Med Educ, 1988 Mar, 22(2), 94 - 8 Can past academic criteria predict students at risk of future failure? Boreham NC, Russell C, Wastell DG. A significant minority of medical and dental students fail their undergraduate courses . Early warning systems (EWSs) have been developed in some areas of higher education to predict 'at-risk' students at an early remedial stage . An attempt is made to develop an EWS to predict failure in the bacteriology component of the Batchelor of Dental Surgery course at Manchester Dental School . A system based on class tests and previous end-of-year performance is derived which is used to predict those students likely to fail or fall in the bottom 20-25% in their finals examination . The predictors are combined by a simple equal weights method, which is found to have the same predictive power as using multiple regression . Failure was correctly predicted in 60% of cases, at the expense of 71% false alarms . The high number of false alarms reflects the low failure rate rather than the lack of predictive information . The need for effective cross-validation of EWSs is discussed; many previous studies have not been tested on independent data. Br J Nutr, 1988 Mar, 59(2), 215 - 21 Bile acid and cholesterol excretion in human beings given soya-bean- and meat-protein-based diets: a study in ileostomy subjects; Bosaeus I et al.; 1 . The effect of partial replacement of meat protein with three different soya-bean-protein products on bile acid and cholesterol excretion was studied in seven ileostomy subjects . Four different tests diets containing 60 g meat, rice and bread protein, or a replacement of 250 g protein/kg total dietary protein by soya-bean protein from soya-bean flour, soya-bean concentrate or soya-bean isolate, were randomly assigned to the subjects in 2-d periods . 2 . Ileostomy contents were collected at 2-h intervals during the day and in one portion during the night, and immediately deep-frozen to avoid bacteriological degradation . Bile acids and cholesterol were quantified by gas-liquid chromatography . 3 . No difference in daily excretion of bile acids and cholesterol was noted between test diets . Ileostomy sterol concentrations were lower when soya-bean products were fed . 4 . Incorporation of moderate amounts of soya-bean products in solid diets does not seem to affect short-term sterol balance in man. J Clin Microbiol, 1988 Mar, 26(3), 401 - 4 Value of needle aspiration in bacteriologic diagnosis of cellulitis in adults; Newell PM et al.; We prospectively studied 30 adult patients with cellulitis, including many who were hospitalized with significant underlying medical problems . Needle aspiration of both central and leading edge areas of their lesions was performed in an attempt to establish a bacteriologic diagnosis . Potential pathogens were isolated by this technique in only 10% of the patients . Neither site of aspiration was clearly superior in terms of culture yield . Because aspirate Gram stains and cultures so rarely provided useful bacteriologic information, they were seldom helpful in guiding antibiotic selection or in influencing the outcome of treatment in most patients . However, clinical information, as well as results of primary lesion cultures when obtainable, may be used to successfully select therapy in most cases of adult cellulitis . On the basis of our results, needle aspiration may not be justified as a routine diagnostic procedure for all adults with cellulitis, though it may still be useful in selected patients. Am J Obstet Gynecol, 1988 Mar, 158(3 Pt 2), 694 - 700 Perspectives on the bacteriology of postoperative obstetric-gynecologic infections; Faro S et al.; The development of postoperative infections is influenced by both host and external factors . The present report focuses on the influence of prophylactic agents on the apparent cause of infection after cesarean section and vaginal hysterectomy . The correlation between in vitro susceptibility patterns of potential pathogens and normal flora and in vivo response is also considered. Br J Surg, 1988 Mar, 75(3), 267 - 71 Diagnosis of Meleney's synergistic gangrene; Davson J et al.; A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made . Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist . Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist . If Meleney's entity cannot be diagnosed its existence becomes debatable . The alternative diagnosis of cutaneous amoebiasis is advanced for consideration . Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria. J Dairy Sci, 1988 Mar, 71(3), 613 - 9 Selection of tests for monitoring the bacteriological quality of refrigerated raw milk supplies; Senyk GF et al.; Raw milk samples were collected from 10 producer bulk tanks . Samples were then subdivided so that milks were subsequently stored at 1.7, 4.4, 7.2, and 10.0 degrees C for 24 and 48 h . After storage, samples were analyzed by seven plating methods: standard plate count, psychrotrophic bacterial count, rapid psychrotrophic count, preliminary incubation count, mesophilic plate count, laboratory pasteurized count, and coliform count by violet red bile agar technique . Impedance protocols on a Bactometer Model 123 for total count, psychrotrophic count, mesophilic count, and coliform count were also used to evaluate the bacteriological quality of the milks . Bacterial counts and impedance detection times were analyzed using nonparametric statistics . Impedance protocols for total count and psychrotrophic count were the best indicators of bacteriological quality . Preliminary incubation count was the best of the plating methods . The laboratory pasteurized count performed poorly . Impedance measurements provided information in the shortest time. Am J Vet Res, 1988 Mar, 49(3), 330 - 7 Combined rotavirus and K99 Escherichia coli infection in gnotobiotic pigs; Benfield DA et al.; Fifty nine 3-day-old gnotobiotic pigs were randomly assigned to 4 experimental groups: 14 pigs were orally inoculated with rotavirus (RV), 14 were orally inoculated with enterotoxigenic Escherichia coli (ETEC), 18 were orally inoculated with both agents, and 13 were controls . Pigs inoculated with RV plus ETEC were given the RV inoculum at 3 days of age and then, 24 hours later, were given the ETEC inoculum . Three pigs inoculated only with RV, 3 pigs inoculated only with ETEC, 4 pigs inoculated with RV plus ETEC, and 3 pigs in the control group were euthanatized at 5 and 7 days of age . Two pigs in each of the 4 experimental groups also were euthanatized at 9 days of age . Intestinal segments from 6 sites in the small intestine were examined by virologic, bacteriologic, and histologic procedures . For 10 days after inoculation, the remaining pigs in each group were observed clinically to monitor severity and duration of diarrhea, mortality, and shedding of RV or ETEC . Pigs inoculated with the combined RV plus ETEC inoculum developed more severe diarrhea, compared with pigs inoculated with the single agents; all dually inoculated pigs died between 3 and 6 days after inoculation . There was no mortality in pigs inoculated with either RV or ETEC . Lesions were restricted to the small intestine in pigs inoculated with RV plus ETEC and in pigs inoculated with RV or ETEC . There was no difference in the severity of the villus atrophy between the dually inoculated pigs and pigs inoculated only with RV.(ABSTRACT TRUNCATED AT 250 WORDS) Am J Vet Res, 1988 Mar, 49(3), 305 - 11 Effects of mizoribine on canine renal allograft recipients; Gregory CR et al.; Heterotopic renal allograft transplantation and bilateral nephrectomies were performed on 12 mixed-breed dogs . Histoincompatibility was confirmed by serologically defined and lymphocyte-defined antigen testing . Mizoribine (5 mg/kg, q 24 h) was administered orally starting the day of surgery . Body weights, blood cell counts, serum biochemical and electrolyte values, immunoglobulin concentration, and serum mizoribine concentrations were determined . Complete urinalyses, including bacteriologic culturing and lymphocyte stimulation assays were performed . The mean survival time for the allograft recipients was 20 +/- 14 days; significantly longer than nontreated historic controls surviving 8.1 +/- 0.6 days (P = 0.0098) . Death was attributed to the combined effects of renal allograft rejection and development of a mizoribine-dependent gastroenteritis . Serum mizoribine concentrations were greater in dogs undergoing rapid allograft rejection because of compromised renal excretion of the drug . This resulted in a rapid onset of gastroenteritis . There were no complications resulting from infection, myelosuppression, or hepatotoxicosis. Zh Mikrobiol Epidemiol Immunobiol, 1988 Mar, (3), 22 - 8 {Dynamics of the shedding of bacterial and ultrafine forms of mycobacteria during the chemotherapy of patients with pulmonary tuberculosis}; Golyshevskaia VI et al.; The specific features of bacterial excretion by patients with pulmonary tuberculosis in the process of chemotherapy, depending on the duration of treatment, have been studied, and the time-course of the excretion of ultramicro forms of mycobacteria by patients with and without caverns in the lungs in the process of chemotherapy has been followed . The results of the detection of M . tuberculosis ultramicro forms with the use of the biological and bacteriological methods indicate that both these methods are highly effective and informative . The method of the direct reversion of ultramicro forms into coccoid ones in Shkol'nikova's culture medium with 10% of plasma added has proved to be the simplest . The injection of sputum filtrates containing filter-passing (ultramicro) forms of mycobacteria into experimental animals induced the development of specific minor tuberculous inflammation of a productive character without the caseation of granulomas or progressing; such inflammation coursed as a latent lympho-hematogenous process. Am J Obstet Gynecol, 1988 Mar, 158(3 Pt 2), 714 - 6 Single-center study results of cefotetan and cefoxitin prophylaxis for abdominal or vaginal hysterectomy; Orr JW Jr et al.; A prospective randomized study of 90 patients undergoing hysterectomy who received a single 1 gm dose of cefotetan and multiple 2 gm doses of cefoxitin was completed . An overall infection rate of 1.2% was recorded . Bacteriologic and clinical success rates were not different between antibiotics. Am J Obstet Gynecol, 1988 Mar, 158(3 Pt 2), 710 - 4 Results of a single-center study of cefotetan prophylaxis in abdominal or vaginal hysterectomy; Gordon SF; In a single-center clinical trial, a single 1 gm dose of cefotetan was as effective as a prophylactic agent as multiple 2 gm doses of cefoxitin in the prevention of postoperative infectious morbidity in women undergoing abdominal or vaginal hysterectomy . Among the 39 clinically evaluable women in the cefotetan group and 19 clinically evaluable women in the cefoxitin group, the successful clinical response rates were 97% and 95%, respectively . None of the women in either group who had vaginal hysterectomies developed postoperative complications . One woman in each group developed a major wound infection at the abdominal hysterectomy site . Although the satisfactory bacteriologic response rate was higher among the 36 bacteriologically evaluable women in the cefotetan group than among the 12 bacteriologically evaluable women in the cefoxitin group (83% versus 80%), the difference was not statistically significant . No drug-related adverse reactions were reported for any patient. J Dairy Res, 1988 Feb, 55(1), 33 - 40 An in-line sampling technique to measure the bacterial contamination of milk during milking; McKinnon CH et al.; The development of devices to sample milk at the clawpiece and at the end of the pipeline during milking are described . The results of tests to compare the bacteriological and compositional quality of milk collected from the sampling devices or from the recorder jar or milk cans were similar, demonstrating that the samples provided accurate and representative values . The use of the in-line sampling technique, whereby samples of the milk are taken at three points during its passage through the milking plant, to assess accurately the sources of bacterial contamination of bulk tank milk on farms is discussed. Am J Infect Control, 1988 Feb, 16(1), 14 - 8 Surgical gowns and drapes as aseptic barriers; Belkin NL; The use of surgical gowns and drapes has become the standard of practice in the arena of surgical aseptic technique . Because of myriad of materials, both woven and nonwoven, are currently available, users are faced with the difficult task of choosing a bacteriologic barrier material that is effective, safe, and economical . Although recommendations are available for general selection and use of barrier materials, no specific guidelines exist to assist the user in evaluating the important features of barriers . In addition, standards are lacking for safety characteristics such as flammability and fiber content . The infection control practitioner needs to be aware of the issues surrounding surgical barrier materials to be able to put the infection control merits of these materials in their proper perspective. Nippon Geka Gakkai Zasshi, 1988 Feb, 89(2), 227 - 37 {Clinical and experimental study on reconstruction after pancreatectomy--Part I . Cholangitis and its relationship to reconstruction}; Shiota M; The purpose of the present study is to clarify pathogenesis of cholangitis after pancreatectomy . The clinical study consisted of follow-up survey and hepatobiliary scintigraphy for the patients with type-I reconstruction (e.g . Imanaga procedure) and type-II reconstruction (e.g . Child