Cardiovasc Intervent Radiol, 1993 Jan-Feb, 16(1), 30 - 6 STIR imaging of synthetic vascular graft infection; Hansen ME et al.; Nine patients with suspected prosthetic vascular graft infection were studied with axial spin echo (SE) and short TI inversion recovery (STIR) magnetic resonance imaging . Images were assessed for presence and extent of abnormality . All patients had either surgical (8/9) or bacteriologic (6/9) confirmation of infection . STIR images better defined the extent of infection and had greater fat-fluid contrast than SE images in 6/9 studies . In 3 cases with peri-graft fluid alone, T2-weighted images had slightly greater contrast, although the STIR images were still diagnostic . STIR imaging can offer improved accuracy in evaluation of suspected prosthetic graft infection when used in conjunction with SE techniques. Eur J Cardiothorac Surg, 1993, 7(1), 19 - 22 The role of ultrasound assisted thoracoscopy in the diagnosis of pleural disease . Clinical experience in 687 cases; Macha HN et al.; Ultrasonic examination is an established method used to differentiate between solid and liquid structures in the pleural space . It can estimate the volume of a pleural effusion and demonstrate whether the effusion is associated with loculations or adhesions . It is complementary to thoracoscopy . In the diagnosis of pleural disease ultrasonic-assisted thoracoscopy should only be used when the less invasive methods of diagnosis such as pleural aspiration for cytological, bacteriological and chemical examinations and needle biopsy of the pleura have not yielded a diagnosis . Although thoracoscopy is a relatively invasive procedure, it has the advantages of speed and accuracy in the diagnosis of pleural disease . This procedure is not widely used as it requires specialized instruments and equipment and may be time-consuming . The latter disadvantage may be minimized by the use of prior pleural sonography . The ultrasonic examination will indicate the optimal point of entry of the thoracoscopy to avoid adhesions . In order to evaluate feasibility, complications and clinical results in ultrasonic-assisted thoracoscopy, we investigated 687 patients with pleural diseases from 1987 to 1990 . As prior induction of a pneumothorax under X-ray control was not necessary, the 20-30 min required for this procedure was saved in all patients . Very few complications were attributable to ultrasonic-assisted thoracoscopy as it could normally be performed under local anesthesia . A macroscopic diagnosis was made in 80% of malignant diseases and 77% of inflammatory diseases in our total of 687 thoracoscopies . The diagnosis of a malignant pleural effusion was confirmed histologically and cytologically in 95% of those 190 patients in whom it was present.(ABSTRACT TRUNCATED AT 250 WORDS) Aesthetic Plast Surg, 1993 Winter, 17(1), 53 - 9 Pilot study analysis of the histologic and bacteriologic effects of occlusive dressings in chemosurgical peel using a minipig model; Zukowski ML et al.; The histologic changes associated with chemosurgery are well documented, but the data concerning the effects of occlusive dressings (adhesive tape, gauze, or ointments) is largely anecdotal . Wide differences of opinion exist as to the best method of phenol application and postpeel wound care regimen . Using a Yucatan minipig as our animal model, we studied the histologic and bacteriologic differences that various commonly used occlusive dressings have upon the initial burn depth and the subsequent healing of peeled skin . We also compared chemical peel with dermabrasion and chemabrasion . Our results showed to statistical difference in peel depth between "wet" versus "moist" phenol application or between occluded versus nonoccluded dressings . Based upon this animal model, we recommend that phenol solutions be applied moist rather than wet and that an occlusive dressing other than adhesive tape be used and maintained for a minimum of four days. Br J Surg, 1993 Jan, 80(1), 66 - 71 Bacterial translocation in acute liver failure induced by 90 per cent hepatectomy in the rat; Wang XD et al.; Bacterial infection and bacteraemia have been observed in patients with acute liver failure . The exact source of bacteria and nature of pathophysiological mechanisms explaining the development of infection remain unclear . In the present study, acute liver failure was induced by 90 per cent hepatectomy in the rat . The mesenteric lymph nodes and organs were harvested aseptically for bacteriological culture after sham operation or 90 per cent hepatectomy . Function of the liver and reticuloendothelial system (RES) was assayed; gut oxygen extraction was also measured . Translocation of enteric bacteria occurred 2 h after operation and increased with time following hepatectomy . Overgrowth of Escherichia coli in the distal small intestine started 2 h after operation . RES function decreased immediately after 90 per cent hepatectomy; uptake rates per gram tissue in other organs increased significantly . These results indicate that bacterial translocation occurred early after 90 per cent hepatectomy, associated with a decrease in RES function and gut oxygen extraction, and overgrowth of intestinal bacteria. J Am Acad Dermatol, 1993 Jan, 28(1), 96 - 8 Erosive pustular dermatosis of the scalp; Caputo R et al.; Three cases of erosive pustular dermatosis of the scalp are reported . In all patients the dermatosis was characterized by pustular, erosive, and crusted lesions; in addition, two patients had areas of scarring alopecia . The results of laboratory tests, bacteriologic and mycologic investigations, and histopathologic examination were nondiagnostic . Although erosive pustular dermatosis of the scalp is characterized by a nonpathognomonic clinical and histopathologic picture, it probably represents a disease entity. Int J Dermatol, 1993 Jan, 32(1), 27 - 9 Tongue involvement in lepromatous leprosy; Sharma VK et al.; BACKGROUND . Involvement of the oral cavity in lepromatous leprosy is well-documented . The tongue may demonstrate multiple nodules, thickening, and scarring . METHODS . Ten consecutive untreated patients with lepromatous leprosy with a bacteriologic index of 4+ or more were clinically and histopathologically studied for evidence of tongue involvement . RESULTS . Three patients showed clinical tongue involvement, as a nodulo-plaque lesion in one patient and fissured tongue (lingua plicata) in two patients . Tongue was clinically normal or showed nonspecific changes in the remaining seven patients . Histologic evidence of tongue involvement by lepromatous process was seen in six patients, including three without clinical involvement . CONCLUSIONS . We conclude from this study that the tongue is as prone to involvement by lepromatous process as buccal and palatal mucosa. Eur Respir J, 1993 Jan, 6(1), 23 - 6 Restrictive treatment policy for pulmonary tuberculosis in a low prevalence country; Norregaard J et al.; In Denmark, treatment of tuberculosis is generally recommended only if the diagnosis is confirmed bacteriologically . This policy may cause a delay in treatment, if the patients are smear negative . We investigated the duration of the treatment delay, and whether the delay would cause any serious health problems for the individual, or risk of contact infections, in a retrospective examination of 324 cases of pulmonary tuberculosis . The mean treatment delay was longer in the oldest age group . Concerning death due to delay, we found no risk for those patients who were not weakened by other disease or old age . Only 11 patients (3.6%) over the age 10 yrs were treated without bacteriological confirmation (1% for Danes) . The infection risk from the smear negative but culture positive patients was minimal, as only one subject was definitely infected from a smear negative patient . However, a risk of transmission exists from patients who are initially culture negative but later become smear positive . In conclusion, we find the epidemiological and individual risks sufficiently low to continue our rather restrictive treatment policy. S Afr Med J, 1993 Jan, 83(1), 42 - 3 Inoculation of peritoneal dialysate fluid into blood culture bottles improves culture rates; Rayner BL et al.; The aim of the study was to determine if direct inoculation of peritoneal fluid into Bactec blood culture bottles would improve the positive bacteriological yield compared with conventional techniques in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis . All patients presenting with suspected peritonitis had peritoneal fluid injected directly into aerobic and anaerobic Bactec blood culture bottles as well as into sterile culture tubes . Thirty-seven paired samples were analysed . Twenty conventional cultures (54%) were positive compared with 33 (89%) done according to the Bactec system (P < 0.002) . In only 1 case did the former technique prove superior . Direct inoculation of peritoneal fluid into Bactec blood culture bottles is therefore superior to conventional methods and has obvious therapeutic implications. Gynakol Geburtshilfliche Rundsch, 1993, 33(2), 107 - 10 {Tuberculosis of the breast}; Benz D et al.; The case of a 89-year-old women with mammary tuberculosis is reported . The diagnosis was based on histopathological and bacteriological examinations . Chest X-ray showed a lung-pleural tuberculosis, so we considered it a secondary organ manifestation. Pediatrie, 1993, 48(1), 17 - 9 {Bacterial meningitis in children: how many lumbar punctures?}; de Montalembert M; With few exceptions in extremely rare circumstances, such as sign of raised intracranial pressure, a lumbar puncture must be performed whenever the diagnosis of meningitis is suspected in a child . It serves to confirm a diagnosis of purulent meningitis, to identify the bacteria and to test its sensitivity to antibiotics . If the child responds appropriately to therapy, some authors recommend no further examination of cerebrospinal fluid (CSF) . However, most prefer to control CSF sterilization after about 48 h of therapy . Apart from its bacteriological interest, this second lumbar puncture seems to be a prognostic indicator of the incidence of neurological abnormalities . No further CSF examination is necessary when the patient's course of illness is uncomplicated . On the other hand, the presence or appearance of neurological abnormalities during the daily physical and neurological examination compels a new lumbar puncture and a CT scan to search for a persistent central nervous system infection or a complication of the meningitis. J Antimicrob Chemother, 1993 Jan, 31 Suppl A, 87 - 95 Efficacy, safety and tolerance of parenteral piperacillin/tazobactam in the treatment of patients with lower respiratory tract infections; Mouton Y et al.; An open, non-comparative multicentre study was conducted at 36 sites in six countries to test the efficacy and safety of piperacillin/tazobactam in the therapy of lower respiratory tract infections . Piperacillin 4 g and tazobactam 500 mg were administered intravenously every 8 h for a minimum of five days . Two hundred and thirty patients were enrolled: 133 were evaluable for clinical efficacy and 106 for bacteriological efficacy . The clinical response was favourable in 96% of evaluable patients and the bacterial eradication rate was 93% . Nine patients (4%) had severe adverse events related to piperacillin/tazobactam and requiring discontinuation of therapy . In this study piperacillin/tazobactam was an effective and safe drug in the treatment of hospitalized patients with lower respiratory tract infection caused by sensitive organisms. J Antimicrob Chemother, 1993 Jan, 31 Suppl A, 105 - 12 Therapy of soft tissue infections with piperacillin/tazobactam; Tassler H et al.; The efficacy and safety of piperacillin in combination with the beta-lactamase inhibitor tazobactam were assessed in an open, multi-centre study of hospitalized patients with skin and soft tissue infections . A total of 136 patients from four countries were treated with piperacillin 4 g plus tazobactam 500 mg every 8 h . The mean duration of treatment was eight days . Clinical and bacteriological evaluations were performed one to three days and ten to 14 days post-therapy, respectively . Among 120 evaluable patients 93% were clinically cured or improved; 91% of bacteriologically evaluable patients were cured or improved . Eradication of the pathogens was observed in 85% and 95% of the evaluable patients at first and second follow-up . In 43% of the patients more than one pathogen was isolated from the wound . Persistence was commonest in patients in whom a complete surgical debridement could not be carried out . There were adverse events in 16 of the 136 patients, most commonly allergic reactions and diarrhoea . Six patients were withdrawn from the study because of side-effects. Bull Soc Pathol Exot, 1993, 86(2), 141 - 3 {Clinical, epidemiological and therapeutic aspects of purulent meningitis in the adult . Apropos of 74 cases treated at CHU of Brazzaville (Congo)}; Boumandouki P et al.; During 2 years and 9 months, 74 patients were hospitalized to purulent meningitis at the Hospital of Brazzaville and 33 were bacteriologically confirmed . The pneumococcus was responsible in 24 cases (33.4%) . The analysis of 74 files showed that 34 patients died, 40 were completely cured without any after effect . The factors for these bad prognosis are: the presence of signs of cerebral pains; a CSF cytology inferior to 500 cells/mm3; total CSF proteins inferior to 2 g/l and the time before hospitalisation superior to 5 days. Bull Soc Pathol Exot, 1993, 86(2), 136 - 40 {Bacteriological aspects of purulent meningitis in Bamako district . Apropos of 1,541 bacterial strains collected from 1979 to 1991}; Koumare B et al.; This study is about bacteriological aspects of purulent meningitis in Bamako area upon 1,541 strains collected from 1979 to 1991 . It showed that N . meningitidis, S . pneumoniae and H . influenzae b are responsible . In general, N . meningitidis is the most frequent, but this depends on years and months . Since 1988, N . meningitidis serogroup C has supplanted serogroup A . N . meningitidis is predominant between 7 to 30 years . S . pneumoniae between 1-28 days and 31 to 68 years, H . influenzae between 1 month to 6 years . The frequency of these species is the same in male and female . The 3 species are quite sensitive to antibiotics tested except sulphonamides and cotrimoxazole . Meanwhile, the appearance of strains of S . pneumoniae to penicillin and H . influenzae to ampicillin must be followed with interest to check any time the importance of the phenomenon. Pneumonol Alergol Pol, 1993, 61(5-6), 287 - 90 {Mycobacterial infection in patients with AIDS}; Zalewska-Schontaler N et al.; Bacteriological diagnosis of tuberculosis was performed in 104 HIV-positive patients, in majority AIDS patients hospitalized in AIDS Clinic of Infections and Parasitic Diseases Institute of Medical Academy . 