Microbial

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 hospital from 1990, of those patients suspected of pancreatic infection were performed direct bacteriologic sampling by CT-guided percutaneous aspiration . According to CT and bacterial results, we decided to whether operate or not . Meanwhile, multi-organ monitored and support therapy underwent . ANP mortalities reduced from 20.5% to 12.5% . We suggest that the dynamic CT and CT-guided aspiration is a safe, and rapid technique for distinguishing pancreatic infection from severe sterile pancreatitis, and may prove helpful in reducing the high morbidity and mortality associated with pancreatic infection.

Mycoses, 1993 Nov-Dec, 36(11-12), 441 - 4
Two cases of exogenous endophthalmitis due to Fusarium moniliforme and Pseudomonas species as associated aetiological agents; Srdic N et al.; Perforative eye injuries in two patients were complicated by fulminant endophthalmitis . In both patients the cornea was free of micro-organisms . Vitrectomy of the posterior pars plana was performed and the contents of the vitreous body were examined mycologically and bacteriologically . Fusarium moniliforme var . subglutinans and Pseudomonas species were isolated from both patients . Fungal and bacterial organisms penetrated the vitreous body via metal foreign bodies.

Wiad Lek, 1993 Nov, 46(21-22), 801 - 5
{Characteristics of patients with pulmonary tuberculosis}; Wolska-Goszka L; The purpose of the study was presentation of the characteristics of patients treated for various forms of pulmonary tuberculosis at the Chair and Department of Pulmonary Diseases and Tuberculosis Medical Academy in Gdansk in the years 1977-1991 . On the basis of medical documentation the incidence and age distribution were analysed . The proportions of patients with different forms of tuberculosis and the duration of their treatment were calculated . In the selected years 1977, 1982, 1987, 1991 the results of bacteriological investigations confirming the diagnosis were compared . In the light of the obtained data it was found that in the last 15 years there was an increase in the number of patients aged over 50 years . In the years 1990 and 1991 a higher per cent of cases of miliary tuberculosis and caseous pneumonia was found as compared with the years 1977-1978 . Caseous pneumonia was diagnosed in 8.4% of all patients treated for tuberculosis in 1977, while in 1991 this proportion was 14.5% . Positive results of bacteriological examination in 1977 were obtained in 57% of cases, in 1987 in 58.8%, and in 1991 in 35 cases, that is 63.6% of all cases of pulmonary tuberculosis.

Pediatr Neurol, 1993 Nov-Dec, 9(6), 494 - 5
Benign intracranial hypertension in an older child with cystic fibrosis; Lucidi V et al.; Despite having normal height and weight, a 6-year-old girl had frequent bowel movements and slight recurrent chest infections since the age of 4 years and headache for 1 year . The patient appeared healthy, but examination of the ocular fundus revealed papilledema . Cranial computed tomography appeared normal . Lumbar puncture disclosed an elevated opening cerebrospinal fluid pressure, with normal biochemical, cellular, and bacteriologic findings . Laboratory investigations indicated pathologic steatorrhea, elevated electrolytes in 3 sweat tests, and low serum levels of vitamins A and E . The diagnosis of pseudotumor cerebri in a patient with cystic fibrosis was made . After treatment with prednisone (1 mg/kg/day), pancreatic extracts, and vitamin supplements, headache and papilledema resolved and serum vitamin A and E levels subsequently became normal . Older children with cystic fibrosis rarely have benign intracranial hypertension, but when present it is often due to hypervitaminosis during correction of malnutrition . In this child, pseudotumor cerebri and associated hypovitaminosis improved after combined corticosteroid and vitamin treatment.

Orthop Clin North Am, 1993 Oct, 24(4), 743 - 9
Diagnosis of infection and the role of permanent excision arthroplasty; Hamblen DL; The symptoms, signs, and investigation of the infected hip replacement are reviewed . Aspiration, combined with needle biopsy of the interface tissue, gives the best opportunity for establishing a bacteriologic diagnosis . The surgical technique for excision arthroplasty is described, and the complications of this procedure reviewed . The functional results of permanent excision arthroplasty are described in relation to the altered biomechanics of the hip pseudarthrosis.

J Nucl Med, 1993 Oct, 34(10), 1646 - 50
Technetium-99m-nanocolloid scintigraphy in orthopedic infections: a comparison with indium-111-labeled leukocytes; Flivik G et al.; Twenty-three patients with clinically suspected acute or chronic osteomyelitis and 21 patients with suspected joint prosthetic infection underwent scintigraphy using both 99mTc-nanocolloid and 111In-labeled leukocytes . The scintigrams of the two tracers were blindly interpreted by three independent observers . Their evaluations showed high correspondence . Patients were classified as having no infection, probable infection or proven infection according to specific criteria which included results of bacteriological cultures and histopathological examinations . For proven and probable infection taken together, the sensitivity with 99mTc-nanocolloid was 94%, the specificity 84% and the accuracy 87%, compared with 75%, 90% and 85% with 111In-labeled leukocytes . We conclude that 99mTc-nanocolloid scintigraphy is at least equivalent with 111In-leucocyte scintigraphy, and its additional advantages are shorter examination time, less complexity and better radiation dosimetry.

Infect Immun, 1993 Oct, 61(10), 4072 - 8
Virulence of Bordetella bronchiseptica: role of adenylate cyclase-hemolysin; Gueirard P et al.; Bordetella bronchiseptica is a pathogen of laboratory, domestic, and wild animals and sometimes of humans . In the present study some characteristics of the virulence of B . bronchiseptica isolates of different origin were studied . All isolates had similar phenotypes, similar bacteriological characters, and synthesized adenylate cyclase-hemolysin, filamentous hemagglutinin and pertactin but not pertussis toxin . These isolates, however, differed in their ability to express dermonecrotic toxin and to cause a lethal infection, but no correlation was found with the human or animal origin of the isolates . The fact that the most virulent isolate did not express dermonecrotic toxin suggests that this toxin does not play an important role in the virulence of the bacteria in the murine model . After infection with virulent B . bronchiseptica a very early synthesis and a persistence of anti-adenylate cyclase-hemolysin and anti-filamentous hemagglutinin antibodies were observed in the sera of infected mice, suggesting a persistence of the bacteria or of its antigens . B . bronchiseptica adenylate cyclase-hemolysin was purified and was shown to be a major protective antigen against B . bronchiseptica infection . Furthermore, we showed that its immunological and protective properties were different from that of B . pertussis adenylate cyclase-hemolysin, confirming that Bordetella species are immunologically different.

Chest, 1993 Oct, 104(4), 1194 - 8
Controlled trial of ciprofloxacin in short-term chemotherapy for pulmonary tuberculosis; Mohanty KC et al.; The study was undertaken in patients with newly diagnosed bacteriologically positive pulmonary tuberculosis . The patients were randomly allocated to receive one of two regimens . In one of the regimens, patients received 2 months of daily treatment with streptomycin, isoniazid, rifampin, and pyrazinamide (SHRZ) followed by isoniazid plus rifampin for 4 months (4 HR) . In the other regimen, patients received 2 months of daily streptomycin, isoniazid, pyrazinamide, and ciprofloxacin (SHZ Cipro) followed by isoniazid plus ciprofloxacin for 4 months . All patients in the SHRZ/HR regimens and all but one in the SHZ Cipro/H Cipro regimens had a favorable bacteriologic response during chemotherapy . In the patients in the SHZ Cipro/H Cipro regimen, ciprofloxacin was well tolerated during the period of treatment . After chemotherapy, one (5.9 percent) of 17 patients in the SHRZ/HR group and three (16.6 percent) of 18 patients in the SHZ Cipro/H Cipro group relapsed bacteriologically.

Genetika, 1993 Oct, 29(10), 1681 - 4
{Frequent occurrence of BoLA w16 in cows susceptible to mastitis}; Simon M et al.; The association between BoLA class I antigens and mastitis was studied in Boheman Pied breed and its crosses . The mastitis status was followed during two years according to three diagnostic criteria: California Mastitis Test, bacteriological findings and the altered taste of milk . The antigen w16 was found to be significantly associated with susceptibility to mastitis in all diagnostic tests . On the other hand there were some indications that the wll animals were rather resistant to mastitis.

Neth J Med, 1993 Oct, 43(3-4), 147 - 55
Paracentesis . The importance of optimal ascitic fluid analysis; Bac DJ et al.; An accumulation of peritoneal fluid can result from a variety of conditions, cirrhosis of the liver being responsible for about 75% of all patients with ascites . Malignancy accounts for 10-12% and cardiac failure for about 5% . The remaining 8-10% of ascites cases have a variety of causes, including tuberculosis, pancreatic disease and kidney disease . An early and accurate diagnosis often depends on an appropriate ascitic fluid analysis . Patients with known liver cirrhosis and clinical deterioration also need to have a paracentesis, with a determination of the ascitic fluid leukocyte and neutrophil count and adequate bacteriological cultures of their ascitic fluid . The diagnostic value of different ascitic fluid parameters and their ability to distinguish between several aetiologies and their complications, is discussed.

Vaccine, 1993 Oct, 11(13), 1291 - 4
Efficacy of Brucella suis strain 2 vaccine against Brucella ovis in rams; Blasco JM et al.; The protective efficacy against Brucella ovis of live vaccine Brucella suis strain 2 (S2) and Brucella melitensis strain Rev 1 has been evaluated in rams . Fourteen 4-month-old Brucella-free Aragonesa rams were vaccinated conjunctivally with 2 x 10(9) c.f.u . S2 . Sixteen rams of the same breed, condition and age were conjunctivally vaccinated the same day with 1.6 x 10(9) Rev 1 . Thirteen rams were unvaccinated controls . Eight months after vaccination all rams were challenged with 6 x 10(9) c.f.u . B . ovis and slaughtered 2 months thereafter for bacteriological and pathological studies . The percentage of infection in the group vaccinated with Rev 1 (43.7%) was significantly lower (p < 0.05) than that of the S2-vaccinated animals (78.6%) and unvaccinated controls (84.6%) . No significant differences were found when comparing the percentages of infection corresponding to S2-vaccinated and control groups . The degree of infection (percentage of necropsy samples infected) was significantly lower in Rev 1-vaccinated (13%) than in S2-vaccinated (36.9%) or control groups (47.4%) (p < 0.001) . However, no significant differences were found when comparing S2-vaccinated and control groups.

Rev Esp Enferm Dig, 1993 Oct, 84(4), 267 - 9
{Multiple hepatic-splenic abscesses . A favorable result with antibiotic treatment}; Cabezali R et al.; The authors report a case of multiple and spleen pyogenic abscesses caused by Peptostreptococcus spp., in a patient who recently underwent laparotomy due to duodenal perforation . He was successfully treated by means of intensive and extended antibiotherapy . We would like to stress the importance of an early and etiological diagnosis performed by percutaneous puncture and bacteriological study, in order to start a selective antibiotherapy . Other therapeutical possibilities are discussed.

Zentralbl Veterinarmed A, 1993 Oct, 40(8), 569 - 75
The relationship between cycle stage and results of uterine culture in the mare; Waelchli RO et al.; A total of 368 uterine swabs were taken from mares in heat (n = 202) and from mares that were not in heat (n = 166) . From 72 of the mares, two swabs were taken; one during either seasonal anoestrus or dioestrus, and one during oestrus . Swabs were taken during anoestrus/dioestrus in 94 other mares and during oestrus in the remaining 130 mares . Bacteriological cultures were done aerobically and classified as negative, insignificant or significant . There was a trend for more positive cytological specimens during oestrus than during anoestrus/dioestrus . The proportions of significant cultures were 12 of 202 (5.9%) in oestrous mares and 14 of 166 (8.4%) in anoestrous/dioestrus mares . Generally more insignificant than negative cultures were obtained during oestrus compared to anoestrus/dioestrus . Seven of 27 cultures that were classified as significant were associated with positive cytological specimens, and only 2 of 16 specimens that yielded pure cultures of E . coli contained neutrophils . Although the culture results did not differ significantly between the cycle stages, oestrus should be the preferred time for uterine examination.

Can J Vet Res, 1993 Oct, 57(4), 231 - 5
The brucellosis and tuberculosis status of wood bison in the Mackenzie Bison Sanctuary, Northwest Territories, Canada; Tessaro SV et al.; Postmortem examinations were done on 51 wood bison (Bison bison athabascae) killed as part of a multidisciplinary research project in the Mackenzie Bison Sanctuary, Northwest Territories, Canada, between 1986 and 1988 . There was no gross, histological or bacteriological evidence of brucellosis or tuberculosis in these bison . Traumatic lesions were seen in one calf that had been attacked by wolves and a second calf that had been gored . Antibody titers to Brucella abortus were not found in sera from these 51 animals or an additional 112 wood bison that were chemically-immobilized or killed in the Sanctuary between 1986 and 1990 . The combined prevalence of the diseases in the population could not have exceeded 5.95% for the necropsy survey to have missed finding at least one infected animal, and the prevalence of brucellosis in the population would have had to be less than 1.95% for the broader serological survey to have failed to find at least one reactor animal on the battery of tests . These results, and the cumulative epidemiological information on brucellosis and tuberculosis in bison, indicate that bovine brucellosis and tuberculosis are not enzootic in the wood bison population in and around the Mackenzie Bison Sanctuary, and suggest that the population is free of these diseases . However, this expanding population is at risk of contracting both diseases from the infected bison population in and around nearby Wood Buffalo National Park.

Tierarztl Prax, 1993 Oct, 21(5), 417 - 28
{Effects of different methods of tooth resection in suckling piglets}; Hutter S et al.; Epizootic examinations were made on 796 newborn piglets to test the consequences of the resection of a piglet's canine and lateral incisor teeth on its first day of life . As a comparative examination the resection was carried out with side-cutter pliers or with the teeth grinder PIGMATIC 110 . A third group of piglets was not treated . Histological, radiographic and bacteriological examinations were made of 10 piglets--in each case with piglets with the resection with side-cutter pliers or with the teeth grinder . 48% of ground teeth reacted with an inflammation of the pulp . The clipping of the crown of teeth with side-cutter pliers caused pulpitis in 92% of the teeth . Inflammation of the gingiva could almost only be seen around clipped teeth . Splinters only occurred with teeth which had been clipped with side-cutter pliers . Gingivitis and pulpitis extended along the splinters to the bottom of the root . Bites among the litter mates were more frequent in the group of piglets whose teeth had not been treated than in the group of piglets with resected teeth . Compared to the grinding or the clipping of needle teeth, bites to the sow's udder were much more frequent if the resection had been omitted . During the whole period of examination the mortality of piglets was at its lowest in the group of piglets with clipped teeth . The development of grinding instruments for the resection of needle teeth presents a method which reduces the negative consequences of the conventional resection with side-cutter pliers and shows clearly the advantages of resection . In terms of animal welfare, teeth resection is an amputation and therefore every case requires veterinary justification.

Tierarztl Prax, 1993 Oct, 21(5), 391 - 5
{Health and disease in humans and animals over the course of history}; Mayr A; A historical review of the terms health and sickness in human beings and animals . The terms health and sickness have changed from ancient history to the present day and have also been modified . The notions of what life really is, when it starts and when it ends, have contributed to these changes . Historically, health and sickness have generally been interpreted anthropocentrically in the course of time, rarely has the companionship between man and animal been taken into account . A closer look over the past three millennia as to the science of the dynamics of diseases, the humoral pathology and the solidistic pathology, leads to the conclusion that the terms sickness and health have only been understood in general, not in detail . In the last decades of the 19th century and up to the present day an essential change of the notion of sickness was initiated through cellular pathology by R . Virchow (1821-1902) . Eventually, bacteriology, virology, molecular biology and gene technology have established new standards with regard to health and sickness and have paved the way to the present holistic medicine, which is based on science . Sickness is defined as a verifiable divergence from the norm of anatomical, physiological, immunological and psychic conditions of an organism and, accordingly, as a pathological form of being, implying a disturbance of homeostasis . The legal issues such as the federal laws on epidemic diseases of human beings and animals and on insurance are dealt with in conclusion.

Gut, 1993 Oct, 34(10), 1429 - 32
Audit of endoscopic surveillance biopsy specimens in HIV positive patients with gastrointestinal symptoms; Lim SG et al.; An audit of upper gastrointestinal endoscopy in HIV infected patients with gastrointestinal symptoms assessed the frequency of disease detected by endoscopy and routine laboratory analysis of surveillance biopsy specimens . Sixty nine consecutive endoscopies were performed in 59 HIV infected patients . Endoscopic biopsy specimens were taken from the lower oesophagus, gastric antrum, and third part of the duodenum for virology, histopathology, parasitology, bacteriology, and mycobacterial culture . Endoscopic appearances detected disease in 25/59 (42.4%) patients (oesophageal candida, 14; oesophageal ulcer, 3; Kaposi's sarcoma, 4; others, 4), but only 4/43 (9.3%) specimens showed evidence of disease in the absence of endoscopic abnormality . Virology for cytomegalovirus (detection of early antigenic fluorescent foci and culture) was positive in 6/59 (10.2%) patients, but parasitology and mycobacterial culture were negative in all cases . Histopathology was abnormal in 11/52 (21%) oesophageal biopsy specimens, 13/47 (28%) gastric biopsy specimens, and 4/65 (6%) duodenal biopsy specimens . Abnormal findings were found predominantly in those with advanced HIV disease (CDC Stage IV) (21/33 patients (64%)) compared with those with early HIV disease (CDC Stage II) (5/26 (19%)) . In conclusion, upper gastrointestinal endoscopy detects macroscopic disease in AIDS patients and those with low CD4 counts, but routine surveillance biopsy specimens of apparently normal bowel in early HIV disease (or where CD4 counts are greater than 0.2 x 10(9)/1) are of little value.

West Afr J Med, 1993 Oct-Dec, 12(4), 211 - 2
Genital tuberculosis in infertile women in northern Nigeria; Emembolu JO et al.; A bacteriological study of 114 infertile patients in Northern Nigeria revealed a prevalence rate for genital tuberculosis of 16.7% . The low incidence of a past history of pulmonary tuberculosis may relate to a gastro-intestinal sources of the infective organisms, illiteracy and delay in seeking medical advice . The presenting features are indistinguishable from those of chronic pelvic inflammatory disease . Since 94.7% of the patients are young (20 to 35 years of age) and the mean duration of infertility long (8.1 years), despite marriage in childhood, infertile women in this environment should be investigated without delay at an earlier age so as to improve diagnosis and subsequent prognosis.

Med Trop (Mars), 1993 Oct-Dec, 53(4), 527 - 30
{Diagnostic problems apropos of 2 clinical cases of lumbar Pott's disease}; Takongmo S et al.; Two cases of POTT's disease without radiological osteoarticular destructions have been diagnosed from a psoas and a dorsal abscess . Bacteriology and histology were negative at the beginning, then became positive after a long evolution of the wound . The recommendation is to think of POTT's disease when confronted with any paravertebral abscess, with or without radiological signs and to repeat the bacteriological and histological tests if necessary.

Med Trop (Mars), 1993 Oct-Dec, 53(4), 455 - 70
{Developmental aspects of a bilharziasis caused by Schistosoma mansoni}; Mara B; The diagnosis of meningo-radiculitis of unknown etiology was posed on a adult Caucasian male patient, based on clinical and biological symptoms offered since 1991, February (CSF: lymphocytic with hyperproteinosis) . The patient had stayed in different bilharzia endemic zones . Confronted with a lack of improvement, even an aggravation and facing an appearance of a pyramidal symptom of the limbs, mostly at left, with ataxia preventing walking, one admitted the patient several times to do biological and radiological tests . They confirmed the troubles at the level of the CSF, already above mentioned; the MRI showed a hypersignal at the low dorso-lumbar level and at the terminal cone without any sign of tumoral processus, associated to an abnormal contrast at the level of meninges . All of that revealed a significant aspect of a meningo-myelo-radiculitis . In front of the various negative sero-bacteriological, viral, parasitic test, of the unresults of the research of any systemic symptom, one decided to perform a neurosurgical intervention to get a biopsy . So was revealed the presence of ovoid elements PAS+with a lateral spur and parasitic aspect . Consequently the diagnosis of bilharziosis was established . A cure of Praziquantel has been prescribed: 3 tablets/day for 10 days, and four more cures at an interval of one month, all of them associated to a long term corticotherapy . Any diminution of the dosis entailed an increase of the painful symptomatology . Because of the perennial posterior cordal painful symptom, the patient has shown a depressive reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiot Khimioter, 1993 Oct-Nov, 38(10-11), 83 - 5
{The training of clinical microbiology and drug therapy personnel}; Safonov TB et al.; The current data on the training of specialists in bacteriology, clinical bacteriology and chemotherapy in the Russian Academy of Postgraduate Medical Training are presented . The contents of the lecture series and their periodicity are indicated . The prospects of the training of specialists in medical bacteriology in the I.M . Sechenov Moscow Medical Academy are also presented.

J Hosp Infect, 1993 Oct, 25(2), 125 - 31
Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages; Davies JG et al.; Two tests for assessing the virucidal activity of antiseptics are proposed . These involve applying either poliovirus (vaccine strain Sabin 1 an) or Escherichia coli bacteriophage (MS2 or K1-5) to the fingertips . Both test viruses are considered safe although poliovirus may be unacceptably tolerant to antiseptics . The use of bacteriophages as test organisms precludes the need for sophisticated recovery systems and can be undertaken readily by any bacteriology laboratory . The virucidal activity of 70%, 80% and 90% ethanol, 7.5% povidone-iodine, and soap and water was assessed using these tests . Thorough cleansing, followed by disinfection with 90% ethanol, was the most effective treatment . Removal of viruses from the gloved hand was also assessed and this was found to be more easily achieved than cleaning and disinfecting the ungloved hand . Wearing gloves protects the hands from viral contamination but changing them after each patient or contact is expensive.

Dtsch Med Wochenschr, 1993 Sep 17, 118(37), 1321 - 4
{Life-threatening diarrhea in atypical course of legionellosis}; Schulte H et al.; After eating a meal of poultry a 41-year-old man fell ill with severe diarrhoea, persistent high fever of around 39 degrees C, dehydration and somnolence . On admission to hospital physical examination was normal except for signs of dehydration . The blood count showed a leukocytosis (13,300/microliters) with 60% stab-form neutrophils . The erythrocyte sedimentation rate was raised to 49/82 mm . Also increased were the serum concentrations of creatinine (3.5 mg/dl), creatine kinase (179 U/l), lactate dehydrogenase (298 U/l) and C-reactive protein (16.8 mg/dl) . Bacteriological and virological examinations of blood and stool were negative . A normal fluid and electrolyte balance was re-established . But as there was no improvement, ampicillin was administered, 2 g three times daily, then ciprofloxacin, 500 mg two times daily, and finally combined with metronidazole, 500 mg three times daily . Despite this treatment a chest radiograph on the tenth day revealed an infiltration in the left basal lung segment, and the legionella titre became positive at 1:2045 . The antibiotic treatment was changed to 150 mg roxithromycin two times daily . The fever fell within 3 days and the diarrhoea stopped after 5 days . He was discharged free of symptoms after 24 days.

Plant Foods Hum Nutr, 1993 Sep, 44(2), 131 - 6
Chilean hazelnut butter, a new alternative for consumers; Villarroel M et al.; Four formulations of Chilean hazelnut butter were prepared containing Chilean hazelnut paste and 5%, 10%, 15% and 20% margarine . As the level of margarine was increased to 20%, the protein and crude fiber content decreased markedly, while those of moisture, crude fat and calories increased . After 90 days of storage, neither the samples stored at 5 degrees C nor those stored at 15 degrees C showed any objectionable effects both from the bacteriological and chemical point of view . Sensory analyses, including quality and acceptability studies, were performed on the various blends . Flavor, color and taste were improved by the addition of margarine to the butter formulas . It is concluded, therefore, that Chilean hazelnut butter represents a new and interesting alternative for human nourishment.

