Am J Med, 1992 Jan, 92(1), 104 - 6 Necrotizing cellulitis caused by Legionella micdadei; Kilborn JA et al.; Legionella micdadei is primarily considered a pathogen of the pulmonary tract of immunocompromised patients, the majority of whom have been renal transplant recipients . We report the case of a necrotizing soft tissue infection in a cadaveric renal transplant recipient resulting in amputation of the left arm . Only one other extrathoracic bacteriologically documented L . micdadei infection has been reported in the literature. Surgery, 1992 Jan, 111(1), 98 - 100 Mycoplasma hominis infection of perihepatic hematomas in a liver transplant recipient; Jacobs F et al.; We report the case of a recipient of liver transplantation in whom postoperative perihepatic hematomas were infected by Mycoplasma hominis . Etiologic diagnosis was delayed because this organism is a rare cause of postoperative infection and usually does not grow on standard bacteriologic media . The role of M . hominis in postoperative infections and the diagnostic problems of this organism are discussed. Scand J Infect Dis, 1992, 24(2), 219 - 25 Efficacy and tolerance of roxithromycin in comparison with erythromycin stearate in patients with lower respiratory tract infections; Paulsen O et al.; The efficacy and tolerance of roxithromycin 150 mg b.i.d . were compared with those of erythromycin stearate 500 mg b.i.d . in patients with lower respiratory tract infections . Out of 86 patients recruited for the study, 79 were evaluable for tolerance and 76 for efficacy . These patients were evenly distributed among the 3 investigational clinics, with 26, 25 and 28 patients, respectively . The diagnosis of lower respiratory tract infections was based on clinical, laboratory, radiological and/or physical findings and, when available, bacteriological and serological findings . The duration of treatment was 10 days, with follow-up at post-treatment visits directly after treatment and 6 weeks thereafter . The clinical outcome was satisfactory with no significant difference between the drugs . More patients reporting adverse events were on erythromycin than on roxithromycin (51.3% vs 17.5%; p = 0.003) . The results suggest that roxithromycin is as effective as erythromycin stearate in the treatment of lower respiratory tract infections and causes fewer adverse effects. Pol Arch Med Wewn, 1992 Jan, 87(1), 61 - 7 {Personal experience with the diagnosis of peritonitis complicating a long-term program of peritoneal dialysis}; Wankowicz Z et al.; Among 37 patients (pts) with irreversible renal failure treated in years 1980-1990 with chronic peritoneal dialysis there were 18 pts treated with continuous ambulatory peritoneal dialysis (CAPD) and 19 pts treated with standard intermitent peritoneal dialysis (SIPD) . Mean incidence of peritonitis (P) was 1 episode per 9.0 patients-months . The important symptoms for early diagnosis of P were as follows: opacity of the peritoneal effluent (PE) and high (more than 50%) percentage of polynuclear cells in the smear of PE sediment . Positive results of PE culture were obtained only in 50% of P episodes in years 1980-1985, mostly in pts treated with CAPD (17/21 pts) . In the period of 1986-1990, in pts treated mostly with SIPD (15/16 pts), positive results were obtained in 80% of P . Improvements of bacteriological diagnosis of P, especially in pts treated with CAPD, were discussed . Prophylactic cultures of PE were found to be of no value. Nephron, 1992, 61(2), 135 - 8 Production of tumor necrosis factor-alpha in patients on hemodiafiltration; Tetta C et al.; The systemic production of tumor necrosis factor (TNF)-alpha was evaluated in uremic patients before and after hemodiafiltration (HDF) and paired filtration dialysis (PFD) and in the interdialytic period . Both HDF and PFD were performed using polysulfone dialyzers with either standard or ultrapure dialysis fluid . TNF-alpha was quantitated by using a specific biological assay based on its cytotoxic effect on a TNF-sensitive human melanoma cell line SK-MEL-109 . Postdialytic mean plasma TNF-alpha levels decreased, albeit not significantly, in regard to predialytic values . These results differ from those obtained in patients on HDF using other high-permeability membranes such as polymethylmethacrylate and polyacrylonitrile (AN 69) as recently described by us . Of interest, the adoption of ultrapure dialysis fluid resulted in a marked reduction in the interdialytic production of TNF-alpha . These results suggest that the enhanced production of TNF-alpha in patients dialyzed with high-permeability membranes is mainly dependent upon the bacteriological purity of dialysis fluid. Klin Khir, 1992, (4), 35 - 6 {Bacteriologic methods of study in acute appendicitis}; Gil'mutdinova FG; In the article, the results of bacteriologic study of effusion from the abdominal cavity in 137 patients with acute appendicitis are summarized . A value of bacterioscopy in urgent diagnosis of the inflammatory agent has been established. Langenbecks Arch Chir, 1992, 377(3), 162 - 7 {The value of clinical, laboratory and sonographic findings in acute appendicitis--effect of surgical experience and bacteriologic diagnosis on the rate of wound healing disorders}; Kallinowski F et al.; A total of 361 patients were admitted to the Department of Surgery of the University of Heidelberg between January 1989 and April 1990 for acute appendicitis . Neither the physical examination nor laboratory results were unequivocally diagnostic in a third of the patients . The ultrasonographic visualization of the inflamed appendix could confirm the diagnosis in 50% of the clinically doubtful cases (predictive value: 84%) . Further diagnostic procedures were rarely necessary . The perforation rate was independent of the duration of the preoperative hospitalization due to the rapid surgical treatment . Contrary to previous reports, the likelihood of an intraoperatively innocent appendix increased with delayed surgery . Wound infection rates were similar after appendectomies by surgeons in training and by fully qualified surgeons although perforated appendices were typically removed by the latter ones . Antibiotic therapy was usually administered for severely inflamed appendices depending on the intraoperative findings and for perforated appendices and reduced the rate of wound infections if more than two bacteria had been cultured from a routine intraoperative swab . The documentation used in Baden-Wurttemberg for quality control should include the result of an intraoperative appendiceal swab. Gesnerus, 1992, 49 Pt 1, 21 - 38 {The bacteriological revolution and theories of the etiology of goiter and cretinism}; Fantini B; During the 19th century, a large number of researchers produced many different and even contradictory theories about the aetiology of endemic goiter and cretinism . The bacteriological revolution, i.e . the acceptance of the germ theory of infectious diseases, pushed scientists to try to isolate a germ for every disease . In the case of goiter and cretinism, this was fruitless endeavour . Nevertheless, the impact of the bacteriological revolution was largely positive because it provided a new scientific model of the genesis of disease and strengthened confidence in the possibility of fighting endemic as well as epidemic disease by simple but generally applied preventive measures such as, in the present case, iodine prophylaxis. Gesnerus, 1992, 49 Pt 1, 11 - 20 {Ludwik Fleck (1896-1961), bacteriologist and scientific theorist: science grows with collective thinking}; Ulrich J; This is a short biography of the Polish-Ukrainian-Israelian bacteriologist and science theoretician Ludwik Fleck, whose life was marked by wars, years of captivity in concentration camps and changes of nationality . His most important insight into the way in which scientific knowledge is gained was that knowledge is not the result of an individual process of a theoretical consciousness by itself, but the result of collective social activity. ORL J Otorhinolaryngol Relat Spec, 1992, 54(2), 95 - 9 Phlegmonous and abscess-forming ENT infections: comparative efficacy of ceftriaxone versus amoxicillin-clavulanic acid; Panosetti E; In this randomized trial, 100 patients received ceftriaxone or amoxicillin-clavulanic acid in phlegmonous or abscess-forming ENT infections . Clinical and bacteriological results confirm that both antibiotics are equally effective, the advantage of ceftriaxone being one administration a day . Drainage surgery is necessary when an abscess has already formed . In 4 cases (ceftriaxone: 3; amoxicillin-clavulanic acid: 1), no positive response could be observed . Systemic and local tolerance was, as a general rule, excellent, and side effects were reported in 3 cases of the ceftriaxone group and in 3 cases of the amoxicillin-clavulanic acid group. Ann Rech Vet, 1992, 23(2), 151 - 60 {Actinomyces pyogenes: conventional and Api system bacteriologic study of 103 strains isolated from ruminants}; Guerin-Faublee V et al.; One hundred and three strains of Actinomyces pyogenes isolated from ruminants were examined for morphological, cultural and biochemical properties by standard tests and by the Api 50 CH and Api Coryne methods . No biotype could be demonstrated, but a few atypical non- or practically non-proteolytic strains were detected which should be differentiated from Arcanobacterium haemolyticum . Criteria for laboratory identification of A pyogenes were established: Gram stain; culture on blood agar; deep agar and Loeffler's medium; catalase, nitrate reduction, acid formation from xylose; Hugh and Leifson test . The Api Coryne system correctly identified only 58 of 103 A pyogenes cultures, which implies that it should be re-evaluated before use in veterinary diagnosis laboratories. Ann Ital Chir, 1992 Jan-Feb, 63(1), 89 - 91; discussion 91-2 {Total parenteral nutrition: a study of the microbial contamination of the bags and the infusion lines}; Pacifici A et al.; The authors have examined during 60 groups of patients submitted to TPN each for a period of 10-15 days . In the first group the whole infusional set became replaced after 24 h., in the second and in the third group such replacement was done, respectively, after 48 and 72 h . The bacteriological examination of the fluid in the was always sterile 6 h . after preparation except in one case of the third group . The bacteriological examination of the terminal part of the infusional set was always negative in the first group, it was positive in the 3.33% of the cases, in the second group and in the 6.66% of the cases in the third group . The authors, consequently, believe that the infusional set has to be replaced after a period no longer than 24 h . Total parenteral nutrition: study on microbial contamination of bags and infusion lines. Alaska Med, 1992 Jan-Mar, 34(1), 21 - 7 Epidemiology and public health in the Yagodnoye district; Beller M; Yagodnoye District (population 48,622 as of January 1, 1991) is one of seven administrative districts in the Magadan Region of the Russian Republic, USSR . The population age-distribution is different from that of the United States or Alaska with a larger proportion of persons 20-49 years of age and relatively few people greater than or equal to 60 years of age . Public health and epidemiologic services are provided by a Sanitation and Epidemiology Station with a staff of approximately 108 persons, including 19 doctors . Major activities include Environmental and Occupational Health, Vector Control, Bacteriology Laboratory, and Epidemiology . Epidemiologic services are highly focused on infectious diseases despite the apparent presence of other major public health problems. Probl Tuberk, 1992, (1-2), 49 - 53 {Development of laboratory investigation methods in phthisio-pulmonology (summary of activities of the Central Research Institute of Tuberculosis, USSR Ministry of Health, during the twelfth 5-year plan of the laboratory section of the All-Union program 0.69.08)}; Averbakh MM; Comprehensive laboratory studies were performed to develop and introduce new techniques for examining patients with respiratory tuberculosis and some other pulmonary diseases . The techniques should improve and develop the immunologic and bacteriological diagnosis of tuberculosis, sarcoidosis, various exogenous allergic alveolitis and nonspecific inflammatory (microbial and mycotic) pulmonary diseases . Some of the methods were elaborated for morphological verification of sarcoidosis, alveolitis and rare pulmonary diseases . Radioimmuno-, enzyme immuno-, and other assays for the activity of various enzymes, as well as biochemical methods for assessing the superficial properties of individual cellular elements have found application in performing biochemical studies in pulmonary tuberculosis and non-specific diseases . Immunologic, bacteriological, cytologic and biochemical methods of study have been adjusted to examine the amount of bronchoalveolar washings in patients with different pulmonary diseases. Med Trop (Mars), 1992 Jan-Mar, 52(1), 21 - 7 {Leptospirosis in French Polynesia: 120 case reports}; Gendron Y et al.; Because of its clinical polymorphism and the difficulties to made a bacteriological and/or serological diagnosis, leptospirosis is an affection always non-detected . Nevertheless it is daily met affection in French Polynesia . Based on a homogenous series of 120 observations gathered from 1984 to 1990, all of them bacteriologically and/or serologically confirmed, we studied the different clinical and evolutive features of that disease . Fever is present in 91.6 p.c., cephalgia in 79.16 p.c . and myalgia in 70.83 p.c . Admission was necessary once out of four times . The four syndromes we observed in Tahiti are: infections syndrome, meningeal syndrome (30 p.c.) associated to an hyperproteinic grade in the C.S.F . (40 p.c.) and a lymphocytic reaction (60 p.c.) . Liver syndrome, with