390 samples were examined, e.d . 3.75 from each patient (from 1 to 22 samples) . M . Tuberculosis was diagnosed in 14 patients and all of them were clinically observed because of pulmonary tuberculosis . The highest percentage of positive results was obtained from bronchial fluid evacuated during bronchoscopy. Pneumonol Alergol Pol, 1993, 61(5-6), 263 - 7 {Coexistence of pulmonary tuberculosis and alcoholism in Poland}; Masztalerz J et al.; The aim of study was to determine a number of alcoholics in new diagnosed cases of bacteriological confirmed pulmonary tuberculosis in 1989-1990 . Data were obtained from the Central Register of Tuberculosis . It was found that the number of alcoholics among new registered patients with tuberculosis increased from 8.8% to 10.5% . Young patients were more than 60% group . Results of treatment of severe types of pulmonary tuberculosis in alcoholics were also not so effective as in typical patients. Pneumonol Alergol Pol, 1993, 61(5-6), 224 - 30 {Tuberculosis in the central register for tuberculosis}; Miller M et al.; Applied methods and results of antituberculosis treatment of all registered patients in 1990 in Poland are presented . Tuberculosis prevention was achieved in 91.9% of sputum-positive patients similarly, diagnostic mistakes were detected in 10% patients with non-bacteriologically determined tuberculosis . In one year since registration 7.7% of sputum-positive patients and 3.9% of patients with non-bacteriologically confirmed tuberculosis have been dying in one year since registration time . Majority of patients in Poland were treated too long because of tuberculosis. Vet Med (Praha), 1993, 38(5), 305 - 17 {The occurrence of avian mycobacteriosis in wild birds during various epizootic conditions of tuberculosis in poultry}; Hejlicek K et al.; The occurrence of tuberculosis in free-living birds was studied in relation to a certain epidemiological situation in a long-term study from 1966 to 1990 . A total of 3210 birds were examined . Mycobacteria were isolated in five cases from free-living birds in the environment of six poultry rearing farms where tuberculosis was found in domestic fowl . At individual localities, the occurrence of mycobacteria was 3.5-50.0% . Generalized tuberculosis was found in one case in house sparrow (Passer domesticus) . On the investigated poultry rearing farms, the distribution of tuberculosis infection in free-living birds was directly related to the distribution and stage of tuberculosis in poultry or to the achieved extent of eradication . On a poultry rearing farm where no mycobacteria were isolated from free-living birds, a successful eradication of tuberculosis by flock exchange was in progress . During the examination of free-living birds on three farms, mycobacteria were found at two localities where poultry infected with tuberculosis was kept either on the farm or in its immediate vicinity . On the third farm, where no mycobacteria were found in free-living birds, only sporadic reactors to tuberculin were found during survey in spatially separated flocks . No mycobacteria were isolated from birds examined on two farms in whose vicinity poultry was not reared at all . Similarly, bacteriological cultures were negative in a group of 298 birds examined during five years in the environment of a poultry enterprise farm free from tuberculosis . No mycobacteria were found in a large group of 2303 free-living birds taken in the wild except four rooks (Corvus frugilegus) . However, this is a migratory species which is noted for its considerable longevity . It is thus more probable that these birds were infected outside the locality which the specimens were taken from . Out of the isolated strains of mycobacteria that were further examined by a biological experiment, 86.6% were pathogenic to domestic fowl, serotype M . avium 2 . The results of these examinations suggest that the presence of tuberculosis-infected poultry as a major source of M . avium is necessary for the infection of free-living birds . The infectious agent apparently does not persist and spread within the flocks of free-living birds. Acta Vet Scand, 1993, 34(1), 83 - 93 Variations during lactation in total and differential leukocyte counts, N-acetyl-beta-D-glucosaminidase, antitrypsin and serum albumin in foremilk and residual milk from non-infected quarters in the bovine; Ostensson K; Quarter samples of foremilk and residual milk were taken approximately every second week from 2 days post partum (pp) throughout lactation month 9, from 5 dairy cows in their second lactation period . Bacteriologically positive milk samples were excluded . The aim was to study the variation in total and differential leukocyte counts, N-acetyl-beta-D-glucosaminidase (NAGase), antitrypsin (ATR) and serum albumin (BSA) in milk during the lactation period and different stages of oestrous cycle . Also the between milkings variation was studied from lactation month 4 to 9 . At 2 days pp, each fraction of milk contained significantly higher numbers of leukocytes and had a higher activity of NAGase and ATR than later in the lactation period . In foremilk the highest content of BSA was also recorded at 2 days pp . From lactation month 2 to 9, stage of lactation had, in general, a slight effect on the variation in the variables measured . The total leukocyte count in residual milk tended to increase as lactation proceeded . The proportion of monocyte-macrophages in foremilk was significantly decreased during the last 4 months . NAGase and BSA in both fractions and ATR in residual milk increased significantly towards the end of the lactation period . From lactation month 4 to 9 the highest recorded ranges of variation between milkings, within quarter and stage of lactation, in the total leukocyte count, proportions of neutrophils, lymphocytes, monocyte-macrophages, NAGase, ATR and BSA in foremilk were 215 x 10(3)/ml, 42%, 34%, 54%, 6.68 units, 0.36 units and 0.14 mg/ml respectively . The corresponding figures in residual milk were higher except for the variation in BSA which was slightly lower in residual milk than in foremilk . In residual milk there was a positive correlation between the proportion of neutrophils and the total leukocyte count, when calculated on data from all cows and the entire experimental period . During the oestrous periods, the proportion of neutrophils in residual milk was higher than during the dioestrous periods . Foremilk and residual milk differed in the total as well as the differential leukocyte counts in all the various stages of lactation, whereas the contents of NAGase, ATR and BSA were equal in both fractions . The exception was 2 days pp when the proportions of lymphocytes were equal in both fractions and BSA-significantly higher in foremilk than in residual milk. Ann Fr Anesth Reanim, 1993, 12(1), 11 - 6 {Effects of postoperative autotransfusion in prosthetic surgery of the hip with the ConstaVac device}; Guerrero M et al.; A new device for postoperative autotransfusion (ConstaVac, Stryker) was assessed after total hip replacement in 43 patients, mean age 63 +/- 13 years . Intraoperative blood was administered to 27 patients (63%), autologous blood only in 19, homologous blood only in 6 and both autologous and homologous blood in 2 . The blood shed during an average 5-hour postoperative period had an haematocrit of 23 +/- 7% and included only few platelets (72 +/- 83 G.l-1) . It did not clot as it contained there was less than 0.1 g.l-1 of fibrinogen and a high concentration of D-dimers . In 30 patients (70%), the amount of blood thus collected exceeded 200 ml . An average of 327 +/- 131 ml were subsequently retransfused to these patients . Postoperative autotransfusion induced a moderate but significant decrease in platelet counts (205 +/- 66 vs . 224 +/- 67 G.l-1, p < 0.02) and fibrinogen concentrations (2.3 +/- 0.7 vs . 2.4 +/- 0.6 g.l-1, p < 0.03), and an increase in circulating D-dimers (p < 0.001) . Coagulation tests, free plasma haemoglobin and potassium concentrations were not significantly altered . Since the haematocrit of the blood lost was lower than that of the patients', the haematocrit did not increase significantly . Posttransfusion shivering occurred in two patients (7%) . Bacteriological cultures of the lost blood and of venous samples obtained after postoperative autotransfusion remained sterile . Postoperative autotransfusion is a simple technique with few side-effects, which might be safely associated with other methods used to decrease the rate of homologous blood transfusion. Rinsho Shinkeigaku, 1993 Jan, 33(1), 78 - 82 {Leptomeningeal abnormality on Gd-DTPA enhanced MRI in a case of SLE presenting diffuse organic brain syndrome}; Okano R et al.; Involvement of the central nervous system associated with SLE (CNS lupus) is not rare . Two types of CNS lupus are noted clinically; one group manifesting focal neurological symptoms and another group showing mental symptoms . Though it is well known that neurological symptoms are caused by arteritis and thrombus, pathophysiological mechanisms leading to mental symptoms remain obscure and there is no established clinical evidence responsible for these symptoms . A 41-year-old woman was confused and her attention was markedly impaired . Her mental symptoms consisted of disorientation, restlessness, euphoria and emotional incontinence . There were neither focal neurological signs nor meningeal signs . Cerebrospinal fluid (CSF) examination showed increased number of polymorphonuclear cells and permeability of the blood-brain barrier, calculated based on the CSF/plasma protein ratio, was also elevated . Repeated bacteriological examinations revealed to be negative . Gd-DTPA MRI demonstrated diffuse enhancement of the cerebral leptomeninges . Methylprednisolone pulse therapy ameliorated her mental deterioration effectively, and subsequently the leptomeningeal enhancement with Gd-DTPA MRI disappeared in parallel . These radiological and laboratory findings suggest that SLE itself causes inflammation of vessels in the leptomeninges and adjacent cerebral cortex . We consider mental symptoms associated with SLE may be caused, at least in part, by this mechanism . To our knowledge, we could not find similar reports in the literature . Gd-DTPA enhanced MRI seems to be of clinical use for making diagnosis, evaluating clinical activity and understanding of CNS lupus. An Otorrinolaringol Ibero Am, 1993, 20(3), 225 - 34 {Retropharyngeal abscess due to atypical mycobacteria . Case report}; Bernat Gili A et al.; It is a rare clinico-pathological infection located in the retropharyngeal space . Our contribution refer to a young man suffering this complaint caused by atypical mycobacteria, being the aim of the paper to underline the exceptional placement . The difficulties encountered in establishing the bacteriological diagnosis as well the excellent response to a combined treatment with tuberculostatics and surgery. Hist Philos Life Sci, 1993, 15(1), 3 - 21 A bacteriological paradigm in influenza research in the first half of the twentieth century; van Helvoort T; Scholars have argued that the beginning of virology can be dated from the end of the 19th century: the discovery that some infectious agents could pass through ultrafilters produced a criterium to distinguish ultrafilterable viruses from infectious agents that are not filterable, e.g . bacteria . A filterable agent, claimed to be the cause of human influenza, was isolated in 1933 . It will be argued in this paper, however, that the influence of a bacteriological paradigm on influenza research in the first half of the twentieth century was very powerful . Until the late 1940s influenza viruses were studied as infectious entities which, although filterable, were conceived of as analogous to bacteria . It was assumed that filterable viruses which infected animals were a kind of ultrabacteria . According to the bacteriological paradigm the assumed dependence of the filterable viruses on living cells was easy to account for . The second half of the 1940s saw the 'modern concept of virus' begin to be applied to the influenza viruses . Influenza vaccinations in 1946 did not appear to provide protection, from which it was concluded that the influenza virus is very variable . Furthermore, in 1946 and 1947 experimental studies were published, which indicated that the influenza virus may go through an eclipse during its multiplication: it disappears as an infectious agent . Viewed from this perspective, it was only by the second half of the 1940s that research on the influenza virus became emancipated from the bacteriological paradigm. J Fr Ophtalmol, 1993, 16(10), 501 - 5 {Bacteriological study of