Am J Otol, 1994 May, 15(3), 408 - 12 Otitis externa: management of the recalcitrant case; Selesnick SH; Most cases of otitis externa respond to routine treatment, however, there is a subset of patients who frequently develop otitis externa that is usually severe and recalcitrant to routine therapy . These patients include the immunocompromised, those with AIDS, transplant recipients, severe diabetics, patients treated with high dose steroids or chemotherapeutic agents, and those who are malnourished or are chronically ill . Local factors that lead to worsening of otitis externa include dermatitides and prior local irradiation . Patients who find topical therapy painful may be noncompliant with medications, and they too, may develop recalcitrant otitis externa . For successful treatment, a broad understanding of external auditory canal anatomy, the microbiology and pathophysiology of otitis externa, and available treatment options, including topical and systemic medications, must be attained . These topics are reviewed. Radiol Med (Torino), 1994 May, 87(5 Suppl 2), 77 - 89 {Interventional modalities in immunosuppressed patients}; Dore R et al.; In immunocompromised patients interventional modalities have diagnostic and/or therapeutic purposes--in both cases they are justified on the basis of the frequently aspecific clinical and instrumental findings and because of the clinical need to carry out the most specific treatment as soon as possible . The authors stress the particular weakness of immunocompromised patients to invasive approaches and discuss the indications, contraindications and precautions which must be taken when performing interventional radiologic modalities . Diagnostic imaging uses radioscopy, US and CT for guidance, each of them allowing a rapid percutaneous confirmation of lesion nature, the assessment of infection in a collection, of a neoplastic lesion type, or of the microbiology of an infectious lesion . Interventional modalities are frequently indicated in chest diseases--e.g., for punctures and percutaneous drainage of empyematous pleural collections or of pulmonary abscesses, percutaneous needle biopsies of lung lesions, or endoscopic dilatation of tracheobronchial stenoses . The percutaneous drainage of lung abscesses in immunocompromised patients makes recovery easier . The diagnostic accuracy of the results of needle biopsy is lower in lung infections than in neoplastic lesions . Indications to abdominal interventional procedures are less frequent--i.e., percutaneous drainage of rare abscesses, percutaneous needle biopsy of nodal mesenteric or lumboaortic masses . Some clinical conditions are diagnosed only with invasive radiologic procedures--e.g., ERCP diagnoses sclerosing cholangitis in AIDS . CT is the basic and the best modality to guide percutaneous drainage in both the abdomen and the chest, to assess contraindications or to indicate some specific modes; in some cases even plurifocal abscesses can be treated with a percutaneous imaging approach. Arch Pathol Lab Med, 1994 May, 118(5), 578 - 83 An introductory orientation to clinical pathology core and on-call responsibilities; Pappas AA et al.; An introductory 4-week orientation for clinical pathology is described . There were 76 hours of lectures, 74 hours of conferences, and 68 hours of laboratories for a total of 221 hours . During the orientation, all calls handled by the residents were evaluated as to resolution, patient outcome, and interaction required . Eighty calls were received during the orientation from 57 technologists (71%), 16 physicians (20%), and seven nurses (9%) . The calls originated concerning the following: blood banking, 37 (46%); hematology, 21 (27%); chemistry, 14 (18%); microbiology, five (6%); and administration, three (4%) . Sixty percent of the calls were consultative and 40% were supervisory . Ninety-nine percent were handled appropriately by the residents . Patient outcome was moderately or significantly affected in 44% of all calls, divided between 67% of all consultative calls and 9% of all supervisory calls . Significant pathologist interaction was required in 49% of all calls, divided between 71% of the consultative calls and 16% of the supervisory calls . Using this integrated, dynamic system of resident instruction, on-call experience, and evaluation, residents quickly gain confidence in handling call, didactic clinical consultation, and patient management . The orientation and on-call system described provides for a relevant and dynamic system for resident education. Am J Surg, 1994 May, 167(5), 481 - 4 Early recognition of neonatal abdominal wall necrotizing fasciitis; Sawin RS et al.; Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate . Improved survival requires early diagnosis followed by aggressive surgical debridement . During a 10-year period, we treated 7 infants who developed NF . During the same period, 32 infants were admitted with omphalitis that did not progress to NF . The patients with omphalitis and those with NF were compared . Tachycardia, abnormal white blood cell counts, induration, and violaceous skin discoloration were seen exclusively in the NF patients . Polymicrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients . All omphalitis patients survived, whereas 5 of 7 (71%) NF patients died . Adjuvant hyperbaric oxygen therapy was used for 4 infants with NF, 2 of whom survived (50%) . NF is a highly morbid disease, that can be distinguished from other infant abdominal wall infections by the skin changes, white blood cell counts, heart rate, and microbiologic results . Prompt diagnosis of NF improves survival when combined with aggressive surgical debridement. J Infect Dis, 1994 May, 169(5), 1166 - 9 Mycobacterium abscessus pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation; Maloney S et al.; After 15 patients had positive cultures for Mycobacterium abscessus without evidence of infection (i.e., pseudoinfection) following endoscopy, retrospective cohort studies of patients undergoing endoscopy and microbiologic sampling of the environment were done to examine potential nosocomial transmission and to identify the source and risk factors for M . abscessus pseudoinfection . In the epidemic period, M . abscessus-positive cultures were significantly more likely to be obtained during bronchoscopy than gastroendoscopy (16/149 vs . 1/860, P < .001) and during procedures using bronchoscopes disinfected in an automated washer rather than by other methods (16/54 vs . 0/95, P < .001) . M . abscessus was recovered from the automated washer, the inlet water feeding the washer, and a flexible bronchoscope . Environmental and case-patient isolates had identical large restriction fragment (LRF) patterns of genomic DNA separated by pulsed-field gel electrophoresis . Molecular typing using LRF analysis supported the epidemiologic results and demonstrate the utility of combined epidemiologic and laboratory investigations in nosocomial outbreaks of nontuberculous mycobacteria. J Clin Microbiol, 1994 May, 32(5), 1369 - 72 Low-stringency PCR with diagnostically useful primers for identification of Leptospira serovars; de Caballero OL et al.; Primers proposed for the diagnosis of the pathogenic spirochete Leptospira spp . (C . Gravekamp, H . V . D . Kemp, M . Franzen, D . Carrington, G.J . Schoone, G.J.J.M . Van Eys, C . O . R . Everard, R.A . Hartskeel, and W.J . Terpstra, J . Gen . Microbiol . 