procedure) after pancreatoduodenectomy . The experimental study was performed in dogs by creating three types of biliary reconstruction, namely, cholecystoduodenostomy (C-D), cholecystojejunostomy (C-J) and Roux-Y cholecystojejunostomy (R-Y) . In the follow-up survey, cholangitis occurred in 19.0% of 21 type-I patients and in 33.3% of 18 type-II patients . In the hepatobiliary scintigraphy, type-I demonstrated smooth transit of bile along the reestablishing intestine . Type-II, on the other hand, showed marked stagnation of bile in the excluded loop, which could even trigger cholangitis . The experimental study showed that the results obtained from R-Y were no better than those obtained from C-D and C-J with respect to prevention of cholangitis based on histological, biochemical and bacteriological point of view . These studies suggest that type-I reconstruction carries little risk of causing cholangitis, whereas type-II reconstruction is not effective in preventing cholangitis. Paraplegia, 1988 Feb, 26(1), 52 - 5 Tumour or infection? Misleading spinal radiographs; Dreghorn CR; Radiological appearances alone are often insufficient to make a precise diagnosis of spinal pathology, and should be supplemented by appropriate investigations, which ideally should include histological and bacteriological examination of the diseased tissues. Eur J Obstet Gynecol Reprod Biol, 1988 Feb, 27(2), 157 - 64 The prevention of sexually transmitted diseases which affect fertility: methodological problems and initial results; Job-Spira N et al.; Sexually transmitted diseases and their consequences for fertility are currently a major preoccupation in public health . A joint research project is being carried out in France to develop an STD prevention program and then to implement it experimentally to evaluate its efficiency . It includes 2 phases: a feasibility phase, currently concluded, and an active phase, a community randomized trial . The aim of the feasibility phase was to test the research methods and tools and to act as a basis for the design of the prevention program . It measured the incidence of discharge (men and women) at a one-year interval and patient characteristics . Participating physicians were GPs in a French administrative department near Paris . Between the two measurements, information and sensitization actions were carried out in the same department among health professionals and the general public . The results show that the incidence of discharge (chosen here as indicators of STDs) in daily general medical practice is low, of the order of 6 cases per 1000 consultations . The community randomized trial will now be conducted in 6 French administrative departments, randomly divided into 3 treated departments, benefiting from a prevention campaign, and 3 controls, where no actions will be undertaken, and its results will be used in a national STD prevention campaignPIP: The complications of sexually transmitted diseases -- epididymitis in men and pelvic inflammatory disease in women -- result in 12,000 cases of infertility a year in France . It is therefore necessary to implement a program for the prevention of sexually transmitted diseases in France . The 1st step in such a program must be a feasibility study to determine the level of participation of general practitioners and the suitability of the questionnaires . The feasibility study was carried out in 2 steps, one in 1984 and a similar one in 1985 . In each year, during a 4-week period, 57 participating doctors filled out questionnaires for each patient consulting for leucorrhea or urethral discharge . During the year between the studies, information brochures on sexually transmitted diseases were produced for doctors and the public . In 1984, the physicians noted 154 cases of leucorrhea and urethral discharge; in 1985, they noted 121 cases, an average of 6 cases/1000 patients . Of the 275 cases, 141 were in men, 134 in women . Only 4% of the men and 9% of the women were under 20, indicating that young patients go to a free health clinic rather than to private practitioners . Over 1/2 of the men, but only 1/5 of the women had multiple sexual partners, and 1/2 the patients were consulting for a recurrence . Bacteriological screening showed that the commonest organisms in the male infections were Gonococcus and Chlamydia trachomatis, while in women mycoses were more prevalent . The feasibility study showed that general practitioners cooperated and that the quality of the data was good . The 2nd phase of the study, a community randomized trial, is currently being conducted in 6 French administrative departments, 3 for treatment and 3 to act as controls . In each department 50 physicians are participating . All available information will be disseminated in the 3 treatment departments for 3 months after beginning the experiment . Arch Intern Med, 1988 Feb, 148(2), 343 - 8 Blinded comparison of cefuroxime to cefaclor for lower respiratory tract infections; Schleupner CJ et al.; Cefuroxime axetil was compared with cefaclor for the therapy for lower respiratory tract infections . Sixty-one patients were randomized to receive the following drug dosages: (1) cefuroxime axetil, 250 mg orally every 12 hours (21 patients); (2) cefuroxime axetil, 500 mg orally every 12 hours (21 patients); and (3) cefaclor, 500 mg orally every eight hours (19 patients) . Of these 61 patients, 80% were male, with a mean age of 59.5 years; 56% had acute pneumonia, and the remainder had an acute bronchitis . Causative pathogens included typical respiratory tract pathogens . Overall, 23 of 27 patients with bronchitis were clinically cured at the end of therapy . Thirty-one of 34 pneumonias were clinically cured or improved at the end of therapy; the three pneumonia treatment failures occurred in the lower dose cefuroxime (n = 2) and cefaclor (n = 1) treatment groups . Overall, bacteriologic cure occurred in 86% of patients treated with 500 mg of cefuroxime axetil compared with 60% of cefaclor-treated patients . Adverse clinical effects were uncommon . From this study, it was concluded that cefuroxime given every 12 hours is at least as clinically efficacious as cefaclor; it is a new oral cephalosporin with pharmacologic and bacterial spectrum advantages over many older agents. Postgrad Med J, 1988 Feb, 64(748), 140 - 2 Melioidosis with brain abscess; Pit S et al.; Central nervous system involvement in melioidosis is rare . We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei . Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion. Surgery, 1988 Feb, 103(2), 174 - 7 In situ bacteriologic diagnosis of total parenteral nutrition catheter infection; Vanhuynegem L et al.; An evaluation of the in situ bacteriologic status of a total parenteral nutrition (TPN) catheter, when the patient is pyretic but the cause of infection is not obvious, permits continued use of the catheter if the result is negative, as opposed to removal of the suspected catheter . To find a predictive value for the infection of the catheter, semiquantitative blood cultures taken through the TPN catheter were examined during the pyretic episodes . A total of 227 catheters from 204 patients were studied . Of these 149 were investigated during pyretic episodes . Twenty TPN catheters were removed because their semiquantitative blood cultures were positive, and in all cases the clinical conditions of the patients improved after removal of the catheters . The remaining 129 catheters investigated showed negative results and had predictive values of 100% . These catheters were left in place and all subsequently proved to be sterile on their removal at the end of the TPN . Thus 87% of the 149 suspected catheters were saved. Ann R Coll Surg Engl, 1988 Jan, 70(1), 16 - 20 The practical management of Fournier's gangrene; Scott SD et al.; Effective early treatment of this serious condition is necessary to prevent death . Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes . Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary . Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful . Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications . In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further debridement, irrigation and change of dressings, until the infective process is halted . This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery. Zentralbl Gynakol, 1988, 110(8), 523 - 9 {Acute abdomen in the puerperium}; Krafft W et al.; Reporting 6 cases as examples the problems of symptoms and diagnosis of peritonitis in puerperium are discussed . Main source of the peritonitis is the ascending of pathogenic germs . The unknown bacteriologic vaginal milieu and the behaviour of the physician associated with caesarean section and premature rupture of the membranes play an important role for developing a peritonitis . Laparotomy with removing of uterus in time is the singlest method to rescue life threatening maternal situations. Rev Mal Respir, 1988, 5(2), 129 - 36 {Tuberculosis in the Department of Seine-Saint Denis . I . Cases under treatment in 1984}; Lepetit C et al.; A prospective study of notified cases of tuberculosis started on treatment during 1984 in the department of Seine-Saint-Denis situated in the northern suburb of Paris was undertaken with the help of the Ministry of Health, and the National Committee for the Prevention of Tuberculosis . Fifty-seven hospitals were involved as were 42 sanatoria, 19 clinics and private hospitals and 157 doctors enabled 578 cases of tuberculosis to be registered . For these 578 cases there were 884 notifications coming principally from the control services of the Social Security and public hospitals . Although several sources of notification had declared the same patient, no source had registered all the patients of whom they had knowledge . The notifications made on 12 different forms were often incomplete and sometimes erroneous . Of the 578 patients declared there were 34 different nationalities, of whom 190 were French, approximately 33%; 87 were Algerian, or 15%; 83 came from Mali, or 14% . The study compared the level of notification of tuberculosis in the French, Algerians and those from Mali and has shown that they are six times higher amongst Algerians than the French population and 39 times higher in those from Mali than in the French population . The proportion of patients already treated were 11% and those patients suffering from exclusively extra-respiratory tuberculosis was 16% . A bacteriological and/or histological confirmation was obtained in 70% of cases . The study of the socio-demographic characteristics of the patients has enabled a portrayal of the representation of unskilled workers and the unemployed in comparison to the general population of the department.(ABSTRACT TRUNCATED AT 250 WORDS) Rev Pneumol Clin, 1988, 44(1), 18 - 23 {Pleurisy and sarcoidosis}; Natali F et al.; Two cases of sarcoidosis associated with pleurisy are presented . The pleural effusion had the same characteristics in both cases . Histology showed non-caseating epithelioid and giant cell granulomas in the parietal pleura . The first case was consistent with sarcoid pleurisy, but in the second case culture of a pleural biopsy specimen fragment demonstrated tuberculous pleurisy . Pleurisy may complicate sarcoidosis in about 2.5% of patients, notably in extensive pulmonary sarcoidosis with extrathoracic lesions . The clinical presentation and the appearance of the pleural fluid are varied . In most cases, a predominantly lymphocytic sero-fibrinous exudate is present . Thorough bacteriological studies, best performed on pleural tissue cultures, must follow the discovery of non-caseating tuberculoid granulomas which are also found in tuberculous pleurisy . Among the various pathogenetic theories considered, the immune reaction theory deserves special mention. Geburtshilfe Frauenheilkd, 1988 Jan, 48(1), 29 - 31 {Amniocentesis following premature rupture of fetal membranes and suspected premature rupture of fetal membranes in late pregnancy}; Schmidt R et al.; Amniocentesis during the third pregnancy trimenon in case of suspected premature rupture is performed for two reasons: on the one hand, the maturity parameters can be determined as usual from the amniotic fluid, and on the other hand it serves to determine the presence of germs that may have caused the premature rupture . At the same time, it is possible to confirm the suspicion of premature hydrorrhoea gravidarum by instillation of dyestuff into the amniotic cavity . Premature rupture was confirmed in 21 of 65 cases where clinical findings had not supplied safe evidence; in the remaining 44 cases this method permitted the exclusion of premature hydrorrhoea . An evaluation was performed by means of a retrospective study of parturitions between 1975 and 1985 with regard to late amniocenteses in cases of suspected premature rupture, the investigated parameters being the course of pregnancy and of birth, postpartal state of well-being, bacteriological findings in the amniotic fluid, and results of instillation of blue dyestuff. Br J Dermatol, 1988 Jan, 118(1), 101 - 8 Hydroa vacciniforme: a review of ten cases; Sonnex TS et al.; Ten patients with hydroa vacciniforme are reported . The condition appears to be a distinct clinical and histological entity . Haematological, biochemical, immunological, bacteriological and viral investigations were negative . Three patients demonstrated low minimal erythema doses (MEDs) following monochromatic ultraviolet (UVA) irradiation of back skin; such UVA sensitivity may be a feature of hydroa vacciniforme . Treatment was unsatisfactory, although spontaneous improvement in the condition tended to occur and regular application of sunscreens with high protection factors against both UVA and UVB was helpful. Am Rev Respir Dis, 1988 Jan, 137(1), 149 - 52 Pulmonary infection with nontuberculous mycobacteria; Contreras MA et al.; Nontuberculous mycobacterial infections (NTM) are being increasingly recognized as a cause of chronic pulmonary disease . We recently reviewed the clinical, radiologic, and bacteriologic presentation of 89 adult patients ill enough to have been hospitalized between 1981 and 1985 with the diagnosis of NTM . Preexisting lung disease was present in 82% and alcohol abuse in 40% . Although M . avium complex was identified in 51% of the patients, M . xenopi, which is usually reported to occur infrequently, accounted for 38% of our cases and M . kansasii for only 9% . Treatment was limited by a high incidence of associated disease, in vitro drug resistance, drug toxicity, and a mortality rate of 32% within 18 months of admission . Nevertheless, bacteriologic conversion occurred in 29% of those treated . M . xenopi appears to be an important pathogen in southern Ontario . It differs from the other NTM by having a different pattern of in vitro drug resistance but not by its clinical or radiologic presentation. Infection, 1988, 16 Suppl 1, S29 - 43 Worldwide clinical data on efficacy and safety of ciprofloxacin; Schacht P et al.; During the clinical trials 8,861 patients have been treated with ciprofloxacin worldwide . 