the intraocular fluid at the end of cataract surgery}; Feys J et al.; The authors studied bacterial contamination of the anterior chamber during extracapsular cataract extraction with intraocular lens implantation . A first study was conducted to determine the rate of contamination of anterior chamber aspirates, before surgery, in 46 patients undergoing cataract extraction . A second study concerned 200 patients undergoing extracapsular extraction with posterior chamber lens . Anterior chamber fluid was aspirated at the end of surgery, and inoculated into blood culture bottles . Bacteriological results were positive in 11 cases, and were compared with conjunctival smears . The way in which aqueous humor was aspirated and inoculated is described . The bacteriological method was tested with a small inoculum of bacteria . Bacteriological study of intraocular fluid at the end of cataract surgery might be useful in the diagnosis and treatment of postoperative endophthalmitis. Ann Med Interne (Paris), 1993, 144(5), 323 - 8 {Role of human immunodeficiency virus infection in 67 patients with tuberculosis}; Beaulieu P et al.; This retrospective study compared the epidemiological, clinical and bacteriological characteristics of tuberculosis in HIV-infected (HIV+) and seronegative (HIV-) patients in France . It included 67 cases of tuberculosis observed in the hospital setting between 1985 and 1990 . The 35 HIV+ patients (52.2%) were more frequently of European origin, while those of African origin were HIV- . Disseminated tuberculosis predominated in HIV+ patients, as opposed to pulmonary tuberculosis in HIV- patients . The tuberculin test was more often positive in HIV- patients than in HIV+ ones (65.6 versus 17.1%; p < 0.001) . Direct bacteriological examination of the sputum was positive more frequently in HIV- than HIV+ patients (56.2 versus 22.8%; p < 0.01) . A high percentage of the Mycobacterium tuberculosis strains isolated from HIV+ patients (20%) was resistant to anti-tuberculous drugs, primarily isoniazid, while no resistance was found in HIV- patients . The initial response to treatment and the therapy-associated side effects did not differ between the two groups . Four relapses (11.4%) occurred in HIV+ patients, raising the question of the indication of drug prophylaxis following tuberculosis in HIV-infected patients. Vet Med (Praha), 1993, 38(10), 619 - 28 {Epizootiology and pathogenesis of avian mycobacteriosis in doves (Streptopelia sp.)}; Hejlicek K et al.; The collared turtle-dove (Streptopelia decaocto) and the turtle dove are common synanthropic bird species . The collared turtle dove in particular comes to close contact with farm animals, including with tuberculosis-infected small poultry on farms . It can thus be infected by avian mycobacteria and to become their further source and disseminator . Elucidating the occurrence of avian mycobacteriosis in turtle we examined 218 specimens of the collared turtle-doves and 22 specimens of turtle-doves taken in habitats with different epidemiological setting . We found no pathomorphological tuberculous lesions and isolated no mycobacteria from organs or the contents of intestines in any of them, though we also examined turtles living near poultry farms infected with tuberculosis or near farms where avian tuberculin-positive cattle was reared . Under the same conditions we found repeatedly, e.g . in sparrows, both the tuberculous lesions and mycobacteria . The turtle dove can thus be considered as very resistant to avian mycobacteria and the occurrence of avian mycobacteriosis can be regarded as rather exceptional . The susceptibility of the collared turtle-dove to avian mycobacteria was verified also by experimental infections . After intramuscular infections of M . avium serotype 2 suspension, we demonstrated macroscopic tuberculosis lesions only in the site of inoculation from day 21 onwards . The histological lesions were found in the liver, spleen and bone marrow from day 28 after inoculation . However, mycobacteria were isolated from various organs and tissues as early as 12 days after inoculation . Attempts to demonstrate tuberculous lesions and to isolate mycobacteria from the intestines failed . No tuberculous lesions produced in turtle dove within the period of 122 days after peroral infection by food contaminated by TBC poultry livers and bacteriologically examined was negative too . After free contact between TBC poultry and turtle doves the sporadic histological TBC changes in liver were found after 180 days and in one case mycobacteria were isolated from the liver and muscle after 157 days . The transfer of M . avium from TBC infected turtle doves pigs and poultry was successful . After 45 days of join contact among TBC turtle doves, healthy pigs and poultry in stables and after further stay of pigs and poultry in contaminated environment for additional 65 and 175 days, respectively . In the course of the experiment, 105 days after its onset, marked reaction to avian tuberculin was demonstrated in one pig . Simultaneously with it, the TBC lesions in mandibular and mesenteric lymphatic glands were found . In one pig, mycobacteria were isolated from those suspectedly affected lymphatic glands.(ABSTRACT TRUNCATED AT 400 WORDS) Rev Mal Respir, 1993, 10(5), 437 - 44 {A trial comparing artificial noses and heat exchangers during assisted ventilation using tracheotomy at home . CARDIF . The Committee of the Organization of Respiratory Assistance of the Ile-de-France}; Antoun F et al.; Thirteen patients with a tracheostomy who were undergoing artificial ventilation at home were included in a study covering 62 episodes, during a month of treatment, which was undertaken with three different humidification systems: A Puritan Bennet Cascade humidifier (C), a Swedish nose Vygon-(V) (a hydroscopic condenser humidifier) and a Pall filter (P) . Five patients abandoned the study because of discomfort with C (1), P (2), or V (2) . The discomfort described by three patients was identical with the three systems used during ventilation . The two systems using the artificial heat humidification exchanger were considered more simple to use than the Cascade for the patients . Using the system for three years for a patient who was being ventilated for 12 hours out of 24 showed the increasing cost ranging from the Vygon nose, to the Cascade and finally to the Pall filter . The percentage of time spent on antibiotics was identical with the three systems (11% of the time) . A bacteriological study showed that only the Pall filter permitted the respirator tubes to be kept sterile . The most polluted circuit from the bacteriological point of view was that used with the Cascade . In conclusion, when it was compared to the humidifier Cascade the two artificial noses appeared as simple to use and the Pall filter was the safest bacteriologically. Arch Immunol Ther Exp (Warsz), 1993, 41(1), 99 - 103 A comparison of efficacy of Tołpa Torf Preparation (TTP) in the treatment of cervicitis with or without surgery; Woyton J et al.; Tolpa Torf Preparation (TTP) is an immunomodulating drug produced by Torf Corporation, Wroclaw and registered for human use in Poland . TTP enhances the process of tissue regeneration . Authors evaluate TTP effectiveness in the treatment of inflammatory states of the cervix, especially cervical erosions and the influence of this preparation of the macroscopic, cytological and bacteriological state of the cervix . TTP was used in 31 patients with the diagnosis of cervical erosion . All patients treated as yet were classified into 3 groups, depending on the treatment of cervical erosion used previously . TTP was administered orally in the dose of 5 mg (in 10 ml of water) daily during 10 days and locally in the form of tampons soaked with 1% TTP solution in the volume of 5 ml also during 10 days . TTP administered this way has beneficial therapeutic effects on the healing of cervical erosion accelerating the process of epithelialization and bringing normalization of the cytological picture . Especially beneficial in the treatment of cervical erosion is combined use of TTP and electrocoagulation or curettage--the healing time can be shortened by half. Med Dosw Mikrobiol, 1993, 45(1), 45 - 9 {Occurrence of antituberculous antibodies in patients with lung tuberculosis and other inflammatory states of the respiratory system}; Kaczmarek A et al.; In this study an indirect immunofluorescence method was applied . Determinations regarded the level of anti-H37Rv antibodies in patients with bacteriologically confirmed lung tuberculosis and in a control group consisting of healthy volunteers . Antibody levels were significantly higher in sick patients . We conclude that this method may be applied as a supplementary diagnostic test in doubtful cases and that it can prove useful as screening test for investigation of groups of population especially at risk from tuberculosis . Applied method of indirect immunofluorescence is easy to perform, quick (time of the test takes about 3 hours), available in Poland, and cheaper than ELISA. J Orthop Trauma, 1993, 7(5), 473 - 82 The incidence of osteitis in open fractures: an analysis of 948 open fractures (a review of the Hannover experience); Suedkamp NP et al.; Even though treatment protocols of open fractures have been improved in the past two decades, osteitis is still a major complication in these injuries . To investigate the primary factors responsible for posttraumatic osteitis, 19 cases of osteitis out of 297 open fractures (retrospective series from 1981 to 1983) and nine cases of osteitis out of 651 open fractures (prospective series from 1984 to 1989) were analyzed . The Hannover fracture scale was used for quantitative evaluation of the injury . A high prognostic index for bone infections was found for the amount of bone loss, the fracture type, the type of bacteriologic contamination, deep soft-tissue defects, compartment syndromes, vascular injuries, and soft-tissue infections. Genetica, 1993, 88(2-3), 107 - 17 Variable X chromosome inactivation patterns in near-tetraploid murine EC x somatic cell hybrid cells differentiated in vitro; Takagi N; For the cytogenetic study of X chromosome inactivation as an X chromosome dosage compensation mechanism, we isolated a number of XXXX, XXX, and XXY near-tetraploid mouse hybrid cell clones by fusing XX or XO embryonal carcinoma cells with lymphocytes carrying a structurally altered X chromosome(s) . The inactive X chromosome from the female lymphocyte was reactivated in these hybrid clones which retained embryonal carcinoma morphology so far as they were cultured on the collagen-coated plastic surface in the medium supplemented with leukemia inhibitory factor (LIF) and betamercaptoethanol (BME) . Some of these clones developed balloon-like cystic embryoid bodies when they were allowed to form cell aggregates in medium without LIF and BME in bacteriological petri dishes to which they do not adhere . X chromosome inactivation occurring during this process detected by the incorporation of 5-bromodeoxyuridine did not conform to the expected pattern leaving two X chromosomes active in every tetraploid cells . This may suggest either that the X-inactivation mechanism evolved primarily, for the diploid cell is unable to deal with tetraploid conditions efficiently, or that the present system of in vitro differentiation represents an anomalous situation never encountered in vivo. Rev Gastroenterol Peru, 1993, 13(1), 13 - 9 {Prognostic factors in typhoid perforation}; Paredes C et al.; This retrospective study evaluated 112 patients who had undergone surgery by typhoid perforation at the Belen Hospital, Trujillo, Peru, from 1967 trough 1990 in order to identify by univariate analysis the combination of factors predictive of postoperative morbidity and mortality . All the patients had one or more of the following diagnostic criteria: bacteriologic, serologic, anatomopathologic and surgical . The surgical procedures performed were: simple closure (n = 70), intestinal resection in conjunction with primary anastomosis (n = 6), intestinal resection plus ileostomy (n = 33), whilst peritoneal drainage operations were used in 3 cases . The following parameters were evaluated: age, sex, length of history, length of perforation, low intestinal hemorrhage, leukocyte count, type of peritoneal fluid and number of perforations . The operative mortality rate for all patients was 21.4% and morbidity rate was 80.4% . Significant differences in morbidity were only found in patients with perforations over 48 hours (p < 0.05) . Analysis of post-operative mortality: length of perforation over 48 hours (p < 0.001), presence of hematochezia (p < 0.01), leukopenia (p < 0.05), fecaloid peritoneal fluid (p < 0.05) or the evidence of 3 or more intestinal perforations (p < 0.05) . We concluded that a surgeon must take into account all of these factors to lead to satisfactory results. Ann Otolaryngol Chir Cervicofac, 1993, 110(6), 332 - 6 {Malignant external otitis . Apropos of 7 recent cases}; Ceruse P et al.; Seven recent malignant external otitis are described . The authors report criteria of both etiology, bacteriologic, radionuclide scanning computed tomography . Now, for the positive diagnosis, the radionuclide scanning is essential . The computed tomographic scan provided the best anatomic imaging of the infection process . The treatment of choice is systemic antibiotic therapy as fluoroquinolones antibiotic . This antibiotic is active against P . Aeruginosa and has an excellent bone penetration . Only one patient died and another suffered from osteomyelitis of the base of the skull . The radionuclide scanning is very important for criteria of healing, particularly about stoppage of systemic antibiotic therapy. Acta Microbiol Hung, 1993, 40(3), 239 - 47 Quality assurance in clinical bacteriology--a continuous development in Hungary since 1927; Lanyi B; In Hungary, uniform methods and quality assessment date back as early as 1927, when the National Institute of Hygiene and regional public health laboratories were established . The National Microbiology Committee organized in 1984 was replaced in 1992 by the National Clinical Microbiology Board and the Joint Quality Assurance Committee of Clinical Microbiology for which the National Institute of Hygiene acts as an operating centre . A long-range programme of proficiency testing and on-site inspections had a beneficial effect on performance in public health laboratories: in 1989 20 out of 24 of them were scored in the excellent or good degree . Hospital laboratories, which joined this programme only in 1984, exhibited less satisfactory results. Drugs Exp Clin Res, 1993, 19(5), 223 - 7 Randomized comparative trial of imipenem/cilastatin versus aminoglycoside plus amoxycillin plus clindamycin in the treatment of severe intra- and post-operative infections; Cakmakci M et al.; In a prospective, randomized, controlled study, clinical and bacteriological efficacy of imipenem/cilastatin (I/C) was compared with a standard combination of aminoglycoside + amoxycillin + clindamycin (C) in patients (pts) with severe intra- and postoperative infections . A total of 84 pts were randomly separated into two groups of 42 pts . Diagnoses were pneumonia n = 21 (14 in I/C group and 7 in C), peritonitis n = 45 (16 in I/C group and 29 in C), septicaemia n = 12 (9 in I/C group and 3 in C), and 7 other infections (3 in I/C group and 4 in C) . Doses used were imipenem/cilastatin 1 g q 8 h and amoxycillin 2 g q 8 h plus clindamycin 0.6 g q 6 h, plus netilmicin according to serum concentrations . Success rates were 85.4% (n = 35: 34 cured and one improved) in the I/C group and 83.3% (n = 35: 30 cured and five improved) in the C group . Six pts in group I/C and 7 in group C failed to respond to treatment . One patient in the I/C group was not assessable . 