Surg Gynecol Obstet, 1993 Sep, 177(3), 215 - 22
A fifteen year experience with open drainage for infected pancreatic necrosis; Bradley EL 3rd; Advances in the understanding of the pathophysiologic factors of acute pancreatitis, combined with several recent technologic breakthroughs, have led to the establishment of infected pancreatic necrosis as the most common, the most severe and the most lethal of the infectious complications of acute pancreatitis . In this report, a single institutional experience in the surgical management of infected pancreatic necrosis during a 15 year period is chronicled . Using open drainage with scheduled abdominal re-explorations, the overall mortality rate was 15 percent in 71 consecutive patients with infected pancreatic necrosis . In the most recent 25 instances, sequential re-explorations were performed until retroperitoneal granulation occurred, at which time the abdomen was closed over lesser sac lavage catheters . Compared with the original 46 patients permitted to heal entirely by secondary intention, patients undergoing delayed secondary closure and lavage had a significant decrease during the hospitalization period (48.8 versus 30.1 days; p < 0.05), without a significant change in the mortality rate . In the most recent patients, dynamic pancreatography and fine needle aspiration bacteriologic factors were accurate in the preoperative prediction of pancreatic necrosis and microbial infection in 95 and 97 percent of the patients, respectively . Preoperative endoscopic retrograde cholangiopancreatography demonstrated leakage of contrast material from necrotic pancreatic ducts in seven of eight patients, while postoperative pancreatograms revealed abrupt truncation or other abnormalities in 11 of 13 patients . These observations establish that necrotizing pancreatitis involves pancreatic parenchyma as well as peripancreatic adipose tissue . Open drainage with contingent secondary closure and high volume lavage deserves a place in the management of patients with extensive infected pancreatic necrosis.

Ann Intern Med, 1993 Sep 1, 119(5), 377 - 82
Pathologic changes in the small bowel in nine patients with diarrhea associated with a coccidia-like body; Connor BA et al.; OBJECTIVE: To confirm a suspected small-bowel injury in patients with a syndrome of protracted diarrhea associated with a coccidia-like body (CLB) . DESIGN: Investigation of an epidemic including a case-control study . SETTING: Outpatient clinic in Kathmandu serving primarily the tourist and expatriate community in Nepal . PATIENTS: Nine patients with diarrhea with at least one stool specimen that was positive for the presence of a CLB and seven noninfected volunteer controls . MEASUREMENTS: Clinical data, microscopic examination of stool, bacteriologic and viral studies on submitted stool specimens, upper gastrointestinal endoscopy including duodenal aspiration and microscopy, small-bowel biopsy with subsequent light and electron microscopy . RESULTS: Endoscopic evidence of inflammation of the distal duodenum was present in five of nine patients with CLB and in none of the seven controls . All nine patients with CLB were noted to have histologic evidence of small-bowel injury, which included acute and chronic inflammation, surface epithelial disarray, and varying degrees of villous atrophy and crypt hyperplasia . One of the seven controls had similar pathologic findings and developed CLB-related diarrhea 5 days later . The other controls had normal distal duodenal histologic results . The organism was found in two of nine duodenal aspirates but was not present in the preserved biopsy specimens as determined by light or electron microscopy . CONCLUSIONS: The pathologic basis of CLB-associated diarrhea appears to be small-bowel injury whose cause remains to be elucidated.

Zentralbl Bakteriol, 1993 Sep, 280(1-2), 214 - 20
Helicobacter pylori antibodies in sera of children suffering from chronic abdominal pain; Gosciniak G et al.; 107 pediatric patients aged 9 to 18 with persistent gastric complaints were examined serologically and bacteriologically for Helicobacter pylori . Helicobacter was identified in 48 (45%) of individuals . 51 (48%) of children were found to be seropositive when H . pylori antibodies were detected by the ELISA; 56 (52%) when the passive haemagglutination test was used, and 41 (38%) in the latex agglutination test . 25% of culture-negative patients were found to be seropositive . The percentage of raised H . pylori antibody titres in the control (healthy subjects) varied from 20 to 27%, depending on the method applied.

Zentralbl Bakteriol, 1993 Sep, 280(1-2), 186 - 96
Humoral and cellular immunity in HIV positive and HIV negative Helicobacter pylori infected patients; Benz J et al.; The prevalence of H . pylori associated gastritis seems to be different in HIV positive and HIV negative patients . Therefore a correlation to immunodeficiency can be postulated . The histology of gastritis, status of H . pylori infection and parameters of humoral and cellular immune response were investigated in 41 HIV positive and 47 HIV negative patients, who were subjected to upper endoscopy for the evaluation of gastrointestinal symptoms . In HIV positive patients 37% had active chronic gastritis against 62% of the HIV negative patients . In 73% of HIV positive cases of active chronic gastritis H . pylori was detected by bacteriological culture and/or Warthin-Starry stain . In HIV negative patients active chronic gastritis was always associated to H . pylori infection . Production of antibodies as measured by two commercially available ELISA tests was significant in HIV positive and HIV negative patients; both tests correlated well with H . pylori detection by culture or direct microscopy . Immunoglobulin class specific immunoblots corresponded to the ELISA results in HIV negative patients but to a lesser extent in the HIV positive group which was assumed to be related to unspecific polyclonal activation in these patients . Systemic cellular immunity was investigated by proliferation assays of peripheral blood mononuclear cells (PBMC) . Proliferative response to the unspecific mitogen PHA was reduced in HIV positive patients . A sonicated H . pylori antigen failed to induce lymphocyte proliferation . The antimitogenic effect was also seen in case of coincubation with PHA . This observation was independent of H . pylori and HIV infection status . We conclude that in HIV positive as in HIV negative patients active chronic gastritis is predominantly related to H . pylori infection . The prevalence of H . pylori associated gastritis in HIV positive patients is significantly reduced (p < 0.025) compared to HIV negative controls . Decreased susceptibility to H . pylori infection in HIV positive patients may not be explained by the abnormal reactivity of their humoral or cellular immune response.

Jpn J Antibiot, 1993 Sep, 46(9), 827 - 35
{A clinical study on the efficacy of ceftazidime alone or in combination with aspoxicillin against infections in obstetric and gynecological patients}; Chimura T et al.; We studied clinical effects of ceftazidime (CAZ) alone or in combination with aspoxicillin (ASPC) against various infections in obstetric and gynecological patients . 1 . Obstetric and gynecological patients (n = 91) with various infectious diseases were treated with CAZ alone (1-2 g x 2/day, n = 54) or in combination with ASPC (1-2 g x 2/day, n = 37) administered via drip infusion . 2 . CAZ alone or in combination with ASPC was efficacious in 50 out of 54 (92.6%) or 33 out of 36 (91.7%) patients, respectively . Overall, the efficacy ratios were 46/49 (93.9%) against gynecological infections, 21/25 (84.0%) against perinatal infections and 16/16 (100%) against other infections . The bacteriological efficacy ratio was 21/21 (100%) while clinical effectiveness in cases in which causative agents were known was observed in 20 out of 21 (95.2%) patients . In patients who had not respond to other treatments, CAZ alone, and in combination with ASPC were effective in 15 out of 16 (93.8%) and 6 out of 8 (75.0%) patients, respectively, hence the overall efficacy ratio was 21/24 (87.5%) . 3 . Abnormal values in clinical laboratory tests were obtained in 3 out of 91 (3.3%) patients . No other adverse side effects were observed in any of the patients.

Lepr Rev, 1993 Sep, 64(3), 219 - 26
Reversal reaction in multibacillary leprosy patients following MDT with and without immunotherapy with a candidate for an antileprosy vaccine, Mycobacterium w; Kar HK et al.; Immunotherapy with a candidate for an antileprosy vaccine, Mycobacterium w, was given in addition to standard multidrug therapy (MDT) to 53 multibacillary lepromin negative patients belonging to BB, BL and LL types of leprosy (vaccine group) . An equal control group received MDT and injections of micronized starch as placebo . Both the vaccine and placebo were administered intradermally every 3 months . The patients were evaluated at determined intervals by clinical, bacteriological and histopathological parameters and lepromin testing . Reactional episodes were analysed with reference to incidence, onset, frequency and severity during and after release from treatment (RFT) . Incidence of reversal reaction (RR) was marginally higher in the vaccine group (22.6% vaccine group vs 15% control group) . All cases with a history of downgrading type 1 reaction developed RR during therapy . Most episodes occurred within the 1st year of the commencement of therapy--50% developing within 3 months . Late reversal reaction (after RFT) were observed in 3.8% of cases in both groups, and 50% of the reactors in the control group and 33% in the vaccine group had repeated reactional episodes . Incidence of neuritis associated with RR as well as isolated neuritis was similar in both groups.

Kekkaku, 1993 Sep, 68(9), 597 - 603
{Pulmonary tuberculosis in compromised hosts in pathological view--the present state of mycobacterial disease in autopsy cases in two university hospital}; Nagata N et al.; To clarify the present state of mycobacterial disease in autopsy cases, we reviewed the case records and autopsy data of 3848 cases who died in Kyushu University Hospital between 1976 and 1990, and 1193 cases died in University of Occupational and Environmental Health between 1981 and 1990 . The incidence of mycobacterial disease has significantly decreased during the period examined, and that of active disease was about 1% between 1986 and 1990 . Significantly more cases of fatal mycobacteriosis were received with corticosteroid than those of active but not fatal mycobacteriosis . Antemortem diagnosis of mycobacteriosis was made in 25.9% and 20% of fatal cases in each University Hospital . The possibility of mycobacteriosis was not suspected at all in some cases of fatal mycobacteriosis . Regardless of the suspicion of mycobacterial disease, the diagnosis was not made in other fatal cases, because of the negative bacteriology.

Kekkaku, 1993 Sep, 68(9), 589 - 96
{Lower lung field tuberculosis}; Miyazaki N et al.; Lower lung field tuberculosis has been considered as rare disease, but it was observed about ten percent in the literature . It seemed that the important problems in lower lung field tuberculosis are delay and difficulty of diagnosis . The materials for this report was accumulated over a period of 10 years, from January 1983 to December 1992 at the National Sanatorium Fukuoka-Higashi Hospital . The criteria for lower lung field tuberculosis are: (1) disease confined to lower lobe except for S6a, middle lobe and lingular segment, (2) bacteriologically and/or histologically proved diagnosis of tuberculosis, (3) clinically considered as tuberculosis for which improved by only anti-tuberculous drugs . During this period, 672 new patients suffering from active pulmonary tuberculosis were admitted to the sanatorium . Of the total of 672 patients, 57 patients were selected as the criteria for lower lung field tuberculosis . The incidence of them was 8.5 percent of the total new admissions . Of these 57 patients, 30 were females and 27 males . The mean age of these 57 patients was 59.4 years ranging between 19 and 86 years . The incidence of them obtained through ten years did not show any tendency to increase or decrease . The respiratory and general symtoms most commonly observed were cough and chest pain . The average duration of used for diagnosis of the lower lung field tuberculosis over 65 years old was 71.7 days and it seemed to show the delay and difficulty of diagnosis.

Biomaterials, 1993 Sep, 14(11), 854 - 60
Field-dependent fibroblast orientation on charged surfaces is independent of polarity and adsorbed serum proteins; Kapur R et al.; Electrets were used to induce a dipolar charge on fluorinated ethylene propylene (FEP) and bacteriological grade polystyrene (PS) films . The serum protein surface concentration adsorbed on FEP and PS from cell-free media was dependent on both the magnitude and the polarity of the surface charge density . Chick embryo fibroblasts were cultured on charged and uncharged FEP surfaces, and cellular orientation and biosynthetic activity (protein synthesis) were determined . The orientation of fibroblasts was found to be significantly dependent on the magnitude of the surface charge but independent of its polarity . The biosynthetic activity of fibroblasts was observed to be dependent on both magnitude and polarity of the surface charge density.

Clin Otolaryngol, 1993 Aug, 18(4), 268 - 71
The incidence and role of actinomyces in recurrent acute tonsillitis; Gaffney R et al.; Although actinomyces has been identified in between 1.77% and 37% of resected tonsils its possible role in recurrent acute tonsillitis has received little attention . A histological and bacteriological study of 129 pairs of tonsils from patients with recurrent acute tonsillitis showed actinomyces to be present in 29.5% . The organism, however, was also present in 40% of tonsils from 10 patients with no history of tonsillar disease . In neither of these groups was there any specific evidence of tissue reaction to actinomyces nor was there a male preponderance as in clinical actinomycosis . The presence of actinomyces in the tonsil was not favoured by the concurrence of beta-lactamase producing bacteria . These data indicate that actinomyces does not have a causal role in recurrent acute tonsillitis.

Pediatrics, 1993 Aug, 92(2), 202 - 5
Prevalence of rotavirus on high-risk fomites in day-care facilities; Butz AM et al.; STUDY OBJECTIVE . The objective of this study was to determine the prevalence of rotavirus contamination on environmental surfaces in day-care environments, using the polymerase chain reaction technique . DESIGN . High-risk fomites were identified in two day-care centers and sampled biweekly during a 6-month study period . Water samples from water-play tables in each center were also collected during the study period . During an infectious disease outbreak, fomites were sampled from the rooms in which the outbreak occurred . Reverse transcriptase/polymerase chain reaction was carried out for viral detection of rotavirus from the fomites, and standard bacteriologic measures were used to detect bacteria in samples from water-play tables . RESULTS . A total of 96 fomite samples were tested for presence of rotavirus from the two centers, of which 18/96 (19%) tested positive for rotavirus . The timing of the positive samples differed between the two centers . In the center that housed infants, a peak of rotavirus-positive fomites coincided with two enteric outbreaks . Rotavirus contamination was found on the telephone receiver, drinking fountain, water-play table, and toilet handles in both centers . Bacteria in large quantities were also identified in water-play table samples . CONCLUSIONS . Moist surfaces including the telephone, water fountains, and water-play tables are common sources of rotavirus contamination within the day-care environment . Until a safe and affordable drug or vaccine against rotavirus is available for general use, avoidance of rotaviral infections is the most effective method for the prevention of rotavirus gastroenteritis.

Z Gesamte Inn Med, 1993 Aug, 48(8), 392 - 7
{Tuberculosis--a forgotten disease?}; Wieser O; Statistics show that half of the world population are infected by mycobacterium tuberculosis . However, in third-world countries with the highest mortality rates no statistics are available . In the industrialised countries AIDS leads to a new spread of tbc, particularly with mycobacteria other than tuberculosis (MOT) . Epidemiology, modes of infection, bacteriology, pathology, diagnostics, standards and therapy in selected cases (MOT) are surveyed . This seems necessary from a statistic point of view a general practitioner is contacted only every 5th-12th year by a patient suffering by tuberculosis.

Geburtshilfe Frauenheilkd, 1993 Aug, 53(8), 568 - 73
{Bacterial pathogen colonization of the uterus in puerperium}; Henrich W et al.; In a prospective study the spectrum of bacteriological organisms in the uterus was analysed within the first 3 days post partum . Smears were taken from the ectocervix and from the cavum uteri from 80 asymptomatic puerperae (70 had delivered spontaneously and 10 had had a vaginal-operative delivery) . The smears were achieved using an endometrium catheter with a pilot cap . After the specialised sampling had been undertaken, in 47 of the 70 patients with spontaneous delivery and in 1 of the patients with operative delivery, no bacterial invasion was found in the cavum uteri . After prophylactic administration of antibiotics prenatally, bacterial organisms were found significantly less often (p < 0.05) . On the other hand, intrauterine bacterial organisms were found significantly more frequently in patients who had had cervix priming with PGE2 and where foetal blood analysis had been performed sub partum (p < 0.05) . Contrary to the smears from the cavum uteri, all ectocervical smears were positive . In 13 of 23 cases with positive proof of intrauterine bacterial organisms, a difference was found in the bacteriological spectrum compared with the parallel cervical smear taken . Further obstetrical factors play a role in influencing the bacterial invasion, however, there were no complications in any of the cases due to the smears being taken and no infections were observed during the rest of the lying-in period.

Bol Oficina Sanit Panam, 1993 Aug, 115(2), 103 - 10
{Quality of sputum microscopy in the network of tuberculosis bacteriology laboratories in Colombia}; Leon CI et al.; The objective of this study was to evaluate the technical quality of sputum microscopy carried out for diagnostic purposes in the Network of Tuberculosis Bacteriology Laboratories in Colombia . The National Central Reference Laboratory received 6,529 slides for reexamination from the network of 513 sectional, regional, and local laboratories, which contributed 33.2%, 27.6%, and 39.2%, respectively, of the slides . These included all the positive (3,283) and negative (3,246) smears processed during a 4-month period . The reexamination was carried out by six laboratory workers who did not know the origin of the slides or the original diagnosis . When qualitative problems were detected, a second reexamination was done, which significantly increased the percentage of agreement for both the positive results (93.9%) and the negative (98.7%) . Overall, the level of agreement was 96.3% . A significant correlation was found (P < 0.05) between good slide preparation and staining and agreement in the readings, as well as between thin smears, presence of fuchsin precipitates, and deficient coloration and conflicting readings (P < 0.05) . The highest percentages of agreement were associated with laboratories that performed the largest number of sputum examinations each month (96.5%), and with readings done by experienced, university-trained bacteriologists (96.6%) . It is concluded that indirect technical supervision and ongoing training of laboratory personnel are important determinants of the impact of the tuberculosis control program.

Am J Obstet Gynecol, 1993 Aug, 169(2 Pt 2), 441 - 5
History and review of bacterial vaginosis; Eschenbach DA; OBJECTIVES: Review publications that significantly impacted on the knowledge of bacterial vaginosis . STUDY DESIGN: Assessment of information on the epidemiology, bacteriology, and pathology of bacterial vaginosis . RESULTS: Bacterial vaginosis has a complex microbiology . Further information is required on the epidemiology . The large increase in the concentration of vaginal bacteria among patients with bacterial vaginosis is associated with postpartum and postsurgical infections and with preterm delivery . CONCLUSIONS: Bacterial vaginosis is the most important vaginal infection because of its potential to cause upper genital tract infection in specific settings.

Tuber Lung Dis, 1993 Aug, 74(4), 267 - 72
The impact of intensified supervisory activities on tuberculosis treatment; Jin BW et al.; A Health Subcentre-based randomized controlled trial was conducted in order to determine the importance of the motivation of the tuberculosis personnel in improving the results of a treatment programme . A total of 1300 newly detected tuberculosis patients from 7 Health Centres were divided into study and control groups using the Health Subcentre areas as sampling units . In the study group, worker motivation was intensified through special regular sessions and closer supervision, while in the control group the usual procedures were followed . Treatment performance was remarkably improved in the study areas: treatment completion rate was 78.8% in the study group, compared with 65.2% in the control group . Bacteriological conversions among those having completed the treatment were 91.9% and 62.2% respectively, and overall efficacy was 75.2% and 45.8%, respectively . In addition to improved treatment, the follow-up case examinations also showed markedly increased performance . Although this study was done in facilities using conventional regimens which have been replaced with short-course regimens more recently, the study results still clearly indicate the importance of motivating personnel in the field to attain better case management.

Tuber Lung Dis, 1993 Aug, 74(4), 261 - 6
Intrathoracic paediatric tuberculosis: a report of 202 cases; Pineda PR et al.; Until recently paediatric tuberculosis rates were in decline in developed countries, but more recently there has been a significant change in these trends . Tuberculosis in British Columbia (BC) is centralized and all paediatric cases diagnosed between 1979 and 1988 were reviewed . There were 252 notifications during the study period but 50 cases were excluded (31 extrapulmonary cases, 11 with missing records and 8 because of incorrect diagnoses) . There were 109 (54%) female patients . The age range was 4 months-15 years (6.4 +/- 4.1 years) . 52% were 5 years old or less . 75 (37.1%) were aboriginal Canadians, 61 (30.2%) were Asian, 50 (24.8%) were Caucasian and 16 (8%) were included in miscellaneous or unknown groups . Primary pulmonary disease occurred in 197 (97.5%); the remaining 5 had post-primary disease . A history of close contact was elicited in 158 children (78.2%) . All but 8 (4%) had a positive PPD response to 5TU . 40% of children had symptoms, the most frequent being cough (51%) and fever (28.4%) . Mycobacteriology was carried out in 169 (83.7%) children . Bacteriologic confirmation was achieved in 45 patients (22.2%) . Chest X-rays were reviewed in 186 cases . Lymphadenopathy occurred in 93.5%, with hilar (34%) and combined hilar-paratracheal (26%) being the commonest findings . The majority of patients were treated with isoniazid and rifampin, with a minority receiving streptomycin or pyrazinamide in the initial intensive phase . 14 (6.9%) children had adverse reactions to their drugs but these were rapidly reversed with the withdrawal of the responsible drug . Response to therapy was excellent and there were no deaths.

Antimicrob Agents Chemother, 1993 Aug, 37(8), 1645 - 8
Use of rifabutin in treatment of systemic Mycobacterium paratuberculosis infection in mice; Chiodini RJ et al.; BALB/c mice were infected intraperitoneally with Mycobacterium paratuberculosis and, after allowing the infection to progress for 30 days, were treated with rifabutin at 0, 12.5, 25, and 50 mg/kg of body weight . Rifabutin was administered in drinking water under conditions of water deprivation, whereby the entire daily dose was delivered within a 1-h period . Animals were killed at biweekly intervals from time zero of treatment to 180 days . Spleens and livers from each animal were examined by quantitative bacteriologic culture and histopathology . Restricted water availability was found to be a viable alternative to daily gavage for single-dose bolus administration . Infection, as assessed by bacterial counts, was reduced only in animals that received 50 mg of rifabutin per kg . In these animals, bacterial counts in the liver and spleen were reduced from 7.2 x 10(5) +/- 4.1 x 10(4) and 6.5 x 10(5) +/- 4.1 x 10(4) to 3.0 x 10(3) +/- 1.8 x 10(2) and 3.1 x 10(3) +/- 2.2 x 10(2), respectively, over the 6-month treatment period . Rifabutin may be an appropriate chemotherapeutic drug for long-term treatment of M . paratuberculosis infection and should be considered in any multidrug regimen.

Srp Arh Celok Lek, 1993 Aug-Dec, 121(8-12), 143 - 6
{Miliary tuberculosis of the lungs}; Radosavljevic G et al.; The study concerned 37 adults patients with miliary tuberculosis, who were treated at the Institute for Lung Diseases and Tuberculosis in Belgrade, over the period from 1987 to 1990 . This number of patients is 1.37% of the total number of hospitalized patients with TB . The average age was 51 yrs (21-78) . The sex distribution was equal . Associated diseases and predisposing conditions existed in 28 (76%) patients, most often haematologic diseases, systemic diseases of the connective tissue, and alcoholism . Classical X-ray finding of the lungs was present in 89% of the patients, and poor and atypical in 11% . The accompanying pleural exudation was observed in 13.5% of the patients, smaller cavernae in 5.4%, and enlarged mediastinal lymph nodes in one patient . The diagnosis of miliary TB was bacteriologically or pathohistologically confirmed in 31 (84%) patients, on autopsy in 2 cases and by antituberculotic test in 4 cases . Positive Loewenstein culture media were obtained in 62% of patients, from sputum in 64% of cases, in the liquor in 5.4%, and from the pleural fluid in 2.7% of patients . (BK was found by direct sputum microscopy in 6 pts - 16%) . Positive pathohistological findings was obtained in 18 (49%) patients: by pleural biopsy in 2 cases, lung biopsy in 8 (bronchoscopy in 5 pts, aspiration needle biopsy in 2 pts), and by biopsy of extrathoracic tissues and organs in 8 pts . Early diagnosis was established in 62% patients.

Vet Rec, 1993 Jul 31, 133(5), 119 - 21
A field study of meningoencephalitis in calves with particular reference to analysis of cerebrospinal fluid; Scott PR et al.; Meningoencephalitis was recorded in 10 two- to 14-day-old calves during a two-year field study . Analysis of lumbosacral cerebrospinal fluid revealed a marked increase in protein concentration with a pronounced neutrophilic pleocytosis . Three calves with positive bacteriological cultures which were treated with chloramphenicol survived whereas six calves treated with penicillin G had to be destroyed on humane grounds after their condition deteriorated . Only two of the 10 calves had concurrent lesions of omphalophlebitis which may indicate that this is not the major route of bacterial invasion in neonatal meningoencephalitis . None of the constituents of cerebrospinal fluid proved to be a reliable prognostic indicator of meningoencephalitis . It is concluded that the analysis of cerebrospinal fluid is a useful ancillary aid in the investigation of abnormal mental states in neonatal calves and a sensitive test for the presence of an inflammatory lesion involving the leptomeninges.