139:1691-1700, 1993) have been found to produce complex serovar-specific patterns under low-stringency PCR conditions . Such patterns obtained by low-stringency PCR, which maintain the specific band as an internal control, offer, an approach to the standardized identification of Leptospira serovars in clinical laboratories. J Clin Microbiol, 1994 May, 32(5), 1211 - 6 Development of species-specific enzyme-linked immunosorbent assay for diagnosis of Johne's disease in cattle; Vannuffel P et al.; The previously described (M . De Kesel, P . Gilot, M.-C . Misonne, M . Coene, and C . Cocito, J . Clin . Microbiol., 31:947-954, 1993) a362 recombinant polypeptide of Mycobacterium paratuberculosis was used as reagent for an enzyme-linked immunosorbent assay (ELISA) . This ELISA, which is endowed with species specificity with respect to the other mycobacteria, was applied to the analysis of bovine paratuberculosis (Johne's disease), an endemic mycobacteriosis of cattle caused by M . paratuberculosis . The distribution of anti-a362 antibodies in the cattle population was analyzed by a computer program (mixture population model) to determine a cutoff value for the test . The prevalence of a362 seropositivity in the Belgian bovine population was estimated to be 12% . The sensitivity of the a362 assay was 70%, as determined with reference sera from the U.S . National Repository of Paratuberculosis Specimens . Some 40% of the animals in the herds with paratuberculosis analyzed were found to be positive by the a362 assay . The latter proved to be 95% specific with respect to both healthy and tuberculous cattle. Scand J Gastroenterol, 1994 May, 29(5), 419 - 24 Relationship between infective load of Helicobacter pylori and reactive oxygen metabolite production in antral mucosa; Davies GR et al.; Helicobacter pylori infection has been associated with stimulation of gastric mucosal reactive oxygen metabolite production . To provide further evidence of a causal relationship we looked for a dose-response relationship . We studied antral biopsy material from 110 patients . Quantitative H . pylori assessments were made using histologic and microbiologic methods . Reactive oxygen metabolite production was measured by luminol-dependent chemiluminescence . The usefulness of timed urease test colour changes as a guide to infective load was assessed . There was a positive association between mucosal reactive oxygen metabolite production and histologic (p = 0.002, n = 69) and microbiologic (Spearman's R = +0.6, p = 0.05, n = 18) quantitative H . pylori assessments . H . pylori infective load varied markedly over small areas (coefficient of repeatability of paired cultures (in colony-forming units/mg) = 1.9 x 10(6) . Urease test timing correlated with histologic (p = 0.01) and microbiologic (p = 0.03) H . pylori quantitation . Histologically assessed mucosal damage was related to quantitative H . pylori assessment and to mucosal reactive oxygen metabolite production (p = 0.0001) . These results support the hypothesis that H . pylori stimulates gastric mucosal reactive oxygen metabolite production and that this phenomenon is of pathogenic importance. J Clin Monit, 1994 May, 10(3), 201 - 9 System ergonomic analysis of the morning ward round in an intensive care unit; Friesdorf W et al.; OBJECTIVE . Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended . METHODS . An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions . RESULTS . The median length of discussions was 5 min . In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems . Specific variables relating to organ system conditions were seldom used (e.g., inspired O2 concentration, 35%; temperature, 28%; ventilation mode, 25%) . We recorded two interruptions per MWR; only 17% of them were related to urgent decisions . Information that could not be found in the patient's file usually concerned microbiology findings (10%) or surgical procedures (6%) . CONCLUSIONS . We recommend the following structure: (1) Addressing the patient by saying "hello"; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition. Rinsho Byori, 1994 May, 42(5), 521 - 5 {Elective course "Anatomic Pathology"}; Namiki T et al.; The elective course "Anatomic Pathology" consists of three domains including (1) autopsy, (2) surgical pathology (biopsy) and (3) cytology . The major objectives are to gain knowledge and master various technics to make a high quality pathomorphological diagnosis . The training duration is fundamentally 2 years, but can be shortened to 1 year . The GIOs and SBOs of each domain are listed separately followed by specific learning subjects such as special stains, immunohistochemistry, electron microscopy, microbiology and forensic pathology . The major diseases in the various systems and organs are included . The minimal requirement for each domain is also mentioned. J Biolumin Chemilumin, 1994 May-Jun, 9(3), 211 - 5 Use of lux genes in applied biochemistry; Hill PJ et al.; Bioluminescence has emerged in the last decade as a major tool for the study of bacterial adaptation and survival . In addition to the advantages of sensitivity and the real-time, non-invasive nature of this reporter, the imaging potential of using low-light and photon-counting video cameras has been particularly influential in establishing its ascendancy-over more traditional reporter systems . This review provides a reflection of personal activity in this field through applications in Food Microbiology and collaboration with colleagues both in the UK and beyond. Comput Biol Med, 1994 May, 24(3), 179 - 88 Measurement of inhibition zone diameter in disk susceptibility tests by computerized image analysis; Gavoille A et al.; This paper presents an application of computerized image analysis in microbiology . This application permits the automatic detection and diameter measurement of inhibition zones in disk susceptibility tests . Each inhibition zone boundary was extracted according to an edge detection method based on the Student's t-test and a priori knowledge (geometry, densitometry) . Evaluation of the method was performed by comparing the results from an image analyser and a trained observer . For this purpose, we used kappa statistics and obtained a close agreement (a kappa coefficient equal to 0.84) on a set of about 600 inhibition zones . The results encourage us to develop the method further to include the detection of antagonism and synergism. Arch Pathol Lab Med, 1994 May, 118(5), 517 - 22 Antineutrophil cytoplasmic autoantibody-associated alveolar capillaritis in patients presenting with pulmonary hemorrhage; Bosch X et al.; The objective of this study was to determine the significance of the antineutrophil cytoplasmic autoantibodies (ANCAs) from the clinicopathologic viewpoint of pulmonary hemorrhage occurring as a prominent event of disease . Forty-three consecutive patients with both pulmonary