Microbial

J Clin Microbiol, 1998 Jun, 36(6), 1544 - 8
Identification of new influenza B virus variants by multiplex reverse transcription-PCR and the heteroduplex mobility assay; Zou S et al.; A quick genetic approach for the screening of influenza virus variants was developed in this laboratory (S . Zou, J . Clin . Microbiol . 35:2623-2627, 1997) . It uses multiplex reverse transcription and multiplex PCR to amplify and differentiate the variable region of the hemagglutinin genes of different types and subtypes of influenza viruses . Variants within the same type or subtype are then identified by the heteroduplex mobility shift assay of the amplicons . The method was used to screen influenza virus isolates received from provincial laboratories during the 1996-1997 season and was able to identify new influenza B virus variants . Sequencing of the amplicons derived from the hemagglutinin gene of the identified variants and comparison with the vaccine strain B/Harbin/7/94 showed substitution rates of 2.26 to 2.55% at the nucleotide level and 4.26 to 4.68% at the amino acid level . The result further demonstrated that the approach provides a quick, sensitive, and reliable screening for influenza virus variants . It also suggested the necessity of close monitoring of influenza B virus isolates in the 1997-1998 season and critical evaluation of the reference strain for the type B influenza virus.

J Clin Microbiol, 1998 Jun, 36(6), 1530 - 3
Routine use of PCR-reverse cross-blot hybridization assay for rapid identification of Mycobacterium species growing in liquid media; Sanguinetti M et al.; A PCR-reverse cross-blot hybridization assay procedure that is able to rapidly identify 13 species of clinically relevant mycobacteria was evaluated for routine use in the identification of acid-fast isolates growing in BACTEC 460 TB (12B and 13A) and BACTEC 9000 MB (Myco/F) liquid media . Eight of the probes used were already described by Kox et al . (L . F . F . Kox et al., J . Clin . Microbiol . 33:3225-3233, 1995) . In addition, we used six other probes specific for M . chelonae, M . malmoense or M . szulgai, M . genavense, M . gordonae, M . terrae, and M . marinum/M . ulcerans that we designed ourselves . This procedure allowed us to identify 459 mycobacterial species directly from broth cultures of 5,466 clinical samples collected over 1 year and processed with the radiometric or nonradiometric BACTEC system . Our results were in agreement with those obtained by conventional identification methods and also with those obtained by mycolic acid analysis by high-performance liquid chromatography . This assay seems to be a reliable procedure for the routine identification of mycobacteria, providing an accurate identification of mycobacterial isolates more rapidly than conventional tests, with remarkable implications for an efficacious specific antimycobacterial therapy.

Clin Lab Manage Rev, 1998 Jul-Aug, 12(4), 248 - 55
Impact on human resources: Core Laboratory versus laboratory information system versus modular robotics; Dadoun R; Technological advances in laboratory systems have had a great impact on human resources . Surviving the changes requires an in-depth understanding of the technology to implement the appropriate operational model . St . Mary's is a 414-bed, acute care hospital . For 18 months, the laboratories went through the process of moving from a noncomputerized traditional model laboratory (i.e., by discipline) to a fully computerized Core Lab . The Core Lab concept fully integrates biochemistry, hematology, blood bank, and microbiology into two sections (not physically separated): tests processed by automation and tests processed manually . This approach led to a 15% reduction in staff while the volume doubled . The transitions occurred sequentially: from traditional laboratory to Core Lab (noncomputerized), from manual Core Lab to fully computerized Core Lab, and ultimately from a simulation of manual preanalytical phase to automated preanalytical phase (modular robotics) . The findings show that Core Lab and computerization have almost the same impact on human resources, 35% and 30% respectively, and modular robotics the least impact with 17%.

Methods, 1998 May, 15(1), 15 - 26
Biochemical methods for analysis of kinetoplastid RNA editing; Sabatini RS et al.; RNA editing is a posttranscriptional process involving mRNAs {reviewed by K . Stuart et al . (1997) Microbiol . Mol . Biol . Rev . 61, 105-120; G . J . Arts and R . Benne (1996) Biochim . Biophys . Acta 1307, 39-54; and S . L . Hajduk and R . S . Sabatini (1996) in Molecular Biology of Parasitic Protozoa (Smith, D . S., and Parsons, M., Eds.), pp . 134-158, Oxford Univ . Press, Oxford} and tRNAs {K . M . Lonergan and M . Gray (1993) Science 259, 812-816} that has now been described in an increasing number of eukaryotic organisms . In this process sequences differ from their gene sequences by the addition, removal, or conversion of specific ribonucleotides . RNA editing was first described within the mitochondrion of kinetoplastid protozoa . Several of the mitochondrial mRNAs in these flagellates have uridine residues inserted and deleted at specific sites . In some cases, more than 50% of the mRNA is created by RNA editing . In this article, we describe some of the biochemical methods used in analyzing the process of RNA editing in kinetoplastid mitochondria.

Ann Rheum Dis, 1998 Feb, 57(2), 107 - 9
Quality control of synovial fluid crystal identification; von Essen R et al.; OBJECTIVE: To establish a quality assessment programme for the diagnosis of crystal arthropathies by synovial fluid (SF) microscopy . METHODS: Three or four cytocentrifuge slides prepared from suitable patient SF specimens were distributed to 25-47 predominantly Finnish clinical laboratories once a year . Sodium urate crystals were included in every survey . RESULTS: Returns for the years 1989-1996 were reviewed . Laboratories that participated in > four surveys made on an average one error a year (range 0.25-2) . The error rate for specimens containing abundant crystals was acceptable but it increased considerably for specimens showing few crystals per microscope field . No laboratory characteristic predictive of successful performance was found . CONCLUSION: Errors in quality assessment results for crystal identification were much more frequent than in the fields of, for example, clinical chemistry or microbiology . Despite efforts to provide educational feedback, no improvement was seen during the study period . Because of the dearth of data from other parts of the world it is not known for certain whether this study has merely pinpointed a local problem or if the same trend applies elsewhere.

Stomatologiia (Mosk), 1994 Apr-Jun, 73(2), 22 - 6
{The multivariate analysis of clinico-laboratory data in stomatology}; Balashov AN et al.; The authors demonstrate the potentialities of multidimensional analysis methods: component, cluster, and discriminant as exemplified by clinico-laboratory examinations of 26 patients with medium-severe periodontitis and concomitant diseases . A two-stage modification of multidimensional grouping of biomedical objects is suggested . The first stage implies detection of the principal components and their estimation for each examinee . The second stage consists in realization of multidimensional grouping method according to G . S . Kil'dishev and Iu . I . Abolentsev in relation to individual component values . Different typologically homogeneous groups of patients with a specific microbiologic and biochemical status evidently requiring a differentiated approach to treatment may be singled out within the frames of a current classification of periodontal diseases basing on clinical and laboratory data.

J Comput Assist Tomogr, 1998 May-Jun, 22(3), 437 - 43
Osteomyelitis of the pelvis/hips in paralyzed patients: accuracy and clinical utility of MRI; Huang AB et al.; PURPOSE: The goal of our study was to determine the accuracy and clinical utility of MRI in the diagnosis of osteomyelitis of the pelvis/hips in paralyzed patients . METHOD: In 44 paralyzed patients, 59 consecutive MR examinations of the pelvis/hips were evaluated prospectively . Criteria for diagnosis of osteomyelitis were based on those established in previous studies of complex, nonhematogenous osteomyelitis (diabetic foot) . Average follow-up was 3 years . The standard of reference for the diagnosis of osteomyelitis was histologic/microbiologic results of surgical biopsy specimens or clinical follow-up . Note was made if decubitus ulcers, sinus tract, fistula, fluid collection, abscess, septic arthritis, joint effusion, bursitis, or heterotopic ossification was present on MRI . Comparison of the extent of infection by MRI and surgical margins was performed . Effect on surgical treatment was defined by absence of recurrent infection at the surgical site within 6 weeks of limited resection . RESULTS: The criteria for diagnosis of osteomyelitis were fulfilled in 49 of 57 MR studies for an overall accuracy of 97% . There was one false-negative MR study . MRI for the diagnosis of osteomyelitis yielded a sensitivity of 98% and a specificity of 89% . There were 41 decubitus ulcers, 28 sinus tracts, 2 fistulae, 14 fluid collections, 15 abscesses, 9 hips with septic arthritis, 10 "bland" hip effusions, 5 cases of trochanteric bursitis, and 30 patients with heterotopic ossification . Twenty-one patients underwent limited surgical resection guided by MR findings in which only the enhancing area was resected . There was only one recurrence of osteomyelitis at the surgical margins . CONCLUSION: MRI is accurate in the diagnosis of osteomyelitis and associated soft tissue abnormalities in spinal cord-injured patients . MRI can delineate the extent of infection in guiding limited surgical resection and preserving viable tissue.

Eur J Obstet Gynecol Reprod Biol, 1998 May, 78(1), 5 - 10
Elevated interleukin-8 concentrations in amniotic fluid of mothers whose neonates subsequently develop bronchopulmonary dysplasia; Ghezzi F et al.; OBJECTIVE: To determine if an intrauterine sub-clinical inflammatory process is a risk factor for the development of bronchopulmonary dysplasia . METHODS: A cohort study was conducted in patients who met the following criteria: (1) Singleton gestation; (2) preterm labor or preterm premature rupture of the membranes; (3) amniocentesis for microbiologic studies of the amniotic fluid and (4) delivery between 24 and 28 weeks of gestation . Bronchopulmonary dysplasia was defined as the need for supplemental oxygen for 28 days or longer after birth, associated with compatible chest radiographic findings . Amniotic fluid interleukin-8, was measured using a specific immunoassay . Logistic regression analysis and bootstrap procedure were used for statistical purposes . RESULTS: Forty-seven patients met the inclusion criteria for this study . Among these patients, the prevalence of bronchopulmonary dysplasia was 23.4% (11/47) . Amniotic fluid culture was positive in 21 out of 47 (44.7%) patients . Median (range) amniotic fluid interleukin-8 concentration was higher in patients whose neonates subsequently developed bronchopulmonary dysplasia than in those who did not (17 {9.8-583.7} ng ml(-1) versus 9.6 {0.91-744} ng ml(-1), P=0.057) . An amniotic fluid IL-8 level greater than 11.5 ng ml(-1) was far more common in mothers whose fetuses went on to develop bronchopulmonary dysplasia than in those who did not (10/11 {90.9%} versus 17/36 {47%}; P=0.01) . This relationship remained significant even after correcting for the effect of gestational age and birthweight (Odds ratio: 11.9; P<0.05) . CONCLUSION: Sub-clinical intrauterine inflammation is a risk factor for the subsequent development of bronchopulmonary dysplasia . We propose that in utero aspiration of fluid with high concentration of pro-inflammatory mediators may contribute to the lung injury responsible for the development of bronchopulmonary dysplasia.

J Clin Periodontol, 1998 Apr, 25(4), 271 - 7
Interrelationship between periodontics and adult orthodontics; Ong MA et al.; The purpose of this review article is to provide the dental practitioner with an understanding of the interrelationship between periodontics and orthodontics in adults . Specific areas reviewed are how periodontal tissue reacts to orthodontic forces, influence of tooth movement on the periodontium, effect of circumferential supracrestal fiberotomy in preventing orthodontic relapse, effect of orthodontic bands on the periodontium, specific microbiology associated with orthodontic bands, mucogingival considerations and time relationship between orthodontic and periodontal therapy . In addition, the relationship between orthodontics and implant restorations (e.g., using dental implants as orthodontic anchorage) will be discussed.

Telemed J, 1998 Spring, 4(1), 11 - 7
Telemicrobiology: feasibility study; McLaughlin WJ et al.; BACKGROUND: Rural hospitals generally lack staffing with infectious disease specialists or pathologists . Without on-site pathologists, the range of microbiology services offered by clinical laboratories may be limited as well . OBJECTIVE: To study the feasibility of using static-image telepathology to evaluate Gram stains of microbiologic preparations . MATERIALS AND METHODS: In this retrospective feasibility study, three pathologists evaluated Gram stains of slides from 50 cases by two viewing modalities: static-image telepathology and conventional light microscopy . Digital video images of slides were captured at two magnifications (using 40x and 100x objective lenses) at 1024 x 768 x 24-bit color and transmitted over standard telephone lines at 14,400 kbps . Pathology reports and culture results served as "truth diagnoses." Categories of interpretations were correct, minor discrepancy, or major discrepancy with regard to the implications for patient care . RESULTS: The diagnostic accuracy of video image readings and conventional light microscopy readings were nearly identical, with no statistically significant differences in the performances of specialty and nonspecialty pathologists (P > 0.05) . The mean accuracies of readings of the video images and light microscopy images were 95.3% and 95.4%, respectively . Taking into account the time required by a referring pathologist to capture video digital images, telemicrobiology was somewhat less efficient than conventional light microscopy . CONCLUSIONS: Pathologists can accurately evaluate digital video images of preselected fields on Gram-stained slides . In clinical practice, however, a limiting factor may be the availability of local personnel qualified to select the microscopic fields for evaluation by telepathologists . The adequacy of the video images suggests that telepathology may also be used for remote supervision of quality assurance programs in microbiology laboratories, as well as for remote proficiency training of laboratory personnel.

J Clin Microbiol, 1998 Apr, 36(4), 979 - 82
Performance of a PCR assay for detection of Pneumocystis carinii from respiratory specimens; Caliendo AM et al.; This study evaluates the performance of a PCR assay for the detection of Pneumocystis carinii from respiratory specimens that has been designed for use in the clinical microbiology laboratory . The test includes a simple method for nucleic acid extraction and amplification, a colorimetric probe hybridization technique for detection of amplicons, and an internal control to evaluate for the presence of inhibitors of amplification . Two hundred thirty-two clinical specimens (120 induced-sputum {IS} and 112 bronchoalveolar lavage {BAL} specimens) from 168 patients were tested by both immunofluorescent (direct fluorescent-antibody {DFA}) staining and PCR . Of the 112 BAL specimens, 17 were positive for P . carinii by DFA staining and PCR . An additional two specimens were DFA negative and PCR positive . For BAL specimens, the sensitivity and specificity of PCR compared to DFA were 100 and 98%, respectively . Eighteen IS specimens were positive for P . carinii by DFA, and 27 were positive by PCR . One of the 18 DFA-positive IS specimens was negative by PCR; this patient had just completed therapy for P . carinii pneumonia . Of the 10 specimens that were PCR positive and DFA negative, 4 were from patients who had a subsequent BAL specimen that was positive by DFA and PCR . For IS specimens, the sensitivity of DFA and PCR was 82 and 95%, respectively . The specificity of PCR for IS specimens was 94% . Due to the high sensitivity of PCR for the detection of P . carinii from IS specimens, a PCR-based diagnostic test may be a useful screening test and may alleviate the need for bronchoscopy in some patients.

Chest, 1998 May, 113(5), 1394 - 8
The role of atropine premedication in fiberoptic bronchoscopy using intravenous midazolam sedation; Williams T et al.; OBJECTIVE: Atropine premedication is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodilatation, or preventing vasovagal reactions . The objective of this study was to see whether atropine premedication is really of practical benefit when patients are sedated with i.v . midazolam . DESIGN: In a double-blind study, patients were randomly allocated to receive i.m . atropine (0.6 mg) or saline placebo (1 mL) as premedication 30 to 60 minutes before they were sedated with progressive doses of i.v . midazolam until judged to be lightly asleep . SETTING: A District General Hospital in England . PARTICIPANTS: One hundred consecutive patients referred for bronchoscopy . MEASUREMENTS AND RESULTS: Samples taken during the procedure were washings for microbiology and cytology and brushings for cytology and biopsy, but no transbronchial biopsies . Peak flow readings were recorded before premedication and before the start of the procedure . During the procedure an estimate was made of pharyngeal and tracheobronchial secretions, bleeding, use of saline to wash out secretions, and local anesthetic needed to control coughing . Patients were monitored for saturation and cardiac rhythm . There was no significant bronchodilatation after premedication in either group, nor were there differences in secretions, use of saline, tracheobronchial bleeding, desaturation, and arrhythmias . More local anesthetic was needed to control coughing in the placebo group (mean 357 mg vs 331 mg in the atropine group, p=0.02), but this was not of practical significance . CONCLUSION: When intravenous midazolam sedation is used for bronchoscopy, atropine premedication is not of benefit.

Epidemiol Infect, 1998 Mar, 120(2), 117 - 23
Invasive pneumococcal infection in South and West England; Smith MD et al.; Variation in the incidence of invasive pneumococcal disease across South and West England, in 1995, was measured through a survey of microbiology laboratories . A 100% response rate was achieved . The incidence by laboratory varied between 5.2 and 20.4 per 100,000 catchment population (P < 0.001) . Adjusting for pneumococcal vaccine uptake rate in over 65 year olds, hospital admission rates, blood culture system used and for the age and sex structure of the population, did not account for this variation . When blood culture sampling rates were included in a logistic regression model, the variation between laboratories was much less and of lower statistical significance (P = 0.019) . Higher rates of blood culture sampling were associated with a higher incidence of invasive pneumococcal disease . Consistently high sampling should be encouraged because a higher diagnostic rate should result in more selective prescribing of antibiotics, and secondly because improved ascertainment of severe pneumococcal infections is a prerequisite for the evaluation of new pneumococcal conjugate vaccines.

Sheng Li Ke Xue Jin Zhan, 1996 Apr, 27(2), 101 - 6
{Helicobacter pylori: a great discovery}; Wang ZJ; Within the past decade, there has been an explosion of investigative activity and publications about Helicobacter pylori pathogen . Its role in gastroduodenal diseases is becoming remarkably evident . It is accepted that H . pylori is intimately involved in the pathogenesis of chronic gastritis microbiol/DT and peptic ulcer disease . Furthermore, it is also associated with stomach cancers . The old creed in medical field that "No acid, no ulcer" would probably be changed to "No H . pylori infection, no ulcer" . So, the discovery of H . pylori revolutionized our understanding of gastroduodenal diseases.

Biophys J, 1998 May, 74(5), 2272 - 7
Spatial sensing of stimulus gradients can be superior to temporal sensing for free-swimming bacteria; Dusenbery DB; Predictions of the minimal size an organism must have to swim along stimulus gradients were used to compare the relative advantages of sensory systems employing spatial (simultaneous) and temporal (sequential) gradient detection mechanisms for small free-swimming bacteria, leading to the following conclusions: 1) there are environmental conditions where spatial detection mechanisms can function for smaller organisms than can temporal mechanisms, 2) temporal mechanisms are superior (have a smaller size limit) for the difficult conditions of low concentration and shallow gradients, but 3) observed bacterial chemotaxis occurs mostly under conditions where spatial mechanisms have a smaller size limit, and 4) relevant conditions in the natural environment favor temporal mechanisms in some cases and spatial mechanisms in others . Thus, sensory ecology considerations do not preclude free-swimming bacteria from employing spatial detection mechanisms, as has been thought, and microbiologists should be on the lookout for them . If spatial mechanisms do not occur, the explanation should be sought elsewhere.

Otolaryngol Pol, 1998, 52(1), 5 - 10
{Deep neck infections in the antibiotic era}; Zietek E et al.; The paper presents 43 patients treated between 1971 and 1995 in the Otolaryngology Clinic of the Pomeranian Medical Academy in Szczecin because of deep neck space infections . The authors analyse their own clinical material paying particular attention to the diagnosis, microbiology, patients prognosis and basic therapeutic procedures . Out of the 43 cases, deaths occurred in 3, which denotes 7% mortality rate . The reason for failure was discussed . It was revealed that needle aspiration and sonography were for valuable to identify early abscess formation . The analyses have confirmed that the prognosis of the deep neck space infections is influenced by early diagnosis and prompt, extensive surgical treatment.

Hinyokika Kiyo, 1998 Mar, 44(3), 193 - 4
{A case of septic shock following incarceration of the penis}; Horiguchi A et al.; An 84-year-old male presented to the emergency room with the chief complaint of painful, swollen penis following the use of a constriction ring to maintain penile erection . A high fever, chills and hypotension were recognized . Septic shock was presumed, and administration of antibiotics was started . Microbiologic cultures revealed Escherichia coli in blood . We herein report a rare but serious complication accompanying incarceration of the penis.

Eur J Cardiothorac Surg, 1998 Feb, 13(2), 190 - 5
Frozen section diagnosis and surgical biopsy of lymph nodes, tumors and pseudotumors of the mediastinum; de Montpreville VT et al.; OBJECTIVE: Our experience with the use of frozen section (FS) was reviewed in order to assess its interest and limits, during minimally aggressive mediastinal surgery for staging of lung carcinomas and biopsy of primary lesions . METHODS: The retrospective study was based on a series of 420 consecutive mediastinal biopsies with FS performed through cervicotomy (n = 12), mediastinoscopy (n = 345), mediastinotomy (n = 43), manubriotomy (n = 13) or videothoracoscopy (n = 7), in 417 patients, aged 8-86 years (mean: 52.5 +/- 15.6) . The FS diagnoses were compared with the final diagnoses and consequences of the FS analyses were analyzed . RESULTS: Biopsies with FS had a 99.4% (351/353) efficiency rate for a precise definitive diagnosis (excluding normal lymph nodes) . However, two patients required a second operation: one for typing a lymphoma and the other to correct a FS misdiagnosis of small cell carcinoma on a crushed normal lymph node . The sensitivity for detection of carcinoma lymph node metastases was 99% (200/202) . The two false negative FS diagnoses, including one post-chemotherapy, were related to micrometastases . There were 46 correct FS diagnoses of non-metastatic lymph node which were followed by an immediate thoracotomy during the same anesthesia, for benign lung lesions (n = 9) or for carcinomas (n = 37), including 30 lung carcinomas that were immediately resected and proved to have no mediastinal involvement (n = 24), or only a limited involvement in a non-biopsied site (n = 6) . In the 51 cases of primary mediastinal tumors excluding carcinomas, FS indicated a resectable lesion with a sensitivity of 87.5% (7/8) and a specificity of 97.7% (43/44) . Five lesions were immediately resected: one Castleman's disease, one intrathoracic goiter, two of six thymomas and a Hodgkin's disease, which was diagnosed as thymoma on FS . An invasive thymoma was resected during a second operation after a FS diagnosis of carcinoma . FS had a sensitivity of 100% in the 62 cases of sarcoidosis and a sensitivity of 90% in the 20 cases of infectious lesions . One of the 18 cases of tuberculosis and an infectious pseudo-tumor of the anterior mediastinum had no microbiologic study because of FS diagnoses of tumor necrosis and lymphoma . CONCLUSIONS: FS efficiently secures the adequacy of the samples and guides the surgeon's decision making for the resection of lung carcinomas, but is less effective for a precise diagnosis of some primary mediastinal lesions, which may have close histologic appearances.

J Marmara Univ Dent Fac, 1993 Sep, 1(4), 337 - 41
Dental procedures and infective endocarditis: current approaches of cardio-vascular surgery departments from different centres (Part 1); Akincibay H et al.; The relationship between dental procedures and infective endocarditis is well known . Therefore, in order to prevent infective endocarditis, pre-operative antibiotic prophylaxis is recommended . However, a total agreement has not been achieved regarding which dental procedures and specific heart diseases require prophylaxis . The aim of the present study is to review the latest concepts dealing with heart diseases regarding the choice of appropriate antibiotic regimen, determination of patients at risk of infective endocarditis and dental procedures which require pre-operative prophylaxis . Our review revealed that there is still some disagreement regarding the above concepts . We believe that dentists, especially periodontists, can play a significant role in the prevention of infective endocarditis following dental procedures, by giving more attention to the subject and also by alerting the infectious diseases/microbiology departments and related medical staff.

Genitourin Med, 1997 Dec, 73(6), 498 - 502
Evaluation of the microparticle enzyme immunoassay Abbott IMx Select Chlamydia and the importance of urethral site sampling to detect Chlamydia trachomatis in women; Brokenshire MK et al.; OBJECTIVE: To evaluate the commercial microparticle enzyme immunoassay (MEIA), Abbott IMx Select Chlamydia, for the detection of Chlamydia trachomatis in women and to compare its performance with endocervical cell culture . Also, to determine whether sampling the urethral site is an important part of chlamydial diagnosis in women . SETTING: The Auckland, Manukau, and Waitakere Sexual Health Clinics, Auckland, New Zealand and the Department of Clinical Microbiology, Auckland Hospital, Auckland, New Zealand . PATIENTS: The study population consisted of 622 consecutive women who attended the three sexual health clinics . METHODS: The IMx Chlamydia assay was performed on an IMx analyser, following a specimen treatment procedure . All reactive samples from the IMx Chlamydia assay were confirmed using the IMx Chlamydia blocking antibody reagent . The Syva direct fluorescent antibody (DFA) test was used to aid in resolving discrepancies . The cell culture technique was performed in shell vials using cycloheximide treated McCoy cells, which were stained using a fluorescein conjugated monoclonal antibody . RESULTS: When compared against the endocervical cell culture, the IMx Chlamydia had a sensitivity of 82.1% (23/28) and a specificity of 99.3% (590/594) . When compared against an expanded gold standard, the IMx Chlamydia and endocervical cell culture had sensitivities of 84.4% (27/32) and 87.5% (28/32), specificities of 100% (590/590) and 100% (590/590), positive predictive values of 100% (27/27) and 100% (28/28), negative predictive values of 99.2% (590/595) and 99.3% (590/594), and accuracies of 99.2% (617/622) and 99.4% (618/622), respectively . The prevalence rate by endocervical cell culture and the expanded gold standard were 4.5% and 5.1%, respectively . Additional urethral cell culture testing revealed a further nine patients positive from this site only, giving a 28% (9/32) increase in the number of patients diagnosed for chlamydia, thus giving an overall prevalence of 6.6% (41/622) . CONCLUSIONS: The IMx Chlamydia assay is an easy and rapid test to perform, it is cost effective, and shows similar performance to endocervical cell culture in the female population studied and is thus an excellent alternative to culture for the diagnosis of C trachomatis . The study also showed the importance of urethral site sampling in these women, as endocervical testing alone will underestimate the prevalence of chlamydial genital infection.

Enferm Infecc Microbiol Clin, 1998 Jan, 16(1), 14 - 8
{Meningitis by enterovirus in pediatrics . Clinical characteristics and virologic diagnosis}; Rubio G et al.; BACKGROUND AND METHODS: With the aim of knowing the etiology of aseptic meningitis (pleocytosis in LCR with negative bacterial culture and positive or negative virus culture or without pleocytosis with viral culture in positive LCR), 48 children attending the Emergency Department of our hospital from June to December, 1995 were prospectively studied . Pharyngeal and rectal swab, LCR for bacteria and virus and blood cultures were carried out . The samples were inoculated in fibroblasts MRC-5, RD and BGM . The cytopathic effect was identified by immunofluorescence . Typing was performed in the National Center of Public Health Care Microbiology, Virology and Immunology in Majadahonda (Spain) . RESULTS: Isolation of the virus was positive in 40/48 (83.3%) of the children: in 17 (35.5%) of LCR and the remaining 23/40 (47.9%) of pharyngeal and/or rectal swab . In all the cases the cytopathic effect was detected in MRC-5 . The viruses found were echovirus 30 and 5 . A greater incidence of the disease was observed in November and December . CONCLUSIONS: Meningitis by enterovirus is frequent in our area . Culture of the virus in LCR, the pharynx and stools is useful on suspicion of aseptic meningitis since the virus may be isolated from LCR in more than one third of the patients . Serotyping aids in surveilling the appearance of outbreaks and to know the predominant viruses . Cell culture is the diagnostic treatment of choice, but has a low sensitivity and is slow . The application of other techniques such as PCR which have a greater sensitivity and with high specificity for the diagnosis of these infections is necessary.

Anesthesiology, 1998 Apr, 88(4), 935 - 44
Open-lung biopsy in patients with acute respiratory distress syndrome; Papazian L et al.; BACKGROUND: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids . However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia . The aim of this observational case series was to evaluate the safety and utility of open-lung biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures . METHODS: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS . The severity of ARDS was assessed by a lung injury score of 3.1 +/- 0.4 (mean +/- SD) and a median ratio of the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of 118 mmHg . Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed . RESULTS: Fibrosis was present in only 41% of the lung specimens obtained by OLB . Only six patients received corticosteroids (17%) . In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids . Histologic cytomegalovirus pneumonia was diagnosed in 18 cases . Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases . No significant change in arterial blood gases was noted as linked to the biopsy procedure except an increase of the PaO2/FiO2 ratio . One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB . Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax) . Five patients had moderate air leaks from operative chest tubes for 2-10 days . CONCLUSIONS: Open lung biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS . It permitted the diagnosis of unexpected cytomegalovirus pneumonia.

Am J Obstet Gynecol, 1998 Apr, 178(4), 759 - 64
Inhibition of amniotic prostaglandin E release by ampicillin; Vesce F et al.; OBJECTIVE: The effect of antibiotics in the prevention of preterm labor needs to be further investigated . The aim of this study was to determine the effect of ampicillin on prostaglandin E release from amnion as a possible explanation for its ability to retard preterm labor . STUDY DESIGN: The effect of the beta-lactam antibiotic ampicillin on prostaglandin E release from human amnion was tested under basal and stimulated conditions . RESULTS: Ampicillin dose dependently inhibits basal prostaglandin E release from amnion in both static and dynamic conditions . In our experiments, 10(-7) mol/L ampicillin (a concentration able to significantly inhibit prostaglandin E output) leaves the microbiologic features of the medium substantially unmodified up to 5 hours of incubation . Moreover, the drug reversibly counteracts the prostaglandin E elevation induced by arachidonic acid or oxytocin . CONCLUSION: This finding (i.e., that ampicillin inhibits prostaglandin E release from amnion) may offer an explanation for a beneficial response to ampicillin therapy in the case of preterm labor even in the absence of bacterial infection.

Minerva Stomatol, 1998 Jan-Feb, 47(1-2), 51 - 6
{Aspergillus-induced maxillary sinusitis}; Fancello A et al.; Maxillary aspergillosis sinusitis more often occur in immunocompromised patients, but this pathology is increasing also in healthy people . Many risk factors are known and clinical and radiologic findings are aspecific; diagnosis therefore is possible with histologic and microbiologic aid . This particular disease and its surgical-pharmacological approach is explained.

Eur J Biochem, 1998 Apr 1, 253(1), 263 - 9
The function of the periplasmic Sud protein in polysulfide respiration of Wolinella succinogenes; Klimmek O et al.; The periplasmic Sud protein was previously isolated as a sulfide dehydrogenase from Wolinella succinogenes . Sud modified by a C-terminal His-tag (Sud-His6) was produced in Escherichia coli by expression of the sud gene . Sud-His6 catalyzed thiocyanate formation from cyanide and polysulfide . The Vmax of this activity was more than one order of magnitude higher than that of sulfide oxidation by dimethyl-naphthoquinone and that of polysulfide reduction by BH4- . The apparent Km was less than 20 microM polysulfide . Polysulfide and not elemental sulfur was found to be the product of sulfide oxidation by dimethyl-naphthoquinone, in contrast to the earlier view {Kreis-Kleinschmidt, V., Fahrenholz, F., Kojro, E . & Kroger . A . (1995) Arch . Microbiol . 165, 65-68} . Sud-His6 did not contain metal ions or other prosthetic groups . Replacement by site-directed mutagenesis of the single cysteine residue of the Sud monomer caused complete loss of activity, while the exchange of the single histidine residue or of the lysine residue situated next to cysteine did not affect activity . In equilibrium dialysis, the Sud-His6 monomer bound up to ten polysulfide sulfur atoms with a dissociation constant of 0.2 mM . Sud-His6 loaded with polysulfide sulfur showed an absorption spectrum in the range of 350-400 nm; this spectrum differed from that of free polysulfide . Electron transport from H2 to polysulfide catalyzed by the membrane fraction of W . succinogenes was stimulated by the presence of small amounts of Sud-His6 . The apparent Km for polysulfide decreased sevenfold in the presence of saturating amounts of Sud-His6 (1 microM Sud-His6 dimer) . Similar results were obtained with intact W . succinogenes cells containing low and high amounts of Sud . Sud appears to function as a polysulfide binding protein and probably binds polysulfide sulfur to its cysteine residue and transfers it to the substrate site of the membraneous polysulfide reductase.

Appl Environ Microbiol, 1998 May, 64(5), 1805 - 11
Use of inducible feedback-resistant N-acetylglutamate synthetase (argA) genes for enhanced arginine biosynthesis by genetically engineered Escherichia coli K-12 strains; Rajagopal BS et al.; The goal of this work was to construct Escherichia coli strains capable of enhanced arginine production . The arginine biosynthetic capacity of previously engineered E . coli strains with a derepressed arginine regulon was limited by the availability of endogenous ornithine (M . Tuchman, B . S . Rajagopal, M . T . McCann, and M . H . Malamy, Appl . Environ . Microbiol . 63:33-38, 1997) . Ornithine biosynthesis is limited due to feedback inhibition by arginine of N-acetylglutamate synthetase (NAGS), the product of the argA gene and the first enzyme in the pathway of arginine biosynthesis in E . coli . To circumvent this inhibition, the argA genes from E . coli mutants with feedback-resistant (fbr) NAGS were cloned into plasmids that contain "arg boxes," which titrate the ArgR repressor protein, with or without the E . coli carAB genes encoding carbamyl phosphate synthetase and the argI gene for ornithine transcarbamylase . The free arginine production rates of "arg-derepressed" E . coli cells overexpressing plasmid-encoded carAB, argI, and fbr argA genes were 3- to 15-fold higher than that of an equivalent system overexpressing feedback-sensitive wild-type (wt) argA . The expression system with fbr argA produced 7- to 35-fold more arginine than a system overexpressing carAB and argI genes on a plasmid in a strain with a wt argA gene on the chromosome . The arginine biosynthetic capacity of arg-derepressed DH5 alpha strains with plasmids containing only the fbr argA gene was similar to that of cells with plasmids also containing the carAB and argI genes . Plasmids containing wt or fbr argA were stably maintained under normal growth conditions for at least 18 generations . DNA sequencing identified different point mutations in each of the fbr argA mutants, specifically H15Y, Y19C, S54N, R58H, G287S, and Q432R.

J Clin Microbiol, 1998 May, 36(5), 1236 - 9
Detection of Ureaplasma urealyticum in endotracheal tube aspirates from neonates by PCR; Nelson S et al.; A PCR-based test was optimized for the detection of Ureaplasma urealyticum from neonatal respiratory specimens, with primers directed against the multiple-banded antigen gene (L . J . Teng, X . Zheng, J . I . Glass, H . Watson, J . Tsai, and G . H . Cassell, J . Clin . Microbiol . 32:1464-1469, 1994) . Endotracheal tube aspirates (225) from 103 low-birth-weight neonates (<1,250 g) were taken, when possible, at days 0, 4, and 14 after birth and examined by culture and by PCR . Of 77 specimens positive by either method, 73 were detected by PCR and 60 were detected by culture . Overall, 36% of the neonates were positive for U . urealyticum by either method . Of 16 patients with PCR-positive-culture-negative results, 13 had positive cultures at another sampling point, and one additional patient had a twin with positive cultures . Of 11 patients with day 0 specimens positive by PCR alone, 9 subsequently became culture positive, demonstrating the utility of this test in early detection . Multiple serovars were present in over 50% of positive specimens, with serovars 3 and 14 in combination being most prevalent . The amplicon size generated from the specimen by PCR correctly predicted the biovars isolated in over 85% of positive specimens . Thus, this PCR test was valuable in allowing early detection of U . urealyticum in neonatal respiratory specimens, as well as in providing biovar information.

J Bacteriol, 1998 May, 180(9), 2515 - 21
Developmental regulation of transcription of whiE, a locus specifying the polyketide spore pigment in Streptomyces coelicolor A3 (2)
Kelemen GH, Brian P, Flardh K, Chamberlin L, Chater KF, Buttner MJ.
whiE is a complex locus that specifies the polyketide spore pigment in Streptomyces coelicolor A3(2) . Two divergently oriented promoters, whiEP1 and whiEP2, were identified in the whiE gene cluster, and their activities were analyzed during colony development in wild-type and sporulation-deficient strains . Both promoters were developmentally regulated; whiEP1 and whiEP2 transcripts were detected transiently at approximately the time when sporulation septa were observed in the aerial hyphae, and transcription from both promoters depended on each of the six known "early" whi genes required for sporulation septum formation (whiA, -B, -G, -H, -I, and -J) . Mutation of the late sporulation-specific sigma factor gene, sigF, had no effect on the activity of whiEP1 but blocked transcription from whiEP2 . However, sigmaF-containing holoenzyme was not sufficient to direct transcription of whiEP2 in vitro . The whiEP2 promoter controls expression of whiE ORFVIII, encoding a putative flavin adenine dinucleotide-dependent hydroxylase that catalyzes a late tailoring step in the spore pigment biosynthetic pathway . Disruption of whiE ORFVIII causes a change in spore color, from grey to greenish (T.-W . Yu and D . A . Hopwood, Microbiology 141:2779-2791, 1995) . Consistent with these observations, construction of a sigF null mutant of S . coelicolor M145 caused the same change in spore color, showing that disruption of sigF in S . coelicolor changes the nature of the spore pigment rather than preventing its synthesis altogether.

Appl Environ Microbiol, 1998 May, 64(5), 1766 - 72
Molecular analysis of a laccase gene from the white rot fungus Pycnoporus cinnabarinus; Eggert C et al.; It was recently shown that the white rot basidiomycete Pycnoporus cinnabarinus secretes an unusual set of phenoloxidases when it is grown under conditions that stimulate ligninolysis (C . Eggert, U . Temp, and K.-E . L . Eriksson, Appl . Environ . Microbiol . 62:1151-1158, 1996) . In this report we describe the results of a cloning and structural analysis of the laccase-encoding gene (lcc3-1) expressed by P . cinnabarinus during growth under xylidine-induced conditions . The coding region of the genomic laccase sequence, which is preceded by the eukaryotic promoter elements TATA and CAATA, spans more than 2,390 bp . The corresponding laccase cDNA was identical to the genomic sequence except for 10 introns that were 50 to 60 bp long . A sequence analysis indicated that the P . cinnabarinus lcc3-1 product has a Phe residue at a position likely to influence the reduction-oxidation potential of the enzyme's type 1 copper center . The P . cinnabarinus lcc3-1 sequence was most similar to the sequence encoding a laccase from Coriolus hirsutus (level of similarity, 84%).

Appl Environ Microbiol, 1998 May, 64(5), 1743 - 9
Sensitive and rapid detection of viable Giardia cysts and Cryptosporidium parvum oocysts in large-volume water samples with wound fiberglass cartridge filters and reverse transcription-PCR; Kaucner C et al.; We recently described a reverse transcription-PCR (RT-PCR) for detecting low numbers of viable Cryptosporidium parvum oocysts spiked into clarified environmental water concentrates . We have now modified the assay for direct analysis of primary sample concentrates with simultaneous detection of viable C . parvum oocysts, Giardia cysts, and a novel type of internal positive control (IPC) . The IPC was designed to assess both efficiency of mRNA isolation and potential RT-PCR inhibition . Sensitivity testing showed that low numbers of organisms, in the range of a single viable cyst and oocyst, could be detected when spiked into 100-microliter packed pellet volumes of concentrates from creek and river water samples . The RT-PCR was compared with an immunofluorescence (IF) assay by analyzing 29 nonspiked environmental water samples . Sample volumes of 20 to 1,500 liters were concentrated with a wound fiberglass cartridge filter . Frequency of detection for viable Giardia cysts increased from 24% by IF microscopy to 69% by RT-PCR . Viable C . parvum oocysts were detected only once by RT-PCR (3%) in contrast to detection of viable Cryptosporidium spp . in four samples by IF microscopy (14%), suggesting that Cryptosporidium species other than C . parvum were present in the water . This combination of the large-volume sampling method with RT-PCR represents a significant advance in terms of protozoan pathogen monitoring and in the wider application of PCR technology to this field of microbiology.

Acta Cytol, 1998 Mar-Apr, 42(2), 305 - 11
Relative value and cost-effectiveness of culture and special stains in fine needle aspirates of the lung; Krane JF et al.; OBJECTIVE: To define the role of microbiologic stains and culture in lung fine needle aspiration (FNA) specimens . STUDY DESIGN: All lung FNA specimens over a nine-year period, with results of both culture and microbiologic stains (Gram's, methenamine silver and acid fast) were reviewed and correlated with clinical information . RESULTS: Sixty-five cases were identified; 13 cases represented clinically significant infections (20%) . Gram's stain identified 3 infections and had 1 false positive result, while culture identified 7 infections and had 9 false positive results . However, all false positive cultures represented easily identifiable contaminants, and eight of nine cases had no associated acute inflammation or necrosis . Aspergillus species were detected in four cases by Papanicolaou and silver stain, while culture was positive in only one case . Coccidioides immitis was detected by both Papanicolaou stain and culture in one case . A single case of Mycobacterium tuberculosis was identified by both culture and acid-fast stain . While culture appeared more cost-effective than Gram's stain for identifying bacteria, both Papanicolaou and methenamine silver stain were more cost-effective for identifying fungi . CONCLUSION: In lung FNA specimens, culture and special stains should be restricted to specimens with acute inflammation or necrosis . Gram's stain and fungal culture are insensitive and not cost-effective, and fungi are often identifiable with routine stains.