62% of the bacterial isolates were eradicated in the I/C group and 55% in group C . 7% were suppressed in I/C and 5% in C . It is concluded that imipenem/cilastatin is an effective and well-tolerated alternative to antibiotic combinations in severe intra- and post-operative infections . It offers the advantages of fewer drug doses and less renunciation of serum drug concentration monitoring. Trans Am Ophthalmol Soc, 1993, 91, 441 - 516 Age as a factor in the bacteriology and response to treatment of subperiosteal abscess of the orbit; Harris GJ; The clinical course of SPA of the orbit is associated with the age of the patient . That association might be explained through a series of intermediate relationships: the clinical course correlates with the bacterial constituency, the bacterial constituency is related to physiologic derangement within the sinuses, the physiologic derangement may vary with the degree of obstruction of the sinus ostia, and the ostial caliber relative to the volume of the cavity that must be drained decreases with patient age into late adolescence . The controversy between pediatricians and surgeons over the appropriate indications for drainage might be resolved with the acknowledgement that each side is correct on the basis of the patient populations treated . It is hoped that recognition of the age-related variations in SPA will permit a more systematic approach to the management of this complex infectious disease. Klin Khir, 1993, (7-8), 34 - 7 {Prevention of suppurative inflammatory complications in traumatology}; Levenets VN et al.; On the basis of the data of clinical, bacteriologic, immunologic investigations, the system for prevention of purulent-inflammatory complications (PIC) in treatment of closed and open fractures of the extremities has been developed . Use in the clinic of a system for prophylaxis permitted to reduce the incidence of PIC development in operative treatment of closed fractures from 5.6 to 1.64%, after performance of the emergency operations for open injuries--from 18.3 to 5.4%. Rev Elev Med Vet Pays Trop, 1993, 46(1-2), 303 - 8 Study of efficacy of Lamstreptocide A & B on cases of dermatophilosis within the Caribbean; Isitor GN et al.; The efficacy of Lamstreptocide A & B was studied on 9 natural cases of bovine and caprine dermatophilosis in 8 different farms in St . Kitts, employing standard histopathologic and bacteriological methods . The lesions of 5 of the treated cases were dried-up, and there was marked peeling-off of scabs of a severely affected case exposing erythematous underlying tissue, at 3 weeks post-application of the product . Apart from 3 mild cases which were not available for follow-up studies and which were reported to have recovered, there was no outright recovery of the 5 animals after treatment at 3 weeks, and even after a second application of the product . An in vitro sensitivity test of the product revealed a slowing down of growth of Dermatophilus congolensis at concentrations in excess of 1% by agar-streak method . However, there was no inhibition of growth of the bacterium by an agar-impregnated sensitivity method. Rev Elev Med Vet Pays Trop, 1993, 46(1-2), 263 - 9 Experimental dermatophilosis in murine models of immunodeficiency; Sasiak AB et al.; Gnotobiotic mice with congenital immune deficiencies were infected with the skin pathogen Dermatophilus congolensis . Athymic (nude) mice with T cell deficiency were less susceptible than nude mice which also carried the beige mutation (beige-nude) with NK cell and granulocyte defects, as part of the murine equivalent of Chediak-Higashi syndrome . The additional presence of the x-linked immunodeficiency gene in other beige mutant mice, giving reduced B cell responsiveness, did not increase their susceptibility . BALB/c mice with the nude mutation and evidence of macrophage insufficiency, had a moderate level of susceptibility, greater than that of outbred nude mice but less than that of beige, nude mice . The appearance of the lesions on the haired mice was different from that on those with hairless skin (nude and beige-nude) . On the haired mice thin crusts developed and healed rapidly, while on the hairless mice the lesions started as nodules and later progressed to crusts . The nude BALB/c mice developed atypical lesions, which resembled ulcers . Germ-free nude and beige-nude mice showed the same types and time course of infection as the gnotobiotic animals, suggesting that bacterial interference, by a limited skin flora, did not play a major role in defence against D . congolensis . However, bacteriological analysis indicated that D . congolensis could survive in the gut of germ-free mice . This work emphasizes the importance of non-specific immune mechanisms, such as epidermal hyperproliferation and the neutrophil, in resistance to D . congolensis. Proc Annu Symp Comput Appl Med Care . 1993;:678-82. Database access and problem solving in the basic sciences; de Bliek R et al.; This study examined the potential contribution that access to a database of biomedical information may offer in support of problem-solving exercises when personal knowledge is inadequate . Thirty-six medical students were assessed over four occasions and three domains in the basic sciences: bacteriology, pharmacology, and toxicology . Each assessment consisted of a two-pass protocol in which students were first assessed for their personal knowledge of a domain with a short-answer problem set . Then, for a sample of problems they had missed, they were asked to use a database, INQUIRER, to respond to questions which they had been unable to address with their personal knowledge . Results indicate that for a domain in which the database is well-integrated in course activities, useful retrieval of information which augmented personal knowledge increased over three assessment occasions, even continuing to increase several months after course exposure and experience with the database . For all domains, even at assessments prior to course exposure, students were able to moderately extend their ability to solve problems through access to the INQUIRER database. Verh K Acad Geneeskd Belg, 1993, 55(4), 305 - 17 {Hieronymus Fracastorius, from syphilographist to oenologist}; Van Laere J; The poem Syphilis sive morbus gallicus was published by Fracastor in 1530 . It is written in excellent Latin and gives a valuable description of the symptomatology of this venereal disease, that had appeared in Europe some years before . In his De morbis contagiosis, printed in Venice in 1546, Fracastor describes the cause of syphilis and appears as a precursor of bacteriology . Fracastor was born in 1483 within a well-known medical family . He studied the Fine Arts, Mathematics and Medicine in Padova . He made himself famous not only as a physician, but also as an astronomer, a naturalist, a poet and a philosopher . He acted as arbitrator between two of his fellow-physicians--Gaioni and Fumanelli--who couldn't come to an agreement as to the "nature" of wine . He communicated his reasons and conclusions in his treaty De vini temperatura sententia, published in 1534 . Leaning on a rather scholastic reasoning, he takes the side of Fumanelli, who considers wine as being a "dry" remedy . What may be of interest for the modern reader, are the passages where Fracastor, as an excellent oenologist, enumerates the different wines and describes the indications for wine as a medicine . Remarkable are also the passages in which he, be it rather reluctantly, dares to contradict the Ancients. Arkh Patol, 1993, 55(6), 45 - 8 {Diagnostic criteria of pyloric helicobacter infection in peptic ulcer}; Sklianskaia OA et al.; Helicobacter pylori (HP) in 41 patients (10 with stomach ulcer and 31 with duodenum ulcer) was found in gastro-biopsies from the stomach antrum before and after the treatment . The following methods to reveal HP were used: Giemsa staining, immunoperoxidase reaction with polyclonal monospecific antibodies against HP, urease rapid test . HP was also revealed in the blood serum by antibodies against HP by means of enzyme immunoassay . Electron microscopy was performed in 5 patients and bacteriologic study in 10 patients . Immunohistochemical method allows one to judge about real HP colonization of the gastric mucosa . Bacterioscopy with Giemsa staining gives good results but they are not true markers of HP presence this being explained by other methods . Serologic enzyme immunoassay gives an idea about the patient contamination, but not about HP eliminations as a result of treatment . Urease-test is adjuvant. Acta Neurochir (Wien), 1993, 125(1-4), 58 - 63 CT-guided stereotactic aspiration and treatment of brain abscesses . An experience with 24 cases; Hasdemir MG et al.; The present study reports our experience with stereotactic puncture, aspiration and drainage of brain abscesses in 24 patients from a series of 34 consecutive cases . In all patients an intracavitary catheter was left in place for external drainage and daily irrigation with antibiotics . The patients received pre- and postoperatively triple broad spectrum antibiotic treatment, associated with low dose steroids and anti-epileptic drugs . Follow-up CT scans showed immediate reduction of the abscess size and gradual diameter diminution of the enhancing ring structure until its disappearance . The clinical presentation, risk factors, aetiology, outcome, bacteriological and CT findings were analysed . Mortality in this series was 4% . The majority of patients (96%) had no or minimal disability according to the Glasgow Outcome Scale . Our results confirm the value of this treatment policy and suggest that the stereotactic technique is a simple and safe method with minimal mortality and morbidity in the treatment of the majority of chronic brain abscesses. Rev Mal Respir, 1993, 10(6), 557 - 9 {Thoracic actinomycosis . Two aspects of an infection with protean manifestations}; Kerjan A et al.; The authors report two cases of thoracic actinomycosis with contrasting presentations, just as the diagnosis was obtained by different tests underlying the varied aspects of this disease . Indeed this infectious pathology does infrequently mimic tuberculosis or lung cancer with similar clinical and radiological appearances . The particular characteristic of the bacteriological culture and the quasi specific character of the pale, yellow grains on histology are recalled, as well as the different treatments necessary to ensure a cure in 90% of cases. Rev Chir Orthop Reparatrice Appar Mot, 1993, 79(2), 111 - 3 {Clinical and bacteriological outcome of wounds treated with honey . An analysis of a series of 40 cases}; Ndayisaba G et al.; Since a long time, honey has been used in wounds and skin ulcer treatment . Nowadays, it's healing properties are again being discovered . Its good application on wounds and infected burns gives satisfactory results . This work is a study done on 40 patients with wounds of various origin . Honey has healed 88 per cent of the cases . Some germs have been found on the wound at the end of the cicatrization but have not blocked the healing process . This simple, efficient, cheap and with no side effects treatment deserves being better known and integrated in the set of common antiseptics. Acta Vet Hung, 1993, 41(1-2), 41 - 9 Treatment of calf pneumonia with tilmicosin; Fodor L et al.; The therapeutic effect of a single injection of tilmicosin (10 mg/kg body mass) against natural cases of pneumonia of calves, compared to other conventionally used antibiotics, was examined under field conditions . The trials were conducted in three cattle herds and included the treatment of 135 calves with 82 controls . The animals' age ranged from 1 week to 4 months . Prior to the treatment and in case of death bacteriological examinations from nasal