3,822 of the therapeutic courses were valid for analysis of efficacy according to FDA standards . The following dosages were usually administered: UTI: 100 to 500 mg twice daily orally or 100 mg twice daily intravenously; RTI: 250 to 1000 mg twice daily orally or 200 mg twice daily intravenously; septicemia: 200 mg intravenously twice daily; gonorrhea: 250 to 500 mg single tablet orally; all other infections: 500 to 1000 mg twice daily orally or 200 mg twice daily intravenously . Ciprofloxacin was administered to 762 courses of lower RTI, 88 courses of upper RTI, 108 courses of bacteremia, 766 courses of skin structure infection, 142 courses of bone and joint infections, 149 courses of intra-abdominal infections, 33 courses of gastrointestinal infections, 1,633 courses of UTI, 49 courses of pelvic infections, 279 courses of STD, mainly gonorrhea, and three courses of meningitis . The clinical response was resolution in 76%, improvement in 18% and failure in only 6% . Bacteriologic response by all sites evaluable: pathogens were eradicated from 74%, markedly reduced in 2%, persisted in 10% . Relapse occurred in 4% and reinfection was observed in another 6% . The overall response was favourable for 90% of the patients . Drug safety was established on a data base of 8,861 courses worldwide . The following side-effects according to COSTART terminology were observed: digestive 5%, metabolic nutritional 4.6%, central nervous 1.6%, skin 1.4%, hemic and lymphatic 1%, cardiovascular 0.4%, body as a whole 0.4%, urogenital 0.3%, special senses 0.3%, musculo-skeletal 0.1%, respiratory 0.08% . Several courses had more than one reaction . Thus the total incidence of side-effects for the treated patient population was 10.2% . Ciprofloxacin is a highly effective drug and a breakthrough in several areas of medical interest . It is relatively safe and side-effects are usually mild or moderate in intensity and transient. J Infect, 1988 Jan, 16(1), 3 - 23 The hazard of infection from the shared communion cup; Gill ON; Interest and concern that the shared communion cup may act as a vehicle for indirectly transmitting infectious disease was reawakened when the human immunodeficiency virus (HIV) was detected in the saliva of infected persons . Bacteriological experiments have shown that the occasional transmission of micro-organisms is unaffected by the alcoholic content of the wine, the constituent material of the cup or the practice of partially rotating it, but is appreciably reduced when a cloth is used to wipe the lip of the cup between communicants . Nevertheless, transmission does not necessarily imply inoculation or infection . Consideration of the epidemiology of micro-organisms that may be transmitted via saliva, particularly the herpes group of viruses, suggests that indirect transmission of infection is rare and in most instances a much greater opportunity exists for direct transmission by other means . There is substantial evidence that neither infection with hepatitis B virus nor HIV can be transmitted directly via saliva so that indirect transmission via inanimate objects is even less likely . No episode of disease attributable to the shared communion cup has ever been reported . Currently available data do not provide any support for suggesting that the practice of sharing a common communion cup should be abandoned because it might spread infection. Gastrointest Radiol, 1988, 13(1), 52 - 4 Hepatitis tuberculosis presenting as tumoral disease on ultrasonography; Blangy S et al.; Macronodular involvement of the liver is a rare manifestation of hepatitis tuberculosis . Two cases of this pseudotumoral form are reported on ultrasonography, demonstrating multiple hypoechoic nodules distributed throughout the liver . The authors state the difficulty in differentiating this form in its atypical presentation from lymphomatous or secondary malignancies . They stress the importance of the bacteriological and/or histological diagnosis which can be performed with fine-needle percutaneous biopsy under ultrasound guidance and which allows effective therapy. Chest, 1988 Jan, 93(1), 43 - 8 Community-acquired pneumonia . Importance of initial noninvasive bacteriologic and radiographic investigations; Levy M et al.; During a one-year epidemiologic survey of acute community-acquired pneumonia, we prospectively investigated in 116 adult nonimmunocompromised patients (a) the importance of initial noninvasive investigations (ie, blood culture and quantitative sputum culture) and the value of the initial radiologic type of pneumonia in diagnosing of the etiologic agent, and (b) the management of pneumonia . Quantitative sputum culture or blood culture (or both) permitted bacteriologic diagnosis in 44 percent of the cases . The radiologic types found were segmental or alveolar densities in 75 patients (65 percent), patchy alveolar densities in 11 (9 percent), mixed opacities in 26 (22 percent), and interstitial infiltrates in four (3 percent) . We observed that (a) the prognosis was identical whether a bacteriologic diagnosis was made or not, (b) the Gram stain, an inexpensive procedure, was as contributive for bacteriologic diagnosis as quantitative sputum culture, diagnosis as (c) blood cultures were poorly contributive in patients without severe infections, and (d) alveolar densities were associated with a bacterial infection in 90 percent of the cases of known etiology . On the basis of these results, a pragmatic strategy of initial management of community-acquired pneumonia is proposed. Pharmatherapeutica, 1988, 5(3), 183 - 8 Comparative study of the efficacy of co-trimoxazole and cephalexin in respiratory infections; Phadtare JM et al.; An open, randomized trial was carried out in 50 patients with severe respiratory tract infections due to various pathogens to compare the effectiveness and tolerability of co-trimoxazole and cephalexin . Patients were divided into two groups, each of 25, and treated for 15 days with either 1 tablet of co-trimoxazole (160 mg trimethoprim plus 800 mg sulphamethoxazole) every 12 hours or 1 capsule of cephalexin (500 mg) every 6 hours . The results of bacteriological and radiological investigations before and after 10 and 15 days of treatment showed that, although response to cephalexin was somewhat faster, both drugs were equally effective and well-tolerated over the full treatment period and there was good correlation between the laboratory findings as well as clinical improvement in symptoms . Taking the cost-benefit ratio into consideration, it is suggested that co-trimoxazole should be used for first-line therapy in respiratory tract infections and cephalexin only as a reserve drug for infections which do not respond to the routine use of co-trimoxazole. Mikrobiyol Bul, 1988, 22(3), 245 - 53 {Acute gastroenteritis in childhood}; Doganci T et al.; In this retrospective study, 190 patients with acute gastroenteritis who have been hospitalized between the date of 1.6.1986 to 1.11.1986 were evaluated from the points of familial and environmental conditions and clinical and bacteriological features. Mikrobiyol Bul, 1988, 22(3), 235 - 7 {Bacteriologic evaluation of ophthalmic methylcellulose preparations prepared at the hospital}; Irkec M et al.; Fifteen methylcellulose preparations prepared in the hospital were evaluated bacteriologically . None of the solutions yielded bacterial growth and it was concluded that methylcellulose solutions prepared in the hospital are safe to use intraocularly. Drugs Exp Clin Res, 1988, 14(8), 559 - 60 Multidisciplinary approach to the therapy of chronic sinusitis; Bassetti D et al.; Twenty patients with maxillary sinusitis were treated with cefotetan (1 g, i.m.) twice a day . Samples of blood and maxillary sinus mucous membrane were taken in eight patients 2 h after dosing during the third day of therapy to evaluate drug concentration . Results show the excellent clinical and bacteriological effectiveness of cefotetan, as well as its high tissue penetration. Ter Arkh, 1988, 60(11), 57 - 60 {Suppurative meningitis in adults due to rare species of the causative agent}; Lisukova TE et al.; Altogether 20 patients with purulent meningitis caused by agents of rare species were observed . Difficulties in etiological diagnosis and the severity of a clinical course were noted . In most cases this disease developed in persons with associated diseases . In a lingering course of the disease repeated bacteriological investigations of blood and liquor, and serological investigations are recommended. Zentralbl Allg Pathol, 1988, 134(8), 719 - 26 {The importance of atypical adenoma of the thyroid gland}; Adolf W et al.; Histological appraisals were made of 8,741 specimens of removed thyroid glands at the Pathologico-Bacteriological Institute of Kaiserin Elisabeth Spital, between 1978 and 1987 . Included, according to classification, were 234 atypical adenomas, 47 encapsulated follicular carcinomas, and 158 invasive follicular carcinomas . Atypical adenoma was found to differ histologically from encapsulated follicular carcinoma by non-detectability of vascular invasions . The age distribution of the patients involved failed to provide any conclusive clue to the effect that atypical adenoma was a precursor of encapsulated follicular carcinoma . Females were more often affected than males with atypical adenoma . No recurrence, metastasation nor complaints are recordable at present from any of the surviving patients with atypical adenoma . Patients who died did not reveal any sign indicative of a thyroid disease as cause of death . The five-year survival rate has been 95 per cent for encapsulated follicular carcinoma . Diagnosis of atypical adenoma is not merely a qualitative problem but a quantitative problem as well . Atypical adenoma of the thyroid gland should be classified as a neoplasia in its own right and as absolutely benign. J Orthop Trauma, 1988, 2(2), 79 - 93 The role of external fixation in the treatment of posttraumatic osteomyelitis; Jupiter JB et al.; External skeletal fixation played a central role in the reconstruction of 30 limbs involved in posttraumatic osteomyelitis . The tibia was involved in 15, the femur in six, the ankle in five, and the foot and radius in two each . Of the thirty limbs, 27 were ununited . Positive bacteriology and/or histology was found in each case . A total of 36 frames were used with 20 unilateral half-frame constructs and 16 bilateral transfixion frames . The average duration of external fixation was 60 days . Specific procedures for soft tissue coverage were required in 21 cases and autogenous bone grafting in 26 . Loosening and local infection occurred in three of 168 external fixation pins . There were no cases of pin-track osteomyelitis, fractures through pintracks, or neurovascular damage from pin insertion . Infection was controlled in 29 of 30 limbs, with one requiring a below-knee amputation . Skeletal union was achieved in all cases . At an average follow-up of 35 months, 20 of 28 lower limbs in 27 patients tolerated full weight bearing without ambulatory aides . Four used a patellar tendon-bearing polypropylene orthosis, two used a cane, and one a walker . In the 23 patients ambulating without upper-extremity aides, the average time from the start of treatment to reach this functional status was 14 months. Zentralbl Chir, 1988, 113(24), 1576 - 9 {Pyomyositis in childhood (0-10 years) . An analysis of 154 cases}; Gluschko S et al.; An evaluation was made of 154 cases of pyomyositis in childhood which occurred through a period of 30 months, patients being between zero and ten years of age . Reference is made to clinical, bacteriological, and therapeutic aspects as well as to complications. Pharmacotherapy, 1988, 8(6), 315 - 8 Randomized trial of imipenem-cilastatin versus gentamicin plus clindamycin in the treatment of polymicrobial infections; Danziger LH et al.; The comparative efficacy of imipenem-cilastatin versus clindamycin and gentamicin in the treatment of polymicrobial infections was evaluated . Eleven patients completed treatment with the former and nine with the latter . Conditions treated included infected extremity ulcers, peritonitis, perirectal abscess, soft-tissue abscess, abdominal abscess, and acute diverticulitis . Similar rates of bacteriologic