Orv Hetil, 1993 Jul 25, 134(30), 1627 - 30
{Endoscopic study of the small intestine}; Banai J; The author summarises the possibilities of small bowel endoscopy . In case of haemorrhage of unknown origin, enteroscopy may be helpful . Sonde type fiber- or video-enteroscopes can be used . This procedure is time-consuming and needs an experienced team . In case of life-threatening bleeding intraoperative enteroscopy is recommended . "Push" enteroscopy is the best, rapid method in the diagnostics of suspected diffuse intestinal diseases or circumscript lesions of the proximal small bowel . Adult or pediatric colonoscopies or jejunoscopes are available for this investigation . Endoscopic biopsy specimens are suitable for histological examination and for enzyme assay as well . Aspiration of jejunal fluid for bacteriological culture is a way for revealing of bacterial overgrowth . The author emphasises the importance of the deep duodenoscopy made by an upper panendoscope in the diagnostics of villous atrophy.

Infect Immun, 1993 Jul, 61(7), 3047 - 59
Early and early disseminated phases of Lyme disease in the rhesus monkey: a model for infection in humans; Philipp MT et al.; We demonstrate that Borrelia burgdorferi infection in the rhesus monkey mimics the early and early disseminated phases of human Lyme disease . Clinical, bacteriological, immunological, and pathological signs of infection were investigated during 13 weeks after inoculation of the spirochete . Three animals were given B . burgdorferi (strain JD1) by needle inoculations, six animals were exposed to the bite of B . burgdorferi-infected Ixodes dammini ticks, and three animals were uninfected controls . B . burgdorferi could be recovered from all animals that were given the spirochete . Bacteria were detectable until week 6 postinoculation (p.i.) in blood, until week 8 p.i . in skin biopsies, and at 10 weeks p.i . in the conjunctiva of one of two animals which developed conjunctivitis . Erythema migrans (EM) appeared in one of the three animals infected by needle inoculation and in five of the six animals infected by ticks . Deep dermal perivascular lymphocytic infiltrations (characteristic of human EM) were observed in all animals showing EM clinically . Both EM and conjunctivitis were documented concomitantly with the presence of the spirochete . Lethargy, splenomegaly, and cerebrospinal fluid pleocytosis were also noted in some animals, but the direct connection of these signs with the infection was not shown . The appearance rate of immunoglobulin M and immunoglobulin G antibodies to B . burgdorferi, as well as the antigen spectra recognized, were remarkably similar to those seen in humans . Serum antibodies from infected animals were able to kill B . burgdorferi in vitro in the presence of rhesus complement . The rhesus monkey model appears to be useful for the investigation of the immunology and pathogenesis of Lyme disease and for the development of immunoprophylactic, diagnostic, and chemotherapeutic protocols.

Jpn J Antibiot, 1993 Jul, 46(7), 596 - 603
{A clinical study on cefditoren pivoxil in pediatrics}; Satoh Y et al.; Clinical evaluations of cefditoren pivoxil (CDTR-PI, ME 1207) in granules were carried out . The obtained results are summarized as follows . 1 . Thirty-nine patients with pediatric infections were treated with CDTR-PI . Clinical responses of 36 assessable cases were excellent in 25, good in 9 and fair in 2 . The overall efficacy rate was 94% . 2 . Bacteriologically, 30 of the 31 identified bacteria presumed to be pathogens were eradicated and the eradication rate was 97% . 3 . Side effects observed were diarrhea in 3 of 39 patients . The incidence was 7.7% . Abnormal laboratory test results were not observed . The results suggested that CDTR-PI might be a very useful and safe drug for the treatment of pediatric infections.

Jpn J Antibiot, 1993 Jul, 46(7), 568 - 76
{Pharmacokinetic and clinical studies of flomoxef in the perinatal period}; Matsuda S et al.; Pharmacokinetic and clinical studies on flomoxef (FMOX) in the perinatal period were carried out and following results were obtained 1 . The pharmacokinetic parameter T1/2's of FMOX in maternal serum, umbilical cord serum and amniotic fluid in mothers after single intravenous injection of 1 g (n = 46) and 2 g (n = 34) were 1.11, 9.24, 9.24 hours and 2.54, 12.49, 12.49 hours, respectively . Cmax's and Tmax's of umbilical cord serum and amniotic fluid were 12.71, 11.77 micrograms/ml and 0.57, 3.35 hours upon single dose of 1 g i.v., and 35.17, 12.37 micrograms/ml and 0.32, 3.42 hours upon single dose of 2 g i.v., respectively . 2 . Clinical usefulness were evaluated in 93 cases including were various infections in pregnancy and puerperal period . In pregnancy cases, clinical efficacy rate was 95.5% (21/22), and 100% in puerperal period . Bacteriological response rate was 84.6% (eradicated: 29, decreased: 4, unchanged: 2, replaced: 4 and unknown: 8 cases) . No severe side effects nor clinical laboratory test results were observed in any cases . From above basic and clinical results, we conclude that FMOX is a useful and safe agent for various infections in pregnancy and puerperal period.

Kekkaku, 1993 Jul, 68(7), 469 - 78
{Retreatment of pulmonary tuberculosis--duration of chemotherapy}; Wada M et al.; Although standard chemotherapy for initial treatment of pulmonary tuberculosis has been established, regimens for retreatment of tuberculosis have not yet been established . One hundred fifty nine retreatment pulmonary tuberculosis cases admitted to Fukujuji Hospital were retrospectively analyzed . Regardless of the age at the start of retreatment, majority of cases were treated previously between 1955 and 1960 . Bacillary negative conversion rate, duration of chemotherapy, follow-up period and bacteriological relapse rate were compared according to resistance against isoniazid and/or rifampicin . Sixty four cases were sensitive to both INH and RFP . For this group the average duration of chemotherapy was 14.6 months, mean follow up period was 47.3 months and relapse rate was 3.1% . This rate was similar to that of initial treatment cases . Sixty one (94%), were treated with more than two sensitive drugs containing INH and RFP . The 22 INH-resistant and RFP-susceptible cases were treated for 18.6 months and followed up for 55.2 months . The relapse rate of this group was 13.6% . Thirteen cases were treated with more than 2 sensitive drugs containing RFP . Eleven cases were resistant to both INH and RFP . Five of them were surgically operated of which 3 cases were converted to negative and among the nonsurgical cases in this group only one remained sputum positive . All of these retreatment regimens did not contain pyrazinamide and ofloxacin . Although bacillary positive rate of INH and RFP susceptible cases was 13.0% at 6 months after treatment and 5.3% at 12 months after treatment, that of INH resistant and RFP susceptible cases were 25.0% and 12.5%, respectively . A certain rule of retreatment could be obtained from the result of this study.

J Biomed Mater Res, 1993 Jul, 27(7), 851 - 9
Behavior of primary bone cells on characterized polystyrene surfaces; Callen BW et al.; Primary bone cells, isolated from the periosteally stripped calvariae of neonate rats, were cultured on 60Co gamma-irradiation-sterilized bacteriologic-grade polystyrene that had been either surface treated with concentrated sulfuric acid or received further gamma-irradiation treatments facilitated cell colonization of the polystyrene compared to those surfaces not treated in the laboratory . x-Ray photoelectron spectroscopy (XPS) showed that the two treatments introduced different chemical groups onto the polymer surface and that cell adhesion was related to gamma-irradiation in a dose-dependent manner . These results show that simple biologic assays, such as cell colonization, are not able to distinguish between differences in surface chemistry demonstrated by such a routinely employed surface analysis technique . Thus, there is a need to develop more sensitive biologic assays that provide functional information of a precision that can be correlated with subtle changes in substratum surface chemistry . Further, we argue that because cells isolated by tissue digestion using proteolytic enzymes respond more readily to changes in the surface chemistry of the substratum they colonize, compared to explanted cells; biologic assays designed for biomaterials testing must take into account changes effected in cell adhesion behavior by isolation procedures.

Clin Infect Dis, 1993 Jul, 17(1), 7 - 20
Mycobacterium avium complex infection and AIDS: advances in theory and practice; Benson CA et al.; The role of disseminated infection with the Mycobacterium avium complex (MAC) in the natural history of AIDS has been controversial . It is now clear that this complication of immunosuppression induced by human immunodeficiency virus type 1 (HIV-1) has a major impact upon the quality of life and duration of survival of patients with advanced HIV-1 infection . Progress has been made in our understanding of the bacteriology, pathogenesis, prevention, and treatment of MAC infection . Drs . Constance Benson and Jerrold Ellner (of Rush Medical College in Chicago and Case Western Reserve University in Cleveland, respectively) have led the effort by the AIDS Clinical Trials Group to develop new methods of managing this serious complication of advanced HIV-1 infection . In this AIDS commentary they review our current knowledge of MAC organisms and the clinical problems resulting from infection with these mycobacteria.

Mil Med, 1993 Jul, 158(7), 448 - 57
Evolution of America's pioneer bacteriologist: George M . Sternberg's formative years; Flaumenhaft E et al.; George M . Sternberg, 1838-1915, M . D., USA, activated modern American bacteriology . He produced the first general bacteriology book in the English language in 1880 . His first publications on chemical disinfection (1879) preceded Koch's Sternberg discovered the pneumococcus (1880) before Pasteur did and speculated about phagocytosis (1881) before Metchnikoff . As an experimentalist and author, Sternberg stood "at the head of the American school of working bacteriologists" by the early 1880s . Our essay on Sternberg's evolution as a scientist explains what motivated him and why his early achievements as a bacteriologist, praised by contemporaries, have been underestimated more recently.

J Clin Microbiol, 1993 Jul, 31(7), 1918 - 20
Sensitivity of culture compared with that of polymerase chain reaction for detection of Helicobacter pylori from antral biopsy samples; van Zwet AA et al.; Polymerase chain reaction (PCR) was used to test the sensitivity of standard bacteriological culture of Helicobacter pylori . The tests were concordant in 97% of cases . PCR did not detect more treatment failures after triple treatment than did the standard culture method . In the present study, culture was as sensitive as PCR for the detection of H . pylori.

Am J Surg, 1993 Jul, 166(1), 24 - 7
Analysis of pH and pO2 in abscesses, peritoneal fluid, and drainage fluid in the presence or absence of bacterial infection during and after abdominal surgery; Simmen HP et al.; The diagnostic significance of pH, pO2 (partial pressure of oxygen), and pCO2 (partial pressure of carbon dioxide) was studied in pus, peritoneal fluid, and drainage fluid obtained during or after abdominal surgery . Measurements of these fluids in 59 patients with clinically and bacteriologically documented abdominal or anorectal infection (median pH: 6.75, median pO2: 28 mm Hg, median pCO2: 89 mm Hg) differed significantly (p < 0.001) from data of 105 patients undergoing elective laparotomy for a reason other than infection (median pH: 7.49, median pO2: 144 mm Hg, median pCO2: 92 mm Hg) . The combined use of a threshold criterion for pH and pO2 allowed for excellent discrimination between infected (pH less than 7.1, pO2 less than 49 mm Hg) and noninfected patients, with positive and negative predictive values of 98% and 99%, respectively . In conclusion, conditions prevailing during standard in vitro susceptibility tests more closely reflect physiologic conditions as opposed to the conditions prevailing at the site of abdominal infections . Measurements of pH and pO2 allow for an easy, quick, sensitive, and specific diagnosis of bacterial abdominal infection.

Invest Ophthalmol Vis Sci, 1993 Jul, 34(8), 2487 - 92
Corneal epithelial cell attachment with endogenous laminin and fibronectin; Ohji M et al.; PURPOSE . To evaluate the role of endogenously produced laminin and fibronectin as well as the effect of exogenous laminin and fibronectin in the attachment of human corneal epithelial cells in vitro . METHODS . Primary cultured human corneal epithelial cells labeled with 3H-thymidine were seeded onto plates coated with laminin or fibronectin, or onto uncoated bacteriologic plates . Attachment of cells was measured in the presence or absence of antisera against laminin or fibronectin, by counting radioactivity . RESULTS . Human corneal epithelial cells attached to plates coated with human laminin or human fibronectin in a dose-dependent manner, with 69% and 50% of cells attached to the wells coated with 40 micrograms/ml of laminin and fibronectin, respectively (P < 0.001) . The percentage of attachment to uncoated bacteriologic plates increased from 1.2% at 45 min of incubation to 6.7% at 90 min, 22.2% at 3 hr, and 40.1% at 6 hr of incubation . Cycloheximide, a protein synthesis inhibitor, completely inhibited cell attachment . Rabbit antiserum against human fibronectin reduced cell attachment to the uncoated plates to 67% of the control value (P < 0.01), whereas rabbit antiserum against human laminin decreased the attachment to 52% of the control (P < 0.01) . A combination of these two antisera reduced cell attachment to 46% of the control (P < 0.01) . CONCLUSIONS . Endogenous laminin and fibronectin as well as exogenous laminin and fibronectin play significant roles in the attachment of human corneal epithelial cells in culture.

West Afr J Med, 1993 Jul-Sep, 12(3), 136 - 40
Single oral dose of azithromycin for therapy of susceptible sexually transmitted diseases: a multicenter open evaluation; Odugbemi T et al.; In three randomised, multicentre studies, azithromycin treatment (1g) as a single dose was administered to patients with uncomplicated gonococcal and non-gonococcal urethritis attending STD Research Laboratories in Lagos, Jos and Ibadan; between January 1989 and December, 1990 . One hundred and eighty three patients, comprising 106 males and 77 females who had infections were evaluable at the end of the treatment . Of these 71% of the N . gonorrhoeae isolates were penicillinase producers (PPNG), while 39% were non-PPNG . One hundred and fourteen (95%) of 120 patients with gonococcal urethritis including 104 cases due to penicillinase producing Neiserria gonorrhoeae (PPNG) were clinically and bacteriologically cured with a single 1g dose of azithromycin . Fifty-four (90%) out of 60 patients with non-gonococcal urethritis were cured whilst administered the same dose of azithromycin . The side effects reported for azithromycin were mainly mild and moderate gastro-intestinal complaints and there were no major abnormalities in laboratory parameters . It is concluded that azithromycin was efficacious and safe for the treatment of uncomplicated gonococcal and non-gonococcal infections and may improve patient compliance.

Pediatr Med Chir, 1993 Jul-Aug, 15(4), 367 - 70
{Recurrent cystitis in children: do predisposing factors exist for its onset?}; Franchini F et al.; It is known that a great number of subjects, mainly little girls, frequently go to pediatric's observation for recurrent episodes of pollakiuria, dysuria or burning miction . They often complain enuresis, sometimes tenesmus so intense that they arrive at the incontinence (urge incontinence) . Many of these cases, quickly defined as cystitis, really revealed that they weren't . Repetitively negative bacteriologic examinations allow us to classify them as "sham syndromes", as Stephens called them . According to what we said above, we wondered whether any recurrent cystitis are not favoured by missed observation of definite rules.

Infection, 1993 Jul-Aug, 21(4), 262 - 4
Biliary tract infections treated with ciprofloxacin; Karachalios GN et al.; Thirty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were treated with ciprofloxacin intravenously followed by oral ciprofloxacin . Complete clinical and bacteriological cure has been observed in 28 out of 32 patients and therapy failure occurred in four patients . Overall, no major adverse effects were encountered . These data suggest that intravenous ciprofloxacin followed by oral administration is an effective and safe agent for the therapy of severe biliary tract infections.

Age Ageing, 1993 Jul, 22(4), 289 - 93
The association of age with the presentation and outcome of tuberculosis: a five-year survey; Teale C et al.; Of the 411 patients notified with tuberculosis in Leeds during 1986 through 1991, case notes were available on 406 (99%) and the diagnosis of mycobacterial disease was accepted in 397 (98%) . Twenty-two patients had infection with atypical mycobacteria and were excluded from analysis, as were children under 16 years . Comparison between the age groups was further restricted to white patients because of a skew distribution of Asian patients towards the younger age range . Ninety-six elderly patients (aged 65 years and older) were compared with 127 younger patients . The distribution of pulmonary and extrathoracic disease was similar as was the incidence of positive bacteriology . Elderly people had more frequent lower-zone and more frequent miliary shadowing, otherwise radiographic features were similar . Elderly people were nearly three times more likely to have reactions to antituberculous drugs, six times more likely to die from tuberculosis and over twenty times more likely than younger patients to have the diagnosis made at autopsy rather than during life.

Korean J Intern Med, 1993 Jul, 8(2), 73 - 7
Prevalence of Helicobacter pylori infection in patients with peptic ulcer diseases and non-ulcer dyspepsia; Lee HR et al.; BACKGROUND: Helicobacter pylori is known to be a cause of active chronic gastritis and has been proposed as an etiologic factor in the development of peptic ulcer disease, but controversy continues regarding the pathogenic importance and mechanism . We examined the prevalence of H . pylori infection in patients with peptic ulcers and non-ulcer dyspepsia . METHOD: 749 patients (373 with duodenal ulcer, 303 with gastric ulcer, 73 with non-ulcer dyspepsia) were included . Endoscopic mucosal biopsies were done at antrum, duodenum, and, if present, ulcer margin . The specimens were tested by Gram staining, Giemsa staining, culture, urease testing for identification of H . pylori . Antibody to H . pylori was examined in 83 patient of these patients by ELISA, and the result was compared with the results of bacteriologic studies . RESULT: Prevalence of H . pylori in antral mucosa was higher in patients with duodenal ulcers (81.5%) than in patients with gastric ulcer and non-ulcer dyspepsia (56% and 52.8%) (P < 0.05) . Also in the duodenal mucosa of non-ulcer sites, and the ulcer margin of patients with duodenal ulcers, the detection rates (12% and 40.7%) were higher than those in the duodenal mucosa of patients with gastric ulcer and non-ulcer dyspepsia (7% and 8%)(p < 0.005) . Antibody to H . pylori was detected in all patients with duodenal and gastric ulcers and non-ulcer dyspepsia who were tested for antibody . In contrast, the detection rates of antibody in adult control and child control were 33.3% and 27% . Among patients with antibody to H . pylori, H . pylori was detected in 85.7% of patients with duodenal ulcer, 62.5% of patients with gastric ulcers and 22.2% of patients with non-ulcer dyspepsia (p < 0.05) . CONCLUSION: These data suggest that H . pylori is a possible pathogen for duodenal ulcer by duodenal colonization probably via gastric metaplasia . Also the past or present infection of H . pylori in antral mucosa may play a role at least partially in generation of upper gastrointestinal symptoms.

J Med Microbiol, 1993 Jul, 39(1), 39 - 47
Serum IgG and sputum IgA antibody to core lipopolysaccharide antigen from Pseudomonas cepacia in patients with cystic fibrosis; Nelson JW et al.; The immunological response of cystic fibrosis (CF) patients to lipopolysaccharide (LPS) antigens of Pseudomonas cepacia was investigated . Enzyme-linked immunosorbent assays (ELISA) with either P . cepacia whole cells or extracted core LPS from a clinical isolate of P . cepacia as antigen were used to measure serum IgG and sputum IgA anti-P . cepacia antibodies . The ELISA with core LPS distinguished nine CF patients colonised by P . cepacia from nine age- and sex-matched non-colonised CF patients . The rate of increase of anti-P . cepacia IgG antibodies after bacteriologically proven P . cepacia colonisation varied in individual patients: in some patients the first isolation of P . cepacia was preceded or accompanied by a two-to-four-fold rise in anti-P . cepacia LPS IgG titres . Absorption studies and immunoblot analysis of serum from patients colonised with P . cepacia demonstrated that a significant component of the anti-P . cepacia core LPS antibodies was specific for P . cepacia and did not react with the core LPS of P . aeruginosa . Immunoblotting also illustrated that there may be a degree of core heterogeneity between different isolates of P . cepacia . Detection of P . cepacia LPS specific antibodies in serum (IgG) and sputum (IgA) from CF patients is recommended to assist the identification of P . cepacia colonisation in CF patients.

Cas Lek Cesk, 1993 Jun 28, 132(13), 401 - 5
{Surveillance of tuberculosis in the Czech Republic in 1991}; Trnka L et al.; They authors present an interim report on the epidemiological situation of tuberculosis and the effectiveness of control measures as regards tuberculosis in the Czech Republic in 1991 . The data are compared with previous years . The incidence of tuberculosis of all forms was 19.9/100,000 population, TB of the respiratory organs 16.2/100,000 and the incidence of bacteriologically confirmed respiratory TB 11.5/100,000 population . As compared with previous years, no statistically significant differences were found . Extrapulmonary TB accounted for less than 10% of the incidence, the position was similar also as regards mycobacterioses other than TB . The incidence of TB in children was 1.3/100,000 children under 15 years, after a transient increase in 1990 (microepidemic in gypsy children), a marked decline was recorded . The TB mortality rate was low (1.1/100,000 population), the prevalence to the date of Dec . 31 1991 was 21.7/100,000 population . On account of complaints 76% new cases were detected, the majority within 1 month, antituberculous treatment was effective, the mean period of treatment was reduced to less than 8 months . However, long in-patient treatment persists usually at the beginning of antituberculous treatment (3 months).

J Am Vet Med Assoc, 1993 Jun 15, 202(12), 1975 - 7
Comparison of enzyme-labeled immunosorbent assay and particle concentration fluorescence immunoassay with standard serologic methods and bacteriologic culture for detection of Brucella sp-infected cows in herds with brucellosis; Nicoletti P et al.; Bacteriologic culture of udder secretions and card, rivanol, and complement fixation tests for detection of brucellosis were performed on samples from 828 cows vaccinated with strain 19 in herds with brucellosis . An ELISA and a particle concentration fluorescence immunoassay were performed on sera from 560 and 569 cows, respectively . A field strain of Brucella abortus or strain 19 was isolated from 278 cows . The ELISA and the card test had high sensitivity, but low specificity . Data suggested that there is no advantage to using primary binding assays rather than the simple buffered antigen agglutination procedures to detect cows infected with a field strain of B abortus.

Hepatology, 1993 Jun, 17(6), 1081 - 5
Bacterial translocation in acute and chronic portal hypertension; Garcia-Tsao G et al.; Patients with cirrhosis are predisposed to develop spontaneous bacteremias and peritonitis, mainly by enteric bacteria . Portal hypertension, by producing congestion and edema of the bowel wall, could increase the passage of bacteria from the intestinal lumen to regional lymph nodes to the systemic circulation or to both, a process termed bacterial translocation . The aim of this study was to investigate bacterial translocation at two stages of experimental portal hypertension: (a) acute (when shunting is minimal); and (b) chronic (when shunting is extensive and mimics the portal hypertension of cirrhosis) . Rats were killed 2 days (acute) or 15 days (chronic) after partial portal vein ligation or control surgeries . Samples of mesenteric lymph nodes, blood, liver and spleen for standard bacteriological cultures and a fragment of ileum for histological examination were obtained . Two days after surgery, a significantly greater proportion of rats with acute portal hypertension (12 of 13 or 92%) had positive mesenteric lymph node cultures compared with both control groups: sham-operated (4 of 13 or 31%) and inferior vena cava-ligated (3 of 10 or 33%) animals (p < 0.01) . However, 15 days after surgery no differences in translocation to mesenteric lymph nodes were found between rats with chronic portal hypertension (3 of 15 or 20%) and sham-operated controls (3 of 11 or 27%) . In neither the acute nor the chronic rats were bacteria isolated from blood, spleen or liver . Rats with acute portal hypertension had significantly greater mesenteric inflammation than rats with chronic portal hypertension and control animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Br J Oral Maxillofac Surg, 1993 Jun, 31(3), 178 - 9
Fatal disseminated intravascular coagulation complicating dental extraction; Marshall DA et al.; A case is reported of fatal disseminated intravascular coagulation occurring 8 h after routine extraction of wisdom teeth in a 24-year-old woman . Since all bacteriological specimens taken were sterile and no other precipitant was found, we believe this case represents an example of the generalised Shwartzman reaction to the local trauma of dental extraction leading to fatal initiation of the coagulation system.