hemorrhage as a prominent clinical manifestation and a positive test for antineutrophil cytoplasmic autoantibodies were studied . Thirty-six patients underwent open lung biopsy, including histologic, tissue immunofluorescence, and microbiologic studies . Immunoassays were performed to investigate the antigenic specificities of antineutrophil cytoplasmic autoantibodies in the patients studied . All patients with lung biopsy confirmation had pauci-immune hemorrhagic alveolar capillaritis as the main morphologic substrate . In addition, renal involvement in the form of pauci-immune crescentic glomerulonephritis was a common finding . Serum samples from the 43 study patients contained antibodies that were monospecific for proteinase 3 (n = 13) or myeloperoxidase (n = 30) . In our study, whereas anti-proteinase 3 antibodies were mainly detected in patients with alveolar capillaritis and a well-established diagnosis of Wegener's granulomatosis, antimyeloperoxidase antibodies were principally found in those patients who had alveolar capillaritis and polyarteritis nodosa not only as a primary finding but also accompanying other diseases . However, a significant number of patients with alveolar capillaritis and antimyeloperoxidase antibodies showed no evidence of polyarteritis nodosa (idiopathic pulmonary-renal syndrome and isolated forms of pulmonary hemorrhage) . We conclude that in patients presenting with pulmonary hemorrhage as a prominent event of disease, antineutrophil cytoplasmic autoantibodies are a new clue strongly supportive of a pulmonary capillary vasculitis, irrespective of the primary underlying disease . Moreover, the antigenic subtype of antineutrophil cytoplasmic autoantibodies helps in recognizing the type of vasculitic disorder involved. Ukr Biokhim Zh, 1994 May-Jun, 66(3), 54 - 60 {Amperometric enzyme biosensor with a glucose oxidase-polyaniline membrane}; Dziadevich SV et al.; An amperometric glucose biosensor was made by electrochemical polymerization of aniline onto the gold electrodes in presence of the enzyme glucose oxidase in the phosphate buffer solution with pH 7.0 . Aniline is easily polymerized forming a thin film, which adheres tightly on the electrodes surface . During the electropolymerization process glucose oxidase was entrapped into polyaniline film which then became the catalyst of the enzyme reaction of glucose hydrolysis . Experiments were performed to determine optimal conditions of polyaniline-glucose oxidase film preparation . Glucose was amperometrically determined with the electrochemically fabricated biosensor in the concentration range 10(-4) M to 2 x 10(-2) M . The linearity of the enzyme electrode response ranged from 2 x 10(-4) M to 6 x 10(-3) M . The electrochemical synthesis of a polyaniline-enzyme thin film a high-technologic one and this permits fabricating various microbiosensors and multisensors in the continuous technological cycle. Eur J Biochem, 1994 Apr 15, 221(2), 617 - 30 Proteins under pressure . The influence of high hydrostatic pressure on structure, function and assembly of proteins and protein complexes; Gross M et al.; Oceans not only cover the major part of the earth's surface but also reach into depths exceeding the height of the Mt Everest . They are populated down to the deepest levels (approximately 11,800 m), which means that a significant proportion of the global biosphere is exposed to pressures of up to 120 MPa . Although this fact has been known for more than a century, the ecology of the 'abyss' is still in its infancy . Only recently, barophilic adaptation, i.e . the requirement of elevated pressure for viability, has been firmly established . In non-adapted organisms, increased pressure leads to morphological anomalies or growth inhibition, and ultimately to cell death . The detailed molecular mechanism of the underlying 'metabolic dislocation' is unresolved . Effects of pressure as a variable in microbiology, biochemistry and biotechnology allow the structure/function relationship of proteins conjugates to be analyzed . In this context, stabilization by cofactors or accessory proteins has been observed . High-pressure equipment available today allows the comprehensive characterization of the behaviour of proteins under pressure . Single-chain proteins undergo pressure-induced denaturation in the 100-MPa range, which, in the case of oligomeric proteins or protein assemblies, is preceded by dissociation at lower pressure . The effects may be ascribed to the positive reaction volumes connected with the formation of hydrophobic and ionic interactions . In addition, the possibility of conformational effects exerted by moderate, non-denaturing pressures, and related to the intrinsic compressibility of proteins, is discussed . Crystallization may serve as a model reaction of protein self-organization . Kinetic aspects of its pressure-induced inhibition can be described by a model based on the Oosawa theory of molecular association . Barosensitivity is known to be correlated with the pressure-induced inhibition of protein biosynthesis . Attempts to track down the ultimate cause in the dissociation of ribosomes have revealed remarkable stabilization of functional complexes under pseudo-physiological conditions, with the post-translational complex as the most pressure-sensitive species . Apart from the key issue of barosensitivity and barophilic adaptation, high-pressure biochemistry may provide means to develop new approaches to nonthermic industrial processes, especially in the field of food technology. Schweiz Rundsch Med Prax, 1994 Apr 5, 83(14), 414 - 25 {The importance of CAPD in kidney replacement therapy}; Schaffner AD et al.; Continuous ambulatory peritoneal dialysis (CAPD) a method suitable for self-treatment by patients with chronic renal failure, was introduced for clinical use at the end of the seventies . It was rapidly accepted and used worldwide . Based upon a ten-year-old clinical experience at the renal unit of the Stadtspital Waid, Zurich, and on data of a cohort of 113 unselected patients treated by this method, this report aims at the importance of CAPD for renal replacement therapy . Experiences with developments of materials, techniques and measures preventing complications, collected during an observation period, from 1979 to 1989 were analyzed and data from three arbitrarily fixed consecutive periods compared . The Tenckhoff catheter, primarily used for dialysis, has been replaced by the Oreopoulos-Zellermann catheter because of a reduced complication rate . The number of patients treated with CAPD doubled within these ten years . The survival rate for different methods was similar in the three time periods investigated . In accordance with other centers, peritonitis was found to be the most frequent cause for a drop-out and was equally the most frequent complication whose incidence, however, declined over the observation periods . Compared to other centers, incidence of peritonitis was already low before at the renal unit of SWZ . 