and clinical cure or improvement were achieved with the two treatments . Superinfection occurred in two patients who received imipenem-cilastatin and one who received clindamycin and gentamicin . No significant difference in adverse effects was noted . Imipenem-cilastatin appears to be an effective antibiotic in treating polymicrobial infections; however, a much larger patient population would be required to detect a significant difference in the efficacy rates or frequency of adverse effects when comparing the two regimens. J Urol (Paris), 1988, 94(7), 319 - 22 {Surgical correction of intermittent vesico-ureteral reflux without radiologically detectable reflux}; Cukier J et al.; On the basis of a series of 62 children with no radiological evidence of reflux but with an abnormality of a ureterovesical implantation similar to that seen in children with radiologically detected reflux, the authors attempt to show that under certain precise conditions (presence of cortico-papillary renal lesions, recurrent episodes of acute pyelonephritis, even in the absence of renal lesions), the absence of radiologically detectable reflux is not sufficient to confirm the primary nature of pyelonephritis . The sub-mucosal course of the ureters was found to be short in all of these children, and anti-reflux surgery was carried out on one or both sides according to whether the abnormality of uretero-vesical implantation was uni or bilateral . In this small selected group, clinical and bacteriological results were similar to those obtained by anti-reflux surgery in children with radiologically detected vesico-renal reflux. J Hyg Epidemiol Microbiol Immunol, 1988, 32(4), 407 - 13 Observations on commensal rats and their status to plague in Bombay; Renapurkar DM; The distribution pattern of various types of commensal rodents in Bombay city reveals that Bandicota bengalensis constitutes the predominant commensal rodent species followed by R . rattus and Rattus norvegicus . Apart from these three types, Bandicota indica, M . musculus and an insectivore (Suncus murinus) are the three species of commensal small mammals that are frequently encountered in or near human habitations . These small mammals are prevalent throughout the year and their percentage distribution varies very little during different months of the year . None of the rodent species examined during the years 1976-85 revealed presence of Y . pestis infection by bacteriological or serological methods . From these findings, it could be concluded that in the city of Bombay a focus of zoonotic plague infection does not exist. Indian J Lepr, 1988 Jan, 60(1), 71 - 6 Multidrug therapy in hospitalised leprosy cases; Tiwari VD et al.; Fifty eight cases including 44 paucibacillary and 14 multibacillary leprosy diagnosed at Command Hospital SC Pune were hospitalised for the entire period of multidrug therapy . 76% cases belonged to high endemic states of India . Reactions occurred in 13 cases during treatment, type I in 10 and type II in three . 7 Multibacillary cases experienced reaction . 69% reaction patients developed reaction within two months of starting MDT and all of them were multibacillary . Usually it took 3-6 months for majority (61.5%) of reactions subside completely . In 65.5% paucibacillary patients activity subsided within twelve months, however 70.5% paucibacillary cases took more than six months to exhibit subsidence of activity . In 13 multibacillary cases activity subsided by 18 months though bacteriological negativity was obtained from fourth to twelve months. Indian J Lepr, 1988 Jan, 60(1), 26 - 33 A follow up study of borderline tuberculoid leprosy under sulphone monotherapy; Ramu G et al.; A retrospective study is presented herewith of 94 cases classified as BT and treated with sulphone monotherapy . A system of scoring based on the number and extent of lesions, and nerve involvement was followed . It was observed that cases with a clinical score of 2 or having more than 15 lesions or patients with extensive lesions covering 3 or more of 7 sectors of the body had a bad prognosis in respect of time taken for subsidence, occurrence of deformities and most importantly occurrence of relapses . Hence it is suggested that such cases should be considered as Multibacillary and treated as such, despite bacteriological findings which may be either negative or a bacteriological positivity of less than 2 at any one site. Geogr Med Suppl, 1988, 1, 81 - 6 Problems related to the treatment of drinking water in tropical climates; Mascher F et al.; A study on the bacteriological quality of drinking water in a camp of an oil-company in Thiang Rial (South Sudan) showed that the filtered drinking water in the water storage containers contained distinctly higher colony counts (up to 10(6) colonies/ml) than the untreated water flowing approximately 20 meters from the bank of the White Nile (up to 10(4) colonies/ml), from where the water was pumped to the camp . The qualitative bacteriological analysis also confirmed that the untreated water from the Nile was of a better quality than the treated water in the camp . This decrease in quality of the water was due to secondary contamination between the filtration system and the consumer. Ter Arkh, 1988, 60(8), 103 - 9 {Mycotic complications in acute leukemia (personal observations and review of the literature)}; Volkova MA et al.; The authors reported some data on the frequency and spectrum of mycotic infections in 76 adult patients with different types of acute leukemia over the last 3 years . The growth of fungi of various species was noted in 50 (23%) of 213 bacteriological tests, candidomycetes being the most common type . Three patients with aspergillosis were described in detail, in 2 of them intravital diagnosis was established . One of these patients with a complete response received amphotericin B therapy despite the fact that acute leukemia in this case was refractory to therapy . The other patient died of profuse pulmonary hemorrhage . The main nosological types of systemic mycoses, their clinical picture, prevention, therapy and characteristic features in acute leukemias were under consideration. J Hyg Epidemiol Microbiol Immunol, 1988, 32(4), 419 - 23 Mycobacterial species responsible for tuberculosis and mycobacteriosis cases in the Czech Socialist Republic, 1981-1985; Kubin M et al.; This study is based on the analysis of nation-wide notification data on the bacteriologically proved mycobacterial infections registered in the national Information System on Bacillary Tuberculosis . Over the 5-year period under study, as many as 2,226 M . tuberculosis isolations were on average reported annually in the country (i.e . 21.6 per 100,000 population), and of these 62.5% were isolations in males, 63.5% were repeated isolations and 87% were isolations from sputum specimens; identification of human of M . bovis infection was reported in 13 patients annually only, mostly in those of higher age categories . The annual average of notified M . kansasii isolations was 138 (1.3 per 100,000 population), repeated isolations of the agent were reported in 66.6% of patients, mostly males 45-54 years old, and 81% of all reports came from an endemic area in the North-Moravian Region; notification of positive M . avium-intracellulare isolations occurred in 24 persons annually, in 48% of these repeatedly, M . xenopi isolation was reported in 87 and M . fortuitum/chelonei in 12 cases annually. Clin Ther, 1988, 10(3), 266 - 75 Controlled multicenter clinical comparison between two cefatrizine administration schedules: a contribution to improvement of compliance in clinical nonhospital use of antibiotics; Postoperative infections in the upper respiratory tract; Department of Otorhinolaryngology, Sodersjukhuset, Karolinska Institute, Stockholm, SwedenPathogenesis, prophylaxis and treatment of postoperative infections in the upper respiratory tract are discussed . Surgical procedures always hamper the normal mucosal defence system, which means that true pathogens and members of the normal flora can establish a heavy growth that will, inevitably, to some extent challenge the humoral and cellular defense of the mucosal and submucosal tissues . It is stressed that the activation of granulocytes and macrophages, which leads to the release of proteolytic proteases, can cause tissue destruction and thus also bacterial invasion . Prophylaxis should be based on good surgical technique, efficient drainage of the wound and prevention of accumulation of secretions . Antibiotic prophylaxis is recommended in risk situations, such as in extensive surgery and when the wound extends through the tissue from the skin to the mucosa . Postoperative infections have to be treated with surgical drainage and elimination of devitalized tissues in combination with antibiotic regimes based on results of bacteriological analysis. Zentralbl Allg Pathol, 1988, 134(8), 743 - 51 {The life and work of Carl Weigert (1845-1904) in Leipzig 1878-1885}; Wohlrab F et al.; Coming from Breslau, together with J . Cohnheim (1839-1884), Carl Weigert arrived at the University of Leipzig in 1878 . Here, in 1879, he was appointed extraordinary professor at the Department of Pathology . Apart from his growing commitment to autopsy and teaching, due to progressive illness of Cohnheim and the resulting involvement in management of the Department . Weigert studied topical issues of pathology, such as coagulation necrosis and pathogenesis of tuberculosis . His studies into histological staining techniques (principle of elective staining, mordant staining, staining of myelin sheaths) as well as into microtome techniques proved essential to progress in pathology and bacteriology . Weigert left the Leipzig Department of Pathology at the end of March 1885, after the Medical Faculty had failed to appoint him as the successor to Cohnheim . On the 1st of April, 1885, Weigert accepted the position of Director of Senckenberg's Pathological Institute at Frankfurt/Main. Scand J Infect Dis, 1988, 20(6), 613 - 7 Intramuscular ceftriaxone versus ampicillin-chloramphenicol in childhood bacterial meningitis; Girgis NI et al.; 70 children aged 4 months-12 years, with bacteriologically proven bacterial meningitis were treated with either intramuscular (IM) ceftriaxone (CFT) 100 mg/kg given once daily, or with combined IM ampicillin 160 mg/kg/day and IM chloramphenicol 100 mg/kg/day (AMC) given every 6 h . There were 35 children in each of the treatment groups . The children in both groups were comparable with regard to age, sex, duration of illness, and state of consciousness . 29 children in the CFT group and 26 in the AMC group recovered without any permanent complications or sequelae . Of the 15 children who died 10 (3 in the CFT and 7 in the AMC group) were in deep coma when treatment was started . Intramuscular CFT given once daily proved effective and much easier to administer than our standard hospital therapy with combined AMC given every 6 h IM. Drugs, 1988, 35 Suppl 7, 53 - 6 Sulbactam/ampicillin in the treatment of lower respiratory infections; Castellano MA; The increasing number of beta-lactam antibiotic-resistant infections has led to the development of an alternative treatment: the combination of a beta-lactam antibiotic with an irreversible, suicide-type, beta-lactamase inhibitor . Such a combination, sulbactam/ampicillin, was used in clinical trials at 4 European and 1 American centres to treat severely ill patients with lower respiratory tract infections including bronchiectasis, pneumonia and purulent tracheobronchitis . The sulbactam/ampicillin combination was assessed for safety, efficacy and tolerance in a total of 91 patients . Investigators from all 5 centres reported satisfactory bacteriological and clinical results . The combination agent either cured or improved the condition of virtually all patients who were evaluated . The few side effects reported mainly involved pain at the injection site . A review of these studies indicates that therapy with sulbactam/ampicillin effectively treats lower respiratory tract infections in severely ill patients without causing serious adverse reactions. Proc Annu Conf Res Med Educ, 1988, 27, 100 - 5 Studying the utilization and effects of a computer-based educational intervention in bacteriology; Friedman CP et al.; We introduced a computerized database as part of a problem-oriented component of bacteriology instruction for first year medical students . This paper explores utilization of the computer resource and its effects on students' knowledge in the field. Nephrologie, 1988, 9(4), 155 - 7 {Lung transplantation}; Dartevelle P et al.; Three different ways of pulmonary transplants are feasible: heart and lungs together, one single lung or both lungs . While concerning the primitive or secondary pulmonary arterial hypertension, only the cardio-pulmonary transplant is possible, concerning the respiratory deficiency; the respective indications of each of these transplants are not yet clearly defined . During the postoperative period, rejection and bacteriological, viral, fungal or parasitical infections are responsible for a mortality of about 30% . In the long term, the transplant patients are in danger of respiratory insufficiency by obliterating bronchiolitis due to untreated chronic rejection . The development of these transplants is considerably limited by the rarity of donors whose lungs are usable and by the frequency of isolated heart removals to the prejudice of the cardiopulmonary bloc transplants. Indian J Lepr, 1988 Jan, 60(1), 34 - 46 Secondary and primary dapsone resistant leprosy: an analysis of 199 patients from St . Thomas Hospital and leprosy project, Chettupattu, South India; Aschhoff M et al.; The occurrence of secondary and primary dapsone resistance in 199 patients in our control area and the influence of certain variables such as age, initial bacteriological and morphological indices, duration of regular dapsone monotherapy, on the emergence of dapsone resistance was investigated . Ninety one of 122 patients and 29 out of 77 showed secondary (SDR) and primary (PDR) resistance to dapsone respectively . Very low BI (BI:2.5) group also showed both SDR (60%) and PDR (40%) . Low or high MI group exhibited the same degree of resistance . Multiplication of M . leprae was obtained even when the MI of the inocula was zero . Even in the group who had 1 to 5 years duration of regular dapsone treatment, 85% patients showed SDR . Significance of such results are discussed in relation to chemotherapy . The overall minimum prevalence of SDR was found to be 5.6% and 21% in the case of PDR in our control area. Zentralbl Allg Pathol, 1988, 134(3), 251 - 7 {Regional lymph node micrometastases in malignant melanoma of the skin}; Adolf W et al.; Histological studies were conducted into 352 primary malignant melanomas of the skin together with 4,003 associated and surgically removed lymph nodes at the Institute of Pathology and Bacteriology of Kaiserin-Elisabeth-Spital, between 1982 and 1987 . Particular attention was given to micrometastases of regional lymph nodes . 