Chest, 1993 Jun, 103(6), 1808 - 12
Acute exacerbation in idiopathic pulmonary fibrosis . Analysis of clinical and pathologic findings in three cases; Kondoh Y et al.; We treated three patients with idiopathic pulmonary fibrosis who had an acute clinical exacerbation . We analyzed their clinical, radiographic, therapeutic, and pathologic findings . Their initial symptoms were influenza-like illness or cough with fever, and all had leukocytosis and elevation of C-reactive protein . Infectious events were ruled out by extensive bacteriologic and serologic examination . The patients' lung injury scores progressed rapidly to severe lung injury compatible with adult respiratory distress syndrome . Findings from bronchoalveolar lavage fluid showed marked neutrophilia and elevation of albumin concentrations . All patients showed various degrees of improvement following corticosteroid therapy . Histologic findings from open lung biopsy specimens showed both usual interstitial pneumonia (UIP) and organizing acute lung injury pattern . Whether these two forms of interstitial pneumonia (UIP and acute lung injury pattern) are variants of one disease or are unrelated and also the effectiveness of corticosteroid therapy on such conditions remain to be determined by further studies.

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 73 - 9
A comparative study of azithromycin and amoxycillin in paediatric patients with acute otitis media; Mohs E et al.; In this open study, a three-day regimen of azithromycin (single daily dose of 10 mg/kg) was compared with a ten-day regimen of amoxycillin paediatric suspension (30 mg/kg/day in three divided doses; children > 20 kg received 250 mg tid daily) in 154 children (aged 2-12 years) with a clinical diagnosis of acute otitis media (13 recurrent) . Full clinical, bacteriological and laboratory safety assessments were performed during and after the study . Of the 77 azithromycin patients, 61 (79%) were considered cured, 15 (19%) improved and one (1%) failed, compared with 45 (58%) cured, 28 (36%) improved and four (5%) failed among the 77 amoxycillin patients . Excluding from analysis the 13 patients with recurrent otitis media, azithromycin was found to be significantly superior to amoxycillin (P = 0.003) . The incidence of side-effects was low, with only two (3%) and three (4%) patients reporting adverse events with azithromycin and amoxycillin, respectively . These were gastrointestinal in nature and of mild or moderate severity, except for one case of severe diarrhoea in the amoxycillin group . No treatment-related abnormalities in the laboratory safety tests were observed, and no patients withdrew from therapy . A three-day regimen of azithromycin was therefore shown to be more effective than, and as well tolerated as, amoxycillin in the treatment of children with acute otitis media.

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 153 - 62
Comparison of azithromycin versus clarithromycin in the treatment of patients with lower respiratory tract infection; Bradbury F; The efficacy and safety of azithromycin and clarithromycin in lower respiratory tract infection (LRTI) were compared in an open, multicentre study . Five hundred and ten adult patients with a diagnosis of LRTI, including acute bronchitis, acute infective exacerbations of chronic bronchitis (AIECB) or pneumonia were enrolled . The patients were randomly assigned to receive either azithromycin (n = 252) as a single daily dose of 500 mg for three days, or clarithromycin (n = 258) 250 mg twice daily for ten days . In AIECB patients, baseline comparisons of the two treatment groups showed that there were no differences in the number of previous episodes of infection or in the incidence of current or past smokers . The overall clinical efficacy was found to be similar in each treatment group on day 10 to 14, with a satisfactory response (cured or improved) in 94% of azithromycin- and 97% of clarithromycin-treated patients . At follow-up evaluation (day 18 to 22), 97% of azithromycin- and 100% of clarithromycin-treated patients who had improved at day 10 to 14, showed satisfactory outcomes . Bacteriological efficacy was similar in both treatment groups, with eradication of 100% vs 95% of isolates in the azithromycin and clarithromycin groups, respectively . In AIECB, 100% of pathogens were eradicated by azithromycin, although one patient was clinically assessed as failed . Clarithromycin eradicated 93% of pathogens in this group; all patients being assessed as cured or improved . Both drugs were well tolerated, with 9% and 6% of patients reporting adverse events with azithromycin and clarithromycin, respectively . These adverse events were largely gastrointestinal in origin . It was concluded that a three-day course of azithromycin is as effective and well tolerated as a ten-day course of clarithromycin in adults with acute LRTIs.

J Chemother, 1993 Jun, 5(3), 174 - 80
A single-blind, randomised, comparative study of clarithromycin and amoxycillin suspensions in the treatment of children with lower respiratory tract infections; Macklin JL et al.; One hundred and forty-five children with signs and symptoms of lower respiratory tract infections were entered into this multicentre, General Practice, investigator-blind study, designed to demonstrate equivalent efficacy between clarithromycin and amoxycillin suspensions . Seventy one children were randomised to treatment with clarithromycin suspension 7.5 mg/kg bodyweight twice daily and 74 to treatment with amoxycillin suspension 125 mg (bodyweight < 25 kg) or 250 mg (bodyweight > or = 25 kg) three times a day according to bodyweight . Duration of therapy was 5-10 days as determined by the investigator . Clinical evaluations were performed pretreatment, during treatment and post-treatment within 72 hours of cessation of therapy . Fifty two children in the clarithromycin group and 57 in the amoxycillin group were clinically evaluable . Both study medications were effective and there were no significant differences between the groups with respect to clinical cure rate (60% for clarithromycin and 63% for amoxycillin), clinical success rate (cure plus improvement, 96% for clarithromycin and 95% for amoxycillin) or rate of resolution of clinical signs and symptoms in clinically evaluable patients . The intention to treat analysis for all patients entered similarly showed no significant differences in efficacy . The two treatment groups did not differ significantly with respect to incidence or severity of adverse events which were generally mild and associated with the gastrointestinal system . Therapy was withdrawn because of adverse events in three children on clarithromycin and one on amoxycillin . Bacteriological cure rates could not be determined because of an insufficient number of evaluable pre-treatment sputum samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Int J Lepr Other Mycobact Dis, 1993 Jun, 61(2), 205 - 13
Development of giant reaction in response to PPD skin test in lepromatous leprosy patients; Sampaio EP et al.; The present study analyzes some clinical and immunological aspects of the giant reaction (GR) in lepromatous leprosy . Sixteen out of a total of 147 (10.9%) lepromatous patients developed the clinical features of GR upon the intradermal administration of PPD; most (14 of 16) GRs occurred in bacteriologically positive cases . GR precipitated an episode of erythema nodosum leprosum (ENL) in three patients . In addition, patients with GR showed enhanced in vitro response to PPD, by the lymphoproliferation test and interferon-gamma assay, as compared to either PPD-negative individuals or PPD-positive patients without GR . Therefore, cell-mediated-immune response to mycobacterial antigens is present in lepromatous patients with GR . It is suggested that the exacerbated in vivo response to PPD in lepromatous leprosy is the result of an increased immunoreactivity to the antigen, which well may be associated with the local and/or systemic release of cytokines {tumor necrosis factor-alpha (TNF alpha) and interferon-gamma (IFN gamma)} by the inflammatory cells . These episodes may, in fact, play an important role in determining the development of disabilities and reactional states, thereby interfering with the prognosis of leprosy disease.

Tuber Lung Dis, 1993 Jun, 74(3), 163 - 6
Bacteriology and drug susceptibility of tuberculosis at St Vincent's Hospital, Melbourne 1962-1991; Hurley JC et al.; 39,000 specimens were examined for the growth of Mycobacterium tuberculosis over a 27-year period (1962-1989) at St Vincent's Hospital, Melbourne . The culture positive rate was 2.0% overall but was as high as 3.5% for tissue specimens and less than 1% for specimens of pleural fluid . There were 329 culture positive patients over a 29-year period (1962-1991) of whom 34 (10.5%) yielded an isolate resistant to at least one anti-tuberculosis drug and 19 (5.8%) were resistant to isoniazid . An overall increase in the rate of drug resistance together with important ethnic group differences were noted.

J Antimicrob Chemother, 1993 Jun, 31(6), 963 - 72
Clarithromycin versus cefaclor for the treatment of mild-to-moderate acute bacterial bronchitis; Wettengel R et al.; Four hundred and eight outpatients with the clinical signs and symptoms of mild-to-moderate acute bronchitis of bacterial aetiology were enrolled in a multicentre, double-blind, randomized clinical trial comparing the efficacy and safety of clarithromycin and cefaclor, both administered orally . Two hundred and seven patients received clarithromycin 250 mg bd and 201 patients received cefaclor 500 mg tds for a maximum of seven days . Clinical and bacteriological evaluations were performed before treatment was initiated, during the course of treatment, and within 72 h of completing therapy; all adverse events were recorded . Two hundred and three patients in the clarithromycin group and 195 in the cefaclor group were evaluable for clinical response and 129 and 124 patients in the clarithromycin and cefaclor groups, respectively, were evaluable for bacteriological response . The clinical response rates three to five days after starting treatment and at the post-treatment assessment were 97% (193/199) and 99.5% (202/203), respectively, for the clarithromycin group and 97.4% (187/192) and 97.9% (191/195), respectively, for the cefaclor group . The bacteriological cure rates were 94.6% (122/129) for the clarithromycin group and 90.3% (112/124) for the cefaclor group . None of the differences between the groups was statistically significant . Adverse events, which were generally mild and predominantly related to the gastrointestinal tract, were reported by 5.8% of clarithromycin-treated patients and 10.4% of cefaclor-treated patients . Adverse reactions caused one patient in the clarithromycin group and three in the cefaclor group to discontinue treatment prematurely . The results of this study indicate that clarithromycin and cefaclor are comparable with respect to efficacy and safety when used as treatment for patients with mild-to-moderate acute bacterial bronchitis.

Lepr Rev, 1993 Jun, 64(2), 110 - 6
Concurrent skin and nerve histology in leprosy and its role in the classification of leprosy; Kaur S et al.; Concurrent skin and nerve histology was evaluated in 60 leprosy patients (25 BT, 28 BL and 7 LL) . The twin aims were to study the comparative histology and the usefulness of nerve histology in the classification of the disease . In BT patients, clinical and histological classification was in agreement in 11 (44%) skin and 17 (68%) nerve biopsies . Concurrent skin and nerve histology was in consonance in 14 (56%) BT patients, while in 6 (24%) patients, only nerve histology was helpful in the classification of the disease, the skin histology being non-specific . Nerve histology was classified as BL in 3 (12%) BT patients, the skin histology was non-specific . In the BL group, the histology of 23 (82.4%) nerve biopsies correlated with the clinical classification, in contrast to skin histology which correlated with clinical assessment in 19 (68%) patients only . In the LL patients, the histology of nerve correlated with the clinical classification in 5 patients (71.4%), compared to histology of the skin in 4 (57%) patients only . The GF was higher in the nerves than in the skin throughout the leprosy spectrum (BT, BL, LL); the difference was, however, marginal in BL leprosy . The average bacteriological index (BI) was higher in nerves (4+) compared to that of skin histology and slit skin smears (3+) in BL leprosy . There was, however, no difference in the BI of the slit skin smears, skin and nerve biopsies in lepromatous leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)

Wiad Lek, 1993 Jun, 46(11-12), 456 - 8
{Pulmonary miliary tuberculosis in a 14-year old boy}; Boznanski A et al.; A case is presented of a rare form of pulmonary miliary tuberculosis in a 14-year-old boy beginning with dramatic symptoms with negative the test and negative result of bacterioscopy . The preliminary diagnosis was made on the basis of clinical observation and radiological examination . Confirmation was achieved after obtaining of a positive result of bacteriological examination.

J Hosp Infect, 1993 Jun, 24(2), 153 - 6
Does the addition of pre-operative skin preparation with povidone-iodine reduce groin sepsis following arterial surgery?
May J, Brooks S, Johnstone D, Macfie J.
Sixty-four consecutive patients undergoing elective vascular surgery involving exposure of the femoral artery at the groin were randomized to one of two groups . Group A (N = 34) received twice-daily skin preparation with 10% aqueous povidone-iodine for 48 h preoperatively, while group B (N = 30) did not . Both groups were examined on a daily basis following surgery and any discharge from the wound was recorded and sent for bacteriological culture . The groups were well matched for age, sex and the type of vascular graft material used . In group A there were six (18.7%) groin wound infections and in group B there were five (17.2%) . In this series of patients the addition of preoperative skin preparation with 10% povidone-iodine to standard peri-operative prophylaxis had no effect on the incidence of postoperative groin wound sepsis.

J Commun Dis, 1993 Jun, 25(2), 57 - 61
Epidemiological features of cholera outbreak in Delhi in 1988; Datta KK et al.; During 1988 a large scale outbreak of cholera occurred in Delhi giving rise to a total of 1708 bacteriologically proved El Tor cholera cases, the highest number recorded in a single year in Delhi, following its first detection in 1965 . Civil lines and Shahdara zones were the worst affected areas recording 85.7 and 55.7 cases per 100,000 population respectively . The highest incidence rate was observed in the age group of 1-4 years (77 per 100,000) . Males and females were equally affected . The data of moving average show the endemicity of cholera in Delhi with an increasing trend . The risk factors identified are lower socioeconomic status, poor personal hygiene, drinking water and food storage practices.

Pol Tyg Lek, 1993 May 17-31, 48(20-22), 488 - 9
{Pseudomembranous colitis in patients with kidney failure}; Wardyn K et al.; Two cases of pseudomembranous colitis in patients with renal failure are presented . Both patients were treated with antibiotics . Clinical course, bacteriologic examination of feces, and endoscopy of the colon plays an important role in the diagnosis of this complication . No gut endoscopy was performed in both patients due to severe disease course . Pseudomembranous colitis was diagnosed by clinical symptoms and bacteriologic examination of feces out of which C . difficile was isolated . Teicoplanin-a drug of a known efficiency in the treatment of C . difficile infection-was given and vancomycin was used in the second patient . We would like to stress that renal failure predisposes to the a development of pseudomembranous colitis . An emphasis is also on the dose adjustments of drugs in renal failure.

Harefuah, 1993 May 2, 124(9), 546 - 8, 599
{Is lumbar puncture in bacterial meningitis necessary?}; Pinhas-Hamiel O et al.; 3 children with the clinical picture of bacterial meningitis are described . Lumbar puncture was not done on admission due to increased intracranial pressure, cardiopulmonary shock, or petechial rash with suspected coagulopathy . Prompt treatment with broad spectrum antibiotics resulted in successful outcomes . The diagnosis of meningitis can usually be made clinically and the bacteriological diagnosis from blood cultures . We maintain that in fulminating cases lumbar puncture might prove fatal, and should therefore be deferred until the child's condition improves . However, if bacterial meningitis is suspected and lumbar puncture is delayed, intravenous antibiotics should be given immediately after blood is drawn for culture.

Andrologia, 1993 May-Jun, 25(3), 159 - 62
Bacterial foci in the teeth, oral cavity, and jaw--secondary effects (remote action) of bacterial colonies with respect to bacteriospermia and subfertility in males; Bieniek KW et al.; Bacteriospermia requiring medical treatment were diagnosed in more than 70% of the subfertile patients who had since 1988 attended the gynecological clinic at the RWTH hospital in Aachen . In 23% of all cases specific treatment with antibiotics did not reduce the concentrations of bacteria in sperma . Thirty-six patients with bacteriospermia resistant to antibiotic therapy were then subjected to dental examination . A high incidence of potential dental foci was found in all patients . In a test group of 18 patients these sources of potential infection were eliminated . Between dental operations and therapy swabs were taken to determine bacterial levels and bacteriological composition . It could be demonstrated that the bacterial spectrum of the intraoral samples was almost identical with the spermiograms . Six months following completion of dental treatment a further spermiogram analysis was carried out . In the test group about two thirds of the spermiograms proved sterile . Spermatological parameters, such as motility, density and morphology, had also clearly improved . In the control group the findings of the spermiogram remained poor . This study indicates that a direct causal relationship exists between bacterial colonies (dental foci) and therapy-resistant bacteriospermia which probably leads to subfertility.

J Hand Surg {Am}, 1993 May, 18(3), 520 - 2
Osteomyelitis of the hand after a human bite; Gonzalez MH et al.; Twenty-four cases of osteomyelitis of the hand after human bite were reviewed . The mechanism of injury was equally divided between incisor bites and clenched fists . Eleven of twelve of the clenched-fist injuries showed a tooth mark in the bone or cartilage at the site of inoculation . The incisor bites showed initial infection of the soft tissues or joint with a secondary infection of the bone . Factors leading to the development of osteomyelitis included a delay of more than 24 hours before debridement or inadequate initial treatment . Bacteriologic study commonly showed mixed infections with skin and oral flora . The infections were prone to relapse, and nine patients required more than one surgical debridement.

Radiol Clin North Am, 1993 May, 31(3), 517 - 31
Sonography of the chest in children; Ben-Ami TE et al.; Sonography is an extremely important tool in the evaluation of the chest in children . Its easy availability, versatility, and portability make it an obvious choice as the next diagnostic examination after an abnormal chest radiograph . Patience and meticulous technique coupled with good anatomic knowledge will produce useful studies . Sonography is equivalent and sometimes superior to CT because of its Doppler ability and superior fluid and tissue characterization . It is most helpful in the assessment of anterior and middle mediastinal masses, opaque chest, and pleural and juxta-diaphragmatic abnormalities; in the classification of perplexing radiographs; and in the assessment of peripheral chest lesions . Sonography provides guidance for diagnostic and therapeutic aspiration, providing not only excellent anatomic demonstration, tissue characterization, and vascular information but also immediate access to bacteriologic and tissue diagnosis when required.

Infect Control Hosp Epidemiol, 1993 May, 14(5), 268 - 72
Brucellosis among hospital employees in Saudi Arabia; Kiel FW et al.; OBJECTIVE: To report experience with brucellosis among expatriate hospital employees in an area of the world where brucellosis is endemic . DESIGN: Review of cases from the viewpoints of direct supervisor and treating physician, including epidemiologic interviews and clinical follow-up . SETTING: Tertiary care hospital center in a developing country that increased from 125 beds to 450 beds during the period studied . PATIENTS: Employees with clinical findings suggesting brucellosis and in whom a positive blood culture or significantly elevated serologic test confirmed the diagnosis . RESULTS: Nine hospital employees from nonendemic areas developed brucellosis . Five were from England and four from North America . Seven were bacteriology technologists, one was a nurse, and one was an obstetrician . Each had an acute febrile illness with malaise, arthralgia, or headache . Brucella titers were > or = 1:1,280 . Five were bacteremic with positive Brucella cultures . All responded to anti-Brucella therapy . Three patients had relapses, but there were no complications . CONCLUSIONS: Among Saudi patients, brucellosis is generally attributable to drinking infected milk or contacting infected animals . On the other hand, among expatriate hospital employees, the infection is likely due to processing Brucella cultures or dealing with infected body fluids . In 1988, the laboratory began stricter infection control measures . Since then, there has been only one case of brucellosis among the hospital employees.

J Am Vet Med Assoc, 1993 May 1, 202(9), 1461 - 4
Association of abnormal uterine discharge with new intramammary infection in the early postpartum period in multiparous dairy cows; Epperson WB et al.; The association of abnormal uterine discharge with the development of intramammary infection (IMI) was studied in 62 multiparous Holstein cows during the nonlactating period and from lactation days 3 through 30 . Duplicate milk samples were obtained from each mammary gland at approximately day 30 of the nonlactating period . Milk samples for bacteriologic culture also were obtained from each gland from all cows at the end of the previous lactation, at parturition, and on a minimum of 7 additional dates during the first 30 days of lactation . Beginning after parturition and continuing once weekly for 4 weeks, each cow was examined, using a vaginal speculum to visually estimate the quantity of abnormal uterine discharge in the vagina . Additionally, uterine swab specimens were obtained for aerobic bacteriologic culture . Cows were allotted to groups on the basis of the maximal amount of abnormal uterine discharge observed at any 1 of the 4 examinations . Cows in group 1 had normal discharge or < 30 ml of abnormal discharge; in group 2, > or = to 30 ml of abnormal discharge, observed only on examination by vaginal speculum; and in group 3, > or = to 30 ml of abnormal discharge visible externally . A difference was not detected in the development of new IMI in the nonlactating period between cows that subsequently developed uterine discharge and those that did not . Although significant differences were not found, a tendency for lactating cows with abnormal uterine discharge to be at increased risk for developing new IMI was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagn Microbiol Infect Dis, 1993 May-Jun, 16(4), 321 - 3
Bacteriologic investigations of unusual mycobacteria isolated from immunocompromised patients; Siddiqi SH et al.; Mycobacterial isolates from blood and other extrapulmonary sites of six patients with AIDS were investigated because the isolates grew only in liquid media and failed to grow on solid culture media even on subculturing . Our investigations indicated that these mycobacteria possess common, but unusual, characteristics and probably belong to an unrecognized species recently reported as "Mycobacterium genavense."

J Urol, 1993 May, 149(5), 1137 - 8
Necrotizing cavernositis secondary to periodontal abscess; Pearle MS et al.; Spontaneous cavernositis is a distinctly uncommon entity . Corporeal infection and abscess formation have been described in association with priapism, cavernosography, intracavernous injection therapy, trauma and penile prostheses . We report a case of acute necrotizing cavernositis in a diabetic patient, which presumably originated with hematogenous seeding from a periodontal abscess . Isolation of typical oral pathogens from corporeal cultures provides bacteriological evidence of a dental source for the corporeal infection.

Indian J Med Res, 1993 May, 97, 104 - 7
Value of a single Widal test in the diagnosis of typhoid fever; Rasaily R et al.; Results of a single Widal test in patients with bacteriologically confirmed typhoid fever (116), clinically suggestive but culture negative fever (170) and non-typhoidal febrile illness (98) and in normal control children (54) were analysed . Positive Widal test (antibody titre against S . typhi O antigen of 1:160) was recorded in 61.2 per cent of patients with bacteriologically confirmed typhoid fever and in 58.8 per cent with culture negative but clinically suggestive typhoid fever . In contrast, the same titre was observed in 10.2 per cent patients with other febrile illnesses of known etiology and in 1.8 per cent of normal children . Differences in the positivity of Widal test in patients with bacteriologically confirmed typhoid fever and clinically suggestive but culture negative fever were highly significant (P < 0.000001) when compared to that of patients with non-typhoidal febrile illnesses and normal controls . High specificity and positive predictive value in 1:160 dilution makes the Widal test acceptable as a diagnostic tool.

Rev Prat, 1993 May 1, 43(9), 1078 - 80
{Imaging of acute pyelonephritis}; Lugagne PM et al.; Despite the advances achieved in imaging methods, the diagnosis of acute pyelonephritis rests on clinical and bacteriological date . Yet imaging is of considerable value to exclude a possible obstacle in the excretory canals which might be responsible for acute pyelonephritis . Ultrasonography associated with plain abdominal radiography without preparation or with intravenous urography is the choice method . In case of atypical forms, patients at risks or resistance to medical treatment, computerized tomography provides an information that is invaluable for the diagnosis as well as for the prognosis.

Vnitr Lek, 1993 May, 39(5), 437 - 44
{Early empiric antibiotic therapy of infectious complications in patients with neutropenia}; Kubesova H et al.; Aggressive chemotherapy used at present for the treatment of malignant haematological diseases leads to prolonged aplasia of the bone marrow with the possible development of fulminant infectious complications . Treatment of these complications must be started immediately when they are detected, i.e . as a rule without knowing the bacteriological finding at the time . The objective of the present work was to assess by analysis of 376 positive bacteriological findings from hospitalized patients with neutropenia and 141 findings of immunocompromised patients in their homes a combination of antibiotics for empirical treatment of infectious complications which developed during hospitalization or treatment at home.

Ann R Coll Surg Engl, 1993 May, 75(3), 181 - 5
To dry or not to dry? An assessment of the possible degradation in efficiency of preoperative skin preparation caused by wiping skin dry; Kutarski PW et al.; A controlled study of the effects of wiping skin dry after application of aqueous povidone-iodine was carried out in 24 subjects . There was no significant difference in the reduction from baseline counts of skin flora at 5, 30, 60 and 120 min between wiping the agent off after 30 s of application and leaving it to dry . It would appear that wiping skin dry that has been prepared for operation with this solution in order to allow application of adhesive drapes is a bacteriologically safe practice.