41% of the patients died, most of them because of cardiovascular problems . Infections of the catheter tunnels were less frequent, but their rate could not be influenced in the course of the ten-year period . Clinical experiences of the first ten years with CAPD at the renal unit of SWZ yielded positive results: 1 . CAPD represents a simple and effective method for dialysis therapy of equal value compared to hemodialysis . 2 . Success of the CAPD program depends crucially on amelioration of the CAPD materials and techniques as well as on an optimal education of the patient by the nursing staff and the physician . 3 . Obviously, the significant decline of the rate of peritonitis in the Stadtspital Waid was due to the introduction of a simple microbiologic method for self-control (so-called dialysate-digest medium tube-method) and to the prophylaxis for fungal peritonitis with Nystatin per os accompanying every antibiotic therapy . 4 . A future challenge is seen in increased attention and better prevention of the second most common complication of CAPD, catheter-tunnel infection. Nucl Med Biol, 1994 Apr, 21(3), 407 - 17 Overview: diagnostic tests for viral infections transmitted by blood; Holland PV; The risk of transmitting viral infections by transfusion today is quite remote . The many, sensitive, diagnostic tests in place, when applied to the blood of volunteer, unpaid (unremunerated), unpressured donors who are also carefully evaluated at the time of donation, make blood and blood component transfusions very safe . A number of sensitive laboratory tests are performed on each unit of donated blood and plasma to reduce the risk of transmission of hepatitis viruses and retroviruses from asymptomatic donors to transfusion recipients . With the tests, we hope to catch otherwise undetectable individuals who may be carrying these viruses yet appear healthy and deny risk factors for their carriage . However, the laboratory tests in use in blood banks were designed to aid in the diagnosis of patients with viral diseases . Therefore, a reactive test, even if reproducible, on a sample from a healthy blood donor is more apt to be falsely than truly positive . An ideal microbiologic test is one which is one hundred percent sensitive, i.e., it will identify every person with an infectious disease (including asymptomatic carriers) . In addition, a perfect test would have one hundred percent specificity, i.e., it would not be reactive in anyone without the infectious agent . The decision point or "cutoff" for an ideal test would be above the (negative) results for all normal and uninfected samples, but below that for all (positive) infectious ones . In reality, there is an overlap between some of the results on normals and those on diseased individuals, including persons who are carrying an infectious agent . When we try to obtain maximal sensitivity, e.g., to detect all asymptomatic carriers of a virus, the assay cutoff is set very low for tests applied to blood donors; but this approach will compromise the specificity of a test . The net effect is that many normal people donating blood are said to have "abnormal" test results which, among other things, necessitates the loss of their blood and plasma . In addition, we must follow up the reactive results by enzyme linked immunoassays (EIA or ELISA) or radioimmunoassays (RIA) used to screen or preliminarily test blood from donors with supplemental or confirmatory tests to verify whether the initial test is a true positive or a false positive one . Trying to explain the significance of a false positive test for AIDS or hepatitis to a healthy donor often causes fear, concern and/or anger . Thus, the use of very sensitive tests on blood donors will increase the safety of transfusion for recipients but result in loss of some donors and discard of many blood components unnecessarily . Despite the problems in applying sensitive tests to asymptomatic individuals who are not patients, the assays in place in blood banks have, nonetheless, resulted in remarkably small risks of virus transmission by transfusions . Currently, the risk of HCV infection following a transfusion is about 1 in 3,300 per unit transfused . This is an enormous improvement compared to the risks of what was called non-A, non-B hepatitis in the 1970s and 1980s before the use of the test for antibodies to HCV . For HTLV-1 (and, potentially, HTLV-II) the risk of transfusion transmission is about 1 in 50,000 per unit of screened blood . Using blood which is anti-HIV-1/2 non-reactive, the risk is about 1 in 225,000 units of transmitting HIV . The risk of transfusion associated AIDS is thus quite remote in 1993 . For hepatitis B virus, only about 1 in 200,000 units of blood transmit this virus now . In sum, only about 3 units of blood per 10,000 of those collected from acceptable, volunteer donors are currently likely to transmit a serious or fatal transfusion-transmitted viral infection . In contrast, in America, about 6 out of every 1,000 patients hospitalized will die from an accidental or preventable cause other than the underlying disease for which he/she was hospitalized . (ABSTRACT TRUNCATED) Int J Syst Bacteriol, 1994 Apr, 44(2), 285 - 92 A taxonomic review of the genera Kitasatosporia and Streptoverticillium by analysis of ribosomal protein AT-L30; Ochi K et al.; An analysis of the ribosomal AT-L30 proteins from 42 strains of 35 species belonging to the genera Streptomyces, Streptoverticillium, and Kitasatosporia and related genera revealed that all of the members of the genera Streptoverticillium and Kitasatosporia examined had the same sequence as Streptomyces exfoliatus or a highly homologous sequence and exhibited high levels of relatedness to Streptomyces lavendulae . These results strongly support the previous suggestion of Witt and Stackebrandt (D . Witt and E . Stackebrandt, Syst . Appl . Microbiol . 13:361-371, 1990) and Wellington et al . (E . M . H . Wellington, E . Stackebrandt, D . Sanders, J . Wolstrup, and N . O . G . Jorgensen, Int . J . Syst . Bacteriol . 42:156-160, 1992) that the genera Streptoverticillium and Kitasatosporia should be united with the genus Streptomyces on the basis of 16S rRNA data. Can J Surg, 1994 Apr, 37(2), 143 - 7 Synergistic effects of tumour necrosis factor and morphine on gut barrier function; Leslie KA et al.; OBJECTIVE: To study the effects of tumour necrosis factor (TNF) and morphine on intestinal permeability, intestinal transit and bacterial translocation in the rat . DESIGN: A randomized interventional controlled experiment . SETTING: University surgery and microbiology research laboratory . PARTICIPANTS: Forty-four rats in five groups as follows: control (n = 9); treated with morphine every 2 hours for 8 hours (n = 9); treated with TNF for 5 minutes (n = 10); treated with TNF plus morphine every 2 hours for 8 hours (n = 6); and treated with TNF plus morphine every 3 hours for 24 hours (n = 10) . MAIN OUTCOME MEASURES: Intestinal permeability as measured by the uptake of chromium-51 ethylenediaminetetraacetate (51Cr-EDTA) over 8 hours, intestinal transit as measured by the amount of 51Cr-EDTA remaining in the gastrointestinal tract at the time of animal sacrifice, intestinal bacteria counts and translocation of bacteria as measured from bacterial counts of mesenteric