swabs and from the lungs were carried out . Clinical signs were recorded in all groups and in one group body mass gains were also recorded . After tilmicosin treatment, the body temperature returned to the normal level within 24 h and the animals recovered within 1 to 2 days . Ten calves (7.41%) showed relapse during the 3rd and 4th week after treatment in contrast to 9 (10.98%) in the control group . Three calves (2.22%) died in the groups treated with tilmicosin and 6 calves (7.32%) among the controls . In one of the treated groups the body mass gain was 6.2% higher compared to the controls at the age of 3 months . These results suggest that treatment with a single dose of tilmicosin is effective in most cases of calf pneumonia caused by bacteria. Rev Argent Microbiol, 1993, 25(1), 1 - 6 {Detection of enterotoxigenic Escherichia coli adhesion antigens . Study of their expression in different culture media}; Sanz ME et al.; Polyclonal antibodies were raised in rabbits against the adherence antigens K88ab, ac, ad K99 and F41 of enterotoxigenic Escherichia coli (ETEC) . Their specificity for the antigen was tested by using homologous and heterologous E . coli strains, which had been grown under permissive and nonpermissive conditions for pili expression and also confronted to a purified extract of each fimbrial adhesin . Optimal conditions for agglutinating bacterial suspensions were established for both antisera and antigens . Expression of adhesins was studied in several culture media, which are being commonly used in clinical bacteriology . K99, K88ab and K88ad were satisfactorily expressed in both Minca broth and solid media on T.S.I . Mac Conkey and E.M.B . K88ac was not expressed on G1253 strain when grown on T.S.I . or in Mac Conkey when the inoculum was obtained from E.M.B . However, Mac Conkey allowed K88ac expression when inoculum had been grown on Luria-Bertani . On the other hand, F41 was only satisfactorily expressed in Minca broth, failing in being detected by agglutination in the remaining culture media . These results allow to use alternative media, beyond the recommended Minca broth, to detect adhesins K99, K88ab, and K88ad on ETEC isolates. J Formos Med Assoc, 1993 Jan, 92(1), 34 - 41 Reappraisal of skeletal tuberculosis: role of radiological imaging; Hsu SH et al.; Skeletal tuberculosis (TB) can present with a broad spectrum of variable clinical manifestations which may cause diagnostic difficulties . To further elucidate these possible diagnostic pitfalls, 14 cases of bacteriologically or histologically proven skeletal TB, which were initially diagnosed otherwise, are reviewed . In five cases with lumbar or midthoracic spinal involvement, concomitant traumatic history and degenerative radiological changes were the main reasons for not suspecting the possibility of skeletal TB . A differential diagnosis between TB and metastatic lesions can be difficult in the very early stage when X-ray images usually have a low contrast and are not sharp . In nine cases with bone and joint involvement, a long-lasting discharging sinus led the clinician to an initial impression of septic arthritis; sometimes concomitant gouty arthritis can mask the clinical manifestations of skeletal TB . In five cases, minor erosive lesions over the peripheral margin of the involved bone were the earliest findings on the plain X-ray films and were overlooked . To facilitate the early diagnosis of skeletal TB and to avoid the possibility of complications in the management of patients, medical practitioners should be familiar with the usual forms of the condition and the wide variety of clinical manifestations. Ann Otolaryngol Chir Cervicofac, 1993, 110(8), 482 - 4 {Tuberculosis of the submandibular gland . Apropos of a case and review of the literature}; Manipoud P et al.; Tuberculosis of the submaxillary gland is uncommon . Surgery is often necessary . Histologic analysis and the bacteriology made the diagnosis. Zh Nevropatol Psikhiatr Im S S Korsakova, 1993, 93(3), 89 - 90 {Aneurysms of the cerebral vessels and pneumococcal infection}; Kononenko VV et al.; Two cases of cerebral aneurysm rupture with repeat subarachnoidal haemorrhage are reported in patients with pneumococcal infection confirmed bacteriologically . It is concluded that in pathogenesis of the aneurysmal rupture in pneumococcal infection a significant role is played not only by pneumococcal tropism to the meninges, but also by affection of the endothelium and cerebral vascular membranes, hemostasis defects, arterial hypertension as manifestations of a general adaptation syndrome. Ann Fr Anesth Reanim, 1993, 12(6), 594 - 7 {Postoperative acute adrenal insufficiency}; Messiant F et al.; Acute adrenal insufficiency is an uncommon complication of lung cancer and adrenal metastasis resection . Diagnosis is difficult to establish but an early recognition and treatment may be life-saving . A 55-year-old man underwent right upper lobectomy and adrenalectomy for lung carcinoma with right adrenal metastasis . Anaesthesia was obtained with propofol, alfentanil, atracurium and isoflurane . Blood pressure remained stable throughout surgical procedure and blood loss was about 3,000 ml . Several hours after the end of the procedure which was uneventful the circulator status worsened . The blood pressure was initially controlled with 500 ml of gelatin . External blood loss was about 200 ml . Clinical examination, chest X-ray and ECG were normal . Postoperative laboratory data showed a serum sodium at 134 mmol-1.l-1 and a serum potassium 5.1 mmol.l-1; haemoglobin concentration was 93 g.l-1 . Arterial blood gas analysis, with a 5.1.min-1 nasal O2 flow showed a PaO2 at 108 mmHg, a PaCO2 at 30 mmHg and a pH at 7.44 . Twelve hours later, a transient cardiac arrest occurred which responded to fluid load, dopamine and dobutamine . Six hours later, the patient went in ventricular fibrillation responding to an external electric countershock . No change in clinical status was noticed, except hyperthermia at 39.5% degrees C . Serum potassium concentration before cardiac arrest was 4.7 mmol-l-1 . Main considered diagnoses were septic shock and acute adrenal insufficiency . Antibiotics (imipenem, amikacin and vancomycin) and hormonal treatment (hydrocortisone 200 mg.day-1), after blood samples had been obtained for bacteriological and hormonal examinations . The patient's condition improved dramatically within 48 hours . Shock was under control, dopamine and dobutamine were rapidly discontinued.(ABSTRACT TRUNCATED AT 250 WORDS) Rocz Panstw Zakl Hig, 1993, 44(2-3), 221 - 5 {Comparative bacteriologic examinations of bathing water in Szczecin province using methods from northern regions of the Federal Republic of Germany and in the Polish State Hygienic Station}; Torun D et al.; For the purpose of this work was the comparison of the obligatory directive lines using by sanitary-epidemic station in Poland and confrontation with EWG Guideline and comparison of the bacteriological examinations methods of surface waters using in Poland and northern Lands of Germany . The parallel examination of 120 water samples, according to PZH method and the method, using broth's Brila-MUG, prepared by the group of german specialists, were performed . The equivalent results in 60% of tested samples were obtained . If confirmed on purpose the preparating of uniform directive lines and evaluation criterium for maritime and inland bathing waters, according to EWG Guideline, and as well as taking into consideration possibility of application the method with Brila MUG broth to bacteriological examination of maritime bathing waters at first. Pediatrie, 1993, 48(9), 633 - 7 {Antibiotic therapy of perforated appendicitis in children: comparison between the amoxicillin-clavulanic acid and the benzylpenicillin-netilmicin-metronidazole combinations}; Schmitt M et al.; In a multicentre trial we compared the clinical efficacy of amoxicillin/clavulanate used as a single-agent therapy with that of the three-agent combination usually prescribed in the post-operative period for appendicular peritonitis in children . Only bacteriologically documented peritoneal infections were included . Sixty-four patients were randomly distributed between two groups: Group A (29 cases) treated with amoxicillin/clavulanate, first administered iv (100 mg/kg/d), followed by conversion to the oral route (50 mg/kg/d) once the patient had been afebrile for 48 hours; Group B (35 cases) first treated by the iv route with benzylpenicillin (100,000 IU/kg/d) plus netilmicin (5 mg/kg/d) plus metronidazole (30 mg/kg/d), followed by conversion to the oral route for metronidazole (30 mg/kg/d) . In both groups, the total duration of parenteral and oral treatment was not less than 5 days . One hundred and seventy nine bacterial strains were recovered from peritoneal fluid samples obtained during surgery; 86% of these were sensitive to amoxicillin/clavulanate . Clinical efficacy, assessed on the basis of time until return to normal temperature and gut transit and duration of hospitalization, was identical in both groups, with follow-up monitoring on day 30 showing recovery in all cases . Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patients in group B (non significant difference) . Tolerance was excellent and identical in the two groups with the exception of three cases of thrombophlebitis which occurred in group B . The results of this study suggest that amoxicillin/clavulanate may be useful as single-agent therapy as a first-line curative treatment for appendicular peritonitis in children. Arch Immunol Ther Exp (Warsz), 1993, 41(5-6), 309 - 13 Serological examinations in patients with Helicobacter pylori infections; Gosciniak G et al.; A passive microhemagglutination test was applied for the detection of H . pylori antibodies . The presence of elevated antibody titers was most frequently encountered in the sera of patients from whom H . pylori was isolated . No relationship between the level of antibodies and the clinical picture of peptic ulcer disease was noted . In addition, negative results from bacteriologic and serologic studies in patients with confirmed histopathologic changes and typical clinical symptoms may suggest that peptic ulcer disease and chronic inflammation of gastric mucosa is not always accompanied by the presence of H . pylori . It is concluded that the passive microhemagglutination test is a convenient and easily performed screening method. Rev Chil Obstet Ginecol, 1993, 58(6), 455 - 60 {Female genitoperitoneal tuberculosis an in force pathology}; Rosmanich A et al.; We present the experience during 1987-1991 years, about Female Genital Tuberculosis, at the University of Chile Clinical Hospital . We present 16 cases with histologic and bacteriologic demonstration; in two cases also positive cultures for myco bacterium tuberculosis . It is made emphasis about personal characteristics of patients physical examination findings, laboratories procedures and technics of diagnostic, treatment and posterior control of patients . We comments utility of new procedures as laparoscopy, gynecologic sonography and A.D.A . analysis of ascitis. Probl Tuberk, 1993, (3), 33 - 5 {Expression of intoxication syndrome in patients with destructive pulmonary tuberculosis discharging Candida fungi}; Balasaniants GS et al.; The severity of intoxication in tuberculous patients with destructive forms was quantified as the number of middle-size molecules . Diagnostic criteria for Candida infection are provided in the range from Candida carriage to invasive candidiasis basing on enzyme immunoassay and bacteriological examinations findings . Candida carriage is shown to be of little relevance to the intoxication progress and severity, whereas mucosal dissemination on the bronchial tree and subsequent development of the mycotic lesion affect intoxication symptoms aggravating tuberculosis course. Probl Khig, 1993, 18, 44 - 50 {The hygienic characteristics of the hospital environment in a cardiovascular pathology ward during the heating season}; Toshkov S et al.; A study is carried out on the microclimate, physiological reaction of patients, chemical and bacteriological composition of the air in rooms of different location in the ward for cardiovascular pathology during the heating period of the year, according to some basic and integral indices . The characteristics of the interhospital environment in the rooms of the investigated ward is determined mainly by the irrational regime of heating, location, size of the glazed transparent area . In the hospital rooms are formed unsatisfactory hygienic norm parameters of the microclimate and the chemical composition of the air . The specific thermal environment affects the physiological reactions of the patients and leads to creation of conditions of discomfort and loading of the thermoregulation in direction of overheating. Dakar Med, 1993, 38(2), 187 - 91 {Bacterial, viral and parasitic etiologies of acute infantile diarrhea in a rural Senegal}; Aidara A et al.; We have studied the incidence of parasites, viruses and bacteria associated with acute infantile diarrhea in rural Senegal . Among parasitoses, Cryptosporidium parvum (7.7%) is the most frequent, followed by Entamoeba histolytica (5.1%) . The first bacteriological etiologic agent is Escherichia coli (20.9%) . Rotavirus are also frequently isolated (14.7%) . Prevalence of pathogens is higher: among children over 6 months and under two years old, among children either with mixed feeding or weaned, during the raining season, except for rotaviruses . Breast feeding seems to be a good protective factor against bacterial and parasitological infections but not against rotavirus contaminations. Bull Inst Marit Trop Med Gdynia, 1993-94, 44-45(1-4), 33 - 7 Guided fine needle absorption biopsy in the diagnosis of cysts in maritime