Rev Med Interne, 1993 May, 14(5), 307 - 12
{Current aspects of brucellosis}; Janbon F; In France, human brucellosis decreased significantly between the 70's (800 annual cases) and 1992 (102 cases), the result of the veterinary fight against animal disease . Bovin brucellosis is almost eradicated except into Massif Central, Pyrenees and Alpes, where goats and sheep are always responsible for the contamination of cows . B . melitensis 9/11 biovar 3 is the more frequent contaminant . Clinical features of human disease are unchanged but skeletal and visceral focalisations become less frequent than previously--Blood cultures--too often left--and seroagglutination remain classical means of diagnosis . I.I.F . and ELISA are more precise because recognition of specific IgM and IgA which are good evidence of recent or persistent infection . In vitro antibody production--assay (IVAP) is more sophistical; its value should be assessed . Today antibiotherapy for acute or subacute forms is based on associations: Tetracycline (2 g/d) or better Doxycycline (200 mg once daily for 45 d) are always associated with either Streptomycin (1 g daily for 21 days) or Rifampicin (900 mg once daily for 45 d) . The first regimen is probably more efficient than the second one because relapses occur more often (5-10%) with Doxycycline-Rifampicin than with Doxycycline-Streptomycin (relapses: 4-5%) . In pregnant women Cotrimoxazole-Rifampin is efficient enough and atoxic if the treatment is stopped 7 days before delivery . The same regimen is recommended in children less 8 years of age . Veterinary action should be going on in spite of its cost . Individual measures (gloves, antiseptic solution for shoes, boiled milk...) are always necessary . Specific immunization (vaccin Merieux, France) often seems efficient despite a few light adverse effects; its use is recommended in farmers, veterinary and bacteriologic workers.

Bull Acad Natl Med, 1993 May, 177(5), 719 - 26; discussion 726-8
{Critical study of surveillance of nosocomial infections}; Maisonnet M; The institution of a continuous surveillance program is a compulsory prerequisite to the effective control of nosocomial infections . This is actually the main task of the Committee for Nosocomial Infection Control as ruled by the decree of 8 May 1988 . The methodology of this surveillance relies on the continuous collection of data . It must apply to hospitals of any size and lead to practical actions, at the general or local level according to circumstances . Data concern patients and staff as well . They must be collected from different sources among which the bacteriology and hygiene laboratories play an important role . However infection records from wards constitute the cornerstones for the surveillance program: the personnel involved in the filling of the forms must be clearly identified . The scope of the surveillance and analytical methods are also discussed: a comprehensive control of the whole hospital associated with incidence measurement appears to be the best approach . Prevalence surveys are also performed . They allow a better control of continuous surveillance processes . However these processes will only be profitable if the data to be recorded have been previously specified . It is of importance to get the most comprehensive data about infectious hazards . One might rely not on global infection rates per hospital, as they have no significance, but on specific infection rates in correlation with body sites or risk factors.

J Clin Microbiol, 1993 May, 31(5), 1232 - 6
Identification of specific antigens of Pseudomonas pseudomallei and evaluation of their efficacies for diagnosis of melioidosis; Anuntagool N et al.; Current methods for the diagnosis of melioidosis are based on bacteriological culture . A number of serological tests currently available lack specificity and sensitivity . This is largely due to the use of crude antigens which results in a significant cross-reactivity with sera from individuals infected with other bacteria . In this study five different antigens were prepared and evaluated for their potential usefulness in diagnosis of melioidosis . These included a 19.5-kDa antigen which was previously shown to be specific by Western blotting (immunoblotting), a crude cell extract, a veronal extract, a 39.0-kDa antigen, and an immunoaffinity-purified antigen . All antigens were used for detecting antibody in sera from patients with septicemic melioidosis by indirect enzyme-linked immunosorbent assay . The results were compared with those obtained with sera from patients with other bacterial infections and normal sera from areas where the infection is and is not endemic . The 19.5-kDa antigen exhibited the most satisfactory results, with 92% sensitivity, 91% specificity, 81% positive predictive value, and 96% negative predictive value based on a background obtained with normal sera from the area where the infection is nonendemic . These values were 82% sensitivity, 96% specificity, 94% positive predictive value, and 87% negative predictive value based on results with normal sera from the area where the infection is endemic . Results from this study showed that the 19.5-kDa antigen was potentially useful in the diagnosis of melioidosis and deserves further investigation.

Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Apr, 31(4), 426 - 30
{Endoscopic classification of healing process in tracheobronchial tuberculosis}; Rikimaru T et al.; Out of 404 patients with pulmonary and/or tracheobronchial tuberculosis treated during the last 10 years at Kurume University Hospital and St . Mary Hospital, in 41 patients, who had been histopathologically or bacteriologically diagnosed as having active tracheobronchial tuberculosis, tracheobronchial lesions were examined by use of bronchofiberscope . Most patients were treated by a combination of three antituberculous agents (INH, RFP and SM or EB) . In 31 patients out of the 41 patients, broncho-fiberscopic examinations were performed twice or more . We observed the ulcerous lesions of bronchial tuberculosis at various stages of healing, and could classify the ulcerous lesions into the following three stages . Active Stage: stage A; ulcer formation without regenerating epithelium, Healing Stage: stage H; ulcer formation with regenerating epithelium, Scarring Stage: stage S; and no ulcer formation . Only the lesions of stage A were observed before treatment . In many patients during the first and second month of treatment, the lesions were stage A or H . It was found that healing of the lesions of tracheobronchial tuberculosis progressed through the stages A, H, and S, in this order . The smear positive rates in sputum were 88.5% in stage A, 12.9% in stage H and 5.0% in stage S . The culture positive rates in sputum were 88.5% in stage A, 20.0% in stage H, and 0% in stage S . We conclude that at least 3 months were generally required for the healing of tracheobronchial tuberculosis with ulcerous lesion . However, it seems that the period of time for healing of ulcerous lesions is shorter in patients who are treated by aerosol therapy with SM.(ABSTRACT TRUNCATED AT 250 WORDS)

J Chemother, 1993 Apr, 5(2), 124 - 32
Comparison of the efficacy and safety of ceftibuten and cefaclor in the treatment of pneumonia and bronchiectasis; McCabe R et al.; In a multicentre, international study of 187 adult patients with bacterial pneumonia or bronchiectasis, the safety and efficacy of a regimen of 200 mg ceftibuten administered twice-daily was compared with cefaclor given in a dosage of 500 mg three times a day . Of the 94 evaluable patients, 66 received ceftibuten and 28 received cefaclor . The overall bacteriological response was similar in the two treatment groups with elimination of the original pathogen in 91% and 89% of the patients receiving ceftibuten and cefaclor, respectively . The overall clinical response mirrored the bacteriological results with a successful clinical outcome in 92% of ceftibuten-treated patients compared with 93% in patients receiving cefaclor . Adverse experiences were, in general, few and mild, being reported in 8% and 17% of patients receiving ceftibuten and cefaclor, respectively.

J Appl Physiol, 1993 Apr, 74(4), 1521 - 7
Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation; Tokyay R et al.; Splanchnic ischemia has been associated with bacterial translocation and increased endotoxin absorption from the gut . To study the effects of major burn on splanchnic circulation, minipigs were randomized to receive 40% flame burn and Parkland resuscitation or sham burn and maintenance fluids . Total and fractionated blood flow, O2 delivery and consumption, mucosal pH of the intestine, and endotoxin levels in the superior mesenteric vein were measured for 48 h, and then abdominal organs were harvested for bacteriological culture and histopathological analysis . Total mesenteric blood flow and fractionated blood flow to the mucosa-submucosa of the jejunum, cecum, and colon decreased 2 and 4 h postburn . Although mesenteric O2 consumption was unchanged, mesenteric O2 delivery and intestinal mucosal pH were decreased during the early postburn period . Concomitantly, endotoxin levels in the superior mesenteric vein were significantly elevated during the first 8 h postburn . The bacteriological cultures of the systemic tissue samples showed increased bacterial translocation in the burn group . After major burns, there is a transient selective splanchnic vasoconstriction, which is associated with intestinal mucosal acidosis and increased incidence of bacterial translocation and endotoxin absorption from the gut.

J Antimicrob Chemother, 1993 Apr, 31(4), 599 - 606
Audit of prescription and assay of aminoglycosides in a UK teaching hospital; Shrimpton SB et al.; Despite potential nephrotoxicity and ototoxicity, aminoglycosides are widely used in the treatment of severe sepsis but monitoring of serum levels is necessary . The use and assay of aminoglycosides, together with microbiologists' and pharmacists' advice on dosage and potential toxicity were examined in a teaching hospital group during an eight week period . A total of 480 courses of aminoglycoside was recorded in 440 hospital in-patients and of these, 306 (64%) were for prophylaxis . For 79 (45%) of 174 therapeutic courses, bacteriological results were available at the start and the choice of antibiotic was appropriate in 69 cases . Serum aminoglycoside assays were performed in 86% (149/174) of therapeutic courses . Correct assay request forms were used in 79% of 473 assay requests, and the clinical diagnosis was given on 73% of forms . In so-called peak samples with a documented time of collection, this ranged from 5 min to over 9 h post dose . Potentially toxic concentrations were present in 56 (12%) serum samples from 50 courses, in ten of which there was a serum creatinine rise of > 40 microM . However, there were confounding factors in five cases . Probable nephrotoxicity was rare, although assays were not performed in 14% of therapeutic courses . There were no symptomatic cases of ototoxicity but audiometry and vestibular studies were not performed . Closer liaison between the microbiologists, pharmacists and clinical staff is essential to improve clinical practice . Computer notification of inadequately monitored courses would be helpful . The routine therapeutic use of aminoglycosides needs to be reviewed in the light of the rising costs of assay litigation and the increasing number of alternative antibiotics available.

Ann Plast Surg, 1993 Apr, 30(4), 341 - 4
A study of simplified porcine skin preservation; Visuthikosol V et al.; The study of preserved porcine skin was done by using split-thickness skin grafts of pigs weighing approximately 25 to 30 kg . The harvesting of split-thickness skin grafts was performed under aseptic and antiseptic conditions . The povidone-iodine solution and 0.25% acidified sodium hypochlorite solution were used before immersion of the skin in 90% glycerine solution . Prepared skin graft was stored in the freezer compartment of a home refrigerator . Serial studies of the bacteriology and the histology of specimens were performed monthly for 12 months . No bacterial organisms were found during the study . The integrity of the skin lasted up to 5 months, however, the property of the preserved skin was as good as the other biological dressing even after 6 months . This simple, low-cost procedure is useful for restoring allografts or even autografts in a hospital without conveniences or adequate facilities.

Infusionsther Transfusionsmed, 1993 Apr, 20 Suppl 1, 48 - 55
{Serum IgG concentrations and antibody titer of burn patients after preventive intravenous IgG substitution with a Pseudomonas immunoglobulin}; Stuttmann R et al.; In a randomized clinical trial 30 patients with burn injury received supportive therapy with a Pseudomonas hyperimmunoglobulin (Psomaglobin N) . The control group received no additional therapy . The patients of both groups were between 15 and 60 years of age and had a full-thickness burn of 30-70% of the body surface area with inhalational trauma being optional . The whole trauma was classified and scored with the 'Abbreviated Burn Severity Index' (which allows another extra score point for inhalational trauma) . Both groups underwent the same intensive care unit treatment with preference to early wound excision and wound grafting following functional aspects of reconstructive surgery . Bacteriological monitoring was performed on suspicion of wound infection and bacteremia by taking wound swabs and blood cultures . The supportive treatment group received a total of 250 mg/kg hyperimmunoglobulin on days 3, 5, 7, 10, and 13 . Of 30 patients in the control group 16 had an additional inhalation trauma, and 8 of those (50%) died (only 1 of 14 patients without inhalation trauma died) . In the group receiving supportive treatment, 23 out of 30 patients had an inhalation trauma, and 8 of those (35%) died (1 of 7 patients without inhalation trauma) . In both groups with inhalation injury, the patients were at risk of developing bacteremia: 13 of 23 of the immunoglobulin-treated patients and 12 of 16 patients of the control group . Bacteremic controls died at a lower score than bacteremic immunoglobulin-treated patients (8.6 vs . 10.3 points).(ABSTRACT TRUNCATED AT 250 WORDS)

Resuscitation, 1993 Apr, 25(2), 119 - 36
Visceral, hematologic and bacteriologic changes and neurologic outcome after cardiac arrest in dogs . The visceral post-resuscitation syndrome; Cerchiari EL et al.; We studied the post-resuscitation syndrome in 42 healthy dogs after normothermic ventricular fibrillation cardiac arrest (no blood flow) of 7.5, 10, or 12.5 min duration, reversed by standard external cardiopulmonary resuscitation (CPR) (< or = 10 min) and followed by controlled ventilation to 20 h and intensive care to 72 h . We reported previously, in the same dogs, no difference in resuscitability, mortality, or neurologic outcome between the three insult groups . There was no pulmonary dysfunction, but post-arrest cardiovascular failure, of greater severity in the 12.5 min arrest group . This report concerns renal, hematologic, hepatic and bacteriologic changes . Renal function recovered within 1 h after arrest, without permanent dysfunction . Clotting derangements at 1-24 h postarrest reflect transient disseminated intravascular coagulation with hypocoagulability, more severe after longer arrests, which resolved by 24 h after arrest . Hepatic dysfunction was transient but more severe in the animals that did not recover consciousness and correlated with neurologic dysfunction, but not with brain histologic damage . Bacteremia was present in all animals postarrest . We conclude that in the previously healthy organism after cardiac arrest of 7.5-12.5 min no flow, visceral and hematologic changes, although transient, can retard neurologic recovery.

Surg Neurol, 1993 Apr, 39(4), 290 - 6
Review of 140 patients with brain abscess; Yang SY et al.; There were 140 cases of brain abscess treated between 1980 (when CT scanning became available) and June 1991 . These arose by spread of a contiguous area of infection in 37%, and from another identified cause in 22%; the origin was undetermined in 41% . There were multiple abscesses in 11% . The abscess was < 2 cm in diameter in 21% . In two-thirds of the patients, the intracranial pressure was raised, there were localizing neurologic signs in 33%, and in 28% there were epileptic seizures . The computed tomographic (CT) feature of an abscess in the capsular stage was a thin, regular, and uniform, ring-like enhancement . In the cerebritis stage, nine out of 17 patients showed a uniform enhancement throughout the lesion . Since 1989, 14 cases have been investigated with magnetic resonance imaging (MRI) . In 11, the abscess was in the capsular stage . In both T1- and T2-weighted images, the abscess and the surrounding inflammatory area were well demonstrated, and with T2-weighting, the capsule showed a low-intensity signal clearly . In the three abscesses in the cerebritis stage, there was a uniform abnormality with indistinct margins between the abscess, inflammatory edema, and surrounding grey and white matter . All cases received a combination of wide-spectrum antibiotics before the organism was identified; and later the medication was administered according to bacteriologic indication of the organism of 112 cases, organisms were identified in 71%, with anaerobic organisms occurring in 30% of these . In 127 cases, surgical treatment was used: either repeated aspiration, excision or both . We treated 13 cases that had small, early, or multiple abscesses with antibiotics only . The mortality with surgical treatment was 7.9%, and no case treated conservatively died.

Unfallchirurg, 1993 Apr, 96(4), 192 - 9
{Tuberculosis of bones and joints}; Richter-Turtur M et al.; In developing countries tuberculosis of the bones and joints is a disease with an endemic character . In industrialized nations it is also gaining importance again as a result of social problems and of cases of immune deficiency . After the bacteriologic/histologic diagnosis of tuberculosis of the bones and joints, the primary therapy is non-operative with immobilization and antituberculous chemotherapy . Nevertheless, there are indications when an abscess and arthrodesis or spondylodesis must be cleaned operatively . An absolute and urgent indication for operative cleansing and stabilization is acute progressive paraplegia.

J Vasc Surg, 1993 Apr, 17(4), 710 - 8
Human vascular endothelial cell attachment and growth inhibition by type V collagen; Ziats NP et al.; PURPOSE: Human vascular prostheses develop a pseudointima that after time is devoid of a complete endothelial lining . The composition of this pseudointima consists of both cellular and noncellular components such as coagulation proteins and extracellular matrix proteins . Of these extracellular molecules, type V collagen has been reported to be localized to surfaces of vascular prostheses . We have hypothesized that type V collagen may be involved in the mechanisms of inhibition of endothelialization on vascular prostheses . In this study, interactions of human protein and cells with clinically used material and reference surfaces were analyzed in vitro . METHODS AND RESULTS: Human collagen types IV and V or human fibronectin was coated on disks punched from expanded polytetrafluoroethylene, bacteriologic polystyrene, and tissue culture-treated polystyrene . Fibronectin adsorbed equally to these surfaces, but differential adsorption of type V collagen occurred . The attachment and growth of human saphenous vein and umbilical vein endothelial cells and of human skin fibroblasts were also evaluated on protein-coated or uncoated surfaces . Type IV collagen and fibronectin promoted the attachment of these cells, but type V collagen reduced cellular adhesion . Growth of endothelial cells was significantly inhibited on surfaces coated with type V collagen even when additional growth substances such as serum, retinal-derived growth factor, and heparin were present in the medium . Human adult dermal fibroblast adhesion and cell growth were not affected by coating the surfaces with type V collagen . CONCLUSIONS: The components of the extracellular matrix of the pseudointima may directly influence endothelial cells by inhibiting cell proliferation, migration from within the graft or from anastomoses, or both . Type V collagen, a matrix protein found at luminal surfaces of vascular prostheses, may be one protein responsible for control of endothelial responses.

J Vasc Surg, 1993 Apr, 17(4), 635 - 45
Infected infrarenal aortic aneurysms: when is in situ reconstruction safe?
Fichelle JM, Tabet G, Cormier P, Farkas JC, Laurian C, Gigou F, Marzelle J, Acar J, Cormier JM.
Twenty-five infected infrarenal aortic aneurysms operated on between 1968 and 1989 were reviewed . They were classified into post-embolic (mycotic) aneurysms (group I), infective aortitis (group II), and infected atherosclerotic aneurysms (group III) . Aortoduodenal fistulas were found in eight patients and aortocaval in two . Five patients were operated on in a state of shock, and 12 had preoperative positive blood cultures . Surgical procedures included in situ reconstruction of the aorta (n = 21) and extra-anatomic bypass associated with aneurysmal resection (n = 4) . In 19 patients, prostheses were covered with omental flaps, and antibiotics were continued for more than 6 weeks in all patients . In patients who underwent in situ reconstruction, three deaths were related to the initial surgery . All surviving patients were regularly followed up, and none showed any sign of late septic recurrence . In patients who underwent extra-anatomic bypass, two died in the postoperative period, one underwent reoperation 2 years after the initial surgery, and the last patient is doing well . Positive postoperative blood cultures (n = 4) revealed persistent sepsis: two cholecystitis, one spondylitis, and one aortic infection . An exhaustive review of the literature was performed; clinical, bacteriologic, and operative features and results were analyzed; prognostic factors were evaluated; and a practical therapeutic approach was suggested . The importance of preoperative diagnosis, complete resection, debridement of infected tissues, omental flap coverage, and long-term antibiotic therapy with regular computerized tomographic scanning follow-up is stressed.

Clin Infect Dis, 1993 Apr, 16(4), 540 - 9
Extrapulmonary and disseminated infections due to Mycobacterium malmoense: case report and review; Zaugg M et al.; Mycobacterium malmoense is a potentially pathogenic species that was first described in 1977 . During the past decade M . malmoense has been recognized with increasing frequency as a pulmonary pathogen . More than 180 cases of M . malmoense infection have been reported . Most of these infections affected a previously damaged lung . Other infection sites included the skin, lymph nodes, and bursae . Five cases of disseminated infection have been reported . The antituberculous drugs associated with the most favorable susceptibility patterns are rifampin and ethambutol . Because of the slow growth of M . malmoense on conventional, egg-based bacteriologic media, the incubation time should be > 6 weeks; special solid and liquid media are recommended . We report a case of disseminated pulmonary and gastrointestinal infection due to M . malmoense in a patient with AIDS, who was treated successfully with a combination of rifabutin (ansamycin), clofazimine, and isoniazid . In addition, we review the characteristics of extrapulmonary and disseminated infections due to M . malmoense.

Rev Med Interne, 1993 Apr, 14(4), 253 - 6
{Relapsing polychondritis and mesenteric panniculitis: apropos of 2 cases}; Sauvaget F et al.; We report two cases of polychondritis associated with mesenteric panniculitis . Case 1 . In February 1989, a woman born in 1949 presented with 40 degrees C fever accompanied by pain in the abdomen and pelvis . Eight days later, nodular skin lesions appeared on her lower limbs . The abdomen was swollen with gas and undepressible . An abdominal CT scan revealed partitioned peritoneal collections, and a guided needle aspiration produced a chylous fluid . Direct and indirect bacteriological examinations gave negative results . Histology showed intense inflammatory reaction with giant cells and lipophages, thereby confirming the presence of mesenteric panniculitis . Six months later, the development of chondritic lesions on the nose and the helix of the ear clinched the diagnosis of polychondritis . The patient was put on corticosteroid therapy for a few months, and in January this year (1993) she is durably asymptomatic . Case 2 . In October 1977, a woman born in 1937 presented with polychondritis with prolonged fever, inflammatory syndrome and chondritic lesions of the nose, larynx and helix of the ear . In December 1978, she developed signs of abdominal obstruction . Laparotomy revealed infiltration by multiple nodular formations of the entire posterior line of attachment of the mesentery . Biopsies withdrew a puriform fluid . Histology showed a partly necrotic adipose tissue with giant cells and lipophages . High-dose corticosteroid therapy partially controlled the chondritic and abdominal manifestations . The occurrence of abdominal pain in patients with polychondritis may result from several disorders, such as iatrogenic complications, digestive tract vasculitis or ulcerative colitis, but also associated mesenteric panniculitis.

Zhonghua Liu Xing Bing Xue Za Zhi, 1993 Apr, 14(2), 78 - 80
{A report on investigation of an outbreak of Legionnaires' disease in a hotel in Beijing}; Deng C; During the period from February to March, 1992, an outbreak of upper respiratory infection (influenza-like syndrome) took place in a hotel in Beijing . An epidemiological investigation and bacteriological examination were carried out in this hotel . The results showed that it was an outbreak of Legionnaires' disease caused by Legionella pneumophila serogroup 10 (Lp10): The incidence was 13.51% (5/37) . This is the first report on LP10 infection in China.

Indian J Lepr, 1993 Apr-Jun, 65(2), 173 - 80
Comparative study of short term results in two multidrug regimens in multibacillary leprosy; Singh RP et al.; Thirty lepromatous and Borderline lepromatous leprosy patients were treated with multidrug therapy in an open trial . Fifteen of them received the standard WHO multidrug regimen ie., rifampicin 600 mg and clofazimine 300 mg monthly, supervised, and dapsone 100 mg daily and clofazimine 100 mg on alternate days as self administered; the other 15 received a modified multidrug therapy regimen comprising of rifampicin 600 mg, clofazimine 100 mg and dapsone 100 mg daily for 21 days as suggested by the Indian Association of Leprologists, followed by the standard WHO regimen . The observation period was six months . Clinical, bacteriological, histological and immunological parameters were studied . The fall in morphological index was much faster in patients receiving modified multidrug therapy regimen compared to those receiving the standard WHO regimen . Otherwise, there was no difference between the two groups of patients . Five patients developed type I (upgrading) reaction with one developing ulnar nerve paralysis . No untoward effects of drugs were noted in the study subjects except for darkening of skin colour of all the patients.