Ned Tijdschr Geneeskd, 1998 Feb 21, 142(8), 415 - 9
{Hepatic steatosis during treatment with zidovudine and lamivudine in an HIV-positive patient}; ter Hofstede HJ et al.; A 33-year-old HIV-infected man was given antiretroviral therapy with zidovudine and lamivudine . After ten months' treatment the patient had elevated hepatic transaminase levels . Severe hepatic steatosis was found in the biopsy . Clinical history, laboratory, microbiologic and X-ray examination revealed no other abnormalities . The transaminase levels remained high after withdrawal of zidovudine alone, but a decrease was observed when both zidovudine and lamivudine were stopped . Rechallenge of lamivudine therapy caused the levels to increase again . The hepatic steatosis was considered to be caused by the antiretroviral therapy, lamivudine having a synergistic influence on this side effect of zidovudine . Ten months after the therapy was changed to the protease inhibitor indinavir combined with zalcitabine and stavudine, two other nucleoside analogues, hepatic steatosis recurred.

Crit Care Clin, 1998 Apr, 14(2), 221 - 50
Postcardiac surgery infections; Lutwick LI et al.; Infections following cardiac surgery, although generally uncommon, are associated with difficult management decisions and significant morbidity and mortality . They often present while the patient is either in a critical care unit, or requires CCU management . This review analyzes infections related to median sternotomy wounds, prosthetic heart valves, transvenous permanent pacemakers, automatic implantable cardioverter-defibrillators, and left ventricular assist devices . The diagnosis, microbiology, treatment and outcome of each is also discussed.

Cesk Patol, 1998 Jan, 34(1), 3 - 6
Evolution of pathology practice in the United States: current status and future trends; Sims KL et al.; This article traces the development of pathology practice from its origins in autopsy pathology to its current practice in the United States . The American model of practice differs markedly from that in continental European countries because of the extensive incorporation of "Clinical Pathology" with the traditional disciplines of anatomic pathology under the auspices of the Pathology Department . "Clinical Pathology" as it is now defined includes the laboratory testing disciplines of Chemistry, Hematology, Immunology, Medical Microbiology, and Transfusion Medicine . The increasing importance of computers and information management, DNA diagnostic techniques, and the multiple roles of the pathologist as a researcher and consultant in pathology practice in the United States is discussed.

Dent Today, 1998 Feb, 17(2), 104, 106, 108 - 11
The key to success: maintaining the long-term health of implants; Silverstein L et al.; During the infancy years of dental implantology, the emphasis for long-term success of osseointegrated implants was the surgical phase of dental implantology . In the years that followed, the emphasis for success had switched from a purely surgical influence to focusing more on the proper fixture placement which would be dictated by the prosthetic and aesthetic needs of each particular case . In more recent years, the dental profession has recognized professional implant maintenance and diligent patient home care as two critical factors for the long-term success of dental implants . The microbiota and clinical presentation of peri-implantitis is the same as periodontitis around a natural tooth.

Microsc Res Tech, 1998 Mar 15, 40(6), 463 - 72
Cytochemical and biochemical studies on adenylate cyclase activity in preneoplastic and neoplastic liver tissue and cultured liver cells; Mayer D et al.; The ATP-analogue adenylyl(beta,gamma-methylene)diphosphonate was chosen as substrate for the cytochemical localization of adenylate cyclase (AC) activity . The tissues investigated covered normal rat liver and liver from carcinogen-treated animals with preneoplastic lesions and hepatocellular neoplasms, as well as cultured liver cells . The AC reaction product methylene diphosphonate was precipitated with Pb2+ immediately at the place of production . This approach permitted a precise localization of AC activity by light and electron microscopy . The specificity of the AC reaction was demonstrated by control reactions, including inhibition of AC with 2'5'-dideoxyadenosine and activation with forskolin, glucagon, and cholera toxin . Endogenous phosphatases were inhibited with tetramisole and NAD . In normal liver, AC activity was mainly localized in the sinusoidal membrane of hepatocytes . A distinct gradient in activity was observed within the liver lobule . Hepatocytes localized around the terminal hepatic venule showed a significant higher AC activity compared to hepatocytes near the portal tract . AC was clearly decreased in focal preneoplastic liver lesions of the glycogenotic-basophilic cell lineage leading to hepatocellular carcinomas . Cytochemically detected intensity of AC activity corresponded to data obtained by microbiochemical assays in laser-dissected tissue samples . A remarkable interdependence of AC activity and degree of differentiation was also seen in epithelial rat liver cell lines: Highly differentiated cells show high enzyme activity and vice versa, as shown by both cytochemical and biochemical examinations . It is concluded that alterations in cellular signal transduction caused by alterations in AC activity play an important role in hepatocarcinogenesis.

J Pediatr Ophthalmol Strabismus, 1998 Mar-Apr, 35(2), 73 - 9; quiz 110-1
Clinical practice guidelines for the management of orbital cellulitis; Uzcategui N et al.; PURPOSE: A retrospective study was performed to review the management of periorbital and orbital cellulitis at Miami Children's Hospital, between January 1, 1993 and February 15, 1996 . RESULTS: One hundred and one patients were included in this study . The variables analyzed in this study included age, sex, length of hospital stay, imaging studies, laboratory tests, and microbiology specimens collected . Patients were classified according to the modified Chandler classification . Average length of stay for our patient population was 4.5 days . Data regarding the radiologic studies, laboratory tests, and microbiology yield of specimens were analyzed . CONCLUSIONS: The incidence of orbital infection, manifested by lid swelling alone is much more common (stages I and II) than orbital infection involving postseptal findings (stages III, IV, and V); 84.16% compared with 15.84%, respectively . An updated approach and a general guideline for the management of periorbital and orbital cellulitis according to the clinical staging of the process is presented.

J Virol, 1998 May, 72(5), 4508 - 14
Feline coronavirus type II strains 79-1683 and 79-1146 originate from a double recombination between feline coronavirus type I and canine coronavirus; Herrewegh AA et al.; Recent evidence suggests that the type II feline coronavirus (FCoV) strains 79-1146 and 79-1683 have arisen from a homologous RNA recombination event between FCoV type I and canine coronavirus (CCV) . In both cases, the template switch apparently took place between the S and M genes, giving rise to recombinant viruses which encode a CCV-like S protein and the M, N, 7a, and 7b proteins of FCoV type I (K . Motowaka, T . Hohdatsu, H . Hashimoto, and H . Koyama, Microbiol . Immunol . 40:425-433, 1996; H . Vennema, A . Poland, K . Floyd Hawkins, and N . C . Pedersen, Feline Pract . 23:40-44, 1995) . In the present study, we have looked for additional FCoV-CCV recombination sites . Four regions in the pol gene were selected for comparative sequence analysis of the type II FCoV strains 79-1683 and 79-1146, the type I FCoV strains TN406 and UCD1, the CCV strain K378, and the TGEV strain Purdue . Our data show that the type II FCoVs have arisen from double recombination events: additional crossover sites were mapped in the ORF1ab frameshifting region of strain 79-1683 and in the 5' half of ORF1b of strain 79-1146.

Oral Microbiol Immunol, 1996 Oct, 11(5), 365 - 8
Characterization of a 4.2-kb plasmid isolated from periodontopathic spirochetes; Chan EC et al.; Oral anaerobic treponemes are assoicated with active periodontal disease and may comprise up to 57% of the microbiota in periodontal pockets . Four treponeme strains (designated U2a, U2b, U9b, and U9c) isolated from clincial cases were found to harbor a new 4.2-kb plasmid when plasmid DNA was extracted and purified employing the Qiagen Plasmid Kit . This plasmid differs from the smaller plasmids (2.0-, 2.6-, and 2.7-Kb) reported previously by others in Treponema denticola . The newly discovered 4.2-kb plasmid was found to be the same in all four treponeme strains by restriction endonuclease analysis . It is a circular plasmid since restriction with PstI, Pvu II, Sma I, Xma I, Ava 1 or Bam HI produced a single band of the same size . Bacterial strain U2b was shown to be Treponema socranskii and U9c to be T . denticola . The plasmid is designated "pTS1" . The presence of the same plasmid in different species of the treponemes isolated from the same patient suggests the possibility of a naturally occurring genetic transfer system within the oral spirochetes or their ability to take up and maintain mobilizable plasmids.

Acta Microbiol Immunol Hung, 1997, 44(4), 309 - 25
Extended-spectrum beta-lactamases: an actual problem of hospital microbiology (a review); Szabo D et al.; Although there is a variety of mechanisms of bacterial resistance to beta-lactam antibiotics, the most important one is production of beta-lactamases inactivating penicillins and cephalosporins . The classification of beta-lactamases is based on biochemical, enzymological (i.e . molecular structure, inhibitory property, substrate-profile, relative rate of hydrolysis) and immunological characters . Extended-spectrum beta-lactamases (ESBLs) can be derived from TEM or SHV enzymes . These enzymes have now been sequenced and it has been found that relatively few point mutations have occurred in the gene of the TEM and SHV type enzymes . These point mutations clustered in five areas of the gene . The amino acid mutations can alter the conformation, the active site and change the hydrance of beta-lactamase-cephalosporin binding capacity . So the enzyme is able to bind and hydrolyse the third generation cephalosporins . Successive mutation interacted radically increasing the binding capacity of enzymes and confer resistance to newer cephalosporins . The use of these drugs provides a strong selective pressure to develop these mutations . Sporadic nosocomial outbreaks due to strains producing an ESBL led to an epidemic problem in some hospitals resulting in a concurrent dissemination of genes, plasmids or strains . Clinical epidemiological importance and role of ESBLs and emergence of multiply resistance of bacteria of nosocomial importance are discussed in this brief.

Rev Med Brux, 1998 Feb, 19(1), 5 - 9
{Septic thrombophlebitis of the internal jugular vein and Lemierre syndrome}; Bouton F et al.; The authors report a case of Lemierre's syndrome . This uncommon clinical entity is characterized by a septic internal jugular vein thrombosis with secondary metastatic abscesses and Fusobacterium necrophorum septicemia, following an acute oropharyngeal infection . The diagnosis is primarily clinical and it should be suspected when a severe septicaemic illness, with pulmonary symptoms, occurs after an acute pharyngotonsillar infection . This article reviews the clinical picture, microbiology and treatment of this forgotten complication of acute tonsillitis.

Rev Esp Salud Publica, 1997 Mar-Apr, 71(2), 181 - 7
{The evaluation of epidemiological services related to brucellosis in the Autonomous Community of the Basque Country}; Coll Jorda D et al.; BACKGROUND: Spain's Epidemiologic Notifiable Disease Surveillance System (ENDSS) was evaluated by reference to Brucellosis, the zoonoses with greatest incidence countrywide and a disease that is notifiable on a case by case basis in the Basque Autonomous Region (BAR) . METHODS: ENDSS information and the use to which it was put, were analysed . Active case searching was carried out via the Microbiologic Information System (MIS), public hospitals and the Occupational Disease Registry (ODR) . A comparison was run between reported and search data . The capture-recapture method was used to compare ENDSS against hospital cases . RESULTS: Risks and outbreaks wee detected . Suspect cases were not reported . There was a 40% post-search increase in cases, i.e., 40 versus a previous figure of 24 . Sensitivity was estimated at 60% . Predictive Value Positive could not be computed however . No case definition was in force . As estimated by the capture-recapture method, overall sensitivity for both ENDSS and hospital-based surveillance was 84% (95% IC: 70-100) . The number of cases estimated by this method was 38 +/- 8 . CONCLUSIONS: Underreporting is in evidence and, as a consequence, sensitivity is low . A case definition is called for . Response time is slowed by awaiting confirmation before reporting . The number of cases detected through active searching is compatible with that calculated by the capture-recapture method using only two sources.

Ophthalmology, 1998 Apr, 105(4), 707 - 16
Additional procedures after the initial vitrectomy or tap-biopsy in the Endophthalmitis Vitrectomy Study; Doft BH et al.; OBJECTIVE: The study aimed to assess the frequency, indications, and outcome of additional ocular procedures after initial treatment of vitrectomy (VIT) or tap-biopsy (TAP) for patients with endophthalmitis after cataract extraction . DESIGN: The study design was an analysis of observational data collected as part of a multicenter, randomized clinical trial . PARTICIPANTS: Of the 420 patients enrolled in the Endophthalmitis Vitrectomy Study, the 148 who had additional procedures were compared with the 272 who did not . MAIN OUTCOME MEASURES: The types, indications, and number of additional ocular procedures were assessed . A masked examiner measured visual acuity 9 to 12 months after study entry . RESULTS: Within 1 week of study entry, 8% of VIT eyes and 13% of TAP eyes underwent additional procedures, 14% for complications of the initial procedure and 86% for worsening ocular inflammation or infection . Cultures were obtained in 33 of the 38 eyes operated on for worsening inflammation or infection and were positive in 42% . Cultures obtained from the early additional procedures were positive more frequently in eyes with an initial TAP (71%) than in eyes with an initial VIT (13%) . Both virulence of initial microbiologic organism isolated and poor presenting vision were risk factors for requirement of reoperation . In all cases in which a single organism was cultured at the initial procedure, when the reculture was positive, it was the same organism . Late additional procedures (after 7 days) were required in 27% of patients . Visual outcome was much worse for eyes that had an additional procedure compared to eyes that did not, and this was especially the case for eyes that had an early additional procedure . Only 15% of eyes that had an early additional procedure achieved 20/40 visual acuity as compared to 57% of eyes that did not . CONCLUSION: Need for an additional procedure was a marker of more severe disease, and patients who underwent additional procedures achieved poorer visual acuity at final follow-up.

Am J Orthop, 1998 Mar, 27(3), 207 - 10
Relation of surface area to in vitro elution characteristics of vancomycin-impregnated polymethylmethacrylate spacers; Holtom PD et al.; To study the relationship between surface area and antibiotic elution from antibiotic-impregnated polymethylmethacrylate (PMMA) spacers, a standard block spacer made of vancomycin (4 g) and 40 g of PMMA was compared with two unique spacer designs, the "donut" and "fenestrated." The spacers were incubated in phosphate-buffered saline, which was changed daily, and a microbiologic assay was used to measure the antibiotic activity of the eluates . The donut and fenestrated spacers had 12% and 40% more surface area than the standard spacer, respectively . There was no significant difference, however, in daily elution levels of antibiotic between the donut spacer and the standard spacer . The fenestrated spacer displayed significantly better elution than either the standard or donut spacers, with an average of 20% more antibiotic eluted on any given day.

Vet Pathol, 1998 Mar, 35(2), 108 - 16
Cutaneous and systemic necrotizing vasculitis in swine; Thibault S et al.; A systemic vasculitis involving particularly the skin and kidneys has been recently described in swine under the name dermatitis/nephropathy syndrome . Twelve pigs with gross cutaneous lesions typical of this condition were necropsied, and morphologic, immunohistochemical, microbiologic, and epidemiologic characteristics were studied . The pigs were divided into three groups comprising eight pigs with acute lesions, two with chronic lesions, and two with acute lesions kept for sequential skin biopsies . Acute skin lesions consisted of round to irregular, red to purple macules and papules that often coalesced to form large, irregular patches and plaques . With time, the lesions became covered by crusts and faded gradually, sometimes leaving scars . Characteristic distribution included the perineal area of the hindquarters, limbs, dependent parts of the abdomen and thorax, and margins of the ears . In the acute phase of the disease, necrotizing and leucocytoclastic vasculitis of small-caliber blood vessels were observed within the dermis and panniculus and in various extracutaneous locations such as the renal pelvis and synovial membranes . All pigs had macroscopic evidence of pneumonia and generalized lymphadenopathy . Microscopically, they had interstitial pneumonia and perivascular cuffing of mononuclear cells in various tissues including skin . The presence of immunoglobulins and complement was demonstrated by immunofluorescence in and around necrotic vessels of the skin in the early stages . Porcine reproductive and respiratory syndrome (PRRS) virus (PRRSV) antigens were detected by immunohistochemistry in macrophages located around vessels of the tissues examined (skin and kidneys) in acute and chronic cases . PRRSV RNA was demonstrated by reverse transcription-polymerase chain reaction in lung and spleen homogenates from all pigs . The PRRSV was isolated in cell culture from 11 of the pigs . These findings suggest that PRRSV infection may play a role in the pathogenesis of this systemic vascular disease of swine.

J Biochem (Tokyo), 1998 Feb, 123(2), 247 - 52
Purification and characterization of a puromycin-hydrolyzing enzyme from blasticidin S-producing Streptomyces morookaensis; Nishimura M et al.; Blasticidin S-producing Streptomyces morookaensis JCM4673 produces an enzyme which inactivates puromycin (PM) by hydrolyzing an amide linkage between its aminonucleoside and O-methyl-L-tyrosine moieties {Nishimura et al . (1995) FEMS Microbiol . Lett . 132, 95-100} . In this study, we purified to homogeneity the enzyme from the cell-free extracts of S . morookaensis . The molecular weight of PM-hydrolyzing enzyme, estimated by SDS-PAGE and gel filtration, was 68 and 66 kDa, respectively, suggesting that this protein is monomeric . The PM-hydrolyzing activity was strongly inhibited by Zn2+, Fe2+, Cu2+, Hg2+, and N-bromosuccinimide, but was stimulated by DTT . The optimum pH and temperature for PM-hydrolyzing activity were 8.0 and 45 degrees C, respectively . Several L-aminoacyl-beta-naphthylamides were good substrates for the enzyme, suggesting that the PM-inactivating enzyme has an aminopeptidase activity . The N-terminal sequence of the first 14 amino acids (Val-Ser-Thr-Ala-Pro-Tyr-Gly-Ala-Trp-Gln-Ser-Pro-Ile-Asp) of the enzyme showed no significant homology with any published hydrolase sequences.

Compend Contin Educ Dent, 1997 Sep, 18(9), 881 - 4, 886, 888 passim; quiz 894
Genetic risk for severe periodontal disease; Newman MG; The discovery of a genetic marker that is highly associated with increased risk for severe periodontitis is a major breakthrough in the clinical management of all dental patients . The marker is not diagnostic; rather, it is a prognostic test, and it is used to identify patients who are much more susceptible to plaque . Individuals who have the marker have a 6 to 19 times higher chance of getting severe periodontitis than those who do not have the marker . It is estimated that 30% of the US population will test positive . This new information supplements existing microbiology and immunology research . A limitation with the established view of the etiology of periodontal disease makes it difficult to explain to patients why they are more or less at risk based solely on their level of oral hygiene . It has also been difficult to predict the clinical outcomes of various treatments for individual patients because each person responds differently to their own plaque . The genetic discovery helps to explain why some people with a little plaque have a lot of disease, and why other people with a lot of plaque have only minor problems . By incorporating the constant factor, genetics, into your philosophy of practice, the patient's periodontal needs and desires can be better understood and managed.

Med Tr Prom Ekol, 1998, (1), 13 - 6
{State of local immunity under exposure to anthropogenic factors of biological, chemical and physical nature in industry}; Litovskaia AV et al.; The authors studied immunologic features of saliva in 1714 workers exposed to vibration and other occupational hazards in microbiologic, chemical enterprises . The examinees demonstrated lower activity of lysozyme and concentrations of IgA, higher levels of IgG . Immunologic features of saliva was proved to have extreme diagnostic importance, therefore could be used to detect early signs of exposure to occupational hazards and to diagnose pathologic conditions caused by those hazards.

Epidemiol Infect, 1998 Feb, 120(1), 37 - 42
Surveillance of outbreaks of waterborne infectious disease: categorizing levels of evidence; Tillett HE et al.; Public health surveillance requires the monitoring of waterborne disease, but sensitive and specific detection of relevant incidents is difficult . The Communicable Disease Surveillance Centre receives information from various sources about clusters of cases of illness in England and Wales . The reporter may suspect that water consumption or recreational water exposure is the route of infection, or subsequent investigation may raise the hypothesis that water is associated with illness . It is difficult to prove beyond reasonable doubt that such a hypothesis is correct . Water samples from the time of exposure are seldom available, some organisms are difficult to detect and almost everyone has some exposure to water . Therefore, we have developed a method of categorizing the degree of evidence used to implicate water . The categories take into account the epidemiology, microbiology and water quality information . Thus outbreaks are classified as being associated with water either 'strongly', 'probably' or 'possibly' . This system allows a broad database for monitoring possible effects of water and is not confined to the few outbreaks which have been intensively investigated or have positive environmental microbiology . Thus, for reported incidents, the sensitivity of classifying it as water associated should be high but this may be at the expense of specificity, especially with the 'possible' association.

Rinsho Byori, 1998 Feb, 46(2), 124 - 31
{External quality assessment for clinical microbiology and good laboratory management}; Kumasaka K; The Tokyo Metropolitan external quality assessment (EQA) program has revealed some serious problems in private independent microbiology laboratories in Tokyo since 1982 . The poor performance in the EQA surveys closely related to poor laboratory managements, the type of training, experience of the medical technologists or technicians, and supervisory ability of the consultant physicians in independent laboratories . Social factors impede the reform of the quality assurance of clinical microbiology . Such factors include poor infrastructure of continuing education for small private laboratories, closure of the central clinical laboratories in the hospitals and outsourcing of laboratory tests due to restructuring in response to economic problems, and limited numbers of certified clinical pathologists of the Japan Society of Clinical Pathology (JSCP) . Therefore, the Tokyo Metropolitan EQA Scheme is still confidential and its main role is educational . Good two way communication between participants and the organizers' clinical pathologists is essential, if the quality of laboratory tests is to be improved . The new JSCP edition of the postgraduate training requirement in clinical pathology includes "Laboratory Administration and Management" . Good laboratory management(GLM) is an increasingly important component of good laboratory practice . The practice activities of clinical pathologists must include general management in addition to exercising there specialized knowledge in medicine and technology . Whereas leadership of a good clinical pathologist provides the direction of where a good laboratory is going, good management provides the steps of how to get there . And I believe quality system models from business and industry may provide us with strong guidance to build a quality system for the good laboratory that will endure into the next century.

Rev Invest Clin, 1997 Sep-Oct, 49(5), 369 - 72
{Bibliometric repercussions of adopting English as the sole language for publication}; Bracho-Riquelme RL et al.; OBJECTIVE: To determine the effect that the change from French to English had on the impact of the Annales de l' Institut Pasteur . THEORETICAL REFERENCE: The Pasteur Institute journals have a prestige of over 100 years of existence and eight Nobel Prize winners in Physiology and Medicine . Changes through time on the impact of these journals can be monitored as they are included in databases of the ISI (Institute for Scientific Information) . METHODS: A year by year analysis from 1974 to 1992 was done using simple regression between percentage of articles published in English and: a) their impact factor; b) their ranking among journals of the same field . RESULTS: The determination coefficient (r2) between the percentage in English and the impact factor was 0.108, and that between percentage in English and the journal's rank in similar publications was 0.178 for the Ann Microbiol, 0.045 for the Ann Immunol and 0.122 for the Ann Virol . CONCLUSIONS: The change of language did not increase the impact factor of the French journals.

J Periodontol, 1998 Feb, 69(2), 190 - 4
Microbiota associated with experimental peri-implantitis and periodontitis in adult Macaca mulatta monkeys; Eke PI et al.; This study examines the microbiota associated with the progression of experimental peri-implantitis and periodontitis induced concurrently in partially edentulous adult monkeys . Root-form and plate-form implants with fixed prosthesis in place for at least 12 months and their corresponding opposite molar teeth were ligated for 6 months . The microbiota in plaque around these ligated dental implants and molars were studied at 0, 1, 2, 3, and 6 months post-ligation . Plaque samples were analyzed by dark-field microscopy and selective and non-selective culture . Putative periodontal pathogens were detected as a major component of the microbiota cultured from plaque samples obtained from experimental peri-implantitis sites . Overall, the types and relative proportions of putative periodontal pathogens in plaque associated with ligature-induced peri-implantitis and ligature-induced periodontitis were similar . Only levels of anaerobic Actinomyces and spirochetes were significantly different between both sites . Spirochete levels were significantly higher at peri-implantitis sites when compared with levels at periodontitis sites after 6 months, and spirochete levels increased significantly between 0 and 6 months post-ligation at implant sites . Levels of spirochetes correlated significantly with probing depth and bone loss at peri-implantitis sites . Overall, Actinomyces levels were higher at periodontitis sites . Porphyromonas species were not detected continuously as part of the peri-implantitis microbiota . In conclusion, this study finds that the microbiota associated with the progression of experimental peri-implantitis and periodontitis occurring concurrently in partially edentulous mouths are similar.

Int J Dermatol, 1998 Jan, 37(1), 1 - 6
Dermatoepidemiology . III . ABC principles for a critical review of the literature; Chuang TY et al.; EPIDEMIOLOGY: Is the study of disease occurrence in human populations . As a science, epidemiology emphasizes descriptive and analytic observation, clinical trial, behavioral intervention, and the practical utility of diagnostic tests . "Epidemiology" is derived from the Greek epi (among), demos (people), and logos (doctrine) . CLINICAL EPIDEMIOLOGY: Is the application of epidemiologic principles and methods to problems arising in clinical medicine, dermatology included . For dermatologists, understanding this discipline is as important as mastering other basic sciences, such as immunology, microbiology, and dermatopathology . The recognization of Lyme disease is a classic work of "infectious" disease epidemiology . In 1972, a disease characterized by erythema chronicum migrans and "endemic arthritis" clustered in Lyme, Connecticut . By 1975, an infectious agent was suspected to be the cause of the disease . In 1977, the tick was thought to be the vector; in 1980, the spirochete became the prime suspect and, in 1982, Borrelia burgdorferi was identified as the etiologic agent . The study of hexachlorobenzene exposure, resulting in porphyria turcica, is an example of classic "chronic" disease epidemiology . The illness began in 1955 when sporadic cases of porphyria occurred in eastern Turkey . In 1957, the first case with illness resembling congenital erythropoietic porphyria was described . In subsequent years, over 3000 patients developed "epidemic" porphyria . The cause was due to the ingestion of seed wheat which had been treated with fungicides containing 20% hexachlorobenzene . EPIDEMIOLOGIC METHODS: For research, published elsewhere as Dermatoepidemiology . I., include descriptive observational study, analytic observational study, epidemiologic experimental study and tests for sensitivity, specificity, and positive/negative predictive value . Epidemiologic principles, instead, stress the correct interpretation of data, minimization of bias, and the appreciation of natural variations in collected data.

Clin Ther, 1998 Jan-Feb, 20(1), 88 - 100
Comparison of ceftibuten once daily and amoxicillin-clavulanate three times daily in the treatment of acute exacerbations of chronic bronchitis; McAdoo MA et al.; In medical practice, antibiotics are generally given empirically for the treatment of acute exacerbations of chronic bronchitis (AECB) . To be effective, antibiotic therapy should be broad in spectrum, and it should also cover the common beta-lactamase-producing pathogens . In this multicenter, randomized, investigator-masked study, 469 patients with AECB were randomized (in a ratio of 2:1) to receive 400-mg oral ceftibuten capsules once daily or 500-mg amoxicillin-clavulanate tablets three times daily for 5 to 15 days . Patients receiving ceftibuten were further divided into those who took the capsule with a meal (fed) and those who took the capsule 1 hour before a meal (fasted) . Clinical and microbiologic responses were evaluated after treatment at 0 to 6 days (end of treatment) and 7 to 21 days (follow-up) . Overall clinical success was determined by cure/improvement of signs and symptoms of AECB at the end of treatment and at follow-up . Overall microbiologic assessment was graded as eradication, persistence, relapse, reinfection, colonization, superinfection, or unassessable . Tolerability was evaluated by grading observed adverse events . The mean duration of treatment was 10.4 days for patients who received ceftibuten and 10.1 days for patients who received amoxicillin-clavulanate . A total of 252 patients receiving ceftibuten and 117 patients receiving amoxicillin-clavulanate were evaluable for clinical efficacy, and 55 patients were evaluable for microbiologic response . Both treatments improved the signs and symptoms of bronchitis, and overall clinical success rates were equivalent for patients treated with ceftibuten (211 of 252 {84%}) and amoxicillin-clavulanate (93 of 117 {79%}) (95% confidence interval {CI}, -4.5% to 13.6%) . Overall microbiologic eradication rates were also similar for patients treated with ceftibuten (36 of 37 {97%}) and amoxicillin-clavulanate (12 of 14 {86%}) (95% CI, -5.2% to 21.2%) . The most frequently reported treatment-related adverse events were gastrointestinal disturbances, which occurred in 15% (47 of 316) and 24% (36 of 152) of patients treated with ceftibuten and amoxicillin-clavulanate, respectively . No significant difference was observed in the ceftibutenfed and ceftibuten-fasted groups in overall clinical assessments of the clinical efficacy population and safety population . In conclusion, 400 mg oral ceftibuten once daily has a similar clinical success rate to 500 mg amoxicillin-clavulanate three times daily, with a trend toward fewer gastrointestinal side effects, in the treatment of patients with AECB.

J Biol Chem, 1998 Feb 27, 273(9), 5155 - 66
Purification, regulation, and molecular and biochemical characterization of pyruvate carboxylase from Methanobacterium thermoautotrophicum strain deltaH; Mukhopadhyay B et al.; We discovered that Methanobacterium thermoautotrophicum strain DeltaH possessed pyruvate carboxylase (PYC), and this biotin prototroph required exogenously supplied biotin to exhibit detectable amounts of PYC activity . The enzyme was highly labile and was stabilized by 10% inositol in buffers to an extent that allowed purification to homogeneity and characterization . The purified enzyme was absolutely dependent on ATP, Mg2+ (or Mn2+ or Co2+), pyruvate, and bicarbonate for activity; phosphoenolpyruvate could not replace pyruvate, and acetyl-CoA was not required . The enzyme was inhibited by ADP and alpha-ketoglutarate but not by aspartate or glutamate . ATP was inhibitory at high concentrations . The enzyme, unlike other PYCs, exhibited nonlinear kinetics with respect to bicarbonate and was inhibited by excess Mg2+, Mn2+, or Co2+ . The 540-kDa enzyme of A4B4 composition contained a non-biotinylated 52-kDa subunit (PYCA) and a 75-kDa biotinylated subunit (PYCB) . The pycB gene was probably monocistronic and followed by a putative gene of a DNA-binding protein on the opposite strand . The pycA was about 727 kilobase pairs away from pycB on the chromosome and was probably co-transcribed with the biotin ligase gene (birA) . PYCA and PYCB showed substantial sequence identities (33-62%) to, respectively, the biotin carboxylase and biotin carboxyl carrier + carboxyltransferase domains or subunits of known biotin-dependent carboxylases/decarboxylases . We discovered that PYCB and probably the equivalent domains or subunits of all biotin-dependent carboxylases harbored the serine/threonine dehydratase types of pyridoxal-phosphate attachment site . Our results and the existence of an alternative oxaloacetate synthesizing enzyme phosphoenolpyruvate carboxylase in M . thermoautotrophicum strain DeltaH (Kenealy, W . R., and Zeikus, J . G . (1982) FEMS Microbiol . Lett . 14, 7-10) raise several questions for future investigations.

Chest, 1998 Mar, 113(3 Suppl), 188S - 193S
Nosocomial pneumonia guidelines: an international perspective; Mandell LA et al.; Hospital-acquired pneumonia is a serious illness with substantial morbidity and mortality . Management of this illness is challenging for the physician and a number of diverse issues must be considered when initiating therapy . Guidelines for the treatment of hospital-acquired pneumonia have been developed in Canada and the United States . A questionnaire sent to infectious disease physicians or clinical microbiologists in 29 countries showed that Australia, Sweden, and France had national guidelines in addition to Canada and the United States, while Hong Kong and France had single hospital-based guidelines . These guidelines are reviewed and some of the controversial issues relating to nosocomial pneumonia are discussed.

J Gynecol Obstet Biol Reprod (Paris), 1997, 26(8), 781 - 8
{Diagnostic difficulties in infiltrating lobular breast cancer: value of ultrasonography . 33 cases}; Escolano E et al.; Thirty three invasive lobular carcinoma (ILC) were submitted to mammography, ultrasonography and finally surgery . The type of tumor proliferation and the absence of microcalcifications within the invasive tissue led to 15% of false negative responses in the mammographic analysis . Ultrasonography disclosed only 12% of false negatives . Sonographic appearance, especially fine needle aspirations or microbiopsy under ultrasonographic control, allows modification of mammographic and clinical diagnosis errors . Thus, this method appears of importance in diagnosis of ILC.

Eur J Cardiothorac Surg, 1998 Jan, 13(1), 71 - 7
Factors affecting the yield of cardiac valve allografts from living unrelated donors; Hunt CJ et al.; OBJECTIVE: Allografts are the valve of choice for fertile women, patients with infective endocarditis and those with small aortic roots . However, the supply of valves is problematic and widespread usage is restricted by limited availability . Allograft valves are available from cadaveric donors and from the explanted hearts of transplant recipients . Potentially, hearts from these patients could be an excellent source of usable aortic and pulmonary valves . However, little information is available on the suitability of such donors, the procurement rate of allograft valves from this source, or the factors that limit the yield of implantable valves from explanted hearts . METHOD: In order to examine some of these issues, we have carried out a retrospective study on the explanted hearts offered to the East Anglian Tissue Bank by Papworth hospital . Papworth hospital carries out approximately 90 heart and heart/lung transplants per year . Over a 2 year period, the tissue bank was offered 72 hearts from this programme . RESULTS: Of the 72 hearts offered, 58 were accepted for subsequent dissection and further examination . A total of 14 hearts were refused . The main reasons for refusal were extensive cardiectomy trauma (4 hearts) and abnormal valve morphology (four hearts) . Of the 116 valves from those hearts accepted for dissection, 55 valves were rejected upon further examination . Reasons for rejection included: cardiectomy trauma (26 valves), abnormal morphology (22 valves), procurement/dissection trauma (7 valves) . Of the 61 valves banked, four were subsequently rejected due to positive or incomplete microbiology . Procurement trauma fell to 0% in the last 12 months of the study but cardiectomy trauma remained constant and was related to previous cardiac surgery . Overall, the yield of implantable valves was 0.8 valves/donor . However, the yield showed considerable variation, from 1.0 valves/donor for donors diagnosed as cardiomyopathy to 0.5 valves/donor for donors with ischaemic heart disease who had undergone previous cardiac surgery . CONCLUSION: It is possible to predict the likely yield of explanted heart valves from different groups of heart transplant recipients, based on diagnosis and previous history . The yield of usable valves could be increased by avoidance of injury, both during cardiectomy and subsequent removal of the valves; this is achievable through appropriate training.

Gac Med Mex, 1997, 133 Suppl 1, 111 - 24
{Advances in the molecular diagnosis of infectious and parasitic diseases}; Sweet-Cordero A et al.; During the last decade molecular diagnostic techniques have moved from the research laboratory into the clinical microbiology laboratory . The application of molecular biology for the diagnosis of infections and parasitic diseases by the detection of nucleic acids has steadily grown, and it is very probably that, while they may not displace the traditional diagnostic laboratory, they will be common place in the not to distant future . A detailed description of the principal molecular diagnostic techniques that are currently being used or that have a potential use for the diagnosis, evaluation of disease progression or response to therapy of selected infectious and parasitic diseases, is presented . Emphasis is placed on the rational use of these techniques in regional reference laboratories or highly specialized hospitals; the importance of selecting and implanting those diagnostic techniques with the highest cost-benefit ratio; and finally, the need to train human resources which are highly qualified in the theory and practice of molecular biology.

Allerg Immunol (Paris), 1998 Jan, 30(1), 18 - 24
{Updates on the earlier treatments for atopic dermatitis}; Jelen G; The GERDA classes have the function of updating our knowledge of dermato-allergology . One of the themes tackled this year was the treatment of atopic dermatitis . Apart from consideration of treatment or exception with cortisone, it seemed to be of interest to find the relevance of "old treatments" for atopic dermatitis, either preventive or symptomatic . Preventive treatment made reference to correction of food factors (diet in infants, removal of maternal allergens, supplementation on fatty acids) and of environmental factors especially the fight against house dust mites by use of anti-mite mattress covers . Miracle treatments of atopy do not always exist . Thus there is often need for, besides local corticosteroid therapy, an external symptomatic treatment where the emphasis is on the struggle against skin microbiology, the fight against pruritic inflammatory conditions and above all the battle against xerosis . Knowledge of the physiology of the stratum corneum gives better understanding of the effect of emollients and moisturizers in restoration of the cutaneous barrier, of which dysfunction is one of the elements of atopic dermatitis.

J Radiol, 1997 Nov, 78(11), 1141 - 6
{Stereotactic core biopsy of breast microcalcifications . Aid to diagnosis?}; Chopier J et al.; We assessed the accuracy with which stereotactic core biopsy of breast microcalcifications helps to justify follow-up or indicate required surgical planning . Eighty-nine patients underwent stereotactic breast biopsy performed with large core needles . Histopathologic findings of microbiopsies were correlated with radiological findings, with follow up and with surgical findings . Agreement between radiological and histopathologic findings on biopsies was obtained in 86% for benign results . Even in the case of benign radiological findings, the histological results of microbiopsies required a surgical biopsy justified in 10% of cases . Radiologically suspicious or malignant microcalcifications were correlated with 35% benign and 65% malignant histologies on biopsies . The positive predictive value, negative predictive value and accuracy were respectively 93%, 86% and 95% . Invasive lesions were found on microbiopsies in 39% of excised malignant lesions . Multifocal lesions were proved on microbiopsies in 50% of all excised carcinomas . Microbiopsies help to disclose malignant lesions undetected on radiological analysis, and may obviate diagnostic surgical biopsy in many cases.

Virology, 1998 Mar 1, 242(1), 68 - 79
An equine herpesvirus type 1 recombinant with a deletion in the gE and gI genes is avirulent in young horses; Matsumura T et al.; The cell culture-adapted KyA strain of equine herpesvirus type 1 (EHV-1) has been found to be attenuated in young horses (Matsumura et al., 1996, Vet . Microbiol . 48, 353-365) . The KyA strain lacks at least six genes in its genome, including those encoding glycoproteins gE and gI . To elucidate whether EHV-1 glycoproteins gE and gI play a role in viral virulence, we have constructed an EHV-1 recombinant that has the genes encoding both gE and gI deleted from its genome and its revertant . Growth properties of the deletion mutant virus in vitro were compared with those of the parent and the revertant viruses . Plaque size of the mutant virus in fetal horse kidney (FHK) cells was significantly smaller than those of the parent and the revertant viruses . In one-step growth experiments, however, the yields of infectious virus from FHK cells infected with the deletion mutant, the parent, or the revertant virus were approximately the same . The results suggested that gE and/or gI of EHV-1 promoted cell-to-cell spread of the virus, but that these glycoproteins were not involved in the process of virus maturation and release or in virus attachment and penetration . Subsequently, the virulence of mutant and revertant viruses was examined in young horses . No clinical signs were observed in six horses, including three colostrum-deprived foals inoculated intranasally with the deletion mutant virus, whereas three colostrum-deprived foals inoculated intranasally with the revertant virus manifested clinical signs typical for EHV-1 respiratory infection (i.e., pyrexia, nasal discharge, and swelling of submandibular lymph nodes) . The results obtained from in vivo studies revealed that the EHV-1 mutant defective in both gE and gI genes was avirulent in young horses, suggesting that gE and/or gI of the EHV-1 have an important role in EHV-1 virulence . However, the EHV-1 mutant defective in both gE and gI genes induced only a partial protectivity in inoculated foals from manifestation of respiratory symptoms after challenge infection.

Int J Periodontics Restorative Dent, 1997 Aug, 17(4), 334 - 47
Follow-up of two cases of Papillon-Lefèvre syndrome and presentation of two new cases; Boutsi EA et al.; Periodontitis resulting from Papillon-Lefevre Syndrome has been known to cause early loss of primary dentition with subsequent involvement of the permanent dentition . In this study, two Papillon-Lefevre Syndrome patients were followed for 3 years after initial treatment and improvement of their periodontal condition . In addition, two new cases of Papillon-Lefevre Syndrome are presented . The follow-up treatment of the first two patients included monitoring the oral hygiene and performing ultrasonic scaling . Their present clinical appearance is very satisfactory . The periodontal condition of the third (new) patient was brought under control by extracting the involved deciduous teeth under antibiotic coverage, and by scaling and root planing the already erupted permanent teeth as well as by maintaining a high standard of oral hygiene . In the fourth case, all permanent teeth had erupted and the periodontium had already been severely destroyed . Actinobacillus actinomycetemcomitans was not detected by microbiologic examination after the periodontal conditions improved, except in the fourth case . Western blot analysis showed that the three first three patients had positive antibody response to the same antigens of Actinobacillus actinomycetemcomitans . Phagocytosis by polymorphonuclear neutrophil leukocytes) had not decreased, but the expression of surface receptors of polymorphonuclear neutrophil leukocytes was within the normal limits.