workers; Bartelik W et al.; Cysts in the organs of the abdominal cavity revealed in ultrasonographic examinations in patients with none or with unclear clinical symptoms cause diagnostic and fitness for work assessment problems . The aim of the study was to evaluate the usefulness of ultrasonography of cysts, combined with biochemical, bacteriological, cytological examinations and analysis of markers CEA and AFP of the fluid collected with fine needle aspiration biopsy (FAB) . The study material examined were maritime workers who were submitted to these examinations for diagnostic purposes and/or previous to issue of certificate of health for work at sea . Examinations results provided support for usefulness of the method discussed in diagnosis and differentiation of inflammatory and neoplastic processes with simple cysts . This was crucial for final diagnosis, for decision about treatment and recognizing fitness for work at sea . It was concluded that the method FAB is safe both in hospital as well as in ambulatory conditions. Schweiz Rundsch Med Prax, 1992 Dec 22, 81(52), 1561 - 4 {The difficult diagnosis of tuberculosis}; Brandli O; In spite of alarming reports from third world and industrialized countries, no increase in the incidence of tuberculosis has been seen in Switzerland . This is mainly attributable to the consistently performed initial treatment with a multiple-drug combination and the good compliance of our patients . In Switzerland the diagnosis of tuberculosis is difficult, because of its low incidence (1990: 1229 reported cases), as well as its nonspecific initial symptoms . Screening tests are only indicated in high risk-populations with direct contact to infectious tuberculosis cases, inhabitants of centres for homeless or immigrants, foreign workers and HIV-positives . The fast introduction of the gene amplification method with the polymerase chain reaction (PCR) would allow bacteriologic diagnosis within 48 hours . This would be of great practical relevance, allowing a quicker initiation of therapy and with that, a decrease of infection risk for physicians and medical staff, especially in endoscopy-rooms, emergency- and intensive care units . In Switzerland the multiple-drug resistance of mycobacteria (against insoniazid, rifampicin and other antimycobacterial agents) is seen only rarely (0.7 to 1.3% of cases) . In patients with origin from countries with frequent drug-resistance to isoniazid and even more in case of suspected multiple drug-resistance or high initial bacterial count (cavernous tuberculosis), an initial combination therapy with four different antimycobacterial drugs should be applied, until the result of the susceptibility-tests is available. Med J Aust, 1992 Dec 7-21, 157(11-12), 771 - 5 Dr John Thomson (1847-1909) . Pioneer surgeon, military surgeon and a founder of St John Ambulance in Australia; Pearn J et al.; Surgeon John Thomson (1847-1909), a Scot who made his life's work in Queensland, was a pioneer surgeon, radiologist and bacteriologist, and one of the founders of the St John Ambulance movement in Australia and the Railway Ambulance Corps . He was variously President of the British Medical Association (Queensland Branch), the Medical Board of Queensland, the Medico-Ethical Association, and the Intercolonial Medical Congress, which was held in Brisbane in 1899 . A pioneer military surgeon in this country, he was the foundation Principal Medical Officer (as Surgeon-Major) of the Queensland Ambulance Corps within the Queensland Defence Force . His advocacy for a university north of Sydney was one of the factors which led to the foundation of the University of Queensland, a body which honoured him by the establishment of the John Thomson Lectureship, which for half a century was its most prestigious public oration . The life and times of this singular doctor exemplify one small class of pre-Federation medical pioneers whose professional outreach established a number of voluntary organisations which have blossomed in Australian society to the present day. Clin Otolaryngol, 1992 Dec, 17(6), 531 - 4 Bacteria and endotoxin in middle ear fluid and the course of secretory otitis media; Ovesen T et al.; To determine the influence of bacteria and bacterial products on the course of secretory otitis media (SOM) following ventilation tube insertion we examined 68 middle ear effusions from 57 children with SOM . Swabs were taken for bacteriological examination and the content of endotoxin was measured . The children were followed up for one year and relapse of SOM was recorded . Bacteria were present in 38% of effusions and endotoxin was detectable in 96% . Relapse occurred in 26% of the patients and was related to the presence of bacteria in the original effusion (P < 0.01) . The concentration of endotoxin, however, did not correlate with the course of SOM. FEMS Microbiol Lett, 1992 Dec 1, 78(2-3), 311 - 6 Simplified procedures for detection of amplified DNA using fluorescent label incorporation and reverse probing; Woolford AJ et al.; Conventional methods of detecting polymerase chain reaction (PCR) products require equipment and expertise which may not be available in diagnostic bacteriology laboratories, especially in developing countries . To this end we have examined other methods of product detection, including fluorescein-12-dUTP incorporation during PCR amplification, and reverse probing, where the PCR product is used as the probe in a scaled down hybridization with a fixed capture probe consisting of a fragment entirely internal to the sequence of the PCR product . These techniques have shown sensitivities of 20 fg of purified mycobacterial DNA, which corresponds to approximately five cells. Lepr Rev, 1992 Dec, 63(4), 358 - 64 Immunotherapeutic potential of ICRC vaccine: a case control study; Bhatki WS et al.; A bacteriological follow-up of 16 lepromatous patients with a high initial Bacteriological Index (BI) showed that in 8 randomly selected patients who received single doses of ICRC Vaccine (C44) at the onset of multidrug therapy, the average reduction of BI was from 4.4+ to 1+ in 2 years--3 of these patients became negative and 3 showed BI 1+ or less . Comparable bacteriological assessments in 8 non-vaccinated but otherwise similar patients showed an average reduction of BI from 4.7+ to 2.6+, i.e . consistent with the expected response to MDT in lepromatous patients . Here we discuss the role of immunotherapy and the selection of a desirable antileprosy vaccine in the context of fixed-duration MDT. Lepr Rev, 1992 Dec, 63(4), 350 - 7 Initial intensive therapy for multibacillary leprosy patients--in retrospect; Rao PS et al.; We analysed the results of 4845 multibacillary (MB) patients being treated with multidrug treatment (MDT) in the Srikakulam District of Andhra Pradesh, India . Of these, 2309 (47.7%) patients were given an initial 14-day intensive therapy with rifampicin, clofazimine and dapsone, followed by the WHO recommended pulse therapy . The rest of the cases were given only pulse therapy . The improvement in terms of bacteriological clearance and the proportion of cases declared released from treatment (RFT) was found to be significantly higher among patients treated with only pulse therapy . Clinic attendance was found to be better and more regular in patients treated with intensive therapy, and no relapses were seen with either therapy . The implications of these findings on the operational aspects of programme implementation are discussed. J Periodontol, 1992 Dec, 63(12 Suppl), 1052 - 7 Differential diagnosis in clinical trials of therapy for periodontitis; Ranney RR; For purposes of clinical trials of therapies for periodontitis, it is recommended that population samples be identified as adult periodontitis (systemically modified or not systemically modified), early onset periodontitis (localized or juvenile, generalized or rapidly progressive, or associated with systemic disease), or necrotizing ulcerative periodontitis, avoiding overlapping criteria . Population samples of adult or early onset periodontitis modified by or associated with systemic conditions should be used in clinical trials only when the intent is to study effect on the specifically modified condition . Objective identification of the modifying systemic condition should be required for all subjects in such trials . Population samples should be homogeneous for the diagnosis, whether systemically modified or not . Refractory periodontitis, prepubertal periodontitis, and periodontitis associated with systemic disease are not recommended as useful descriptors of population samples without discrete identification of underlying systemic abnormality for all included subjects . Definition of population sample by a bacteriological or a host response feature is not recommended unless the trial is specifically aimed at that feature and the sample is homogeneous for it . All trials of efficacy should include physical or radiographic measurement of attachment level or bone height as a critical outcome variable . Results from trial in one form of periodontitis should not be applied directly to other forms. J Dairy Sci, 1992 Dec, 75(12), 3339 - 51 The effect of chronic immunostimulation of the nonlactating bovine mammary gland with interleukin-2, pokeweed mitogen, and lipopolysaccharide; Nickerson SC et al.; Interleukin-2, pokeweed mitogen, and lipopolysaccharide were evaluated for their ability to accelerate involution and to stimulate local cellular defenses in the nonlactating bovine mammary gland . Twelve cows were divided into three treatment groups of 4 cows each to receive interleukin-2, pokeweed mitogen, or lipopolysaccharide . One day after drying off, 3 mammary quarters of each cow were infused with 100 micrograms of immunostimulant daily for 21 d; the remaining control quarter received PBS . Secretion samples were collected weekly to determine bacteriologic status, total SCC, and differential cell counts . On d 21, cows were killed, and tissues were collected for microscopy . Overall, SCC were higher in immunostimulated quarters, but only those infused with interleukin-2 were significantly elevated over controls . By wk 3, the percentage of neutrophils decreased in interleukin-2 and pokeweed mitogen quarters over pretreatment values, percentage of macrophages increased in interleukin-2 quarters, and percentage of lymphocytes increased in pokeweed mitogen and lipopolysaccharide quarters . Percentage of alveolar lumina was reduced, and connective tissue stroma increased, in all immunostimulated quarters compared with those of controls, suggesting accelerated involution . Involution was greatest in quarters treated with interleukin-2 . Leukocyte infiltration was greater in immunostimulated quarters than in control quarters . Similarly, concentrations of Ig-producing plasma cells were greater in immunostimulated quarters than in control quarters . Quarters infused with interleukin-2 exhibited the greatest concentration of plasma cells, followed by quarters treated with pokeweed mitogen and lipopolysaccharide; IgG1 plasma cells predominated, followed by IgG2, IgA, and IgM . Interleukin-2 accelerated involution and stimulated local antibody production more than did the two mitogens, suggesting a potential role for this cytokine as a general immunostimulant at drying off. Clin Infect Dis, 1992 Dec, 15(6), 974 - 82 Systemic manifestations of invasive amebiasis; Ahmed M et al.; Eighty-four patients with serious infection due to Entamoeba histolytica were evaluated for systemic complications by objective criteria for dysfunction of the organ systems normally assessed in surgical sepsis . Of 71 patients with amebic liver abscess (ALA), 41% had systemic complications and 13% had more than one organ system involved . Patients > or = 40 years of age and those being treated with steroids were at significantly increased risk of developing complications (P < or = .05) . The erythrocyte sedimentation rate and the levels of the acute-phase markers C-reactive protein (CRP) and serum amyloid A (SAA) were significantly elevated in patients with ALA over values in those without ALA (P < or = .05) . ALA patients with complications had lower CRP and SAA concentrations than those without complications (P < or = .05) . Blood and liver aspirates in ALA patients were usually bacteriologically sterile . The pathogenesis of systemic complications and the associated acute-phase response requires further study, and ways of predicting disease severity and intervening therapeutically must be devised. Aktuelle Traumatol, 1992 Dec, 22(6), 272 - 5 {Epidural "sulmycin implant" coverage for local prevention of infection in surgical management of open craniocerebral injuries}; Kolodziejczyk D et al.; In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17% . In this paper the operative experience with 22 cases of penetrating head injuries is discussed . In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier . 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely . There were no signs of suppurative complications in superficial wounds or in the brain . 4 patients died due to their severe brain damage with multiple contusional lesions . Postoperative complications were as follows: one patient suffered extradural and one patient subdural rebleeding . Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered . The revision was done successfully using the "Sulmycin Implant" . Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant". Minerva Pediatr, 1992 Dec, 44(12), 595 - 600 {Long lasting conjunctivitis: research of etiological factors}; Riva C et al.; Forty children with long-lasting or recurrent conjunctivitis were included in this etiological study . It is well known that purulent conjunctivitis is mainly bacterial, with a major source of infection from Chlamydia; recently, however, a greater percentage of viral forms, with the exception of conjunctivitis without secretion, has been reported . The authors focused their attention on the clinical symptoms and on bacteriological studies of the forms of Chlamydia and Mycoplasma conjunctivitis, highlighting their marked sensitivity to antibiotics and the clinical response and recommending the importance of an etiological study in all cases in which conjunctivitis does not resolve within a short period of time. J Dermatol, 1992 Dec, 19(12), 953 - 8 Significance of antibodies to phenolic glycolipid-I in leprosy diagnosis; Prakash K et al.; A gelatin particle agglutination assay for the detection of anti PGL-I antibodies in 40 clinically diagnosed and variously classified groups of leprosy cases revealed elevated PGL-I antibody titers in 85% of cases . In contrast, the slit-skin smear examination was positive in only 30% of cases . It was further observed that, out of 28 cases with Bacteriological Index (B.I.) zero, 22 cases (78.5%) had significant levels of PGL-I antibodies . There was no case in which the slit skin smear was positive and the PGL-I antibody titer was not significant . The elevated titers of PGL-I antibody better correlated (84%) with histopathological findings than did B.I . Thus it was concluded that estimation of PGL-I antibody titer is a better supplement to clinical diagnosis than B.I . Significant levels of PGL-I antibody were seen in 85% of cases who had no earlier chemotherapy or were treated for less than 2 months . Similar findings were observed in 12 patients who were on MDT for more than 5 months but for less than 2 years . In order to determine the significance of anti PGL-I antibodies in monitoring the response of patients to chemotherapy, a longer follow up with a greater number of cases should be contemplated. Tuber Lung Dis, 1992 Dec, 73(6), 384 - 7 10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-I-Dang, Thailand; Sukrakanchana-Trikham P et al.; Tuberculosis control among displaced persons is fraught with difficulties to ensure adherence of patients to treatment for a prolonged period of time . In the Khao-I-Dang camp for Cambodian refugees an approach with daily, directly observed treatment throughout the course of 6 months duration was chosen to address the problem . Of a total 929 patients with sputum smear-positive tuberculosis who were enrolled from 1981 to 1990, 5.0% died, 75.5% completed treatment and were bacteriologically cured with a day-to-day adherence of more than 98%, none failed bacteriologically, 19.2% were transferred to another camp where continuation of treatment was guaranteed, and only 0.4% absconded from treatment . These data suggest that the approach to tuberculosis control in this refugee camp was very effective in cutting the chain of transmission of tuberculosis in a highly mobile population and in reducing substantially unnecessary morbidity and mortality. Enferm Infecc Microbiol Clin, 1992 Dec, 10(10), 581 - 6 {Septic shock: epidemiology and prognosis}; Rello J et al.; As part of an infection control program in ICU, we studied prospectively 1500 consecutive patients admitted to a medical and surgical ICU from January 1988 to July 1990 . Over this period of time, 69 patients developed septic shock, and 38 of them died (55.1%) . Primary source of infection was the lower respiratory tract or intraabdominal in more than 50% of cases, and were related to a high mortality rate, however SS arising from a biliary tract infection is associated with a mortality rate below 20% . In the univariate analysis, nosocomial origin (p = 0.0001), creatinine serum level > 175 mumol/l (p = 0.005), multiple organ failure in the first 24 hours after shock started (p = 0.02), underlying cancer disease (p = 0.02) or liver cirrhosis (p = 0.03) were associated with a statistically significant higher risk for dying . No differences were found regarding age, sex, admission date, coma, recent surgery, prior cardiac arrest, diabetes, organ transplantation, corticosteroid therapy, cancer chemotherapy, absence of fever, bacteriology of the infection and appropriate antibiotic therapy . The multivariate analysis further identified that creatinine serum level > 175 mumol/l (p = 0.004), underlying cancer disease (p = 0.005), liver cirrhosis (p = 0.02) and nosocomial-acquired infection (p = 0.02) were independently associated to a higher risk for dying . These data allows the identification of factors related to a worst outcome . The high mortality rates recorded for septic shock still recommends the rapid transfer of the patient to an ICU as well as the use of aggressive therapy in all cases. Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Dec, 30(12), 2139 - 45 {A case of idiopathic pulmonary fibrosis with histology of usual interstitial pneumonia that responded to pulse therapy followed by combined immunosuppression with prednisolone and azathioprine}; Shishido M et al.; A 64-year-old woman who was admitted with cough and dyspnea showed severe hypoxemia and interstitial lung shadows . The clinical diagnosis was idiopathic interstitial pneumonia (synonymous with idiopathic pulmonary fibrosis in the United States), since there were no specific immunological or bacteriological findings . No clinical signs or laboratory data compatible with collagen disease were observed . Methylprednisolone pulse therapy was given followed by prednisolone (0.8 mg/kg) and azathioprine (15 mg/kg) . Marked improvement of hypoxia, chest X-ray and spirometry results was observed after five weeks . Histological examination of an cases of residual interstitial shadow obtained by open lung biopsy revealed usual interstitial pneumonia . Tapering of the immunosuppressant drugs led to a recurrence 3 months later, which was controlled by reintroduction of the same regimen . Therefore, only prednisolone was tapered, and data obtained in an outpatient clinic 6 months after the recurrence were as follows: %VC 108%, %DLco 72%, PaO2 80 Torr . The value of this regimen for acute IPF or exacerbation of IPF is suggested because of its life-saving effects. J Chemother, 1992 Dec, 4(6), 358 - 63 The efficacy and safety of once-daily ceftibuten compared with co-amoxiclav in the treatment of acute bacterial sinusitis; De Abate CA et al.; The efficacy and safety of a once-daily oral regimen of 400 mg ceftibuten was compared with oral co-amoxiclav 500 mg three times daily in a multicentre, single-blind study . In patients with a bacteriologically confirmed infection, a successful clinical outcome was reported in 25 of 25 patients treated with ceftibuten and 10 of 10 patients treated with co-amoxiclav . In a further group of 88 patients, most of whom had been excluded from the primary efficacy evaluation because no pathogen was isolated pretreatment, overall successful clinical outcomes of 87% and 88% were reported for ceftibuten and co-amoxiclav, respectively . The duration of treatment and the time to resolution of the signs and symptoms of sinusitis were not significantly different in the two treatment groups . The incidence of adverse events was higher in the co-amoxiclav-treated patients (31% versus 15% in the ceftibuten group) as was the incidence of severe events (10% for co-amoxiclav-treated patients versus < 1% in the ceftibuten group) . In summary, once-daily ceftibuten can be considered a safe and effective treatment for acute bacterial sinusitis. Asian Pac J Allergy Immunol, 1992 Dec, 10(2), 145 - 50 Use of endotoxin antigens in enzyme-linked immunosorbent assay for the diagnosis of P . pseudomallei infections (melioidosis); Petkanjanapong V et al.; An enzyme-linked immunosorbent assay (ELISA) with endotoxin preparations of P . pseudomallei as antigen was developed for detection of IgG antibodies specific to melioidosis . Forty-seven sera of bacteriologically confirmed melioidosis patients, 55 non-melioidosis sera and 50 sera of healthy blood donors from non-endemic areas were subjected to this assay in comparison with indirect hemagglutination assay (IHA) . The data were treated by receiver operating characteristics analysis . The sensitivity, specificity and accuracy in this ELISA were 95.7%, 94.2%, and 94.7%, respectively, with cut-off value of OD = 0.312 at 490 nm . Meanwhile, those in IHA were 81.0%, 91.4%, and 88.1%, respectively, with a cut-off value of > or = 1:160 . From these results, the ELISA was judged to be more reliable than IHA as the seroassay for diagnosis of melioidosis. Bull Acad Natl Med, 1992 Dec, 176(9), 1491 - 503; discussion 1503-4 {Bacterial flora of two sources of natural mineral waters; characterization by restriction patterns of the genes coding for ribosomal RNA; specificity and biological stability}; Leclerc H et al.; The bacterial flora of natural mineral waters was analysed using ribosomal ribonucleic acid gene restriction patterns in addition to customary identification techniques . Two springs were studied between 1989 and 1990 and six water samples per source were examined . Among the 206 bacterial strains collected at the spring, 91 (49%) were identified at species level using the API system and 99 representative strains from the two sampling points were selected for ribosomal ribonucleic acid gene restriction analysis . Forty six patterns were detected without common patterns to two springs . The bacterial association of each mineral water has a specific character (100% of specific patterns) shown by a series of patterns, not common to the other spring . This bacteriological specificity is preserved over a marked period of time, as, for each source, a great number of characteristics patterns was repeatedly found. Nucleic Acids Res, 1992 Nov 25, 20(22), 6091 - 6 In vivo specificity of EcoRI DNA methyltransferase; Smith DW et al.; The EcoRI adenine DNA methyltransferase forms part of a bacterial restriction/modification system; the methyltransferase modifies the second adenine within the canonical site GAATTC, thereby preventing the EcoRI endonuclease from cleaving this site . We show that five noncanonical EcoRI sites (TAATTC, CAATTC, GTATTC, GGATTC and GAGTTC) are not methylated in vivo under conditions when the canonical site is methylated . Only when the methyltransferase is overexpressed is partial in vivo methylation of the five sites detected . Our results suggest that the methyltransferase does not protect host DNA against potential endonuclease-mediated cleavage at noncanonical sites . Our related in vitro analysis of the methyltransferase reveals a low level of sequence-discrimination . We propose that the high in vivo specificity may be due to the active removal of methylated sequences by DNA repair enzymes (J . Bacteriology (1987), 169 3243-3250). Vet Rec, 1992 Nov 21, 131(21), 477 - 80 Radiographic and radionuclide lung perfusion imaging in healthy calves and calves naturally infected with bovine respiratory syncytial virus; Verhoeff J et al.; Nine calves between three and 18 weeks old with serologically confirmed natural bovine respiratory syncytial virus infection were examined clinically, radiographically and by radionuclide lung perfusion imaging . The results were compared with those from seven healthy calves . The diseased calves were euthanased and examined pathologically, virologically and bacteriologically . The clinical signs indicated that the disease was in an acute stage . Radiography of the diseased animals revealed cysts, corresponding morphologically with bullous emphysema, and infiltrations roughly corresponding in distribution with atelectatic and, or, pneumonic areas . Radionuclide lung perfusion imaging revealed no perfusion shifts between the left and right lungs and a normal perfusion pattern in five of the nine diseased calves . The abnormalities in the perfusion patterns of three calves were probably caused by anatomical disorders such as cysts and pleural adhesions, but no cause of the abnormality could be found in one calf . These findings suggest that in calves infected with bovine respiratory syncytial virus, the normal perfusion pattern is maintained until anatomical disorders occur . The pathological examination and radiography revealed that the cranioventral lung fields were particularly poorly ventilated . This finding and the normal perfusion pattern indicate that these parts of the lungs are probably the sites where shuntings and perfusion-ventilation mismatchings occur. Ann Nucl Med, 1992 Nov, 6(4), 235 - 9 Ga-67 citrate scan in vascular graft infection; Banzo I et al.; The clinical utility of the Ga-67 scan has been studied in 9 patients with clinical suspicion of vascular graft infection . Eleven grafts were analyzed: 4 aortobifemoral, 2 iliofemoral, 3 femoropopliteal, 1 axillofemoral, and 1 axillobifemoral . The Ga-67 scan was positive in 8 grafts with bacteriological proof of infection and negative in 3 grafts in which infection was ruled out by clinical follow-up . A Ga-67 scan also demonstrated the spread of infection to the thigh in two patients and to the pelvis in another two patients . In 4 patients CT was performed . The CT findings included graft thrombosis, perigraft fluid collection and thickened graft wall . No discrepancies were found between the CT scan and Ga-67 scan . In three patients a control Ga-67 scan was carried out after specific antibiotic and surgical treatment . Two of these showed increased Ga-67 uptake and spreading of infection along the graft; in the other patient, a Ga-67 scan revealed normalization after resolution of an abdominal abscess . In conclusion, the Ga-67 scan proved useful in the diagnosis of vascular graft infection, the definition of location of the extent of the disease and in the evaluation of the efficiency of treatment. Kekkaku, 1992 Nov, 67(11), 709 - 13 {Influence of bronchoscopic examinations on the statistics of tuberculosis incidence}; Yoshiyama T et al.; The frequency of the modes of bacteriological examinations other than direct sputum smear were observed for a total of 955 "smear-positive" pulmonary tuberculosis cases which were notified at 7 health centres in the Metropolitan and suburban areas during 1986-1990 . Of them 21 cases (2.2%) were examined for the specimens obtained by bronchofiberscopic procedures, and in 4 cases (0.4%) gastric juice was taken . The proportion of the non-sputum positivity as seen above was higher in females than in males, but it was uniform across all age group . Non-cavitary cases showed higher proportion of the non-sputum positivity than cavitary cases . There was wide variation in the frequency of these aggressive modes of examination among health centres, probably indicating the difference in the extent to which hospitals are interested in these modes of examination in each health center area . In addition to the above observed cases, there were 60 cases with direct smear positive finding of mycobacteria other than tuberculosis (MOTT) . They account for 5.9% of all of 1,015 new notifications of AFB-smear positive cases . It is possible that these non-sputum "smear positive" cases, as well as the MOTT-smear positive cases may be underestimated in our study, because of the notification form not necessarily requesting to enter the type of bacteriological examinations . They may contribute to the recent upward trend of incidence rate of smear positive tuberculosis in Japan to a considerable extent.