results are summarized below . 1) Clinical effects of S-1108 against 18 cases of bacterial infections were excellent in 5 cases, good in 10 cases, fair in 1 case and poor in 2 cases, thus the clinical efficacy rates was 83.3% . 2) Bacteriological effects were evaluated in 16 strains . The elimination rate was 100% . 3) No adverse effects nor abnormal laboratory test results were observed in any of the cases. Gastroenterologist, 1993 Dec, 1(4), 248 - 56 Management of severe acute pancreatitis; Dominguez-Munoz JE et al.; Currently, there is no specific therapy for acute pancreatitis . The management of the disease is supportive in approximately 80% of patients who suffer mild to moderate attacks . The remaining 20% of patients develop one or more major complications and require intensive care . Classification of acute pancreatitis according to severity is, therefore, necessary for proper management . Severe acute pancreatitis is detected early by the determination of circulating levels of polymorphonuclear elastase (PMN-E) and/or C-reactive protein (CRP) . Patients with low levels of both PMN-E and CRP who have no major local or systemic complication of the disease can be classified as having mild acute pancreatitis . These patients require only supportive therapy and basic monitoring of vital functions . Patients with high levels of PMN-E and/or CRP and disease-related complications should be classified as severe . These patients should be managed in an intensive care unit for close monitoring of cardiovascular, respiratory, renal, metabolic, and hematological functions, and for early treatment of complications . Any organic dysfunction needs to be specifically treated . Development of extrapancreatic organ failure is closely related to the extent of pancreatic necrosis . Therefore, contrast-enhanced computed tomography (CT) should be performed in every patient classified as having severe acute pancreatitis . If sepsis develops, fine-needle ultrasound or CT-guided aspiration of necrotic tissue for bacteriological examination should be performed . Infected necrosis and persistent systemic failure under maximal intensive treatment require surgical treatment by necrosectomy and continuous lavage of the lesser sac . Late local complications of acute pancreatitis (i.e., abscesses and persistent pseudocyst) must be drained percutaneously or, more often, surgically. Arch Mal Coeur Vaiss, 1993 Dec, 86(12 Suppl), 1869 - 75 {Surgery in acute bacterial endocarditis . Restraints--possibilities}; Dreyfus G; The limitations and possibilities of surgery in acute infective endocarditis depend on the indication, haemodynamic or bacteriological, the site of infection, aortic or mitral, and whether affecting a native or prosthetic valve . The common possibility of conserving the mitral valve in acute endocarditis is an additional therapeutic option . Similarly, the use of aortic homografts has improved the results in aortic endocarditis . Surgical principles have therefore evolved with conservative mitral valve surgery and "biological" aortic valve replacement . Techniques in prosthetic valve endocarditis have not surgery and earlier extra-anatomical procedures to avoid multiple recurrence with use of homografts or Danielson's technique for the aortic orifice . There have been fewer innovations for recurrent endocarditis on mitral valve prostheses . Irrespective of the site or type of endocarditis, the precocity of surgical treatment is an essential prognostic factor. Int J Artif Organs, 1993 Dec, 16 Suppl 5, 130 - 4 Evaluation of platelet concentrates with the new Dideco blood cell separator: Excel; Schooneman F; The Excel Cell Separator produced by Dideco represents a good compromise between automation and Platelet efficiency . Platelet activation is a phenomenon that we can find with the concentrates of all cell separators . Although, the complement activation of Excel is extremely lower in comparison with the same data obtained using all the other cell separators, the 5-day storage is acceptable . It will be important to research the bacteriological controls . Like the pH of the platelet bags, because in certain cases it was too low . For the future it will be interesting to study the possibility to predict the quantity of platelets collected having a system that is adaptable with the donor parameters. J Heart Lung Transplant, 1993 Nov-Dec, 12(6 Pt 1), 924 - 7 Tuberculosis in transplanted lungs; Dromer C et al.; Over a 4-year period in four of 61 patients (6.5%) who survived lung transplantation, pulmonary tuberculosis developed at a mean of 7.5 months (range 3 to 13 months) after operation . Clinical and radiologic features were atypical . Definitive bacteriologic diagnosis, which was established on bronchial, sputum, and pleural fluid samples, may be delayed by the concomitant presence of other infective organisms