hepatalgia (58.33 p.c.) and pain at the mass motion of liver (65 p.c.), that is an important sign in the local context; jaundice (28.33 p.c.) on the presence of which we must not based a diagnosis of leptospirosis: Biological renal syndrome displayed by transitory renal insufficiency with proteinuria, hematuria and leucocyturia . Neurological complications are mainly of encephalitic manifestations (5.8 p.c.) . Hemorrhagic syndrome is expressed in digestive hemorrhage (8.33 p.c.) epistaxis (6.66 p.c.) and hemoptysis (6.66 p.c.) . Cardiovascular manifestations are expressed in collapsus in 5.83 of the cases . Pulmonary abnormalities are frequent: cough (26.66 p.c.) and non specific X Ray image (19.16 p.c.) . All patients are treated by Penicillin G (10 to 20 millions per day) by parenteral route with enteral alternative for an average of 10 days . Recovery was fast (7 to 10 days) . In 65.8 p.c., slower in 15 p.c . (15 to 20 days); failure at first stage was observed in 10 p.c . of the cases, and relapse at medium or long term occurred under treatment in 8 cases (6.66 p.c.) . Three dead were deplored (mortality 2.5 p.c.). J Med Primatol, 1992 Jan, 21(1), 24 - 9 Survey of Saguinus mortality in a zoo colony; Letcher J; Six years of necropsy records from a zoo colony of four tamarin species (Saguinus oedipus, S . geoffroyi, S . imperator, and S . mystax) were examined . Mean age at death was 4.0 years, average length in the colony at time of death was 3.4 years . Annual mortality rate varied between 9 and 30% . Gross necropsy findings, histopathologic, and bacteriological results indicate primary cause of death as follows: peritonitis (26%), septicemia (14%), nephritis (5%), hepatitis (5%), pneumonia (2%), and others. Antimicrob Agents Chemother, 1992 Jan, 36(1), 158 - 62 Multicenter prospective randomized trial comparing ceftazidime plus co-trimoxazole with chloramphenicol plus doxycycline and co-trimoxazole for treatment of severe melioidosis; Sookpranee M et al.; A prospective randomized trial was conducted at Srinagarind and Khon Kaen hospitals . Ceftazidime (100 mg/kg of body weight per day) and co-trimoxazole (trimethoprim, 8 mg/kg/day; sulfamethoxazole, 40 mg/kg/day) therapy was compared with conventional therapy (chloramphenicol, 100 mg/kg/day; doxycycline, 4 mg/kg/day; trimethoprim, 8 mg/kg/day; sulfamethoxazole, 40 mg/kg/day) in the treatment of 64 patients with bacteriologically confirmed cases of severe melioidosis who were admitted during September 1986 to January 1989 . Of 61 evaluable patients (3 were excluded because of severe drug allergies), 42 were septicemic, and 31 of these patients had the most severe form, disseminated septicemic melioidosis . Their cumulative mortalities on day 7 were compared . There were significantly lower overall mortalities from melioidosis, septicemic melioidosis, and disseminated septicemic melioidosis in the group receiving the new treatment compared with those in the group receiving the conventional treatment (47 versus 18.5% {P = 0.039}, 57.7 versus 25% {P = 0.039}, and 82.3 versus 30.7% {P = 0.006}, respectively); but the differences could have been influenced by the greater severity of illness, e.g., shock at initial presentation, in the patients who received the conventional treatment . Among patients with disseminated septicemia and initial shock, there was no significant difference in mortality between the regimens . Both regimens effectively eradicated bacteria from the circulation within 24 h (97 versus 96%, respectively) . We recommend ceftazidime and co-trimoxazole as the drugs of choice for treatment of severe melioidosis, especially in those patients with disseminated septicemia. Rev Mal Respir, 1992, 9 Suppl 1, R57 - 9 {Acute pneumopathies in the aged}; Yernault JC; Acute infectious pulmonary diseases have a particular importance in elderly subjects because of their frequency and severity . This particular sensitivity to respiratory infections is linked to the global reduction in defense immune mechanisms: reduction in T-lymphocyte response in the presence of mutagens, reduction of the late hypersensitivity reactivity, alteration of B- and T-lymphocytes cooperation, reduction in bacterial opsonization . The presence of associated chronic diseases like chronic obstructive airway diseases, cardiovascular diseases, diabetes, renal failure or cancers is, for a large part, responsible for these infections . The diagnosis is often difficult because of the paucity and the lack in specificity of clinical signs . Radiological and, eventually, bacteriologic investigations are most often necessary to limit the prescription of multiple antibiotic treatments that are responsible of serious side effects direct and/or related to possible drug interactions . These risks are indeed increased because of the modification in metabolism and the pharmacokinetics of antibiotics in elderly subjects . Criteria for hospitalizing elderly subjects with an acute pulmonary infection are not different from those which apply in younger patients, but they imply more awareness . It is also important to take into account socioeconomic conditions and the individual functional capacities in the initial assessment of the severity of the condition . In conclusion, the multiple aspects and the potential severity of pulmonary infections in older subjects require a particular awareness, a more precise diagnosis and the initiation of antibiotics based on a probabilistic judgment, most often during an hospitalization. J Cancer Res Clin Oncol, 1992, 118(5), 395 - 9 Febrile neutropenic events in cancer patients: treatment for fever and neutropenia in young adult patients during intensive chemotherapy for solid tumours; Nobbenhuis M et al.; Febrile neutropenic events (FNE) were studied in 90 patients on chemotherapy protocols for solid tumours, from 1986 to 1990 . All patients received intensive chemotherapy with a high dose intensity . There were 51 FNE admissions in 31 patients, with an average event rate of 1.6/patient . The average periods of granulocytopenia, fever and admission were 3.5, 2.7 and 5.4 days respectively . The management of FNE consisted of accurate clinical observation and antibiotic treatment if indicated by symptoms of infection or by bacteriological cultures . Only 25 of 51 patients admitted received empiric broad-spectrum antibiotics, while 7 were treated after the results of bacteriological cultures were known . One patient died during granulocytopenia, of interstitial pneumonitis for which no bacteriological source was established . Recurrences of infection after discharge from the hospital were not seen . We conclude that in this group of young adult patients, FNE runs a favourable course . Only a short period of admission and a limited form of antibiotic treatment are needed, minimizing the load on the patient and the costs of their care. Clin Ther, 1992 Jan-Feb, 14(1), 97 - 109 Efficacy of two comparative antibiotic regimens in the treatment of serious intra-abdominal infections: results of a multicenter study; Eckhauser FE et al.; A multicenter, open-label randomized trial was conducted to evaluate the efficacy and tolerability of monotherapy with imipenem-cilastatin (I-C) compared with combination therapy with clindamycin and an aminoglycoside (C+A) for treatment of 117 patients with serious intra-abdominal infections . Fifty-three patients (45%) received I-C and 64 patients (55%) received C+A . The overall clinical success rate was 96.2% for the I-C patients and 92.2% for the C+A patients . Clinical failure rates were 3.8% and 7.8%, respectively (P = NS) . Eradication or suppression of pathogens was observed in 81.8% and 82.2% of patients, respectively . Uniform bacteriologic response was observed among all infection subgroups . Fourteen of 145 patients experienced adverse symptoms, including six of 66 (9.1%) monotherapy patients and eight of 79 (10.1%) combination-therapy patients (P = NS) . The results of this study demonstrate that I-C monotherapy was as effective as C+A combination therapy for the treatment of serious intra-abdominal infections, regardless of the site or severity of infection or the clinical status of the patient . Both regimens also were found to be comparable in tolerability. Clin Ther, 1992 Jan-Feb, 14(1), 41 - 53 Loracarbef (LY163892) versus cefaclor in the treatment of acute bacterial bronchitis; Dere WH et al.; In this double-blind study, 319 patients (133 men, 186 women) with acute bronchitis were randomly assigned to receive 200 mg of loracarbef twice daily (n = 160; mean age, 42 years) or 250 mg of cefaclor thrice daily (n = 159; mean age, 43 years) for seven days . Clinical and bacteriologic responses were assessed in 63 loracarbef-treated and 56 cefaclor-treated patients in whom pretreatment positive cultures of pathogens susceptible to loracarbef and cefaclor were found . Among these evaluable patients, a clinical cure was found in 68.3% of the loracarbef-treated patients and in 66.1% of the cefaclor-treated patients and improvement in 27.0% and 28.6%, respectively; the pathogen was eliminated in 7.9% and 10.7% and presumed eliminated in 82.5% and 82.1%, respectively . Three in the loracarbef group discontinued treatment because of adverse events, two of which (nausea, nausea/diarrhea/vomiting) were presumably related to the drug . Headache was reported by 9.4% of the 160 patients in the loracarbef group and 6.9% of the 159 patients in the cefaclor group; diarrhea by 5.6% and 6.9%, respectively; and dyspepsia/abdominal pain/gastrointestinal disorders by 5.6% and 4.4%, respectively . It is concluded that both loracarbef and cefaclor are safe and effective in the treatment of acute bacterial bronchitis. Acta Otolaryngol, 1992, 112(1), 96 - 101 Opsonization of middle ear bacteria during chronic suppurative and secretory otitis media; Stenfors LE et al.; Samples of middle ear effusion were obtained from 16 patients with chronic suppurative otitis media (COM) (20 ears, age range from 1 1/12 to 69 years) and 13 patients with secretory otitis media (SOM) (15 years, age range from 8 months to 13 8/12 years) . Qualitative and quantitative bacteriological analyses of the effusions were performed and the intensity of immunoglobulin G (IgG) and complement component C3b adhering to the bacteria was estimated using immunofluorescence technique . In COM effusions, S . aureus in particular was intensely opsonized, whereas Ps . aeruginosa showed minimal, if any, coating with IgG and C3b . SOM effusions exhibited extremely sparse IgG- and C3b-coated bacteria . The difference in IgG and C3b coated bacteria between COM and SOM effusions was significant (p less than 0.01) . Specific (IgG) as well as non-specific (C3b) coating of the bacteria that have gained access to the middle ear cavity is of importance for the host defence. Gastroenterol Clin Biol, 1992, 16(2), 148 - 54 {Anal and perianal lesions in symptomatic HIV infections . Prospective study of a series of 190 patients}; Denis BJ et al.; The aim of this study was to determine the prevalence and type of symptomatic anal and perianal diseases in patients belonging to group IV of the Centers for Disease Control classification of infections with human immuno-deficiency virus . Among the 190 prospectively included patients, 31 (16.3 percent) (30 men, 29 homosexuals or bisexuals; 1 woman) had anal symptoms and were referred for proctological examination . Thirty-five "specific" diagnoses were reached in 25 (13.2 percent) patients: 21 ulcerations, 7 condyloma acuminata, 6 perianal sepsis and 1 non-Hodgkin malignant lymphoma . The causes of ulcerations were 16 herpes, one syphilitic chancre and one fissure-in-ano . Three ulcerations remained unexplained despite bacteriological, viral, and histological investigations . Eight patients underwent 10 surgical procedures without significantly delayed wound healing. Minerva Chir, 1992 Jan, 47(1-2), 49 - 54 {The evaluation of the efficacy of drapes and gowns of nonwoven fabric versus drapes and gowns of cotton in reducing the incidence of postoperative wound infections}; Treggiari M et al.; The importance of the preparation of an operative field which will guarantee satisfactory conditions of asepsis during the entire operation is an indispensible premise for controlling the development of postoperative wound infections . This paper compared the efficacy of disposable clothes and gowns in TNT FABRIC 450* in relation to cotton gowns in reducing the incidence of postoperative wound infections . Cotton items were used for 25 subjects out of a group of 50 operated patients and nonwoven fabric (TNT FABRIC 450*) items were used for the other 25 . Thorough bacteriological tests were performed in each patient before, during and after the operation . On the basis of the duration of the operation, it was observed that TNF FABRIC 450* was as efficacious as cotton in controlling postoperative infections in those operations with a short or medium duration; it offered greater protection in lengthy operations, with a higher risk of endogenous and exogenous contamination . It was also observed that disposable items were indispensable in patients treated with radioactive materials and offered greater safety in seropositive patients. Acta Cytol, 1992 Jan-Feb, 36(1), 91 - 4 Fine needle aspiration diagnosis of lymphomatoid granulomatosis . A case report; Williams WL et al.; The diagnosis of lymphomatoid granulomatosis (LG) of the lung depends on obtaining adequate histologic material to demonstrate the characteristic angioinvasive, polymorphous, lymphoid infiltrate and normally requires an open lung biopsy . Fine needle aspiration biopsy (FNAB), if only smeared directly, does not allow an assessment of the lymphoid infiltrate in relation to blood vessels . However, we report a case diagnosed by FNAB in which the specimen was processed by an alternative method that allows cell blocks to be made from all visible particles . Percutaneous FNAB of a nodular pulmonary infiltrate was performed after bronchoscopy and transbronchial needle biopsy failed to yield a diagnosis . The FNAB specimen was placed in 50% alcohol and submitted for processing . The specimen was then filtered through a fine sieve, and all visible tissue was embedded in bacteriologic agar and processed as a standard surgical specimen . The filtrate was processed as standard fluid cytology . The atypical, angioinvasive, lymphoid infiltrate was clearly demonstrated on the cell blocks, and the diagnosis of LG was made . This diagnosis was confirmed by subsequent open lung and skin biopsies. Rev Clin Esp, 1992 Jan, 190(1), 24 - 6 {Leprosy: identification of an isolated case}; Fernandez Galan MA et al.; Leprosy is an infrequent disease in Spain . 