(ABSTRACT TRUNCATED AT 250 WORDS) Paraplegia, 1992 Nov, 30(11), 795 - 8 Management of pyogenic vertebral osteomyelitis with spinal cord compression in the elderly; Gepstein R et al.; Five elderly and debilitated patients presented with compressive myelopathy due to pyogenic spondylitis . All had undergone surgery which consisted of eradication of the infected tissue via an anterior approach followed by primary bone graft . Supplementary antibiotic treatment was determined by intraoperative bacteriological culture . This aggressive approach, disregarding the patients' advanced age and poor general medical state, resulted in total resolution of the neurological deficit and the patients' return to their preoperative everyday activity. Nucl Med Commun, 1992 Nov, 13(11), 799 - 805 99Tcm-HMPAO-labelled leucocyte scintigraphy in suspected chronic osteomyelitis related to an orthopaedic device: clinical usefulness; el Esper I et al.; Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS) . The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively . Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS . When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16) . When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative) . It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs. Thorax, 1992 Nov, 47(11), 986 - 7 Unusual spinal tuberculosis after adequate chemotherapy for lymph node tuberculosis in an immunocompetent man; O'Hickey SP et al.; A 35 year old man developed paraplegia due to an epidural mass 15 months after completion of a full chemotherapy course for pulmonary and lymph node Mycobacterium bovis infection . His cellular immune function was normal after treatment . It is suggested that the lesion was a granulomatous healing response rather than bacteriological recurrence. Chest, 1992 Nov, 102(5), 1470 - 6 Proteinase/proteinase inhibitor imbalance in sputum sol phases from patients with chronic obstructive pulmonary disease . Suggestions for a key role played by antileukoprotease; Piccioni PD et al.; In order to characterize the imbalance between proteinases and proteinase inhibitors in sputum sol phases, we studied 25 patients (mean age, 59 +/- 11 yr) with exacerbated chronic obstructive pulmonary disease (COPD) . An aliquot of sputum was used for bacteriologic determinations, and the remainder was centrifuged in order to obtain gel and sol phases . On the basis of the bacteriologic data, patients were divided into colonized patients (14) and noncolonized patients (11) . All of the major inhibitors were immunologically detectable in sol phases without a significant difference between colonized and noncolonized patients (alpha 1-proteinase inhibitor {alpha 1-PI}, 2.56 microM +/- 0.53 microM and 2.39 microM +/- 0.72 microM; alpha 2-macroglobulin {alpha 2-MG}, 0.21 microM +/- 0.07 microM and 0.16 microM +/- 0.05 microM; antileukoprotease (ALP), 1.78 microM +/- 0.57 microM and 1.53 microM +/- 0.6 microM, respectively {mean +/- SE}) . With regard to proteinase activities, both free elastase-like and free chymotrypsin-like activities were detectable in the majority of patients (15/25) (0.59 microM +/- 0.15 microM and 0.74 microM +/- 0.15 microM for elastase-like activity {ELA}, and 0.010 microM +/- 0.003 microM and 0.017 microM +/- 0.007 microM for chymotrypsin-like activity {CLA}, respectively {mean +/- SE}) . The inhibitory profile of proteinase activities, performed by means of a panel of inhibitors, allowed us to assign specific activities mainly to neutrophil elastase and cathepsin G (Cat G) . Next we looked at the relationships between inhibitors and proteinase activities . We found a significant negative correlation between neutrophil elastase activity and ALP (r = -0.58; p < 0.01) . In confirmation of this suggestion, sol phases were divided into samples (15) with detectable ELA (> 0.50 microM) and samples (10) with no detectable ELA (< 0.18 microM) . Levels of alpha 1-PI and alpha 2-MG did not differ significantly between the two groups, whereas ALP values were higher in the group with no detectable ELA (3.12 microM +/- 0.69 microM) than in the other group (0.58 microM +/- 0.21 microM; p < 0.001) . We conclude that most sputum sol phases from patients with exacerbated COPD have a high burden of free neutrophil elastase and Cat G . Antileukoprotease seems to be the major naturally occurring inhibitor effective in the modulation of proteinase activities in bronchial secretions under these conditions. Riv Eur Sci Med Farmacol, 1992 Nov-Dec, 14(6), 383 - 7 {The vaginal ecosystem in a group of asymptomatic women}; Andreassi S; In physiological conditions the vaginal flora reflects, from a quantitative a quality point of view, the metabolical, local and hormonal situation of the woman . The vaginal infections could be facilitated by borderline conditions, between physiology and pathology . The prevention may contribute to limit the development and diffusion of infections . For this reason, we have examined, with a bacteriological and symptomatological test who 50 women requested a gynecological control for different reasons from vulvovaginiti . The results suggest that women often silently accept borderline conditions. Vet Rec, 1992 Oct 24, 131(17), 383 - 6 Development of a control strategy for Leptospira hardjo infection in a closed beef herd; Little TW et al.; Serological evidence of infection with a leptospire belonging to the Sejroe serogroup was identified in a closed population of Luing cattle in the west of Scotland, and the geographical isolation of the population presented an opportunity to control and possibly eradicate the infection in a large beef herd farmed under extensive conditions . Serological and bacteriological studies revealed that infection was present at a high level throughout the herd, and that the infecting serovar was hardjo . Unlike endemic hardjo infection in dairy herds, new infections were still occurring in older age-groups . Investigations of other domestic and free-living species sharing the habitat demonstrated that the maintenance of an endemic focus of hardjo was restricted to the cattle . Changes in management to prevent the transmission of infection to successive cohorts of young animals were impractical and risky, and antibiotic treatment followed by removal to clean pasture failed to prevent new cases . Thus vaccination offered the only means of control and possible eradication, and the epidemiological characteristics of the infection dictated that the programme be applied to the whole herd. J Am Vet Med Assoc, 1992 Oct 15, 201(8), 1253 - 7 Diskospondylitis associated with Brucella canis infection in dogs: 14 cases (1980-1991); Kerwin SC et al.; A retrospective study of 135 dogs with diskospondylitis revealed 14 dogs with concurrent Brucella canis infection . Sexually intact male dogs and dogs in the southeastern United States appeared to be at higher risk . Results of bacteriologic culturing of blood were less likely to be positive for dogs with diskospondylitis caused by B canis infection than for dogs with diskospondylitis caused by other organisms . Follow-up evaluation of 13 of the 14 dogs revealed complete remission of clinical signs in nine, but serologic test results continued to be positive for B canis infection long after resolution of clinical abnormalities . Radiographic follow-up evaluation in 6 dogs revealed active lesions despite complete remission of clinical abnormalities. Cancer Res, 1992 Oct 15, 52(20), 5803 - 7 Inhibition of cell attachment by selenite; Yan L et al.; Brief pre-exposure of HeLa cells to micromolar concentrations of selenite resulted in a dose-dependent decrease in the rate of their subsequent attachment to a solid matrix (tissue culture dish) . Similar low concentrations of selenite also inhibited colony formation, but only when the cells were exposed prior to their attaching to the dish, not when they were exposed after attachment . This indicates that inhibition of cell proliferation by selenite requires exposure to higher concentrations for longer periods of time . In contrast, selenate, selenomethionine, selenocystine, and sulfite did not affect cell attachment, even at significantly higher concentrations . Thus, the inhibition of cell attachment is a specific effect of selenite . Selenite also inhibited the attachment of cells to bacteriological dishes coated with fibronectin, laminin, or collagen, proteins that are components of the extracellular matrix . There was no inhibition when the tissue culture dishes or the protein-coated dishes were pre-exposed to selenite . There was also no inhibition when the cells were exposed to selenite during the attachment process . Thus, pre-exposure of the cells to selenite was necessary for inhibition of attachment . Since cell attachment has been shown to be an important early step in tumor cell invasion and metastasis, these results suggest a novel mechanism of the anticarcinogenic effect of selenite: inhibition of the attachment of tumor cells to the extracellular matrix. Laryngoscope, 1992 Oct, 102(10), 1103 - 7 Posttympanostomy otorrhea: the efficacy of canal preparation; Scott BA et al.; Otorrhea is the most common posttympanostomy complication . This study is designed to determine the efficacy of canal preparation prior to tympanostomy tube placement . One hundred thirty ears were prospectively randomized into prepared (Betadine and alcohol) and nonprepared (control) groups . Cultures obtained before, during, and after preparation were analyzed to determine the external canal flora and effectiveness of sterilization . Prepared ears and nonprepared control ears were examined for relation to otorrhea . Forty percent of the canals were sterile before preparation, and only 8% harbored suspected pathogenic organisms . Canal preparation successfully sterilized only 33% of the ears that contained bacteria . There was no difference in the otorrhea incidence among treatment groups (9.8%) . Based on these bacteriologic and clinical findings, it is concluded that canal preparation with Betadine and alcohol does not reduce posttympanostomy otorrhea. Health Serv Manage Res, 1992 Nov, 5(3), 225 - 37 Routine low-cost pathology tests: measuring the value in use of bacteriology tests in hospital and primary care; Szczepura A; The introduction of a managed market in health care in the NHS will encourage managers and clinicians to examine clinical services, such as pathology, more closely . However, simple cost-minimization may not be sufficient; the recent Audit Commission report on pathology emphasises a need to measure and monitor cost-effectiveness of clinical services such as pathology . This paper presents the findings of a study to measure the cost-effectiveness of one routine pathology test; the culture and antibiotic susceptibility test performed by all microbiology laboratories . Over 2,900 requests were examined and test results tracked in hospitals and general practices served by three laboratories . The findings show that, although average test costs are low for the three main user groups (4.3-5.9 pounds), the cost of producing an effect on patient management (change to therapy) is high at 54-67 pounds . In addition to therapy changes, the one major effect recorded was that of clinician reassurance . If all measured effects are weighted by their reported clinical utility, cost-utility ratios of 27.0 pounds +/- 1.0 pounds, 45.5 pounds +/- 4.5 pounds and 44.5 pounds +/- 3.5 pounds per patient management effect are calculated for general practitioner, outpatient and inpatient use respectively . A theoretical model is presented which will allow the comparative cost-effectiveness of a range of routine diagnostic tests to be measured through the use of a test-utility index, similar to the health index which is currently used to measure the outcome of medical interventions (QALYs). Thorax, 1992 Oct, 47(10), 770 - 5 National survey of notifications of tuberculosis in England and Wales in 1988 . Medical Research Council Cardiothoracic Epidemiology Group. {Infections with enteropathogenic Escherichia coli (EPEC) in cattle . 1 . Comparison of different animal models and a cell culture system for the establishment of a detection system for "attaching and effacing" (AE) lesions} Meyer A, Corboz L, Straumann-Kunz U, Pospischil A. Institute fur Veterinarpathologie, Universitat Zurich, Sch