and the necessity for repeated sampling . All patients were treated successfully with antituberculous chemotherapy, but one patient also required lobectomy . At a mean follow-up of 2.25 years (range, 1 to 3 years), three patients are free of active disease, and one patient had a recurrence at 2 years . Tuberculosis in transplanted lungs is an uncommon but serious infection that may elude diagnosis but respond well to treatment. Jpn J Antibiot, 1993 Nov, 46(11), 1030 - 4 {Clinical study on S-1108 in treatment of pediatric infections}; Kubota M et al.; To evaluate the efficacy, the safety and the usefulness of a novel and esterified cephem antibiotic for oral use, S-1108, in pediatric infections, a clinical trial was performed . The study subjects were 15 patients including 9 with acute pharyngitis, 1 with acute tonsillitis, 2 with acute bronchitis, 1 with chronic pyelonephritis, 1 with acute abscess of the skin and 1 with impetigo contagiosa . S-1108 was administered orally at a dose of 3.7 mg/kg to 12.5 mg/kg t.i.d . for 4 to 9 days . Clinical effects were excellent in 7 cases, good in 6, fair in 1 and poor in 1 . The Overall efficacy rate was 86.7% . Bacteriologically, causative organisms were all eradicated in evaluable 4 cases . As to side effects, diarrhea was observed in 2 cases . No abnormal laboratory test values were obtained. Respir Med, 1993 Nov, 87(8), 621 - 3 Six months versus nine months chemotherapy for tuberculosis of lymph nodes: final results; Campbell IA et al.; Of 199 patients treated for peripheral lymph node tuberculosis, 157 completed treatment as planned . Fifty received E2H9R9, 56 Z2 H9R9 and 51 Z2H6R6 regimens (E = Ethambutol; H = Isoniazid; R = Rifampicin; Z = pyrazinamide: numbers denote duration of therapy in months) . In follow-up from 9 to 30 months, there were no significant differences between the regimens in enlargement of existing nodes, development of new glands or sinuses, in the need for new operative procedures, or in the percentage with measurable nodes at 30 months . Nine patients were felt to have had a clinical relapse (4 E2H9R9; 2 Z2H9R9; 3 Z2H6R6) although this was not confirmed bacteriologically in the five cases where material was sent for culture . These differences were not statistically different . The 6 month Z2H6R6 regimen performs just as well as the 9 month regimens Z2H9R9 and E2H9R9 in patients with fully sensitive organisms, and has the additional benefits of convenience and reduced cost. Eur J Nucl Med, 1993 Nov, 20(11), 1078 - 83 Use of immunoscintigraphy in the diagnosis of fever of unknown origin; Becker W et al.; Fever of unknown origin (FUO) has been defined as an elevation in temperature (38 degrees C) for at least 2-3 weeks despite intensive investigation . The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO . Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up . In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found . No cause for fever could be found in 11% . The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively . The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52% . False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm . If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95% . This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis. Berl Munch Tierarztl Wochenschr, 1993 Nov, 106(11), 361 - 4 {Abortions in a lower Austrian sheep facility caused by Coxiella burnetii}; Damoser J et al.; In a flock of sheep the causal connection between abortions and the infection with Coxiella burnetii is demonstrated serologically, bacteriologically and by pathological examination . In order to identify C . burnetii as causing agent in case of abortions the submission of placental parts in addition to the fetus, in combination with a serological control of the flock, is recommended . To check the seroprevalence of C . burnetii in the region concerned random blood samples of 12 flocks were taken and analysed by CFT . At least 10 samples per herd, taken from animals more than 1 year old, were examined . Positive titers were found in 5.6% of the checked animals which originated from 6 different flocks . Health risks of different groups of the human population are being discussed. J Bone Joint Surg Br, 1993 Nov, 75(6), 904 - 13 Massive allografts sterilised by irradiation . Clinical results; Hernigou P et al.; From 1984 to 1988 we implanted 127 massive allografts irradiated with a dose of 25,000 grays . These were reviewed at a minimum follow-up of three years to determine the effect of irradiation on infection, the complications and the functional result . No bacteriological infection was seen in the 44 patients who had allografts for revision of joint arthroplasty or for a tumour with no adjuvant therapy . For the 83 patients who also had chemotherapy or radiotherapy or both for a bone tumour, the rate of infection