Indian J Gastroenterol, 1993 Apr, 12(2), 45 - 6
Identification of Helicobacter pylori by endoscopic crush cytology; Nijhawan R et al.; BACKGROUND: Gastric crush cytology is employed in a variety of situations including diagnosis of malignant disease and the detection of Helicobacter pylori infection . OBJECTIVE: To evaluate the usefulness of gastric crush cytology in the detection of H pylori infection . METHODS: Gastric biopsy specimens from 50 patients of gastric or duodenal peptic ulceration were studied by gastric crush cytology, histopathology, bacteriologic culture and rapid urease test and results of various methods compared . RESULTS: Thirty seven patients had H pylori demonstrable in crush smears and 28 in histopathological sections . In 15 patients, the organism was detected by cytology alone and in 6 samples by histopathology alone . There was concordance of 76% between these two morphological techniques . The organism could be cultured from 22 biopsy specimens and urease test was positive in 37 specimens . CONCLUSION: Gastric crush cytology is a useful method for detection of H pylori infection.

Acta Ophthalmol (Copenh), 1993 Apr, 71(2), 165 - 8
Acute conjunctivitis . A comparison of fusidic acid viscous eye drops and chloramphenicol; Horven I; Fucidic acid viscous eye drops 1% given twice daily was compared with chloramphenicol eye drops 0.5% given 6 times daily in patients with acute conjunctivitis . Patients were recruited from 38 general practitioners in Norway . The mean duration of treatment was 6.6 days for Fucidic acid, 6.2 days for chloramphenicol . There was no major differences between the two groups in the bacteriological findings, and there was no significant difference in response to treatment . The use of fusidic acid in a carbomer vehicle as in Fucithalmic, has proved to give a long-lasting antibiotic concentration in the tear fluid, which allows the preferable twice daily application.

Am J Med, 1993 Mar 22, 94(3A), 195S - 200S
Randomized comparative study of fleroxacin and chloramphenicol in typhoid fever; Arnold K et al.; This study compared fleroxacin, 400 mg daily for 7 or 14 days, with chloramphenicol, 50 mg/kg per day for 14 days, for the treatment of patients with typhoid fever in a multicenter study . A total of 184 patients were randomly assigned to the three treatment groups . Efficacy was determined by culture of blood and stool, overall clinical response, and time to defervescence . Safety was assessed by occurrence of adverse events and laboratory abnormalities . A total of 97 patients were evaluable for efficacy, 28 in the fleroxacin 7-day group, 35 in the fleroxacin 14-day group, and 34 in the chloramphenicol group . All showed rapid defervescence with high cure rates . Bacteriologic cure rates were 96% in the fleroxacin 7-day group, 97% in the fleroxacin 14-day group, and 85% in the chloramphenicol group . Clinical cure rates were 83-100% with fleroxacin and 82% with chloramphenicol . The time to defervescence was shorter for patients treated with fleroxacin than for those treated with chloramphenicol . All three treatment regimens were well tolerated . Fleroxacin, 400 mg daily for 7 days, appears to be satisfactory for the treatment of typhoid fever and compares favorably with the standard 14-day therapy with chloramphenicol.

Am J Med, 1993 Mar 22, 94(3A), 142S - 149S
Intravenous fleroxacin versus ceftazidime in the treatment of acute nonpneumococcal lower respiratory tract infections; Farkas SA; Fleroxacin, administered intravenously at a dosage of 400 mg once a day, was compared with ceftazidime, 0.5-2 g three times daily or 1-2 g twice daily, administered for 4-21 days, for treatment of nonpneumococcal lower respiratory tract infections . A total of 319 patients were enrolled and randomized to receive treatment with fleroxacin or ceftazidime in a 2:1 ratio . Of those enrolled, 68 fleroxacin- and 49 ceftazidime-treated patients were included in the efficacy analysis . The most common diagnoses were pneumonia or pneumonitis (47% of the fleroxacin group and 57% of the ceftazidime group) and exacerbation of chronic bronchitis (38% and 33%, respectively) . In the fleroxacin group, 59 (88%) of 67 patients were bacteriologic cures, and in the ceftazidime group, 40 (90%) of 49 were bacteriologic cures . It could be concluded with 95% confidence that the bacteriologic outcomes, by infection, for the two groups were equivalent (fleroxacin, 88%; ceftazidime, 90%) . The rates of clinical cure were 59 (88%) of 67 for the fleroxacin group and 40 (82%) of 49 in the ceftazidime group, but since the 95% confidence limit around the between-group difference was greater than the stipulated +/- 15%, it could not be concluded that the outcomes were equivalent . The percentage of patients who experienced adverse clinical or laboratory events was similar in the two treatment groups (12% and 13%) . The bacteriologic outcomes, by infection, were equivalent for the two treatment groups . Protocol requirements permitting a determination of equivalence of the outcomes for clinical cure were not met, although the rates were similar.

Am J Med, 1993 Mar 22, 94(3A), 136S - 141S
Fleroxacin versus amoxicillin in the treatment of acute exacerbation of chronic bronchitis; Ulmer W; The objective of this double-blind, multicenter study was to compare the efficacy and safety of oral fleroxacin, 400 mg once daily for 7 days, with amoxicillin, 500 mg administered every 8 hours for 7 days, in the treatment of acute exacerbation of chronic bronchitis . Adult male or female inpatients or outpatients were included . Patients gave informed consent and underwent a physical examination . Appropriate sputum specimens were collected, gramstained, and cultured before and 3-9 days after therapy . Complete blood count, serum chemistry, and urinalysis were performed before and 3-9 days after therapy . Of the 625 enrolled patients, 286 (148 in the fleroxacin group and 138 in the amoxicillin group) were evaluable for efficacy . The rate of bacteriologic cure was 96% (142 of 148) among patients in the fleroxacin group and 83% (114 of 138) among patients in the amoxicillin group, showing a statistically significant superiority for fleroxacin . The rate of clinical cure in the patients evaluable for this parameter was 90% (131 of 145) in the fleroxacin group and 82% (111 of 136) in the amoxicillin group . The differences were not significant, but the trend supported the bacteriologic results . Adverse clinical events related to the trial medication were reported by 61 (19%) of 313 patients receiving fleroxacin and by 27 (9%) of 310 patients treated with amoxicillin . The rates of bacteriologic cure and clinical success for fleroxacin were higher than those for amoxicillin . While the overall rate of adverse events was higher in the fleroxacin group, the proportions of patients with severe adverse events was higher in the fleroxacin group, the proportions of patients with severe adverse events were similar in the two groups . Most of the reported events were not serious or severe and were generally well tolerated, as reflected by the low proportion of premature withdrawals for this reason.

Minerva Chir, 1993 Mar 15, 48(5), 193 - 7
{Anastomotic pseudoaneurysms of the femoral bifurcation . Clinical experience}; Bonelli U et al.; The authors report their experience of the treatment of anastomotic pseudoaneurysms of the femoral tripod . The paper analyses 231 cases treated over the past 8 years by the Division of Vascular Surgery using an alloplastic prosthetic implant in correspondence with the femoral tripod . Pseudoaneurysms were observed in 23 patients (9.8%) and emergency corrective surgery was required in 10 cases (43%) and elective surgery in 13 (56.5%) . A total of 6 trans-obturator by-passes, 2 femoro-femoral by-passes using the saphena vein, 2 axillo-popliteal by-passes, 8 resections and re-implants, and 5 ligatures were performed . Immediate permeability was obtained in 15 patients, whereas 5 were amputated at the thigh and the remaining patient undergoing ligature preserved the limb but with chronic ischemic symptoms; 2 patients died . In the long-term follow-up of those patients who were permeable on discharge, permeability had persisted in 5 (83%) treated with trans-obturator by-pass and in 7 (87%) who had undergone resection and re-implant . The remaining axillo-popliteal by-pass had thrombosed after 6 months but the patient had not lost the limb . The authors underline the unpredictability of this pathology and analyse the causes which may provoke the development of this complication which inevitably leads to thrombosis or hemorrhage . However, suture materials (continuing pseudoaneurysm in spite of not using silk), the infective etiology (the extreme difficulty of obtaining a positive bacteriological culture) and the inguinal region (onset of pseudoaneurysm during aorto-femoral by-pass but hardly ever during femoro-popliteal by-pass) may be contributory causes but not decisive factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Epidemiol, 1993 Mar, 9(2), 217 - 23
Etiology of traveller's diarrhea in Spanish travellers to developing countries; Gascon J et al.; A cohort of 337 Spanish travellers to developing countries is presented . They all consulted us for traveller's diarrhea (TD) . Bacteriological, parasitological and virological examinations were performed . A bacterial cause was found in 61.65% of travellers . Toxigenic and classical pathogenic Escherichia coli strains were the main bacterial agents . In comparison with other studies, Spanish travellers harboured Y . enterocolitica and EPEC organisms as a cause of TD . G . lamblia and E . histolytica were the most frequently isolated protozoa . Helminths were found in only 9 patients . No rotavirus infections were diagnosed . Previous antibiotic treatment had been taken by 161 patients . The percentage of isolated enteropathogens was similar in travellers who had previously taken antibiotic treatment and those who had not.

Changgeng Yi Xue Za Zhi, 1993 Mar, 16(1), 19 - 24
Extrapulmonary tuberculosis in children; Chung JL et al.; Extrapulmonary tuberculosis is not a rare infection of children in Taiwan . From 1985 to 1989, we studied 39 children with the diagnosis of extrapulmonary tuberculosis from a total of 43 sites . They were diagnosed by routine diagnostic tests including bacteriologic cultures in 11, pathological features in 25, and clinical presentations in 2 patients . Positive mycobacterial DNA probe method was obtained from a patient with tuberculous meningitis . The most common sites of involvement were lymph nodes in 9 (20.9%), meninges in 7 (16.3%), bone in 7 (16.3%), joint in 6 (14.0%) and miliary infection in 6 (14.0%) . The median age of the 2 patients with renal tuberculosis was 14.5 years, which was older compared to the patients with other organ systems involvement . Tuberculin skin tests were significantly positive (> 10 mm) in 54% of the tested children . Among the treated patients, 76% were cured after 9 to 12 months of antituberculous chemotherapy without sequelae, while 24% had sequelae associated with tuberculous infection despite treatment . There was no death reported during the study period . We conclude that extrapulmonary tuberculosis remains an important health problem to the pediatric population of this island despite the overall decline in the incidence of tuberculosis . Early detection and thorough treatment for a suitable period are mandatory to improve the prognosis of this potentially curable infectious disease.

Rev Fr Gynecol Obstet, 1993 Mar, 88(3 Pt 2), 215 - 7
{Antibiotics and bacterial vaginosis}; Berrebi A; The two questions that arise in the treatment of bacterial vaginosis are: who should be treated and how can the frequent recurrences be avoided? Metronidazole is the reference agent in this setting . At a dose of 500 mg bid for 3-7 days, the clinical and bacteriologic cure rates range from 80 to 100 p . cent . Clindamycin and amoxycillin-clavulanic acid are both effective; amoxycillin is less effective but can be used when other antibiotics are contraindicated (pregnancy, etc.) . Not all cases of bacterial vaginosis should be treated, as about 50 p . cent are totally asymptomatic . However, the risk of occasionally serious infectious complications calls for treatment of patients with risk factors, such as symptomatic vaginosis, high-risk pregnancy, a history of gynecological infection, pelvic surgery (particularly by the vaginal route), and sterility . Although bacterial vaginosis is not strictly a sexually transmitted disease, treatment of the partner can reduce the risk of recurrence . Suitable antibiotic treatment is usually associated with clinical and bacteriological resolution of bacterial vaginosis . Unfortunately, long-term follow-up of these patients has shown a risk of recurrence as high as 80 p . cent at nine months, for reasons which remain to be elucidated.

Salud Publica Mex, 1993 Mar-Apr, 35(2), 119 - 31
{The Free Trade Agreement and environmental health in Mexico}; Hernandez-Pena P et al.; This work offers an overview of the state of the art and future state of environmental health in our country from a viewpoint of the impact of the commercial opening established in the Free Trade Agreement among Mexico, the USA, and Canada . In the first section of this work, we analyze the expected economic changes resulting from the implementation of the FTA and foretells the way in which those changes will influence the present environmental and epidemiologic profiles of this country in the medium and long term . The main changes predicted by the analysis are, in the epidemiologic context, the acceleration of the transference of occupational, consumption, environmental and population risks, characteristic of industrialized countries, to the country's polarized epidemiologic profile; and, in the environmental context, a transition consisting of a broadening and composition of the spectrum of pollutants, including and important lagging of bacteriologic control . The second section offers an analysis of the predicted response capacity facing the new environmental risk dynamics in the country, encompassing regulation, normativeness and enforcement of environmental and consumer protection, as well as obstacles found in health services to the implementation of surveillance, detection and treatment of health damages caused by environmental factors . The analysis of the organized social response to these problems discloses a relative flexibility of the normativeness and enforcement functions in comparison with our northern neighbors, a paramount factor for the possible transference of environmental risks, as well as the informational and research deficiency about environmental issues, basic elements for sustaining environmental health in the country, aiming at speeding up the development and transference of technologies for prevention, detection and management of environmental risks in the country, drawing upon the systematization of our experience and that of our neighbors . This speeding process ought to match, in the medium term, the velocity of risk transference produced by the commercial opening . In this way, the commercial integration of North America will become a favorable context for the development of the environmental health infrastructure of the country.

J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 159 - 68
Dirithromycin in the treatment of skin and skin structure infections; Derriennic M et al.; The efficacy and safety of dirithromycin were compared with those of erythromycin or miocamycin for the treatment of skin and/or skin structure infections in two double-blind, double-dummy, randomized, parallel group, multicentre studies conducted in North America and in Europe, and one single-blind, randomized, parallel group study conducted in Italy . The US and European study patients, in which bacterial infection was confirmed by culture, received either dirithromycin 500 mg once daily or erythromycin base 250 mg four times daily for seven days . Patients in the Italian trial were treated with either 500 mg dirithromycin once daily or with 600 mg miocamycin twice daily for seven days . A total of 156 of the 304 US patients treated with dirithromycin and 127 of the 274 patients treated with erythromycin qualified for efficacy analysis post-therapy . At the post-therapy evaluation, 112 (71.8%) dirithromycin-treated patients were cured and 34 (21.8%) improved compared with 94 (74.0%) and 25 (19.7%) patients treated with erythromycin . The pathogen was eliminated or presumably eliminated in 136 (87.2%) and 110 (86.6%) dirithromycin- and erythromycin-treated patients, respectively . A total of 100 of the 193 dirithromycin-treated patients qualified for efficacy analysis, as did 99 of the 198 erythromycin-treated patients in the European study at post-therapy . Favourable clinical responses (cure or improvement) at the post-therapy visit were recorded in 96 (96.0%) dirithromycin- and 98 (99%) erythromycin-treated patients, and pathogens were eliminated or presumed to have been eliminated in 87 (87.0%) and 88 (88.9%) patients respectively, in the dirithromycin and erythromycin treatment groups . Efficacy analysis was performed in 56 of the 70 Italian patients treated with dirithromycin and in 62 of the 71 patients treated with miocamycin . At post-therapy evaluation, a favourable clinical response was observed in 98.2% of the dirithromycin-treated patients compared with 95.1% of miocamycin-treated patients, whereas a favourable bacteriological response was observed in 52 (92.9%) dirithromycin- and 52 (83.9%) miocamycin-treated patients respectively . In all studies no serious treatment-related events were noted . Events most frequently reported were gastrointestinal in nature . Overall in the three studies, no statistically significant differences were observed between two treatment groups in the clinical and bacteriological outcomes.

J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 139 - 51
A multicentre study comparing the safety and efficacy of dirithromycin with erythromycin in the treatment of bronchitis; Gaillat J; This European multicentre (110 centres), double-blind, randomized clinical trial compared the safety and efficacy of dirithromycin (500 mg orally once daily) and erythromycin (250 mg orally qds) in the treatment of either acute bacterial bronchitis or acute bacterial exacerbations of chronic bronchitis . From January 1989 to September 1990, 1222 patients (529 with acute bronchitis and 693 with acute exacerbations of chronic bronchitis) were included in the trial . Clinical and bacteriological evaluations were performed on 135 evaluable patients with acute bronchitis (72 in the dirithromycin group and 63 in the erythromycin group) and in 202 patients with acute exacerbations of chronic bronchitis (89 treated with dirithromycin and 113 treated with erythromycin) . Evaluations were performed during treatment (days 3-5), post-therapy (three to five days after therapy completion), and late post-therapy (10-14 days following the end of therapy) . In acute bronchitis, both drugs were effective with clinical success rates of 93.0% and 95.2% at post-therapy, and 96.9% and 100% at late post-therapy for dirithromycin and erythromycin, respectively . Pathogen eradication rates at post-therapy were 83.3% for the dirithromycin group and 85.7% for the erythromycin group . In acute exacerbations of chronic bronchitis, the drugs were also effective with 89.9% and 92.1% cure or improvement at post-therapy and 98.7% and 95.0% at late post-therapy for dirithromycin and erythromycin, respectively . Pathogen eradication rates were 75.3% in both treatment groups . There were no statistically significant differences in clinical and bacteriological results between treatments in patients with acute bronchitis or acute exacerbations of chronic bronchitis . Of the 1222 patients included, no significant differences in the number of patients reporting adverse events were observed . There were nine early discontinuations due to adverse events in the dirithromycin group and 14 in the erythromycin group . Dirithromycin (500 mg once daily for seven days) was as effective and as safe as erythromycin (250 mg qid for seven days) in the treatment of acute bacterial bronchitis and acute bacterial exacerbations of chronic bronchitis.

J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 131 - 8
Clinical efficacy of dirithromycin in acute exacerbations of chronic bronchitis; Sides GD; The efficacy and safety of seven days treatment with oral dirithromycin 500 mg given once daily was compared with oral erythromycin 250 mg qid in patients with acute bacterial exacerbations of chronic bronchitis . A total of 393 patients received dirithromycin and 409 erythromycin . Of 101 dirithromycin-treated patients analysed for efficacy, 87 (86%) had favourable clinical responses compared with 72/81 (89%) of those treated with erythromycin . Proven or presumed pathogen elimination was noted in 85/101 (84%) dirithromycin-treated patients and 66/81 (82%) erythromycin treated patients . Late post-therapy responses were also similar between treatment groups . Favourable clinical responses were noted in 89% of patients treated with dirithromycin and 91% of those receiving erythromycin . A favourable bacteriological response was noted in 87.5% and 89.6% of the dirithromycin- and erythromycin-treated groups, respectively . Adverse events were also similar between treatment groups . Gastrointestinal events were the most common events in both groups of patients; erythromycin was associated with a significantly higher incidence of diarrhoea (P = 0.003) . Dirithromycin was associated with a higher incidence of lung events (P = 0.043) . It is concluded that dirithromycin given once a day is comparable in efficacy and safety to four-times-daily erythromycin in the treatment of acute bacterial exacerbations of chronic bronchitis.

J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 121 - 9
Clinical efficacy of dirithromycin in pneumonia; Jacobson K; In a double-blind, double-dummy, multicentre study the efficacy and safety of dirithromycin 500 mg/day given orally once daily for 10-14 days were compared with those of erythromycin 1000 mg/day given orally four times daily for 10-14 days in patients with bacterial pneumonia . At 3-5 days post-therapy, 90 dirithromycin- and 83 erythromycin-treated patients were evaluable; the main reason for non-evaluability was failure to isolate the causative organism . Symptomatic responses were favourable in 94.5% of dirithromycin- and 100% of erythromycin-treated patients at post-therapy . At late post-therapy (2-3 weeks after completion of treatment), symptomatic responses were favourable in 98.7% of dirithromycin- and 94.8% of erythromycin-treated patients . At post-therapy, 63.3% of dirithromycin- and 50.6% of erythromycin-treated patients were unable to be evaluated bacteriologically, mainly due to Mycoplasma pneumoniae or Legionella pneumophila being assessed serologically . In the remaining evaluable patients treated with dirithromycin and erythromycin, bacteriological responses were favourable in 91.4% and 87.8%, respectively . At late post-therapy, favourable bacteriological responses occurred in 89.7% and 86.8%, respectively, of dirithromycin- and erythromycin-treated patients . Abdominal pain was the only treatment-emergent event to occur significantly more frequently in dirithromycin-treated patients.

Int J STD AIDS, 1993 Mar-Apr, 4(2), 110 - 3
Roxithromycin compared to doxycycline in the treatment of genital chlamydial infection and non-specific urethritis; Lidbrink P et al.; A single-blind randomized follow-up study was conducted to evaluate the efficacy and tolerance of roxithromycin 300 mg once a day compared to doxycycline 200 mg day 1 and 100 mg day 2-10 in the treatment of genital chlamydial infection in men and women and non-specific urethritis (NSU) in men . A total of 211 patients (200 men and 11 women) between 18 and 46 years were enrolled . The women were excluded from the efficacy analysis because of the low number, but were included in the tolerance analysis . The clinical (clearance of polymorphonuclear leucocytes in urethral smears) and bacteriological response was evaluated one and 11 days after the treatment . Of 113 included men with chlamydial infection, 105 (93%) and 96 (85%) were evaluable on respective follow-up visits and of 87 included men with NSU, 74 (85%) and 64 (74%) were evaluable one and 11 days after treatment, respectively . The bacteriological eradication rate immediately after the treatment in chlamydia positive patients was 92.7% and 100% for roxithromycin and doxycycline, respectively, and 91.8% and 100% at follow-up . The clinical cure rate of all evaluable patients was 83.1% and 80.7% for roxithromycin and doxycycline, respectively, one day after the treatment and 80.5% and 85.3% for the two drugs, respectively, 11 days after treatment . None of these observed differences was statistically significant . The diagnosis did not influence the clinical response rate with either drug . Probable and possible drug-related side-effects were more common after doxycycline than after roxithromycin, 35% and 19% respectively (P = 0.0032).(ABSTRACT TRUNCATED AT 250 WORDS)

Am Surg, 1993 Mar, 59(3), 149 - 54
Fournier's gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance; Stephens BJ et al.; Experience with 11 cases of Fournier's gangrene during the decade 1979-1988, prompted this review of the English language literature to determine whether there have been changes in demography, etiology, and outcome, as compared to cases dating to 1763 . All cases were evaluated according to age, sex, bacteriology, etiology, and outcome . In the decade 1979-1988, 449 cases were reported . The average age of the patients was 49.8 years; with 14 per cent occurring in females . Synergistic polymicrobial infections were present in all cases . The most commonly reported etiologies were colorectal (33%), idiopathic (26%), and genitourinary (21%) . Mortality associated with colorectal etiology was highest (33%, p < 0.05) . Female mortality (49%) was not significantly greater than male mortality (17%), when obstetrical etiology was excluded . Overall mortality was 22% . Comparison with 386 cases of Fournier's gangrene reported between 1763 and 1978 reveals that the mean age of patients remains relatively low, and males continue to predominate . The pathophysiologic aspects of this disease appear similar in both sexes . The mortality rate from colorectal sources is significantly greater than from other common causes . Neither the introduction of antibiotics nor the development of newer ones has reduced mortality significantly . In spite of newer diagnostic techniques, the etiology remains unclear in over one-fourth of cases.

Berl Munch Tierarztl Wochenschr, 1993 Mar, 106(3), 80 - 3
{Sarcosporidia as the cause of sudden death during anesthesia in sheep}; Brumloop A et al.; The first two out of an experimental group of 17 sheep assigned for orthopaedic surgery died during inhalation anaesthesia with halothane-nitrous oxide-oxygen before the arthrotomy of the knee joint could start . Further casualties could be prevented by the use of epidural anaesthesia . Each of the 17 sheep underwent a pathologic-anatomical, histological, bacteriological and parasitological examination . It was found that all of them were infected with sarcosporidia-oocysts with myocarditis of different intensity . Possible infections with sarcosporidia-oocysts in animals, which could have had contact to carnivora, and which are taken for therapeutic surgery or for an experiment should be taken into consideration, because the lesion in the heart due to sarcosporidia-oocysts can be the cause of sudden death.