lymph nodes, spleen and liver at the time of sacrifice . RESULTS: Morphine increased intestinal transit time and ileal bacteria counts (p < 0.05) . TNF alone did not increase intestinal permeability or bacterial translocation . TNF plus morphine increased intestinal transit time, intestinal permeability, bacterial counts and bacterial translocation (p < 0.05) . CONCLUSIONS: Morphine or increased intestinal transit time, or both, increases the concentration of intestinal bacteria . Morphine plus TNF increases intestinal bacteria counts, intestinal permeability and bacterial translocation . Morphine alone does not increase intestinal permeability or bacterial translocation. Am J Clin Pathol, 1994 Apr, 101(4 Suppl 1), S6 - 13 The role of the microbiology laboratory in diagnosing mycobacterial diseases; Salfinger M et al.; Recent surveys show that many mycobacteriology laboratories continue to use less-than-optimal culture and susceptibility methods . This review summarizes available methods to diagnose . Mycobacterium tuberculosis . Although the local epidemiologic characteristics of M tuberculosis will partially determine what diagnostic measures are used, all laboratories should use a broth culture method in addition to a solid medium when culturing for M tuberculosis . Laboratories serving communities where drug resistance is common should use the BACTEC system for susceptibility testing or send isolates to a laboratory that uses it . Conventional testing in this setting must be aggressively discouraged . Rapid genetic amplification methods to detect mycobacteria in clinical specimens can greatly reduce the time needed to diagnose tuberculosis, especially if these methods can reliably detect M tuberculosis in smear-negative specimens . Many other diagnostic methods are being developed and clinicians and laboratories must regularly reassess whether a new method would be beneficial to their patients and the public. Am J Clin Pathol, 1994 Apr, 101(4 Suppl 1), S22 - 6 Rapid diagnostic tests in microbiology in the 1990s; Daly JA; The selection and management of all diagnostic tools should be guided in the 1990s by carefully informed decisions . Concerns of test sensitivity and specificity must be balanced against cost . Although clinical judgment alone is often prompt and cost-effective, the risk of inaccuracy and serious consequences may be too great to forgo rapid diagnostic assays . The clinical effect and the imperatives in health care of the 1990s will guide the intelligent management and use of advancing rapid assay technology. J Histochem Cytochem, 1994 Apr, 42(4), 513 - 22 Localization of hyaluronic acid in human articular cartilage; Asari A et al.; To demonstrate localization of hyaluronic acid (HA) in articular cartilage of the human femur, biotinylated HA-binding region, which specifically binds HA molecules, was applied to the tissue . In sections fixed by 2% paraformaldehyde-2% glutaraldehyde, HA staining was detected in lamina splendens and chondrocytes in the middle zone . By pretreatment with trypsin, intense HA staining appeared in the extracellular matrix of the deep zone and weak staining in the superficial and middle zones . Moreover, pre-treatment with chondroitinase ABC (CHase ABC) intensely enhanced the stainability for HA in the superficial and middle zones and weakly in the deeper zone . Combined pre-treatment of trypsin with CHase ABC abolished intra- and extracellular staining for HA in all zones . By microbiochemical study, the concentrations of HA and dermatan sulfate were high in the middle zone, whereas those of chondroitin sulfate and keratan sulfate were high in the deep zone . These results suggest that HA is abundantly synthesized in and secreted from the chondrocytes, particularly in the middle zone, whereas it is largely masked by proteoglycan constituents in the extracellular matrix. Acta Neurol Scand, 1994 Apr, 89(4), 293 - 8 Surgical intervention and heparin-anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis; Winkler J et al.; It is still controversial, whether early surgical removal of infectious material and heparin-anticoagulation to reduce vascular complications will improve outcome in acute meningitis . In the present pilot-study 40 patients with acute or delayed post-traumatic or oto-/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS) and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6) . All patients, independent of surgical approach, received therapeutic heparin-anticoagulation . Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF-findings, CT-scans and prognostic factors . Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non-significant) . Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p < 0.01) . In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p < 0.01) and were dependent upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non-significant) . In 31 patients CSF-leakage was identified: among these, 17 patients had CSF-leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery . The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1994 Apr, 32(4), 935 - 41 Detection and identification of Leptospira interrogans serovars by PCR coupled with restriction endonuclease analysis of amplified DNA; Savio ML et al.; Primers for PCR were selected from a sequenced fragment of clone pL590, which contains a repetitive element present in the genome of Leptospira interrogans serovar hardjo type hardjoprajitno (M . L . Pacciarini, M . L . Savio, S . Tagliabue, and C . Rossi, J . Clin . Microbiol . 30:1243-1249, 1992) . A specific DNA fragment was amplified from the genomic DNAs of serovar hardjo type hardjoprajitno and nine serovars also belonging to L . interrogans as a consequence of the spread of the same or a closely related repetitive element within this species (Pacciarini et al., J . Clin . Microbiol . 30:1243-1249, 1992) . In addition, specific amplification was obtained from two Leptospira borgpetersenii serovars (tarassovi and hardjo type hardjobovis) . Negative PCR results were observed with all of the other Leptospira serovars tested, including nonpathogenic ones (serovars patoc and andamana), another spirochete (Borrelia burgdorferi), bacteria commonly found in biological samples, and swine and bovine cell lines . Direct PCR on biological samples such as kidney samples demonstrated that preliminary isolation and culture of Leptospira cells are not required for efficient detection . Furthermore, digestion of the amplified DNA with the enzymes HinfI and DdeI yielded specific polymorphic patterns, allowing discrimination among the majority of the serovars . These methods were applied to 25 field isolates of serovar pomona, leading to the conclusion that they were suitable for the simple and rapid detection of L . interrogans and for serovar identification. Zentralbl Hyg Umweltmed, 1994 Apr, 195(4), 288 - 98 {Introduction of an infection registration program for surgical wound infection based on the WHOCARE software of WHO}; Ziesing S et al.; Surveillance of surgical wound-infection (SWI) is an important instrument in the internal and external quality control in surgery . In the past it