4,714 cases of leprosy was registered in the last national census (1979) . The disease is still common in certain regions, such as Levant, Andalusia, Extremadura, Canary Island and Galicia . Lepromatous type is more frequent, a typical hallmark of endemies with low activity or characterized by regression . We report a patient affected of borderline lepromatous leprosy with the following characteristics: 1) the only known case in his locality, 2) lack of reaction after the treatment, and 3) due to its clinic, histological, and bacteriological characteristics was quite difficult to determine the leprosy's type . Even though the leprosy is an infrequent disease, it can be seen in everyday's practice, so that the internist and specialist . Have to know the disease in order to make an early diagnosis and to treat the patient effectively. Rev Mal Respir, 1992, 9(1), 69 - 79 {Transthoracic lung punctures}; De Koster J et al.; Transcutaneous needle aspiration (PTT) is a diagnostic technique which consists of biopsying pathological lung tissue using a needle (which in general is specifically designed for the purpose) which is introduced into the thorax transcutaneously . The target is lined up, either radioscopically or using a CT scanner and this enables the needle to be positioned in the centre of the lesion radiologically where one or more biopsies can be taken . According to the type and diameter of the needle these biopsies will enable a histological examination to be performed in addition to a cytological and bacteriological examination . This performance is particularly indicated in the final assessment of a periphery pulmonary nodule which is suspected of being neoplastic where bronchofibroscopy has been non contributory and where an immediate thoracotomy (diagnostic or therapeutic) is not recommended for one or other reason . When performed for this indication the technique often achieves a sensitivity of 90% with an average specificity of 98% . The diagnostic yield for benign tumours is less . It is always necessary to maintain a degree of vigilance in view of the risk of false negative or "benign" results . The complications exist above all of pneumothoraces which occur in 20-30% of cases and which will require a drain in 5-10% of cases . Haemorrhage and haemoptysis are less frequent but potentially fatal even in the absence of any coagulation disturbance. Rev Mal Respir, 1992, 9(1), 57 - 68 {The shielded bronchial brush and transcutaneous tracheal puncture}; Benhamou D et al.; Specific bacteriological diagnosis is the first condition for optimal treatment in bacterial pneumonias . Despite many attempts to improve its reliability, bacteriological examination of the sputum is a non-sensitive and non-specific examination . Transtracheal aspiration (TTA) and bronchoscopic protected brush (BPB) are more reliable examinations but their practice is limited because of their invasive characteristic . Then treatment of non-critical pneumonia is often based on the probable organism . BPB is carried out using a protected brush with a double catheter which is introduced into the bronchial tree under fiberscopic control . Although easy, such a technique must be accurate in its performance . Even if good reliability of this method is well establish in in vitro and in vivo studies, it remains that false positive results have been described in clinical studies, so that quantitative cultures are needed . Results are evident in non-intubated patients without bronchial disease in which identifying the responsive germ is the only purpose . But in intubated ventilated patients two problems are faced: firstly on establishing a positive diagnosis of bacterial pneumonia and secondly on identifying the responsive germ . TTA technique prevents pollution of the specimen with oropharyngeal flora: bronchial secretions are aspirated by a catheter introduced into the trachea via percutaneous route through crico-thyroid membrane . Its performance is easy, quick and severe complications are very rare when usual contraindications are taken into account (severe hypoxia, hemostatic disorders) . Being of good sensitivity, the TTA shows false positive results in patients with chronic bronchial diseases . On a bacteriological point of view, these protected techniques have to be used only when pyogenic bacteria are suspected . Invasive techniques are needed when there are factors of specific severity or other risk factors . The choice (TTA or PBP) depends mostly on medical habits and material availability. Nippon Sanka Fujinka Gakkai Zasshi, 1992 Jan, 44(1), 41 - 8 {Experimental and clinical study on chorioamnionitis as a cause of preterm labor}; Morizaki J; I performed the following studies to confirm the recent recognition of chorioamnionitis as a cause of preterm labor and to evaluate the effect of antibiotics in the treatment of this disease . 1 . Models of chorioamnionitis were prepared using prepartal rabbits by directly inoculating bacteria at various concentrations into the amniotic cavity . Preterm deliveries occurred 2-3 days after inoculation in most of the animals when given no antibiotic, but not when treated with antibiotic after inoculation at 10(3) cells/ml or less . 2 . These results were confirmed pathologically and bacteriologically in animals sacrificed 3 days after inoculation . 3 . When morphologies of the placenta and umbilical cord obtained at various gestational weeks were examined, it was revealed that patients developing preterm labor or PROM before 33 gestational weeks had significantly severer inflammation than did others . 4 . While I have undertaken antibiotic therapy in PROM patients since April, 1985, it has been noted that the length of time between its diagnosis and delivery can be prolonged by antibiotic therapy and that such treatment can also prevent neonatal infection . Thus it is concluded that infection is a cause of preterm labor and should therefore be treated with antibiotics to prevent preterm labor without hesitation. Avian Dis, 1992 Jan-Mar, 36(1), 114 - 24 Sudden death in turkeys with perirenal hemorrhage: pathological observations and possible pathogenesis of the disease; Larochelle D et al.; A pathological study was conducted on 32 turkeys that died of sudden death with perirenal hemorrhage syndrome . Turkeys were selected from routine necropsy cases in a diagnostic laboratory . A higher incidence was observed in heavy tom turkeys . In addition to the characteristic gross lesions of perirenal hemorrhage, splenomegaly, and pulmonary congestion, turkeys in most cases had a hypertrophic cardiopathy . Microscopic lesions included moderate-to-marked acute passive congestion of all tissues examined (32/32), severe perirenal hemorrhage (32/32), and splenic lymphoid depletion (25/32) . Changes in the thyroid follicular epithelium of most birds suggested an increased glandular activity . No lesions suggestive of arterial hypertension were observed . Adenoviral infection was detected in only four of 32 birds . Bacteriological cultures revealed no significant pathogen . Results suggest that sudden death in turkeys with perirenal hemorrhage is caused by an acute congestive heart failure consecutive to a hypertrophic cardiopathy . The perirenal hemorrhage would be a consequence of a severe passive congestion in kidneys. Probl Tuberk, 1992, (3-4), 51 - 3 {Quantitative and qualitative characteristics of bacterial excretion in socially maladapted patients with pulmonary tuberculosis and outcomes of the process}; Bondin SV; A clinico-bacteriologic examination comprised 103 patients with destructive forms of pulmonary tuberculosis who excreted the bacterial and L-forms of M . tuberculosis . Patients were divided into two groups depending on their social adaptation . Group I included 66 patients with asocial behaviour, group 11-37 patients whose way of life was normal . Patients of group I exhibited copious excretion of M . tuberculosis and L-forms with a high degree drug resistance and multiresistance of M . tuberculosis to antituberculous preparations . Patients of group I had progress of the tuberculosis process with fatal outcomes 4.2 times more frequently. Ann Otolaryngol Chir Cervicofac, 1992, 109(2), 87 - 94 {Evaluation of the efficacy of the combination amoxicillin-clavulanic acid-tobramycin for the prevention of infections after surgery for ORL cancers}; Philip V et al.; The clinic and economic evaluation of a probabilist antibiotherapy Augmentin/Nebcine administered until the wound healing was studied in 60 patients, operated of upper aerodigestives tracts cancer . The antibiotherapy efficiency was estimated at the end of 6 days in terms of clinic and bacteriologic results . In case of therapeutic failure, the treatment was adapted according to antibiogram results . The association Augmentin/Nebcine was effective in 93% of cases . Antibiotherapy was to be modified for five patients (one for allergy and four for bacteriological unsuccessful) . The bacteriologic sample shows the predominance of Gram(-) germs . 83% of them were sensitive to one of these antibiotics in vitro . The daily mean cost of antibiotherapy was about FF 71 . The overcost, due to antibiotherapy failures, represented only 1% of the whole cost of the 60 treatments . These results justify the use of a large spectrum antibiotherapy reaching Gram(-) germs. Klin Khir, 1992, (2), 24 - 6 {Use of acelysin solution in the treatment of acute purulent inflammatory diseases of soft tissues}; Pyshkin SA et al.; The authors have successfully used for local treatment of purulent wounds a new preparation acelysin . In animals with the induced abscesses, under the influence of acelysin, more rapid recovery than in the control group of animals treated with hypertonic sodium chloride solution, dioxidine solution was achieved . The effectiveness of treatment was judged by duration of the course of a wound process, findings of morphologic, cytologic and bacteriologic studies . Use of acelysin solution in 24 patients with suppuration of an operative wound has confirmed its effectiveness. Chemotherapy, 1992, 38 Suppl 2, 29 - 32 Clinical trials on pediatric lower-respiratory-tract infection: results and comments with cefetamet pivoxil; Paupe J et al.; A total of 30 pediatric patients suffering from lower-respiratory-tract infections were admitted to a three-arm, open, randomized study comparing two different doses of cefetamet pivoxil (either 10 or 20 mg/kg b.i.d.; groups A and B, respectively) with the standard cefaclor treatment (10 mg/kg t.i.d.; group C) for 7-12 days . The 30 cases were randomly assigned to the three treatment arms which were comparable with regard to demographics as well as to diagnosis on admission and concomitant medication . The children ranged from 1.08 to 12 years in age, and comprised 18 males and 12 females, with a weight range of 11-42 kg . As is to be expected in these patients, bacteriology was mostly not assessable . The overall clinical outcome was cure in 9, 8 and 9 cases, respectively, and improvement in 1, 2 and 0 cases, respectively . In the cefaclor group 1 patient failed to respond . Signs and symptoms of disease improved significantly in the three treatment groups; there were no intergroup differences . Vital signs (morning and evening temperature and pulse rate) improved in parallel . Radiological results had improved by the end of treatment in 9/10 patients in group A, in 10/10 patients in group B, and in 9/10 evaluable patients in group C . Mild to moderate nausea or vomiting were each reported in 1 patient in group A . Platelet increase was reported as a mild adverse event in 2 patients in each of the cefetamet pivoxil groups and in 4 patients given cefaclor.