27 lymph node micrometastases were recorded from 25 patients . Spots of melanin were also found in lymphatic tissue, but no tumour cells were detectable . There is no clinical aid by which micrometastases of lymph nodes might be possibly diagnosed, and, on principle, they are greatly accidental findings even for the pathohistologist . However, undetected lymph node micrometastases may have a deteriorating impact upon the prognosis of malignant melanoma . Complete microscopic elucidation of surgically removed lymph nodes, there fore, is absolutely essential . Capillaries are present in abundance deep inside lymph nodes, and from these points of departure tumour cells may enter into the blood flow and cause haematogenic metastases . That is why the prognostic importance attributed to histologically verified micrometastases is just as great as that attached to macrometastases. Vet Res Commun, 1988, 12(2-3), 179 - 89 A review of leptospirosis in Malaysia; Bahaman AR et al.; This paper reviews the literature on leptospirosis in Malaysia from its first description in 1928 until the present day . Most of the early reports were on investigations of leptospirosis in wildlife and man and up-to-date, thirty-seven leptospiral serovars from thirteen serogroups have been bacteriologically identified . The thirteen serogroups are: Australis, Autumnalis Bataviae, Canicola, Celledoni, Grippotyphosa, Hebdomadis, Icterohaemorrhagiae, Javanica, Pomona, Pyrogenes, Sejroe and Tarassovi . Rats have been ascribed as the principal maintenance host of leptospires in Malaysia . However, serovars from the Pomona, Pyrogenes and Sejroe serogroups have yet to be isolated from rats . It is considered that the majority of leptospirosis cases in man were due to association of man with an environment where rats were plentiful . Recent investigations on domestic animals disclosed a high prevalence of infection in cattle and pigs and they were suspected as being the maintenance host for serovar hardjo and pomona respectively . There is ample scope for research in leptospirosis, particularly in the epidemiology and control of the disease in domestic animals . The strategy to control the infection in domestic animals and man in Malaysia is bound to be different from that of the temperate countries, basically due to the presence of a large number of leptospiral serovars in wildlife, further confounded by geographical and financial constraints. Trans R Soc Trop Med Hyg, 1988, 82(2), 185 - 9 Tropical ulcer--a reappraisal based on recent work; Adriaans B; Tropical ulcer is a disease which predominantly affects young children in the tropics . The course of the disease can be interrupted in the early stages by the administration of antibiotics so it seems likely that infection may play a role . The disease extends rapidly from the initial lesion, a tiny papule, to a large area of necrosis . This makes a toxic factor likely in the pathogenesis . The epidemiology and some of the causative factors of this disease are currently being investigated . Patients with tropical ulcers were assessed, in areas where the disease is still endemic (Gambia, Papua New Guinea, southern India and Fiji), by a paediatrician or a dermatologist . All patients had swabs taken from the ulcers for bacteriological examination . Skin biopsies were taken from the edge of the ulcers as often as possible . The bacteriological samples were transported anaerobically to London where the laboratory work was performed . The results are discussed in relation to previously reported work. Acta Chir Hung, 1988, 29(2), 137 - 41 The importance of closed bladder irrigation in prostatectomy; Vegh A et al.; Closed bladder irrigation in transvesical prostatectomy is an important factor in arresting bleeding and preventing or diminishing bacterial infection . A bladder irrigation of appropriate intensity may ensure that the blood clots be removed rapidly from the bladder and thereby the formation of larger clots and bladder tamponade can be avoided . The bacteriological examination of the eluents of 82 patients revealed that the longer the patient is maintained on a catheter, the longer bacteriuria and pyuria will persist . Two days are considered by the authors to be the optimal time of maintaining a closed bladder irrigation. Geogr Med Suppl, 1988, 1, 33 - 44 On the drinking water situation on the Cape Verde Islands (Islands of Santiago); Buchrieser V et al.; On the Cape Verde Islands drinking water investigations were made . The drinking water was tested in chemical and bacteriological respects as well as on amoebas and rotaviruses . The isolated germs were investigated on their reaction against several antibiotics and chemotherapeutics by means of the agar diffusion test . The changing of drinking water quality from water supply places to households was investigated as well . The results make evident the urgency of extensive sanitations of water supply places on the Cape Verde Islands. Urol Radiol, 1988, 10(1), 25 - 30 Renal tuberculosis; Becker JA; Imaging of renal tuberculosis is reviewed, with the observation that early changes are best seen with urography/pyelography and chronic changes are best evaluated with ultrasound/computed tomography . Imaging procedures are of limited value until a proven bacteriologic diagnosis is made. Rev Mal Respir, 1988, 5(3), 279 - 83 {Tuberculosis and pregnancy}; Dautzenberg B et al.; Tuberculosis is neither more frequent, nor more serious in pregnant than non-pregnant women . The risks for the child are threefold: a doubling in the mortality level on account of the illness in the mother if she is not treated; a risk of toxicity linked to the anti-tuberculous drugs and a risk of tuberculous infection at birth . Isoniazid (INH) and ethambutol have a weak toxicity . These two antibiotics can be prescribed during pregnancy (after confirming the absence of Vitamin B6 deficiency in the mother) . Rifampicin is teratogenic in high doses in animals, but epidemiological studies do not reveal any notable risk in man . For prudence it is only prescribed in the first trimester of pregnancy, in confirmed cases of tuberculosis . The data on the teratogenicity of pyrazinamide is insufficient and it should not be used in pregnancy . Thus the treatment of tuberculosis in pregnancy will be rifampicin + isoniazid + ethambutol (the ethambutol being stopped after two months and the isoniazid and rifampicin after 9 months of treatment) . At the moment of confinement, if maternal tuberculosis is confirmed bacteriologically at the time of microscopy, chemoprophylaxis will be started in the new born with isoniazid, in a dose of 5 mg/kg until the mother is bacteriologically negative on microscopic examination, the new born should then be vaccinated with BCG . If the treatment of the mother is correctly prescribed and followed breast-feeding is possible and no isolation of either mother or child is necessary . The amount of antibiotic that passes in the mothers milk is minimal and such specific nourishment should not be dispensed with if the treatment is necessary. J Spinal Disord, 1988, 1(3), 224 - 31 Pyogenic osteomyelitis of the spine--a review of 16 consecutive cases; Chan KM et al.; Pyogenic osteomyelitis of the spine is an uncommon disease . A series of 16 cases is reported . The site of involvement includes the lumbar, cervical, and thoracic segments, in that order of frequency of occurrence . Drug addiction and diabetes mellitus are important predisposing factors . The spectrum of clinical presentation is described . Late presentation is usually masked by old age, debilitation, and previous antibiotic treatment . Rapid progression with septicemia is also encountered . The importance of differentiating this condition from tuberculosis spondylitis is emphasized . Definitive diagnosis should depend on bacteriological, histological, and, with the recent introduction of antituberculosis antibody test, serological studies . Timely surgical intervention is indicated in complicated cases . Radical excision and anterior spinal fusion yields early and complete eradication of the infected material plus arthrodesis, which prevents late collapse of the spine. J Gynecol Obstet Biol Reprod (Paris), 1988, 17(2), 191 - 7 {Assessment of the inflammatory evolution of the sequelae of salpingitis}; Leroy JL et al.; Fifty-four patients who had consulted because of their sterility had a laparoscopy carried out with bacteriological, cytological and biochemical studies of the peritoneal fluid as well as a histological assessment of the peritoneal adhesions . The purpose of this prospective study was to show the usefulness of laparoscopy in pre-operative assessment of tubal sterility and to look for objective criteria of the progress of inflammation . To do the study, two groups of women in different clinical stages (29 patients with no pelvic infection and 25 patients who had salpingitis) were divided into three sub-groups: 25 free of disease, 4 subsiding salpingitis patients and 25 with tubo-peritoneal sequellae . Different samples taken with the laparoscope made it possible to decide whether the inflammatory process was carrying on or not in these 25 cases . Using swabs for bacteriological examinations we had to employ transport medium and this showed bacteria in 7 cases . We found a significant correlation between the serum and peritoneal levels of anti chlamydia antibodies and the levels of AC antibodies when there was a tubal lesion . There was little value in carrying out cytology on the peritoneal fluid except when the histology showed that this was necessary . The level of serum and peritoneal orosomucoid was found to be different in the two groups of patients . This study shows that it is necessary to assess several different parameters to exclude pelvic inflammatory disease before resorting to reparative tubal surgery. J Antimicrob Chemother, 1988 Jan, 21 Suppl A, 133 - 9 Intraperitoneal teicoplanin in the treatment of peritonitis associated with continuous ambulatory peritoneal dialysis; Bowley JA et al.; The efficacy of teicoplanin in the treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was evaluated in a randomised comparison with vancomycin . The dosage regimen used was 50 mg of vancomycin or teicoplanin per 2 1 bag of dialysate for 48 h followed by 25 mg per bag for a further five days . Twelve episodes of peritonitis were studied . There was no significant difference in the bacteriological or clinical cure rates of either antibiotic. J Gynecol Obstet Biol Reprod (Paris), 1988, 17(5), 635 - 40 {An unusual clinical form of intraductal breast carcinoma: an inflammatory syndrome . Apropos of 5 cases}; Weber J et al.; The authors report 5 cases of in situ intraductal breast carcinoma (IDC) revealed or complicated by a clinical inflammatory syndrome . These cases showed some common features with other IDCs, such as mammographic signs and histologic forms of epitheliamatous proliferation, but were also characterized by clinical inflammatory signs different from those of rapidly developing "inflammatory" cancer, frequent nipple discharge, frequent positive results in bacteriologic examinations of nipple discharge and the role of cytologic studies of discharge in determining a definite diagnosis of carcinoma . Some hypotheses as to etiology are also discussed. Med Microbiol Immunol (Berl), 1988, 177(6), 333 - 8 Rapid detection of pneumococcal antigens in sputa in patients with community-acquired pneumonia by coagglutination; Zhang XP et al.; This paper introduces the clinical use of coagglutination as a method for the rapid detection of pneumococcal antigens in patients with community-acquired pneumonia and compares it with the sputum Gram stain and culture methods . Among 105 patients, 50 (48%) were diagnosed as having pneumococcal pneumonia by at least one of the three methods . Of 95 sputa tested, 44 (46%) were found to be positive by the coagulation test, 26 (27%) by Gram staining and only 16 (17%) by the bacterial culture method . The rate of detection of pneumococcal antigens was thus greater with coagulation than with either of the other two methods . The differences were very significant (both P less than 0.01) . Our study indicates that the advantages of coagglutination over the traditional bacteriological methods are its