was 13% . The major mechanical complications were nonunion in seven grafts (5.5%) and fracture in eight (6%) . These rates do not differ greatly from those reported for non-irradiated grafts . Our results suggest that irradiation, which remains the most convenient and acceptable method of sterilisation, does not jeopardize the clinical results. Chest, 1993 Nov, 104(5), 1541 - 7 Cardiopulmonary effects of bronchoalveolar lavage in critically ill patients; Montravers P et al.; Bronchoalveolar lavage (BAL) has been proposed as a useful procedure for bacteriologic diagnosis of lower respiratory tract infection in mechanically ventilated patients . To determine the cardiopulmonary effects of this procedure and to identify the patients at risk of poor tolerance, 30 critically ill ventilated patients suspected of having pneumonia were studied . Hemodynamic and gas exchange parameters were continuously recorded using an arterial catheter, a Swan-Ganz catheter with SvO2 display, and a pulse oximeter . In addition to the basal sedation required by these patients, midazolam, 0.1 mg/kg intravenously, was administered 5 min prior to bronchoscopy . A moderate increase (10 percent from basal values) in heart rate, mean arterial pressure, and cardiac index was recorded at each measurement during the procedure . A marked decrease in PaO2 was observed during bronchoscopy associated with an increase in oxygen consumption . Maximal changes in SaO2 and SvO2 were recorded at the end of BAL . Two hours after the end of BAL, PaO2 values were still 20 percent lower than pre-BAL values in 40 percent of the patients . We conclude that BAL can be performed safely in most critically ill ventilated patients who have stable hemodynamic and ventilatory parameters . However, none of the recorded parameters allows identification of the patients at risk of poor tolerance of the procedure. J Antimicrob Chemother, 1993 Nov, 32 Suppl B, 195 - 204 Randomized comparative study of cefepime and cefotaxime in the treatment of acute obstetric and gynaecological infections; Newton ER et al.; Patients with presumed acute gynaecological infections were randomized (2:1) to receive cefepime 2 g every 12 h (n = 159) or cefotaxime 2 g every 8 h (n = 72), both im or by a 30-min i.v . infusion . For evaluation of efficacy, patients were required to have a bacteriologically documented infection, with at least one pathogen isolated susceptible to both drugs . Duration of treatment was 2-8 days in the 95 cefepime-treated patients and 3-10 days in the 36 cefotaxime-treated patients with evaluable infections; approximately three-quarters of the patients in each group were treated for 4-5 days . Clinical response was satisfactory in 81/95 (85%) of the evaluable cefepime recipients and 30/36 (83%) of the evaluable cefotaxime recipients (P = 0.802) . In total, 211 (85%) of the 247 pathogens isolated from evaluable cefepime recipients were eradicated, compared with 98 (90%) of 109 pathogens isolated from evaluable cefotaxime recipients . All pathogens were eradicated in 77 (81%) cefepime-treated patients and in 31 (86%) cefotaxime-treated patients (P = 0.379) . Overall response to treatment, calculated by combining clinical response and individual patient bacteriological response, was considered effective, partially effective or ineffective in 77%, 13% and 11% of cefepime-treated patients respectively and in 75%, 19% and 6% of cefotaxime-treated patients respectively (P = 0.932 for effective response) . Adverse clinical events were reported by 68 (43%) of 159 cefepime recipients and by 26 (36%) of 72 cefotaxime recipients (P = 0.342); adverse events were deemed drug-related in 6% of cefepime recipients (diarrhoea, rash and headache) and in 1% of cefotaxime recipients (diarrhoea, pruritus and rash) . Treatment was discontinued prematurely due to adverse events in five cefepime-treated patients and in one cefotaxime-treated patient (P = 0.476) . Local intolerance was reported by 33 (21%) of the 159 cefepime-treated patients and by 14 (19%) of the 72 cefotaxime-treated patients receiving drug via the iv route alone; none of the patients discontinued treatment because of local intolerance . Laboratory test abnormalities were observed in a small number of patients in each group (1-8%), but none warranted discontinuation of treatment . Cefepime 2 g bd appears to have efficacy and safety comparable to that of cefotaxime 2 g tid in the treatment of acute obstetric and gynaecological infections. Minerva Pediatr, 1993 Nov, 45(11), 453 - 7 {Vulvo-vaginitis in pediatric age}; Beolchi S et al.; In pediatric gynecology, inflammatory vulvo-vaginitis are very common . Their diagnosis cannot be based either on the symptoms (itching or pain) or on the signs (leucoxanthorrhea) for these classifications are "non-specific" . At the Consulting Room of pediatric gynecology of the