Bone Marrow Transplant, 1998 Jan, 21(2), 195 - 203
A detailed analysis of charges for hematopoietic stem cell transplantation at a children's hospital; Kline RM et al.; We analyzed hospital charges for pediatric hematopoietic stem cell transplantation (HSCT) to understand better the medical origin of these charges . Forty-nine patients undergoing HSCT at Kosair Children's Hospital between January 1992 and August 1995 had hospital charges analyzed by cost center, donor type and clinical outcome . Thirty-three autologous, two syngeneic and 14 allogeneic transplants were performed . Twenty-four transplants were performed for hematological malignancies, 22 for solid tumors, and three for non-malignant diseases . Pharmaceutical charges comprised the largest single component of total hospital charges (THC), accounting for 38.9% . Room charges were the next largest group at 33.7% of THC . Other cost centers, in order of magnitude, were central supply (7.9%), transfusion services (7.5%), laboratory (5.8%), microbiology (3.6%), miscellaneous (1.9%), and radiology (1.4%) . Within the pharmaceutical cost center, colony-stimulating factors comprised the largest single item, making up 18% of total pharmacy charges and 7% of THC . Antibiotics were the second largest component, at 16% of pharmacy charges and 6% of THC . Patients transferred to the intensive care unit (ICU) had charges 68% greater than non-ICU patients . Allogeneic transplant patients had THC 35% greater than autologous transplant patients, but also a four-fold greater chance of becoming an ICU patient . THC for non-ICU allogeneic transplant patients were 18% greater than for autologous non-ICU patients . THC for allogeneic ICU patients were 21% greater than for autologous ICU patients . Patients who died of transplant-related toxicity prior to day 100 had THC 83% greater than those who survived beyond day 100 . This is the first published comprehensive and detailed analysis of charges associated with hematopoietic stem cell transplantation . With increased emphasis on the provision of cost-effective care in both Europe and the USA, medical practices must be examined with the goal of reducing inefficiencies while preserving quality of care . Understanding the genesis of charges in expensive procedures such as stem cell transplantation is an initial step in cost containment.

Bratisl Lek Listy, 1997 Oct, 98(10), 559 - 62
{Epidemiologic and microbiologic aspects of mycobacteriosis in Slovakia . M . fortuitum}; Badalik L et al.; The purpose of this paper is to confront the knowledge about the epidemiology of this disease abroad with information obtained in Slovakia . The methodology of this paper is based upon surveillance of tuberculosis as applied on mycobacterioses . Pulmonary infections caused by M . fortuitum presents only 10% of pulmonary mycobacterioses caused by facultative pathogenic mycobacteria . Since the year 1979 were in the territory of Slovakia newly discovered 5 cases of mycobacterioses caused by M . fortuitum . 4 of them are men (age 61-77 years old) and 1 women (57 years old) . 3 patients are from Eastern Slovakia and 2 patients are from Central Slovakia . All of them had pulmonary location of disease . Another 8 cases (5 men and 3 women) are suspect for mycobacterioses for the meantime . In each isolation of the agents was made 5-8 times but without verification of clinical activity . Findings of M . fortuitum in biological material even when repeated can mean contamination only . During the period of last 10 years 768 isolations of M . fortuitum from 496 persons were registered . (Ref . 36.)

Pathologica, 1997 Oct, 89(5), 495 - 502
{Origin and development of pathological anatomy in Trieste: a paradigmatic history}; Melato M; The history of the Italian city of Trieste is somewhat unique . In 1382, being unable to compete with nearby Venice, it gave itself up to the Archduchy of Austria, which, while ensuring Trieste a certain degree of autonomy, did nothing to improve the town's economy . Things changed, however, after 1719, when Trieste was declared a Free Port . The city, at the time poor and lacking the human and economic resources that might have given life to the long-awaited trading activities, started to attract flocks of immigrant labourers and professionals, including many physicians . Thus, from mid-18th C onwards, Trieste witnessed the rise of a local class of physicians . Graduates from the major European universities of the times, these physicians were highly active in the rapid professional and cultural growth of the city . Being free from traditions or affiliations to specific medical schools, this unusually multicultural class of professionals provides a sample of the times' medical class which is particularly suitable for understanding what schools of thought dominated during that period . A number of publications, largely dealing with pathology, and many historical circumstances show that this newly formed class of physicians was influenced by the scientific method advanced by Morgagni in his De Sedibus . It is also clear that Morgagni's influence greatly benefited the city's doctors and soon turned them into fertile and original promoters of ideas, as well as highly skilled professionals . When the times became ripe to take on a specialist in pathology, both medical class and local authorities showed great interest in the field by making sure that the successful candidate, Dr . Simon Pertot, had all the resources and equipment necessary for the specialist to become a central figure in professional training and medical research in Trieste . Thus, the kind of clinical pathology where a single physician performed macroscopic examinations to identify his patient's cause of death gave way to a more specialised discipline which was able to transfer--to post-mortem examinations first and soon after to surgically removed tissues--the wealth of notions developed in the middle of the 19th C in the basic sciences of chemistry, microbiology and physiology, as had been advanced by the second founding father of the discipline, Virchow . Trieste, therefore, may be said to offer a unique example of the origins and development of pathologic anatomy in Central Europe . And the recollection of the city's experience promotes, in the modern pathologist, an awareness of belonging to a discipline which has always been the soundest leader in the advancement of medicine.

Can J Cardiol, 1998 Jan, 14(1), 85 - 6
Purulent pericarditis secondary to Candida parapsilosis and Peptostreptococcus species; McNamee CJ et al.; Purulent pericarditis secondary to Candida pericarditis is a rare but lethal infection . The first case of pericardial infection by Candida parapsilosis in combination with Peptostreptococcus species in an immunocompetent nondebilitated individual is reported . Urgent pericardiectomy was required after pericardial drainage failed to stop symptoms of tamponade . The etiology, microbiology and treatment of this unusual condition are reviewed.

Tidsskr Nor Laegeforen, 1998 Jan 10, 118(1), 67 - 70
{A classification system of anogenital findings . A diagnostic tool in the assessment of sexually abused children}; Myhre AK et al.; The assessment of suspected sexual child abuse demands teamwork where the paediatrician plays a central role . From a juridical point of view, the task of the paediatrician is to evaluate the anatomic, microbiologic and forensic medical findings . In 1995, in order to improve the quality of this work, Norwegian paediatricians established a peer review group which meets on a regular basis . Based on available literature and the experience of the individual members, a classification system for anogenital findings has been developed . The findings are divided into five classes . Class one comprises findings frequently seen in children who have not been abused . Class two comprises findings not considered to be normal, but for which there could be many different causes . Classes three, four and five represent findings which are increasingly predictive with respect to injury penetration or attempted penetration . Since our knowledge of anogenital anatomy in children who have not been abused is limited, our classification system should be updated regularly.

Histol Histopathol, 1998 Jan, 13(1), 129 - 36
Characterization of natural occurring Pneumocystis carinii pneumonia in pigs by histopathology, electron microscopy, in situ hybridization and PCR amplification; Ramos Vara JA et al.; Macroscopic, histologic, ultrastructural, microbiologic, in situ hybridization (ISH) and PCR detection results in three 8-week-old pigs naturally infected with Pneumocystis carinii (PC) are described . All animals had a nonsuppurative interstitial pneumonia and intra-alveolar Pneumocystis organisms with foamy eosinophilic and PAS positive appearance . Ultrastructurally, PC trophozoites and cysts were observed in pigs No . 2 and No . 3, with the former being much more numerous . PC organisms were located on the alveolar surface or within the alveolar septa . Trophozoites had numerous filopodia and were thick-walled . Cysts had no or few filopodia, were thick-walled and contained intracystic bodies . Using non-isotopic ISH on formalin-fixed, paraffin-embedded lung tissue sections, PC DNA from pigs No . 2 and No . 3 hybridized with a probe specific for PC ribosomal RNA (rRNA) . Using primers specific for mitochondrial rRNA gene (pAZ102-E/pAZ102-H), and for the internal transcriber spacers of ribosomal gene of PC, PCR methods amplified a product in the lung of pigs No . 2 and No . 3 using either frozen or formalin-fixed and paraffin-embedded lung tissue . DNA from Pig No . 1 samples did not amplify with any primer . This is the first time that molecular biology techniques (in situ hybridization and PCR) have been applied to the study of porcine pneumocystosis.

CLAO J, 1998 Jan, 24(1), 48 - 51
Twice-a-day versus four-times-a-day ofloxacin treatment of external ocular infection; Friedlaender MH; PURPOSE: The purpose of this study was to compare the efficacies of 0.3% ofloxacin eyedrops, when given twice-a-day (BID) versus four-times-a-day (QID), for the treatment of external ocular disease . METHOD: Fifty patients with blepharitis, conjuctivitis, or blepharoconjunctivitis were randomly assigned to treatment with 0.3% ofloxacin eyedrops, BID or QID, for 10 days . Signs, symptoms, and cultures were evaluated at the beginning and at the end of the study . RESULTS: The clinical outcome was virtually identical in the two groups . There was a significant decrease in clinical scores in the BID and QID groups by days 3 to 5 (2.6-3.0 points) and a further decrease by day 11 (4.3-5.0 points) . There was no significant difference between the two groups at any time interval . Microbiologic studies showed a reduction in colony-forming units in 87% of the BID group and in 80% of the QID group . CONCLUSION: The treatment of external ocular disease with 0.3% ofloxacin eyedrops was equally effective when given BID or QID.

BMJ, 1998 Jan 24, 316(7127), 253 - 8
Epidemiology and detection of HIV-1 among pregnant women in the United Kingdom: results from national surveillance 1988-96; Nicoll A et al.; OBJECTIVE: To describe the epidemiology of HIV-1 infection in pregnant women in the United Kingdom . DESIGN: Serial unlinked serosurveillance for HIV-1 in neonatal specimens and surveillance through registers of diagnosed maternal and paediatric infections from reporting by obstetricians, paediatricians, and microbiologists . SETTING: United Kingdom, 1988-96 . SUBJECTS: Pregnant women proceeding to live births and their children . MAIN OUTCOME MEASURES: Time trends in prevalence of HIV-1 seropositivity in newborn infants (as a proxy for infection in mothers); the proportions of mothers with diagnosed HIV-1 infections, and their characteristics . RESULTS: HIV-1 prevalence among mothers in London rose sixfold between 1988 and 1996 (0.19% of women tested; 1 in 520 in 1996) . Apart from in Edinburgh and Dundee, levels remained low in Scotland (0.025%; 1 in 3970) and elsewhere in the United Kingdom (0.016%; 1 in 1930) . Over a third of births to infected mothers in 1996 occurred outside London . In London the reported infections were predominantly among black African women, whereas in Scotland most were associated with drug injecting . The contribution of reported infection among African women increased over time as that of drug injecting declined . In Scotland 51% of mothers' infections were diagnosed before the birth . In England, despite a national policy initiative in 1992 to increase the antenatal detection rate of HIV, no improvement in detection was observed, and in 1996 only 15% of previously unrecognised HIV infections were diagnosed during pregnancy . CONCLUSIONS: HIV-1 infection affects mothers throughout the United Kingdom but is most common in London . Levels of diagnosis in pregnant women have not improved . Surveillance data can monitor effectively the impact of initiatives to reduce preventable HIV-1 infections in children.

Epidemiol Mikrobiol Imunol, 1997 Sep, 46(3), 124 - 7
{Today's tasks in medical mycology}; Jesenska Z; The author analyzes contemporary tasks of mycology . Problems comprise clinical as well as environmental mycology which possesses a large amount of new findings and thus offers many research opportunities for young microbiologists.

Acta Microbiol Immunol Hung, 1997, 44(3), 291 - 4
The development and results of oral microbiology at the Semmelweis University of Medicine; Banoczy J et al.; The development of oral microbiology at the Semmelweis University of Medicine started around 1980 in the Institute of Microbiology . The teaching of oral microbiology was introduced to the dental educational program, basic research was initiated, appropriate methods learned and used . An intensive collaboration with the Department of Conservative Dentistry developed, which resulted between 1983 and 1995 in about 23 publications (the majority in international journals) and eight lectures, mainly on international forums.

Oral Microbiol Immunol, 1996 Dec, 11(6), 425 - 7
Distribution of a newly described species, Kingella oralis, in the human oral cavity; Chen C; The oral distribution of Kingella oralis was investigated in 10 periodontally healthy subjects . 11 untreated adult periodontitis patients and 6 untreated localized juvenile periodontitis patients . From each subject, 6-8 each of supra- and subgingival tooth samples, 4 mucosa samples and a saliva sample were examined by culture for the presence of K . oralis . K . oralis was found in at least one oral site in 26 of the 27 study subjects, and in at least one tooth site in each of these 26 positive subjects . Its prevalence in dental plaque ranged from 23% to 59% in different subject groups . The mean percentage of K . oralis in total microbiota in the dental plaque ranged from 0.40% in the periodontally healthy group to 4.60% in localized juvenile periodontitis subjects . The organism was a significant species in a few periodontitis sites, constituting > 5% of the total microbiota.

Onderstepoort J Vet Res, 1997 Sep, 64(3), 195 - 9
Strains of Actinobacillus spp . from diseases of animals and ostriches in Zimbabwe; Mohan K et al.; Among the Actinobacillus spp . only A . lignieresii represents a homogenous and well studied taxon . However, haemolytic and non-haemolytic strains of A . equuli and A . suis are also isolated from a wide range of diseases in a variety of hosts . These isolates often pose problems in definitive identification . Consequently, several studies have been published, emphasizing the need for detailed studies to reclassify various members of this genus and also to assess their disease significance . We isolated 48 strains of Actinobacillus from clinical cases in horses, cattle, sheep, cat, pigs and ostrich . In order to investigate the association of various taxa of Actinobacillus in different pathological conditions in these hosts, the Zimbabwean isolates were characterized in detail and assigned to the recently described taxa of Actinobacillus . Representative strains of different taxa were also confirmed at the Department of Veterinary Microbiology, Frederiksburg C, Denmark . Of the 48 isolates, 22 were identified as A . lignieresii, 13 as A . equuli; 6 as A . suis, four as belonging to Taxon 11 and one as belonging to Taxon 9 . These two taxa were recently described . Details of pathological conditions in the respective hosts and the significance of isolation, are discussed . We have reported for the first time isolation of A . lignieresii from a post-operative wound in a cat and there is also a first report of isolation from an ostrich . We considered A . equuli to be the primary cause of equine abortion and septicaemia, and Taxon 9 as causing "sleepy foal" disease . We did not encounter any case of "wooden tongue", but isolated A . lignieresii from cases of superficial lymphadenitis in cattle and sheep . This appears to be a first report of detailed descriptions of Zimbabwean strains of Actinobacillus spp.

J Clin Microbiol, 1998 Feb, 36(2), 526 - 30
Evaluation of PCR primers for early diagnosis of cytomegalovirus infection following liver transplantation; Mendez JC et al.; The availability of microbiologic methods that detect early replication of cytomegalovirus (CMV) posttransplantation will enhance the process of initiating preemptive antiviral therapy prior to the appearance of CMV disease . Using PCR techniques we sought to determine which region of the CMV genome present in peripheral blood leukocytes (PBLs) or serum provides the highest sensitivity for the detection of CMV posttransplantation . Blood samples were prospectively collected weekly for at least 8 weeks from a cohort of 21 consecutive liver transplant recipients not receiving anti-CMV prophylaxis . Results of PCR assays were correlated with recovery of CMV in cell cultures and histopathological findings from biopsy specimens of infected organs to assess clinical symptomatic infection . Of 148 specimens, primer pairs directed to the HindIII-X fragment region of CMV detected target DNA with a 94% sensitivity, compared to an 87% sensitivity with primer pairs directed to EcoRI fragment D, 32% sensitivity with primer pairs directed to the immediate-early antigen 1 gene (IEA1 gene), and 20% sensitivity with primer pairs directed to the major immediate-early (MIE) gene . The performance characteristics in terms of the sensitivity of primers for amplifying CMV DNA associated with symptomatic infection ranged from 100% (HindIII-X) to 20% (MIE gene); however, specificity was inversely related (HindIII-X, 45%; MIE gene, 91%) to primers directed to these gene targets . When HindIII-X and EcoRI-D primer sets were used, CMV DNA from PBLs was a more sensitive target than CMV DNA from serum for the early detection of symptomatic CMV infection (17 versus 12 days) . Importantly, CMV DNA was not detected in five patients with no evidence of this viral infection . In conclusion, primers directed to the HindIII-X fragment region were the most optimal for the early detection of CMV DNA in PBLs and sera from symptomatic liver transplant recipients.

Appl Environ Microbiol, 1998 Feb, 64(2), 492 - 5
Engineering of a cold-adapted protease by sequential random mutagenesis and a screening system; Taguchi S et al.; A cold-adapted protease subtilisin was successfully isolated by evolutionary engineering based on sequential in vitro random mutagenesis and an improved method of screening (H . Kano, S . Taguchi, and H . Momose, Appl . Microbiol . Biotechnol . 47:46-51, 1997) . The mutant subtilisin, termed m-63, exhibited a catalytic efficiency (expressed as the kcat/Km value) 100% higher than that of the wild type at 10 degrees C when N-succinyl-L-Ala-L-Ala-L-Pro-L-Phe-p-nitroanilide was used as a synthetic substrate . This cold adaptation was achieved with three mutations, Val to Ile at position 72 (V72I), Ala to Thr at position 92 (A92T), and Gly to Asp at position 131 (G131D), and it was found that an increase in substrate affinity (i.e., a decreased Km value) was mostly responsible for the increased activity . Analysis of kinetic parameters revealed that the V72I mutation contributed negatively to the activity but that the other two mutations, A92T and G131D, overcame the negative contribution to confer the 100% increase in activity . Besides suppression of the activity-negative mutation (V72I) by A92T and G131D, suppression of structural stability was observed in measurements of activity retention at 60 degrees C and circular dichroism spectra at 10 degrees C.

J Dent Assoc S Afr, 1996 Dec, 51(12), 726 - 9
Peer-reviewed oral and dental research output in South Africa, 1990-1994; Dreyer WP et al.; The aim of this project was to determine the oral and dental research output in South African dental schools over a 5-year period . All refereed research articles emanating from South African dental schools which appeared in peer-reviewed journals during the 5 year period, 1990-1994, and which could be traced, were recorded, scrutinized and classified according to the thrust of the research . During this period the 5 schools published 494 articles, 176 from the University of the Witwatersrand, 145 from the University of Stellenbosch, 85 from the University of Pretoria, 54 from the Medical University of Southern Africa and 34 from the University of the Western Cape . Papers were classified into 22 categories . The majority were produced in oral biology, oral pathology and microbiology and dental materials, followed by pharmacology and anaesthetics, epidemiology, community dentistry, preventive dentistry and prosthetic dentistry . A number of articles featured in the rest of the categories . Fifty-five per cent of manuscripts appeared in overseas journals while the bulk of locally published contributions featured in the Journal of the Dental Association of South Africa . The output of research remained constant over the 5 year period with a slight increase of articles in dental materials . The findings indicate that the South African dental schools may have reached a limit in their capacity to produce peer-reviewed research.

Eur J Biochem, 1997 Dec 15, 250(3), 758 - 63
Structure of a hydroxymycolic acid potentially involved in the synthesis of oxygenated mycolic acids of the Mycobacterium tuberculosis complex; Quemard A et al.; Mycolic acids are believed to play a crucial role in the architecture of the mycobacterial envelope . However, very few steps of their biosynthetic pathway have yet been elucidated . We previously isolated {Dubnau, E., Laneelle, M . A., Soares, S., Benichou, A., Vaz, T., Prome, D., Prome, J . C., Daffe, M . & Quemard, A . (1997) Mycobacterium bovis BCG genes involved in the biosynthesis of cyclopropyl keto- and hydroxy-mycolic acids, Mol . Microbiol . 23, 313-322} a gene cluster from Mycobacterium bovis BCG, cmaA-D, which confers upon M . smegmatis the ability to synthesize cyclopropanated ketomycolic acid, and a new type of mycolic acid which is hydroxylated . A meticulous analysis of all the mycolic-like fatty acids of M . bovis BCG and M . tuberculosis showed that these organisms produce small amounts of the hydroxymycolic acid . The structure of this molecule, determined by NMR spectroscopy, mass spectrometry and stereochemical studies, strongly suggests that there is a direct biosynthetic relationship between the keto- and the hydroxy-mycolic acids.

J Laparoendosc Adv Surg Tech A, 1997 Apr, 7(2), 87 - 94
The fate of intraperitoneally retained gallstones with different morphologic and microbiologic characteristics: an experimental study; Yerdel MA et al.; Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known . This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model . Forty albino mice were divided into four groups . Group I served as the control group (simple laparotomy, n = 10) . Groups II, III, and IV (n = 10 in each group) were study groups . "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) {group IVa} and "crushed" (n = 5) {group IVb} "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals . Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection . Animals were sacrificed 6 and 12 weeks after the operations . Cultures and tissue samples were obtained . No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative . In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered . The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III . In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice . All remaining mice showed severe adhesions with localized abscesses at the 12th week . In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder . It is for this group of patients that laparotomy for total stone clearance is probably not justifiable . Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.

J Infect, 1997 Nov, 35(3), 289 - 94
A study of 42 episodes of overwhelming post-splenectomy infection: is current guidance for asplenic individuals being followed?
Waghorn DJ, Mayon-White RT.
Individuals without a spleen have an increased risk of overwhelming post-splenectomy infection (OPSI) . Improved awareness in recent years has stimulated increased efforts to prevent OPSI . Published guidelines have described policies for immunization, chemoprophylaxis and other measures considered beneficial to asplenic patients, yet OPSI episodes continue to occur . In an attempt to investigate why serious infections are still being seen, we have conducted a nationally based survey of recent OPSI episodes, using mainly a network of medical microbiologists . Data including clinical background to both splenectomy and OPSI episode, immunization and chemoprophylaxis history have been collated . Forty-two cases of overwhelming infection were reported by June 1996 . Patients of all ages were affected with OPSI occurring up to 59 years after splenectomy . A mortality rate of 45% was seen . Pneumococcal infection caused at least 37 of 42 episodes, but only 12 patients had received pneumococcal vaccine . Four cases were possible vaccine failures . Only 22% of individuals had taken any chemoprophylaxis since splenectomy, and only one carried a medical alert card . Much more needs to be done to ensure that asplenic patients are warned of the risks of infection, and given at least pneumococcal vaccine . The role of antibiotics for either continual prophylaxis or as a reserve supply for self-prescription at appropriate times also needs greater discussion . Further work on improving pneumococcal vaccine response together with suitable programmes for revaccination are required . Surveillance should continue until the incidence of OPSI reaches an irreducible minimum.

Rev Biol Trop, 1997 Jun, 45(2), 753 - 71
In search of a bacterial species definition; Moreno E; The bacterial species concept was examined within the framework of plant and animal associated alpha-2 proteobacteria, taking into consideration the phylogenetic, taxonomic and biological approaches as well as the microbiologists' perception . The virtue of the phylogenetic approach is that it gives an evolutionary perspective of the bacterial lineage; however the methods used possess low resolution for defining species located at the terminal branches of the phylogenetic trees . The merit of the taxonomic approach is that species are defined on the basis of multiple characteristics allowing high resolution at the terminal branches of dendograms; its disadvantage is the inaccuracy in the earlier nodes . On an individual level, the qualitative biological characteristics used for the definition of species frequently reveal shortcomings because many of these properties are the result of coevolution, parallel evolution or the horizontal transfer of genes . Nevertheless, when considered together with the phylogenetic and taxonomic approaches, important uncertainties are discovered: these must be weighed if a practical definition of bacterial species is conceived . The microbiologists' perception is the criterion expressed by a group of sponsors who, based on scientific and practical grounds, propose a new bacterial species . The success of this new proposal is measured by its widespread acceptance and its permanence . A difficult problem concerned with defining bacterial species is how to distinguish if they are independent evolutionary units or if they are reticulate evolutionary units . In the first case the inherence is vertically transmitted as a result of binary fission and clonal expansion . This may be the case of some animal cell associated bacteria in which recombination appears to be precluded or exceptional . In the second case adaptive changes occurring within an individual can be horizontally transferred to many or all group members . This seems to be the condition of many intestinal and plant associated bacteria . Genetic drift and speciation in clonal bacteria will depend almost exclusively on mutation and internal genetic rearrangement processes, whereas speciation in reticulate bacteria will depend not only on these processes but in their genetic interactions with other bacterial strains . This uncertainty, which corresponds to the evolutionary process, is at the same time one of the key factors in defining a bacterial species.

Respirology, 1996 Mar, 1(1), 31 - 7
DNA diagnosis of pulmonary infections: particular emphasis on Mycobacterium tuberculosis; Tan WC et al.; The past two decades have brought significant changes to the clinical laboratory . Microbiologists now have highly sensitive, rapid and specific molecular methods of identifying infectious agents by the direct detection of DNA or RNA sequences unique to a particular organism . Advanced DNA technology such as nucleic-acid hybridization, PCR and DNA fingerprinting have been used in the direct detection of causative organisms in clinical specimens, with resultant benefits such as increased sensitivity and specificity of the diagnostic approach and reduction of turnaround time . This review outlines a brief description of the various DNA diagnostic tools used in the detection of pulmonary infections with emphasis on their applications in the diagnosis of Mycobacterium tuberculosis.

J Clin Microbiol, 1998 Jan, 36(1), 309 - 10
Case of triple endocarditis caused by Rothia dentocariosa and results of a survey in France; Kong R et al.; This is the first case of endocarditis in which Rothia dentocariosa was cultured from three affected valves . In addition, the records of two microbiology laboratories in France showed that R . dentocariosa was rarely involved in severe infection and that positive blood cultures were not associated with endocarditis.

J Clin Microbiol, 1998 Jan, 36(1), 277 - 80
Detection and confirmation of Mycoplasma pneumoniae in urogenital specimens by PCR; Sharma S et al.; Following the isolation of Mycoplasma pneumoniae from urogenital specimens (M . Goulet, R . Dular, J . G . Tully, G . Billows, and S . Kasatiya, J . Clin . Microbiol . 33:2823-2825, 1995), a study was undertaken to confirm the observations by PCR . Specific primers directed to the P1 adhesin gene of M . pneumoniae were used . A total of 300 genital specimens were tested for M . pneumoniae and Mycoplasma genitalium by culture and PCR . Of these, 15 were positive by culture and 17 were positive by PCR for M . pneumoniae . No M . genitalium was detected in any of the specimens by either method . The present study demonstrates that PCR is sensitive and rapid compared to cumbersome culture methods and can be used to detect M . pneumoniae in urogenital specimens in a routine diagnostic laboratory.

J Clin Microbiol, 1998 Jan, 36(1), 168 - 78
Evaluation of four DNA typing techniques in epidemiological investigations of bovine tuberculosis; Cousins D et al.; DNA fingerprinting techniques were used to type 273 isolates of Mycobacterium bovis from Australia, Canada, the Republic of Ireland, and Iran . The results of restriction fragment length polymorphism (RFLP) analysis with DNA probes from IS6110, the direct repeat (DR), and the polymorphic GC-rich sequence (PGRS) were compared with those of a new PCR-based method called spacer oligonucleotide typing (spoligotyping) developed for the rapid typing of Mycobacterium tuberculosis (J . Kamerbeek et al., J . Clin . Microbiol . 35:907-914, 1997) . Eighty-five percent of the isolates harbored a single copy of IS6110, and 81.5% of these carried IS6110 on the characteristic 1.9-kb restriction fragment . RFLP analysis with IS6110 identified 23 different types, RFLP analysis with the DR probe identified 35 types, RFLP analysis with the PGRS probe identified 77 types, and the spoligotyping method identified 35 types . By combining all results, 99 different strains could be identified . Isolate clusters were frequently associated within herds or were found between herds when epidemiological evidence confirmed animal movements . RFLP analysis with IS6110 was sufficiently sensitive for the typing of isolates with more than three copies of IS6110, but RFLP analysis with the PGRS probe was the most sensitive typing technique for strains with only a single copy of IS6110 . Spoligotyping may have advantages for the rapid typing of M . bovis, but it needs to be made more sensitive.

Sangre (Barc), 1997 Jun, 42(3), 159 - 64
{Determination of the cytokine level during storage of partially leukocyte-depleted (<0.5 x 10(9)) or totally leukocyte-depleted (<0.5 x 10(6)) platelets}; Algora M et al.; PURPOSE: To evaluate the levels of interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) during the storage of pools of PCs obtained after removing the buffy-coat, in comparison with the amount of leukocytes present in these components . MATERIAL AND METHODS: Blood was collected in quadruple-bag-system containing 63 mL of CPD as anticoagulant and 100 mL of SAG-M solution as additive for the red cells . Approximately twelve hours after collection, blood separation was made automatically by Compomat (NPBI) and platelet concentrates were prepared from the buffy-coat fraction . Five or six PCs were mixed to obtain a pool (n = 28) . Eight pools were WBC reduced by filtration (PXL-8, Pall Espana) . Before storage a sample of each pool was obtained in order to count platelets and WBC as basal values . All kind of pools were stored at room temperature with continuous agitation during a period of 10 days . Volumes were measured by weight and specific gravity . Platelets and leukocytes were counted in the Coulter-counter (STKR Counter . Izasa) or in Nageotte chamber for the filtered products . On days 1, 4 and 7 interleukins were measured by ELISA (EASIA Kits, Medgenix Diagnostics, Brussels), Lecture was done at 450 nm using a spectophotometer (ANTHOS 2001) . Lower limits of sensitivity were 2 pg/mL for IL-1 beta and 3 pg/mL for IL-6 and TNF-alpha according to the manufacturer . Wilcoxon test was used for statistical analysis . RESULTS: The average volume of the pools was 460 mL and 374 for the filtered ones . The total platelet amount was 3.63 x 10(11) and 2.8 x 10(11) respectively, with a WBC contamination of 380 x 10(6) and 0.54 x 10(6) for the filtered . The yield of platelets after filtration was 84% with a loss of 99.90% of WBC (3-log) . The measures of interleukins were not homogeneous, but a great variability was found shown among the different pools, not always in relationship with the amount of leukocytes . The levels of IL-1 beta were 3.58 pg/mL on day 1, 6.36 pg/mL on day 4 and 8.76 pg/mL on day 7 (p < 0.005) . For the IL-6 we found 13.08 pg/mL on day 1, 15.43 pg/mL on day 4 and 19.77 on day 7 (p < 0.05) . For the TNF-alpha, 13.65 pg/mL an day 1,24.33 pg/mL on day 4 and 30.10 pg/mL on day 7 (p < 0.05) . In the filtered pools the detections of IL-1 beta and IL-6 were always under the sensibility threshold, but there was an increment of TNF-alpha on day 7 (16.91 pg/mL) . Microbiologic cultures were always negative . CONCLUSION: The accumulation of IL-1 beta, IL-6 and TNF-alpha is not prevented by the fact of removing the buffy-coat layer when preparing PCs, although these levels are considerably lower in comparison with those obtained by the PRP technic . Filtration of pooled PCs avoids the presence of these cytokines except TNF-alpha, where a low amount can be detected.

Electrophoresis, 1997 Sep, 18(10), 1709 - 14
Capillary electrophoresis of DNA for molecular diagnostics; Righetti PG et al.; A number of applications of capillary zone electrophoresis (CZE) in sieving liquid polymers (notably linear polyacrylamides and cellulose) for the analysis of polymerase chain reaction (PCR) products of clinically relevant, diagnostic DNA, are reviewed . The fields covered are: human genetics, quantitative gene dosage, microbiology and virology, forensic medicine and therapeutic DNA (notably, antisense nucleotides) . Some unique, novel developments are highlighted, such as: (i) nonisocratic CZE, i.e., temperature-programmed CZE for detection of DNA point mutations; (ii) the synthesis of novel N-substituted acrylamides, offering extreme resistance to alkaline hydrolysis coupled to high hydrophilicity . In the field of denaturing gradient gel electrophoresis (DGGE), as routinely performed in gel slabs, a novel methodology is described in CZE: double-gradient DGGE . In this technique, two gradients are simultaneously applied along the migration direction: a chemical (or thermal) denaturing gradient, for partially unwinding homo- and hetero-duplexes of DNA, and a porosity gradient, for recompacting diffuse bands melting over a broader range of denaturing conditions . It is thus demonstrated that chemical gradients, in addition to temperature gradients, can be easily implemented even in a capillary format.

Surg Laparosc Endosc, 1997 Oct, 7(5), 426 - 8
Laparoscopic management of ruptured pyogenic liver abscess; Siu WT et al.; Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness . Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis . We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically . The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples . A thorough peritoneal lavage could be also performed . The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.

Oral Dis, 1997 May, 3 Suppl 1, S54 - 7
Intergroup comparisons of oral lesions in HIV-positive South Africans; Arendorf TM et al.; OBJECTIVE: To determine whether there are any differences in the oral manifestations of sub-groups of persons with HIV . These data could provide information for planning of oral health promotion and prevention programmes . DESIGN: A comparative inter-group cross-sectional investigation of the oral manifestations of HIV . Ethnic, gender and sexual orientation differences were taken into consideration . SETTING: Three large general hospitals that offer comprehensive medical investigations and care to persons with HIV . SUBJECTS AND METHODS: A total of 485 HIV-positive adults participated . Clinical examination and, where necessary, swabs or smears of lesions for microbiology, biopsies for histology . MAIN OUTCOME MEASURES: Presence of lesions, associated signs, incidence and type of micro-organisms . RESULTS: A total of 485 HIV-positive persons were examined over a period of 3 years consisting of 225 Blacks, 191 Coloureds (persons of 'mixed' descent) and 69 Whites . Data were analysed using, where relevant, the chi 2 test or Fisher's exact test . Heterosexual males revealed a higher prevalence of all oral lesions combined when compared with heterosexual females . A similar finding was evident when HIV-associated periodontal diseases was compared in these two groups . Homosexual males had a higher prevalence of candidal infections than heterosexual males . Coloured heterosexuals had a higher prevalence of oral lesions combined than black heterosexuals . All these results showed statistical significance . CONCLUSIONS: The study tends to show that different patterns of prevalence emerge when inter-group comparisons are made of oral soft tissue diseases evident in HIV-infected South Africans.

Am Heart J, 1998 Jan, 135(1), 130 - 7
Skeletal muscle myosin heavy chains in heart failure: correlation between magnitude of the isozyme shift, exercise capacity, and gas exchange measurements; Vescovo G et al.; BACKGROUND: Patients with congestive heart failure (CHF) have a reduced exercise capacity because of the early appearance of fatigue and dyspnea . Qualitative changes in the skeletal muscle composition and metabolism can be responsible for the origin of symptoms METHODS: We correlated the myosin heavy chain (MHC) composition of the gastrocnemius in 20 patients with different degrees of CHF to NYHA class, diuretic consumption, echocardiographic parameters, and expiratory gases measured during cardiopulmonary exercise testing . MHC composition was determined electrophoretically in skeletal muscle needle microbiopsies and the percent distribution was calculated by densitometry . Maximal cardiopulmonary exercise testing was performed on a treadmill with a modified Naughton protocol . A capnograph was used . RESULTS: There was no correlation between ejection fraction, left ventricular end systolic diameter, left ventricular end diastolic diameter, and MHC composition . We found a significant positive correlation between the percentage of MHC 1 (slow aerobic isoform) and NYHA class (r2 = 0.62, p < 0.0001), peak VO2 (r2 = 0.5, p < 0.0004), ventilatory threshold (VT) (r2 = 0.33, p = 0.008) and O2 pulse (peak VO2/HR) (r2 = 0.40, p = 0.003) . There was a negative correlation between both MHC2a (fast oxidative) and MHC2b (fast glycolytic) with peak VO2 (r2 = 0.38, p = 0.004 and r2 = 0.37, p = 0.004, respectively), VT (r2 = 0.2, p = 0.046 and r2 = 0.34, p = 0.007, respectively), and O2 pulse (peak VO2/HR) (r2 = 0.39, p = 0.003 and r2 = 0.23, p = 0.03) . NYHA class was also correlated positively with MHC2a and MHC2b (r2 = 0.46, p = 0.001 and r2 = 0.41, p < 0.006, respectively) and negatively with the same clinical and functional parameters . CONCLUSIONS: The correlation between the magnitude of the MHC shift from the slow aerobic to the fast glycolytic and fast oxidative with both functional and objective measurements of exercise capacity (peak VO2, VT, O2 pulse) seem to suggest that changes in skeletal muscle composition may play a determining role in exercise tolerance in patients with CHF.

Vet Microbiol, 1997 Nov, 58(2-4), 187 - 93
Evaluation of polymerase chain reaction for detection of Mycoplasma meleagridis infection in turkeys; Moalic PY et al.; Different methods were compared for the detection of the turkey pathogen Mycoplasma meleagridis in a turkey field flock before and after antibiotic (oxytetracycline) treatment . They included culture, serology (detection of antibodies by ELISA) and a polymerase chain reaction (PCR) based assay developed by Boyle et al . {Boyle, J.S., Good, R., Morrow, C.J., 1995 . Detection of the turkey pathogens Mycoplasma meleagridis and M . iowae by amplification of genes coding for rRNA . J . Clin . Microbiol . 33, 1335-1338} . Culture and PCR assay with tracheal swab samples were much more sensitive than ELISA with serum samples . Percentages of infected birds detected by culture or PCR for samples collected prior to antibiotic treatment were almost identical but the percentage of positive samples detected after antibiotic treatment was much higher with the PCR test.

Cent Afr J Med, 1997 Jun, 43(6), 165 - 72
Subtypes of HIV-1 and the impact of dual infections of HIV-1 and measles virus on micronutrient levels of pregnant women in Harare, Zimbabwe; Obi CL et al.; OBJECTIVE: To determine subtypes of HIV-1, simultaneous prevalence of HIV-1 and measles virus antibodies and their impact on micronutrient levels of pregnant women in Harare, Zimbabwe . DESIGN: Cross sectional . SETTING: Budiriro and Edith Opperman Antenatal Clinics Harare; Departments of Medical Microbiology, Medical Laboratory Technology and Institute of Food, Nutrition and Family Sciences, University of Zimbabwe . SUBJECTS: Pregnant women attending antenatal clinics in Harare, Zimbabwe . MAIN OUTCOME MEASURES: HIV-1 subtypes, measles virus seropositivities and levels of micronutrients among the pregnant women . RESULTS: Results showed that 101 (22.7%) out of a total of 444 pregnant women screened were HIV-1 positive . A separate group of 238 (inclusive of the 444) were screened for measles antibody and 118 (49.5%) were positive, whereas 41 (17.2%) were HIV-1 positive . Thirty five (29.7%) were seropositive for both HIV-1 and measles virus (simultaneous infection) . HIV-1 subtypes revealed subtype C (70.4%) as the predominant subtype . HIV-1 subtypes B, A and D accounted for 40.8%, 39.8% and 22.4% respectively whereas HIV-1 subtypes E and F were not detected . Dual infections showed that 37.7%, 36.7%, 7.1% and 4.4% harboured subtypes A and C; B and C; A and D and B and D respectively . Multiple infections with subtypes A, B, C and D (5.1%) were also recorded whereas 9.2% were non-reactive . Results on micronutrients portrayed that HIV-1 positive pregnant women had significantly lower zinc than the control but co-infection with measles virus did not cause further decrease . Infection by either HIV-1 or measles virus increased serum copper (p < 0.05) but co-infection by the two viruses reduced the copper level significantly (p < 0.05) . HIV-1 seropositivity did not affect serum magnesium level but was lower (p < 0.05) in women positive for both HIV-1 and measles virus . CONCLUSION: This is a single report on HIV-1 infection, HIV-1 subtypes, simultaneous prevalence of HIV-1 and measles virus antibodies and their impact on micronutrient levels of pregnant women in Harare, Zimbabwe . The study is of nutritional, clinico-epidemiologic importancePIP: HIV and measles virus seropositivities among pregnant women in Harare, Zimbabwe, are 30.4% and 28.9%, respectively . Measles and HIV/AIDS are both associated with persistent diarrhea, opportunistic infections, nutritional status, and neurological problems . Both viruses also have an affinity for lymphocytes . Findings are presented from an investigation of HIV-1 infections, HIV-1 genotypes/subtypes, measles virus seropositivities, and micronutrient status among pregnant women screened in Harare . 101 (22.7%) of the 444 pregnant women screened were HIV-1 seropositive . 118 (49.5%) of the 238 women screened for measles antibody were seropositive only for measles virus, while 41 (17.2%) of the 238 were seropositive for HIV-1 only . 35 (29.7%) of the 118 pregnant women seropositive for antibody to the measles virus were also seropositive for HIV-1 . HIV-1 clades of 98 HIV-1 positive samples were determined . 69 (70.4%) HIV-1-infected women were infected with HIV-1 subtype C . HIV-1 subtypes B, A, and both types of D accounted for 40.8%, 39.8%, and 22.4% of infections, respectively . Subtypes E and F were not detected . 37.7% of the HIV-1 positive women were infected with both subtypes A and C, 36.7% with B and C, 7.1% with A and D, and 4.4% with B and D . 5.1% of the women were infected with subtypes A, B, C, and D . Micronutrient examination found that HIV-1-positive pregnant women had significantly lower serum zinc than did control subjects; co-infection with measles virus caused no additional decrease . Infection with either HIV-1 or measles virus increased serum copper, but co-infection with the 2 viruses significantly reduced the copper level . HIV-1 seropositivity did not affect serum magnesium level, but was lower in women positive for both HIV-1 and measles virus .