speed, sensitivity, convenience and also its relative independence of antibiotic therapy . It thus provides a new dimension in the aetiological diagnosis of pneumococcal pneumonia. Acta Leprol, 1988 Jan-Mar, 6(1), 7 - 16 {Bacterial sampling using lymph node puncture-aspiration . A study of 50 patients with leprosy}; Latapi-Contreras F et al.; Fine needle aspiration of lymph nodes was performed in 50 leprosy patients and was compared with usual techniques of bacillary smears taken from nasal mucosa, ear lobule and cutaneous lesion we found that the former was more sensible (30%) regarding bacteriologic and morphologic (34%) indices; moreover this proceeding was more sensible (50%) en patients with type II leprosy reaction . After 6 month-multi-therapy schedule in 3 patients, the morphologic index decreases 2 points (SFG) and bacteriologic index 1 + (mean value) . It is concluded that fine needle aspiration of lymph nodes is a useful method, because of its simplicity and low traumatic effects and its sensibility to follow-up treatment and reactional phases. Acta Derm Venereol, 1988, 68(4), 351 - 5 Acne fulminans with bone lesions; Pauli SL et al.; We present 5 young men who developed acne fulminans . During the acute, febrile illness, all had musculoskeletal symptoms, and X-ray and bone scan examinations revealed that 4 of the patients had osteolytic bone lesions . The disease was resistant to various antibiotics and one patient needed surgical trepanation of the sternum . No evidence of sepsis or bacterial osteomyelitis was found, as all bacteriological cultures proved negative and the tissue reaction was unspecific . The dermatopathogenetic origin of bone lesions in the present patients seems evident, but speculation that the etiology depends on immune mechanisms remains open. Arch Otolaryngol Head Neck Surg, 1987 Dec, 113(12), 1294 - 300 Nasal mucosal changes in children with frequent infections; Petruson B et al.; Children with frequent recurrent respiratory tract infections and constant mucopurulent secretion from the nose were thoroughly examined, including bacteriologic and immunologic analyses . Biopsy specimens from the nasal mucosa were investigated by light and electron microscopy . Eight different histopathologic factors were distinguished and evaluated in relation to the continual nasal discharge . The mucus production was increased, due to an increased number of goblet cells or submucosal glands . The mucus transport was impaired owing to a decreased number of ciliated cells or different deficiencies in the structure of the cilia . The secretion of periciliary fluid was altered due to dysfunction of microvilli-equipped cells and the availability of tissue fluid due to vascular changes . Leakage of tissue fluid partly reflects deficiencies in the epithelial lining . Purulent discharge was observed from microabscesses . Reactive changes in the nasal mucosa are described and discussed in relation to treatment schedules aimed at reducing short- and long-term discomfort and complications. J Oral Maxillofac Surg, 1987 Dec, 45(12), 1011 - 4 Bacteriology of the maxillary sinus; Cook HE et al.; The bacteriologic findings in the maxillary sinus of 20 patients who underwent surgical repositioning of the maxilla are presented . Using an open sterile surgical technique, three samples from each patient were collected prior to the planned osteotomy . The specimens included a section of the anterior bony sinus wall, an aspirate of the irrigated sinus, and a swab of the sinus membrane procured through an antral window . All specimens were cultured for aerobic and anaerobic organisms . In addition to bacterial culture samples, a portion of the sinus membrane was resected and examined microscopically for the presence of an inflammatory cell infiltrate . Eighty per cent (16/20) of the patients studied showed no bacterial growth from any sinus specimen . The remaining 20% (four of 20) had some bacterial growth, but in negligible numbers . Microscopically, all mucosal specimens showed some degree of inflammatory cell infiltrate, but the specimens where bacteria were present showed a more acute inflammatory response . It was concluded that the asymptomatic adult maxillary sinus is usually sterile, but that a few transient bacteria may exist in a clinically silent antrum . When bacteria are present, they are recognized as foreign and elicit the appropriate inflammatory responses. Scand J Gastroenterol, 1987 Dec, 22(10), 1211 - 6 Hydrogen (H2) breath excretion in peptic disease before and during treatment with ranitidine; Armbrecht U et al.; Gastric juice pH, bacterial flora, and the H2 breath excretion were studied in patients treated with 150 mg ranitidine twice daily . The intragastric pH and bacterial contents rose during therapy . Before treatment upper respiratory tract bacteria were found in 4 of 23 patients and after 4 weeks of medication in 15 of 23 . The median bacterial concentration was increased (p less than 0.01) and in five patients included bacteria normally found in the colon . Prolonged therapy for up to 12 weeks (n = 8) did not further change the bacteriologic pattern . Prophylactic treatment for 1 year (n = 3) showed gastric bacteria in high concentration, including Pseudomonas, in one patient . Postprandial H2 production remained unchanged after 4 (n = 23) and 12 (n = 7) weeks of therapy . In two of three patients treated prophylactically H2 excretion was increased after 1 year of medication . We conclude that acid reduction with ranitidine causes changes of the intragastric bacterial flora similar to those with other acid-reducing drugs in equipotent doses . The unchanged H2 breath test result after 4 and 12 weeks of treatment contradicts small-intestinal bacterial overgrowth . The elevated H2 excretion in two of the three patients after 1 year of treatment suggests the importance of a time factor in small-intestinal bacterial colonization. J Clin Microbiol, 1987 Dec, 25(12), 2407 - 9 Spondylitis and osteomyelitis caused by Kingella kingae in children; Chanal C et al.; Two cases of documented osteoarticular infections caused by Kingella kingae in children are reported . The main bacteriological characteristics and antibiotic susceptibilities of these two isolates are described . The pathology of K . kingae, particularly in bones and joints, is reviewed. Clin Otolaryngol, 1987 Dec, 12(6), 441 - 6 Systemic antibiotic prophylaxis and reconstructive ear surgery; Carlin WV et al.; This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery . Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively . The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period . The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms. Chemioterapia, 1987 Dec, 6(6), 445 - 50 Results of clinical trials with ciprofloxacin in Italy; Bianchi W et al.; The Authors report about the results of 23 clinical trials carried out in Italy with oral formulations of BAY o 9867 (ciprofloxacin) in the treatment of infections in various sites of the body . Altogether 644 patients were evaluated for therapeutic efficacy; positive clinical results were obtained in 95 to 100% of the treated patients, according to the site of the infection . The bacteriological examinations performed on 575 cases show eradication in 89.22%, eradication with relapse or reinfection in 2.26%, and persistence in 6.09% . Adverse reactions were observed in 38 out of 646 patients (5.89%); none of them, however, were severe or irreversible. Int J Lepr Other Mycobact Dis, 1987 Dec, 55(4), 633 - 6 Antibodies to phenolic glycolipid-I during long-term therapy: serial measurements in individual patients; Miller RA et al.; Levels of IgM antibody to phenolic glycolipid-I (PGL-I) were measured in serum specimens collected over the initial 5 or more years of therapy from 11 leprosy patients . All three patients with paucibacillary disease had undetectable levels of antibody throughout their treatment . The eight patients with multibacillary disease had initially elevated levels which fell quite rapidly with treatment, reaching levels of 10% to 30% of their initial pre-treatment level after 5 years of therapy . The single patient with prolonged therapeutic noncompliance had an increase in antibody level, although clinical or bacteriologic relapse was not documented . These results in individual patients demonstrate that IgM antibody to PGL-I declines rapidly and consistently with treatment in multibacillary patients. Ann Thorac Surg, 1987 Dec, 44(6), 625 - 7 A comparative study of conventional versus high-frequency jet ventilation with relation to the incidence of postoperative morbidity in thoracic surgery; Nevin M et al.; Sixty-five patients undergoing a thoracic procedure were randomly allocated to one of two groups . The first group received a conventional method of ventilation (double-lumen endobronchial tube and collapse of one lung) and the second, high-frequency jet ventilation (HFJV) . The incidence of postoperative chest infections (clinical and bacteriological), the chest drain volumes, and the length of postoperative stay in the hospital were recorded . Results showed the jet ventilator group had a significantly reduced mean hospital stay (p less than 0.01), which could be attributed to a lower incidence of postoperative chest infections (p less than 0.001) and significantly improved arterial blood O2 tensions at 4 hours (p less than 0.05), 24 hours, and 7 days postoperatively (p less than 0.001). Tubercle, 1987 Dec, 68(4), 291 - 6 Neonatal BCG vaccination and mycobacterial cervical adenitis in childhood; Katila ML et al.; Mycobacterial cervical adenitis is an uncommon disease in children in Finland . During 10 years, from 1977-1986, its incidence was of the order of 0.3/year/100,000 children . Of the 12 bacteriologically verified cases, M . avium-intracellulare was isolated in nine, M . malmoense in two and M . tuberculosis in only one case . Neonatal BCG vaccination seemed to protect children against non-tuberculous mycobacterial infection, especially at 1-4 years of age . In Sweden, where neonatal BCG vaccination has been discontinued, the incidence of non-tuberculous mycobacterial adenitis is at least 30 times greater. Eur J Epidemiol, 1987 Dec, 3(4), 381 - 5 Cryptosporidium oocysts in immunocompetent children: epidemiologic investigations in the day-care centers of Poitiers, France; Lacroix C et al.; The recent discovery of self-resolving Cryptosporidium infection in immunocompetent patients has aroused growing interest in this parasite, which has thus far been known to affect mainly immunodeficient individuals . Following the hospitalization of two children attending the same day-care center in February 1986 Cryptosporidium oocysts were found in the stools of one of them . This led to an epidemiological investigation to assess the frequency of Cryptosporidium oocysts in the stools of children attending the 7 day-care centers in the city of Poitiers, France . Testing for Cryptosporidium oocysts was performed on formalinized stools, after smear staining by the modified Ziehl-Neelsen procedure . Each positive stool was also submitted to virological and bacteriological examination . Stool specimens from 235 children were studied: 9 (3.8%) of them had Cryptosporidium oocysts in their stools . Four of the children had diarrhea, and 5 (2.2%) were asymptomatic . The existence of healthy carriers should lead to caution in the interpretation of stool parasitology. J Exp Med, 1987 Dec 1, 166(6), 1685 - 701 Monoclonal antibody to the murine type 3 complement receptor inhibits adhesion of myelomonocytic cells in vitro and inflammatory cell recruitment in vivo; Rosen H et al.; Macrophage interactions with extracellular matrix and other cells are important in phagocytosis, inflammation, and immunity . To learn more about the surface molecules involved in adhesion we compared the binding of murine macrophages and polymorphonuclear leukocytes (PMN) with artificial substrate in vitro . A distinctive type of adhesion of thioglycollate-elicited peritoneal macrophages (TPM) to bacteriologic plastic (BP) was defined, which was pronase-sensitive, Mg2+-dependent, and required cytoskeletal stabilization . A rat mAb designated 5C6 was isolated because it inhibited TPM attachment to BP, as well as mediating detachment of TPM adherent to that substratum . In addition, it inhibited the attachment of PMN to tissue culture plastic . This antiadhesive property of 5C6 mAb required intact IgG; the F(ab')2 fragment was partially effective and Fab was ineffective . 5C6 recognized the type 3 complement receptor, inhibiting rosetting of EAC3bi to TPM and immunoprecipitating a heterodimer of 160 and 95 kD that comigrated with the M1/70 immunoprecipitate . 5C6 recognized a pronase-stable epitope distinct from that of M1/70 . Other mAbs, including M1/70 (CR3) and 2.4G2 (FcR), failed to have any antiadhesive effect in vitro . The inhibitory activity of 5C6 in short-term adhesion assays correlated with its inhibition of recruitment of myelomonocytic cells to a thioglycollate-elicited peritoneal exudate in vivo, after intravenous injection of mAb . 5C6 IgG inhibited recruitment of myelomonocytic cells by 84 +/- 3% at 1 d compared with saline-injected controls . The F(ab')2 fragment and a class-matched control IgG had little effect . Recruitment of TPM at 4 d was also efficiently inhibited by 5C6 IgG . 