Ann Otol Rhinol Laryngol, 1993 Mar, 102(3 Pt 1), 222 - 6
Efficacy of ceftibuten for acute otitis media caused by Hemophilus influenzae: an animal study; Rosenfeld RM et al.; Ceftibuten is a new oral cephalosporin with an unusual stability to beta-lactamases that can hydrolyze other extended-spectrum cephalosporins . Using the chinchilla animal model, we compared the efficacy of ceftibuten (n = 33) with that of saline (n = 34), ampicillin (n = 32), and cefixime (n = 31) for the treatment of acute otitis media caused by beta-lactamase-producing nontypeable Hemophilus influenzae . Ceftibuten was superior to ampicillin regarding the time necessary to sterilize the middle ear (p < .001) and eliminate effusion (p < .001) . The mean days of therapy required for bacteriologic cure were 2.57 for ceftibuten, 2.95 for cefixime, 7.95 for ampicillin, and 8.16 for saline . At the conclusion of therapy, chinchillas treated with ceftibuten had a significantly lower prevalence of positive cultures and middle ear effusion than did animals treated with ampicillin . No significant differences were observed between ceftibuten and cefixime . The results of this randomized, investigator-blinded experiment warrant further consideration of ceftibuten as a second-line agent for acute otitis media caused by ampicillin-resistant H influenzae.

Ann Pharmacother, 1993 Mar, 27(3), 294 - 7
Ceftriaxone distribution and protein binding between maternal blood and milk postpartum; Bourget P et al.; OBJECTIVE: To study postpartum distribution and protein binding of ceftriaxone (CTX) between maternal blood and milk and to discuss risk factors and possible impact for the neonate . DATA SOURCES: Reference articles and books are identified in the text . DATA SYNTHESIS: CTX distribution and protein binding between maternal blood and milk postpartum were studied in a patient at term presenting with acute pyelonephritis caused by Escherichia coli . The antibiotic therapy prescribed pending bacteriology results consisted of CTX 2 g/d, ornidazole 1 g/d, and tobramycin 3 mg/kg/d . Pharmacokinetics of total CTX were studied after the first 2-g infusion . At plateau (i.e., two days after delivery; seventh infusion), pharmacokinetics and milk distribution of total and free CTX also were studied . No accumulation of CTX was noted in the plasma at plateau . When high dosages of CTX are used (approximately 2 g), its penetration into the milk is important (i.e., protein binding capacity is overwhelmed) . No notable adverse reactions occurred in mother or child . Thus, an important diffusion into the milk (4.4 percent of the dose) appears not to be clinically important . Our knowledge of both metabolism and milk distribution of drugs with high protein binding (> or = 95 percent) and an acid characteristic should be expanded to better understand their use during both the pregnancy and postpartum periods . Finally, the child of the patient described here has normal initial growth and development at the present time . CONCLUSIONS: Caution should be taken when drugs such as CTX, which have both high protein binding (> or = 95 percent) and an acid characteristic are administered to breastfeeding women . Drugs of this type should be systematically investigated to better understand their use during pregnancy and postpartum.

Ann Surg, 1993 Mar, 217(3), 286 - 92
Effect of total parenteral nutrition plus morphine on bacterial translocation in rats; Kueppers PM et al.; OBJECTIVE: This study tested the hypothesis that gut stasis induced by parenteral morphine sulfate (MS) leads to enhanced bacterial translocation in rats on total parenteral nutrition (TPN) . SUMMARY BACKGROUND DATA: TPN and MS are common adjuncts in the care of critically ill patients . TPN is known to provoke a variable degree of translocation . MS induces gut stasis with an accompanying bacterial overgrowth . The effect of these two treatments in combination on translocation is not known . METHODS: Rats were provided with central and subcutaneous lines for the continuous infusion of nutrients and drugs, respectively . Intestinal transit was assessed by the caudal movement of a fluorescent marker intubated into the proximal duodenum . Quantitative bacteriology was carried out from various segments of the gut and from ileocecal mesenteric lymph nodes (MLN), spleen, liver, and systemic blood obtained by cardia puncture on sacrifice at 96 hours . RESULTS: Transit was unchanged by TPN alone but prolonged when given in combination with MS . Bacterial overgrowth was also enhanced by MS and increased the bacterial translocation to MLN from 50% of animals with TPN, to 100% in those receiving both TPN and MS; the colony-forming units per MLN increased from 33 +/- 14 with TPN alone to 2079 +/- 811 (STD) with TPN plus MS . Furthermore, no bacteria were found at systemic sites with TPN alone, but in 93.3% of animals receiving TPN and MS . In a subgroup of rates provided with glutamine in TPN, the TPN plus MS effects on translocation were not reversed . CONCLUSIONS: These observations demonstrate the important role that morphine plays in promoting translocation, presumably by disrupting fasting motility and enhancing bacterial overgrowth.

Pediatr Infect Dis J, 1993 Mar, 12(3), 184 - 8
Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis; Kilpi T et al.; The relationship between length of prediagnostic history and course and sequelae of childhood bacterial meningitis was prospectively examined by collecting data from 286 children with bacteriologically confirmed bacterial meningitis . The cases were divided into three groups: short (< or = 24 hours, N = 141); intermediate (> 24 to 48 hours, N = 75); and long (> 48 hours, N = 70) history . The level of consciousness and serum C-reactive protein normalized sooner during hospitalization in patients with a longer history . They also showed neck stiffness more often and longer and had thrombocytosis earlier and more prominently than patients with a shorter history . The differences were not influenced by etiology, sex or age . The occurrence of neurologic abnormalities in the hospital or during the first 6 months after discharge was not affected by duration of illness before hospitalization . We conclude that our results support the view that bacterial meningitis presents in two forms . At presentation the more acute form often has a history of less than 24 hours and poses a great danger to the patient . In contrast the other form develops insidiously and is more difficult to detect but does not have a worse prognosis than the acute form.

Chest, 1993 Mar, 103(3), 697 - 701
Treatment of community-acquired pneumonia . A multicenter, double-blind, randomized study comparing clarithromycin with erythromycin . Canada-Sweden Clarithromycin-Pneumonia Study Group; Chien SM et al.; The efficacy and safety of orally administered clarithromycin and erythromycin in the treatment of community-acquired pneumonia were assessed in a multicenter, double-blind, randomized study . Two hundred sixty-eight patients were randomized to receive either clarithromycin, 250 mg twice a day, or erythromycin stearate, 500 mg 4 times a day, for 7 to 14 days . Efficacy was evaluable in 173 patients (92 for clarithromycin, 81 for erythromycin) . No statistically significant difference in clinical success rate (cure or improvement) was observed between the two groups (clarithromycin, 97 percent; erythromycin, 96 percent) . Both groups had identical radiologic response (97 percent with resolution or improvement) . Similarly, no statistically significant difference in bacteriologic response toward the target pathogens was observed among evaluable patients (clarithromycin, 23/26; erythromycin, 17/17; p value = 0.287) . Clinical response toward Mycoplasma and Chlamydia pneumonia was comparable between the two groups (clarithromycin, 15/16; erythromycin, 10/11) . However, patients receiving erythromycin had a twofold higher incidence of adverse events, mostly related to the gastrointestinal system, and were five times more likely to withdraw from therapy because of drug-related adverse events . These results show that clarithromycin is as effective as erythromycin in the outpatient treatment of community-acquired pneumonia . Furthermore, the lower incidence of adverse events associated with clarithromycin indicates that it is more acceptable to patients and, therefore, can enhance compliance.

ORL J Otorhinolaryngol Relat Spec, 1993 Mar-Apr, 55(2), 93 - 6
Cefetamet pivoxil in otitis media; Quevedo A et al.; In this multicentre, open, randomized, parallel-group study, 270 children with acute otitis media aged between 1 and 15 years were randomized to receive either cefetamet pivoxil 10 mg/kg b.i.d . for 7 days (n = 134) or cefaclor 13.5 mg/kg t.i.d . for 7 days (n = 136) . At the end of treatment, bacteriological cure occurred in 44/44 (100%) patients receiving cefetamet pivoxil and 24/28 (86%) patients receiving cefaclor . Clinical cure or improvement was experienced by 117/121 (97%) of patients receiving cefetamet pivoxil and 104/115 (90%) patients in the cefaclor group . Adverse side effects, mainly gastrointestinal disorders, occurred in 11% of patients in the cefetamet pivoxil group compared with 15% of patients in the cefaclor group . All adverse events were of mild or moderate severity and subsided rapidly after treatment . Premature treatment withdrawals occurred in 0.7% of patients who received cefetamet pivoxil and in 2.2% of those who received cefaclor.

Int J Dermatol, 1993 Mar, 32(3), 214 - 7
Topical phenytoin in wound healing; Pendse AK et al.; BACKGROUND . Phenytoin, introduced in 1937 as an antiseizure medication, has since been reported to promote wound healing when applied as a topical agent . This study was undertaken to evaluate its effectiveness in chronic skin ulcers . METHODS . Seventy-five inpatients with chronic skin ulcers were included in this controlled trial . Forty patients were treated with topical phenytoin, and 35 patients with conventional saline dressings . Assessment of the wounds included wound area, bacteriologic cultures, and clinical assessment by blind observers at baseline and every 7 days thereafter over the 4-week treatment period . RESULTS . Wound area reduction was greater in the phenytoin group than in controls . Fifty percent of phenytoin-treated wounds had negative cultures by day 7, compared to 17% of controls . Healthy granulation tissue appeared earlier with phenytoin . At the end of the fourth week, 29 of 40 phenytoin-treated ulcers had healed completely versus 10 of 35 controls . CONCLUSIONS . Topical phenytoin appears to be an effective, inexpensive, and widely available therapeutic agent in wound healing . Further clinical use and evaluation is merited.

Arch Surg, 1993 Mar, 128(3), 329 - 36
Do surgical and endoscopic sphincterotomy prevent or facilitate recurrent common duct stone formation?
Cetta F.
The possible formation of brown recurrent common duct stones (RCS) as a long-term side effect of sphincterotomy (SPHT) has been evaluated in 63 patients with stone formation after cholecystectomy, 253 who underwent SPHT or choledocholithotomy, 131 with postoperative monitoring of bile bacteriologic characteristics through the T tube, and 20 with stone and bile analysis at both operations . In addition, findings are also reported in 145 patients who underwent surgical SPHT and radiologic review of up to 28 years after surgery, five who underwent ampullectomy, and 55 who underwent endoscopic SPHT . The RCS were usually brown (72.5% of cases), and were always associated with bile infection caused by Escherichia coli . Sixty-two percent of brown RCS were found after SPHT . Eleven percent of patients who underwent surgical SPHT, 9% who underwent endoscopic SPHT, and 66.6% who underwent ampullectomies had brown RCS . Sphincterotomy determined a fivefold greater incidence of postoperative bactibilia, and a seven-fold greater incidence of brown RCS, than did choledocholithotomy . It is suggested that: (1) since brown RCS are secondary to bile contamination from the duodenum, SPHT (and subsequent stricture), facilitating both bile contamination and bacterial overgrowth, could be considered a basic factor in the formation of these stones; and (2) since true RCS are mostly of the brown subtype, SPHT could prevent the occurrence of retained stones by flushing the stones that were missed during the first operation, but undoubtedly increases the total incidence of RCS.

Am J Gastroenterol, 1993 Mar, 88(3), 388 - 92
Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study; Llovet JM et al.; In order to identify the predictive factors of hospital mortality in cirrhotics with spontaneous bacterial peritonitis (SBP), we studied 64 patients who fulfilled the accepted diagnostic criteria . All cases were treated with cefotaxime up to 2 days after the infection was considered cured (7.7 +/- 2.9 days) . Eleven patients (17%) died while in hospital, six of them before SBP was cured . After uni- and multivariate analyses, only seven routine clinical, biological, and bacteriological variables studied were independently associated with hospital mortality . These were: the presence of upper gastrointestinal bleeding at admission (beta = 2.01), the absence of abdominal pain as presenting symptom (beta = -1.29), the polymorphonuclear count (%) in the ascites (beta = 0.48), prothrombin rate (beta = -0.22), and serum Na (beta = -0.64), creatinine (beta = 0.50), and cholesterol (beta = -0.68) . When the equation obtained was computed in a randomly selected sample of the patients studied, it correctly predicted the outcome in 92.3% of the cases . We conclude that short-term outcome of SBP patients depends on the existence of recent gastrointestinal bleeding, the severity of SBP, and the degree of liver and renal failure . The prognostic value of this model needs prospective validation in a new series of patients.

Rev Sci Tech, 1993 Mar, 12(1), 27 - 34
{Preliminary studies of the effect of diseases and environmental pollution on the population dynamics of wild rabbits (Oryctolagus cuniculus Linnaeus, 1758) in the federal state of North Rhine-Westphalia (Germany)}; Lutz W; A survey was conducted of wild rabbits (Oryctolagus cuniculus) shot in all districts of the Federal State of North Rhine-Westphalia (Germany) . A total of 104 rabbits were examined during 1988 and 1989 . Attempts to isolate myxoma virus and other viruses were unsuccessful . Two serum samples neutralised myxoma virus . In 1990, 210 rabbits were examined; 57 animals were subjected to tests for the presence of the virus of viral haemorrhagic disease of rabbits and 42 were tested for specific antibody . No virus was isolated . Antibody titres were judged to be significant in 5% of the rabbits tested . Bacteriological, histological and virological tests showed no evidence of ill health in these animals . With the exception of abnormal cadmium content of tissues, detailed examination of ovaries and testes and lead assays failed to reveal reduced fertility as a reason for the fall in population.

Surg Gynecol Obstet, 1993 Mar, 176(3), 255 - 61
Piperacillin/tazobactam versus imipenem/cilastatin in the treatment of intra-abdominal infections; Niinikoski J et al.; The current multicenter study was conducted at five sites using 86 patients to evaluate the safety and efficacy of piperacillin/tazobactam (4 grams per 500 milligrams every eight hours) compared with imipenem/cilastatin (1 gram every eight hours) in the treatment of patients who were hospitalized with a clinically or bacteriologically confirmed diagnosis of intra-abdominal infection . Forty-seven patients received piperacillin/tazobactam and 39 received imipenem/cilastatin . The favorable response among patients who were clinically evaluable with a valid response in the group treated with piperacillin/tazobactam was 87 percent . In the group treated with imipenem/cilastatin it was 77 percent . Bacteriologic eradication rate among bacteriologically evaluable patients with a valid response in the group treated with piperacillin/tazobactam was 100 percent . In the group treated with imipenem/cilastatin it was 89 percent . The eradication rate of pathogens isolated from patients who were evaluable by biologic factors in the group treated with piperacillin/tazobactam was 100 percent and in the group treated with imipenem/cilastatin treatment, 96 percent . In the group treated with piperacillin/tazobactam the incidence and type of adverse reactions were similar to those seen with piperacillin alone . It is concluded that piperacillin/tazobactam is safe and efficacious in the treatment of patients hospitalized with intraabdominal infections and that tazobactam extends the spectrum of piperacillin.

Eur Cytokine Netw, 1993 Mar-Apr, 4(2), 147 - 51
Pulmonary edema and shock after high-dose aracytine-C for lymphoma; possible role of TNF-alpha and PAF; Chiche D et al.; Four out of 23 consecutive patients treated with high-dose Ara-C for lymphomas in our institution developed a strikingly similar syndrome during the perfusion . It was characterized by the onset of fever, diarrhea, shock, pulmonary edema, acute renal failure, metabolic acidosis, weight gain and leukocytosis . Thorough bacteriological screening failed to provide evidence of infection . Sequential biological assays of IL-1, IL-2, TNF and PAF were performed during Ara-C infusion to ten patients, including the four who developed the syndrome . TNF and PAF activity was found in the serum of respectively two and four of the cases, but not in the six controls . As TNF and PAF are thought to be involved in the development of septic shock and adult respiratory distress syndrome, we hypothesize that high-dose Ara-C may be associated with cytokine release.

Zentralbl Hyg Umweltmed, 1993 Mar, 193(6), 563 - 6
{Legionella in membrane expansion vessels}; Hengesbach B et al.; Membrane expansion vessels (MEV) are installed between cold drinking water supply and hot water system to compensate pressure changes and water losses . An elastic membrane inside the MEV divides a gas pressurized compartment from a water filled compartment, which--in case of flow-through type of MEV--is directly coupled to the water current . While heating the system the expanding water enters the last mentioned compartment . When cooling down, the water is flowing out . Thus MEVs may prevent water losses . Bacteriological investigations of two DEVs of the flow-through type showed the following results: 1 . While 5 samples taken from the cold water supply did not yield Legionella, all 7 samples from the outlets of both DEVs tested positive for Legionella (average 21 CFU/ml) . 2 . In each of 4 samples taken from the outlet of a DEV, total colony counts exceeded the guide value of 100 colonies/ml demanded in the German Drinking Water Act (average 724 colonies/ml at 20 degrees C, 921 colonies/ml at 36 degrees C) . 3 . Swab and contact culture from one of the membrane indicated excessive surface colonization with Legionella . The findings show the necessity to include MEVs in investigations of hot water systems for Legionella.

Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Mar, 31(3), 364 - 7
{A case of spontaneous pneumothorax due to rupture of bleb infected with aspergillosis}; Hiura K et al.; A 17-year-old male was diagnosed as having left spontaneous pneumothorax by chest X-ray . Chest CT scan showed a cystic shadow with a thick wall in the left apex . Thoracotomy was performed, and the bleb was resected . Histologically, aspergillus was found in the cavity and the wall of the resected bleb . In this case, we consider that focal aspergillus infection in the bleb caused spontaneous pneumothorax . In cases of spontaneous pneumothorax in which the bleb wall is thick, the bleb should be evaluated by histological and bacteriological examination . Such a case has been rarely reported in Japan.

Acta Otorhinolaryngol Ital, 1993 Mar-Apr, 13(2), 131 - 6
{Bronchoalveolar lavage (BAL) in the diagnosis of pulmonary infections in immunocompromised children}; Bottero S et al.; The authors report their personal case records of broncho-alveolar lavage in immuno-compromised children . 22 children were observed from 1991 to 1992 at the E.N.T . Department of the Bambino Gesu Hospital, National Research Institute, in Rome . Flexible bronchoscopy is used under both local and general anesthesia without muscle relaxants . The epithelial lining fluid collection is greater than that obtained when muscle relaxation is used . For each patient 3 specimens are collected: for virological, bacteriological, mycological and immunological analysis . In 90% of the cases a correct etiological diagnosis of the pulmonary disease was possible . In 14 cases the diagnosis was possible even after a week from the beginning of the antibiotic therapy.

Br J Biomed Sci, 1993 Mar, 50(1), 17 - 20
Tissue bonding: the bacteriological properties of a commercially-available cyanoacrylate adhesive; Matthews SC; The medical use of cyanoacrylate adhesives for tissue bonding is well established, and their use for tacking skin grafts into place is a regular procedure, for which purpose their case and speed of use seems highly advantageous . As medical grade cyanoacrylate tissue adhesives are fairly expensive, the bacteriological safety of using a commercially-available over-the-counter cyanoacrylate adhesive was investigated . The product was found to be sterile when purchased and remained so during use and between patients . There was also some evidence of bacteriostatic properties . These investigations suggest that the commercially-available product is bacteriologically acceptable, and at approximately 28% of the cost of the medical grade product would show considerable cost savings.

Presse Med, 1993 Feb 27, 22(7), 288 - 92
{Acute cystitis in women over 50 years of age . Efficacy of pefloxacin with single dose and norfloxacin for 10 days}; Guibert J et al.; This multicentre, open, randomized trial, involving 482 patients and conducted by private practitioners, compared the effectiveness and safety of a single 800 mg dose of pefloxacin and of a 10 days' course of norfloxacin 400 mg bid . in the treatment of uncomplicated acute cystitis in women aged over 50 years . Clinical effectiveness was evaluated on days 17-19 and 28-32 respectively, and bacteriological effectiveness on days 15-17 and 26-28 respectively . The median time taken for the symptoms to disappear was 2 days with pefloxacin and 3 days with norfloxacin (P < 0.001) . Irrespective of the nature of cystitis and the patients' age, no significant difference could be found in eradication of the pathogens . Undesirable side-effects were recorded in 7.8 percent of patients under pefloxacin and in 8.8 percent of those under norfloxacin (P = 0.68); gastrointestinal disorders were predominant . The acceptability of treatment, as judged by the patients themselves, was regarded as excellent by 55 percent of women treated with single dose pefloxacin and by 37.6 percent of those treated with norfloxacin (P = 0.001).

Lancet, 1993 Feb 6, 341(8841), 335 - 9
Once versus thrice daily gentamicin in patients with serious infections; Prins JM et al.; Aminoglycosides are usually given in two or three divided doses . A once-daily regimen might be more effective and less toxic . We have conducted a randomised trial in consecutive patients with serious infections for whom an aminoglycoside seemed warranted . Exclusion criteria were neutropenia or severely impaired renal function . 123 patients were enrolled . For efficacy analysis only those patients were considered in whom treatment with the aminoglycoside was not stopped within 72 h (n = 67); toxicity was analysed on patients receiving aminoglycosides for more than 48 h and not using other nephrotoxic medication (n = 85) . Gentamicin 4 mg/kg every day (OD) or gentamicin 1.33 mg/kg three times daily (MD) (with dose-reduction in case of renal dysfunction) were given intravenously . In almost all patients intravenous amoxycillin 1 g every 6 h was also started . Baseline characteristics were comparable in both arms . A good clinical response was observed in 32/35 (91%) of the OD and in 25/32 (78%) in the MD group (difference 13%, 95% confidence interval -6.4% to +26.9%) . 2 patients in each group died with uncontrolled infection . An insufficient bacteriological response (persistent positive cultures, resistance, or superinfection) was observed in 2 patients with OD and 3 patients with MD . In patients treated for more than 48 h duration of therapy and mean doses were 7.0 days (1590 mg) and 7.4 days (1672 mg) in OD and MD respectively . Mean first serum trough/peak levels were 0.6/10.2 mg/L and 1.4/5.2 mg/L . Nephrotoxicity (a rise in serum creatinine of 45 mumol/L or more) developed in 2/40 (5%) in OD and 11/45 (24%) in MD (p = 0.016) . Risk factors for nephrotoxicity were duration of therapy and baseline creatinine clearance rate . High-tone audiometry was performed when possible; no significant differences were found in hearing loss (3/12 and 3/11) or prodromal signs of ototoxicity (5/12 and 4/11) . A once-daily dosing regimen of gentamicin is at least as effective as and is less nephrotoxic than more frequent dosing.

Kansenshogaku Zasshi, 1993 Feb, 67(2), 116 - 21
{Sporadic case of hemolytic uremic syndrome associated with verotoxin producing Escherichia coli O2:K1:H7}; Kobayashi Y et al.; Cases of enterohaemorrhagic Escherichia coli (EHEC) are being increasingly reported in Japan . Bacteriological isolation of EHEC has been a constant problem because the organism is shed for a short duration after onset on illness and generally during the prodromal stages . In order to ease the diagnosis of EHEC infections in this country, we have developed a LPS-based solid phase enzyme linked immunosorbent assay for serological diagnosis of the infection . Adequate knowledge on the prevalence of EHEC serogroups in Japan is mandatory for the success of such a diagnostic test . O157 is currently the prominent serogroup associated with EHEC infections in Japan followed by O111, O26 and O128 in that order of prevalence . In February 1992, a 1 year-old infant developed hemolytic uremic syndrome (HUS) 15 days later the prodrome of watery diarrhoea . Stool sample obtained on day 15 was cultured for detection of EHEC . Ten colonies of E . coli picked from MacConkey agar plate were examined by the polymerase chain reaction (PCR) using primers specific for both verotoxins (VT1 and VT2) . Of the 10 colonies, only one was positive for the VT2 gene . The strain was confirmed to be cytotoxic on cultured Vero cells . The strain agglutinated with antisera of E . coli O2, K1 and with H7 serogroups . As of date, none of such strains of O2:K1:H7 EHEC has been reported in Japan . The patient's sera was found to be positive for antibodies against LPS from the homologous isolate as well as against VT2 . The patient recovered uneventfully from HUS 40 days after the onset of the disease and was discharged from the hospital.