Gynecol Obstet Invest, 1997, 44(4), 260 - 4
A clinical method for testing the safety of catamenial pads; Farage-Elawar MA et al.; Methods are described for assessing the gynecologic, dermatologic, and microbiologic effects of deodorant and non-deodorant catamenial pad use over a 6-month period . A controlled, randomized, investigator-blind parallel study was conducted with 190 women between the ages of 18 and 45 years . Data on medical histories, physical examinations, diagnostic laboratory tests, gynecologic and dermatologic examinations and microbiology were collected . No significant differences in gynecologic, dermatologic, or microbiologic parameters were observed between control and treated groups, and no pad-related adverse health effects were observed in this clinical study.

J Periodontol, 1997 Dec, 68(12), 1194 - 205
Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications . A literature review; Greenstein G; This paper addresses the diagnostic and therapeutic implications of increased probing depths . In general, in untreated and treated patients, when deep and shallow probing depths are compared, the data indicate that deep sites are associated with increased bleeding upon probing, elevated subgingival temperatures, higher levels of pathogens, more probing errors, a greater amount of infiltrated connective tissue, reduced ability to remove subgingival deposits with root planing, and diminished effectiveness of oral hygiene to alter the subgingival microbiota . Clinical trials demonstrate that probing depth is not a good predictor of future disease progression . However, deep sites are at greater risk of disease progression than shallow sites in untreated and treated patients . Furthermore, the deeper the probing depth, the greater the risk of future disease progression . Overall, the preponderance of evidence indicates that it is advantageous, but not always necessary, for patients to have shallow probing depths . With regards to surgical reduction of probing depths beyond that attained with non-surgical therapy, clinicians need to consider the advantages (e.g., ease of maintenance, reduced risk of disease progression) and disadvantages (e.g., root sensitivity, cosmetic defects) of treatment procedures . Since numerous variables require consideration (e.g., response to root planing, goals of therapy, acceptable level of risk for future disease progression), treatment decisions will vary depending on the patient and the desired clinical outcome at specific sites.

J Clin Periodontol, 1997 Dec, 24(12), 881 - 7
Effect of triclosan on the subgingival microbiota of periodontitis-susceptible subjects; Rosling B et al.; The present study evaluated the long-term effect of (i) meticulous self-performed, supragingival plaque control and (ii) the use of a triclosan/copolymer containing dentifrice in adult subjects susceptible to destructive periodontitis . 40 individuals were recruited into the trial . 3-5 years prior to the baseline examination, they had all been treated by nonsurgical means- for advanced periodontal disease . During the subsequent maintenance phase, all subjects had at different time intervals exhibited sites with recurrent periodontitis . At a baseline examination, 6 surfaces per tooth were examined regarding bleeding on probing, probing pocket depth, and probing attachment level . The deepest pocket site in each quadrant (i.e . 4 sites per subject) was selected and samples of the subgingival bacteria were taken . At baseline, all volunteers received detailed information on proper oral hygiene techniques . This information was repeated on an individual need basis during the course of the subsequent 36-months . No professional subgingival therapy was delivered between the baseline and the 36-month examinations . The subjects were randomly distributed into 2 equal groups of 20 individuals each, 1 test and 1 control group . The members of the test group were supplied with a fluoridated dentifrice containing triclosan/copolymer (Total, Colgate), while the controls received a corresponding dentifrice but without triclosan/copolymer . The findings demonstrated that in subjects with advanced and recurrent periodontitis, carefully practiced supragingival plaque control had some effects on the subgingival microbiota, but also that this was insufficient to prevent disease progression . In a corresponding group of subjects, however, who used a triclosan/copolymer dentifrice, the subgingival microbiota was reduced in both quantitative and qualitative terms and recurrent periodontitis was almost entirely prevented.

J Biol Chem, 1998 Jan 23, 273(4), 1933 - 8
Identification of DNA gyrase inhibitor (GyrI) in Escherichia coli; Nakanishi A et al.; DNA gyrase is an essential enzyme in DNA replication in Escherichia coli . It mediates the introduction of negative supercoils near oriC, removal of positive supercoils ahead of the growing DNA fork, and separation of the two daughter duplexes . In the course of purifying DNA gyrase from E . coli KL16, we found an 18-kDa protein that inhibited the supercoiling activity of DNA gyrase, and we coined it DNA gyrase inhibitory protein (GyrI) . Its NH2-terminal amino acid sequence of 16 residues was determined to be identical to that of a putative gene product (a polypeptide of 157 amino acids) encoded by yeeB (EMBL accession no . U00009) and sbmC (Baquero, M . R., Bouzon, M., Varea, J., and Moreno, F . (1995) Mol . Microbiol . 18, 301-311) of E . coli . Assuming the identity of the gene (gyrI) encoding GyrI with the previously reported genes yeeB and sbmC, we cloned the gene after amplification by polymerase chain reaction and purified the 18-kDa protein from an E . coli strain overexpressing it . The purified 18-kDa protein was confirmed to inhibit the supercoiling activity of DNA gyrase in vitro . In vivo, both overexpression and antisense expression of the gyrI gene induced filamentous growth of cells and suppressed cell proliferation . GyrI protein is the first identified chromosomally nucleoid-encoded regulatory factor of DNA gyrase in E . coli.

Int J Tuberc Lung Dis, 1997 Oct, 1(5), 454 - 9
Rapid and improved recovery rate of Mycobacterium tuberculosis in Mycobacteria Growth Indicator Tube combined with solid Löwenstein Jensen medium; Rivera AB et al.; SETTING: Clinical microbiology laboratory with limited resources in a developing country . OBJECTIVE: To determine the recovery rate of Mycobacterium tuberculosis (MTB) in Mycobacteria Growth Indicator Tube (MGIT) combined with Lowenstein Jensen (LJ) culture medium . DESIGN: Stock cultures and reference strains of mycobacteria and clinical specimens were inoculated into MGIT and onto LJ . The combined recovery rate was determined and time to positive culture in each medium was compared . RESULTS: All known stock and reference cultures of mycobacteria grew in both media . MGIT combined with LJ increased the recovery rate from 109 (63.4%) to 122 (70.9%) of 172 clinical specimens . Of those isolated, the yield in MGIT (99.2%) exceeded that in LJ (89.3%) . The average day to detection of MTB in MGIT was earlier by 14.2 days compared to LJ (15.7 days vs . 29.9 days) . For mycobacteria other than tuberculosis (MOTT), there was little difference in the recovery time, except for M . kansasii where growth in MGIT was earlier by one week and M . triviale where growth in MGIT was detected later than LJ . CONCLUSION: MGIT is an excellent system for the rapid isolation of mycobacteria . It increases the recovery rate of MTB when combined with LJ.

Int J Tuberc Lung Dis, 1997 Oct, 1(5), 446 - 53
Risk factors for relapse in human immunodeficiency virus type 1 infected adults with pulmonary tuberculosis; Johnson JL et al.; SETTING: A study conducted by the Uganda-Case Western Reserve University Research Collaboration in Kampala, Uganda, a country with high incidence rates of tuberculosis (TB) and human immunodeficiency virus type 1 (HIV-1) infection . OBJECTIVE: To assess clinical, microbiologic and radiographic factors associated with risk for relapse in HIV-infected adults treated for initial episodes of pulmonary TB . DESIGN: Nested case-control study within a randomized prospective clinical trial comparing the safety and efficacy of thiacetazone- and rifampicin-containing regimens for TB treatment in HIV-infected adults . RESULTS: The analysis was based on 119 patients who completed therapy . Median follow-up for all subjects was 22.3 months . Ten patients relapsed a median of 12.7 months after the end of therapy; seven of these were initially treated with the thiacetazone (T)-containing regimen . Each relapse case was matched to four controls by length of follow-up after initial TB treatment . In a univariate analysis risk for relapse was associated with treatment with the T-containing regimen (OR = 4.2, P = 0.08), age > or = 30 yrs (OR = 2.9, P = 0.16), and irregular compliance (OR = 3.6, P = 0.1) . Baseline anergy on Mantoux tuberculin skin testing, cavitary disease, radiographic extent of disease and sputum bacillary burden, two month culture negativity, and residual cavitary disease at the end of treatment did not differ between relapses and controls . CONCLUSION: Older HIV-1 infected patients, those with poor treatment compliance, and those being treated with T-containing regimens, may be at increased risk for relapse after TB treatment and require closer post-treatment surveillance . Risk for relapse in HIV-infected adults with pulmonary TB after treatment with a nine month rifampicin-containing regimen was low (3.1 per 100 person-years observation) compared with those treated with a thiacetazone-containing regimen (10.1 per 100 person-years observation).

Sex Transm Dis, 1998 Jan, 25(1), 14 - 9
Can serology diagnose upper genital tract Chlamydia trachomatis infections? Studies on women with pelvic pain, with or without chlamydial plasmid DNA in endometrial biopsy tissue; Chernesky M et al.; BACKGROUND: Upper genital tract chlamydial infections in women are on the increase, and serology might be a convenient tool for diagnosis . Evaluations of this approach are needed in women with or without microbiologic evidence of organisms in the upper genital tract . GOALS: To compare the results of antibody assays with cervical culture and upper genital tract histopathology in women with pelvic pain and chlamydial plasmid DNA in endometrial biopsies . STUDY DESIGN: Chlamydia trachomatis plasmid DNA was detected by polymerase chain reaction (PCR) on extracted deparaffinized endometrial biopsy tissue . Five antichlamydial antibody assays were performed measuring total antibodies or immunoglobulin G (IgG), IgM, and IgA classes on sera from 14 women with plasmid DNA as well as 31 without plasmid DNA . RESULTS: Accepting the presence of plasmid DNA as the gold standard, no single test had total diagnostic accuracy . The best sensitivity and specificity occurred with the following assays: whole inclusion fluorescence (WIF) (100% and 80.6%); microimmunofluorescence IgM (MIF IgM) (78.6% and 93.6%); and heatshock protein-60 enzyme immunoassay (42.9% and 100%) . Although recombinant anti-lipopolysaccharide enzyme-linked immunosorbent assays measured anti-chlamydial antibodies in a large proportion of these women, specificity was low . The sensitivity and specificity of cervical culture was 28.6% and 100% and of endometrial histopathology was 71.4% and 48.4% . Analysis of patient serological profiles suggested that and 6 women without plasmid DNA may have been cases that were missed by PCR . CONCLUSIONS: Evaluations of assays to diagnosis Chlamydia trachomatis upper genital tract infections could use the presence of organisms or their markers in the upper genital tract as a standard of comparison . Some of these serological assays, such as WIF or MIF IgM, may be helpful in diagnosis, but more studies are needed.

Cornea, 1998 Jan, 17(1), 17 - 22
Clinicomicrobiological review of Nocardia keratitis; Sridhar MS et al.; PURPOSE: To present the clinical profile, laboratory results, and outcome of treatment in 16 patients with Nocardia keratitis . METHODS: A retrospective review of 16 culture-proven cases of Nocardia keratitis was done . Clinical and microbiologic data were analyzed . RESULTS: Nocardia constituted 1.7% of laboratory-confirmed bacterial keratitis and was seen predominantly in male subjects (13 of 16) with a mean age of 39.1 years . Although the predisposing factor was unknown in the majority, a definite history of trauma was present in four (25%) cases . Patchy stromal infiltrates were seen in 12 patients . Wreath pattern of infiltrates (six of 16) and hypopyon (nine of 16) were notable features . Nocardia was detectable in corneal scrapings of 10 patients with Gram stain and all patients with 1% acid-fast preparation (six of six) . Nocardia asteroides was the causative agent in all except one (N . caviae) . All isolates were sensitive to gentamicin; however, topical 30% sulfacetamide was the preferred drug for treatment . Favorable outcome (healed scar) was achieved in 11 . CONCLUSION: Although Nocardia keratitis is a rare condition, a high index of clinical suspicion should be kept in agricultural workers or in patients with trauma who have patchy stromal infiltrates . Sulfonamides are the initial drug of choice, and gentamicin could be an effective alternative . If recognized early, Nocardia keratitis responds to medical treatment with good visual recovery.

Ann Clin Lab Sci, 1997 Nov-Dec, 27(6), 428 - 33
Outcomes assessment of a residency program in laboratory medicine; Morse EE et al.; During a down-sizing of residency programs at a State University Medical School, hospital based residents' positions were eliminated . It was determined to find out the characteristics of the residents who graduated from the Laboratory Medicine Program, to compare women graduates with men graduates, and to compare IMGs with United States Graduates . An assessment of a 25 year program in laboratory medicine which had graduated 100 residents showed that there was no statistically significant difference by chi 2 analysis in positions (laboratory directors or staff), in certification (American Board of Pathology {and subspecialties}, American Board of Medical Microbiology, American Board of Clinical Chemistry) nor in academic appointments (assistant professor to full professor) when the male graduates were compared with the female graduates or when graduates of American medical schools were compared with graduates of foreign medical schools . There were statistically significant associations by chi 2 analysis between directorship positions and board certification and between academic appointments and board certification . Of 100 graduates, there were 57 directors, 52 certified, and 41 with academic appointments . Twenty-two graduates (11 women and 11 men) attained all three.

Virology, 1997 Dec 8, 239(1), 169 - 75
Reassessing the organization of the UL42-UL43 region of the human cytomegalovirus strain AD169 genome; Mocarski ES et al.; A polymorphism in the UL42-UL43 region of the human cytomegalovirus genome has been characterized by nucleotide sequence analysis, revealing a 929-bp insertion following nt 54,612 relative to the published strain AD169-UK genome sequence (M.S . Chee et al., 1990, Curr . Top . Microbiol Immunol . 154, 125-170) . Although AD169-UK exhibited polymorphism in this genomic region, other CMV strains (Towne, Toledo, and AD169-ATCC) carried only the newly characterized longer form . The additional sequence altered the assignment of UL42 and UL43 open reading frames . UL42 decreased in size from 157 to 125 codons, retaining 76 of the previously reported carboxyl terminal codons, and UL43 increased in size from 187 to 423 codons, retaining 185 of the previously reported amino terminal codons . This additional sequence makes UL43 a more conserved betaherpesvirus US22 family member . Only AD169-UK exhibited restriction fragment length polymorphism in this region, suggesting that a deletion occurred during the propagation of this strain in cell culture . The additional sequence should be considered a bona fide part of the cytomegalovirus genome and the AD169 genome size should be corrected to 230,283 bp.

IEEE Trans Biomed Eng, 1997 Dec, 44(12), 1185 - 91
Artificial neural network identification of heterotrophic marine bacteria based on their fatty-acid composition; Giacomini M et al.; The traditional approach to biochemical identification of marine fresh isolates requires considerably long culture preparation times and large quantities of expensive materials and reagents, and the results are not reliable . On the other hand, taxonomy tests based on DNA composition, although sensitive and reliable, require long execution time and high costs . A method is presented for the classification of fatty-acid profiles, extracted from marine bacteria strains, at genus level based on supervised artificial neural networks . The proposed method allows the correct identification of all patterns belonging to the test set . Moreover, a quantitative measure of the importance of each fatty acid for bacterial classification is also achieved . This measure allows the determination of a cluster of fatty acids to be controlled with greater care . The results show that the proposed method is reproducible and rapid, so that it can be routinely used in the marine microbiology laboratory to identify fresh isolates.

Rev Esp Enferm Dig, 1997 Oct, 89(10), 781 - 5
{Prophylactic antibiotics in acute pancreatitis . Results from a consensus conference}; Martinez JF et al.; Pancreatic infection is the leading cause of death from acute pancreatitis . Patients with severe necrotizing pancreatitis are most at risk . Early dynamic computed tomography and percutaneous fine-needle aspiration microbiology of areas of necrosis enable early diagnosis . Several studies has been undertaken in order to investigate the type of bacteria and the concentration reached in pancreatic tissue by different antibiotics . Nevertheless, up to now only three clinical trials of prophylactic antibiotics in acute pancreatitis has been reported . In the IV meeting of the Spanish Association for the Study of the Pancreas, a consensus conference took place with this topic.

J Hosp Infect, 1997 Nov, 37(3), 175 - 80
Diploma in Hospital Infection Control (Dip HIC)
Emmerson AM, Spencer RC, Cookson BD, Roberts C, Drasar BS.
The London School of Hygiene and Tropical Medicine (LSHTM) has established a Diploma in Hospital Infection Control (Dip-HIC) . The course for this new Diploma is run under the auspices of the Hospital Infection Society (HIS) and the Public Health Laboratory Service (PHLS) and will commence in October 1997 . The aim of this course is to provide infection control staff with systematic training in the sciences relevant to hospital infection control which will allow them to provide, and to take responsibility for, a broad-based infection control service . Topics will include the epidemiology of infectious diseases, clinical microbiology, health care economics, statistics, surveillance methods and patient management . The course will be multi-disciplinary and open to UK and overseas students, both medical and non-medical.

Acta Physiol Scand Suppl, 1997, 638, 67 - 80
The intestines of carnivorous fish: structure and functions and the relations with diet; Buddington RK et al.; The intestine is a complex multifunctional organ . In addition to digesting and absorbing feedstuffs, the intestine is critical for water and electrolyte balance, endocrine regulation of digestion and metabolism, and immunity . The intestines of carnivorous fish have evolved for processing a highly digestible, nutrient dense diet that is high in protein and low in carbohydrate . Correspondingly, abilities to digest protein are well developed, but carbohydrate digestion is low compared to omnivorous and herbivorous fish . Furthermore, the evolutionary stable diet is associated with a lack or reduced abilities to adaptively modulate digestive functions to match changes in diet composition . Despite similar selective pressures, intestinal structure is highly variable among carnivorous fish, reflecting phylogenetic diversity . Due to economic considerations, diets for cultured species often have varying proportions of plant-based ingredients . Although such feeds are effective for raising omnivorous and herbivorous species, they have provided limited success for carnivores, and this has been attributed to digestive limitations . Recent evidence of inflammatory responses to as yet unidentified components of some plants suggest involvement of the enteric immune system . Changes in temperature and salinity alter intestinal structure and functions, and therefore processing of dietary inputs . A relatively unknown component of the intestine involves the resident microbiota and its role in the health and disease of carnivoraus fish.

J Fam Pract, 1997 Dec, 45(6), 473 - 81
Respiratory syncytial virus infection in infants and young children; Levy BT et al.; Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in infants and young children . Epidemics occur yearly from December to March or April, leading to 100,000 hospitalizations in the United States at an estimated cost of $300 million . Physical examination findings may include clear coryza, evidence of respiratory distress, wheezing, and dehydration . Complications include apnea . Mortality runs as high as 0.5% to 1.5% in hospitalized patients . Diagnosis is based on clinical presentation, seasonal pattern, and microbiologic testing . Therapy remains largely supportive . The preponderance of evidence argues for the use of bronchodilators, especially epinephrine or albuterol, in the treatment of acute bronchiolitis . Steroids do not seem to confer any advantage . Ribavirin is expensive and should be used very selectively in infants at high risk for serious RSV disease . These infants may benefit from prophylaxis with RSV immune globulin.

Medicine (Baltimore), 1997 Nov, 76(6), 392 - 400
Fever of unknown origin (FUO) . I A . prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria . The Netherlands FUO Study Group; de Kleijn EM et al.; Internal medicine wards in all 8 university hospitals in the Netherlands participated in this prospective study of fever of unknown origin (FUO) from January 1992 until January 1994 in order to update information on the spectrum of diseases causing FUO . We used fixed epidemiologic entry criteria to achieve completeness of enrollment and to avoid unintended selection bias . After entry, immunocompetent patients were included using criteria for FUO according to Petersdorf and Beeson (30) . A standardized diagnostic protocol was used, and potentially diagnostic clues (PDCs) and their use in the diagnostic process were prospectively registered . Thus, the criteria of classic FUO have been adjusted to modern times: immunocompromised patients are excluded, and the time-criterion "1 week in hospital without a diagnosis" has been replaced by a quality-criterion stating that certain investigations must be performed as a minimum, and PDCs must be followed adequately for at least 1 week, without a diagnosis being reached . A total of 167 immunocompetent patients with FUO were thus retrieved, of whom 43 (25.7%) had infections, 21 (12.6%) had neoplasms, and 40 (24.0%) had noninfectious inflammatory diseases . No diagnosis was made in 50 patients (29.9%), 37 of whom recovered spontaneously . This study confirms the changing spectrum of diseases causing FUO . Indeed, as shown by another recent study, the group of patients with FUO in whom no diagnosis can be made is expanding, and mostly it concerns self-limiting or benign fevers . Others have suggested that this trend is not really occurring (29) . We did not place patients with diseases of unknown origin in the "nondiagnosis" group, and indeed made presumptive diagnoses when necessary . Nevertheless, this category of undiagnosed fevers is increasing . We believe that the higher percentage of undiagnosed cases can be attributed to the greater use of advanced diagnostic techniques attendant on an increased number of self-limited illnesses in patients meeting criteria for FUO . Because of ongoing development in diagnostic techniques and the prospective influence on the spectrum of diseases causing FUO, studies should be performed regularly to update information on this subject . Because the number of outpatient evaluations for FUO is expected to increase, patients seen on an outpatient basis should be included in future studies . To avoid unwanted selection bias, fixed epidemiologic entry criteria should be used to ensure completeness of enrollment . To shorten the period of collecting data, multicentric studies can be done using standardized diagnostic protocols . In patients with recurrent fever or fever lasting longer than 6 months, the chance of reaching a diagnosis is significantly lower, and especially in this group one should exercise the greatest caution to avoid abundant and extensive diagnostic procedures . The diagnostic process in patients with FUO remains an intriguing problem in medicine . Recent microbiologic techniques may be useful as an approach to the relatively large proportion of patients in whom we now fail to make a diagnosis.

Cardiologia, 1997 Sep, 42(9), 941 - 6
{Myosin isoforms in skeletal muscle in patients with chronic heart decompensation: distribution and correlation with with exercise tolerance}; Serafini F et al.; Chronic heart failure (CHF) is accompanied by a reduced exercise capacity, and the symptoms can be at least in part explained by qualitative and quantitative changes in the skeletal muscle composition and metabolism . We have correlated the myosin heavy chain (MHC) composition of the gastrocnemius in 20 patients with different degrees of CHF to expiratory gases measured during maximal cardiopulmonary exercise testing, NYHA functional class and echocardiographic parameters . MHC composition was determined electrophoretically in skeletal muscle needle microbiopsies and the percent distribution calculated by laser densitometry . There was no correlation between ejection fraction, left ventricular end-diastolic and end-systolic diameters and MHC composition . The percentage of MHC 1 (slow aerobic isoform) was positively correlated with peak VO2 (r2 = 0.5, p = 0.0004), ventilatory threshold (VT, r2 = 0.33, p = 0.008), and O2 pulse (peak VO2/HR, r2 = 0.40, p = 0.003) . There was a negative correlation between MHC 2a and 2b (fast isoforms) and peak VO2 (r2 = 0.38 and 0.37, p = 0.004, respectively), VT (r2 = 0.2, p = 0.05; r2 = 0.34, p = 0.007, respectively) and O2 pulse (r2 = 0.39, p = 0.003; r2 = 0.23, p = 0.03, respectively) . NYHA functional class was also negatively correlated with the same parameters (r2 = 0.2, p = 0.01; r2 = 0.4, p = 0.001; r2 = 0.34, p = 0.006, respectively) as well as with MHC 1 (r2 = 0.62, p = 0.0001) . A positive correlation was found between NYHA functional class and MHC 2a and 2b (r2 = 0.46, p = 0.001; r2 = 0.41, p = 0.002, respectively) . The severity of heart failure is paralleled by a shift of the MHC pattern toward the fast MHC 2b . The correlation between the magnitude of the MHCs shift, from the slow aerobic to the fast type, with both clinical parameters (NYHA functional class) and functional measurements (peak VO2, VT, O2 pulse) of exercise capacity seem to suggest that changes in skeletal muscle composition may play a key role in exercise tolerance in patients with CHF.

Clin Nurs Res, 1997 Nov, 6(4), 363 - 74
A descriptive study of the handwashing environment in a long-term care facility; Hattula JL et al.; The authors present a clinical research project accomplished by a nurse during her first year of practice after graduating from a B.S.N . program . In her caregiving at a long-term care facility subacute unit, she was unable to do proper handwashing . The poorly placed pump-style paper towel dispensers were inadequate for the task . She knew that handwashing before and after resident contact is the single most effective infection control measure to prevent nosocomial infections . In consultation with her university professor, she designed and implemented a descriptive study of the facility's handwashing environment . She mapped and measured handwashing areas, explained constrictions the environment placed on handwashing technique, collected random cultures from the sinks and dispenser levers, and illustrated for administrative and auxiliary personnel the basic principles of microbiology . Implications for infection prevention and control in long-term care facilities are discussed in light of increased "high-end skilled nursing" being offered in subacute units.

Ophthalmology, 1997 Nov, 104(11), 1897 - 901
The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic; Rodman RC et al.; OBJECTIVE: The purpose of the study is to compare the utility of culturing corneal ulcers in a tertiary referral clinic and a general ophthalmology clinic . DESIGN: A retrospective review of medical and microbiologic records was performed . PARTICIPANTS: One hundred fifty-seven patients with corneal ulcers were included in the study . Eighty-two ulcers were treated in the referral clinic and 75 ulcers were treated in the general ophthalmology clinic . MAIN OUTCOME MEASURES: The authors determined the percentage of corneal ulcers in each clinical setting that failed to respond to empiric therapy and required a culture-directed change in treatment . RESULTS: One hundred fifty-seven ulcers were included . Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results . All 75 patients in the general clinic responded to empiric antibiotics, such that culture data never were required for modification of therapy (0%, P = 0.007) . In contrast to patients treated in the Cornea Clinic, patients treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulceration other than contact lens wear . CONCLUSIONS: Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers . However, it appears reasonable for general ophthalmologists to use culturing more judiciously . Patients with significant corneal ulcers should be cultured regardless of the clinic to which they present . However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics . Close follow-up is mandatory to discover the rare patient who will not respond to empiric therapy.

Appl Environ Microbiol, 1997 Dec, 63(12), 4638 - 44
The faeA genes from Aspergillus niger and Aspergillus tubingensis encode ferulic acid esterases involved in degradation of complex cell wall polysaccharides; de Vries RP et al.; We report the cloning and characterization of a gene encoding a ferulic acid esterase, faeA, from Aspergillus niger and Aspergillus tubingensis . The A . niger and A . tubingensis genes have a high degree of sequence identity and contain one conserved intron . The gene product, FAEA, was overexpressed in wild-type A . tubingensis and a protease-deficient A . niger mutant . Overexpression of both genes in wild-type A . tubingensis and an A . niger protease-deficient mutant showed that the A . tubingensis gene product is more sensitive to degradation than the equivalent gene product from A . niger . FAEA from A . niger was identical to A . niger FAE-III (C . B . Faulds and G . Williamson, Microbiology 140:779-787, 1994), as assessed by molecular mass, pH and temperature optima, pI, N-terminal sequence, and activity on methyl ferulate . The faeA gene was induced by growth on wheat arabinoxylan and sugar beet pectin, and its gene product (FAEA) released ferulic acid from wheat arabinoxylan . The rate of release was enhanced by the presence of a xylanase . FAEA also hydrolyzed smaller amounts of ferulic acid from sugar beet pectin, but the rate was hardly affected by addition of an endo-pectin lyase.

J Can Dent Assoc, 1997 Nov, 63(10), 775 - 9
Dental unit waterline microbiology: a cautionary tale; Barbeau J et al.; The question of dental unit waterline contamination now concerns the dental profession on a number of levels and has become part of the landscape in dentistry . Researchers have identified the problem, studied it, and published their results . Official organizations have reacted to the problem by issuing press releases and recommendations . In the mean time, dental companies have jumped into the fray, ensuring a proliferation of products designed to mitigate a problem that certain people feel is imaginary are artificially inflated . Despite the number of publications describing waterline contamination, we still face the challenge of determining whether are picture of the problem is truly accurate . For example, it has become almost customary to use the term contamination when talking about waterlines, even though it is inadequate . In addition, we are moving ahead with water quality standards for dental units at a time when certain fundamental questions remain unanswered . What should we be measuring and what methods should we be using? Do certain disinfection procedures have an opposite effect to the one desired? Finally, the question of health risks linked to the colonization of waterlines has not been adequately addressed by researchers.

J Clin Microbiol, 1997 Dec, 35(12), 3248 - 53
Direct detection of Mycobacterium tuberculosis complex in clinical samples from patients in Norway by ligase chain reaction; Lindbrathen A et al.; Our aim was to investigate the use of DNA amplification with the ligase chain reaction (LCR) for detection of the Mycobacterium tuberculosis complex directly in human clinical specimens . The LCR assay employed was the Abbott LCx MTB Assay, which uses the gene encoding protein antigen b as the target template . Four hundred eighty-two samples from 457 patients in one clinical microbiology laboratory in Norway were processed by routine culture analysis (BACTEC culture), direct microscopy (Ziehl-Neelsen staining) and LCR . Of the 118 specimens containing cultivable M . tuberculosis, 106 (90.6%) were detected by LCR . Among the 364 culture-negative specimens, 356 samples were negative also by LCR and 8 (1.6%) were positive by LCR . In five of the eight LCR-positive and culture-negative samples, another sample from the same patient was M . tuberculosis culture positive and/or the patient had symptoms of tuberculosis . In comparison with culture, the sensitivity of LCR was 96.7% for smear-positive samples and 72.0% for smear-negative samples, respectively . For all samples combined, the sensitivity, specificity, and positive and negative predictive values were 90.2, 99.2, 97.4, and 96.7%, respectively . Challenging the M . tuberculosis LCR test with DNAs and cultures from strains of Mycobacterium ulcerans and Mycobacterium marinum, which are the mycobacterial species most closely related to the M . tuberculosis complex, resulted in all-negative test results . The sensitivity, specificity, and positive and negative predictive values of BACTEC culture in comparison with the LCR test and clinical criteria were 95.9, 100, 100, and 98.6%, respectively . A certain prioritization of samples subjected to the LCR assay should be based on clinical indications and risks with regard to infection transmission and patient isolation policy . More automation and lower expenses are generally desired for nucleic acid amplification kits . However, this M . tuberculosis LCR assay represents a valuable tool in routine mycobacterial diagnostics.

Am J Obstet Gynecol, 1997 Nov, 177(5), 1184 - 7
Bacterial vaginosis as a risk factor for upper genital tract infection; Peipert JF et al.; OBJECTIVE: The objective of this study was to determine whether the clinical diagnosis of bacterial vaginosis is associated with objective evidence of acute upper genital tract infection . STUDY DESIGN: Women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or had other "nonclassic" signs of upper genital tract infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis) were evaluated with either an endometrial biopsy or a laparoscopy with endometrial and fimbrial biopsies for objective evidence of upper genital tract infection . Bacterial vaginosis was considered present if three of the four following criteria were found: (1) homogeneous gray-white vaginal discharge, (2) vaginal pH > 4.5, (3) positive "whiff" test result, and (4) the presence of > 20% of epithelial cells classified as clue cells . Patients were considered to have upper genital tract infection if they had histologic, microbiologic, or laparoscopic evidence of upper tract infection . RESULTS: One hundred sixteen women were evaluated between August 1993 and March 1997 with complete evaluations . Objective evidence of upper tract infection was present in 56% (14/25) of women with the clinical diagnosis of bacterial vaginosis compared with 30% of women (27/91) who did not meet the clinical criteria (p = 0.015) . Using logistic regression to control for confounding variables, we found that the presence of bacterial vaginosis was associated with a threefold increased risk of upper genital tract infection (adjusted odds ratio = 3.0, 95% confidence interval 1.2 to 7.6) . CONCLUSIONS: Bacterial vaginosis is associated with an increased risk of objective evidence of acute upper genital tract infection . Future prospective studies are needed to determine whether treatment of bacterial vaginosis can reduce the risk of ascending infection.

Carbohydr Res, 1997 Sep 26, 303(3), 313 - 8
The relationship between the structures of the O polysaccharides from Escherichia coli O17 and O16; Batley M et al.; The chemical structure of the O16 antigen from the lipopolysaccharide of Escherichia coli strain P4 has been determined . Comparison with the structures of other O16 antigens and that of the O17 antigen explains the previously reported cross-reaction of O antigen from the O16 strain K-12 with anti-O17 antibody {D . Liu and P.R . Reeves, Microbiology, 140 (1994) 49-57}.

J Virol, 1997 Dec, 71(12), 9833 - 6
The published DNA sequence of human cytomegalovirus strain AD169 lacks 929 base pairs affecting genes UL42 and UL43; Dargan DJ et al.; Compared with the published DNA sequence (M . S . Chee, et al . Curr . Top . Microbiol . Immunol . 154:125-170, 1990), most isolates of human cytomegalovirus strain AD169 contain an additional 929 bp after nucleotide 54612 . This results in a changed reading frame for the 5'-terminal 50 codons of gene UL42 and expansion of gene UL43 (a US22 family member) from 187 (3'-truncated) to 423 (full-length) codons . The UL42 and UL43 gene products are nonessential for growth in culture.

J Immunol Methods, 1997 Sep 24, 207(2), 195 - 201
Particle counting assay for anti-toxoplasma IgG antibodies . Comparison with four automated commercial enzyme-linked immunoassays; Galanti LM et al.; An assay for anti-toxoplasma IgG antibodies based on agglutination of latex particles was set up and compared with commercial immunoassays . The reaction was measured by instrumental counting of particles remaining unagglutinated . The running time was 45 min . This test (PaC) was compared using 243 serum samples with four automated commercial immunoassays: the Enzymum test Toxo IgG (ES300, Boehringer), the Vidas Toxo IgG (Biomerieux), the IMX Toxo IgG (Abbott), the Magia Toxoplasma gondii IgG (Merck) . The mean values (+/- SD) obtained by IMX (25 IU +/- 68) and ES300 (45 IU +/- 142) were significantly lower than the values obtained by Vidas (73 IU +/- 237, p < 10(-4) and p = 0.006, respectively), by Magia (80 IU +/- 300, p < 10(-4) and p = 0.0005) and by PaC (70 IU +/- 260, p < 10(-4) and p = 0.0126) . The correlations between PaC and Toxo IgG Boehringer, Biomerieux, Abbott, Merck were r = 0.97, r = 0.98, r = 0.94, r = 0.98, respectively . The correlation coefficients between the enzyme-immunoassays ranged from 0.96 to 0.99 . All positive samples by PaC were found to be positive by enzyme-immunoassays except for eight sera which were doubtful positives by the Enzymum test ToxoIgG from Boehringer . No negative sample by PaC was found positive by any of the enzyme-immunoassays . In PaC, when two latex preparations coated with different antigen were compared, the correlation was rather weak (r = 0.93) suggesting that the selection of the antigen can be critical . In conclusion, the four automated commercial immunoassays now available gave similar results . However, the discrepancies observed in this study underlined the importance of clinical and biological follow-up of the patients and the necessity to confirm the result . The introduction of a new technique such as PaC, which is now available for a large variety of assays in Clinical Chemistry and Microbiology, is justified by its intrinsic advantage of homogeneity . Therefore, automation is easy as well as the control of possible interference.

Pediatr Emerg Care, 1997 Oct, 13(5), 329 - 30
Tuberculous lymphadenopathy masquerading as a bronchial foreign body; Pereira KD et al.; A case of recent onset of wheezing with clinical and radiologic findings suggestive of foreign body aspiration is presented . Rigid bronchoscopy revealed an extraluminal compression of the airway . Histopathologic and microbiologic examination revealed tuberculous lymphadenopathy.

J Thorac Imaging, 1997 Oct, 12(4), 272 - 84
Ultrasound-guided transthoracic biopsy of peripheral lung, pleural, and chest-wall lesions; Yang PC; Ultrasound (US)-guided transthoracic biopsy is well suited for the sampling of those mediastinal, hilar, pleural, chest-wall, and peripheral lung lesions that provide an adequate acoustic window to the transducer . Chest-wall, pleural, and peripheral lung lesions are generally hypoechoic relative to their surrounding tissues . A special puncture transducer is used to perform US-guided biopsy with real-time visualization of the biopsy needle and the lesion . For vascular lesions and lesions adjacent to mediastinal vessels, a color Doppler puncture device is now available . The accuracy of US-guided biopsy of peripheral lung lesions or chest-wall lesions is 88% to 100%, with particular utility in the diagnosis of pulmonary masses with large necrotic centers . Other lung lesions amenable to US-guided biopsy diagnosis include those producing superior vena cava (SVC) syndrome, Pancoast's syndrome, or obstructive pneumonitis . Pulmonary consolidation, lung abscess, and parapneumonic effusions are easily sampled for microbiologic diagnosis . The peripheral nature of lesions accessed by US guidance accounts for a very low rate of complications . Although US-guided needle biopsy requires certain expertise, the technique is relatively easy to master and can be performed in many situations where computed tomography-guided biopsy would previously have been used.

Arch Surg, 1997 Nov, 132(11), 1184 - 8; discussion 1188-9
The effect of empiric and prophylactic treatment with fluconazole on yeast isolates in a surgical trauma intensive care unit; Safran DB et al.; OBJECTIVE: To assess the effect of aggressive antifungal prophylaxis and empiric antifungal therapy using fluconazole on the mycotic microbiology and associated infectious complications in a surgical intensive care unit . DESIGN: Retrospective review of a cohort of critically ill surgical patients treated during an 11-month period . SETTING: Surgical intensive care unit, university hospital, state-designated level I trauma center . PATIENTS: All patients treated with fluconazole during the study . MAIN OUTCOME MEASURES: Positive fungal cultures obtained after commencement of antifungal prophylaxis or antifungal treatment with fluconazole . Overall and infectious mortality rates for patients with positive cultures were also measured . RESULTS: Of 72 surgical patients who were treated with fluconazole; 16 (22%) had secondary mycoses . Fourteen (88%) of these patients were receiving fluconazole as antifungal prophylaxis or as empiric treatment of suspected but unproved infection . The predominant organisms isolated from these 16 patients were Candida glabrata (41%) and Candida parapsilosis (41%) . Overall mortality for this group was 44%, and infectious mortality was 38% . The infectious mortality rate was significantly higher than the rate found in patients who were successfully treated with fluconazole for primary mycoses, and who did not have secondary infections with resistant organisms (mortality, 9%; P < .01, chi 2) . CONCLUSIONS: Emergence of resistant species after treatment with fluconazole does occur in surgical patients, and suggests that the development of a secondary fungal infection with a resistant organism may be associated with a poor prognosis.

Mt Sinai J Med, 1997 Nov, 64(6), 383 - 5
Acute gouty sacroiliitis: a case report and review of the literature; Bastani B et al.; A 45-year-old black woman with an acute attack of severe unilateral sacroiliitis, negative microbiologic studies, is presented . An open biopsy specimen of the sacroiliac joint revealed evidence of tophaceous gout . The unique features of the case, differential diagnosis, and pertinent literature on gouty sacroiliitis are reviewed . Acute gouty sacroiliitis, although it is rare, does occur and should be included in the differential diagnosis of unilateral sacroiliitis in patients with a long-standing history of gout.

Appl Environ Microbiol, 1997 Nov, 63(11), 4267 - 71
Effects of dissolved organic carbon and salinity on bioavailability of mercury; Barkay T et al.; Hypotheses that dissolved organic carbon (DOC) and electrochemical charge affect the rate of methylmercury {CH3Hg(I)} synthesis by modulating the availability of ionic mercury {Hg(II)} to bacteria were tested by using a mer-lux bioindicator (O . Selifonova, R . Burlage, and T . Barkay, Appl . Environ . Microbiol . 59:3083-3090, 1993) . A decline in Hg(II)-dependent light production was observed in the presence of increasing concentrations of DOC, and this decline was more pronounced at pH 7 than at pH 5, suggesting that DOC is a factor controlling the bioavailability of Hg(II) . A thermodynamic model (MINTEQA2) was used to select assay conditions that clearly distinguished among various Hg(II) species . By using this approach, it was shown that negatively charged forms of mercuric chloride (HgCl3-/HgCl(4)2-) induced less light production than the electrochemically neutral form (HgCl2), and no difference was observed between the two neutral forms, HgCl2 and Hg(OH)2 . These results suggest that the negative charge of Hg(II) species reduces their availability to bacteria and may be one reason why accumulation of CH3Hg(I) is more often reported to occur in freshwater than in estuarine and marine biota.