(ABSTRACT TRUNCATED AT 250 WORDS) Acta Paediatr Hung, 1992, 32(1), 53 - 70 Monitoring the therapy of acute lymphoid leukemia (ALL) in children--changes induced in clinical, cytological and immunological parameters during treatment of high malignancy ALL with ALL-BFM 88; Babosa M; The ALL-BFM 88 RF greater than 1.7 treatment of high malignancy ALL patients in remission was monitored at the 4th week of Protocol I . The qualitative and quantitative processing of parameters indicating cellular transformations by light and electronmicroscopy was performed in lymphocytes separated from peripheral blood drawn at scheduled times of therapy . The immunophenotype of sample lymphocytes was determined by indirect immunofluorescent techniques, by listing the percentual level of CD2, CD3, CD4, CD8, CD19 surface antigens . The incidence of infections, confirmed clinically and bacteriologically, was recorded . The parameters of the patients were compared to those of healthy children . In the group of patients with high malignancy in the intensive period of ALL-BFM 88 RF greater than 1.7 therapy the incidence of cells rich in organelles, dense granules and vacuoles was significantly (p less than 0.05) higher compared to the control cells, poor in structures . During the weeks of induction and after the consolidating combination with VM-26+ARA-C the expression of surface antigens of the lymphocytes was reduced . That means that up to the introduction of maintenance treatment the presence of surface antigens remained below the range of normal deviation . These data obtained during monitoring revealed that the morphological and functional integrity of cells was damaged in patients with high malignancy ALL during intensive therapy, though only temporarily. Ann Rech Vet, 1992, 23(1), 63 - 71 {Infection by avian chlamydiosis in breeding pigeons in New Caledonia}; Thevenon J et al.; An epidemiological survey on avian chlamydiosis, carried out by serological probing in 8 pigeon breeders representative of New Caledonian livestock, combined with bacteriological research on pigeon organs and droppings was set up in New Caledonia in order to determine the prevalence rate of this infection and to adapt sanitary regulations concerning pigeon imports . All sera collected (230) were analysed by complement fixation test (CFT) . The organs were diluted in sucrose solution, then stored frozen (-70 degrees C), until inoculation of the yolk-sac of 3 6-8-day-old embryonated eggs (2 blind passages) . Yolk-sac smears stained according to the Gimenez method were made in order to detect intracellular chlamydial organisms . Seventeen sera out of 230 were found to be positive, ie 7.4% of the test sample (confidence interval to 95% = 4.0 to 10.8%) . The carrier pigeons were significantly more infected (17.8%) than pigeons of other breeds in New Caledonia . These results resulted in the sanitary authorities easing restrictions on imports of seropositive pigeons by imposing a 45-day compulsory quarantine with daily administration of chlortetracycline at the rate of 150 mg per 1 of drinking water. Rev Mal Respir, 1992, 9(4), 449 - 53 {Comparative epidemiological characteristics of a homogeneous series of acute common pneumopathies seen in a general hospital center (GHC)}; Reboullet V et al.; Between 1979 and 1989, 108 cases of community acquired pneumonia in non-immunodepressed subjects were admitted to hospital to a specialist chest department . The patient's characteristics were as follows: mean age = 56 (range 14-91), 44 women and 64 men . The causal agent was isolated in 44 cases (40%) of which 4 cases were viral (9% of 44 cases) and 12 were Legionella (27%), pneumococci (SP) 11 cases (25%), Mycoplasma pneumoniae (MP) 8 cases (18%), and Chlamydia 8 cases . The microbacteriological criteria for diagnosis were as follows: significant seroconversion for viruses, MP, Chlamydia, Legionella, bacteriological isolation on blood cultures, and pleural liquid for SP . In 64 cases the bacteriological diagnosis was not established . In this series we note as follows: 1) There did not appear to be any seasonal peak in relation to bacteria isolated, contrary to previous reports, in particular for Legionella . On the other hand viruses occur notably in February and March . 2) Chlamydia were more frequent in individuals living in rural areas; 7 cases out of 8 . Whereas amongst the 108 patients 55 were from the country and 34 from the city (16 from institutions and 3 uncertain) . In conclusion, if the level of bacteriological identification (IMB) appears weaker than in previous reference series: 51-65%, the diagnostic yield clearly improved in our experience achieving results nearer to the best achievable: 54% of IMB from 48 cases which were recruited between 1985-1989.(ABSTRACT TRUNCATED AT 250 WORDS) Proc Finn Dent Soc, 1992, 88 Suppl 1, 451 - 61 Mineral-associated adhesion proteins are linked to root formation; Somerman MJ et al.; There is a general agreement that the extracellular environment plays a critical role in controlling cell behavior . Thus, significant research efforts have focused on understanding the effects of extracellular matrix proteins on cell function . In particular we have focused on determining the role of adhesion proteins in the regulation of root formation . Using an OPN antibody, 2arN (generously provided by Drs Craig and Denhardt), the expression of OPN during root formation was determined . OPN (osteopontin) is a bone-associated adhesion protein . OPN was expressed in the dental follicle region of molars obtained from 3 day old CD-1 mice, but was not expressed in the odontoblast layer . In contrast by day 8, positive staining was noted in the odontoblast layer, as well as in the area of Hertwig's epithelial root sheath . However, at this same time point no positive labeling for 2arN was observed in the enamel organ or in the dental papillae cells . By day 15 positive staining for OPN was seen in the area of the periodontal ligament, as well as the region of primary deposition of extracellular matrix onto dentin . Also determined was the ability of fibronectin, OPN and dentin sialoprotein (DSP) to promote the attachment of dental ectomesenchymal cells, in vitro . Interestingly, these cells attached remarkable well on bacteriological dishes (control) in the absence of an adhesion protein . DSP did not increase cell attachment beyond that observed for control cells . In contrast, both fibronectin and OPN enhanced cell attachment . These studies, while preliminary indicate that OPN is expressed in a unique fashion during root development, thus suggesting a regulatory role for such adhesion proteins during root formation. Ir J Med Sci, 1992 Jan, 161(1), 3 - 4 Blood cultures and antibiotic use in a neonatal intensive care unit; McDonald M et al.; A review of the duration of antibiotic courses in our Neonatal Intensive Care Unit (N.I.C.U.) has shown that in a significant number of cases there was non compliance with the antibiotic policy . An audit of neonatal sepsis and antibiotic usage over a six month period was performed in the N.I.C.U . at the Rotunda Hospital . Three hundred and forty-nine of the 3,163 infants born during this time were admitted to the N.I.C.U . One hundred and fifty-two infants had one or more episodes of suspected sepsis . In 168 instances this preceded a course of antibiotic therapy lasting longer than 48 hours . In 56 (33%) the infant was clinically septic and in 16 (9.5%) of those there was bacteriological proven sepsis . There were 112 episodes (60%) where there was no strong clinical evidence of sepsis and a negative investigation for sepsis where antibiotics were continued for more than 48 hours . The possible reasons why antibiotics were not stopped include the non specific nature of signs of sepsis in neonates, physicians' reluctance to discontinue antibiotics once started, and the logistic difficulty of obtaining routine culture results at weekends . The study emphasizes the need for regular surveillance of antibiotic usage in a N.I.C.U. Acta Vet Scand, 1992, 33(2), 147 - 60 Early foetal death in the mare . Histological, bacteriological and cytological findings in the endometrium; Darenius K; Fifteen mares which had each lost their pregnancies 2 to 8 times during the preceding 6 years were used in a study comprising 1 or 2 breeding seasons for each mare . During the research period all 15 mares conceived and 10 of the mares had normal pregnancies in the 1st experimental year . Five mares resorbed/aborted once or twice during the 1st year . This was followed by a pregnancy that terminated in a live foal . Histopathological examinations of uterine biopsies showed a wide range of histopathological conditions, from absence of changes excessive for the mare's age and parity to the most severe changes of the endometrium . Most likely, endometritis, acute as well as chronic degenerative endometritis, is the most common cause of early foetal death in the mare . Good breeding management is essential and was often enough to make the mares produce a foal . Additional treatment was needed in some of the mares and was based on the course of the conceptus loss and the condition of the endometrium, as determined by clinical, histological, bacteriological and cytological examinations. Pneumonol Alergol Pol, 1992, 60(3-4), 42 - 50 {The role of radiophotography in tuberculosis control programs in Poland}; Luszczewska-Heine D et al.; The role of mass radiophotography in Poland in the years 1985-1898 is presented basing on routine data from Antituberculous Centers and Radiophotographic Units . Mass radiophotography detects approximately 30% of new registered pulmonary tuberculosis cases . In the analysed period the number of radiophotographic examinations systematically fell . Also the percentage of the population that was screened using this method decreased, as well as, although to a lesser state, the percentage of new detected cases of pulmonary tuberculosis . A significant decrease in usage of mass radiophotography equipment was also seen . The economical cost of such examination increased . The role and place of mass radiophotography in tuberculosis control programs in Poland is discussed by the authors . It seems that first contact physicians will have the most pronounced role in early diagnosis of pulmonary tuberculosis . Also more emphasis should be placed on bacteriological diagnosis of tuberculosis. Auris Nasus Larynx, 1992, 19(3), 189 - 92 Tuberculoma of the nasopharynx; Sanderson RJ et al.; A 67-year-old female patient with tuberculosis of the nasopharynx is reported . The diagnosis was confirmed on histological and bacteriological examination of a biopsy from her postnasal space . There was no evidence of any other active foci of tuberculosis but she had had a right nephrectomy 45 years previously for renal tuberculosis . A review of the literature on nasopharyngeal tuberculosis shows this to be a very rare disease in the absence of active pulmonary involvement. Probl Tuberk, 1992, (7-8), 19 - 21 {Problem of differential diagnosis of tuberculosis of peripheral lymph nodes and malignant neoplasms}; Shcherba BV; A total of 386 patients admitted with the diagnosis of tuberculous lymphadenitis were subjected to a differential diagnosis of tuberculosis of peripheral lymph nodes and malignant tumours . A histological examination of the removed lymph nodes demonstrated malignant tumours in 22 (5.7%) patients . Difficulties encountered in differentiating between tuberculous lymphadenitis and malignant tumours are due to changes in the clinical course of the process which are manifested in the enlargement of one or several nodes in 80% of patients in the absence of intoxication, which is also typical of primary malignant tumours of the lymph nodes . Histological and bacteriological studies of the removed nodes proved to be more informative for the differential diagnosis of tuberculous lymphadenitis and malignant tumours. ORL J Otorhinolaryngol Relat Spec, 1992, 54(5), 275 - 7 Indispensability of mediastinoscopy in intrathoracic tuberculosis; Salomaa ER et al.; An analysis of 33 patients with histologically confirmed intrathoracic tuberculous lymphadenopathy was made . Tuberculosis could have been diagnosed without mediastinoscopy only in 3 patients: 2 had positive bronchial cultures and 1 simultaneous cervical lymph node tuberculosis . Bacteriological confirmation is conclusive, but seldom possible . Mediastinoscopy provides the best method to obtain tissue samples, and consequently, it is still necessary in the diagnosis of intrathoracic tuberculous lymphadenitis. ORL J Otorhinolaryngol Relat Spec, 1992, 54(6), 324 - 7 Autograft ossiculoplasty in cholesteatoma; el Seifi A et al.; Although using autogenous ossicles in reconstruction offers stable hearing results with good tendency for healing and minimal extrusion, their use in cholesteatomatous ears has been criticized for the possibility of progressive osteitis, bone resorption and cholesteatoma recurrence . In the present study we have been investigating a way which affords safe re-implantation of such ossicles . Treatment by burring followed by autoclaving seems to offer an implant that is safe both bacteriologically and pathologically . We have found no evidence that cholesteatoma could develop from such treated ossicles. Dig Dis, 1992, 10(6), 354 - 62 Acute pancreatitis: when and how to operate; Buchler M et al.; Patients with proved necrotizing pancreatitis should be treated in an intensive care unit . Surgical management of necrotizing pancreatitis is indicated if an acute abdomen or persistent or increasing signs of organ complications develop, such as pulmonary or renal insufficiency, cardiocirculatory dysfunction or metabolic disorders, and these do not respond to maximum intensive care treatment over at least 72 h . Besides these so-called non-responders to ICU treatment, operative management is clearly indicated in patients who develop signs of sepsis on the basis of a bacteriologically positive fine-needle aspiration of pancreatic necroses . In patients with minor necroses without any bacterial contamination and without extensive retroperitoneal fatty tissue necroses intensive care therapy can be successful without the necessity of a surgical intervention . The gold standard of surgical management of necrotizing pancreatitis is careful removal of necrotic tissue, drainage of bacterially infected area, elimination of the pancreatogenic ascites in order to prevent systemic spread of vasoactive and toxic substances and interruption of the inflammatory process . For the treatment of pancreatic necrosis we strongly support surgical debridement (necrosectomy), supplemented by postoperative closed continuous lavage of the lesser sac and the adjacent necrotic cavities . In 152 patients suffering from severe necrotizing pancreatitis the hospital mortality was 12.5% (19/152) by this surgical approach. Scand J Infect Dis, 1992, 24(5), 633 - 5 Bacteriology of the maxillary sinus in healthy volunteers; Sobin J et al.; In order to investigate the bacteriology of the healthy maxillary sinus, 12 volunteers were subjected to antral puncture with instillation of sterile saline, followed by aspiration . Maximum efforts were used to obtain aspirates without contamination . None of the aspirates showed bacterial growth. Rocz Panstw Zakl Hig, 1992, 43(1), 85 - 93 {Results of testing