Anasthesiol Intensivmed Notfallmed Schmerzther, 1993 Feb, 28(1), 23 - 9
{Prevention of pneumonia by endotracheal micronebulization of tobramycin}; Rathgeber J et al.; In 69 artificially ventilated patients the clinical, bacteriological and pharmacological effects of endotracheally administered tobramycin were studied in comparison to a control group . In the therapy group, 52% of all specimens were sterile, in the control group only 25% . During the first 4 days these changes were significant (p < 0.05) . In the therapy group the endotracheal colonisation with ps . aeruginosa was significantly lower between the 4th and 14th day (p < 0.05) . The incidence of secondary pneumonia was reduced from 42% to 17.5% (not significant) . Systemic administration of antibiotics, e.g . of aminoglycosides, was significantly more often necessary in the control group . No increasing of growth of fungi in the upper respiratory tract was observed, but these was a non-significantly higher incidence mainly of staph . epidermidis . The application of 80 mg tobramycin four times a day as an aerosol was well tolerated by the patients . Under there conditions, tobramycin could not be measured in the serum . No allergic reactions, increased respiratory pressures or bronchoconstrictions were observed.

Clin Investig, 1993 Feb, 71(2), 165 - 7
Cefotaxime desensitization; Papakonstantinou G et al.; We report the successful desensitization to cefotaxime in a patient with severe lumbar osteomyelitis of unknown bacteriology and hypersensitivity to the drug . Desensitization was carried out because of the unknown bacteriology, the favorable response to cefotaxime at that time, and hypersensitivity to other antibiotics . On the first day the patient received 1 mg cefotaxime intravenously . The dose was increased for 13 successive days to 4 g cefotaxime intravenously per day . No allergic reaction occurred during desensitization or within 4 weeks of observation under this therapy . Patients with severe infections of unknown bacteriology might benefit from desensitization if therapy with a second-choice antibiotic is impossible.

Aust N Z J Med, 1993 Feb, 23(1), 7 - 11
Culture-positive tuberculosis at St Vincent's Hospital, Melbourne, 1962-1989; Hurley JC et al.; The disease type and demography of patients with culture confirmed tuberculosis (TB) diagnosed at St Vincent's Hospital, Melbourne between the years 1962 to 1989 were reviewed . Four hundred and eighty-two patients with culture-positive TB were identified whose origins were as follows: Australia 194; Northern Europe 38; The Mediterranean 98; Asia 60 and other or unknown 92 . Patients whose country of birth was in Asia or the Mediterranean area accounted for 57% of patients in the 1980s; they presented at a younger age, with a higher proportion of extrapulmonary disease and a more equal sex distribution than did Australian born patients . The main types of extrapulmonary disease also differed for the various ethnic groups . The overall proportion of patients with an isolate resistant to at least one of the anti-TB drugs was 10.0% but in the Asian born was 21.7% . This survey, the longest series of bacteriologically confirmed cases of TB reported from a single institution in Australasia, has identified several changes in how TB is presenting for diagnosis.

Zentralbl Veterinarmed B, 1993 Feb, 40(1), 27 - 30
Preliminary evaluation of a simple method for detection of bovine tuberculosis: the glutaraldehyde test; de Kantor IN et al.; The glutaraldehyde test (GT) is performed by mixing whole blood with a 1.25% glutaraldehyde solution . Gelification time is shorter in tuberculous cattle . This test was performed in blood samples obtained from: (a) 48 cattle with bacteriologically confirmed tuberculous lesions; (b) 61 animals with no evidence of tuberculosis at the time of slaughterhouse inspection, 14 of which had hydatid cysts; (c) 260 tuberculin-negative apparently healthy animals, and (d) 21 cattle, also tuberculin-negative but serologically positive for brucellosis . Sensitivity for detecting tuberculosis was 85.4% (41 of 48 animals) . The test was negative in 298 out of 307 healthy animals (97.1% specificity) . This specificity decreased when the test was applied in animals with evidence of diseases other than tuberculosis . This simple, rapid and inexpensive method could play a complementary role to the tuberculin test for detecting tuberculous cattle, especially in endemic areas with scarce resources and facilities.

Chest, 1993 Feb, 103(2), 547 - 53
Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients; Fagon JY et al.; To evaluate the accuracy of clinical judgment in the diagnosis and treatment of nosocomial pneumonia in ventilated patients, we studied 84 patients suspected of having nosocomial pneumonia because of the presence of a new pulmonary infiltrate and purulent tracheal secretions . We prospectively evaluated the accuracy of diagnostic predictions and therapeutic plans independently formulated by a team of physicians aware of all clinical, radiologic and laboratory data, including the results of Gram-stained bronchial aspirates . Definite (n = 51) or probable (n = 33) diagnoses could be established in all patients by strict histopathologic and/or bacteriologic criteria . Only 27/84 patients were diagnosed as having pneumonia . Organisms responsible for pneumonias were identified by quantitative cultures of samples obtained using a protected specimen brush or pleural fluid cultures . Four hundred eight predictions were made for the 84 studied patients . Clinical diagnoses for patients subsequently diagnosed as having pneumonia were accurate in 81/131 cases (62 percent) . Furthermore, only 43/131 (33 percent) therapeutic plans proposed for these patients represented effective therapy . Common causes of inappropriate treatment included failure to diagnose pneumonia (50 plans), failure to effectively treat highly resistant organisms (21 plans), and failure to treat all organisms in cases of polymicrobial pneumonia (14 plans) . Therapeutic plans formulated for patients without pneumonia included the unnecessary use of antibiotics in 45/277 cases (16 percent) . These findings indicate that the use of clinical criteria alone does not permit the accurate diagnosis of nosocomial pneumonia in ventilated patients, and commonly results in inappropriate or inadequate antibiotic therapy for these patients.

Am J Vet Res, 1993 Feb, 54(2), 333 - 40
Changes in fluid composition on the serosal surface of jejunum and small colon subjected to venous strangulation obstruction in ponies; Ruggles AJ et al.; In 6 anesthetized ponies, 3 segments of jejunum and 3 segments of small colon were isolated from the peritoneal cavity in plastic bags filled with Hanks' balanced salt solution . One jejunal and 1 small colon segment were subjected to venous strangulation obstruction for 3 hours (VSO-3), venous strangulation obstruction for 6 hours (VSO-6), or a 6-hour sham procedure to control for changes induced by isolation in a plastic bag . Additional segments of jejunum and colon that were not placed in bags served as controls for histologic examination and collagenase measurements . Samples of fluid surrounding the intestine were obtained for chemical analyses, nucleated cell count, aerobic and anaerobic bacteriologic culture, and measurement of collagenase activity . Full-thickness tissue samples were obtained for histologic examination and measurement of collagenase content . Bacteria did not cross the intestinal wall after 3 and 6 hours of VSO, despite severe mucosal lesions in these segments . At 6 hours, PO2 was significantly less and PCO2 was significantly (P < 0.05) greater in the fluid surrounding the VSO-6 jejunal segments, compared with the sham jejunal segments . The pH was significantly (P < 0.05) less in fluid surrounding VSO-6 small colon segments, compared with the sham colon segments at 6 hours . For jejunum and small colon, phosphate and lactate concentrations were significantly (P < 0.05) greater in VSO-6 fluid than in the corresponding sham fluids at 6 hours . Fibrin formed around all VSO segments, although fibrinogen was not detected in the surrounding fluid, indicating possible rapid conversion of fibrinogen to fibrin.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1993 Feb, 167(2), 401 - 10
Combined multidrug and Mycobacterium w vaccine therapy in patients with multibacillary leprosy; Zaheer SA et al.; Immunotherapy with Mycobacterium w vaccine was attempted in patients with borderline-borderline, borderline lepromatous (BL), or lepromatous leprosy (LL) to determine whether immunization can hasten recovery and reduce treatment time by invigorating cell-mediated immunity . Mycobacterium w, a nonpathogenic, rapidly growing, atypical mycobacterium, shares a number of common B and T cell determinants with Mycobacterium leprae and Mycobacterium tuberculosis . Patients receiving the vaccine had rapid clinical improvement and accelerated bacteriologic clearance . After treatment with vaccine for 2 years, 13 of 31 BL and LL patients were bacteriologically negative as were 5 of 25 controls . Vaccinated patients had one of two distinct histologic features, either an upgrading in the disease spectrum or complete clearance of granuloma . Some 80% of lepromin conversions were in BL and LL patients who received vaccine versus none and 14.3% of BL and LL controls, respectively . Thirteen of 17 vaccinated LL patients were released from treatment after 2 years in contrast to 2 of 15 controls.

J Chemother, 1993 Feb, 5(1), 32 - 6
Clinical efficacy of azithromycin in lower respiratory tract infections; Morandini G et al.; A total of 51 patients with acute exacerbation of chronic bronchitis and pneumonia were enrolled: 27 treated with azithromycin (500 mg once a day for 3 days), and 24 with roxithromycin (150 mg every 12 hours for 7 days) . The two regimens were equally effective, with clinical cure in 80% and 72% of patients respectively . Bacteriological eradication on day 19-23 was obtained in 7/11 cases (64%) and in 6/13 cases (46%) in the two groups, respectively . No side effects occurred in patients treated with azithromycin, while they occurred in the roxithromycin group (2 vomiting and 1 gastritis) . Clinical and bacteriological efficacy, excellent tolerability, simplified dosage (single daily dose) and short-course (3 days) therapeutic regimen make azithromycin, in our experience, efficacious for the treatment of acute exacerbation of chronic bronchitis and community-acquired pneumonia.

Lik Sprava, 1993 Feb-Mar, (2-3), 121 - 3
{The etiotropic and pathogenetic treatment of patients with chronic gastritis and primary chronic gastroduodenitis}; Lukash NV et al.; 120 patients with chronic gastritis and primary chronic gastroduodenitis were given a three-week course of etiopathogenetic treatment (antichelibacterial and immunocorrective drugs) that allowed to diminish the clinical, bacteriological and immune manifestations of the disease and achieve a complete cure in most patients . Patients with marked chelibacteriosis revealed greater refractoriness . The authors recommend prolonged courses of treatment with alternations of etiologically directed drugs.

West Afr J Med, 1993 Jan-Mar, 12(1), 11 - 20
Viral pathogens of acute lower respiratory infections in pre-school Nigerian children and clinical implications of multiple microbial identifications; Johnson BR et al.; In a prospective study of acute lower respiratory infections (ALRI), at the University College Hospital, UCH, Ibadan, 35 viral pathogens were identified by immunofluorescence (IF) techniques from 24 (68.6%) respiratory specimens from 35 hospitalised pre-school children . The respiratory diagnoses comprised croup, bronchiolitis, pneumonia and pleural effusion . The viral identifications comprised 14 (40.0%) of parainfluenza virus type 3, 10 (28.6%) of respiratory syncytial virus (RSV), 5 (14.3%) of influenza virus type A, 4 (11.4%) of parainfluenza virus type 1 and 2 (5.7%) of influenza virus type B . Two or more viral agents were identified in as many as 10 (41.7%) of the 24 IF positive secretions, 8 (80.0%) of which were obtained from children with features of protein energy malnutrition . Twenty subjects had both virological and bacteriological analyses, in 8 (40.0%) of whom co-existing bacteraemia was identified . Four (50.0%) of these blood culture positive subjects, also had features of overt malnutrition . Neither the age nor the sex was significantly related to the viral identifications (P > 0.81 & 0.35 respectively) . Similarly, the final respiratory diagnoses were not significantly related to the viral identifications despite the seemingly suggestive relationship between a diagnosis of croup and parainfluenza identifications as well as that between pneumonia and RSV/parainfluenza type 3 identifications . It is concluded that the high proportion of positive viral identifications is a pointer to the importance of viruses as possible primary etiological agents of ALRI in countries of the West African sub-region and perhaps in developing countries of other tropical subregions . The multiplicity of microbial identifications (viruses and bacteria), seen in malnourished children, may explain the clinical severity of ALRI in the same group of children . The usefulness of IF as a rapid diagnostic tool, as well as the potential implications of our findings on ARI control in developing countries, are discussed.

J Dermatol, 1993 Jan, 20(1), 16 - 20
Evaluation of phenolic glycolipid-I (PGL-I) antibody as a multidrug therapy (MDT) monitor; Prakash K et al.; Since phenolic glycolipid-I (PGL-I) is an unequivocal marker for Mycobacterium leprae, this antigen has been a good candidate for the serodiagnosis and monitoring of the effectiveness of leprosy chemotherapy . The present study, a continuation of an earlier report, was undertaken to estimate PGL-I antibody titers in 40 leprosy patients 3 and 6 months after starting MDT . All the leprosy groups showed significant declines in anti PGL-I reactivity after 6 months . There was a good correlation between bacteriological indices (BI) and anti PGL-I antibody levels . Thus, PGL-I based serology may be useful in monitoring the response to multidrug therapy.

Respiration, 1993, 60(1), 45 - 50
Multivariate analysis of factors affecting pulmonary function in bronchiectasis; Ip M et al.; Impaired pulmonary function is of prognostic importance in bronchiectasis . To assess the factors affecting pulmonary function in bronchiectasis, we studied the clinical features, atopic status, bronchial responsiveness, systemic inflammatory indices, and sputum characteristics including volume, purulence, leucocyte count, neutrophil chemotactic activity, elastolytic activity (EA) and bacteriology in 82 Chinese patients . The majority of patients had impaired spirometry with airflow obstruction but normal carbon monoxide diffusing capacity . Multivariate analysis showed that factors significantly associated with worse lung function were: bronchial hyperresponsiveness, concomitant asthma, higher serum globulin, higher peripheral leucocyte count, lower serum albumin, greater sputum volume, diffuse disease and older age . When subjects with clinical asthma were excluded, similar factors were identified, and in addition, longer duration of disease, presence of eosinophils in sputum and higher sputum EA were significantly related to worse spirometry . Most of the identified factors reflect a state of inflammation . Thus the findings suggest that persistent inflammation plays an important role in the deterioration of lung function in bronchiectasis.

Schweiz Arch Tierheilkd, 1993, 135(3), 96 - 102
{Local and systemic infections with bacteria of group EF-4 in dogs, cats and in a badger: bacteriologic and pathologico-anatomic results}; Corboz L et al.; Bacteria of Group EF-4 were isolated in 7 dogs and in 5 cats from local purulent lesions in areas of natural openings of the head and from bite wounds, from lungs with focal necrotizing pneumonia in 2 additional cats and from internal organs in a badger with septicemia . The organisms grew mostly in pure culture . In conventional biochemical tests, 12 isolates were shown to belong to biovar EF-4a and 3 isolates to EF-4b . Classification as Group EF-4 was confirmed by assimilation tests performed with the commercially available gallery ATB 32 GN . Results of this study indicate that in veterinary medicine, bacteria of Group EF-4 are not only important from an epidemiological point of view, but that they may be more pathogenic for animals than considered hitherto.

Aust Vet J, 1993 Jan, 70(1), 7 - 12
Benign footrot--an epidemiological investigation into the occurrence, effects on production, response to treatment and influence of environmental factors; Glynn T; Benign footrot was studied in 1 1/2-years-old Merinos on 2 farms in central Victoria from September 1987 to August 1990, inclusive . Treatment groups of 100 sheep grazed together with the remaining untreated sheep . Inspections were carried out every 3 weeks during the spring transmission period until the number of lesions greater than score 2 dropped below 3% . At each inspection, each sheep was weighed and lesion scores for each foot and digit were recorded, the treated group of sheep was treated by standing in 20% (w/v) zinc sulphate-sodium lauryl sulphate for 1 hour, and bacteriological samples were randomly collected from 5 sheep with and 5 without lesions . Dichelobacter nodosus organisms were obtained from sheep in both groups . Laboratory tests indicated benign organisms in flock A and low virulence, intermediate organisms in flock B . During the first 2 years, the number and severity of lesions were greater in flock A than in flock B . However, in the third year, with an early 'autumn break', there was a rapid and severe outbreak of footrot in flock B; 98% of the flock had lesions at the first inspection in July 1989 . Flock A had a less dramatic increase in lesions of footrot . Both treated and untreated groups in flock B recovered rapidly between the third and fourth inspections . A later increase in lesions for both flocks coincided with damage caused by barely grass seeds . During this period there was a significant difference (P < 0.001) in body weight between the treated and untreated sheep on farm B.(ABSTRACT TRUNCATED AT 250 WORDS)

Jpn J Antibiot, 1993 Jan, 46(1), 60 - 6
{Clinical studies of ofloxacin 300 mg once a day administration in chronic respiratory tract infections}; Fukuhara H et al.; Forty patients with chronic respiratory infections were randomly assigned to 2 groups to compare the effect of once daily administration of 300 mg each and 3 times daily administration of 600 mg each of ofloxacin (OFLX) . Twenty patients were administered with 300 mg OFLX a day and 18 cases received 600 mg . The number of underlying diseases in the 300 mg group was greater than that in the 600 mg group . The ratios of general amelioration of clinical symptoms were 80.0% in the 300 mg group and 88.9% in the 600 mg group . For bacteriological effects, the eradication rate was 80.0% in the 300 mg group and it was 84.6% in the 600 mg . The incidence of side effects in the 300 mg group was 0% and that of the 600 mg group was 5.6% (1 patient) but the symptom was mild . The incidence of abnormal laboratory test results was 15.0% in the 300 mg group and it was 11.2% in the 600 mg group, but all of these abnormalities were slight and transient . The safety rates in the 300 mg and the 600 mg groups were 95.0% and 94.4%, respectively . Efficacy rates in the 300 mg and the 600 mg groups were 80.0% and 88.9%, respectively . There was no statistically significant difference in all the results between the 2 treatment groups, and the both treatments were highly effective . From the above results, we consider that once daily administration of 300 mg is a useful therapy in respiratory tract infections.

Wien Klin Wochenschr, 1993, 105(4), 99 - 107
{The Danube Hospital in the East Social Medicine Center . Planning, construction and completion}; Tragl KH; The Danube Hospital is part of a sociomedical center in East Vienna and was conceived to provide medical care for the transdanubian area of the city . In a planned stepwise operation both Depts . of Medicine, the Dept . of Surgery, the Dept . of Traumatology, the Dept . of Gynaecology and Obstetrics, the Dept . of Pediatrics, the Dept . of Pediatric Surgery, the Dept . of Neurology, the Dept . of Physiotherapy, the Dept . of Anaesthesia, the Dept . of Radiology, the Dept . of Laboratory Medicine, the Dept . of Nuclear Medicine, the Dept . of Pathology and Bacteriology, and the hospital pharmacy were opened in April 1992 . Both the Dept . of Ear, Nose and Throat and the Dept . of Urology are due to open at the beginning of 1993, while the Dept . of Ophthalmology, the Dept . of Dermatology, the Dept . of Orthopedics, the Dept . of Maxillary Surgery and Dentistry and the Dept . of Neurosurgery will start operation in 1994 . With the opening of the Dept . of Psychiatry in 1996 the Danube Hospital will be fully operative . By that time 920 beds, with an additional 59 functional beds (Intensive Care Units, Neonatology, Dialysis Ward, and Admission Unit) will be in operation.

Acta Otolaryngol Suppl, 1993, 501, 92 - 6
Five cases of mucormycosis in paranasal sinuses; Ishida M et al.; Five cases of mucormycosis are reported, 2 of them suffered from immunosuppression, the other 3 did not . We conclude that a combination of CT and bacteriological findings is useful for the diagnosis of mucormycosis differentially from other diseases . Therapy consisted of paranasal debridement and administration of amphotericin B.

J Am Dent Assoc, 1993 Jan, 124(1), 59 - 62
Bacteriological analysis of high-speed handpiece turbines; Mills SE et al.; The microbial contamination of handpiece turbines was examined clinically . In 20 handpieces, no bacterial growth was found on any culture from an autoclaved or non-autoclaved handpiece group . But growth occurred in the positive control inoculated with fresh whole human saliva . An adjunctive investigation with saliva substitute showed that oral fluids can contaminate handpiece turbines during simulated clinical treatment.

AIDS, 1993 Jan, 7(1), 73 - 9
Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda; Batungwanayo J et al.; OBJECTIVE AND METHODS: An increasing number of diagnoses of pleural effusions (PE) have been made over the last 8 years in the Department of Internal Medicine of the Centre Hospitalier de Kigali, Rwanda . In order to determine the aetiology of PE and to examine its possible association with HIV-1 infection, we performed an aetiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined aetiology referred to the Division of Pulmonary Diseases of the Department of Internal Medicine of the Centre Hospitalier de Kigali between 14 September 1988 and 16 October 1989 . HIV-1 serological testing was performed for most of the patients . RESULTS: A total of 127 patients (81 men, 46 women; mean age, 34 years; range, 16-71 years) with PE of undetermined aetiology were enrolled . Pleural tuberculosis was diagnosed in 110 (86%) and confirmed histologically and/or bacteriologically in 90 (82%) . Of 98 pleural tuberculosis patients tested for HIV-1-antibody, 82 (83%) were HIV-1-seropositive . Metastatic cancer was responsible for PE in six (5%) patients, Kaposi's sarcoma in three, lymphoma in one (all four HIV-1-seropositive), anaplastic carcinoma in one, and adenocarcinoma in one (both HIV-1-seronegative) . Non-tuberculous pneumonia was documented in five (4%) patients and was associated with HIV-1 infection in four . Other causes of PE were congestive heart failure (three patients), decompensated cirrhosis (one), constrictive percarditis (one), or undetermined (one); only one of these patients was HIV-1-seropositive . CONCLUSIONS: We conclude that tuberculosis is the predominant cause of PE in our patients and is strongly associated with HIV-1 infection . Although less frequent, non-tuberculous pneumonia, Kaposi's sarcoma and lymphoma are other causes of HIV-1-associated PE . In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should be considered a good marker of tuberculosis as well as HIV-1 infectionPIP: Pleural effusion (PE) has been increasingly diagnosed over the last eight years in the Department of Internal Medicine of the Centre Hospitalier of Kigali, Rwanda . To determine the etiology of PE and to examine its possible association with HIV-1 infection and tuberculosis (TB), the authors performed an etiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined etiology referred to the Division of Pulmonary Diseases at the hospital between September 14, 1988, and October 16, 1989 . 81 men and 46 women of mean age 34 years were enrolled in the study . Pleural TB was diagnosed in 86% and confirmed histologically and/or bacteriologically in 82% . 82 of the 98 pleural TB patients tested for antibody to HIV-1 were HIV-1-seropositive . Metastatic cancer was responsible for PE in six patients, Kaposi's sarcoma in three, lymphoma in one, anaplastic carcinoma in one, and adenocarcinoma in one . Non-TB pneumonia was documented in five patients and was associated with HIV-1 infection in four . Other causes of PE were congestive heart failure, decompensated cirrhosis, constrictive pericarditis, or undetermined; only one of these latter patients was HIV-seropositive . The authors therefore found TB to be the predominant cause of PE and it is strongly associated with HIV-1 infection . In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should therefore be considered a good marker of TB as well as HIV-1 infection .

Kekkaku, 1993 Jan, 68(1), 79 - 81
{AIDS and Mycobacterium avium complex infection}; Toida I; Infections with Mycobacterium avium complex (MAC) are the next most common complication in AIDS patients, and disseminated MAC infection is considered as an indicator disease of AIDS . Bacteriological and clinical features of MAC infection complicated with AIDS were reviewed . The number of AIDS patients in Japan has been increasing in a similar rate as in USA and Africa, so the members of Japanese Society for Tuberculosis should be ready for medical care of AIDS patients complicated with mycobacterial infections.

What Is Protein?, What Is Genetics?, What Is Anthrax?, What Is Fermentation?, What Is Growth Medium?, s, Bacterium, a, Bacteriology, o, Microbe, a, Microbes, o, Microbiology, i, Streptococcal, r, Yeasts, n, Nitrobacter, r, Microorganisms, r, Streptococcal, e, Listeriosis, r, Escherichia coli, a, Vibriosis, a, Escherichia coli, n, Broth cultures, r, Bacteriological, s, Escherichia coli, s, Escherichia coli, o, Denitrifying, o, Escherichia coli, n, Microorganism, s, S. cerevisiae, a, Staphylococcus aureus, a, Listeriosis, o, Fermentations, r, Pseudomonas aeruginosa

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005