has been shown that statistics on surgical wound infection are helpful for reduction of wound infection rates . With the engagement of nurses for clinical hygiene at our hospital we had the possibility to evaluate programs for surveillance of nosocomial infection . In a pilot study we began with the surveillance of SWI . The set of data registered was defined by WHOCARE, the software-package used in the study which is distributed by the WHO Europe . Criteria of the NNIS-Study for SWI were applied . Between March and December 1992 approximately 1.300 surgical interventions had been registered . Although the dataset in WHOCARE is limited with regard to an easy surveillance, it was possible to find out infection rates dependent on all major parameters . Additionally reports on individual infection rates and tables containing information of infected cases were sent to every surgeon . By analyzing some of the problems detected during the study, we developed an improved protocol for routine surveillance of SWI . In the future it will save time and will allow the best quality of collected data in narrow collaboration between the departments of microbiology, clinical hygiene and surgery . This protocol should be transferable to other hospitals and represents an anticipated precautious measure with regard to legal regulations on quality control in medicine. Int J Periodontics Restorative Dent, 1994 Apr, 14(2), 166 - 80 A comparative study of the effectiveness of e-PTFE membranes with and without early exposure during the healing period; Simion M et al.; This study compared clinical, microbiologic, and morphostructural aspects of the healing process in clinical cases treated with expanded polytetrafluoroethylene membranes placed in fresh extraction sockets, which did or did not show early membrane exposure . The examination was focused particularly on morphology of the microbic population and its ability to penetrate membrane pores . Results of the study suggest that use of the membranes is effective in the treatment of fresh extraction sockets with osseointegrated implants; that the membranes are highly biocompatible with gingival tissues; and that early exposure of the membranes during healing hinders the effectiveness of guided tissue regeneration in periimplant tissues. Appl Environ Microbiol, 1994 Apr, 60(4), 1232 - 40 Group-specific 16S rRNA hybridization probes to describe natural communities of methanogens; Raskin L et al.; Eight oligonucleotides which are complementary to conserved tracts of 16S rRNA from phylogenetically defined groups of methanogens were designed and characterized for use as hybridization probes for studies in environmental and determinative microbiology . The target-group specificity and temperature of dissociation for each probe were characterized . In general, the probes were very specific for the target methanogens and did not hybridize to the rRNAs of nontarget methanogens . Together, the eight probes circumscribe methanogens now represented in pure culture (with the exception of members of the family Methanothermaceae) . Three probes are order specific; two identify members of the order Methanobacteriales, and one is specific for the order Methanococcales . The fourth probe encompasses three families belonging to the order Methanomicrobiales, the third order within the current classification . The fifth probe is specific for the remaining family within this order (Methanosarcinaceae) . Three additional probes encompass different genera within the Methanosarcinaceae. Med Clin (Barc), 1994 Mar 26, 102(11), 401 - 6 {A surveillance system for the study of the circulation of influenza in Madrid during the 1986-1991 quinquennium . The Influenza Surveillance Group of Madrid}; Perez Brena P et al.; BACKGROUND: The creation of a surveillance system allowing the study of the evolution of the tendency of influenza and act as an alert system for undertaking control measures is necessary due to the great variability characteristic of the circulation of influenza virus . The Madrid Influenza Surveillance Group was therefore designed . The activity carried out during its first five years of existence is evaluated . METHODS: The field work of the Group is based on the clinical study of patients with influenza, among which some are selected for virologic study with the aim to isolate and characterize the circulating virus . The data obtained by the work group itself are used as the dates of the System of Obligatory Disease Declaration and the System of Microbiologic Information as epidemiologic support to define the outbreaks observed . RESULTS: All the virus isolated were similar to those recommended by the World Health Organization for their inclusion in anti-influenza vaccination, with their circulation being largely reproduced throughout Europe . In three of the five seasons studied the type A virus prevailed leading to earlier outbreaks and a greater number of cases than in the two seasons with type B prevalence . CONCLUSIONS: The circulation of the influenza virus in Madrid coincides with that of the rest of Spain at both the maximum peak and relative incidence as well as the type of prevailing virus . The minor circulation detected by the Madrid Group is in concordance with the data provided by the other autonomic communities. Ugeskr Laeger, 1994 Mar 21, 156(12), 1775 - 9 {Respiratory syncytial virus infection . A frequent child disease in Denmark with annual outbreaks}; Dessau RB et al.; Infection with respiratory syncytial virus (RSV) is an important cause of illness in infants often leading to hospital admission during the winter months . Diagnosis of RSV by direct detection of virus antigen has been implemented in a number of departments of clinical microbiology, and on this background a descriptive study of the seasonal incidence, sex and age distribution of RSV in two Danish counties was undertaken . A total of 5533 clinical episodes of respiratory infection were registered from October 1988 to September 1992 in the two counties and 1421 (26%) were positive for RSV . The incidence of hospital admission for RSV infection was 14 per 1000 below three years of age in Copenhagen County in the winter season 1991-1992 . The seasonal peak of RSV infection was postponed about one month in Northern Jutland as compared to the capital area . Only 10 episodes (three positive) were from primary care, the remainder from hospitals and other institutions . RSV-testing was rarely requested in general practice . The study confirmed the importance of RSV infection in young children admitted with lower respiratory tract infection . We recommend the establishment of a surveillance system incorporating the local departments of clinical microbiology for warning of the yearly epidemics during which RSV infections may also be a risk outside the paediatric age span. Biochemistry, 1994 Mar 8, 33(9), 2496 - 502 Roles of the soluble cytochrome c2 and membrane-associated cytochrome cy of Rhodobacter capsulatus in photosynthetic electron transfer; Jenney FE Jr et al.; Genetic evidence indicates that Rhodobacter capsulatus has two different pathways for reduction of the photooxidized reaction center (RC) {Jenney, F . E., & Daldal, F . (1993) EMBO J . 