J Dairy Sci, 1997 Oct, 80(10), 2651 - 4
Manure management . A systems approach; Grusenmeyer DC et al.; Traditionally, the management of manure nutrients has focused primarily on the production, collection, storage, and field application of manure . By contrast, a total systems approach expands this focus to include concerns about human and animal health, odor and fly control, nutrient import and handling, ration balancing and feeding management to optimize dietary nutrient utilization, management of crop harvest and storage to maximize feed palatability and nutrient digestibility, manure processing for export, farm economics of nutrient management, and the broader economic impacts of environmental regulation and enforcement . In the future, the focus of manure and nutrient management must be to optimize nutrient flow and utilization at every point within the total dairy farm system . A total systems approach to nutrient management is vital to the future of the dairy industry . This approach requires a broad spectrum of scientific expertise that includes multidisciplinary teams involving agronomists, dairy scientists, economists, engineers, microbiologists, soil scientists, veterinarians, and regulators to deal successfully with the complex issues pertaining to dairy nutrient management.

ASAIO J, 1997 Sep-Oct, 43(5), M377 - 82
Establishing a protocol to quantify leaflet fibroblast responses to physiologic flow through a viable heart valve; Weston MW et al.; Mechanical stresses are thought to affect the metabolism of a variety of cell types . Little quantitative data exist regarding heart valve leaflet fibroblast activity after dynamic loading . The goal of this study was to examine leaflet fibroblast function and differentiation in response to flow through an intact valve . This requires the development of a flow system capable of reproducing the valve's native environment, as well as assay protocols to analyze cellular viability and protein and collagen synthesis . As a tool to expose viable tissue valves to physiologic flow, a sterilizable pulsatile flow system has been developed to recreate the dynamic flow environment of the aortic valve while preventing contamination from room air . Physiologic flow conditions {frequency 70 bpm, aortic pressure 129/82 mmHg (systolic/diastolic), cardiac output 2.3 L/min} were sustained for 71 hr without microbiologic contamination . Analytic tools for assessment of fibroblast function include a viability assay, which demonstrated that leaflet viability decreases after prolonged exposure to antibiotics . Proline incorporation studies revealed that 11 times more protein is retained by leaflet tissue than is released into the medium, and 27% of this protein is collagen . Polyacrylamide gel electrophoresis clearly resolved collagen Types I and III from both prepared standards as well as leaflet extracts . In ongoing work, the sterile flow loop will be used to expose fresh porcine aortic valves to defined flow conditions, and the viability and protein/collagen biosynthetic activity of leaflet fibroblasts in response to flow will be quantified . These experiments will provide a baseline by which to design and evaluate future tissue engineered substitutes.

Diagn Cytopathol, 1997 Nov, 17(5), 339 - 46
Endometrial collection and interpretation using the Tao brush and the CytoRich fixative system: a feasibility study; Maksem J et al.; BACKGROUND: The cytological assessment of endometrium entails: (1) a collection device that is easy to use, collects material only from the endometrium, and obtains adequate samples; (2) a fixation process that ensures the preservation of individual cells, maintains cell polarity, and allows the recognition of three-dimensional tissue structures (microbiopsies); and, (3) interpretative algorithms that translate histopathologic to cytopathologic diagnoses . The purpose of this study is to show that it is feasible to achieve these ends when endometrial brush sampling is coupled with suspension fixation . METHODS: Obtain endometrium from 100 consecutive hysterectomy uteri using an Indiana University Medical Center sampler (Tao Brush), suspension-fix it in CytoRich fixative, prepare it with a cytocentrifuge using large diameter sample chambers, and compare the cytologic diagnosis to the histologic diagnosis of the hysterectomy specimen . RESULTS: There were no inadequate collections . Cytology regularly separated (1) benign endometrium, (2) low-grade (non-atypical) hyperplasia, (3) high-grade (atypical) hyperplasia/FIGO Grade I adenocarcinoma, and (4) higher-grade carcinomas from one another . Endometrial atrophy was diagnosed in three patients whose histology showed clinically asymptomatic, benign fibrous endometrial polyps . A low volume of abnormal cell aggregates interpreted as endometrial intraepithelial carcinoma was detected in one patient whose initial histology was reported as simple hyperplasia, but whose histology on review after p53 staining revealed intraepithelial surface cancer . In the remaining 96 cases, the cytologic diagnosis consistently represented the histologic diagnosis of the hysterectomy specimen . On a case-by-case basis, any one cytology slide accurately represented the diagnosis of the other cytology slides . CONCLUSION: Endometrial brushing with suspension-fixation is advocated for the detection of endometrial lesions because (1) fixation is uniform, (2) there is substantial preservation of three-dimensional structures among cell aggregates, which allows pattern-based histologic diagnostic criteria to be applied to cytologic samples, and (3) only a limited number of slides need to be examined.

Proc AMIA Annu Fall Symp . 1997;:258-62.
A decision support system for microbiology quality control; Jackson BR et al.; Manual review of antibiotic sensitivity testing results is an essential component of a microbiology laboratory's quality control process . Such review is tedious and prone to human error, however . An expert system is described that remembers which susceptibility patterns are considered typical or atypical by expert reviewers, then uses these to prescreen future isolates . It uses a similarity function to allow matching against this library when two patterns are close, but not identical . Use of this system allows more efficient and reliable review of the laboratory's antibiotic sensitivity testing results.

J Clin Microbiol, 1997 Nov, 35(11), 2983 - 4
Evaluation of the automated COBAS AMPLICOR hepatitis C virus PCR system; Poljak M et al.; To evaluate the reliability and feasibility of the automated Roche COBAS AMPLICOR PCR system for routine detection of hepatitis C virus (HCV) RNA, a total of 405 serum samples previously tested by an in-house nested PCR and manual Roche AMPLICOR microwell plate HCV test were examined . Complete concordance was found between the results with the HCV COBAS AMPLICOR system and the previously determined HCV RNA status . The automated HCV COBAS AMPLICOR system provides the clinical microbiology laboratory with a specific and sensitive PCR method for rapid and reliable detection of HCV RNA.

J Clin Microbiol, 1997 Nov, 35(11), 2969 - 73
Rapid identification of mycobacteria to species level by PCR-restriction fragment length polymorphism analysis of the hsp65 gene and proposition of an algorithm to differentiate 34 mycobacterial species; Devallois A et al.; PCR-restriction fragment length polymorphism analysis (PRA) of the hsp65 gene (A . Telenti, F . Marchesi, M . Balz, F . Bally, E . C . Bottger, and T . Bodmer, J . Clin . Microbiol . 31:175-178, 1993) was applied to 108 mycobacterial isolates representing 34 species to evaluate its potential as a rapid reference method . A total of 49 distinct patterns were obtained; 25 species were characterized by a single PRA pattern, while 9 species gave more than one specific pattern . An algorithm describing these 34 species (which includes five additional species and new subgroups of Mycobacterium kansasii, M . abscessus, and M . peregrinum) is proposed . A relatively simple and inexpensive method, PRA may be particularly helpful in routine clinical microbiology laboratories.

J Clin Microbiol, 1997 Nov, 35(11), 2767 - 72
Molecular characterization of Mycobacterium avium complex isolates giving discordant results in AccuProbe tests by PCR-restriction enzyme analysis, 16S rRNA gene sequencing, and DT1-DT6 PCR; Devallois A et al.; Based on cultural and biochemical tests, a total of 84 strains (72 clinical and 12 environmental isolates from the Caribbean Isles, Europe, and the Indian subcontinent) were identified as members of the Mycobacterium avium complex (MAC) . They were further characterized with MAC, M . avium, and M . intracellulare probes of the AccuProbe system, and this was followed by selective amplification of DT6 and DT1 sequences . Seventy isolates gave concordant results; 63 were identified as M . avium, 5 were identified as M . intracellulare, and 24 remained untypeable by both methods . Fourteen isolates gave discrepant results, as they were DT1 positive but gave negative results by the M . intracellulare AccuProbe test . Consequently, a detailed molecular analysis of all DT1-positive isolates (14 discrepant strains plus 5 M . intracellulare strains) was performed by PCR-restriction analysis (PRA) of the hsp65 gene and 16S rRNA gene sequencing . The results confirmed the reported heterogeneity of M . intracellulare, as only 6 of 19 isolates (32%) gave PRA results compatible with published M . intracellulare profiles while the rest of the isolates were grouped in four previously unpublished profiles . 16S rRNA gene sequencing showed that only 8 of 19 isolates (42%) were related to M . intracellulare IWGMT 90247 (EMBL accession no . X88917), the rest being related to MCRO19 (EMBL accession no . X93030) and MIWGTMR10 (EMBL accession no . X88915) . In conclusion, we have characterized a significant number of MAC isolates which were not identified by the AccuProbe test, PRA, or 16S rRNA sequencing . However, all of them were identifiable by DT1-DT6 PCR (they were DT6 negative and DT1 positive) and could be tentatively identified as M . intracellulare based on previously published observations . It is noteworthy that the majority of such isolates (14 of 19) were from the Indian subcontinent, with 12 of 14 being environmental isolates . Our study confirms the marked heterogeneity of M . intracellulare isolates and shows the utility of in-house DT1 PCR to detect this group of isolates, which would otherwise have been missed by the AccuProbe system in a routine clinical microbiology laboratory.

J Clin Microbiol, 1997 Nov, 35(11), 2728 - 32
Evaluation of three commercial enzyme-linked immunosorbent assays and two latex agglutination assays for diagnosis of primary Epstein-Barr virus infection; Svahn A et al.; Three commercially available enzyme-linked immunosorbent assays (ELISAs) from Gull, Biotest, and Behring (Enzygnost) and two latex agglutination tests for heterophile antibodies (Monolatex {Biotest} and Mono-Lex {Trinity Laboratories}) were evaluated for the diagnosis of primary Epstein-Barr virus (EBV) infection and EBV seropositivity . Two hundred fourteen consecutive samples from 197 patients with symptoms of primary EBV infection were analyzed by the five assays at a clinical microbiology laboratory . The samples were also analyzed independently by immunofluorescence methods at a reference laboratory . According to the reference methods, 37 patients (40 serum samples) had primary EBV infections, 120 patients (127 serum samples) had had past EBV infections, 33 patients (36 serum samples) were seronegative, and 7 patients (11 serum samples) exhibited atypical reactions . The respective sensitivities and specificities for the diagnosis of primary EBV infection were 95 and 100% for the Gull assays, 100 and 94% for the Biotest assays, and 100 and 89%, for the Enzygnost assays . The Monolatex and Mono-Lex methods showed similar sensitivities and specificities (78 to 85% and 100 to 99%, respectively) for the diagnosis of primary EBV infection . This study demonstrates the usefulness of commercially available assays for the rapid diagnosis of primary EBV infection, but also the importance of large-scale testing of routine samples before choosing an assay.

J Clin Periodontol, 1997 Oct, 24(10), 777 - 82
Short-term effects of triclosan on healing following subgingival scaling; Furuichi Y et al.; The present clinical trial was performed to evaluate short-term effects of a triclosan-containing dentifrice/gel combination on soft tissue healing, when applied supra-/sub-gingivally at periodontal sites treated with scaling and root planing . 16 subjects with moderate periodontitis participated in a 2x 2-week, split-mouth designed clinical trial . 2 combinations of gel/dentifrice (the test combination containing triclosan) were used . 2 pairs of contralateral sites with probing pocket depth (PPD) > or 5 mm, and which bled on probing (BoP +) were selected in each patient as experimental units . A baseline examination included assessments of PPD, BoP, gingival index scores, plaque index scores, and the composition of the subgingival microbiota (dark-field microscopy) . The assigned quadrant was anaesthetized and the teeth exposed to meticulous scaling and root planing . Immediately after the completion of mechanical therapy, either the test or control gel was applied subgingivally at the experimental sites . The volunteer was instructed to brush his/her teeth with an assigned dentifrice and to apply the gel (via a custom-made stent) supra-gingivally 2x daily for the following 2 weeks . He/she was recalled on day 7 for a second professional subgingival gel application . Re-examinations were carried out on days 2, 7 and 14 after treatment . 1-week wash-out periods separated the 2 experimental periods . The mean PPD reductions (between days 0 and 14) were 1.8 mm and 1.9 mm for the test and control gel/dentifrice sites . The reduction in BoP and gingival index scores was significantly greater during the test than during the control regimen . No significant differences were observed between the 2 regimens regarding plaque scores and composition of the subgingival microbiota . The findings from the present investigation demonstrated that triclosan, applied both sub- and supra-gingivally reduced soft tissue inflammation following scaling and root planing.

J Reprod Med, 1997 Oct, 42(10), 669 - 71
Ovarian abscess 15 months after vaginal hysterectomy . A case report; Lau M et al.; BACKGROUND: Ovarian abscess is a primary infection of ovarian parenchyma . Since 1869, only 44 cases after vaginal hysterectomy have been reported in the medical literature . The pathophysiology of bacterial infection in these cases is different from the traditional ascending mechanism . CASE: A 28-year-old woman presented with complaints of lower abdominal pain and fever 15 months after transvaginal hysterectomy . Her white blood cell count was 22,700/mm3, with 90% neutrophils . Bimanual examination revealed a tender mass in the cul-de-sac, and computed tomography showed a large, multiloculated pelvic mass . Laparotomy, pathologic examination and microbiologic study confirmed the diagnosis of ovarian abscess . CONCLUSION: Our case represents another rare posthysterectomy ovarian abscess . Most of these cases were managed by surgery and antibiotic treatment.

Appl Environ Microbiol, 1997 Oct, 63(10), 3764 - 9
A model for the combined effects of temperature and salt concentration on growth rate of food spoilage molds; Cuppers HG et al.; We modeled mold growth on a solid culture medium at various temperatures and NaCl concentrations by using five common food spoilage molds (Penicillium roqueforti, Trichoderma harzianum, Paecilomyces variotii, Aspergillus niger, and Emericella nidulans) . For the description of the growth rate (expressed as the increase in colony diameter per unit of time) as a function of temperature and NaCl concentration, a six-parameter model has been developed . The model combines either the Rosso-type or the Ratkowsky-type temperature dependence with the NaCl concentration dependence derived from the relationship between the growth rate and square root of (1 - water activity), as proposed by Gibson and coworkers (A . M . Gibson, J . Baranyi, J . I . Pitt, M . J . Eyles, and T . A . Roberts, Int . J . Food Microbiol . 23:419-431, 1994) . The model will be of use to food microbiologists whose aim is to predict the likelihood of fungal spoilage.

J Dent Res, 1997 Oct, 76(10), 1621 - 4
Dr . Basil Bibby: early fluoride investigator and intellectual provocateur; Handelman S et al.; Dr . Basil Bibby assumed many roles during his productive career as a researcher, teacher, and administrator . Although best known for his research on oral microbiology and on foodstuff as it relates to dental caries, and for fostering the careers of many distinguished researchers, he played an important generative role in determining the local cariostatic effects of fluoride . His seminal work in this area has not received its due because of the mixed success of his initial clinical studies . We hope that a review of his contributions in this area will bring those contributions into focus and illustrate his open personality and multi-dimensional approach to research.

J Biol Chem, 1997 Oct 10, 272(41), 25652 - 8
Heme axial ligation by the highly conserved His residues in helix II of cytochrome b (NarI) of Escherichia coli nitrate reductase A; Magalon A et al.; Optical spectroscopy and EPR studies confirm the existence of two b-type hemes in the NarI subunit (cytochrome bnr) of the membrane-bound nitrate reductase (NarGHI) of Escherichia coli . Replacement of His-56 by Arg and His-66 by Tyr results in the loss of the high-potential heme and of the low-potential heme, respectively . These data support the assignment of the axial ligands to the low-potential heme (His-66 and His-187) and to the high-potential heme (His-56 and His-205) . This pairing is consistent with the model proposed for NarI of the nitrate reductase of Thiosphaera pantotropha (Berks, B . C., Page, M . D., Richardson, D . J . , Reilly, A., Cavill, A., Outen, F., and Ferguson, S . J . (1995) Mol . Microbiol . 15, 319-331) in which the two bis-histidine ligated hemes are coordinated by conserved His residues of helix II and V . EPR and optical studies suggest that the low-potential heme (Em,7 = +17 mV) and the high-potential heme (Em,7 = +122 mV) are located near the periplasmic side and the cytoplasmic side of the membrane, respectively . Moreover, correct insertion of both hemes into NarI requires anchoring to NarGH.

HNO, 1997 Jun, 45(6), 442 - 7
{Ionomer cement prostheses in reconstructive middle ear surgery}; Geyer G et al.; Animal experiments with microbiologic examinations and studies in cell cultures have shown that ionomer cement is a biocompatible and biostable bone replacement material in the head and neck region . Clinical and functional results of its use in the human middle ear have proven to be satisfactory during a maximal period of 2.5 years observation . The present trial was continued in order to determine the long-term behavior of ionomer cement (Ionos partial and total ossicles) after reconstruction of the ossicular chain . The ossicular chain was reconstructed in 343 cases and included various losses of one or more of the ossicles (i.e., incus, incus and malleus, incus and stapes superstructure, and malleus, incus and stapes superstructure) . Follow-up extended over a maximum period of 5.5 years . Patients were examined under a surgical microscope and a pure-tone audiogram was performed at regular intervals . Clinical and audiological results were obtained 3 months postoperatively in all reconstructive procedures performed (partial and total ossicular replacement prostheses) . These were mainly stable but revision surgery was necessary in 9% of the cases . In 5% the prosthesis was displaced and in 3% the prosthesis had partially migrated through the eardrum . Complete rejection of the implants was observed in the course of infections in 1% of the cases . Ionomer cement as a bone replacement material was found to have all required criteria for its use in the middle ear (biocompatibility, biostability, stable audiologic results and easy workability) . These findings show that ionomer cement can be recommended in all cases of ossicular reconstruction.

Eur J Clin Microbiol Infect Dis, 1997 Aug, 16(8), 605 - 7
Rapid detection of Brucella melitensis from blood cultures by a commercial system; Yagupsky P et al.; To assess the capability of the Peds Plus medium of the Bactec 9240 blood culture system to recover Brucella melitensis within the routine seven-day protocol used by most clinical microbiology laboratories, inoculated blood culture bottles were monitored by the Bactec 9240 instrument for four weeks, and blind subcultures were performed once a week . A total of 2579 blood cultures were drawn, 42 (1.6%) of which were positive for Brucella melitensis . Forty-one of the 42 (97.6%) positive cultures were detected by the Bactec 9240 instrument within two to six days; a single positive culture was missed by the instrument and detected by blind subculture performed on day 7.

Pediatr Infect Dis J, 1997 Sep, 16(9), 846 - 51
Impact of a false positive blood culture result on the management of febrile children; Thuler LC et al.; OBJECTIVE: To evaluate the impact of a preliminary positive blood culture result, subsequently confirmed to be a false positive blood culture result on rate of hospitalization, antibiotic therapy and use of microbiologic tests . DESIGN: Retrospective chart review . PATIENTS AND METHODS: Children between 1 month and 18 years old on whom a blood culture was performed were eligible, excluding those with an underlying condition for whom a false positive blood culture may be difficult to assess . During the 1-year study period 9959 blood cultures were performed of which 778 (7.8%) produced growth . Charts of 81 patients with a false positive blood culture were reviewed and compared with those of 162 patients with a true negative blood culture . Patients already hospitalized when blood culture was drawn (n = 24) were analyzed separately from those who were not (n = 219) . Among these, patients were divided into those who were followed as outpatients (n = 104) and hospitalized (n = 115) . RESULTS: Both groups (false positive vs . true negative) were comparable for age, sex, temperature at consultation, white blood cell count and illness severity . Twenty-six percent of patients followed as outpatients who had a false positive blood culture were hospitalized because of a preliminary positive blood culture result . Among patients hospitalized at the initial assessment, the frequency of antibiotic therapy (91% vs . 71%, P < 0.01), the frequency of use of intravenous antibiotics (80% vs . 58%, P < 0.01) and the percentage of unwarranted antibiotic prescription (13% vs . 0%, P < 0.01) were significantly greater in the false positive group than in the true negative group . The same results were found for each of these outcomes among the group of patients followed as outpatients (61% vs . 28%, P < 0.01, 17% vs . 0%, P < 0.01 and 39% vs . 0%, P < 0.01) for false positive vs . true negative, respectively . Patients with false positive blood cultures had more blood cultures drawn subsequently (P < 0.01) . Children already hospitalized when the blood culture was obtained did not show significant differences in main outcomes . CONCLUSIONS: False positive blood culture results generate unnecessary hospitalizations, antibiotic therapy and use of microbiologic tests.

Microbiol Immunol, 1997, 41(9), 703 - 8
Successful development of air-dried microplates (HP-Plates) for susceptibility testing against Helicobacter pylori isolates; Kawakami Y et al.; We have successfully developed and evaluated a new susceptibility testing procedure against Helicobacter pylori strains using air-dried microplates "HP-Plates" containing eight serially-diluted anti-H . pylori agents . HP-Plate wells were reconstituted by the inoculation of 100 microliters of H . pylori cell suspensions . After incubation at 37 C for 48 hr under humidified microaerophilic conditions, HP-Plates were read visually with a circular mirror . We investigated the within-day reproducibility tests of HP-Plates using the six quality control (QC) strains we proposed . Of the 20 testings, determining the minimum inhibitory concentrations (MICs) of all the QC strains fell within +/- 1 log2 dilution ranges . When 200 clinical isolates were tested with HP-Plates and compared with the results obtained with the modified broth macrodilution method of NCCLS, more than 90% of the MICs also fell within +/- 1 log2 dilution ranges . We concluded that the HP-Plate susceptibility test method is a practical and easily applicable alternative of susceptibility testing for clinical microbiology laboratories in determining the MICs of H . pylori isolates.

Klin Monatsbl Augenheilkd, 1997 Jul, 211(1), 70 - 1
{Intrapalpebral migration of a form stable contact lens: a rare complication in contact lens practice}; Heine S et al.; PURPOSE: To demonstrate a rare complication in contactology . CASE REPORT: A 26-year-old female had "lost" her hard contact lens in the right eye 2 years previously . Afterwards, new contact lenses were not tolerated . The patient had a slight intermittent epiphora but no further complaints . She consulted her ophthalmologist for new spectacles . At presentation, there was a firm tumour without signs of inflammation in the right upper lid area . When the lid was everted a hard contact lens was found within the tarsal plate which could be easily removed in the operating room . Microbiologic investigation disclosed no bacteria . Histology showed a circumscribed papillary reaction and a chronic non-specific inflammation with few eosinophils and no giant cells . Two weeks later the lens-related cavity was only slightly filled up by granulation tissue . CONCLUSIONS: After "loss" of a contact lens superior dislocation and finally tarsal implantation should be kept in mind . The process of contact lens migration reveals some interesting features: 1 . Generally, it causes only minor symptoms though it may last for years . 2 . Bacterial contamination rarely occurs . 3 . Histologically, the inflammation is often mild or even absent . Eosinophils and giant cells are of minor or no importance indicating that allergy and giant-cell reaction play no significant role . 4 . The lens related cavity probably heals slowly, possibly because of a (partial) epithelialization.

Khirurgiia (Mosk), 1997, (6), 44 - 6
{Treatment of purulent postoperative wounds with collagen and immobilised gentamycin}; Khanin AG et al.; The results of treatment of purulent postoperative wounds in 184 patients are discussed . All the patients were operated on urgently . Various destructive diseases of the abdominal cavity organs, complicated with peritonitis, were the indication for the surgery . The abdominal cavity was drained through laparatomic wound . The wounds became suppurative with subsequent diastasis of the wound edges . Microbiologic, cytologic and clinical tests were used to estimate effectiveness of the treatment with the use of collagen sponge with immobilised gentamycin . The method has provided fastening of the healing process and shortening of in-hospital stay.

Gac Sanit, 1997 May-Jun, 11(3), 115 - 21
{Incidence of pulmonary tuberculosis: application of the capture-recapture method}; Ferrer Evangelista D et al.; OBJECTIVE: To determine as accurately as possible the incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia during the period 1990-1993, using the capture-recapture method . METHOD: Descriptive study on the population of Health Area 15 (population: -139.903) divided into 4 large groups according to age (0-14, 15-34, 34-54 and 55+) . Data was obtained from the statutory notification system of infectious disease (SNSID) and from the registry of the said area's Hospital Microbiology SERVICE: The main variable under study was the number of cases of pulmonary tuberculosis, both as notified under the SNSID and in terms of cases in the microbiology register in which M . tuberculosis was isolated . The incidence-rates were calculated by age and year of study for both registries employing the capture-recapture method . RESULTS: The mean annual incidence obtained for the SNSID register during the study period was 15.85 cases x 10(-5), and for the microbiology registry it was 23.29 x 10(-5) . When the capture-recapture method was employed the mean annual incidence for the study period was 34.81 x 10(-5) (CI 95%: 31.82-39.92) . In each of the years studied the number of cases identified was greater for the microbiology register than for the SNSID . Around half the cases of tuberculosis are below 34 years of age, with the larger section, and that having the highest incidence of tuberculosis being the 15 to 34 years age-group . There is no apparent upward trend in incidence rates calculated for this period . CONCLUSIONS: The data from the SNSID system on incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia tends to underestimate the true incidence rate . The factual resources of the Hospital Microbiology Service are underutilized, considering the quantity and quality of information it can provide . The capture-recapture method is a good choice of method for measuring tuberculosis incidence . This method merits greater use within the field of epidemiology as much in order to assess the representativeness and thoroughness of surveillance systems as to identify inadequacies in their reporting and localisation of disease outbreaks.

J Biolumin Chemilumin, 1997 Mar-Apr, 12(2), 61 - 78
Commercially available luminometers and imaging devices for low-light level measurements and kits and reagents utilizing bioluminescence or chemiluminescence: survey update 5; Stanley PE; This survey was compiled in July 1997 and includes products not covered in the luminometer survey (Jan 1992: Stanley PE, J Biolumin Chemilumin 1992; 7:77-108 and 7:157-69), kits and reagent survey (Nov 1992; Stanley PE, J Bilumin Chemilumin 1993; 8:51-63), update 1 (June 1993: luminometers, kits and reagents, Stanley PE, J Biolumin Chemilumin 1993; 8:237-240) and update 2 (Dec 1993: luminometers, kits and reagents, Stanley PE, J Biolumin Chemilumin 1994; 9:51-3) and update 3 (Feb 1994: luminometers, kits and reagents, Stanley PE, J Biolumin Chemilumin 1996; 11:175-91) . Technical details are provided together with company address and contact information including email and website where known . Items include: Luminometers, radiometers, low-light imaging, CCD cameras, immunoassays, ATP rapid microbiology, hygiene monitoring, molecular probes, labels, nucleic acid hybridization, reporter genes.

Otolaryngol Head Neck Surg, 1997 Sep, 117(3 Pt 2), S41 - 9
The medical management of rhinosinusitis; Benninger MS et al.; The management of rhinosinusitis depends on a number of variables related to the duration and severity of symptoms in the individual patient . Furthermore acute rhinosinusitis is managed differently than chronic rhinosinusitis . Because a variety of conservative and pharmacologic interventions are available, the physician can find it difficult to develop a cohesive and logical approach to treatment . An understanding of the pathophysiology, microbiology, and natural history of rhinosinusitis is necessary to formulate the best treatment plan for the individual patient.

Med Arh, 1996, 50(1-2), 31 - 3
{Percutaneous drainage of abdominal fluid collections guided by computer tomography}; Lincender L et al.; During the war, June 1992,-August 1994, at the Institute 20 percutaneous fluid collections and abscesses drainages in the belles were done, controlled by the CT . The percutaneous drainage we started in 1984, until now we had 141 cases, 20 cases in the war time, 14 of them were wounded, while the rest was suffering from a malignant process in stomach, pancreas, kidneys . Both groups had post-operative complications after liver injuries . 7 underwent the percutaneous drainage . The length was 1-64 days, drainage contents quantity was 60-5.000 m . The drainage was successful with 14 patients, while in 5 cases we had to repeat, change the catheter place . Only with 1 patients the drainage was not done, but an aspiration . The contents were send to microbiologic analysis . It was a retro-peritoneal abscess collection . Based on our ten-years experience, we are of an opinion that the CT controlled percutaneous drainage is a very efficient, simple and acurata urgent radiology procedure . According to our experiences, nearly all cases were successful.

Nurse Pract Forum, 1997 Jun, 8(2), 77 - 88
Recurrent pregnancy loss: a review; Timbers KA et al.; Recurrent pregnancy loss (RPL) is a frustrating problem for both the patient and the clinician . The causes of RPL are diverse and may be associated with genetic, anatomic, microbiologic, endocrine, or immunologic factors . When a couple is ready for an evaluation, the nurse practitioner needs to be able to discuss possible causes, aspects of diagnostic testing, and available options . Reassurance and clear information about prognosis are important and emotional support must be offered throughout the investigation and subsequent pregnancy.

Am J Orthop, 1997 Sep, 26(9), 617 - 20
The significance of positive cultures from orthopedic fixation devices in the absence of clinical infection; Moussa FW et al.; Microbiologic samples for culture were obtained from 21 patients during elective removal of fracture-fixation hardware . The hardware was being removed for pain, displacement, nonunion or malunion correction, or patient preference . None of the patients had evidence of infection as determined by medical history, physical examination, white blood count, and sedimentation rate performed on the day of hardware removal . Two sets of culture samples were obtained from each patient: swabs of the wound and of the hardware were obtained and processed by the hospital laboratory . Eleven hardware cultures and nine wound cultures were positive for microbiologic growth . None of the patients was treated with antibiotics, and none developed any problems with wound infection or healing nor any evidence of osteomyelitis . We concluded that positive cultures obtained during hardware removal in the absence of clinical signs of infection are not meaningful.

Semin Cutan Med Surg, 1997 Sep, 16(3), 188 - 99
Bacillary angiomatosis and other Bartonella species infections; Wong R et al.; Infections with organisms of the genus Bartonella, for many years important only in South and Central America, have assumed significance in developing countries, especially in conjunction with the advent of the pandemic of the human immunodeficiency virus infection . New molecular and culture techniques have determined that these organisms cause new diseases such as bacillary angiomatosis as well as diseases the etiology of which have been unknown such as cat scratch disease . In this article, the microbiology, pathogenesis, histopathology and clinical manifestations of diseases caused by these organisms are discussed.

J Biol Chem, 1997 Sep 19, 272(38), 23758 - 64
The CheZ-binding surface of CheY overlaps the CheA- and FliM-binding surfaces; Zhu X et al.; CheY, the response regulator of bacterial chemotaxis, plays a pivotal role in signal transduction in bacterial chemotaxis and interacts with at least three proteins: CheA, FliM, and CheZ . CheA receives signals from chemoreceptors and then transfers the signal to CheY by a phosphotransfer reaction . Phosphorylated CheY binds to FliM, one of the switch proteins, resulting in a change in flagellar rotation from counterclockwise to clockwise . Phosphorylated CheY is dephosphorylated by its intrinsic autophosphatase activity and by CheZ . The CheA- and FliM-binding surfaces of CheY have been well studied, but characterization of the CheZ-binding surface of CheY is incomplete . We have analyzed the effect of CheZ on the dephosphorylation rates of 14 mutants of CheY . Nine mutant CheY proteins showed more resistance to CheZ phosphatase activity than did wild-type CheY . These nine mutant CheY proteins could be divided into two groups: one with altered CheZ binding and the other with normal CheZ binding . The mutations causing reduced CheZ binding altered residues on the same surface of CheY, a region consisting of the beta5-alpha5 loop, the alpha1-helix, and part of the alpha5-helix . Mutations rendering CheY resistant to CheZ, isolated by Sanna et al . (Sanna, M . G., Swanson, R . V., Bourret, R . B., and Simon, M . I . (1995) Mol . Microbiol . 15, 1069-1079), were also found to affect this surface . The mutations in the CheY protein that affect CheZ activity but not CheZ binding are located in the beta4-alpha4 loop, which appears to be involved in the catalytic activity of CheZ . Finally, our results indicate that the CheY surfaces that bind CheA, FliM, and CheZ overlap, but are not completely identical.

Cornea, 1997 Sep, 16(5), 503 - 6
An immunologist's view of herpes simplex keratitis: Thygeson Lecture 1996, presented at the Ocular Microbiology and Immunology Group meeting, October 26, 1996; Hendricks RL; PURPOSE: To review recent progress in understanding the mechanisms of herpes simplex virus 1 (HSV-1)-induced immunopathology in the cornea, as revealed by studies in a mouse model . METHODS: The corneas of A/J mice were infected with 5 x 10(4) plaque-forming units (PFU) of the RE strain of HSV-1, and the development of inflammation was assessed by slitlamp, histologic, or immunohistochemical examination . The immunopathologic mechanisms were then defined by observing the effect of in vivo depletion of corneal Langerhans' cells, or T-lymphocyte subpopulations, or in vivo neutralization of cytokines on adhesion molecule expression or leukocytic infiltration of the infected cornea . RESULTS: After corneal infection, 60-70% of mice develop corneal opacity due to leukocytic infiltration, neovascularization, and edema . Polymorphonuclear neutrophils (PMN) represent 90% of the infiltrating cells, with numerous CD4+, but few CD8+, T cells present . Depleting CD4+ T cells of Langerhans' cells prevents inflammation from developing . Neutralizing interleukin-2 (IL-2) or interferon gamma (IFN-gamma) can prevent inflammation or cause a remission of existing disease . IFN-gamma neutralization causes a rapid block of PMN extravasation from the blood in association with reduced platelet endothelial cell adhesion molecule 1 (PECAM-1) expression on the corneal vascular endothelium . IL-2 neutralization results in decreased IFN-gamma production, reduced chemotaxis, and loss of PMN viability in the infected cornea . CONCLUSION: Herpes stromal keratitis is a CD4+ T cell-dependent inflammatory process in which PMN infiltration and destruction of the cornea are regulated, at least in part, by the T-helper type 1 (Th1) cytokines IL-2 and IFN-gamma.

Microbiol Mol Biol Rev, 1997 Sep, 61(3), 294 - 304
Mechanisms of Giardia lamblia differentiation into cysts; Lujan HD et al.; Microbiologists have long been intrigued by the ability of parasitic organisms to adapt to changes in the environment . Since most parasites occupy several niches during their journey between vectors and hosts, they have developed adaptive responses which allow them to survive under adverse conditions . Therefore, the life cycles of protozoan and helminthic parasites are excellent models with which to study numerous mechanisms involved in cell differentiation, such as the regulation of gene expression, signal transduction pathways, and organelle biogenesis . Unfortunately, many of these studies are very difficult because the conditions needed to elicit developmental changes in parasites remain undetermined in most cases . Recently, several interesting findings were reported on the process of differentiation of Giardia lamblia trophozoites into cysts . G . lamblia is a flagellated protozoan that inhabits the upper small intestine of its vertebrate host and is a major cause of enteric disease worldwide . It belongs to the earliest identified lineage among eukaryotes and therefore offers a unique insight into the progression from primitive to more complex eukaryotic cells . The discovery of a specific stimulus that induces trophozoites to differentiate into cysts, the identification and characterization of encystation-specific molecules, the elucidation of novel biochemical pathways, and the development of useful reagents and techniques have made this parasite an excellent model with which to study differentiation in eukaryotic cells . In this review, we summarize the most recent fundings on several aspects of Giardia differentiation and discuss the significance of these findings within the context of current knowledge in the field.

Int J Med Inform, 1997 Jun, 45(1-2), 19 - 23
An information system for metabolic intensive care unit; Sobotka L et al.; The metabolic intensive care unit (MICU) is a special department where patients requiring long-term metabolic and nutritional support are treated . Parenteral nutrition is of primary importance in the MICU . The optimal organisation of many different data within the MICU, requires an information system which is computerised . However, the problem of paramount importance is data collection . To prevent data losses, we have constructed our computerised information system for MICU as the only information channel for mutual communication of physicians, nursing staff, laboratories, etc . The following modules are typical and necessary for work in the MICU: (1) module for parenteral nutrition; (2) module for enteral nutrition; (3) biochemical module; (4) drug therapy administration module; (5) clinical microbiology database; (6) nursing therapeutic module . At present we have 6-years experience of full computerisation of the MICU . According to this experience the assumption that the logical central point of medical information system must be close to the physician, nurse and patient proved to be correct.

Intensive Care Med, 1997 Jul, 23(7), 783 - 6
Systemic inflammatory response syndrome in intravascular lymphomatosis; Ip M et al.; Intravascular lymphomatosis (IVL) is characterized by an intravascular proliferation of atypical mononuclear cells of haematopoietic origin occluding small blood vessels including venules, capillaries and small arteries, and can affect virtually any organ in the body . Clinically, the most common manifestations are involvement of the skin and central nervous system, although various organ involvement has been described . We report a patient who presented with fever and rash, and succumbed with acute neurological symptoms and systemic inflammatory response syndrome (SIRS) with no evidence of infection . The postmortem revealed disseminated involvement of virtually every organ with IVL, the malignant cells being of T-cell origin, which may secrete cytokines including tumour necrosis factor and interleukin-1, that are believed to be mediators in SIRS . In the absence of evidence of infection on microbiology and pathology, we postulate that the features of SIRS in this patient was due to the disseminated malignancy itself.

J Clin Microbiol, 1997 Sep, 35(9), 2210 - 4
Evaluation of spoligotyping in a study of the transmission of Mycobacterium tuberculosis; Goguet de la Salmoniere YO et al.; Spoligotyping (for spacer oligotyping) is an easy, economical, and rapid way of typing Mycobacterium tuberculosis complex strains with the DR spacer markers (J . Kamerbeek et al., J . Clin . Microbiol . 35:907-914, 1997; D . van Soolingen et al., 33:3234-3248, 1995) . The stability of the markers was demonstrated by showing that all the Mycobacterium bovis BCG strains tested gave the same spoligotyping pattern . None of the 42 atypical mycobacterial strains tested gave a spoligotyping signal, indicating the specificity of the technique for M . tuberculosis complex . The utility of the spoligotyping method was demonstrated by analyzing 106 isolates of M . tuberculosis obtained over 1 year in three Paris hospitals . The results obtained by this technique were compared to those obtained by Torrea et al . (G . Torrea et al., J . Clin . Microbiol . 34:1043-1049, 1996) by IS6110-based restriction fragment length polymorphism (RFLP) analysis . Strains from patients with epidemiological relationships that were in the same IS6110-RFLP cluster were also in the same spoligotyping group . Spoligotyping was more discriminative than RFLP analysis for strains with one or two copies of IS6110 . RFLP analysis did not discriminate between the nine strains with one or two IS6110 bands with no known epidemiological relation, whereas spoligotyping distinguished between eight different types . IS6I10-RFLP analysis split some of the spoligotyping clusters, particularly when the IS6110 copy number was high . Therefore, we propose a strategy for typing M . tuberculosis strains in which both markers are used.

AJR Am J Roentgenol, 1997 Sep, 169(3), 661 - 6
Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment; Boiselle PM et al.; OBJECTIVE: The purpose of this study was to prospectively assess the usefulness of the routine addition of an automated biopsy device (ABD) to fine-needle aspiration (FNA) of the lung and to examine the complication rate of this procedure . SUBJECTS AND METHODS: Fifty biopsies were performed under CT guidance using a coaxial technique with a 19-gauge introducer needle and a 22-gauge aspirating needle followed by a 20-gauge ABD . An average of 3.5 FNA specimens and 2.5 core specimens were obtained . Cytology and histology specimens were interpreted separately by two experienced pathologists who were unaware of the other's interpretation . Final diagnoses were based on surgery, microbiology, definitive biopsy diagnosis, and clinical follow-up . All complications were recorded . RESULTS: Of 34 malignant lesions, we achieved a diagnostic accuracy of 94% for FNA and 59% for core biopsy (p < .01) . Combined accuracy was 94% . Of 16 benign lesions, an accurate definitive diagnosis was made in 31% of cases using FNA and in 69% of cases using core biopsy (p = .08) . Combined accuracy was 69% . In the subset of benign lesions that were not acute infections (n = 8), an accurate definitive benign diagnosis was made in 12% of cases using FNA and in 75% of cases using core biopsy (p < .05) . No false-positive diagnoses of malignancy occurred . Complications included pneumothorax, nine (18%) of 50 cases; chest tube, one (2%) of 50 cases minor pulmonary hemorrhage, seven (14%) of 50 cases; and minor hemoptysis, two (4%) of 50 cases . CONCLUSION: The complication rates of FNA with the addition of an ABD are similar to those reported in the literature for FNA alone . The addition of an ABD significantly increases the diagnostic accuracy only for the subset of benign lesions that are not acute infections.