well water from an area influenced by the chemical plant "Police"}; Torun D; The subject of this study was the determination of the correlation between the operation of Chemical Plant "Police" and contamination of underground waters . The waters from ten wells in 16 localities were tested in 1982, 1987 and 1990 . The indicators of contaminations emitted in different form by Chemical Plant "Police" as fluorides, ammonia and its derivatives nitrites and nitrates, sulphates, phosphates and also chlorides were tested . Bacteriological examinations of water also were performed . Investigations performed in 1987, confronted to 1982, showed development concentration of ammonia and minor as depends fluorides and sulphates . In 1990 lowering of average level of all chemical indicators were obtained . Presumable the introduction of technological changes in Plant determined the reduction of contaminations of underground water in this area. Schweiz Arch Tierheilkd, 1992, 134(9), 401 - 9 {Causes of prenatal foal loss in Switzerland}; Pospischil A et al.; In Switzerland during the foaling season 1988 and 1989 the cause of abortion in 60 foals was investigated . Special attention was paid to infections with equine herpesvirus 1 (EHV 1) . Diagnosis were based on post-mortem, histopathological, bacteriological and immunofluorescence investigation . The results confirm data from other countries, that EHV 1 is the most prevalent viral (20%) cause of abortion, followed by various bacterial agents (12%) . Other causes were umbilical torsion, twin pregnancy and malformations . In 18% of the cases the investigation of fetuses did not give any results as to the cause of abortion, suggesting maternal factors as only cause of abortion. J Int Med Res, 1992, 20 Suppl 1, 24A - 30A An open non-comparative pilot study of the safety and efficacy of oral sultamicillin in the treatment of mild to moderate upper respiratory tract infections in children; Arguello A; A total of 49 children (20 females, 29 males; age range, 6 months-12 years) with upper respiratory tract infections (otitis media, sinusitis, pharyngitis and/or tonsillitis) were treated orally with 25 mg/kg.day sultamicillin suspension in two equal doses for an average of 9.2 days . There was bacteriological evidence of sultamicillin-sensitive pathogens in 44 patients prior to treatment . On completion of treatment, 42 (85.7%) patients were rated as clinically cured and there was improvement in the remaining seven (14.2%) patients . Pathogens were totally eradicated in 32/44 (73.7%) cases but were still present in two (4.5%) and in 10 cases follow-up bacteriological evaluation was not possible . Tolerability of sultamicillin was good and only three possible or probable treatment-related adverse events were recorded. J Int Med Res, 1992, 20 Suppl 1, 12A - 23A Low-dose sultamicillin oral suspension in the treatment of mild to moderate paediatric infections in Turkey; Raillard P et al.; A total of 101 children (47 males, 54 females; age range, 3 months-16 years) with mild to moderate upper or lower respiratory tract infections, or skin and soft tissue infections entered a clinical study conducted at two centres in Izmir, Turkey . The children received a mean daily dose of 25 mg/kg sultamicillin oral suspension administered as two equal doses approximately 12 h apart . In total, 100 children met all requirements for evaluability and were included in the clinical efficacy assessment, and 49 children were evaluated for bacteriological efficacy . Clinical cure was reported by the investigators in 93 patients, improvement in six and failure in only one . The bacteriological eradication rate of isolated pathogens was 100% . Of the 101 patients evaluated for drug safety, four experienced adverse drug-related or possibly drug-related reactions . All side-effects were gastro-intestinal and diarrhoea was reported in three patients . No discontinuation of therapy was reported, nor were any significant laboratory abnormalities recorded. Nouv Rev Fr Hematol, 1992, 34(4), 295 - 9 Air filtration and prevention of aspergillary pneumopathies . Preliminary comparative study of two mobile units for bacteriological air purification with recycling; Perraud M et al.; Two mobile units for air filtration with recycling designed to reduce the aerobiocontamination of hospital rooms were tested . Their efficacity was evaluated by measurement of particle retention and by quantitative determination of the reduction of aerobiocontamination in rooms occupied by patients . Results show a significant improvement in the aerobiocontamination of test rooms as compared to control rooms . It is thus reasonable to suppose that these systems may provide a practical solution to the problems posed by hospitalization in ordinary rooms of patients subjected to aplasive chemotherapy . A randomized clinical trial is in progress. Rev Epidemiol Sante Publique, 1992, 40(3), 156 - 63 {Case control studies in investigation of food-borne infection outbreaks . Study of their utilization in France}; Hubert B et al.; Among the 251 foodborne outbreaks investigated by public health officers in France in 1989, 62 (25%) used a case-control study to identify the responsible food . This survey aims to analyse the results of these 62 investigations . Thirty eight (61%) investigations found the responsible food(s); 10 investigations (16%) lacked power because of the small size of the population studied, but allowed to suspect the food with the highest odds ratio; 13 investigations (21%) gave results inconsistent with bacteriological studies or with hypothesis generated by the descriptive study: in 5 of it, food origin is questionable and in 8 investigations, methodological errors are likely . We could not conclude for one study . Among the surveys with case-control studies, 74% identified the food responsible with bacteriological or epidemiological confirmation, as opposed to 17% of other surveys which had only bacteriological confirmation . This study allowed us to give recommendations on the management of investigation and the interpretation of results to improve the efficiency of this practice. Acta Paediatr Hung, 1992, 32(2), 115 - 25 Immunoglobulin prophylaxis during intensive treatment of acute lymphoblastic leukemia in children; Gimesi A et al.; 60 children with acute lymphoblastic leukemia were sequentially randomized at the time of diagnosis: Immunoglobulin (Endobulin, Immuno) was administered intravenously to 30 patients at a dose 100 mg/kg/week during the first 3 months, followed by 2 x 200 mg/kg/month immunoglobulin during the 4., 5., 6 . months . No immunoglobulin was administered to the control patients . We studied the effect of immunoglobulin prophylaxis on the number of days with fever, number of cases with bacteriologically proved infections, length and frequency of antibiotic therapy . Our data confirm the efficacy of immunoglobulin prophylaxis during the intensive phase of leukemia therapy in children. Probl Tuberk, 1992, (3-4), 53 - 6 {Ecologic significance of M . avium infectiousness of waterside and aquatic birds}; Kovalev GK; A total of 777 specimens of the river-side and water birds of 36 species belonging to 8 orders were examined for infectivity by the causative agent of tuberculosis M . avium . Examination was carried out in the northern zone of the land along the lower Volga . Infectivity was studied by serologic and bacteriologic tests . Serologic examination showed that 104 out of the 399 birds were AIT-positive (26.0 +/- 2.195%), in bacteriologic examination 73 out of the 378 specimens were infected (19.57 +/- 2.040%) . The infectivity parameters of birds determined by both methods had certain characteristic features typical of the examination territory . The character of distribution of the infected birds was determined according to the regions of the examination zone. Med Arh, 1992, 46(3-4), 71 - 2 {Significance of exposure of workers in the tanning industry and the prevalence of upper respiratory tract diseases}; Sehovic-Duric N; Respiratory diseases are in prevalence under the other diseases in industry of leather . The exposition to the chemical irritances like bensen and toluene is very important, because a short exposition gives early symptoms . We found in 54% of examined population pathologic ORL cases in a sense of hypertrophic and atrophic forms rhinitis and pharyngitis . Bacterial flora is pathologic in 20% of examined workers and comparing positive bacteriologic form between nose and pharynges we found infections of mucose of nose more frequent than the throat . The occupational atmosphere and its microclime is very important in pathology of upper respiratory diseases . It is etiological factor in morphological changes of the respiratory mucosas . At the end, we can say that the ordinary monitoring which contains monitoring of working place, and biologic monitoring which means ORL, bacteriological, biochemical and toxicologic examinations must be regulated. Magy Traumatol Orthop Helyreallito Seb, 1992, 35(4), 289 - 93 {Examination of infection and infectivity of open injuries}; Rezes D et al.; Authors examined the circumstances of bacteriological infection of open fractures and large size injuries of the soft tissues . Bacteriological examinations were made from the ichor before the primary wound care and immediately after its finishing . It is stated that in open injuries there is only a potential possibility of infection and with an early wound care its danger can be substantially decreased . In the purulent infection after open injuries one has always to think on the possibility of secondary hospital infection. Agressologie, 1992, 33 Spec No 2, 87 - 90 {Bacteriological control of food for immunocompromised host}; Aupee M et al.; This study concerning bacteriological controls of food for immuno-suppressive patients have shown that food sterilized in sterilizer or with pressure-cooker contains sporulated bacteria after treatment . Unit packaging or freeze-drying commercial foods offer no bacteriological quality guarantees . Clinicians have to define acceptable contamination rate according to their patients' condition. Polim Med, 1992, 22(3), 83 - 8 {Application of mini-septopal in surgery of the hand}; Zimmer K; Successful application of the Septopal in treatment of osteomyelitis has created the demand for this form of drug available for implantation into the small operation field, e.c . in the hand . The Chair and Clinic for Traumatology of the Medical Academy in Wroclaw has been chosen to cooperate in the clinical trial on application of the Septopal-minichains in surgery of hand . There were 76 patients treated with the Mini-Septopal implantation . In 18 cases the osteomyelitis or active bacterial soft tissue infection gave indications for this type of treatment . In 58 cases Mini-Septopal was implanted because of high risk of infection in contaminated wounds . In both groups bacteriological examinations have been performed and statistical study revealed successful results even in primary resistant for gentamicin bacteries . Very good results of treatment let us estimate very high the usefulness of Mini-Septopal in bone and soft-tissue infections treatment, if the proper surgical procedures are performed to clean the focus of infection. Pneumoftiziologia, 1992 Jan-Mar, 41(1), 5 - 8 {The exclusively outpatient treatment of pulmonary tuberculosis under the conditions in Romania}; Mihailescu P et al.; In order to demonstrate the possibility of an exclusively outpatient treatment of pulmonary tuberculosis in the present conditions in our country, a study was performed on 140 cases in Bucharest . The admission criteria were as follows: sputum negative patients (M-C-); paubacillary cases, sputum positive only in culture (M-C+); Tb pleuritis; patients refusing hospitalization, regardless their bacteriological status, and sputum positive cases also at smear examination (M+C+), if they had no household contacts under 20 years of age or with a good social economic standard of life . The patients were given the intensive chemotherapy regimen HSRZ 2/7 for 6 months, that was prolonged to 9 months in specified cases . A number of 31 patients were non-bacillary (M-C-) out of which 14 cases with pleuritis; 70 were paucibacillary (M-C+), and 39 were smear positive (M+C+) . Out of 109 patients which were bacteriologically confirmed, sputum reversion in culture was obtained in 71.6% of cases at 2 months and in 89.0% at 3 months . At treatment end, sputum negativation was not obtained in a single patient (0.9%) . Case follow-up for 6-41 months after treatment end led to the registration of 8 therapeutical failures and bacteriological relapses (5.7%) . Five cases recovered through re-treatment, 1 patient (0.7%) died through tuberculosis, and 2 (1.4%) became chronic case . Periodical control of the 95 contact children in the respective households revealed a single conversion of the tuberculin reaction and no Tb case after treatment start in index cases, which proves the epidemiological reliability of the method. Acta Leprol, 1992, 8(2), 79 - 86 Histological changes with combined chemotherapy and immunotherapy in highly bacillated lepromatous leprosy; Natarajan M et al.; Highly bacillated untreated lepromatous cases with an initial BI 4+ of to 6+ were treated with combined multidrug treatment (MDT) and immunotherapy with heat killed Mycobacterium w or BCG . The vaccines were administered intradermally every six months . It was observed that majority of cases on immunotherapy showed increased lymphocytic infiltration (both at local and distant sites) and some cases showed epithelioid cells as well . The lymphocytic infiltration was (slightly) more vigorous in those vaccinated with Mycobacterium w . Such changes were not seen in the patients on MDT alone . Also, the granuloma fraction reduced much faster in cases who were on additional immunotherapy as compared to those on MDT