12, 1283-1292} . One pathway is via the water soluble cytochrome (cyt) c2, and the other is via a novel, membrane-associated c-type cytochrome, cyt cy, now believed to be identical to the cyt cx of Jones et al . {Jones, M . R., et al . (1990) Biochim . Biophys . Acta 975, 59-66} and c354 of Zannoni et al . {Zannoni, D., et al . (1992) Arch . Microbiol . 157, 367-374} . Mutants lacking either cyt c2, cyt cy, or the bc1 complex, as well as various combinations, were utilized to probe the functional role of these cytochromes in electron transfer . Data obtained by monitoring flas induced electron transfer kinetics in the RC, cyt c pool, cyt b, and the carotenoid band shift indicate that there are two pathways for electron transfer from the bc1 complex to the RC in R . capsulatus, one via cyt c2 and the other through cty cy . The two pathways show strikingly different kinetics for RC reduction and cyt c oxidation, and both are present in the wild-type strain MT-1131 . After genetic inactivation of both cyt c2 and cyt cy there remains no flash oxidizible c-type cytochrome, and inactivation of cyt cy rather than cyt c2 has a more pronounced effect on the extent of the light-induced membrane potential under the conditions tested.(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Gastroenterol, 1994 Mar, 29(3), 265 - 74 A prospective study of first attacks of inflammatory bowel disease and infectious colitis . Clinical findings and early diagnosis; Schumacher G et al.; In 105 patients with a first attack of colitis, clinical, microbiologic, laboratory, and histologic features were studied prospectively with the aim of differentiating inflammatory bowel disease (IBD) from infectious colitis as early as possible . Of the patients who proved to have IBD the mode of onset of diarrhoeal symptoms was insidious in 56% and non-insidious in 44%, whereas in 81% of those who proved to have infectious colitis the onset was acute . Most patients with infectious colitis presented within 1 week, had early fever, and did not show histologic features characteristic of IBD . Most IBD patients with a more acute onset had clinical warning signs of IBD such as slight previous bowel symptoms, a late presentation time (> 1 week), and absence of early fever or had histologic features characteristic of IBD . These features were basal plasmacytosis, crypt distortion, more than two vertical crypt branches, villous mucosa, mucosal atrophy, epithelioid granuloma, and Paneth cell metaplasia . Moreover, 61% of the IBD patients with a non-insidious onset fell ill in connection with travelling abroad, gastrointestinal infection, or treatment with antibiotics . Knowledge of the above clinical and histologic factors will facilitate differentiation of IBD from infectious-type colitis. Scand J Gastroenterol, 1994 Mar, 29(3), 209 - 13 Helicobacter pylori infection in north-eastern peninsular Malaysia . Evidence for an unusually low prevalence; Uyub AM et al.; The prevalence of Helicobacter pylori infection was determined in peptic ulcer patients, in non-ulcer dyspepsia (NUD) patients, and in the general adult population . The H . pylori infection rate ascertained by microbiologic examination of multiple gastric antral biopsy specimens was 50% (17 of 34) in duodenal ulcer (DU), 5% (1 of 22) in gastric ulcer, and 9% (15 of 159) in NUD patients . A seroepidemiologic survey showed a prevalence of only 4.2% among 496 blood donors and 4.8% among 921 subjects who attended health screening clinics . H . pylori infection is relatively uncommon and does not appear to be the predominant factor in the pathogenesis of peptic ulcer disease in the area . The incidence of peptic ulcer perforations in the area in 1991-92 was 1.5 per 100,000 person-years, reflecting a relatively low frequency of peptic ulcers, which might be due to the low prevalence of H . pylori infection in the population. Clin Lab Med, 1994 Mar, 14(1), 149 - 69 Automated blood culture systems; Wilson ML et al.; For the first time, clinical microbiologists have the option of purchasing or leasing a variety of automated blood culture systems . Although the performance characteristics of the BACTEC radiometric and nonradiometric blood culture systems are well-documented, we are only beginning to learn the performance characteristics of CMBCS . Well-designed and executed controlled clinical trials are needed to establish performance characteristics and to address issues that are unique to CMBCS . In particular, controlled clinical comparisons of different CMBCS are needed . In terms of the impact on clinical microbiology laboratories, there are no published data to support claims that the use of these systems decreases laboratory workload, staffing, or costs . Although such an impact seems reasonable and even likely, unequivocal documentation of such savings would make it easier for many laboratorians to justify the cost of purchasing or leasing one of these systems . Similarly, there are no published data regarding the long-term reliability of these systems while in clinical use . A documented track record of mechanical and electrical reliability would be useful to clinical microbiologists contemplating the acquisition of a new blood culture system. Clin Lab Med, 1994 Mar, 14(1), 1 - 7 Blood cultures . Introduction; Wilson ML; Clinical microbiologists must be able to evaluate critically the blood culture literature for patient care purposes, for sound laboratory management, and for decision making in regards to purchase or lease of a new system . This skill has never been more important due to the many new commercially available blood culture products and technologies . Critical assessment of the literature requires familiarity with blood culture terminology and an understanding of those factors critical in designing scientifically valid clinical evaluations. J Prosthet Dent, 1994 Mar, 71(3), 295 - 300 The efficacy of antifungal agents incorporated into a facial prosthetic silicone elastomer; Pigno MA et al.; Microbiologic isolation techniques and scanning electron microscopy were used to determine whether a fungus is associated with the black discoloration of some silicone nasal prostheses . Colonies of fungal growth were seen on scanning electron micrographs of the affected areas of a nasal prosthesis, and a fungus belonging to the genus Penicillium was isolated from similar areas . Disk diffusion tests determined that the antifungal agent clotrimazole, when incorporated into silicone samples, was effective in inhibiting in vitro growth of the fungus. Appl Environ Microbiol, 1994 Mar, 60(3), 840 - 6 Extracellular enzyme activity in anaerobic bacterial cultures: evidence of pullulanase activity among mesophilic marine bacteria; Arnosti C et al.; The extracellular enzymatic activity of a mixed culture of anaerobic marine bacteria enriched on pullulan {alpha(1,6)-linked maltotriose units} was directly assessed with a combination of gel permeation chromatography (GPC) and nuclear magnetic resonance spectroscopy (NMR) . Hydrolysis products of pullulan were separated by GPC into three fractions with molecular weights of > or = 10,000, approximately 5,000, and < or = 1,200 . NMR spectra of these fractions demonstrated that pullulan was rapidly and specifically hydrolyzed at alpha(1,6) linkages by pullulanase enzymes, most likely type II pullulanase . Although isolated pullulanase enzymes have been shown to hydrolyze pullulan completely to maltotriose (S . H . Brown, H . R . Costantino, and R . M . Kelly, Appl . Environ . Microbiol . 