Artif Intell Med, 1997 Sep, 11(1), 55 - 73
Lightweight fuzzy processes in clinical computing; Hurdle JF; In spite of advances in computing hardware, many hospitals still have a hard time finding extra capacity in their production clinical information system to run artificial intelligence (AI) modules, for example: to support real-time drug-drug or drug-lab interactions; to track infection trends; to monitor compliance with case specific clinical guidelines; or to monitor/ control biomedical devices like an intelligent ventilator . Historically, adding AI functionality was not a major design concern when a typical clinical system is originally specified . AI technology is usually retrofitted 'on top of the old system' or 'run off line' in tandem with the old system to ensure that the routine work load would still get done (with as little impact from the AI side as possible) . To compound the burden on system performance, most institutions have witnessed a long and increasing trend for intramural and extramural reporting, (e.g . the collection of data for a quality-control report in microbiology, or a meta-analysis of a suite of coronary artery bypass grafts techniques, etc.) and these place an ever-growing burden on typical the computer system's performance . We discuss a promising approach to adding extra AI processing power to a heavily-used system based on the notion 'lightweight fuzzy processing (LFP)', that is, fuzzy modules designed from the outset to impose a small computational load . A formal model for a useful subclass of fuzzy systems is defined below and is used as a framework for the automated generation of LFPs . By seeking to reduce the arithmetic complexity of the model (a hand-crafted process) and the data complexity of the model (an automated process), we show how LFPs can be generated for three sample datasets of clinical relevance.

Nucleic Acids Res, 1997 Sep 1, 25(17), 3486 - 9
The binding of two dimers of IciA protein to the dnaA promoter 1P element enhances the binding of RNA polymerase to the dnaA promoter 1P; Lee Y et al.; Transcription of the dnaA gene from the promoter 1P has been shown to be activated in vitro and in vivo by the binding of IciA protein to two sites on the dnaA promoter region {Lee, Y . S., Kim, H., and Hwang, D . S . (1996) Mol . Microbiol . 19, 389-396; Lee, Y . S., and Hwang, D . S . (1997) J . Biol . Chem . 272, 83-88} . In vitro transcription assays using DNA fragments carrying variable combinations of two IciA binding sites revealed that IciA binding site I (IciA I site), which is located upstream of the promoter 1P, is responsible for the transcriptional activation . Binding of one dimeric IciA protein to the IciA I site is followed by binding of the second dimer . Two dimers of IciA protein, rather than one dimer, on the IciA I site appeared to enhance the binding of RNA polymerase to the promoter 1P, resulting in the activation of transcription from the promoter 1P.

J Biol Chem, 1997 Aug 22, 272(34), 21349 - 56
Lewis X biosynthesis in Helicobacter pylori . Molecular cloning of an alpha(1,3)-fucosyltransferase gene; Martin SL et al.; The lipopolysaccharide of certain strains of Helicobacter pylori was recently shown to contain the Lewis X (Lex) trisaccharide (Galbeta-1, 4-(Fucalpha(1,3))-GlcNAc) . Lex is an oncofetal antigen which appears on human gastric epithelium, and its mimicry by carbohydrate structures on the surface of H . pylori may play an important part in the interaction of this pathogen with its host . Potential roles for bacterial Lex in mucosal adhesion, immune evasion, and autoantibody induction have been proposed (Moran, A . P., Prendergast, M . M., and Appelmelk, B . J . (1996) FEMS Immunol . Med . Microbiol . 16, 105-115) . In mammals, the final step of Lex biosynthesis is the alpha(1,3)-fucosylation of GlcNAc in a terminal Galbeta(1-->4)GlcNAc unit, and a corresponding GDP-fucose:N-acetylglucosaminyl alpha(1,3) fucosyltransferase (alpha(1,3)-Fuc-T) activity was recently discovered in H . pylori extracts . We used part of a human alpha(1, 3)-Fuc-T amino acid sequence to search an H . pylori genomic data base for related sequences . Using a probe based upon weakly matching data base sequences, we retrieved clones from a plasmid library of H . pylori DNA . DNA sequence analysis of the library clones revealed a gene which we have named fucT, encoding a protein with localized homology to the human alpha(1,3)-Fuc-Ts . We have demonstrated that fucT encodes an active Fuc-T enzyme by expressing the gene in Escherichia coli . The recombinant enzyme shows a strong preference for type 2 (e.g . LacNAc) over type 1 (e.g . lacto-N-biose) acceptors in vitro . Certain residues in a short segment of the H . pylori protein are completely conserved throughout the alpha(1,3)-Fuc-T family, defining an alpha(1,3)-Fuc-T motif which may be of use in identifying new fucosyltransferase genes.

Eur J Biochem, 1997 Aug 1, 247(3), 852 - 9
The ribosomal S16 protein of Escherichia coli displaying a DNA-nicking activity binds to cruciform DNA; Bonnefoy E; We have recently shown that the ribosomal S16 protein of Escherichia coli is a magnesium-dependent DNase which introduces nicks into supercoiled DNA molecules {Oberto, J., Bonnefoy, E., Mouray, E., Pellegrini, O., Wikstrom, P . M . & Rouviere-Yaniv, J . (1996) Mol . Microbiol . 19, 1319-1330} . In this work we analysed the DNA-binding and DNA-nicking properties of S16 using two different approaches . Gel-retardation assays showed that S16 is a structure-specific DNA-binding protein displaying a preferential binding for cruciform DNA structures . This specific binding to cruciform DNA was further investigated using a supercoiled plasmid carrying the origin of replication of E . coli (oriC) which is an (A+T)-rich DNA region with abundant palindromic sequences susceptible of forming cruciform-like structures in vivo . We show that the nicks introduced by S16 in oriC are not randomly positioned but are precisely localised near such palindromic sequences . In addition, the nicking activity of S16 appeared to be sequence dependent since the cuts introduced by S16 occurred next to an adenine, in most cases an unpaired adenine, usually followed by a GTT sequence . Overall these experiments indicate that S16 requires a cruciform-like DNA structure to bind DNA and the presence of a particular sequence in order to introduce specific single-stranded cuts into a DNA molecule.

Epidemiol Infect, 1997 Aug, 119(1), 53 - 60
Cryptosporidiosis in children during a massive waterborne outbreak in Milwaukee, Wisconsin: clinical, laboratory and epidemiologic findings; Cicirello HG et al.; During the spring of 1993 an estimated 403000 residents of the greater Milwaukee, Wisconsin area experienced gastrointestinal illness due to infection with the parasite Cryptosporidium parvum following contamination of the city's water supply . To define the clinical, laboratory and epidemiologic features of outbreak-associated cryptosporidiosis in children, medical and laboratory records for all children submitting stool samples to the microbiology laboratory of the Children's Hospital of Wisconsin between 7 April and 13 May 1993 were reviewed retrospectively . Interviews with parents were also conducted to obtain additional clinical history . Cryptosporidium, as the sole pathogen, was identified in stools from 49 (23%) of the 209 children enrolled in the study . Children with laboratory-confirmed cryptosporidiosis were more likely to live in areas of Milwaukee supplied with contaminated water (RR = 1.92, CI = 1.19-3.09), to be tested later in their illness (P < 0.05), to have submitted more than one stool specimen (P = 0.01), to have an underlying disease that altered their immune status (RR = 2.78, CI = 1.60-4.84), and to be older than 1 year of age (RR = 2.02, CI = 1.13-3.60) . Clinical illness in these patients was more prolonged and associated with weight loss and abdominal cramps compared with Cryptosporidium-negative children . In the context of this massive waterborne outbreak relatively few children had documented infection with Cryptosporidium . If many children who tested negative for the parasite were truly infected, as the epidemiologic data suggest, existing laboratory tests for Cryptosporidium were insensitive, particularly early in the course of illness.

Arch Pathol Lab Med, 1997 Aug, 121(8), 859 - 64
Routine rapid Mycobacterium species assignment based on species-specific allelic variation in the 65-kilodalton heat shock protein gene (hsp65); Pai S et al.; OBJECTIVE: To assess the utility of automated DNA sequencing strategies for Mycobacterium species assignment and surrogate rifampin susceptibility testing of Mycobacterium tuberculosis complex isolates in a hospital-based clinical microbiology laboratory . DESIGN: Consecutive patient specimens (n = 161) cultured in BACTEC 12B medium (growth index of 50 or greater) or on solid media (Lowenstein-Jensen) were analyzed . A 360-bp segment of a gene (hsp65) encoding a 65-kd heat shock protein was sequenced to identify species-specific allelic polymorphism . Identification of sequence variation in the rpoB gene encoding the beta subunit of RNA polymerase was used as a surrogate method to assess rifampin susceptibility in M tuberculosis complex isolates . RESULTS: The automated DNA sequencing strategies rapidly identified virtually all mycobacteria (158 {98%} of 161) to the species level and unambiguously characterized the region of rpoB that contains mutations responsible for rifampin resistance in M tuberculosis strains . With few exceptions, DNA sequence-based species assignment data agreed with diagnostic information obtained by conventional methods . All discrepancies were due to ambiguous biochemical test data or interpretation . The rifampin susceptibility phenotype was correctly predicted for all strains by rpoB sequencing . CONCLUSIONS: Rapid mycobacterial species assignment based on hsp65 sequencing can be routinely performed in a hospital diagnostic microbiology laboratory setting . The method is especially useful for identification of fastidious organisms, such as Mycobacterium genavense . Sequencing of the rifampin-resistance-determining region of rpoB provides a convenient surrogate strategy for predicting rifampin susceptibility in M tuberculosis complex isolates.

Am J Clin Pathol, 1997 Aug, 108(2), 191 - 6
Histologic processing of microbiopsies from cervical smears is diagnostically useful in selected cases; Mravunac M et al.; We analyzed the value in cervical cytology of a recently developed technique by which it is possible to remove thick tissue specimens, called microbiopsies, from cervical smears and to process them for histologic examination . In 12 (48%) of 25 cervical smears in which microbiopsies were found, the histologic sections from them confirmed the cytologic diagnosis . Most cases involved classification of lesions diagnosed as cervical intraepithelial neoplasia . In 13 (52%) of 25 smears, processing the microbiopsy allowed considerable modification of the cytologic diagnosis . In six of these cases, microbiopsies consisted of groups of columnar cells that were incorrectly classified as atypical on the basis of cytologic criteria . After histologic processing, the microbiopsies revealed nonatypical columnar cells in four cases and only mildly atypical columnar cells in two cases . In 3 of 13 smears, there were insufficient dispersed atypical cells for a conclusive diagnosis . Processing the microbiopsies in these cases allowed classification into one of the cervical intraepithelial neoplasia categories.

Diagn Cytopathol, 1997 Aug, 17(2), 153 - 9
Direct intrauterine sampling: the IUMC Endometrial Sampler; Tao LC; Endometrial cytology has been studied for more than 25 years, and a variety of cytologic devices have been developed for direct sampling of the endometrium . The quality of endometrial samples procured by various devices is markedly different and greatly affects the diagnostic accuracy . A new endometrial sampling device, the IUMC Endometrial Sampler, was developed at the Indiana University Medical Center and approved by the Food and Drug Administration for general medical use . This device is intended for the early detection of endometrial carcinoma and its precursors . It can be used to monitor the endometrial condition of patients receiving estrogen replacement therapy or tamoxifen . It is also useful for the procurement of uncontaminated endometrial samples for microbiologic studies from patients with suspected endometritis . It has the potential to be used for endometrial dating for patients with infertility disorders . In our clinical trials and sampling tests using hysterectomy specimens, adequate and representative endometrial samples without contamination from endocervix and vagina were consistently obtained by this device . The procedure of endometrial sampling using this device and the preparation techniques for endometrial brushing specimens are discussed and illustrated.

Hepatology, 1997 Aug, 26(2), 398 - 406
Quantitative graphical description of portocentral gradients in hepatic gene expression by image analysis; Lamers WH et al.; The liver consists of numerous repeating, randomly oriented, more or less cylindrical units, the lobules . Although enzyme-histochemical or microbiochemical assays accurately reflect zonal differences in lobular enzyme content, their results cannot be directly compared to biochemical assays . This is because section-based assays typically sample along a linear portocentral column of cells, even though periportal regions contribute substantially more to hepatic volume than pericentral regions . We have developed a time-efficient approach that depends on image analysis to determine the prevalence of hepatocytes (pixels) with a defined cellular concentration of a particular gene product (absorbance), and that generates a graph with the average absorbance per hepatocyte on the ordinate and the percentage of hepatocytes with absorbances in each of a predetermined range of absorbances incrementally summed on the abscissa . The direction of the gradient is read directly from the section . The gradient is a graphical representation of the two-dimensional distribution pattern of the gene product between the portal tracts and the central veins . The total surface area underneath the resulting graph represents the integrated absorbance and is equivalent to the outcome of a biochemical assay . The typical linear portocentral gradient can be derived from that representing the two-dimensional distribution if we assume that liver lobules are uniformly cylindrical or prismatic . The analysis, therefore, yields a quantitative description of the relation between the enzymatic phenotype of hepatocytes and their position on a normalized portocentral radius . We have used the procedure to compare portocentral gradients of different enzymes in the same liver and of the same enzyme in different livers . In addition, bipolar portocentral gradients of the same enzyme in the same liver were analyzed.

Appl Environ Microbiol, 1997 Aug, 63(8), 3291 - 3
Cell-density-dependent sensitivity of a mer-lux bioassay; Rasmussen LD et al.; The sensitivity of a previously described assay (O . Selifonova, R . Burlage, and T . Barkay, Appl . Environ . Microbiol . 59:3083-3090, 1993) for the detection of bioavailable inorganic mercury (Hg2+) by the activation of a mer-lux fusion was increased from nanomolar to picomolar concentrations by reducing biomass in the assays from 10(7) to 10(5) cells ml-1 . The increase in sensitivity was due to a reduction in the number of cellular binding sites that may compete with the regulatory protein, MerR, for binding of the inducer, Hg2+ . These results show that (i) the sensitivity of the mer-lux assay is sufficient for the detection of Hg2+ in most contaminated natural waters and (ii) mer-specified reactions, Hg2+ reduction and methylmercury degradation, can be induced in natural waters and may participate in the geochemical cycling of mercury.

J Clin Microbiol, 1997 Aug, 35(8), 2072 - 5
Evaluation of a nonradiometric system (BACTEC 9000 MB) for detection of mycobacteria in human clinical samples; Zanetti S et al.; This study was carried out to evaluate the rate of recovery and time required for detection of mycobacteria from pulmonary and extrapulmonary human clinical samples, by using a fluorescence-quenching-based oxygen sensor (BACTEC 9000 MB; Becton Dickinson Microbiology Systems, Sparks, Md.) . The results were compared with those obtained by microscopy, conventional culture in Lowenstein-Jensen (LJ) medium, and a BACTEC radiometric system (BACTEC 460 TB; Becton Dickinson) . Of the 779 clinical samples processed, 364 from pulmonary sites and 415 from extrapulmonary sites, 62 (7.9%) were positive for mycobacterial isolates; of the positive samples, 59 (95.1%) were detected with the fluorescent BACTEC 9000 MB system, 57 (91.9%) were detected with the radiometric system (BACTEC 460 TB), and 43 (69.3%) were detected with LJ conventional culture . The mean times to detection of all mycobacteria with BACTEC 9000 MB and BACTEC 460 TB were similar (10.3 and 10.0 days, respectively) . The results obtained indicate that the nonradiometric BACTEC (BACTEC 9000 MB) system is as efficient as Bactec 460 TB and significantly more efficient than LJ for the rapid recovery of mycobacteria from both pulmonary and extrapulmonary clinical specimens . Though the BACTEC 9000 MB system is recommended for respiratory specimens, we demonstrated that it can be successfully used also for recovery of mycobacteria from clinical specimens from various extrapulmonary sites.

J Biol Chem, 1997 Jul 11, 272(28), 17615 - 22
Two modes of ligand binding in maltose-binding protein of Escherichia coli . Functional significance in active transport; Hall JA et al.; In the preceding two papers (Hall, J . A., Gehring, K., and Nikaido, H . (1997) J . Biol . Chem . 272, 17605-17609; Hall, J . A., Thorgeirson, T . E., Liu, J., Shin, Y.-E., and Nikaido, H . (1997) J . Biol . Chem . 272, 17610-17614), we showed that ligands that bind to the Escherichia coli maltose-binding protein (MBP) without producing the closure of its two lobes are not transported into the cytoplasm . Here, we examine various combinations of ligands, MBPs, and membrane-associated transporters, by utilizing reconstituted proteoliposomes, right side-out membrane vesicles, and intact cells . Closed forms of wild type MBP, complexed with maltose or maltodextrins, interacted with wild type transporter complex to stimulate the hydrolysis of ATP by MalK ATPase located on the other side of the membrane, as shown earlier for the maltose-MBP complex (Davidson, A . L., Shuman, H . A., and Nikaido, H . (1992) Proc . Natl . Acad . Sci . U . S . A . 89, 2360-2364) . In contrast, open forms of liganded MBPs, such as the complex containing wild type MBP and reduced, oxidized, or cyclic maltodextrins or the complex containing the mutant MBP MalE254 and unmodified maltodextrins, did not stimulate ATP hydrolysis, suggesting that the proper interaction between the ligand-MBP complex and the external surface of the transporter requires the former to be in the closed conformation . However, when a mutant transporter containing MalG511 was used, the already significant basal level of ATP hydrolysis was further stimulated not only by ligand MBPs in the closed form but also by those in the open form (except that containing beta-cyclodextrin), data suggesting that the mutant transporter does not always require the closed MBP complex presumably because of its exceptionally strong affinity to MBP, described earlier (Dean, D . A., Hor, L.-I., Shuman, H . A., and Nikaido, H . (1992) Mol . Microbiol . 6, 2033-2040) . Furthermore, this mutant transporter was able to transport reduced maltodextrin, and cells expressing the transporter were able to grow by using reduced maltodextrin, if the periplasmic concentrations of MBP were kept low so as not to inhibit the transport process.

Am J Respir Crit Care Med, 1997 Jul, 156(1), 292 - 5
Sand aspiration with near-drowning . Radiographic and bronchoscopic findings; Dunagan DP et al.; Sand and foreign-body aspiration may accompany drowning and near-drowning, but few details regarding such patients are available in the literature . We report a 26-yr-old woman who suffered near-drowning after a motor-vehicle accident . Initial attempts at ventilation were compromised by increased peak airway pressures, which decreased following the removal of large amounts of sand from the patient's endotracheal tube . Chest radiographs and computed tomographic (CT) scans of the patient obtained upon her arrival in the emergency department demonstrated sand bronchograms within the lower lobes of both lungs, and sand within the maxillary sinuses and stomach . We present the radiographic, bronchoscopic, and microbiologic findings within hours after this patient's accident, with a review of the literature and provisional recommendations for the management of such patients.

Clin Microbiol Rev, 1997 Jul, 10(3), 401 - 18
Extrapulmonary pneumocystosis; Ng VL et al.; Extrapulmonary pneumocystosis is an exceedingly rare complication of Pneumocystis carinii pneumonia (PCP) . Prior to the advent of the human immunodeficiency virus type 1 (HIV-1) epidemic, only 16 cases of extrapulmonary pneumocystosis in individuals who were immunocompromised by a variety of underlying diseases had been reported . Since the beginning of the HIV-1 and related PCP epidemic, at least 90 cases of extrapulmonary pneumocystosis have been reported . This review briefly presents a history of the discovery of P . carinii and its recognition as a human pathogen, the controversy regarding its taxonomy, and the epidemiology of this organism . A more detailed analysis of the incidence of extrapulmonary pneumocystosis in HIV-1-infected individuals and its occurrence despite widespread prophylaxis for PCP with either aerosolized pentamidine or systemic dapsone-trimethoprim is presented . The clinical features of published cases of extrapulmonary pneumocystosis in non-HIV-1-infected individuals are summarized and contrasted with those in HIV-1 infected individuals . The diagnosis of extrapulmonary pneumocystosis is discussed, and because clinical microbiologists and pathologists are the key individuals in establishing the diagnosis, the characteristic microscopic morphology of P . carinii as its appears when stained with a variety of stains is presented and reviewed . The review concludes with a brief discussion of treatments for extrapulmonary pneumocystosis.

J Bacteriol, 1997 Jul, 179(14), 4583 - 90
Role of the hemA gene product and delta-aminolevulinic acid in regulation of Escherichia coli heme synthesis; Verderber E et al.; We initiated these studies to help clarify the roles of heme, delta-aminolevulinic acid (ALA), hemA, and hemM in Escherichia coli heme synthesis . Using recombinant human hemoglobin (rHb1.1) as a tool for increasing E . coli's heme requirements, we demonstrated that heme is a feedback inhibitor of heme synthesis . Cooverexpression of rHb1.1 and the hemA-encoded glutamyl-tRNA (GTR) reductase increased intracellular levels of ALA and heme and increased the rate of rHb1.1 formation . These results support the conclusion that heme synthesis is limited by ALA (S . Hino and A . Ishida, Enzyme 16:42-49, 1973; W . K . Philipp-Dormston and M . Doss, Enzyme 16:57-64, 1973) and that the hemA-encoded GTR reductase is a rate-limiting enzyme in the pathway (J.-M . Li, C . S . Russell, and S . D . Cosloy, Gene 82:2099-217, 1989) . Increasing the copy number of hemM, whose product is believed to be required for efficient ALA formation (W . Chen, C . S . Russell, Y . Murooka, and S . D . Cosloy, J . Bacteriol . 176:2743-2746, 1994; M . Ikemi, K . Murakami, M . Hashimoto, and Y . Murooka, Gene 121:127-132, 1992), had no effect on either ALA pools or the rate of rHb1.1 accumulation . The hemA-encoded GTR reductase was found to be regulated by ALA . Some of our results differ from those reported by Hart and coworkers (R . A . Hart, P . T . Kallio, and J . E . Bailey, Appl . Environ . Microbiol . 60:2431-2437, 1994), who concluded that ALA formation is not the rate-limiting step in E . coli cells expressing Vitreoscilla hemoglobin.

Cornea, 1997 Jul, 16(4), 383 - 6
The role of cultures in the management of ulcerative keratitis; Levey SB et al.; PURPOSE: To ascertain the importance of routine cultures and gram stains in the management of ulcerative keratitis . METHODS: We retrospectively reviewed 119 consecutive corneal ulcers seen at Sinai Hospital of Baltimore . Cultures were obtained of the corneal ulcer and of the lids and conjunctivae of both eyes . Gram stains were performed by the hospital microbiology department on corneal scrapings from each ulcer . RESULTS: Positive corneal cultures were obtained from 56 eyes (47.1%) . Initial antibiotic therapy was changed based on culture results in 14.3% of culture-positive eyes that demonstrated a worsening clinical course . Gram stains were negative in all cases . The sensitivity and specificity of the lid and conjunctival cultures were determined . CONCLUSIONS: Corneal cultures are important in the management of ulcerative keratitis . Lid and conjunctival cultures have low sensitivity and specificity.

Laryngoscope, 1997 Jul, 107(7), 863 - 7
Intracranial complications of sinusitis; Giannoni CM et al.; Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic . To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995 . There were 203 patients with 212 suppurative intracranial infections . Sinogenic sources were identified in 12 patients with 19 infections . Most patients had ethmoid or frontal sinusitis . We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases . The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses . The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.

Appl Environ Microbiol, 1997 Jul, 63(7), 2940 - 3
Expression and functional analysis of a hyperglycosylated glucoamylase in a parental host, Aspergillus awamori var . kawachi; Goto M et al.; A modified glucoamylase gene (glaA) with an extra Thr- and Ser-rich Gp-I domain (T . Semimaru, M . Goto, K . Furukawa, and S . Hayashida, Appl . Environ . Microbiol . 61:2885-2890, 1995) was introduced into a mutant parental host, Aspergillus awamori var . kawachi, in which the original glaA gene had been completely deleted and replaced with the hygromycin phosphotransferase gene . The modified glaA was successfully expressed and secreted . The modified glucoamylase possessed higher digestibility of raw corn starch and higher stabilities in response to heat and extreme pH.

Obstet Gynecol, 1997 Jul, 90(1), 54 - 7
Endovaginal sonography for the diagnosis of upper genital tract infection; Boardman LA et al.; OBJECTIVE: To determine the clinical utility of transvaginal sonography for the diagnosis of upper genital tract infection . METHODS: Fifty-five women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or were being seen for non-classic signs of upper genital tract infection were evaluated . During abdominal and endovaginal ultrasound testing, fluid in the cul-de-sac, discrete tubes with or without tubal fluid, multicystic ovaries, and adnexal masses were noted . Upper genital tract infection was confirmed by laparoscopic visualization or histologic or microbiologic evidence of salpingitis of endometritis . RESULTS: The specificity of identifying fallopian tubes with or without intraluminal fluid on ultrasound was 97% (35 of 36); the sensitivity, however, was only 32% (six of 19) . Calculated using Bayes theorem and based on a prevalence rate of 50%, the positive predictive value of visualizing fallopian tubes was 91% . The sensitivities associated with the visualization of a multicystic ovary or tubo-ovarian abscess were 42% (eight of 19) and 32% (six of 19), with specificities of 86% (31 of 36) and 97%, (35 of 36), and positive predictive values of 75% and 91%, respectively . Cul-de-sac fluid was associated with low sensitivity (37%; seven of 19), low specificity (58%; 21 of 36), and the lowest positive predictive value (47%) . CONCLUSION: Endovaginal sonography has limited clinical utility in the diagnosis of upper genital tract infection due to its low sensitivity.

Infect Immun, 1997 Jul, 65(7), 2606 - 12
Enteropathogenic Escherichia coli protein secretion is induced in response to conditions similar to those in the gastrointestinal tract; Kenny B et al.; The pathogenicity of enteropathogenic Escherichia coli (EPEC) is associated with the expression and secretion of specific bacterial factors . EspB is one such secreted protein which is required to trigger host signaling pathways resulting in effacement of microvilli and cytoskeletal rearrangements . These events presumably contribute to the ensuing diarrhea associated with EPEC infections . EPEC encounters several environmental changes and stimuli during its passage from the external environment into the host gastrointestinal tract . In this paper we show that the secretion of EspB is subject to environmental regulation, and maximal secretion occurs under conditions reminiscent of those in the gastrointestinal tract . Thus, secretion is maximal at 37 degrees C, pH 7, and physiological osmolarity . In addition, maximal secretion requires the presence of sodium bicarbonate and calcium and is stimulated by millimolar concentrations of Fe(NO3)3 . The secretion of the four other EPEC-secreted proteins appears to be modulated in a manner similar to that of EspB . Our results also show that secretion is not dependent on CO2, as originally reported by Haigh et al . (FEMS Microbiol . Lett . 129: 63-67, 1995), but that CO2 more likely acts as a component of the medium buffering system, since CO2 dependence was abolished by the use of alternative buffers.

J Virol, 1997 Jul, 71(7), 5455 - 63
Increase in the frequency of hepadnavirus DNA integrations by oxidative DNA damage and inhibition of DNA repair; Petersen J et al.; Persistent hepadnavirus infection leads to oxidative stress and DNA damage through increased production of toxic oxygen radicals . In addition, hepadnaviral DNA integrations into chromosomal DNA can promote the process of hepatocarcinogenesis (M . Feitelson, Clin . Microbiol . Rev . 5:275-301, 1992) . While previous studies have identified preferred integration sites in hepadnaviral genomes and suggested integration mechanisms (M . A . Buendia, Adv . Cancer Res . 59:167-226, 1992; C . E . Rogler, Curr . Top . Microbiol . Immunol . 168:103-141, 1991; C . Shih et al., J . Virol . 61:3491-3498, 1987), very little is known about the effects of agents which damage chromosomal DNA on the frequency of hepadnaviral DNA integrations . Using a recently developed subcloning approach to detect stable new integrations of duck hepatitis B virus (DHBV) (S . S . Gong, A . D . Jensen, and C . E . Rogler, J . Virol . 70:2000-2007, 1996), we tested the effects of increased chromosomal DNA damage induced by H2O2, or of the disturbance in DNA repair due to the inhibition of poly(ADP-ribose) polymerase (PARP), on the frequency of DHBV DNA integrations . Subclones of LMH-D21-6 cells, which replicate DHBV, were grown in the presence of various H2O2 concentrations and exhibited up to a threefold increase in viral DNA integration frequency in a dose-dependent manner . Moreover, inhibition of PARP, which plays a role in cellular responses to DNA breakage, by 3-aminobenzamide (3-AB) resulted in a sevenfold increase in the total number of new DHBV DNA integrations into host chromosomal DNA . Removal of either H2O2 or 3-AB from the culture medium in a subsequent cycle of subcloning was accompanied by a reversion back towards the original lower frequency of stable DHBV DNA integrations for LMH-D21-6 cells . These data support the hypothesis that DNA damage sites can serve as sites for hepadnaviral DNA integration, and that increasing the number of DNA damage sites dramatically increases viral integration frequency.

Eur J Clin Microbiol Infect Dis, 1997 Jun, 16(6), 460 - 4
Fatal Scedosporium prolificans infection in a leukemic patient; Feltkamp MC et al.; The case is described of a 42-year-old patient with acute myeloid leukemia who received two courses of chemotherapy complicated by prolonged bone marrow depression . He was admitted to hospital with fever, hepatosplenomegaly and bilateral nodular pulmonary infiltrates . After admission diffuse cutaneous skin nodules, and hypodense lesions in the hemispheres and cerebellum developed . Cultures of cerebrospinal fluid, bronchoalveolar lavage fluid, skin biopsy specimens and blood revealed Scedosporium prolificans, indicative of disseminated mycosis . Treatment with amphotericin B and fluconazole was unsuccessful and the patient died within five days after admission . Features that may enhance early recognition of Scedosporium prolificans infection by both clinicians and microbiologists, as well as options in the treatment of infection with this fungal agent are discussed.

Epidemiol Infect, 1997 Jun, 118(3), 253 - 7
An outbreak of rubella in British troops in Bosnia; Adams MS et al.; An outbreak of rubella in April 1996 involved four male British soldiers deployed to Bosnia-Herzegovina . All were helicopter ground crew who were members of the same unit and who periodically travelled to and worked at forward air refuelling stations in Bosnia . There was a potential for spread of the infection to adjacent British units, to troops of other nations in the peacekeeping force, and also to the local civilian population . The British force included 620 female personnel, some of whom may have been non-immune to rubella . One pregnant British servicewoman was repatriated to UK for her own protection . There was a potential health risk, including the possibility of congenital rubella syndrome, in the non-immune wives and partners of deployed male personnel, as a result of contact during the mid-tour home leave of the husbands or partners . The outbreak was monitored through a medical surveillance system known as ARRC 97, and was contained by prompt and rigorous control measures . This outbreak shows the importance of effective surveillance and of good microbiology laboratory support during military operations . The role of immunization against rubella during future military deployments is discussed.

Infect Dis Clin North Am, 1997 Jun, 11(2), 257 - 78
Role of molecular epidemiology in infection control; Weber S et al.; Molecular typing methods have enabled infection control personnel to investigate outbreaks and endemic nosocomial infections more quickly and thoroughly than they could have with basic epidemiologic and microbiologic methods . This article reviews molecular typing methods that have been used successfully in the practice of hospital epidemiology . Included is an explanation of the basic principles of these methods and a description of their strengths and weaknesses.

Gastroenterol Clin North Am, 1997 Jun, 26(2), 417 - 44
Molecular diagnosis of gastrointestinal infections associated with HIV infection; Talal AH et al.; Developments in medical microbiology in the past 20 years have had a profound impact on our understanding of infectious diseases and have led the way in the development of new diagnostic techniques . Molecular diagnostic techniques are generally more sensitive, specific, and rapid than conventional methods by which infectious agents are detected . For many of the opportunistic infectious agents of the gastrointestinal tract found in HIV-infected individuals, the application of molecular diagnostic techniques to the clinical laboratory is in its infancy . In this article, methods by which these techniques can be evaluated are demonstrated, and the current status and potential future application of these techniques for each gastrointestinal opportunistic pathogen are described.

J Infect Dis, 1997 Jun, 175(6), 1382 - 9
Genetic and phenotypic analysis of Escherichia coli with enteropathogenic characteristics isolated from Seattle children; Bokete TN et al.; Coliform colonies from children whose stools were submitted for microbiologic analysis were studied prospectively to determine the frequency of shedding of enteropathogenic Escherichia coli (EPEC) . In total, 2225 isolates from 445 patients were probed with eaeA (encoding intimin) and the EAF (EPEC adherence factor) probe, and adherence and actin-aggregating phenotypes were determined . Twenty-five patients (5.6%) shed non-O157:H7 eaeA+ EAF- E . coli . Of these 25 patients, isolates from 5 produced Shiga toxins and from 3 possessed bfpA (encoding the bundle-forming pilus) sequences . Non-O157:H7 eaeA+ E . coli from 21 (84%) of 25 patients adhered locally to and aggregated actin in HeLa cells . Four patients shed nonadherent EAF+ eaeA- E . coli . Non-O157:H7 eaeA+ and EAF- isolates belonged to diverse electrophoretic types and classical and nonclassical enteropathogenic serotypes . EPEC are relatively common in stools submitted for analysis in this North American pediatric hospital . Their etiologic role in childhood diarrhea warrants elucidation.

J Clin Microbiol, 1997 Jun, 35(6), 1504 - 9
Detection and typing of herpes simplex viruses by using recombinant immunoglobulin fragments produced in bacteria; Cattani P et al.; Thirty-seven bacterial clones producing human recombinant monoclonal antibody Fab fragments (rFabs) reactive to herpes simplex virus (HSV) antigens were selected from a human combinatorial antibody library constructed in a phage-display vector by a panning procedure against an HSV lysate . Thirty-four of the HSV-specific rFabs were able to specifically recognize HSV-infected cells in indirect immunofluorescence (IF) assays; of these, 25 recognized cells infected by either HSV type 1 (HSV-1) or HSV-2, while 9 recognized only HSV-1-infected cells . One HSV type-common rFab (rFab H37) and one HSV-1-specific rFab (rFab H85) were further evaluated as reagents for viral detection and typing by IF staining in 134 HSV-positive (72 HSV-1 and 62 HSV-2) viral cultures from clinical specimens . The results obtained with these two rFabs were fully consistent with those obtained with a commercial preparation of fluorescein-labeled anti-HSV type-specific murine monoclonal antibodies . The detection sensitivity with the type-common rFab in indirect IF assays was higher overall than that provided by the type-specific murine monoclonal antibodies . Preparations of rFabs suitable for IF staining can be easily and inexpensively obtained in a clinical microbiology laboratory from Escherichia coli cultures . Similar HSV-specific rFabs, therefore, could be advantageous for in vitro diagnostic purposes.

J Clin Microbiol, 1997 Jun, 35(6), 1484 - 91
Performance of an automated Q-beta replicase amplification assay for Mycobacterium tuberculosis in a clinical trial; Smith JH et al.; We present data from a clinical trial study in which an automated version (Galileo) of a previously described Q-Beta replicase-amplified probe assay (J . S . Shah et al., J . Clin . Microbiol . 33:1435-1441, 1995) was used for the direct detection of Mycobacterium tuberculosis complex in sputum . The assay was designed to target specific regions of 23S rRNA found in M . tuberculosis, Mycobacterium bovis, Mycobacterium africanum, and Mycobacterium microti and had a sensitivity ranging from approximately <10 to 300 CFU . The assay was tested for cross-hybridization by using large numbers (e.g., 10(5)to 10(10) CFU/assay) of 133 other organisms commonly found in respiratory tract samples, including non-M . tuberculosis Mycobacterium spp., other bacteria, fungi, and viruses . All of these competitors tested negative by the assay . Automated assay results for 780 respiratory tract samples (sputum or bronchoalveolar lavage specimens) collected and tested at three trial sites in the United States) were compared with the results of culture and acid-fast microscopy . Aliquots of conventionally digested and decontaminated sputum pellets were heated at 100 degrees C and mechanically disrupted prior to hybridization and background reduction, amplification, and detection in a closed disposable test pack . Pertinent elements of individual patient histories relating to tuberculosis exposure, previous active disease, antituberculosis therapy status, etc., were considered in the resolution of discrepant results for 48 (assay false-positive) samples . Seventy-one of 90 (78.9%) culture-positive samples were positive when tested in the Galileo assay, while 7% of culture-negative samples were assay positive, corresponding to a sensitivity of 79% and a specificity of 93% . Following resolution of discrepant results by chart review, the sensitivity and specificity for the Q-Beta replicase amplification assay with the Galileo analyzer were 84 and 97%, respectively . A total of 69.2% of smear-negative (culture positive) samples were detected by the assay . Ten test packs at a time were automatically processed by the Galileo analyzer without operator intervention following loading of samples . The first result was reported in approximately 3 h, and the last result was available in 6.5 h . To our knowledge, this is the first report of a clinical study with a fully automated amplification probe hybridization assay for the detection of pathogens directly from a clinical specimen.

Hosp Pract (Off Ed), 1997 May 15, 32(5), 169 - 71, 176-8
Exploring the potential of DNA vaccination; Cohen IR et al.; DNA vaccines offer a unique means of stimulating and enhancing the immune response . Subjects are vaccinated with the gene for a particular antigen rather than with the antigen itself--the foreign protein that elicits the response is made intracellularly . This new type of gene therapy may not only extend the limits of immunoprotection but may also provide new insight into microbiologic and immunologic processes.

Arch Intern Med, 1997 May 12, 157(9), 994 - 8
Diagnosis and treatment of Helicobacter pylori infection among California Medicare patients; Roll J et al.; BACKGROUND: Antibiotic treatment of Helicobacter pylori infection in active peptic ulcer disease has been demonstrated to speed ulcer healing, reduce the risk of rebleeding, and prevent long-term recurrence . The objective of this study was to determine whether Medicare patients with peptic ulcer disease who are admitted to acute care hospitals are being tested or treated for H pylori infection as recommended by a National Institutes of Health consensus panel . METHODS: The study was designed as a retrospective medical records survey . From the Medicare National Claims History File, all persons 65 years and older admitted to California fee-for-service hospitals for peptic ulcer disease in 1994 were identified . A random sample of 600 claims was selected for review . After exclusions, 524 patients were eligible for study . The main outcome measures were (1) the proportion of patients who were tested for H pylori infection by 1 of the 5 available methods (histopathologic study, urease assay, microbiologic culture, serum antibody testing, or urea breath test) and (2) the proportion who were treated with antibiotics (amoxicillin, tetracycline, clarithromycin, or metronidazole) for H pylori infection . RESULTS: Thirty-nine percent of patients with peptic ulcer disease were tested for H pylori infection and 3% were treated empirically . Only 47% of the patients who had a positive diagnostic test result for H pylori were treated with antibiotics . CONCLUSION: Because diagnosis and treatment of H pylori infection has been demonstrated to improve outcomes and decrease expenses, the data indicate a substantial opportunity to improve the care of elderly Medicare patients with peptic ulcer disease.

Aust N Z J Ophthalmol, 1997 May, 25 Suppl 1, S33 - 5
Ocular microbiota and polymorphonuclear leucocyte recruitment during overnight contact lens wear; Stapleton F et al.; Bacterial colonization of the ocular surface and contact lens (CL) and recruitment of polymorphonuclear leucocytes (PMN) during overnight CL wear was examined in 11 asymptomatic wearers . The ocular surface was more frequently colonized than the CL, with commensal bacteria (P < 0.05) . Following sleep, more bacteria were recovered from the CL compared with daily use (P < 0.05), and fewer PMN were recruited compared to sleep without CL wear (P < 0.05) . Overnight CL wear may inhibit physiological PMN recruitment to the cornea by preventing their access, by modifying the chemotactic signal or by altering the activation state of the recruited cells.

Appl Microbiol Biotechnol, 1997 May, 47(5), 547 - 53
Influence of aeration and carbon source on production of microcin B17 by Escherichia coli ZK650; Fang A et al.; Previous studies {Connell et al . (1987) Mol Microbiol 1: 195-201} have shown that expression of the microcin B17 (MccB17) promoter is inversely related to the growth rate of the culture, when slower growth was brought about by limitation of sources of carbon, nitrogen or phosphorus . When we used oxygen limitation to decrease growth in a glucose-based chemically defined medium, we found specific MccB17 production to be positively related to growth rate and extent . On the other hand, when we examined various nutritional variations of media, specific production of MccB17 showed a negative relationship to growth rate and extent, as would be predicted by the findings of Connell et al . (1987) . Glucose, glycerol and acetate were found to repress MccB17 production; succinate was not repressive . Succinate is an excellent carbon source for production of MccB17 since high levels can be used with no or little interference in product synthesis.