alone . These changes along with evidence of clinical and bacteriological improvements suggest that immunotherapy may have an important supportive role specially in the therapy of anergic lepromatous cases. Pneumonol Alergol Pol, 1992, 60(5-6), 18 - 25 {Immunological approach to the evaluation of the activity of the tuberculous process}; Kwiatkowska S et al.; The aim of the study was to determine the immunological criteria of the activity of the lung tuberculosis . Some immunological tests based on cellular and humoral immunity were assessed in 3 groups: I--patients with active, bacteriologically confirmed tuberculosis, II--individuals with inactive minimal changes in the lung, III--healthy subjects . We found that among patients with active tuberculosis cellular immunity was depressed: both percentage of T-lymphocytes and their function, usually associated with cutaneous anergy to tuberculin . But the humoral immunity was enhanced . The authors have shown that the people with inactive minimal changes in the lung take place between the patients with active tuberculosis and healthy subjects. Probl Tuberk, 1992, (11-12), 65 - 9 {Experimental models of combined tuberculosis-opisthorchiasis pathology}; Zolotukhin VA; An experimental model of the combined course of tuberculosis and opisthorchiasis is presented in the following variants: pulmonary tuberculosis-chronic opisthorchiasis, acute and chronic opisthorchiasis in combination with tuberculosis contamination, BCG and opisthorchiasis . Specific changes in the combined pathology are shown which differ from those that accompany each of the nosological forma . Data obtained in bacteriologic, parasitologic, immunologic and pathomorphologic studies were used to describe characteristic features of the models . The results obtained allow a suggestion that parasitocenosis of mycobacteria and Opisthorchis organisms has an influence on the pathogenesis, clinical picture, diagnosis, treatment, epidemiology and prevention of tuberculosis-opisthorchiasis combined pathology. Postgrad Med J, 1992, 68 Suppl 3, S60 - 6; discussion S66-7 Comparative trials of cefaclor AF in uncomplicated cystitis and asymptomatic bacteriuria; Hamilton-Miller JM et al.; Two different doses of cefaclor advanced formulation (AF), a new sustained-release formulation of cefaclor, were compared with the regular formulation of cefaclor for efficacy and safety in the treatment of uncomplicated cystitis and asymptomatic bacteriuria . A 7-day course of treatment was used, and the trials were double-dummy and double-blind . In one trial, cefaclor AF 500 mg once daily (at night) was compared with cefaclor 250 mg three times a day . Satisfactory clinical and bacteriological responses were found in 179/189 (94.7%) and 160/191 (83.8%) patients, respectively, given cefaclor AF and in 82/87 (94.3%) and 74/90 (82.2%) patients given cefaclor, 5-9 days after the end of treatment . In the other trial, cefaclor AF 375 mg twice daily was compared with cefaclor 250 mg three times a day . Satisfactory clinical and bacteriological responses were obtained in 164/180 (91.1%) and 156/184 (84.8%) patients, respectively, given cefaclor AF, and in 86/92 (93.5%) and 81/93 (87.1%) patients taking cefaclor, 5-9 days after the end of treatment . Very similar results were found in both studies in those patients who were assessable 3-5 weeks later . Only 4.3% and 2.4% of patients treated with cefaclor AF (375 mg and 500 mg, respectively) and 2.2% of cefaclor patients discontinued therapy due to adverse events . The three most commonly reported events were vaginal moniliasis or vaginitis (8.6%), headache (5.0%) and nausea (4.8%) . No significant differences were found between clinical efficacy and safety parameters in the different study groups, and it was concluded that cefaclor AF in a twice-daily or once-daily dosage is as effective and as safe as the currently recommened three-times-a-day dosage of cefaclor. Postgrad Med J, 1992, 68 Suppl 3, S30 - 6; discussion S36-7 Cefaclor AF versus cefaclor in acute exacerbations of chronic bronchitis; Grossman RF; The effectiveness and safety of cefaclor advanced formula (AF) compared with cefaclor in the treatment of acute exacerbations of chronic bronchitis were evaluated in multicentre trials in the United States and Europe . In the US study, patients were randomized to receive either cefaclor AF 375 mg twice daily or 500 mg twice daily or 250 mg cefaclor three times daily . Three dose levels of cefaclor AF were used in the European study: 375 mg, 500 mg and 750 mg twice daily; the comparative agent was cefaclor 250 mg three times daily in the 375 mg and 500 mg strata, and cefaclor 500 mg three times daily in the 750 mg stratum . The total number of patients receiving cefaclor AF was 667 versus 357 patients receiving cefaclor . Results showed that cefaclor AF administered twice daily at 375, 500 or 750 mg was as effective as cefaclor 250 mg three times daily for the treatment of acute exacerbations of chronic bronchitis . Evaluable patients receiving cefaclor AF in the US study had a clinical response rate of over 90% and a bacteriological response rate of over 85% . In the European study, patients receiving cefaclor AF had clinical response rates over 85% and bacteriological response rates ranging from 50% to 85% . The safety profile for cefaclor AF was similar to that reported for other beta-lactam antibiotics. Dev Biol Stand, 1992, 79, 121 - 8 Control methods and thresholds of acceptability for antibrucella vaccines; Bosseray N; Protection against brucellosis involves both cellular and humoral effectors not yet fully appreciated . Living or killed vaccines can protect against the infection itself or only against abortion . For official controls, vaccines (or new procedures of vaccination) must first be characterized pharmacologically and tested for innocuity . Protection must be tested on natural hosts with a reference vaccine (S19 or Rev . 1) by the agreed method which reproduces the natural infection and measures immunity in toto . Control and vaccinated females are challenged by the conjunctival route at mid-pregnancy under standard conditions (strain, dose) to measure the resulting infection by bacteriological analysis of excretion at parturition and of infection in target organs at slaughter . Results are principally expressed by the infection rate which should be +/- 95% in the control group . In the new vaccine group the rate should be equivalent to, or lower than, the reference vaccine group . To be statistically valid, at least 30 animals per group are required . For routine controls, laboratory models using guinea pigs, not well standardized, inaccurate and expensive, have long been proposed . The mouse model, extensively studied and standardized, should now be preferred to the guinea pig model . In the mouse model, residual virulence of a living vaccine is estimated by the time required by 50% of the mice to eradicate the strain from their spleen (Recovery Time 50%) . Immunogenicity is measured by the ability of mice to restrict their splenic infection after a virulent i.p . challenge at a dose (B . abortus 544; 2 x 10(5) cfu) chosen in order that all mice were still infected 15 days post challenge.(ABSTRACT TRUNCATED AT 250 WORDS) Vet Rec, 1991 Dec 21-28, 129(25-26), 552 - 4 A bovine viral diarrhoea/mucosal disease-like syndrome in moose (Alces alces): investigations on the central nervous system; Rehbinder C et al.; A disease of unknown aetiology has been observed in moose . The animals showed signs of a bovine viral diarrhoea/mucosal disease-like syndrome, and central nervous disturbances . Brains from adult female moose were investigated by means of histology, immunohistochemistry, electron microscopy, virology, and bacteriology . The results indicate that the nervous signs were not associated with a spongiform encephalopathy . The lesions suggest a viral aetiology, although all the virological investigations have so far proved negative. Ned Tijdschr Geneeskd, 1991 Dec 21, 135(51), 2428 - 32 {A tuberculosis project in Ecuador}; Engelsbel S et al.; OBJECTIVE . Determination of the frequency of pulmonary tuberculosis in an Indian community in Ecuador among symptomatic patients and contacts of patients with tuberculosis . Pulmonary tuberculosis was defined as the presence of acid fast rods in sputum . SETTING . Pontificia Universidad Catolica del Ecuador, Quito, Ecuador . DESIGN . Sputum samples were collected with the aid of an educational drama . About 5000 persons were informed on tuberculosis by this performance . The sputum samples from 241 persons were examined for presence of acid-fast rods with a direct Ziehl-Neelsen (ZN) stain and a ZN stain after concentration of the sputum . If ZN stain was negative, the sputum was cultured on Lowenstein-Jensen medium or on Coletsos medium . The Lowenstein-Jensen medium was past the expiration date . RESULTS . Bacteriological examination of the sputum samples from 241 patients and controls brought to light 65 (26.9%) individuals with acid-fast rods in the sputum . Forty per cent of the affected patients were between the ages of 20 and 34 . Investigation of 82 contact persons revealed 19 (23.2%) positive cases . The results of culturing of the sputum samples were disappointing: only 6 of 152 (3.9%) samples showed growth of acid-fast rods . CONCLUSIONS . The frequency of pulmonary tuberculosis (as defined by the presence of acid fast rods in sputum) is high in the community investigated, much higher than the official data on the prevalence of tuberculosis indicate . It is important to investigate contacts of patients with pulmonary tuberculosis to trace a source and to trace new cases. J Am Vet Med Assoc, 1991 Dec 15, 199(12), 1734 - 6 Post-milking teat dip use in dairy herds with high or low somatic cell counts; Erskine RJ et al.; Milk samples for bacteriologic culture were submitted from 71 dairy herds, 24 with low somatic cell count (SCC) and 47 with high SCC and high prevalence of subclinical mastitis . At the time of sample submission to the Mastitis Diagnostic Laboratory of Pennsylvania State University, information regarding the herd mastitis control practices was collected . A combined program of post-milking teat dipping (PMTD) and antibiotic treatment of all cows at the start of the nonlactating period was practiced more frequently for herds with low SCC, (P less than 0.001) than for herds with high SCC . Among all herds for which PMTD was practiced, a higher proportion (P less than 0.001) of those for which chlorhexidine-based products were used had low SCC than high SCC . Conversely, a higher proportion of herds for which a dip with an acrylic latex barrier was used had high SCC rather than low SCC (P = 0.002) . For herds with high prevalence of subclinical mastitis, and despite a program of PMTD and treatment of all cows at the start of the nonlactating period, a change to a different germicidal teat dip product may be indicated to help reduce prevalence of infection. Presse Med, 1991 Dec 14, 20(43), 2185 - 90 {Chronic constrictive pericarditis . 27 cases}; Cacoub P et al.; Twenty-seven cases of chronic constrictive pericarditis seen between 1975 and 1990 in an internal medicine department were analyzed retrospectively . The chronic pericarditis was consecutive to one (n = 5) or several (n = 7) episodes of acute pericarditis . Echography demonstrated the presence of pericardial effusion in 74 percent of the cases, pericardial thickening in 41 percent and/or compression of right heart cavities in 55 percent . Computerized tomography of the chest, performed in 16 cases, showed pericardial effusion in 63 percent of the cases, pericardial thickening in 37 percent and lymph node enlargement in 19 percent . Magnetic resonance imaging of the chest was carried out in 2 patients but showed no abnormality . All 11 patients who underwent cardiac catheterization were found to be adiastolic . The cause of constrictive pericarditis, elicited in 13 patients was neoplasia in 4, sequelae of radiotherapy in 2, injuries in 2, mediastinal and retroperitoneal fibrosis in 2, myocardial infarction in 1, purulent pericarditis in 1 and bacteriologically proven tuberculosis in 1 . Medical treatment with corticosteroids (n = 16) and/or antituberculous therapy (n = 15) was successful in 2 patients; 25 patients had to undergo surgery 7 +/- 11 months after constriction was diagnosed . Pericardial drainage (through a pericardiopleural window in 4 cases) proved to be sufficient in 10/15 patients but failed in 5 . Pericardectomy was performed initially in 3 cases and after failure of medical treatment and/or drainage in 11 cases . The 4 patients with neoplastic constrictive pericarditis died 10 months on average after the diagnosis, but the remaining 23 patients were alive after a 9 to 48 months (mean: 19 +/- 15) follow-up . These results suggest that the data provided by echocardiography and computerized tomography of the chest usually point to the relevant therapeutic measures without a need for invasive haemodynamic exploration . Idiopathic constrictive pericarditis now accounts for 50 percent of the cases; tuberculosis has become exceptional, but the other, previously exceptional causes (neoplasia, heart surgery, radiotherapy, connective tissue diseases) are more frequent . Corticosteroids should be used in chronic constrictive pericarditis occurring after cardiac surgery or in the course of a connective tissue disease, but they are effective only in highly inflammatory forms of the disease . Modern treatment relies on early surgery, since functional results and patient's survival are closely related to the date of pericardectomy which must be carried out before very important myocardial repercussions develop. Chest, 1991 Dec, 100(6), 1503 - 6 The safety and efficacy of clarithromycin in patients with Legionella pneumonia; Hamedani P et al.; Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila . In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated . Forty-six patients were enrolled in the study, 15 of whom had not responded to previous routine anti-Legionella therapy (erythromycin, ofloxacin, rifampin {rifampicin}, or tetracycline) . Twelve patients prematurely discontinued the study (nine by the patient's request while feeling well; one because of cancer diagnosis; and two because of adverse events) . The response rates after treatment were as follows: clinical cure rate, 98 percent (43/44); clinical success (cure or improved), 100 percent (44/44); radiographic success (cure and improved), 93 percent (28/30); direct antigen fluorescence resolution, 100 percent (40/40); and bacteriologic cure, 100 percent (13/13) . Ten patients reported 13 adverse events (seven mild, four moderate, and two severe) . Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila. Clin Intensive Care, 1992, 3((5 Suppl)), 8 - 12 New approaches in the diagnosis of pneumonia in ICU patients; Konrad F; The following clinical criteria can be used for the diagnosis of pneumonia in ventilated patients: 1 . New infiltrates on chest X-ray . 2 . Purulent tracheal secretions (TS) . 3 . Positive bacteriological finding in TS . 4 . Temperature over 38.5 degrees C . 5 . Leucocyte count over 12,000/mm 3 . 6 . Characteristic auscultatory findings . 7 . Impaired gas exchange . When the first three criteria are fulfilled and a further two criteria are positive, a respiratory tract infection is highly probable and therapy with antibiotics justified . When fewer criteria are fulfilled, or in cases in which specific criteria cannot be applied, for example, patients with the acute respiratory distress syndrome (ARDS), a lung contusion, or an infection located elsewhere, invasive bronchoscopic diagnosis by protected specimen brush (PSB) or bronchoalveolar lavage (BAL) is indicated . The PSB method is characterised by very good specificity, though a not so high sensitivity . Compared to the PSB method, the BAL method has a lower specificity but is more sensitive . Pre-conditions for the successful application of both methods include correct technical handling as well as close co-operation between the intensive care physician and the microbiology laboratory. Hepatology, 1991 Dec, 14(6), 1142 - 6 Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses; Moesch C et al.; The deposits obstructing 12 biliary endoprostheses were examined by scanning electron microscopy and analyzed quantitatively by Fourier transform infrared spectroscopy . Calcium palmitate and bilirubinate associated with proteins were found in all the deposits . Apart from the small amount of cholesterol, this composition closely resembled that of brown pigment gallstones and suggested an infectious cause . Facultative aero-anaerobic organisms were found on bacteriological investigation . beta-Glucuronidase activity was only detected in one sample, suggesting that the calcium bilirubinate may have been formed through tissue glucuronidases . In our study, deposit formation was thought to have been caused by the action of bacterial phospholipases (although not measured) rather than beta-glucuronidases. Adv Dent Res, 1991 Dec, 5, 21 - 36 Diagnosis of periodontal diseases; Ranney RR; This paper reviews current (Fall, 1990) information related to the diagnosis of periodontal diseases . As background, principles of diagnostic decision-making and conceptual shifts during the 1970's and 1980's are reviewed in brief . "Diseases" that appeared in many classification schemes for periodontal diseases in the early 1970's--for example, "periodontosis" and "occlusal trauma"--do not appear in most current classifications . A recent (1989a) classification recommended by the American Academy of Periodontology holds that "periodontitis" includes several different diseases . There is, indeed, evidence for several different forms of periodontitis, but the AAP's classification does not conform to the principles of diagnostic decision-making because of the significant overlap between and heterogeneities within its suggested "diseases" . An alternative classification is suggested, based on a concept that the periodontal diseases are mixed infections whose outcome is modified by relative effectiveness of host response . This view suggests that the most usual forms, gingivitis and adult periodontitis, normally occur in persons with essentially normal defense systems . Variation in extent or severity of disease can be understood as a function of the local infection in hosts with various degrees of compromised resistance to the infection . Early-onset periodontitis (EOP) cases could be accounted for by those where host response is abnormal to some significant degree . The greater the abnormality, the greater the extent and severity of disease might be . Localized EOP cases would be those where a relatively effective specific response intervenes to ameliorate progress of disease after the initially rapid progression . Other issues are detection of disease activity and assessment of risk for disease progression . Non-cultural bacteriological tests are available, but have not yet been shown to detect or predict activity or risk . One difficulty in reaching such proof for those or other tests has been the lack of an appropriate "gold standard" for disease activity or progression . This is being remedied by development of improved automated probes and imaging technologies . Considerable effort is being devoted to determining whether factors in gingival crevicular fluid may have diagnostic utility . More evidence is needed before clinical utility is known, but several enzymes and cytokines have potential for aiding diagnostic decisions. Jpn J Antibiot, 1991 Dec, 44(12), 1351 - 8 {Clinical study of intramuscular imipenem/cilastatin sodium in the field of obstetrics and gynecology}; Chimura T et al.; We evaluated the clinical efficacy and safety of intramuscular (as a new route of administration) imipenem/cilastatin sodium (IPM/CS) in patients with intrauterine infections which are typical in the field of obstetrics and gynecology . The obtained results are summarized as follows . 1 . Twenty-seven patients were treated with IPM/CS, 250 mg/250 mg b.i.d . (3 patients), 500 mg/500 mg b.i.d . (22) and other dosages (a change in dosing regimen, 2) . The duration of treatment ranged from 3 to 11 days and the total dosage during an entire course of treatment varied from 1.5 to 9.0 g . The drug was suspended in a lidocaine solution and administered in the gluteal muscle of the patients . 2 . Clinical efficacies were excellent in 7 patients (26%), good in 19 (70%) and poor in 1 (4%) and the overall efficacy rate was 96.3% . All of the 8 patients who had not previously showed improvements with treatment by other antibiotics responded well to this drug . 3 . Bacteriologically, the clinical efficacy rate was 95.8% (23/24) and the eradication rate was 76.2% (16/21) . 4 . No adverse effects due to the drug were observed . As abnormal laboratory test results, transient elevations of GOT and GPT were noted in one patient. Ann Gastroenterol Hepatol (Paris), 1991 Dec, 27(7), 309 - 13 {Disinfection of endoscopes in gastroenterology . Bacteriologic evaluation of the procedure employed in the endoscopic unit at the Mongi Slim Hospital of Tunisia}; Chenoufi Bahri B et al.; An evaluation was made of the incidence of contamination of the endoscopes during gastroscopy and colonoscopy and of the efficacy of the disinfection procedure used in our digestive endoscopy unit . Serial bacteriological samples were made before and after the endoscopy session and also between patient procedures . These samples were taken on the endoscopes and their accessories and also on the walls, examination table, gloves and the uniforms of the staff . Over 60 p . cent of the samples were positive showing that the disinfection technique was not bacteriologicaly satisfactory . Most of the micro-organisms found were opportunists . Firm guidelines regarding adequate disinfection are important and regular micro-biological control of disinfection procedures must be performed. Singapore Med J, 1991 Dec, 32(6), 423 - 6 Tuberculosis in the elderly; Tan KK et al.; A study of 120 cases of tuberculosis in patients aged 65 years and above revealed that there were more males than females with the disease compared with the younger age group of 15 to 45 years old . The elderly group also had significantly more severe and more had bacteriologically positive disease . The majority of them were born outside Singapore and immigrated more than 30 years ago . Risk factors such as diabetes mellitus, past history of tuberculosis, malignancy and gastrectomy were more common in the elderly group . Standard 6-month regimens were well tolerated and adverse side effects to the drugs were negligible. Kansenshogaku Zasshi, 1991 Dec, 65(12), 1593 - 9 {The study on bacterial infection in chronic lower respiratory tract infection--from the viewpoints of acute and chronic infection}; Konishi M et al.; Using mainly changes in the amount of sputum as an index of the infectious course of chronic lower respiratory tract infection associated with purulent sputum over years, the disease was divided into stable and acute exacerbated phases and a bacteriological investigation using transtracheal aspiration (TTA) conducted . TTA was performed 107 and 45 episodes during stable phases and acute exacerbated phases respectively . Monomicrobial and polymicrobial infection were detected most frequently during the stable and acute exacerbated phases respectively (p less than 0.01) . During the stable phases, the single organisms detected most frequently were H . influenzae (26 episodes) and P . aeruginosa (20 episodes), while in the cases in which multiple organisms were detected during stable phases, combination including H . influenzae were most common (19 episodes) . H . influenzae was the most frequently detected organism in cases showing single organisms during acute exacerbated phases (7 episodes) . In the cases in which multiple organisms were detected as well, H . influenzae was the most commonly detected organism assumed to predispose to exacerbation (7 episodes), while P . aeruginosa was not found . These results suggest that in chronic lower respiratory tract infection . H . influenzae and P . aeruginosa are important as persistent infective organisms, while H . influenzae are important in acute exacerbation. Br J Obstet Gynaecol, 1991 Dec, 98(12), 1234 - 8 Emergency cervical cerclage; MacDougall J et al.; OBJECTIVE--To assess the efficacy of emergency cervical cerclage . DESIGN--Retrospective review of patients who underwent emergency cervical cerclage between August 1986 and August 1989 . SETTING--University College and the Middlesex Hospitals obstetric unit, a neonatal referral centre . SUBJECTS--19 women between 16 and 28 weeks gestation with a cervical dilatation between 3 and 10 cm . There were two twin pregnancies . INTERVENTIONS--Amniocentesis and bacteriological assessments were performed prior to cerclage and prophylactic antibiotics were given . Insertion of sutures was aided by a combination of techniques described previously . MAIN OUTCOME MEASURES--Prolongation of gestation and pregnancy outcome . Bacteriological findings at delivery and maternal and fetal morbidity were also recorded . RESULTS--Membranes remained intact in all the women after cerclage . Fifteen live babies were born and 13 of them survived (survival rate 63%) . Gestation was prolonged from between 1 and 19 weeks in these patients and the gestational age at delivery ranged from 25 to 41 weeks . All eight intrauterine or neonatal deaths were associated with infection . Infecting organisms included Escherichia coli, Gardnerella vaginalis, Mycoplasma hominis, Trichomonas vaginalis and Fusobacterium spp . Pregnancy was prolonged for less than or equal to 5 weeks in these infected pregnancies . A cervical laceration occurred in a patient who had the suture inserted at full dilatation and subsequently laboured, but there were no other maternal complications . CONCLUSIONS--Emergency cervical cerclage can prolong pregnancy and influence the outcome favourably. Gut, 1991 Dec, 32(12), 1461 - 4 Simplified single sample 13Carbon urea breath test for Helicobacter pylori: comparison with histology, culture, and ELISA serology; Logan RP et al.; There is no ideal method for detecting Helicobacter pylori . The 'standard' 13Carbon urea breath test (13C-UBT), which involves collecting eight to 15 breath samples and subsequent costly analysis, was modified by pooling 21 samples of expired breath taken at five minute intervals for 40 minutes into a collecting bag, from which a single 20 ml aliquot was taken and analysed by mass spectrometry . This test was evaluated on 50 patients after routine upper gastrointestinal endoscopy, and results were compared with those from the standard 13C-UBT, bacteriology, ELISA serology, and histology--the latter being taken as the gold standard . H pylori were seen in 34 of 50 (68%) patients (in three it was detected in biopsy specimens from the corpus alone) . The modified 13C-UBT was positive (pooled excretion delta 13CO2 greater than 5 per mil) in 31 patients and negative in 19 (three false negative results), specificity was 100% (standard 13C-UBT 94%) and sensitivity 92% (standard 13C-UBT 93%) . The modified 13C-UBT had a coefficient of variation within subjects of 3.7% . For the ELISA serology and culture the specificities were both 100%, but the sensitivities were 82% and 68% respectively . The 13C-UBT results correlated with the grade of histological gastritis . The modified 13C-UBT is simpler, cheaper, more reproducible, and provides an easy non-invasive method for the detection of H pylori. Bull Int Union Tuberc Lung Dis, 1991 Dec, 66(4), 173 - 4 The point of view of a high prevalence country: Malawi; Nyangulu DS; The National Tuberculosis Programme