Vittore Buzzi Hospital, 215 "non-specific" vulvo-vaginitis cases have been analyzed through bacteriological and microscopical examinations of vaginal secretions . The vaginal tampon resulted negative in 53% of the cases and positive in the remaining 47% . Comparing these results with microscopical examinations we obtain: 81.8% of sensibility, 77.4% of specificity, 87.8% of negative predictive value and 62.2% of positive predictive value . In particular, this last figure is influenced by the high number of false positives of the vaginal tampons, due to the growth "in vitro" of opportunist germs momentarily quiescent "in vivo" . Thus it is useful to associated the microscopical examination (that will indicate all the cases in need of treatment) and the bacteriological examination (that will indicate the right cure). Zentralbl Hyg Umweltmed, 1993 Nov, 195(1), 37 - 45 {Microbial contamination of wash water in automatic washing and disinfection machines}; Kolch A et al.; Samples were taken from the water containing tube system of 7 cleaning and disinfection machines located at the university clinics . The machines were used for the treatment of medical tools . The samples were bacteriologically examined . The results showed systemic contaminations of the tubes of all tested machines . The well known positive effect of common ion-exchangers on bacterial growth was not the only reason for the high degree of microbial contaminations . Partial bacterial growth on the inner sides of the water tubes was detected . The reason was the use of bacteriological objectionable tube materials . Recontamination of the post treated medical tools is possible at any time by the last washing water . Preceding sterile filtration showed as supposed no effect . Consequences for the use of cleaning and disinfection machines are discussed. Vet Surg, 1993 Nov-Dec, 22(6), 508 - 14 Endoscopic examination and treatment of paranasal sinus disease in 16 horses; Ruggles AJ et al.; Sixteen horses with suspected paranasal sinus disease had endoscopic examination of the paranasal sinuses with a 4.0 mm arthroscope either while standing and sedated (14 horses) or under general anesthesia (two horses) . Endoscopic diagnosis included sinusitis (four horses), sinus cyst (three horses), hemorrhage (three horses), neoplasia (three horses), and tooth root abnormalities (two horses) . No abnormalities were detected in one horse . Endoscopic findings concurred with the radiographic findings in 13 horses (81%) . Samples of sinus contents for bacteriologic (eight horses) and histologic examinations (five horses) were obtained using sinus endoscopy . Diagnostic sinus endoscopy was combined with debridement, lavage, and suction as a therapeutic technique in 10 horses . In three horses, sinus exploration was performed after diagnostic endoscopy confirmed sinus disease, whereas in three horses, further therapy was not recommended after sinus endoscopy . Clinical signs of sinus disease resolved in 11 horses (69%) overall and in eight of 10 horses (80%) with sinusitis, cyst formation, or hemorrhage using endoscopic techniques alone . Mild, local subcutaneous emphysema occurred at the portal sites in all horses, but healing occurred without additional complications . Iatrogenic damage to sinus structures occurred in one horse . Sinus endoscopy was useful in the diagnosis and management of paranasal sinus disease and avoided the need for exploratory sinusotomy in some horses. Diagn Microbiol Infect Dis, 1993 Nov-Dec, 17(4), 271 - 3 Brucella melitensis growth on Loewenstein-Jensen egg medium from a case of Brucella meningitis; Keness J et al.; Bacteriologic investigation of a cerebrospinal fluid (CSF) specimen for mycobacteria on Lowenstein-Jensen egg medium revealed the presence of Brucella organisms . This coincided with a significant antibody titer against Brucella spp . This is the first documented report of the ability of B . melitensis organisms to grow on Loewenstein-Jensen egg medium. Acta Paediatr, 1993 Nov, 82(11), 987 - 92 Unusual suppurative complications of brucellosis in children; al-Eissa YA; Three cases with suppurative complications of Brucella melitensis infection are presented, demonstrating localized involvement of the brain, bones and lungs, respectively, and the lesions were well defined on radiographic examination . The diagnosis was made on the basis of significant Brucella titres and positive blood culture . Awareness of such complications and performance of the appropriate serological and bacteriological studies will establish the diagnosis and will also differentiate this disease from other infections, especially tuberculosis. Zhonghua Wai Ke Za Zhi, 1993 Nov, 31(11), 650 - 2 {The experience in the treatment of acute necrotic pancreatis}; Sun JB; 24 case patients with acute necrotic pancreatis underwent dynamic CT examination at our