J Cataract Refract Surg, 1997 May, 23(4), 588 - 92
Influence of intraocular lens haptic material on bacterial isolates from anterior chamber aspirate; Agrawal V et al.; PURPOSE: To determine whether intraocular lens (IOL) type affects the bacterial count in anterior chamber aspirates obtained immediately after cataract surgery . SETTING: L.V . Prasad Eye Institute, Hyderabad, India . METHODS: This in vivo study evaluated two groups of eyes that had uneventful cataract extraction and implantation of one of two types of IOLs: all poly(methyl methacrylate) (PMMA) (n = 73) or polypropylene haptic (n = 83) . Anterior chamber fluid aspirates (0.1 mL) were obtained with a 30 gauge cannula at the end of surgery and inoculated onto chocolate agar and in thioglycolate broth . Microbiology evaluation was performed using standard methods . RESULTS: Seven eyes (9.5%) with all-PMMA IOLs and 21 (25.3%) with polypropylene haptic IOLs were positive for bacterial isolates (P = .0322; chi-square test) . Mean colony count (+/-SD) was 11.43 +/- 3.78 and 13.16 +/- 4.78 colony-forming units/ milliliter in the PMMA and polypropylene haptic IOL groups, respectively . No eye developed endophthalmitis . CONCLUSION: Polypropylene haptic IOLs were associated with a significant increase in bacteria in the anterior chamber.

J Pediatr Adolesc Gynecol, 1997 May, 10(2), 59 - 72
Chlamydia trachomatis in adolescents: a review; Reddy SP et al.; Genital infections caused by Chlamydia trachomatis represent the most prevalent bacterial sexually transmitted disease in the United States . An estimated 3-4 million cases annually necessitate the expenditure of more than $2 billion in health care costs per year . The ramifications of infection with this organism have significant reproductive complications . The objective of this paper is to provide the reader with a review of Chlamydia trachomatis in general with particular focus on those areas that are pertinent to the adolescent population . The authors hereby provide an overview of the clinically pertinent microbiology, epidemiology, risk factors, selective screening protocols, diagnostic methods, clinical manifestations, and sequelae of C . trachomatis.

Am J Otolaryngol, 1997 May-Jun, 18(3), 202 - 5
Diagnostic problems of tuberculous cervical adenitis (scrofula); Ibekwe AO et al.; PURPOSE: This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis . Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass . PATIENTS AND METHODS: We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993 . The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed . RESULTS: Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis . All specimens for histopathology were suggestive of tuberculosis . CONCLUSION: A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture . Tuberculosis should be included in the differential diagnosis of neck mass.

Biochem Mol Biol Int, 1997 May, 41(6), 1093 - 100
Over expression of inducible proteins in Escherichia coli by treatment with ethanol; Basu T et al.; It is reported that ethanol enhances DNA synthesis in E . coli cells {Basu, T and Poddar, R . K . (1994), Folia . Microbiol . 39, 3-6} . This communication reports that during growth of E . coli in the presence of 5% v/v ethanol, the derepressed expression of the cytoplasmic enzymes beta-galactosidase and D-serine deaminase per cell increased approximately three fold, while that of the periplasmic enzyme alkaline phosphatase decreased approximately 40% compared to control cell levels . However, in cells transformed with the plasmid pSM 456, bearing phoA-lacZ fusion, the level of induced synthesis of the hybrid protein PhoA-LacZ, controlled by the phoA promoter, was elevated by 25% in the presence of 5% v/v ethanol . This result suggests that the induction of the alkaline phosphatase precursor has also been enhanced by the ethanol treatment, but the inhibition in the export of the precursor across the cytoplasmic membrane, by the influence of ethanol, may represent the reason for the deficient expression of active alkaline phosphatase . It is proposed that there is an ethanol-mediated increase in DNA synthesis, resulting in gene amplification, which may enhance the synthesis of inducible proteins in ethanol-treated cells.

Biomaterials, 1997 May, 18(10), 707 - 13
Biocompatibility of mannuronic acid-rich alginates; Klock G et al.; Highly purified algin preparations free of adverse contaminants with endotoxins and other mitogens recently became available by a new purification process (Klock et al., Appl . Microbiol . Biotechnol., 1994, 40, 638-643) . An advantage of this purification protocol is that it can be applied to alginates with various ratios of mannuronic acid to guluronic acid . High mannuronic acid alginate capsules are of particular practical interest for cell transplantation and for biohybrid organs, because mannuronate-rich alginates are usually less viscous, allowing one to make gels with a higher alginate content . This will increase their stability and reduce the diffusion permeability and could therefore protect immobilized cells more efficiently against the host immune system . Here we report the biocompatibility of purified, mannuronic acid-rich alginate (68% mannuronate residues) in a series of in vitro, as well as in vivo, assays . In contrast to raw alginate extracts, the purified product showed no mitogenic activity towards murine lymphocytes in vitro . Its endotoxin content was reduced to the level of the solvent . Animal studies with these new, purified algin formulations revealed the absence of a mitogen-induced foreign body reaction, even when the purified material (after cross-linking with Ba2+ ions) is implanted into animal models with elevated macrophage activity (diabetes-prone BB/OK rat) . Thus, alginate capsules with high mannuronic acid content become available for applications such as implantation . In addition to the utilization as implantable cell reactors in therapy and biotechnology, these purified algins have broad application potential as ocular fillings, tissue replacements, microencapsulated growth factors and/or interleukins or slow-release dosage forms of antibodies, surface coatings of sensors and other invasive medical devices, and in encapsulation of genetically engineered cells for gene therapy.

Rheum Dis Clin North Am, 1997 May, 23(2), 239 - 58
Septic arthritis; Pioro MH et al.; Septic arthritis is a medical emergency that can lead to significant morbidity and mortality . Prompt recognition and treatment are critical to ensuring a good prognosis . Thus, this article reviews the clinical presentation, microbiology, diagnostic workup, and outcome of nonprosthetic joint infections.

J Pediatr, 1997 May, 130(5), 766 - 73
Endoscopy of the upper gastrointestinal tract as a diagnostic tool for children with human immunodeficiency virus infection; Miller TL et al.; OBJECTIVE: The purpose of this study was to determine the prevalence of upper gastrointestinal tract lesions in children with human immunodeficiency virus (HIV) infection who undergo endoscopy of the upper gastrointestinal tract and to identify important clinical predictors of abnormal endoscopic results . METHODS: All HIV-infected children who underwent endoscopy and were followed at Children's Hospital, Boston, from January 1985 to August 1994 were studied . The main outcome measure was endoscopic results, which were categorized into observational, histologic, and microbiologic findings . Potential predictors included height, weight, nutritional interventions, HIV disease stage, CD4 T-lymphocyte count, medications, active infections, and indications for endoscopy . RESULTS: Forty-three endoscopies in unique patients are reported . Most children had advanced HIV infection (67% acquired immunodeficiency syndrome, mean CD4 T-lymphocyte count z score = -2.71, weight z score = -2.04) . An abnormal endoscopic finding was discovered in 93% of children and confirmed by histologic, microbiologic, or a combination of these studies in 72% of children . Thirty-five percent of children had an opportunistic pathogen identified endoscopically; 65% of these pathogens were previously undiagnosed . Observational findings often were poor indicators of histologic and microbiologic abnormalities . Independent predictors of abnormal histologic findings include younger age at endoscopy (odds ratio (OR) = 1.16 per year, 95% confidence interval (CI) (1.02, 1.33)) and guaiac-negative stools (OR = 16.7, 95% CI (1.92, 142.9)) . Independent predictors of finding a pathogen at the time of endoscopy include a greater number of indications for endoscopy (OR = 2.6 per indication, 95% CI (1.3, 5.3)) and diagnosis of acquired immunodeficiency syndrome (OR = 16.4, 95% CI (1.3, 213)) . No other gastrointestinal, nutritional, or immunologic parameters were significantly predictive of endoscopic outcomes . Medical management was changed in 70% of children because of the endoscopic findings . CONCLUSIONS: Endoscopy is a useful tool to direct therapy against peptic and infectious disorders of the upper gastrointestinal tract in children with HIV infection . Specific gastrointestinal symptoms are not useful predictors of abnormal results.

Chest, 1997 May, 111(5), 1168 - 73
Noncompliance with directly observed therapy for tuberculosis . Epidemiology and effect on the outcome of treatment; Burman WJ et al.; STUDY OBJECTIVES: To describe the epidemiology and clinical consequences of noncompliance with directly observed therapy (DOT) for treatment of tuberculosis . DESIGN: Retrospective review . SETTING: An urban tuberculosis control program that emphasizes DOT . PATIENTS: All patients treated with outpatient DOT from 1984 to 1994 . MEASUREMENTS AND RESULTS: We defined noncompliance as follows: (1) missing > or = 2 consecutive weeks of DOT; (2) prolongation of treatment > 30 days due to sporadic missed doses; or (3) incarceration for presenting a threat to public health . Poor outcomes of therapy were defined as a microbiologic or clinical failure of initial therapy, relapse, or death due to tuberculosis . Fifty-two of 294 patients (18%) who received outpatient DOT fulfilled one or more criteria for noncompliance . Using multivariate logistic regression, risk factors for noncompliance were alcohol abuse (odds ratio, 3.0; 95% confidence interval, 1.2 to 7.5; p = 0.02) and homelessness (odds ratio, 3.2; 95% confidence interval, 1.5 to 7.2; p = 0.004) . Noncompliant patients had poor outcomes from the initial course of therapy more often than compliant patients: 17 of 52 (32.7%) vs 8 of 242 (3.3%); relative risk was 9.9; 95% confidence interval was 4.5 to 21.7 (p < 0.001) . CONCLUSIONS: In an urban tuberculosis control program, noncompliance with DOT was common and was closely associated with alcoholism and homelessness . Noncompliance was associated with a 10-fold increase in the occurrence of poor outcomes from treatment and accounted for most treatment failures . Innovative programs are needed to deal with alcoholism and homelessness in patients with tuberculosis.

J Am Coll Surg, 1997 May, 184(5), 441 - 53
Blunt trauma and operative care in microgravity: a review of microgravity physiology and surgical investigations with implications for critical care and operative treatment in space; Kirkpatrick AW et al.; BACKGROUND: The assembly of the International Space Station in a low earth orbit will soon become a reality . The National Aeronautics and Space Administration envisions inhabited lunar bases and staffed missions to Mars in the future . Increasing numbers of astronauts, construction of high-mass structures, increased extra-vehicular activity, and prolonged if not prohibitive medical evacuation times to earth underscore the need to address requirements for trauma care in nonterrestrial environments . STUDY DESIGN: A search was carried out to review the relevant literature in the MEDLINE and SPACELINE databases . All related Technical, Corporate, and Flight Test Reports in the KRUG Life Sciences corporate library were also reviewed . Bibliographies of all articles were then reviewed from these papers to identify additional pertinent literature . Senior Russian investigators reviewed the Russian literature and translated Russian publications when appropriate . Personal communication and discussion with active microgravity investigators and ongoing microgravity research supplemented published reports . RESULTS: A large volume of data exist to document the multiple detrimental physiologic effects of microgravity exposure on human physiology . Organs systems such as cardiovascular, neurohumoral, immune, hematopoetic, and musculoskeletal systems may be particularly affected . These physiologic changes suggest an impaired ability to withstand major systemic trauma . Observational data also suggest adverse changes in numerous aspects of response to wounding and injury, and in areas such as the behavior of hemorrhage, microbiologic flora, and wound healing . In addition to an increased volume of ongoing and anticipated basic science research in microgravity physiology, preliminary studies of clinical diagnosis and therapy have been carried out in microgravity and microgravity laboratories . The feasibility of a wide range of ancillary critical care techniques has been verified in the parabolic flight model of microgravity . Although Russian investigators first performed laparotomies on rabbits in parabolic flight in 1967, only recently have American investigators demonstrated the reproducible feasibility of open and endoscopic surgical procedures under general anesthetic in animal models in a microgravity environment . CONCLUSIONS: With appropriate instrumentation and personnel, the majority of resuscitative and surgical interventions required to stabilize a severely injured astronaut are feasible in a microgravity environment . Onboard limitations in mass, volume, and power that are ever present in any spacecraft design will limit the realistic capabilities of the medical system . Standard proved and tested trauma and operative management protocols will constitute the basis for extra-terrestrial care . Surgeons should familiarize themselves with the microgravity environment and remain active in planning trauma care for the continued exploration of space.

Cornea, 1997 May, 16(3), 295 - 9
Mycotic keratitis in children: epidemiologic and microbiologic evaluation; Panda A et al.; PURPOSE: To evaluate the demographic features, clinical profile, and laboratory diagnosis in cases of mycotic keratitis in children . METHODS: We retrospectively analyzed 211 cases of mycotic keratitis in children younger than 16 years over a 5-year period in a tertiary eye center . Culture-proven cases of fungal keratitis were reviewed . RESULTS: Trauma was the most common predisposing factor (55.3%), followed by associated systemic illness (11.2%), previous ocular surgery (9.8%), and others . Corneal injury contaminated with vegetable matter was responsible for 60.5% of traumatic cases . Aspergillus species were the most frequent isolates (39.5%) . Others included Fusarium (10.7%), Alternaria (10.2%), Curvularia (7.4%), and Penicillium (7%) . A seasonal variation in the incidence of mycotic keratitis revealed a peak incidence in the months of September and October . One hundred sixty-two children (76.7%) cooperated for examination and scraping under topical anesthesia with or without sedation . General anesthesia for scraping was required in 49 (23%) of 211 children for corneal scraping . Gram stains of corneal scraping were positive for hyphal elements in 54.5% of cases, and potassium hydroxide wet-mount preparation was positive in 90.2% of cases . CONCLUSIONS: This study highlights important risk factors and organisms responsible for mycotic keratitis in children.

Am J Epidemiol, 1997 May 1, 145(9), 794 - 803
Gender gap in cystic fibrosis mortality; Rosenfeld M et al.; The authors conducted the largest study to date of survival in cystic fibrosis . The study cohort consisted of all patients with cystic fibrosis seen at Cystic Fibrosis Foundation-accredited care centers in the United States between 1988 and 1992 (n = 21,047), or approximately 85% of all US patients diagnosed with cystic fibrosis . Cox proportional hazards regression analysis was used to compare the age-specific mortality rates of males and females and to identify risk factors serving as potential explanatory variables for the gender-related difference in survival . Among the subjects 1-20 years of age, females were 60% more likely to die than males (relative risk = 1.6, 95% confidence interval 1.4-1.8) . Outside this age range, male and female survival rates were not significantly different . The median survival for females was 25.3 years and for males was 28.4 years . Nutritional status, pulmonary function, and airway microbiology at a given age were strong predictors of mortality at subsequent ages . Nonetheless, differences between the genders in these parameters, as well as pancreatic insufficiency, age at diagnosis, mode of presentation, and race, could not account for the poorer survival among females . Even after adjustment for all these potential risk factors, females in the age range 1-20 years remained at greater risk for death (relative risk = 1.6, 95% confidence interval 1.2-2.1) . The authors concluded that in 1- to 20-year-old individuals with cystic fibrosis, survival in females was poorer than in males . This "gender gap" was not explained by a wide variety of potential risk factors.

Appl Environ Microbiol, 1997 May, 63(5), 1987 - 94
Stimulation of aryl metabolite production in the basidiomycete Bjerkandera sp . strain BOS55 with biosynthetic precursors and lignin degradation products; Mester T et al.; Aryl metabolites are known to have an important role in the ligninolytic system of white rot fungi . The addition of known precursors and aromatic acids representing lignin degradation products stimulated the production of aryl metabolites (veratryl alcohol, veratraldehyde, p-anisaldehyde, and 3-chloro-p-anisaldehyde) in the white rot fungus Bjerkandera sp . strain BOS55 . The presence of manganese (Mn) is known to inhibit the biosynthesis of veratryl alcohol (T . Mester, E . de Jong, and J.A . Field, Appl . Environ . Microbiol . 61:1881-1887, 1995) . A new finding of this study was that the production of the other aryl metabolites, p-anisaldehyde and 3-chloro-p-anisaldehyde, was also inhibited by Mn . We attempted to bypass the Mn-inhibited step in the biosynthesis of aryl metabolites by the addition of known and suspected precursors . Most of these compounds were not able to bypass the inhibiting effect of Mn . Only the fully methylated precursors (veratrate, p-anisate, and 3-chloro-p-anisate) provided similar concentrations of aryl metabolites in the presence and absence of Mn, indicating that Mn does not influence the reduction of the benzylic acid group . The addition of deuterated benzoate and 4-hydroxybenzoate resulted in the formation of deuterated aryl metabolites, indicating that these aromatic acids entered into the biosynthetic pathway and were common intermediates to all aryl metabolites . Only deuterated chlorinated anisyl metabolites were produced when the cultures were supplemented with deuterated 3-chloro-4-hydroxybenzoate . This observation combined with the fact that 3-chloro-4-hydroxybenzoate is a natural product of Bjerkandera spp . (H . J . Swarts, F . J . M . Verhagen, J . A . Field, and J . B . P . A . Wijnberg, Phytochemistry 42:1699-1701, 1996) suggest that it is a possible intermediate in chlorinated anisyl metabolite biosynthesis.

Clin Infect Dis, 1997 May, 24(5), 894 - 900
Detection of resistance to isoniazid, rifampin, and streptomycin in clinical isolates of Mycobacterium tuberculosis by molecular methods; Nachamkin I et al.; Molecular techniques can detect drug resistance in Mycobacterium tuberculosis, but whether these methods are practical for clinical laboratory use and the management of tuberculosis is unclear . We evaluated several available molecular methods (restriction fragment length polymorphism {RFLP}, heteroduplex, and direct DNA sequence analyses) for detecting resistance to isoniazid, rifampin, and streptomycin and compared these methods with conventional methods for susceptibility testing . RFLP analysis detected the mutation at position S315T in katG in 12 (44.4%) of 27 isoniazid-resistant strains . Heteroduplex analysis of rpoB, detected 16 (76.2%) of 21 rifampin-resistant strains, whereas direct DNA sequencing detected all rifampin-resistant strains . RFLP analysis of the rpsL gene detected only nine (28.1%) of 32 streptomycin-resistant strains, while direct DNA sequencing detected nearly 68% of streptomycin-resistant strains . The specificity of all of the above-mentioned methods was excellent . RFLP analysis for katG and direct DNA sequencing of rpoB and rpsL may be practical methods for routine use in clinical microbiology laboratories or molecular pathology laboratories with good molecular capabilities and autosequencers . Despite the less than optimal sensitivity for some assays, resistance can be detected rapidly . However, molecular methods are not yet capable of replacing more traditional methods of susceptibility testing for M . tuberculosis.

J Mol Evol, 1997 May, 44(5), 542 - 51
Molecular phylogenetic characterization of Streptomyces protease inhibitor family; Taguchi S et al.; We previously found that proteinaceous protease inhibitors homologous to Streptomyces subtilisin inhibitor (SSI) are widely produced by various Streptomyces species, and we designated them "SSI-like proteins" (Taguchi S, Kikuchi H, Suzuki M, Kojima S, Terabe M, Miura K, Nakase T, Momose H {1993} Appl Environ Microbiol 59:4338-4341) . In this study, SSI-like proteins from five strains of the genus Streptoverticillium were purified and sequenced, and molecular phylogenetic trees were constructed on the basis of the determined amino acid sequences together with those determined previously for Streptomyces species . The phylogenetic trees showed that SSI-like proteins from Streptoverticillium species are phylogenetically included in Streptomyces SSI-like proteins but form a monophyletic group as a distinct lineage within the Streptomyces proteins . This provides an alternative phylogenetic framework to the previous one based on partial small ribosomal RNA sequences, and it may indicate that the phylogenetic affiliation of the genus Streptoverticillium should be revised . The phylogenetic trees also suggested that SSI-like proteins possessing arginine or methionine at the P1 site, the major reactive center site toward target proteases, arose multiple times on independent lineages from ancestral proteins possessing lysine at the P1 site . Most of the codon changes at the P1 site inferred to have occurred during the evolution of SSI-like proteins are consistent with those inferred from the extremely high G + C content of Streptomyces genomes . The inferred minimum number of amino acid replacements at the P1 site was nearly equal to the average number for all the variable sites . It thus appears that positive Darwinian selection, which has been postulated to account for accelerated rates of amino acid replacement at the major reaction center site of mammalian protease inhibitors, may not have dictated the evolution of the bacterial SSI-like proteins.

Virology, 1997 Apr 28, 231(1), 43 - 7
Sequence analysis of HIV-1 group O from Norwegian patients infected in the 1960s; Jonassen TO et al.; Three Norwegians, a couple and their daughter, died from AIDS in 1976 after up to 10 years of clinical manifestations of HIV infection (Lindboe et al., 1986, Acta Pathol . Microbiol, Immunol . Scand . 94, 117-123; Froland et al., 1988, Lancet i, 1344-1345) . We here demonstrate the presence of HIV DNA in autopsy materials from the father and the daughter . In phylogenetic analysis, the obtained sequences of the HIV pol and vif genes clustered with the HIV-1 group O clade . The genotyping was confirmed by detection of antibodies against HIV-1 group O in blood samples from the father and the mother . That these and other early isolates of HIV-1 are very similar to the presently circulating viruses and not intermediates between the present subtypes, verifies that the latest common ancestor of HIV-1 existed long before the emergence of the present epidemic . The presence of HIV-1 group O 30 years ago suggests that the limited spread of these viruses, compared to HIV-1 group M viruses, is not due to a later emergence of the group O viruses.

Cancer, 1997 Apr 15, 79(8), 1635 - 40
Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis; Schwarz RE et al.; BACKGROUND: Long term intravenous access is a common requirement for cancer patients . This analysis was designed to determine device-related morbidity and factors predictive of poor long term outcome for patients with subcutaneous single lumen intravenous access ports . METHODS: Six hundred eighty patients who underwent subcutaneous intravenous port placement between June 1987 and May 1989 at Memorial Sloan-Kettering Cancer Center were followed prospectively until port removal, death, or a maximum of 1960 days . Indications for and circumstances of placement, patient diagnoses, patient demographics, and subsequent courses of treatment were recorded, as well as technical and microbiologic device-related complications . Total, device specific, and complication free device durations were calculated . RESULTS: The median patient age was 52.4 years (range, 1.6-83.9 years) . The female-to-male ratio was 1.5 to 1 . Cancer diagnoses included solid organ tumors (84%), leukemia (4%), lymphoma (11%), and others (1%) . Indications included access for systemic chemotherapy (98%), total parenteral nutrition (0.5%), and others (1.5%) . One insertion complication and six insertion failures occurred, without mortality . The estimated mean overall actuarial device specific duration was 1191 days (range, 2-1960 days) . Actuarial mean complication free, device specific duration was 952 days . Complications included sepsis (n = 31; 4.4%), site infection (n = 31; 4.4%), and accessibility failures such as thrombosis and leakage (n = 40, 5.7%) . Reasons for end of port duration were patient death (72.4%), end of treatment (13.5%), functional failure or intractable infection (11.2%), and others (2.9%) . Independent factors correlating with decreased port specific, complication free duration included placement site, age, tumor type, and catheter tip position . CONCLUSIONS: Subcutaneous intravenous access ports in cancer patients are safe and well tolerated . Long term device duration is primarily influenced by patient survival . In this study, 90% of patients alive at 1 year and 70% of patients alive at 4 years had a functional port.

Arch Bronconeumol, 1997 Apr, 33(4), 164 - 7
{Comparative study of acute and chronic forms of pleural tuberculosis}; Haro M et al.; To analyze whether a characteristic pattern distinguishes acute forms (symptoms starting no more than one week earlier) and subacute or chronic forms (symptoms lasting more than one week) of pleural tuberculosis (PT) in our practice . Retrospective analysis of 102 cases of PT diagnosed between 1986 and 1992, comparing the findings of case histories, imaging, pleural biochemistry and cytology, microbiology of sputum, pleural biopsy and fluid, anatomy and pathology studies of the biopsy specimens, course of disease, response to treatment and sequelae after one year and a half . Thirty-two patients (31.4%) had acute PT and 70 (68.6%) had chronic forms . LDH levels and the percentage of pleural nuclear polymorphism were higher in acute cases, while the concurrence of systemic involvement and lymphocytic predominance was more often seen in chronic cases . Other data analyzed were similar in both groups . No specific clinical or X-ray profiles or differences in course of disease and response to treatment distinguishes between acute and chronic forms of PT after 7 days . Only LDH levels and cytology results differentiated acute forms and, occasionally, such cases were indistinguishable from pneumonia-like effusion.

Rev Neurol, 1997 Apr, 25(140), 557 - 9
{HTLV-I myelopathy: presentation of a new case}; Diaz-Guzman J et al.; INTRODUCTION: HTLV-I is a human retrovirus which has been implicated in the genesis of tropical spastic paraparesis (HTLV-I-associated myelopathy) . So far five cases of this illness have been detected in Spain, five of them in immigrants . We present a new case in Spain, with a characteristic chronic clinical picture . CASE REPORT: A 36-year-old black woman native of Ecuatorial Guinea, developed along 10 years a progressive paraparesis of asymmetric onset with important back pain, that arrives to paraplegic spastic phase at the present time . She presents distal amyotrophies, ulcers of decubitus and loss of control of sphincters, with normal mental status . Laboratory tests: blood, biochemistry and microbiologic studies: normal, or negative . She presented positive Western Blot serology for HTLV-I, confirmed by means of PCR technique . Cranial MRI: small and hyperintense subcortical lesions on T2 weighted images; spinal MRI: local atrophy at high thoracic level . A lumbar puncture was performed, with no cells, and with presence of oligoclonal bands, and a high IgG index . Urodynamic study: neurogenic spastic bladder . EMG: mild axonal polyneuropathy with prevalence in legs . CONCLUSIONS: In the differential diagnosis of progressive paraperesis, and mainly with epidemic antecedents, it is necessary to include a determination of HTLV-I between the diagnostic tests.

J Clin Microbiol, 1997 Apr, 35(4), 928 - 36
Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis; Siegman-Igra Y et al.; Catheter-related bloodstream infections increased in incidence during the past decade, causing significant morbidity, mortality, and excess hospital costs . Absence of inflammation at the catheter site in most cases makes clinical diagnosis uncertain . The relative accuracy and cost-effectiveness of different microbiologic tests for confirming that bloodstream infection is catheter related have remained unclear . A meta-analysis of published studies was conducted regarding the accuracy of diagnostic test methods using pooled sensitivity and specificity and summary receiver operating characteristic (ROC) curve analysis . The cost for each test was estimated by methods published by the College of American Pathologists . Costs of catheter replacement and antibiotic therapy for false positive results were included in the cost per accurate test result . Twenty-two studies evaluating six test methods met inclusion criteria for the meta-analysis . Accuracy increased in ROC analysis for catheter segment cultures with increasing quantitation (P = 0.03) (i.e., quantitative > semiquantitative > qualitative) largely due to an increase in specificity . The highest Youden index (mean = 0.85) was observed with quantitative catheter segment culture, the only method with pooled sensitivity and specificity above 90% . For blood culture methods, there was no statistically significant trend toward increased accuracy . The unpaired quantitative catheter blood culture offered the lowest cost per accurate test result but was only 78% sensitive . In conclusion, quantitative culture was the most accurate method for catheter segment culture, and unpaired quantitative catheter blood culture was the single most cost-effective test, especially for long-term catheters.

Diagn Microbiol Infect Dis, 1997 Apr, 27(4), 147 - 50
Mycobacterium avium complex endocarditis: spurious diagnosis resulting from laboratory cross contamination; Hedderwick SA et al.; Contamination between specimens within clinical microbiology laboratories may be responsible for spurious outbreaks of mycobacterial infections . We report the case of a patient who had culture-negative endocarditis and whose cardiac tissue obtained at surgery yielded Mycobacterium avium complex (MAC) . Epidemiologic investigation suggested cross contamination probably occurred during processing of the sputum specimens of a patient with pulmonary MAC disease and the cardiac samples from our patient; molecular strain typing showed the isolates from both patients to be identical . When mycobacterial infection rates increase or an unexpected case of mycobacterial infection occurs, the clinician should be alert to the possibility of cross contamination in the laboratory as a possible explanation.

J Hosp Infect, 1997 Apr, 35(4), 255 - 7
A microbiologist's guide to travellers abroad: do as I say not as I do; Ala'Aldeen DA; Clinical microbiologists do not normally prescribe prophylactic antibiotics for travellers' diarrhoea, and when questioned at a Hospital Infection Society (HIS) meeting only 2% admitted doing so . During a HIS visit to India, 5 (28%) members took daily ciprofloxacin prophylaxis and none of them developed diarrhoea.

Int J STD AIDS, 1997 Apr, 8(4), 257 - 8
Application of 'Clearview Chlamydia' for the rapid detection of cervical chlamydial antigen; Woolley PD et al.; In a study to evaluate the Clearview chlamydia test in a genitourinary medicine clinic, the sensitivity and specificity were 76.4% and 99.4% respectively when compared with the DAKO IDEIA chlamydia test processed in a department of medical microbiology . The time taken to perform and read the Clearview chlamydia test 'on site' did not interfere with the normal routine functioning of the clinic and the nurses who performed it as part of their routine duties found it simple and easy to use.

Semin Oncol, 1997 Apr, 24(2), 156 - 63
Coral reefs, forests, and thermal vents: the worldwide exploration of nature for novel antitumor agents; Cragg GM et al.; Nature has been a source of medicinal treatments for thousands of years, and plant-based systems continue to play an essential role in the primary health care of 80% of the world's population . Nature has provided many of the effective anticancer agents in current use, such as the microbially derived drugs, dactinomycin, bleomycin, and doxorubicin, and the plant-derived drugs vinblastine, irinotecan, topotecan, etoposide, and paclitaxel . The search for novel antitumor agents from natural sources continues with botanists, marine biologists, and microbiologists teaming up with chemists, pharmacologists, toxicologists, and clinicians in the investigation of coral reefs, rainforests, and deep subsurface thermal vents for novel bioactive compounds . The wealth of anticancer drugs of natural origin and critical aspects of the ongoing discovery and development process are discussed.

Am J Gastroenterol, 1997 Apr, 92(4), 653 - 8
A comparison between omeprazole-based triple therapy and bismuth-based triple therapy for the treatment of Helicobacter pylori infection: a prospective randomized 1-yr follow-up study; Lerang F et al.; OBJECTIVES: To compare the efficacy and side effects of standard bismuth triple therapy with those of omeprazole-based triple therapy in patients with Helicobacter pylori infection and duodenal ulcer disease . METHODS: One hundred patients were prospectively recruited and randomized to receive either bismuth subnitrate 75 mg q.i.d., oxytetracycline 500 mg q.i.d., and metronidazole 400 mg b.i.d . (regimen BTM), or omeprazole 20 mg b.i.d., amoxicillin 750 mg b.i.d., and metronidazole 400 mg b.i.d . (regimen OAM), both for 14 days . Upper endoscopy (with antral biopsy specimens for microbiology and antral and corpus biopsy specimens for histology) was performed before treatment, after 2 months, and again 1 yr after treatment . Serum samples for serology (IgG) were taken . Patients with in vitro metronidazole-resistant (M-R) H . pylori strains were excluded . In a nonrandomized study, 41 patients with M-R strains were given either BTM or OAM . RESULTS: According to intention-to-treat analysis, H . pylori cure rates were 91% and 96% with BTM and OAM, respectively (p = 0.45) . In the BTM group, the mean total side effect score was higher (p < 0.001), and more severe side effects were reported (32% vs . 4%, p < 0.001) . In the nonrandomized group of patients with M-R strains, H . pylori cure rates were 88% and 67% with BTM and OAM, respectively . All of the successfully treated patients were still H . pylori-negative after 1 yr . CONCLUSIONS: Both treatment regimens were highly effective in curing H . pylori infection in patients with metronidazole-sensitive strains . Omeprazole-based triple therapy was tolerated better than standard bismuth-based triple therapy.

Am J Obstet Gynecol, 1997 Apr, 176(4), 870 - 7
Antibodies to the chlamydial 60 kd heat-shock protein are associated with laparoscopically confirmed perihepatitis; Money DM et al.; OBJECTIVE: Our purpose was to examine clinical, microbiologic, serologic, and laparoscopic findings associated with perihepatitis . STUDY DESIGN: In a prospective study of 157 women with a clinical diagnosis of pelvic inflammatory disease, 27 women with laparoscopically confirmed perihepatitis and salpingitis were compared with 46 patients with salpingitis alone . RESULTS: Both current use or a history of ever using oral contraceptives was negatively associated with perihepatitis (p = 0.05 and p = 0.008, respectively) . Moderate-to-severe pelvic adhesions were present at laparoscopy significantly more often in the perihepatitis-salpingitis group (70%) than in the salpingitis alone group (35%, p = 0.003) . Antibody to the chlamydial 60 kd heat-shock protein at > or =0.5 optical density was detected in 67% of the perihepatitis-salpingitis group and in 28% of the salpingitis alone group (p = 0.005), and the median titer was significantly higher in the former group (p = 0.02) . CONCLUSION: Compared with women with salpingitis alone, patients with perihepatitis-salpingitis do not have distinctive clinical or microbiologic findings but do manifest a higher prevalence of moderate-to-severe pelvic adhesions and both a higher prevalence and higher titers of antibody to the chlamydial heat-shock protein-60.

AJR Am J Roentgenol, 1997 Apr, 168(4), 1051 - 6
Tuberculosis of the trachea and main bronchi: CT findings in 17 patients; Kim Y et al.; OBJECTIVE: The purpose of our study was to describe the CT findings of tuberculosis of the trachea and main bronchi . MATERIALS AND METHODS: Initial (n = 17) and follow-up (n = 7) CT scans were available from 17 patients (five men and 12 women; aged 25-82 years old) with tracheobronchial tuberculosis . The diagnosis of tuberculosis was based on bronchoscopic, microbiologic, or pathologic findings . RESULTS: The trachea (n = 6), the right main bronchus (n = 6), and the left main bronchus (n = 4) were involved in 10 patients with actively caseating tuberculosis . These airways showed irregular (n = 11) or smooth (n = 4) circumferential narrowing and occlusion (n = 1) . Also, the trachea (n = 2), the right main bronchus (n = 1), and the left main bronchus (n = 6) were involved in seven patients with fibrotic tuberculosis . These airways showed smooth (n = 4) or irregular (n = 3) circumferential narrowing and occlusion (n = 2) . Mediastinitis (increased densities in mediastinal fat) was seen in four of 10 patients with active tuberculosis but not in any of the seven patients with fibrotic disease . Tracheal tuberculosis, which has always been associated with bronchial disease, involved the distal trachea and exceeded 3 cm in length . After the seven patients underwent initial scans and antituberculous chemotherapy, serial CT scans showed improvement in seven of 11 lesion sites: normalized airways (n = 4) or smoothing from irregular narrowing (n = 3) . The remaining four sites showed no change . CONCLUSION: On CT scans, actively caseating tracheobronchial tuberculosis showed circumferential and predominantly irregular luminal narrowing and mediastinitis . When fibrotic disease was found, a CT scan revealed equal distribution of smooth and irregular narrowing and less wall thickening than was seen in patients with active disease . On CT scans, tracheal tuberculosis involved the long segment of the distal trachea, a condition associated with bronchial tuberculosis.

Pediatr Infect Dis J, 1997 Apr, 16(4), 370 - 5
Interleukin 6 in neonates with early and late onset infection; Panero A et al.; OBJECTIVE: To assess the utility of determining interleukin 6 (IL-6) concentrations for diagnosing early (< or = 48 h of life) and late onset infection in a neonatal intensive care setting . METHODS: We measured serum IL-6 values in five groups of neonates on both postnatal Days 1 and 2 (early sampling): Group 1, patients with clinical and microbiologic evidence of early onset infection; Group 2, patients with negative body fluid cultures but strong evidence of infection (clinical septicemia); Group 3, patients without clinical and microbiologic evidence of infection; Group 4, patients in whom infection could be neither confirmed nor excluded; and Group 5, healthy neonates with a normal postnatal course . We also measured IL-6 values in older neonates who during their hospital stay developed systemic infection (late sampling) . Three controls matched for duration of hospital stay and birth date were chosen for each patient . RESULTS: On postnatal Day 1 IL-6 values were elevated in all four patient groups compared with those in healthy neonates (P < 0.05 by analysis of variance (ANOVA)) . There were no significant differences found among patient groups . On postnatal Day 2 IL-6 concentrations were persistently elevated in Groups 1 and 2 compared with values from those in Group 3, Group 4 and healthy controls (P < 0.01) . At this time no significant differences in IL-6 values were found between uninfected symptomatic patients (Group 3), patients with uncertain findings (Group 4) and healthy controls . IL-6 concentrations were significantly higher in patients with late onset infection at presentation than in the patient controls (P < 0.0001) and returned to low values in those who recovered from infection . CONCLUSIONS: There are differences in the serum concentrations of IL-6 that can be helpful in detecting early and late onset infection in preterm and term neonates . During the first 48 h of life serial IL-6 determinations are necessary so as not to overdiagnose infection in a neonatal intensive care setting.

Chest, 1997 Apr, 111(4), 981 - 8
Indwelling small pleural catheter needle thoracentesis in the management of large pleural effusions; Grodzin CJ et al.; STUDY OBJECTIVES: To evaluate the clinical safety, efficacy, and cost of a small indwelling pleural catheter (7F, Turkel Safety Thoracentesis System {Sherwood, Davis, and Geck; St . Louis}) vs repeated needle thoracentesis or closed tube thoracostomy as a means to drain a large-volume pleural effusion . SETTING: Inpatients in a tertiary care university teaching hospital in urban Chicago . DESIGN: Prospective, consecutive patient comparative study using historical controls . PATIENTS: Fifty-seven therapeutic aspirations in 23 patients with large pleural effusions as defined by opacification of at least one third of the hemithorax on chest radiography . Patients were excluded if they had a history of thoracic surgery, documented loculations, structural chest abnormalities, severe coagulopathy, or refused to give informed consent . MEASUREMENTS: Volume of each pleural aspiration, total fluid removed, pleural fluid lactate dehydrogenase, protein, glucose, cytologic analysis, microbiologic stains, and cultures based on clinical indications . RESULTS: We found that initial thoracentesis and repeated pleural drainage using the indwelling catheter system is a safe, efficacious, and cost-effective procedure that may aid the evacuation and management of a large-volume pleural effusion . There were fewer adverse effects and complications such as pneumothorax, splenic laceration, hemopneumothorax, local pain, dry tap, and hematomas, as compared with previous reports . The overall complication rate was 12% (7/57) . There were two pneumothoraces detected (3.5%), one of which required closed tube thoracostomy for treatment (1.75%) . A further benefit comes in the form of a significant cost savings at our institution ($80 vs $240) when this needle-catheter system is used in place of closed tube thoracostomy in the drainage of a large-volume pleural effusion . CONCLUSION: An indwelling pleural catheter with the Turkel safety needle-catheter (as described in the study) can be used to successfully drain the pleural space with reduced morbidity and a significant cost saving in comparison to repeated needle thoracenteses or closed tube thoracostomy.

Clin Microbiol Rev, 1997 Apr, 10(2), 203 - 19
Bartonella spp . as emerging human pathogens; Anderson BE et al.; Members of the genus Bartonella (formerly Rochalimaea) were virtually unknown to modern-day clinicians and microbiologists until they were associated with opportunistic infections in AIDS patients about 6 years ago . Since that time, Bartonella species have been associated with cat scratch disease, bacillary angiomatosis, and a variety of other disease syndromes . Clinical presentation of infection with Bartonella ranges from a relatively mild lymphadenopathy with few other symptoms, seen in cat scratch disease, to life-threatening systemic disease in the immunocompromised patient . In some individuals, infection manifests as lesions that exhibit proliferation of endothelial cells and neovascularization, a pathogenic process unique to this genus of bacteria . As the spectrum of disease attributed to Bartonella is further defined, the need for reliable laboratory methods to diagnose infections caused by these unique organisms also increases . A brief summary of the clinical presentations associated with Bartonella infections is presented, and the current status of laboratory diagnosis and identification of these organisms is reviewed.

Int J Syst Bacteriol, 1997 Apr, 47(2), 492 - 8
Streptomyces seoulensis sp . nov; Chun J et al.; The taxonomic position of an actinomycete strain isolated from Korean soil was examined by a polyphasic approach . The isolate, designated IMSNU-1, was clearly assigned to the genus Streptomyces on the basis of morphological and chemotaxonomic data . The test strain was the subject of a probabilistic identification study using the identification matrices generated by Langham et al . (J . Gen . Microbiol . 135:121-133, 1989) and found to be marginally close to clusters 19 and 39 . An almost complete 16S rRNA gene (rDNA) sequence was obtained for the test strain and compared with those of representative streptomycetes . 16S rDNA sequence data not only support the strain's membership in the genus Streptomyces but also provide strong evidence that our isolate is genealogically distant from representatives of clusters 19 and 39, forming a separate phyletic line in a clade encompassed by streptomycetes . It is therefore proposed from the polyphasic evidence that strain IMSNU-1 be classified in the genus Streptomyces as Streptomyces seoulensis sp . nov.