5C6 IgG was not cytotoxic, had no effect on marrow egress, did not cause increased phagocytic clearance of circulating neutrophils, and had no adverse effect on chemotaxis in vitro . We show that CR3 alone of the LFA-family is necessary for the recruitment of myelomonocytic cells to inflammatory stimuli such as thioglycollate broth . This strategy may be of general use in isolating reagents that inhibit the adhesive function of CR3 and provides a novel approach to antiinflammatory therapy. CMAJ, 1987 Nov 15, 137(10), 897 - 900 Active abdominal tuberculosis in Canada in 1970-81; Jakubowski A et al.; We reviewed all 341 cases of abdominal tuberculosis reported in Canada between 1970 and 1981 . Over the study period abdominal tuberculosis accounted for a stable proportion (0.8%) of all reported cases of tuberculosis in Canada . Its incidence declined steadily . It was more common in women, in native Indians and in people born in Asia . Detailed records of the 55 cases reported to Statistics Canada from British Columbia and of an additional 31 cases not reported to Statistics Canada (usually because they involved concomitant disease elsewhere, notably the lungs) were studied . Five of the 55 cases reported to Statistics Canada had been reported incorrectly . Of the 81 cases in British Columbia 51% involved peritonitis, 21% ileocecal disease, 20% anorectal disease, 10% mesenteric lymphadenitis, 1% disease of the sigmoid colon and 1% disease of the liver . The rate of bacteriologic confirmation was low (51%). Tijdschr Diergeneeskd, 1987 Nov 1, 112(21), 1236 - 42 {Endocarditis and meat inspection in slaughtering pigs . 2 . Various aspects of meat inspection}; Wouda W et al.; The results of meat inspection in 599 slaughtered pigs with endocarditis were studied . Of the pigs examined, 65 per cent were condemned . Condemnation was based on a positive bacteriological examination (Article 2 of the Meat Inspection Regulations) in almost every case . When bacteriological examination was negative, the animal was passed unqualified in nearly every case, regardless of the fact that symptoms were or were not detected in ante-mortem inspection and whether or not signs of sepsis were observed . Subsequently, efforts were made to determine the possible effects of omitting incisions into the hearts of pigs in which neither clinical nor morbid-anatomical examination suggested the presence of endocarditis . It was concluded that endocarditis would have passed unnoticed in 25 per cent of the pigs examined in this case . Of these pigs, fifty per cent were found to be positive on bacteriological examination . Finally, the financial consequences of condemning all pigs showing endocarditis were examined . Compared with current practice in meat inspection, this would result in an annual loss of Dfl . 60,000 in the situation prevailing in the Netherlands . However, if Articles 13, 17 and 18 of the Meat Inspection Regulations were strictly observed, the yield of the pigs passed would not offset the costs of examination. Am J Otolaryngol, 1987 Nov-Dec, 8(6), 356 - 60 Tuberculous otitis: an underdiagnosed disease; Yaniv E; A series of 31 cases (33 ears) of tuberculous otitis was reviewed . Classical findings of the disease, such as painless ottorhea and multiple perforations of the tympanic membrane, are not consistent with the clinical findings reported here . Severe conductive hearing loss, abundant pale granulations, and an eroded malleus handle occur consistently and appear to be important clinical features of the disease . In all cases suspected of tuberculosis, granulation tissue from the middle ear or mastoid was submitted for bacteriologic and histologic examination . As a result, tuberculous otitis was diagnosed in its early stages . In 10 patients (32%), pulmonary tuberculosis was found following confirmation of the tuberculous otitis media . Following 6 months of treatment with oral antituberculous therapy in conjunction with surgery, no evidence of active tuberculosis was present in any of the patients studied. J Antimicrob Chemother, 1987 Nov, 20 Suppl B, 171 - 7 Efficacy and safety of roxithromycin in treating paediatric patients . A European multicentre study; Kafetzis DA et al.; Roxithromycin sachets of 50 mg were given to 304 infants and children, aged 2 months to 14 years, suffering from respiratory and skin infections treated in 25 hospitals in France and one in Greece . The dosage range was from 2.5 to 5.0 mg/kg/12 h and the mean duration of therapy was 8.9 days . The cure rate was 89% of the 266 children evaluable for clinical efficacy and 90.3% of the 50 bacteriologically identified cases . The overall bacteriological efficacy was 82% . The antibiotic was well accepted by the 90% of the 304 children, while in 6.9% an adverse effect was reported, mainly vomiting . There were no toxic effects . Roxithromycin should be considered as an effective and safe oral antibiotic to treat children with upper and lower respiratory tract and skin infections due to common pathogens. J Antimicrob Chemother, 1987 Nov, 20 Suppl B, 157 - 65 Roxithromycin in nongonococcal urethritis; Lassus A et al.; This presentation is a summary of five different studies on the efficacy and tolerance of roxithromycin in the treatment of non-gonococcal genital infections . Three of the studies were double-blind comparative and two were open studies . Of the 924 out-patients whose data were analysed for clinical efficacy, 637 received treatment with roxithromycin 150 mg bd . The standard dose of roxithromycin, 150 mg bd for ten days, was compared with doxycycline 200 mg daily, lymecycline 300 mg bd and roxithromycin 450 mg once daily . The overall clinical success rate was 90% (576 of 637 patients) for roxithromycin 150 mg bd . In the three comparative trials, no significant difference was found between the clinical success rates of roxithromycin 150 mg bd and the other drugs . The overall clinical success rate with roxithromycin 150 mg bd was 92% (512/558) in nongonococcal urethritis and 81% (64/79) in cervicovaginitis . Taking into account all patients treated with roxithromycin 150 mg bd, the bacteriological success rate was 90% (444/492) . In the comparative trials, no significant difference could be found between the treatment groups . Roxithromycin 150 mg bd was effective in eradicating 97% (308/316) of the isolates of Chlamydia trachomatis, 88% (149/170) of Ureaplasma urealyticum, 73% (40/55) of Mycoplasma hominis and 57% (13/23) of Gardnerella vaginalis . The present findings show that a high cure rate can be achieved with a ten-day course of treatment with roxithromycin and that it is at least as effective as the tetracyclines commonly used in the treatment of nongonococcal urethritis . A higher dosage than 300 mg/day of roxithromycin did not offer any clear advantage in terms of efficacy.(ABSTRACT TRUNCATED AT 250 WORDS) J Antimicrob Chemother, 1987 Nov, 20 Suppl B, 153 - 6 Roxithromycin in skin and soft tissue infections; Agache P et al.; In a double blind randomised investigation in 76 patients, roxithromycin (150 mg bd) and doxycycline (200 mg once daily) were compared in two groups of patients who were well-matched for age, sex, body weight, diagnosis, duration and severity of disease and associated pathological conditions, with infected skin conditions . Clinical effectiveness was 92% for roxithromycin and 82% for doxycycline, and bacteriological effectiveness also 92% and 82% respectively, the differences not being statistically significant. Pediatr Infect Dis J, 1987 Oct, 6(10), 914 - 7 Diagnostic value of the Widal test in childhood typhoid fever; Chow CB et al.; The usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas was investigated . The test was done on 150 children with other febrile illnesses and 98 bacteriologically proved cases of typhoid fever . Of the 150 children with nontyphoidal fever, only one had an H agglutinin titer of 1:50 . Using an H or O agglutinin titer of 1:50 or more as a criterion for diagnosis, a positive Widal test was found in 88% of typhoid fever cases on the first occasion on which the test was done . If the test was repeated at least 94% of the typhoid cases had a significant result . The Widal test is a useful diagnostic test in children in endemic areas, provided interpretation of the test is made against background information relating to agglutinin levels in normal children in the region. Lab Anim, 1987 Oct, 21(4), 314 - 7 Acute diarrhoeal disease in rabbit: bacteriological diagnosis and efficacy of oral rehydration in combination with loperamide hydrochloride; Banerjee AK et al.; Acute outbreaks of diarrhoea with high mortality rates are frequently observed in rabbits . Amongst various aetiological factors Escherichia coli or its toxins have been found to be commonly incriminated . Sulphonamides or antibiotics are used to treat rabbits with bacterial diarrhoea . The result of the antibiotic treatment is moderately successful . We had good results using oral rehydration treatment in combination with loperamide hydrochloride (Immodium) in a colony of rabbits with E . coli diarrhoea. Gastroenterol Clin Biol, 1987 Oct, 11(10), 636 - 8 {Can the protein concentration of the ascitic fluid in ascites predict the occurrence of an infection?}; Bercoff E et al.; In cirrhotic patients, spontaneous bacterial peritonitis is frequent and severe . This study was performed to determine if low protein concentration in ascitic fluid on admission could predict the occurrence of spontaneous bacterial peritonitis during hospitalization . Ninety-two cirrhotic patients with ascites, without spontaneous bacterial peritonitis were studied . Bacteriologic study and cultures of ascitic fluid were performed on admission and repeated every 5 days, and if any suspicion of infection occurred; 11 patients developed spontaneous bacterial peritonitis during hospitalization . Among the 92 patients in the study, protein concentration in ascitic fluid was initially less than 10 g/l in 45 and 10 of these 45 patients (22 p . 100) developed spontaneous bacterial peritonitis during hospitalization; protein concentration in ascitic fluid was initially greater than 10 g/l in 47 patients; only one of these 47 patients (2.1 p . 100) developed spontaneous bacterial peritonitis during hospitalization . This difference (22 p . 100 vs 2.1 p . 100) was significant (p less than 0.01) . Ascitic fluid protein concentration (6.9 +/- 2.3 g/l) was significantly lower (p less than 0.01) in the spontaneous bacterial peritonitis group than in patients without peritonitis (13.8 +/- 10.5 g/l) . These results suggest that: 1) ascitic fluid protein concentration on admission is lower in patients who will develop spontaneous bacterial peritonitis during hospitalization than in patients without infection and 2) patients with ascitic fluid protein concentration under 10 g/l on admission represent an high risk group for spontaneous bacterial peritonitis. Int J Dermatol, 1987 Oct, 26(8), 544 - 6 The management of pyodermas; Olumide YM et al.; With the rising cost of medical services, it was decided to reassess the relevance of routine bacteriology investigations to the management of the individual patient with pyoderma . In both prospective and retrospective studies, it was found that laboratory reports were simply confirmatory and did not contribute to the management of the individual patient . A call is made for physicians to continuously look for cheaper ways of managing patients without necessarily causing any disservice to the patient. Crit Care Med, 1987 Oct, 15(10), 930 - 2 ICU pneumonias: a multi-institutional study; Ruiz-Santana S et al.; We conducted a prospective multi-institutional study of nosocomial and community-acquired pneumonias in 1378 patients admitted to the ICUs of six hospitals . We also investigated 1005 of these patients who were intubated and mechanically ventilated for a reason other than pneumonia, the risk of developing pneumonia, and the relationship between the incidence of pneumonia and the length of time during which the patients were mechanically ventilated . A bacteriologic diagnosis was made in 38% of the nosocomial and 21% of the community-acquired pneumonias . The total mortality rate was 40%; 47% of the patients with nosocomial and 17% of the patients with community-acquired pneumonias died . Because it was difficult to make an etiologic diagnosis in two-thirds of the cases, the treatment had to be based on an assumed causative organism. J Clin Periodontol, 1987 Oct, 14(9), 499 - 507 Experimental gingivitis in relation to age in individuals not susceptible to periodontal destruction; Winkel EG et al.; The purpose of the present investigation was to study the effect of age on the rate of development of gingival inflammation in individuals not susceptible to periodontal destruction . 