switched to short-course chemotherapy for smear-positive cases when the IUATLD started to assist in 1984 . Treatment results in smear-positive cases improved from a 50-55% cure rate to an 87% cure rate in new cases (and 89% in retreatment cases) . The hope of reducing the tuberculosis problem was then challenged by the occurrence of HIV-related cases of tuberculosis which are now considerably over-stretching services . Smear-negative cases and extrapulmonary tuberculosis now represent almost two thirds of all patients . For them, standard chemotherapy has now been changed to 2 R3H3Z3/2 HE(or TH)/4H in order to try and save money on syringes, needles and water for injection as well as prevent transmission of HIV through injections . This regimen will also enable the programme to depart from hospitalization since patients will take medication on an ambulatory basis . It may also give more time to district tuberculosis officers for the supervision of health centersPIP: The Malawi National Tuberculosis (TB) Control Programme switched its main means of controlling TB from the standard regimen to a short course chemotherapy (intensive phase=2 months in the hospital for new cases and 3 months for retreatment cases) in 1984 . It 1st introduced the new treatment into 3 districts and TB patients throughout the country were on the short course therapy 2.5 years later . The program had created demonstration centers countrywide to demonstrate the new regimen's effectiveness . The program obtained its data from the District TB Register and the Laboratory Register . It monitored smear positive cases using bacteriology, evaluated their situation every 3 months using cohort analysis, and followed them 15-18 months after initial therapy even though they had completed treatment . The program separated TB patients into new smear positive, smear negative, relapses, and extrapulmonary TB cases . Cure rates prior to 1984 ranged from 50% to 55% but from 86% to 87% for new smear positive patients in 1984-89 and from 89% to 91% for relapsed cases . Since cure rates of retreatment cases basically matched those of new cases, program managers assumed that acquired resistance to rifampicin and isoniazid tended not to occur . Failure rate for retreatment was only 3% . HIV entered the population of Malawi around the mid-1980s resulting in increased TB incidence which hampered TB control efforts . HIV-infected TB patients did respond to treatment as well as those not infected with TB, however . Since HIV incidence was growing and health workers must use syringes and needles to administer streptomycin, it was the most difficult drug because sterilizing syringes and needles and injecting streptomycin required much time . About 66% of all TB cases in Malawi were smear negative and extrapulmonary cases . They received 15 mg ethambutol/kg/body weight/day orally on an ambulatory basis . J Hosp Infect, 1991 Dec, 19(4), 263 - 71 Role of bacteriological monitoring of the hospital environment and medical equipment in a neonatal intensive care unit; Gupta AK et al.; The aim of this study was to evaluate the usefulness of performing routine monthly bacteriological surveillance of the nursery environment, resuscitation equipment, baby placement sites, medications, formula feeds, cleansing solutions and miscellaneous medical items such as intravenous cannulae in relation to development of hospital-acquired bacteraemia in a Neonatal Intensive Care Unit (NICU) over a period of 19 months . The study is based on a retrospective review of records from the neonatal division and the microbiology laboratory . On discriminant analysis, only three NICU sites, namely baby placements, resuscitation equipment and various cleansing solutions were found to be significantly associated with hospital-acquired infections (HAI) (P less than 0.001) . The probability that a batch of newly admitted babies would develop HAI if all three sites were colonized was 0.602 . Similarly, the probability if none of these sites was colonized was 0.10 . On multiple logistic regression analysis, however, the relative risk of infection was greatest if baby placement sites were colonized (Odds ratio = 7.48; P less than 0.01) . In contrast, pathogens present in the inanimate NICU environment, e.g . floors, walls, sink-drains or furniture were not associated with HAI . Routine bacteriological surveillance of the inanimate nursery environment, is not therefore justified . However, our results suggest that routine bacteriological monitoring of medical equipment and cleansing solutions may have a role in the prevention of HAI. J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 73 - 9 A double-blind study of once-daily temafloxacin in the treatment of bacterial lower respiratory tract infections; Kosmidis J; The safety and efficacy of a seven to 14 day course of temafloxacin 600 mg once daily were compared to ciprofloxacin 500 mg bd in adult patients with bacterial infections of the lower respiratory tract in a multicentre, double-blind, randomized clinical trial . Patients were enrolled if they had symptoms and signs of infection consistent with acute exacerbation of chronic bronchitis or uncomplicated pneumonia, confirmed by X-ray . Clinical and bacteriological evaluations were performed within 48 h before enrollment, during treatment (study day 2 to 5), 1-3 days post-treatment, and 5-9 days post-treatment . Interim results are reported . Temafloxacin produced a similar clinical success to ciprofloxacin, 98% (114 of 116) and 97% (117 of 121) of patients respectively; all treated patients with pneumococcal infection except one who received ciprofloxacin were clinical successes . Temafloxacin resulted in earlier bacteriological response, especially apparent after the second and third day of therapy and among smokers and the elderly (greater than or equal to 65 years old) . Five to nine days after stopping treatment 98% of pretreatment pathogens were eradicated: 124/126 and 132/135 in the temafloxacin and ciprofloxacin groups respectively . Adverse reactions occurred among 8.6% (12 of 140) of temafloxacin treated patients compared to 5.8% (8 of 138) of ciprofloxacin treated patients . All adverse events reported were of mild to moderate severity and no patients withdrew from the study prematurely due to these events . The preliminary results from this study suggest that once daily temafloxacin gives high rates of clinical and bacteriological success, similar to twice daily ciprofloxacin, in the management of bacterial infections in the lower respiratory tract. Harefuah, 1991 Nov 15, 121(10), 365 - 7 {Extracardiac malignancy presenting with cardiac tamponade}; Jarchowsky J et al.; We describe a 65-year-old man with cardiac tamponade as the first manifestation of malignancy . Biochemical, bacteriological and cytological examinations of the pericardial fluid were not diagnostic . Abdominal CT showed a mass in the right adrenal and fine needle aspiration revealed metastatic carcinoma . The patient died 4 months later with the clinical and roentgenological picture of bronchogenic carcinoma. Rofo, 1991 Nov, 155(5), 416 - 22 {The place of angiography and radiologic intervention before and after liver transplantation}; Langer R et al.; The study demonstrates the value of angiography and radiological interventions before and after liver transplantation . From September 1988 till February 1991 84% out of 124 hepatic transplant recipients underwent pretransplant angiography evaluation for the exact demonstration of arterial and portal venous blood supply of the liver . Posttransplant angiography was performed in cases with suspected vascular complications, chronic rejection, and spleno-hepatic steal syndrome . Radiological interventions were performed for bacteriological examination and percutaneous drainage of encapsulated fluid collections. J Gerontol, 1991 Nov, 46(6), M204 - 9 Clinical spectrum of pulmonary tuberculosis in older patients: comparison with younger patients; Van den Brande P et al.; We compared the clinical-radiographic presentations of bacteriologically proven tuberculosis in 72 elderly (mean age: 71 yr) and 73 younger patients (mean age: 39 yrs) . The tuberculin test (2 TU PPD) was positive in 55% and 92%, respectively . The prevalence of cough, dyspnea, anorexia, and weight loss was higher in the elderly (p less than .05), and night sweats were more prevalent in the younger patients (p less than .01) . The radiographic pattern was not different between both groups (p greater than .10): "usual" apicoposterior lesions (with or without other abnormalities) were found in more than 70% of both groups; isolated "unusual" lesions consisted in both groups mainly of anterobasal infiltrations and sometimes of pleural effusions, rounded nodules, or miliary patterns . Yet, initially a wrong diagnosis was made more often in the elderly (p = .05) . Malignancy, chronic pulmonary disease, and immunosuppression were more frequently encountered in the elderly (p less than .05), whereas alcoholism and smoking were more frequent in the younger patients (p less than .001) . Tuberculosis-related mortality occurred in 6 elderly and 1 younger patient. Chest, 1991 Nov, 100(5), 1391 - 6 Fever, hyperdynamic shock, and multiple-system organ failure . A pseudo-sepsis syndrome associated with chronic salicylate intoxication; Leatherman JW et al.; OBJECTIVE: To describe a sepsis-like syndrome associated with chronic salicylate intoxication . DESIGN: Retrospective clinical study . SETTING: University-affiliated county hospital . PATIENTS: Five patients who became accidentally intoxicated while ingesting salicylates on a long-term daily basis . RESULTS OF DATA ANALYSIS: All five salicylate-intoxicated patients had clinical and laboratory features that were highly suggestive of sepsis, but no bacteriologic or pathologic evidence of infection could be documented . Features included fever, leukocytosis with increased band forms, hypotension with a reduced SVR and multiple system organ failure (ARDS, encephalopathy, renal failure, and DIC) . A diagnosis of salicylate intoxication was made at the time of admission to the hospital in only one case . In the other four cases, the presumptive diagnosis was sepsis; a correct diagnosis of salicylate intoxication was not established until between 16 h and 10 days after admission in these four cases . Two patients died, one patient required permanent hemodialysis, and two patients recovered fully only after prolonged and complicated hospitalizations . The pathogenesis of this syndrome is uncertain . In two cases, serum levels of TNF-alpha, IL-1 beta and IL-6 were measured by ELISA . In both cases serum IL-6 was markedly increased, and in one case serum TNF-alpha was also elevated . CONCLUSION: Occult salicylate intoxication should be considered when apparent sepsis syndrome occurs without a readily easily identifiable source of infection. Klin Med (Mosk), 1991 Nov, 69(11), 82 - 3 {Early clinical and laboratory diagnosis of pseudotuberculosis}; Antonov VS et al.; As shown by the examination of 188 patients with suspected pseudotuberculosis, the latter produces a greater total of clinical manifestations than any other nosological entities differentiated from it . Conventional (retrospective) techniques of laboratory diagnosis (bacteriological ones, indirect hemagglutination) confirmed the diagnosis in 76.1% of the cases against 93.1% under new rapid techniques of seroindication (enzyme immunoassay and antibody neutralization) . Moreover, the diagnosis with new techniques can be managed earlier . The overall assessment of clinical symptoms and techniques of seroindication allow early administration of valid treatment thus avoiding recurrences and complications of pseudotuberculosis. Jpn J Surg, 1991 Nov, 21(6), 606 - 12 The bacteriology of cholelithiasis--China versus Japan; Guo RX et al.; Cholelithiasis differs considerably from area to area in the world . Calcium bilirubinate stones or brown pigment stones are said to predominate in the Orient, however, this situation may differ within the Orient . In order to compare cases in China and Japan, 102 consecutive cases of cholelithiasis operated on in Shenyang, China were analyzed for the composition of gallstones and bacterial species isolated from bile in relation to the location and composition of gallstones . In Shenyang, calcium bilirubinate stones predominated, occurring in 49.0 per cent of the cholelithiasis cases . This was much higher than in Japan, which had 17.5 per cent . The incidence of bacteria was also very high, ranging from 20 to 96 per cent, with an average of 66.7 per cent depending on the kind of gallstone present . Bacterial species possessing beta-glucuronidase activity were present in nearly all the cases of calcium bilirubinate stones (92.0 per cent) . The incidence of bacteria with beta-glucuronidase activity especially of E . coli was much higher than in Japan (50.8 per cent versus 21.8 per cent) in concordance with the higher incidence of calcium bilirubinate stones in China (49.0 versus 17.5 per cent). Appl Environ Microbiol, 1991 Nov, 57(11), 3226 - 31 Analysis of Legionella pneumophila serogroup 6 strains isolated from a hospital warm water supply over a three-year period by using genomic long-range mapping techniques and monoclonal antibodies; Luck PC et al.; Over a period of 3 years, Legionella pneumophila serogroup 6 strains were isolated from warm water outlets and dental units in the Dental Faculty and from the Surgery and Internal Medicine Clinics at the University of Dresden, Dresden, Germany . In the bacteriological unit of the above-mentioned facility, L . pneumophila serogroups 3 and 12 were grown from warm water specimens . The medical facilities are located in separate buildings connected with a ring pipe warm water system . All L . pneumophila serogroup 6 strains isolated from the warm water supply reacted with a serogroup-specific monoclonal antibo