Appl Environ Microbiol, 1997 Apr, 63(4), 1428 - 33
Organic solvent tolerance and antibiotic resistance increased by overexpression of marA in Escherichia coli; Asako H et al.; We previously reported that overexpression of the soxS or robA gene causes in several Escherichia coli strains the acquisition of higher organic solvent tolerance and also increased resistance to a number of antibiotics (H . Nakajima, K . Kobayashi, M . Kobayashi, H . Asako, and R . Aono, Appl . Environ . Microbiol . 61:2302-2307, 1995) . Most E . coli strains cannot grow in the presence of cyclohexane . We isolated the marRAB genes from a Kohara lambda phage clone and cyclohexane-tolerant mutant strain OST3408 . We found a substitution of serine for arginine at position 73 in the coding region of marR of OST3408 and designated the gene marR08 . Our genetic analysis revealed that marR08 is responsible for the cyclohexane-tolerant phenotype . We observed that the marA gene on high-copy-number plasmids increased the organic solvent tolerance of E . coli strains . Furthermore, exposure of E . coli cells to salicylate, which activates the mar regulon genes, also raised organic solvent tolerance . Overexpression of the marA, soxS, or robA gene increased resistance to numerous antibiotics but not to hydrophilic aminoglycosides.

J Med Virol, 1997 Apr, 51(4), 319 - 25
Construction of four double gene substitution human x bovine rotavirus reassortant vaccine candidates: each bears two outer capsid human rotavirus genes, one encoding P serotype 1A and the other encoding G serotype 1, 2, 3, or 4 specificity; Hoshino Y et al.; Previously, four human x bovine rotavirus reassortant candidate vaccines, each of which derived ten genes from bovine rotavirus UK strain and only the outer capsid protein VP7-gene from human rotavirus strain D (G serotype 1), DS-1 (G serotype 2), P (G serotype 3), or ST3 (G serotype 4), were developed {Midthun et al., (1985): Journal of Virology 53:949-954; (1986): Journal of Clinical Microbiology 24:822-826} . Such human x bovine reassortant vaccines should theoretically provide antigenic coverage for the four epidemiologically most important VP7(G) serotypes 1, 2, 3, and 4 . In an attempt to increase the antigenicity of VP7-based human x animal reassortant rotavirus vaccines which derive a single VP7-encoding gene from the human strain and the remaining ten genes from the animal strain, we generated double gene substitution reassortants . This was done by incorporating another protective antigen (VP4) of an epidemiologically important human rotavirus by crossing human rotavirus Wa strain (P serotype 1A), with each of the human x bovine single VP7-gene substitution rotavirus reassortants . In this way four separate double gene substitution rotavirus reassortants were generated . Each of these reassortants bears the VP4-encoding gene from human rotavirus Wa strain, the VP7-encoding gene from human rotavirus strain D, DS-1, P, or ST3, and the remaining nine genes from bovine rotavirus strain UK . The safety, antigenicity, and protective efficacy of individual components as well as combinations of strains are currently under evaluation.

Med Clin (Barc), 1997 Mar 29, 108(12), 452 - 4
{Analysis of 90 cases of pleural tuberculosis in relation to adenosine deaminase levels}; Haro M et al.; BACKGROUND: To analyze the adenosine deaminase (ADA) pleural levels and the possibility of a typical pattern of tuberculous pleuritis (TP) in relation to these values . PATIENTS AND METHODS: We analyzed 90 consecutive cases of TP dividend into two groups on the basis of the pleural ADA measurements: group 1 (less than 43 U/I) and group 2 (equal or higher than 43 U/I) . We compared: age, sex, tuberculous risk factors, clinic onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural fluid, microbiologic studies on sputum, pleural fluid and biopsies, histologic findings of the biopsies, evolution and sequelae after the treatment . RESULTS: 36 patients in the group 1 (40%) and 54 in the group 2 (60%) (p = 0.01) . All the parameters were similar in both groups excluding LDH pleural levels, that were higher in group 2 . In 20 cases of the group 1, we obtained a second analysis of pleural ADA and we observed in 11 cases (55%) an ADA value above 43 U/I . CONCLUSIONS: We confirmed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a second determination (72%) . ADA activity below 43 U/I cannot exclude the tuberculous aetiology of an effusion and can persist negative in other analyses . The results suggest a response of different chronology without any relation to initial ADA pleural level.

Int J Food Microbiol, 1997 Mar 3, 34(3), 209 - 20
The combined effects of temperature, pH and NaCl on growth of Debaryomyces hansenii analyzed by flow cytometry and predictive microbiology; Sorensen BB et al.; Flow cytometry was applied to determine growth of Debaryomyces hansenii in a laboratory medium . Viable yeasts were enumerated after staining with the fluorogenic ester fluorescein diacetate (FDA) . Initial studies showed that the flow cytometric determinations correlated well with viable yeast populations determined as colony forming units (CFU) whereas the relationship between CFU and optical density was only linear over a narrow range of cell concentrations, 10(5.5)-10(7.5) cells/ml . The flow cytometric measurements could reliably detect D . hansenii at concentrations as low as 10(2) cells/ml whereas the lower detection limit using optical density measurements was 10(5)-10(6) cells/ml . Growth was determined by flow cytometry at different combinations of temperatures (10-30 degrees C), pH (4.7-6.0) and NaCl concentrations (1-12% w/v) . Growth curves were generated by fitting a modified Gompertz equation to the growth data using non-linear regression analysis . Lag phase duration and maximum specific growth rates were derived and quadratic polynomial models were developed describing the effects of environmental conditions on the growth parameters . Model validation based upon repetition of experiments and use of another laboratory medium showed good agreement between observed and predicted maximum specific growth rates whereas predicted lag phases were shorter than the observed lag phases.

J Zoo Wildl Med, 1997 Mar, 28(1), 89 - 93
Itraconazole plasma and tissue concentrations in the spiny lizard (Sceloporus sp.) following once-daily dosing; Gamble KC et al.; Mycotic infections in reptiles present as primary diseases and as secondary problems in healing wounds and immunocompromised animals . A triazole antimycotic drug, itraconazole is orally active and well distributed and is effective against many common fungal pathogens in humans . To assess plasma and tissues concentrations after oral dosing in reptiles, a 23.5-mg/kg (mean) itraconazole dose was administered orally with a standard food bolus once daily for 3 days to 10 groups of three or four spiny lizards (Sceloporus sp.) . On days 0, 1, 2, 3, 4, 6, 9, 12, and 18, group samples of blood, liver, and muscle were collected . Microbiologic assay of itraconazole concentrations was performed on these pooled samples . Values from an elimination graph of the concentrations of area under the curve (377.21 micrograms.hr/ml) and terminal elimination half-life (48.3 hr) were obtained for itraconazole in spiny lizard plasma . Peak itraconazole concentration of 2.48 micrograms/ml was obtained in two half-lives and would be expected to achieve steady state at approximately 3.1 micrograms/ml plasma concentration in 10 days . Peak liver concentration of 4.27 micrograms/ml was attained in 89.95 hr . Muscle concentration did not exceed 0.63 micrograms/ml and declined by 97.3 hr . With this dosing regimen, itraconazole plasma and liver concentrations would persist within reported minimum inhibitory concentrations for many fungal pathogens for 6 days beyond the peak concentration.

Lippincotts Prim Care Pract, 1997 Mar-Apr, 1(1), 3 - 13
Scaling skin disorders; Sinni-McKeehen B; Scaling skin disorders have similar features . Careful inspection to determine the characteristics of the primary lesion, along with distribution patterns and performance of routine diagnostic tests, usually lead to a correct diagnosis . Potassium hydroxide examination should be performed on most scaling skin disorders . If a microscope is not readily available, skin scrapings should be sent to a microbiology laboratory, or a microscope should be purchased and training obtained . A binocular microscope is preferable to view fungal hyphae . KOH examination requires supervised experience to become proficient.

Ann Periodontol, 1997 Mar, 2(1), 98 - 107
Overview of clinical trials of periodontal diagnosis methods and devices; Mandel ID; Changing views of the pathogenesis and progression of the periodontal diseases and new modalities for treatment have stimulated a plethora of physical, biochemical, microbiologic, and immunologic diagnostic procedures, tests, and devices . Clinical trials address needs for: 1) screening tests and risk assessment for disease susceptibility; 2) identification of active and progressive disease sites; 3) making therapeutic decisions; 4) monitoring therapy; 5) establishing a maintenance schedule; and 6) prognosis assessment . Needs and priorities of general, specialty, and public health practitioners differ . Validation of tests proceeds in a hierarchy of study designs from cross sectional and case control studies to retrospective and prospective longitudinal multi-center trials . For broad-scale application, randomized controlled trials (and eventual meta-analysis) will be required . Design issues are those common to all clinical trials in periodontics plus special considerations depending on type of test and its intended use . For diagnostic tests, recommended surrogate endpoints are attachment and alveolar bone levels-the traditional "gold standards." Validation of diagnostic tests is best accomplished by generation of 2 x 2 contingency tables to calculate sensitivity and specificity, positive and negative predictive values, relative and absolute risks, and odds rations . Each has a place-depending on the clinical situation and needs of the clinician.

Ann Periodontol, 1997 Mar, 2(1), 3 - 10
The nature of periodontal diseases; Socransky SS et al.; Periodontal diseases are infections . They have a number of properties in common with infections in other parts of the body, but have unique features resulting from the passage of the tooth through the soft tissue integument into the oral cavity . The tooth provides a solid, non-shedding surface for the colonization of potentially pathogenic bacterial species as well as a wide range of host-compatible species . Periodontal pathogens frequently colonize the periodontal area for prolonged periods of time prior to disease initiation . Disease is caused by a finite set of bacterial species leading to the development of multiple periodontal diseases . Disease occurs at individual periodontal sites and leaves an historical record of the damage to the periodontium in the form of periodontal attachment or bone loss . This feature provides difficulty in investigation since it is often unclear whether the infectious process is presently occurring or is a reflection of past destruction . Control of periodontal diseases is most effectively performed by eliminating or suppressing the organisms that cause them and establishing a host compatible microbiota . When tissue damage has been extensive, regenerative or replacement procedures should be instituted after the infection has been controlled.

J Foot Ankle Surg, 1997 Mar-Apr, 36(2), 120 - 6; discussion 160
Diagnosis of pedal osteomyelitis with Tc-99m HMPAO labeled leukocytes; Blume PA et al.; The diagnosis of pedal osteomyelitis is often complicated by the presence of pre-existing bony abnormalities . In this study, the utility of radiolabeled white blood cell imaging for the detection of complicated pedal osteomyelitis was evaluated . Twenty-seven men and women were prospectively enrolled and underwent plain film radiography, three-phase bone scan, and Tc-99m hexamethylpropylamine oxine white blood cell scintigraphy of their feet . The presence or absence of osteomyelitis was confirmed in all subjects by microbiologic and histopatholigic analysis of resected bone tissue . The results indicated that white blood cell imaging was more sensitive (90%) and specific (86%) for infection than either bone scan (75% sensitive, 29% specific) or plain film radiography (55% sensitive, 57% specific) . This preliminary study suggests that Tc-99m hexamethylpropylamine oxine-labeled white blood cell scintigraphy is a simple, accurate test for the detection of pedal osteomyelitis.

Am J Surg, 1997 Mar, 173(3), 174 - 80
Continuous arteriovenous hemofiltration attenuates polymorphonuclear leukocyte phagocytosis in porcine intra-abdominal sepsis; DiScipio AW et al.; BACKGROUND: Activation of circulating polymorphonuclear leukocytes (PMN) is a characteristic of systemic inflammation and may contribute to organ malfunction . Continuous arteriovenous hemofiltration (CAVH) has been reported to improve organ malfunction during severe systemic inflammation . This study postulates that the CAVH effects may be linked to alterations in PMN activation . METHODS: Sixteen pigs that underwent cecal ligation and rupture were randomized to receive CAVH or no CAVH for 24 hours . The PMN phagocytosis of Candida was measured prior to the insult and at 24, 48, and 72 hours . Temperature, total leukocyte count (WBC), hemodynamic, blood gas, microbiologic, and ionized calcium data were also collected . RESULTS: All animals developed increased temperature, heart rate, and WBC, and positive blood and peritoneal cultures . Hemodynamic, pulmonary, and ionized calcium changes were not different between the CAVH and no CAVH groups . Phagocytosis of PMN increased in the no CAVH group at 24 hours, but not in the CAVH group . After discontinuing CAVH, phagocytosis increased to the no CAVH rate at 48 and 72 hours . CONCLUSIONS: Continuous arteriovenous hemofiltration attenuates the upregulation of PMN phagocytosis of Candida; this effect disappears after CAVH is discontinued . Hemofiltration does not affect many other manifestations of sepsis, which implies that these manifestations may not be related to PMN phagocytosis capacity.

Eur J Biochem, 1997 Mar 1, 244(2), 561 - 7
Purification and properties of acetyl-CoA synthetase (ADP-forming), an archaeal enzyme of acetate formation and ATP synthesis, from the hyperthermophile Pyrococcus furiosus; Glasemacher J et al.; Acetyl-CoA synthetase (ADP-forming) is an enzyme in Archaea that catalyzes the formation of acetate from acetyl-CoA and couples this reaction with the synthesis of ATP from ADP and Pi (acetyl-CoA + ADP + Pi --> acetate + ATP + CoA) {Schifer, T., Selig, M . & Schonheit, P . (1993) Arch . Microbiol . 159, 72-83} . The enzyme from the anaerobic hyperthermophile Pyrococcus furiosus was purified 96-fold with a yield of 20% to apparent electrophoretic homogeneity . The oxygen-stable enzyme had an apparent molecular mass of 145 kDa and was composed of two subunits with apparent molecular masses of 47 kDa and 25 kDa, indicating an alpha2beta2 structure . The N-terminal amino acid sequences of both subunits were determined; they do not show significant identity to other proteins in databases . The purified enzyme catalyzed the reversible conversion of acetyl-CoA, ADP and Pi to acetate, ATP and CoA . The apparent Vmax value in the direction of acetate formation was 18 U/mg (55 degrees C), the apparent Km values for acetyl-CoA, ADP and Pi were 17 microM, 60 microM and 200 microM, respectively . ADP and Pi could not be replaced by AMP and PPi, defining the enzyme as an ADP-forming rather than an AMP-forming acetyl-CoA synthetase . The apparent Vmax value in the direction of acetyl-CoA formation was about 40 U/mg (55 degrees C), and the apparent Km values for acetate, ATP and CoA were 660 microM, 80 microM and 30 microM, respectively . The purified enzyme was not specific for acetyl-CoA or acetate, in addition to acetyl-CoA (100%), the enzyme accepts propionyl-CoA (110%) and butyryl-CoA (92%), and in addition to acetate (100%), the enzyme accepts propionate (100%), butyrate (92%), isobutyrate (79%), valerate (36%) and isovalerate (34%), indicating that the enzyme functions as an acyl-CoA synthetase (ADP-forming) with a broad substrate spectrum . Succinate, phenylacetate and indoleacetate did not serve as substrates for the enzyme (<3%) . In addition to ADP (100%), GDP (220%) and IDP (250%) were used, and in addition to ATP (100%), GTP (210%) and ITP (320%) were used . Pyrimidine nucleotides were not accepted . The enzyme was dependent on Mg2+, which could be partly substituted by Mn2+ and Co2+ . The pH optimum was pH 7 . The enzyme has a temperature optimum at 90 degrees C, which is in accordance with its physiological function under hyperthermophilic conditions . The enzyme was stabilized against heat inactivation by salts . In the presence of KCI (1 M), which was most effective, the enzyme did not loose activity after 2 h incubation at 100 degrees C.

Infect Control Hosp Epidemiol, 1997 Mar, 18(3), 200 - 2
High frequency of pseudobacteremia at a university hospital; Little JR et al.; A prospective survey of all positive blood cultures was performed during a 6-month period at a 390-bed, tertiary-care teaching hospital in St Louis, Missouri . Data were collected from the clinical microbiology laboratory, medical records, and physicians caring for patients with positive blood cultures . Of 5,732 blood cultures, 261 (4.6%) were positive, and approximately half of these (51.3%) were categorized as false positive . Positive cultures were significantly more likely to be true positives if obtained from patients with malignancies or if they became positive within the first 48 hours of incubation.

Pediatr Infect Dis J, 1997 Mar, 16(3 Suppl), S70 - 3
Laboratory, clinic and community: the logistics of liaison; Tarlow M; BACKGROUND: Infectious diseases are the cause of much morbidity and mortality in children . In the industrialized world the majority of childhood infections are treated by primary care physicians; nevertheless a high degree of professional liaison is needed among the various specialists concerned with pediatric infectious disease . OBJECTIVE: To review the contributions of the various medical practitioners to the management of pediatric infections and the ways in which communication between them can be improved . DISCUSSION: Primary care physicians, pediatricians and microbiologists are all concerned with the management of infections in children . Factors that can facilitate communication between these experts include the development of professional trust between the groups, effective education techniques and good communication achieved through the use of structured letters, telephone contact, new technology and outreach clinics.

Ophthalmic Surg Lasers, 1997 Mar, 28(3), 185 - 94
Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis; Essman TF et al.; BACKGROUND AND OBJECTIVE: To review prevalence of organisms, associated factors, and treatment outcomes from one medical center's 10-year experience managing culture-proven endogenous fungal endophthalmitis (EFE) . PATIENTS AND METHODS: The authors retrospectively reviewed the microbiology and corresponding clinical records of patients diagnosed as having culture-proven EFE at the Bascom Palmer Eye Institute during a 10-year period . RESULTS: Culture-proven EFE occurred in 20 eyes of 18 patients . Candida species occurred in 17 of 20 eyes (85%), and Aspergillus species occurred in 3 of 20 eyes (15%) . The most common association was long-term intravenous line placement, which was present in 12 patients (67%) . Whereas 12 patients (67%) had a history of recent hospitalization, only 2 (11%) had a documented history of systemic fungal infection . After initial examination, only 2 patients had a systemic culture positive for a fungal organism (none had a positive blood culture) . Treatment after initial examination included pars plana vitrectomy in 17 of the 20 eyes (85%), intravitreal amphotericin B in 19 eyes (95%), and systemic antifungal medication in 16 eyes of 15 patients . Thirteen of the 17 eyes (76%) with Candida endophthalmitis and 0 of 3 eyes with Aspergillus endophthalmitis achieved visual acuity of 20/400 or better . CONCLUSION: The most common cause of culture-proven EFE at the authors' institution is Candida species . The overall visual outcomes were more favorable for Candida cases than they were for Aspergillus cases . In the treatment of patients with marked vitreous infiltrates from EFE, pars plana vitrectomy, intravitreal amphotericin B injection, and administration of appropriate systemic antifungal medication (fluconazole for Candida) are generally recommended.

Cornea, 1997 Mar, 16(2), 232 - 4
Hydrops and spontaneous perforation in pellucid marginal corneal degeneration; Lucarelli MJ et al.; PURPOSE: Pellucid marginal degeneration of the cornea (1,2) is an idiopathic condition characterized by noninflammatory, nonulcerative thinning of the inferior, peripheral cornea . Occasionally the condition is complicated by acute corneal hydrops (3) . We describe a patient with findings suggestive of pellucid marginal corneal degeneration who experienced acute hydrops and spontaneous perforation of the cornea . METHOD: A retrospective analysis of the case was conducted . RESULTS: A 56-year-old woman was seen with decreased vision in the left eye . Clinical findings, including computerized corneal topography, were suggestive of pellucid marginal degeneration . Two weeks later, the patient had hydrops and spontaneous perforation of the left cornea . Medical workup of the patient and histopathologic and microbiologic studies of the corneal specimen revealed no contributory disease process . The patient underwent emergency tectonic lamellar keratoplasty and is doing well after subsequent optical penetrating keratoplasty . CONCLUSION: We believe this is the first report of a case of pellucid marginal degeneration of the cornea complicated by hydrops and perforation.

Biophys Chem, 1997 Feb 28, 64(1-3), 235 - 51
A mutation in E . coli SSB protein (W54S) alters intra-tetramer negative cooperativity and inter-tetramer positive cooperativity for single-stranded DNA binding; Ferrari ME et al.; E . coli SSB tetramer binds with high affinity and cooperatively to single-stranded (ss) DNA and functions in replication, recombination and repair . Curth et al . (Biochemistry, 32 (1993) 2585-2591) have shown that a mutant SSB protein, in which Trp-54 has been replaced by Ser (W54S) in each subunit, binds preferentially to ss-polynucleotides in the (SSB)35 mode in which only 35 nucleotides are occluded per tetramer under conditions in which wild-type (wt) SSB binds in its (SSB)65 mode . The W54S mutant also displays increased UV sensitivity and slow growth phenotypes, suggesting defects in vivo in both repair and replication (Carlini et al . (Molecular Microbiology, 10 (1993) 1067)) . We have characterized the energetics of SSBW54S binding to poly(dT) as well as short oligodeoxyribonucleotides (dA(pA)69, dT(pT)34, dC(pC)34) to determine the basis for this dramatic change in binding mode preference . We find that the W54S mutant remains a stable tetramer; however, its affinity for ss-DNA as well as both the intra-tetramer negative cooperativity and its inter-tetramer positive cooperativity in the (SSB)35 mode (omega 35) are altered significantly compared to wtSSB . The increased intra-tetramer negative cooperativity makes it more difficult for ss-DNA to bind the third and fourth subunits of the W54S tetramer, explaining the increased stability of the (SSB)35 mode in complexes with poly(dT) . When bound to dA(pA)69 in the (SSB)35 mode, W54S tetramer also displays a dramatically lower inter-tetramer positive cooperativity (omega 35 = 77(+/-20)) than wtSSB (omega 35 > or = 10(5)) as well as a significantly lower affinity for ss-DNA . These results indicate that a single amino acid change can dramatically influence the ability of SSB tetramers to bind in the different SSB binding modes . The altered ss-DNA properties of the W54S SSB mutant are probably responsible for the observed defects in replication and repair and support the proposal that the different SSB binding modes may function selectively in replication, recombination and/or repair.

JAMA, 1997 Feb 26, 277(8), 655 - 62
Relationship of microbiologic diagnostic criteria to morbidity and mortality in patients with ventilator-associated pneumonia; Bregeon F et al.; OBJECTIVE: To evaluate whether the mortality and the morbidity of ventilator-associated pneumonia, defined by positive result of protected specimen brush culture, was different from that defined by other methods . DESIGN: Matched-cohort study . All patients with clinical suspicion of pneumonia were investigated with protected specimen brush, bronchoalveolar lavage, and blind bronchial samplings . Two groups were defined: brush-positive patients (positive culture of the protected specimen brush) and brush-negative patients (negative culture of the protected specimen brush, but positive culture with another method) . SETTING: A 14-bed medicosurgical intensive care unit (ICU) in an 850-bed teaching hospital . PATIENTS: All patients with documented ventilator-associated pneumonia over 4 years 9 months . A total of 102 cases documented by protected specimen brush culture and 223 documented by another sampling procedure . Patients were matched according to diagnosis on admission, age, sex, date of admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and date of onset of pneumonia . MAIN OUTCOME MEASURES: Mortality rate, duration of mechanical ventilation, duration of ICU stay, duration of hospital stay, sampling methods, and microbiologic cultures . RESULTS: A total of 76 pairs were submitted for analysis . The effectiveness of matching was 81.85% . There was no difference in mortality between brush-positive patients and brush-negative patients . The ICU fatality rate was 38% in the brush-positive group and 39.4% in the brush-negative group (odds ratio {OR}, 0.95; 95% confidence interval {CI}, 0.46-1.93) . The hospital fatality rate was 41% (OR, 1; 95% CI, 0.5-2.01) . The mean (SD) duration of ventilation was 26 (23) days in the 2 groups (range, 3-132 days) . The duration of ICU stay was 33 (27.4) days in the 2 groups (range, 3-152 days) . CONCLUSIONS: When confounding factors are controlled, patient outcome is the same if ventilator-associated pneumonia has been diagnosed by protected specimen brush or by another sampling method.

Biochemistry, 1997 Feb 25, 36(8), 1960 - 4
Autophosphorylation-inactivation site of hexokinase 2 in Saccharomyces cerevisiae; Heidrich K et al.; Hexokinase 2 from Saccharomyces cerevisiae is phosphorylated in vivo at serine-15 {Kriegel et al . (1994) Biochemistry 33, 148-152} and undergoes ATP-dependent autophosphorylation-inactivation in vitro when incubated in the presence of D-xylose {Fernandez et al . (1988) J . Gen . Microbiol . 134, 2493-2498} . This study identifies the site of inactivation by autophosphorylation as serine-158 by observation of a single tryptic peptide difference, peptide sequencing, and size determination by mass spectrometry . Mutation of serine-158 to alanine and cysteine, respectively, prevents autophosphorylation and causes a drastic decrease of the catalytic activity while mutational change to glutamate results in a complete loss of enzyme activity . The catalytically active mutant enzymes display an increased affinity for glucose and exhibit higher K(M) with respect to MgATP . Phosphoserine/phosphothreonine-specific protein phosphatase-2A completely reverses the autophosphorylative inactivation of the wild-type enzyme.

Proc Natl Acad Sci U S A, 1997 Feb 4, 94(3), 783 - 9
Geometrics of knowledge; Grenander U; It is argued that knowledge representations formalized through pattern theoretic structures are geometric in nature in the following sense . The configurations and resulting patterns appearing in such representations exhibit invariances with respect to the similarity groups and are characterized topologically through their connection types . Starting with a special pattern from microbiology, it is shown how the basic pattern theoretic concepts are introduced in general and what their function is in representing knowledge . Variance/invariance of the patterns is discussed in geometric language . The measures on the configuration spaces are implemented by difference/differential equations which are used as a basis for computer algorithms.

Methods Inf Med, 1997 Feb, 36(2), 108 - 14
Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique; Karlsson D et al.; There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided . This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine . The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology . It provides advice and explanations regarding the given advice . The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice . The system is intended to be used in a closed local network . With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine . A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

Biosci Rep, 1997 Feb, 17(1), 77 - 83
Mechanisms of oxygen taxis in bacteria; Grishanin RN et al.; Since 1881 when Englemann reported aerotaxis in bacteria, an understanding of the molecular nature of the signal transduction remains a daring goal for microbiologists . This short review discusses known facts and recent advances in the field including the discovery of the flavoprotein receptor which drives Escherichia coli towards oxygen . Possible mechanisms of oxygen sensing in various bacterial species are considered in connection with the existing, often fragmental, data on phototaxis, redox taxis and taxis repellent effect of the reactive oxygen species (ROS).

Genitourin Med, 1997 Feb, 73(1), 29 - 32
Sentinel surveillance of Chlamydia trachomatis infection in women terminating pregnancy; Skjeldestad FE et al.; AIMS: To evaluate demographic characteristics of women terminating their pregnancy for sentinel surveillance of Chlamydia trachomatis infection and to report changing prevalences of C trachomatis over time within this study population . DESIGN: Screening for C trachomatis in women seeking induced abortion was introduced in 1984 at the Department of Gynecology, Regional Hospital, Trondheim, Norway . Over the study years our department has used a precoded medical record covering sociodemographic, medically relevant data, also recording outcome of the C trachomatis test . Throughout the study the Department of Microbiology applied cell culture, enzyme immunoassay, and, during the most recent years a nucleic acid test to identify C trachomatis . STATISTICAL METHODS: Chi square test for linear trend and unconditional logistic regression . RESULTS: Over the study period, women having induced abortion were characterised by being most often single and more often at younger age . The overall age-adjusted prevalence of C trachomatis declined from 9.2% in 1985 to 3.6% in 1995, the major decline occurring from 1987 to 1991, and affected all age-groups simultaneously . There was a 60% decrease in odds ratio of having a C trachomatis infection from 1985 to 1991, and the crude and the adjusted odds ratios did not differ for any year examined . CONCLUSION: Women deciding on pregnancy termination have demographic characteristics that identify high-risk groups for C trachomatis infection . Despite these characteristics, which were relatively constant over the study period, the study population changed from being a high- to a low-prevalence population of C trachomatisPIP: Given the finding of a significant association between postabortion endometritis/salpingitis and the occurrence of Chlamydia trachomatis at the time of induced abortion, the Regional Hospital of Trondheim, Norway, initiated C trachomatis screening in all abortion patients in 1984 . Screening is also performed at antenatal, family planning, and general practitioner visits . This study tracked the prevalence of C trachomatis from 1985 to 1995 as well as changes in the demographic characteristics of abortion patients . During the study period, the number of induced abortions varied from 872 in 1985 to 905 in 1989 and 756 in 1995 . Most notable was an increase in the proportion of unmarried cohabitating women undergoing abortion and a 40% decrease in married abortion patients . The overall age-adjusted prevalence of C trachomatis declined from 9.2% in 1985 to 3.6% in 1995 . The adjusted odds ratio of chlamydia infection decreased by more than 60% from 1985-91, followed by only minor changes . Age and marital status were the only demographic factors significantly predictive of chlamydia infection . The prevalence of C trachomatis was highest among teenagers and decreased significantly with increasing age . Single and cohabitating women were at greater risk of infection than married women . The number of chlamydia screenings performed each year increased from 2200 in 1985 to over 30,000 (almost 50% of sexually active women 15-44 years of age) in 1989 . This high screening level, and subsequent treatment of infection, appears to have turned induced abortion patients from a high- to a low-prevalence population .

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997 Feb, 83(2), 215 - 21
The buccal bifurcation cyst: a prospective study of treatment outcomes in 44 sites; Pompura JR et al.; OBJECTIVE . The clinical, radiographic, and histologic features of the mandibular buccal bifurcation cyst were studied to further define this lesion . The treatment and outcomes were also analyzed . STUDY DESIGN . This prospective study, which spanned 3 years, included 32 patients . Their ages ranged from 5.5 to 11 years (mean of 7.5) . A total of 44 buccal bifurcation cysts were treated solely with enucleation, and patients were followed up for 2.5 to 3 years . RESULTS . All lesions were located at the buccal bifurcation of the mandibular first molar . Tilting of the buccal cusps, causing prominence of the lingual cusps, occurred in 75% of the cases . The lesion extended from the buccal bifurcation to the tooth apex in 81.2%, and a periosteal reaction on the lateral surface of the mandible adjacent to the cyst was noted in 68.8% of the cases . All of the 44 histologic reports were nonspecific, but showed a cyst lining of stratified squamous epithelium with chronic inflammation . Microbiology consisted of mixed oral flora . Complete radiographic healing in all sites without recurrence was noted in 2.5-year follow-up . The periodontal pocket depth around all the involved teeth was normalized . No loss of the mandibular first molars occurred . CONCLUSIONS . The mandibular buccal bifurcation cyst is a distinct site-specific and age-specific clinical entity treatable by enucleation without tooth extraction.

Enferm Infecc Microbiol Clin, 1997 Feb, 15(2), 82 - 4
{Cutaneous infections by Mycobacterium marinum . Description of 3 cases and review of the literature}; Dorronsoro I et al.; BACKGROUND: Human infection by Mycobacterium marinum is infrequent and is currently reported in association with the management of aquariums . The epidemiologic, clinical and microbiologic characteristics of three cases in our hospital are herein reported . METHODS: Three cases of cutaneous infection by M . marinum attended in our hospital from February 1993 to October 1994 are described . RESULTS: The three patients were related with the management of aquariums . In two cases the clinical presentation was of sporotricoid cutaneous dissemination, while the third patient presented a localized cutaneous form . The lesions were localized in the upper right extremity in the three cases . The delay in diagnosis was important in two of the cases . Cure, or improvement, were achieved in three cases with' treatment; one with cotrimoxazol, another with first line tuberculostatic drugs and another did not receive treatment . CONCLUSIONS: Human infection by M . marinum is currently described is association with the management of aquariums . The infection is usually cutaneous, alone or well disseminated, with invasion of deep tissue occasionally observed . The lesions are generally found on the upper extremities . Diagnostic delay is frequent . The most adequate treatment appears to be the combination of rifampicin plus etambutol or cotrimoxazol alone, with cases of spontaneous remission also being observed.

Arch Bronconeumol, 1997 Feb, 33(2), 74 - 9
{Community acquired pneumonia . Reliability of the criteria for deciding ambulatory treatment}; Zalacain R et al.; To determine whether criteria for not admitting community-acquired pneumonia (CAP) patients diagnosed in the emergency room are appropriate, and to characterize the symptoms, etiology and course of CAP . This one-year prospective, protocol study of immunocompetent CAP patients diagnosed in the emergency room of our hospital enrolled patients not considered to require hospital admission according to the recommendations of the Spanish Society of Respiratory Disease (SEPAR) . Medical histories, chest X-rays and blood analysis were obtained for all patients . Blood cultures were analyzed for antibodies against Legionella pneumophila, Mycoplasma pneumoniae, Coxiella burnetii, Chlamydia pneumoniae, Chlamydia psittaci and influenza virus types A and B . The patients received erythromycin for 14 days and were regularly checked by the pulmonologist in the outpatient clinic until signs and symptoms had disappeared . One hundred six patients were enrolled . Mean age was 36 +/- 13 years . Only 3 patients had to be admitted to hospital, after which outcome was good . The main symptoms were fever (106, 100%) and cough (83, 78%) . In 46 (43.4%) chest sounds were normal . Microbiologic diagnoses were achieved for 28 (26.4%) and Coxiella burnetii was the agent most often found (19, 17.9%) . Outcome was good in all cases, with faster disappearance of symptoms than of radiological signs . The SEPAR criteria for admitting patients with CAP are appropriate . The clinical symptoms of such patients are non specific, a noteworthy finding being that many patients had normal chest sounds . Coxiella burnetii was the most common causative agent . Both clinical and radiological outcomes were excellent.

Eur J Epidemiol, 1997 Feb, 13(2), 217 - 21
Surveillance of infections in hospital: agents and antibiotic-resistance; Riccardi F et al.; The surveillance system for Hospital Acquired Infections (HAI) implemented in the S . Eugenio hospital of Rome allows to monitor the distribution of the micro-organisms by service and their resistance to antibiotics . It is based upon the data collected by the Central Analysis Laboratory of the hospital . The data of four high-risk departments (Surgical service, Intensive Care Unit, Haematology, Burn Unit) are reported . In the period October 1992-September 1993, 3909 samples have been analyzed; 1603 (43.1%) were found positive to the microbiologic analysis . The results of the antibiotic resistance concerning four micro-organisms, agents of HAI are reported and discussed . Surveillance systems are necessary to limit the frequency of HAI.

Eur J Surg, 1997 Feb, 163(2), 135 - 42
Starvation increases the number of coliform bacteria in the caecum and induces bacterial adherence to caecal epithelium in rats; Nettelbladt CG et al.; OBJECTIVE: To investigate the impact of starvation for 24 and 48 h on the number of coliform bacteria in the caecal contents, on the mucosal adherence of coliform bacteria, and on bacterial translocation in rats . DESIGN: Open prospective study . SETTING: University departments of surgery and microbiology, Sweden . MATERIAL: 46 adult male Sprague-Dawley rats . INTERVENTIONS: 19 rats served as controls, and were fed until samples were taken . Six animals were starved for 24 h and another 15 for 48 h, with free access to water, and then anaesthetised before blood, mesenteric lymph nodes (MLN), caecum, and caecal contents were sampled . To verify bacterial translocation in this strain of rats, another six rats underwent controlled haemorrhage for 60 min to reduce the blood pressure to 55 mm Hg mean arterial pressure (MAP) . These rats had free access to food and water before haemorrhage but were allowed only water until samples were taken 24 h after haemorrhage . MAIN OUTCOME MEASURES: Presence and number of coliform bacteria in samples taken from caecal contents, caecal epithelium, MLN, and blood . RESULTS: Starvation for 24 h increased the number of coliform bacteria (colony forming units (CFU)/g) in the caecal contents 25-fold (p < 0.05) . Starvation for 48 h further increased the number by a factor of 100 . The number of coliform bacteria that adhered to the caecal epithelium increased 3,000 times in rats that had been starved for 48 h (p < 0.001) . There was no significant difference in translocation (as indicated by cultures from MLN) between rats that had been fed and those that had been starved for 48 h . In 4 of the 6 rats that were bled and then starved for 24 h there were signs of bacterial translocation, which was significantly more than the 1/19 in fed rats (p < 0.05) . CONCLUSION: Starvation increases the number of bacteria in the caecal contents and increases bacterial adherence to the caecal epithelium . These changes may contribute to the previously reported increase in bacterial translocation in starved compared wit fed rats that were subjected to stress . The same changes in the gut were observed in animals subjected to haemorrhagic stress in addition to starvation, and in which bacterial translocation was evident.

Semin Arthritis Rheum, 1997 Feb, 26(4), 675 - 83
Nocardiosis in systemic lupus erythematosus; Mok CC et al.; OBJECTIVES: This study was performed to study the clinical presentations, treatment, and outcome of six cases of nocardial infection in the systemic lupus erythematosus (SLE) population living in Hong Kong and compare these cases with those reported in the English literature . METHODS: Records of 215 SLE patients who attended our lupus and rheumatology clinics were reviewed, and cases of nocardial infection were retrieved and studied in detail . A Medline search from 1966 to 1995 was performed to identify other reported cases . The microbiology, diagnosis, and treatment strategies of nocardiosis were assessed . RESULTS: Six cases of nocardiosis were found in our lupus series, giving a prevalence of 2.8% . Another 26 cases of nocardial infection in SLE were reported in the literature . All except one were caused by Nocardia asteroides . The lung was the commonest site of involvement (81%), followed by the central nervous system (CNS) (13%) . The mortality was high (35%), especially when the CNS was involved (75%) . Sulphonamides were the mainstay of treatment, and adjunctive surgical procedures may be needed for suppurative complications . CONCLUSIONS: Nocardiosis has been increasingly recognized in SLE . Although still uncommon, it is an important opportunistic infection because it is curable and mortality is usually caused by delay in diagnosis and treatment . A high index of suspicion, an aggressive approach to diagnosis, and early empirical therapy are essential principles of management.

FEMS Immunol Med Microbiol, 1997 Feb, 17(2), 67 - 72
Lack of evidence for sialidase activity in Helicobacter pylori; Hirmo S et al.; The role of sialic acid for the adhesion of Helicobacter pylori to gastric mucosa cells and/or to the mucin layer is still under debate . Several but not all H . pylori strains express a sialic acid-binding adhesin, specific for terminal alpha-2,3-sialic acid residues . Recently, the production of sialidase by H . pylori was reported {Dwarakanath, A.D . et al . (1995) FEMS Immunol . Med . Microbiol . 12,213 216} . We analysed several strains isolated from gastric biopsies cultivated both in liquid media and on agar plates for sialidase . Activity of this enzyme was first assayed using the fluorigenic substrate 4-methylumbelliferyl-alpha-D-N-acetylneuraminic acid . Since the fluorimetric assay can give false-positive results caused by non-specific interactions with umbelliferyl-tagged substances, we used also the more sensitive and specific assay with sialyl-{3H}lactitol as a substrate . No evidence for sialidase activity of H . pylori strains, cultivated under both inducible and non-inducible conditions, was obtained.

Lab Anim Sci, 1997 Feb, 47(1), 19 - 26
Spontaneous pathology of the gray short-tailed opossum (Monodelphis domestica); Hubbard GB et al.; The gray short-tailed opossum, Monodelphis domestica, is a newly established laboratory animal that is becoming increasingly important to biomedical research . Because little disease information is available for this species, we reviewed records for spontaneous gross and histologic lesions and microbiologic results in 150 M . domestica necropsies during an 11-year period . We identified 150 (91 female, 59 male) animals from 441 necropsy cases which were controls in experimental protocols or were members of the breeding colony . Initial statistical examinations indicated that the sample was representative of the living members of the breeding colony with respect to age, sex, and range of inbreeding . Causes of death and types of tumors were specifically evaluated . Females died earlier than males (22.6 +/- 13.0 months versus 30.9 +/- 11.9 months), but this difference was not associated readily with diet or inbreeding levels . The organ systems with the greatest lesion prevalences, in decreasing order, were the digestive, urogenital, cardiovascular, and respiratory systems . The most probable causes of all deaths were associated with the digestive system, followed by the cardiovascular and integumentary systems . The principal disease problems were rectal prolapse, congestive heart failure, and dermatitis . Neoplasia was found in 39 of the animals . The prevalence of neoplasia was greatest in the digestive system, followed by the endocrine, urogenital, integumentary, and hematopoietic systems . Pituitary adenoma was the most common neoplasm, followed by uterine leiomyoma and cutaneous lipoma . Specific microbially-induced diseases were not recognized, and endo- and ectoparasites were not found in colony-born M . domestica.

Antonie Van Leeuwenhoek, 1997 Feb, 71(1-2), 3 - 13
The Delft School of Microbiology in historical perspective; la Riviere JW; The paper discusses the contributions made to the Delft School of Microbiology by its founding fathers, defines its contents and analyses its influence . The paper is concluded by a discussion of the significance of the Delft School for the future development of general microbiologyPublication Types:

	Biography
	Historical Article

Personal Name as Subject:

	Beijerinck MW
	Kluyver AJ
	van Niel CB

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