7 younger (mean age 37 years) and 7 older (mean age 58 years) individuals were selected on the basis of the presence of at least 18 teeth, no evidence of extraction due to periodontal destruction, no loss of attachment, shallow pockets, gross amounts of plaque and a history of no interdental cleaning . All individuals were subjected to a carefully controlled oral hygiene program and experimental gingivitis was induced in 1 quadrant of the mouth during a period of 33 days . The amount of plaque, redness and swelling of the gingiva, and bleeding on probing were assessed before, during and after the experiment . At day 33, supra-gingival plaque samples were taken for bacteriological examination and gingival biopsies were taken for histopathological and immunohistochemical investigation . Results showed no differences between the 2 age groups with regard to the amount of plaque accumulation and the rate of development of gingival inflammation . Furthermore phase-contrast microscopy of plaque samples showed no differences between the 2 age groups . Neither histological nor immunohistochemical investigation showed any differences between the 2 age groups . All biopsies diffusely showed presence of IgG, whereas in most biopsies, IgA plasma cells and in one biopsy IgM plasma cells were found . Neither IgD, IgE nor complement deposits were found . It was concluded that age is of minor importance in the development of experimentally-induced gingivitis in individuals not susceptible to periodontal destruction. An Esp Pediatr, 1987 Oct, 27(4), 257 - 60 {Simultaneous determination of total and immature neutrophil C-reactive protein in normal, diseased, and infected newborn infants}; Krauel J et al.; C . reactive protein and immature neutrophils/total neutrophils ratio are measured in 146 newborns . Three groups are considered: 37 healthy, 90 pathologic non infected and 19 bacteriologically confirmed infected newborns . Pathologies other than infection do not alter CRP nor I/T . Levels lower than 20 mg/l for CRP and 0.18 for I/T are considered normal . Both tests are considered very useful for neonatal infection diagnosis (p less than 0.001) . CRP shows a higher sensitivity than I/T in neonatal infection diagnosis even in its initial period (84% versus 63%). Indian J Lepr, 1987 Oct-Dec, 59(4), 416 - 25 Renal involvement in Mycobacterium leprae infected mice . Histopathological, bacteriological and immunofluorescence study; Vaishnavi C et al.; Swiss albino mice were inoculated in the footpads with Mycobacterium leprae obtained from untreated lepromatous patient . The kidneys obtained from the animals sacrificed during different periods were processed for histopathology, presence of AFB and immunofluorescence studies . Renal lesions, AFB and immune complex deposits were seen in the infected animals . Such findings have not been studied in great detail in experimental leprosy earlier. Br J Exp Pathol, 1987 Oct, 68(5), 655 - 61 Stimulatory effects of muramyl dipeptide upon neutrophils isolated from a local bacterial infection; Lamont PM et al.; This study examined the effects of muramyl dipeptide (MDP) in vivo upon the local inflammatory response to a bacterial challenge . In addition to quantitative bacteriology of the tissues surrounding an infected suture, polymorphonuclear leucocytes (PMN) involved in the local inflammatory response were extracted and estimations made of their number, viability and phagocytic activity . Fewer bacteria were recovered from the muscle around the suture in MDP-treated animals compared to placebo-treated controls (P less than 0.02), although there was no difference in the number of bacteria on the suture itself . Polymorphonuclear leucocytes were present in greater numbers (P less than 0.01), more PMNs were viable (P less than 0.01) and more PMNs had visibly phagocytosed bacteria (P less than 0.01) in the MDP group compared to the placebo group . These data indicate that MDP enhances the local inflammatory response to infection with increased influx, viability and phagocytic activity of PMNs, resulting in improved local control of a test bacterial challenge. Am Rev Respir Dis, 1987 Oct, 136(4), 808 - 10 Short-course chemotherapy of pulmonary tuberculosis in pneumoconiotic patients; Lin TP et al.; This is the first prospective clinical trial recorded to date of short-course chemotherapy in pulmonary tuberculosis complicated by pneumoconiosis . Forty-eight anthrasillicotic and 11 silicotic patients with previously untreated pulmonary tuberculosis completed 9-month, short-course chemotherapy regimens: 2 months of daily streptomycin, isoniazid, rifampicin, and pyrazinamide followed by daily isoniazid and rifampicin for 7 months (2SHRZ/7HR) . There were 3 treatment failures (5%) . The remaining 56 patients (95%) all had their sputum converted within 4 months (mean, 1.5 months) . Bacteriologic relapses were noted in 3 patients (5%) after 18 to 40 months of follow-up (mean, 28.4 months) . The relapses occurred within 7 months after chemotherapy was stopped . There were 2 deaths from nontuberculosis causes during the follow-up period . Fifty-one patients (90%) remained bacteriologically sterile for 28.4 +/- 6.1 months . These results suggest that the 2SHRZ/7HR regimen is satisfactory in treating anthrasilicotic or silicotic patients with pulmonary tuberculosis, though antituberculosis chemotherapy seemed less effective in patients with pneumoconiosis than in those without pneumoconiosis. Zentralbl Bakteriol Mikrobiol Hyg {B}, 1987 Oct, 185(1-2), 131 - 8 {Hygiene certification of the Society for Proper Quality of Linen Care, Incorporated}; Junghannss U et al.; This is a survey of textile-technical requirements, of quality controls, of the hygiene certificate as well as of the relevant valid legal provisions, regulations and directions . The test-list for works inspection is quoted . The hygienic-bacteriological control methods as well as the checking methods are described by means of selected examples. Zentralbl Bakteriol Mikrobiol Hyg {B}, 1987 Oct, 185(1-2), 121 - 30 Comparison of endotoxin (LPS) measurements and plate counts for bacteriological assessment of drinking water; Korsholm E et al.; Plate counts were compared with endotoxin (LPS) concentrations in 229 samples of unchlorinated drinking water . Plate counts were obtained on two different media (Kings agar B and R2A), and different fractions of LPS (total, free, and bound) were determined using a chromogenic LAL test kit . The closest correlation was found when total LPS was compared with R2A plate counts (r = 0.60), but based on regression analysis this relation was shown to be insufficient for practical use . Possible explanations for this discrepancy between plate counts and LPS are discussed, and it is concluded that the use of LPS as a surrogate indicator in drinking water bacteriology should not be rejected solely on the basis of a poor correlation with plate counts. Zentralbl Bakteriol Mikrobiol Hyg {B}, 1987 Oct, 185(1-2), 112 - 20 Colony counts in drinking water bacteriology--importance of media and methods; Korsholm E et al.; The productivity of three different plate count media were compared on unchlorinated drinking water samples . The R2A medium gave constantly higher counts than both Kings agar B and PCA, when incubated at 21 degrees C for 3 to 14 days . Spread plates were superior to pour plates for both R2A and Kings agar B, but for the R2A medium this difference diminished with time of incubation . It is suggested that this could partly be assigned to its content of sodium pyruvate as a H2O2 scavenger . Experiments with different strengths of the R2A medium showed that not only its complexity but also the low concentration of nutrients supplied is of significant importance to the productivity of the original formulation of this medium. Ann Gastroenterol Hepatol (Paris), 1987 Oct, 23(5), 261 - 3 {Bilateral abscess of the psoas with aero-anaerobic digestive flora in advanced tuberculosis}; Maillard JB et al.; The authors report a case of bilateral psoas abscess without spondylodiscitis, occurring in the course of an advanced pleuro-pulmonary tuberculosis . The dual bacteriological composition of the pus with an aero-anaerobic flora on direct examination, and mycobacterium tuberculosis in the culture, as well as the presence of an obstructive appendicitis noticed during the surgery, open the discussion of its pathogenesis. Ann Surg, 1987 Oct, 206(4), 427 - 48 The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU; Border JR et al.; The association between support elements (ventilator days = Vd, enteral protein = EnP, number of antibiotics per day = AB/d) and the magnitude of the septic state (SSS) and its bacteriologic manifestations (bacti . log) in 66 patients with blunt multiple trauma (mean HTI-ISS = 40) over 1649 days have been studied retrospectively . SSS is measured by summing the standard deviation units of change in the septic direction for the 16 measurements taken every day in the intensive care unit . Increasing Vd is tightly associated with an increasing SSS (r = +0.52), after day 10 an increasing bacti . log (r = +0.21 to +0.32), and an increasing AB/d (r = +0.26) (all p less than 0.001, N = 1615 - 1626) . The independent variables that best predicted Vd were delayed operations (DORS), day of rising EnP, and total positive blood cultures (TPC) (adj . R sq . = 0.84, F = 104, dF = 3/59) . An increasing AB/d was associated with an increasing SSS (r = +0.38), increasing Vd (r = +0.26), and an increased bacti . log (r = +0.14 to +0.18) (all p less than 0.001, N = 1615) . Only an increased EnP was consistently associated with a reduced SSS (r = -0.38) and a reduction in bacti . log (r = -0.10 to -0.21) (all p less than 0.001, N = 1626-1636) . The independent variables Vd, EnP, AB/d, and TPC best predicted SSS for all surviving patients (adj . R sq . = 0.42, F = 268, dF = 4/1496) . The patients who died of sepsis were not different in terms of bacti . log from those with equal Vd but were distinguished by zero EnP, high AB/d, and persistent ventilatory support . In conclusion, DORS is tightly associated with increased Vd, SSS, AB/d, and zero EnP . If Vd exceeds 10, there is an increasing bacti . log and evidence of infection probably from the gut . This responds only to increased EnP and not to AB/d . Death due to sepsis is not associated with increased bacti . log but with zero EnP and high AB/d and their consequences. Tijdschr Diergeneeskd, 1987 Sep 15, 112(18), 1037 - 46 {Identification and prevention of meat poisoning}; van Logtestijn JG et al.; In this contribution to a series 'Papers of Yesterday and Today' a retrospective review of developments in the identification and control of meat 'poisoning' defined as infections and intoxications following the ingestion of bacteriologically unsound meat and meat products is presented . Starting from two classical Dutch papers, viz . by H . J . H . Stempel (1891) and K . Hoefnagel (1899) illustrating the knowledge of meat 'poisoning' acquired in the nineties of the 19th century, developments in the field of bacteriological research on meats and the resulting efforts to manage meat 'poisoning' are summarised . Attention is paid to the role of Dutch veterinarians in investigations on the aetiology of meat infections resulting in the adoption of legal meat inspection in 1922 and the ensuing reduction in the occurrence of mass outbreaks of meat poisoning . However, despite marked improvement of the standard of hygiene in the food industry in general and expert monitoring of meat production lines by veterinarians in particular, infections and intoxications transmitted by meat and meat products are still quite prevalent . Essentially, their management can only be achieved by strict adherence to Good Manufacturing Practices (GMP) throughout animal husbandry, slaughter, distribution and storage, termed longitudinally integrated safety assurance . Professional monitoring by an up-to-date meat inspection system, however, continues to be indispensable in the prevention of food-borne infections and intoxications . Some recommendations are made for effective intervention in the infection cycle of food-transmitted pathogens originating from the high infection pressure on slaughter lines, resulting from contamination acquired at previous stages of the animal production chain. Diagn Cytopathol, 1987 Sep, 3(3), 198 - 205 The diagnostic cytology of nonspecific vaginitis; Giacomini G et al.; Diagnostic cytology has not kept pace with the general growing interest in nonspecific vaginitis (NSV) . This study on 114 patients compares Papanicolaou vaginal smears with bacteriologic cultures, whiff test, gram-stained vaginal smears, and vaginal pH in the evaluation of nonspecific vaginitis . Cytology is a valid practical test for diagnosis for nonspecific vaginitis; however, it must be emphasized that the coccoid morphotype is the same as the Gardnerella morphotype . Perhaps the Gardnerella morphotype is the most typical of all the inflammatory typologies found in vaginal smears, and it was indeed one of the first to be described in the history of diagnostic cytology--albeit with a slight misnomer . The question is of considerable importance since NSV is the most frequent and persistent of all collapses of the vaginal ecosystem . Cases of NSV must be screened to prevent more serious diseases of the female genital tract. Int J Lepr Other Mycobact Dis, 1987 Sep, 55(3), 454 - 62 Certainty levels in the diagnosis of leprosy; Ponnighaus JM et al.; This paper describes a procedure for grading the degree of confidence with which it can be held that a diagnosis of leprosy is in fact correct, after considering all available clinical, historical, bacteriological, and histopathological information . Individual suspects are assigned to one of four categories corresponding to different levels of overall certainty of the diagnosis . The method is illustrated using data from the Lepra Evaluation Project in Northern Malawi, and validated in the context of an analysis of BCG's protective efficacy against clinical leprosy . Although the procedures described in this paper were designed for a specific epidemiological study, the method could be adapted for use in most leprosy research or control programs. Acta Chir Belg, 1987 Sep-Oct, 87(5), 304 - 6 {Breast tuberculosis: apropos of a case}; Bonnet P et al.; The tuberculosis of the breast has rarely been observed . A new case is reported . The characteristic clinical symptoms are a firm, no-fixed, painless mass with adenopathies . The disease is rarely bilateral . The most difficult problem is differentiation between tuberculosis and carcinoma in the older patient . The clinical appearance of a pyogenic breast abscess is also very similar to tuberculosis . The most reliable diagnosis studies include bacteriologic cultures of aspirate and histologic examination . The best treatment is a complete surgical excision of the le