56:1985-1991, 1990; M . Klingeberg, H . Hippe, and G . Antranikian, FEMS Microbiol . Lett . 69:145-152, 1990; R . Koch, P . Zablowski, A . Spreinat, and G . Antranikian, FEMS Microbiol . Lett . 71:21-26, 1990), the smallest carbohydrate detected in the bacterial cultures consisted of two maltotriose units linked through one alpha(1,6) linkage . Either the final hydrolysis step was closely linked to substrate uptake, or specialized porins similar to maltoporin might permit direct transport of large oligosaccharides into the bacterial cell . This is the first report of pullulanase activity among mesophilic marine bacteria . The combination of GPC and NMR could easily be used to assess other types of extracellular enzyme activity in bacterial cultures. Ther Umsch, 1994 Mar, 51(3), 166 - 71 {Diagnostic guidelines in diarrhea}; Ruppin H et al.; Acute diarrhea is usually short-lasting; therefore, diagnostic procedures are mainly concerning the degree of dehydration . With longer duration of high fever or bloody diarrhea, microbiologic stool tests are necessary . Proctosigmoidoscopy is indicated in case of dysenteric disease or suspected antibiotic-as-associated pseudomembranous colitis . In chronic diarrhea, the most important diagnostic procedure is a careful history . Side effects of drugs and food-related causes are especially noticeable, as are indices of an organic origin, e.g . unwanted weight loss or blood in the stools . Also, careful history and physical examination are essential for the decision about laboratory tests, tests of gastrointestinal function or endoscopy. J Can Dent Assoc, 1994 Mar, 60(3), 209, 212 - 7 The effects of spiramycin and/or scaling on advanced periodontitis in humans; Bain CA et al.; It has long been questioned whether antibiotics, used as a supplement to traditional therapy, provide any lasting benefit in the treatment of chronic periodontitis . This study was designed to evaluate Spiramycin as an adjunct to scaling and root planing in the treatment of advanced chronic periodontitis . In total, 193 patients with advanced periodontitis were recruited in seven centres using selection criteria previously described . After undergoing thorough scaling and root planing, all patients randomly received either Spiramycin, 1,500,000 international units, twice per day (IU, bid) for 14 days (96 patients), or a visually-identical placebo capsule (97 patients) . The clinical parameters measured were plaque index, crevicular fluid level, probing depths, bleeding on probing and attachment level changes . Data was recorded at baseline, two-, eight-, 12- and 24-weeks visits . A total of 189 patients completed the study (96 placebo, 93 Spiramycin) . Statistically significant differences in probing depth, favoring Spiramycin, were seen at two weeks (p < 0.0125), eight weeks (p < 0.0020), 12 weeks (p < 0.0032) and 24 weeks (p < 0.0075) . Spiramycin also produced a significant improvement in attachment level at 12 weeks (p < 0.0146) . All other clinical parameters showed no difference between drug and placebo . This study shows that Spiramycin, as an adjunct to thorough scaling and root planing, provides a statistically significant improvement in probing depths for up to 24 weeks when compared with scaling and root planing alone . Both longer studies and microbiologic evaluations are necessary to determine whether a more lasting benefit is possible. Am J Med, 1994 Mar, 96(3), 200 - 9 New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings . Duke Endocarditis Service; Durack DT et al.; PURPOSE: This study was designed to develop improved criteria for the diagnosis of infective endocarditis and to compare these criteria with currently accepted criteria in a large series of cases . PATIENTS AND METHODS: A total of 405 consecutive cases of suspected infective endocarditis in 353 patients evaluated in a tertiary care hospital from 1985 to 1992 were analyzed using new diagnostic criteria for endocarditis . We defined two "major criteria" (typical blood culture and positive echocardiogram) and six "minor criteria" (predisposition, fever, vascular phenomena, immunologic phenomena, suggestive echocardiogram, and suggestive microbiologic findings) . We also defined three diagnostic categories: (1) "definite" by pathologic or clinical criteria, (2) "possible," and (3) "rejected." Each suspected case of endocarditis was classified using both old and new criteria . Sixty-nine pathologically proven cases were reclassified after exclusion of the surgical or autopsy findings, enabling comparison of clinical diagnostic criteria in proven cases . RESULTS: Fifty-five (80%) of the 69 pathologically confirmed cases were classified as clinically definite endocarditis . The older criteria classified only 35 (51%) of the 69 pathologically confirmed cases into the analogous probable category (p < 0.0001) . Twelve (17%) pathologically confirmed cases were rejected by older clinical criteria, but none were rejected by the new criteria . Seventy-one (21%) of the remaining 336 cases that were not proven pathologically were probable by older criteria, whereas the new criteria almost doubled the number of definite cases, to 135 (40%, p < 0.01) . Of the 150 cases rejected by older criteria, 11 were definite, 87 were possible, and 52 were rejected by the new criteria . CONCLUSION: Application of the proposed new criteria increases the number of definite diagnoses . This should be useful for more accurate diagnosis and classification of patients with suspected endocarditis and provide better entry criteria for epidemiologic studies and clinical trials. Medicine (Baltimore), 1994 Mar, 73(2), 69 - 78 Fungal sinusitis in patients with AIDS: report of 4 cases and review of the literature; Meyer RD et al.; We report here 3 cases of aspergillus sinusitis in patients with AIDS and the 1st fully described case, to our knowledge, of sinusitis associated with Pseudallescheria boydii in a patient with AIDS . We review the microbiology and pathology of fungal sinusitis in patients with AIDS and the morphologic and clinical features and treatment of P . boydii infection and aspergillus sinusitis . Fungal sinusitis in patients with HIV or AIDS generally occurs later in the course of primary disease with low CD4+ lymphocyte counts (< 50/mm3), unlike bacterial sinusitis which may occur at any time . Differentiation between invasive and noninvasive forms is likely not important, in contrast to fungal sinusitis in noncompromised patients . The number of cases is likely to increase as the number of patients with AIDS increases, patients survive longer, and other opportunistic infections are prevented or treated . Causative agents are likely to be resistant to fluconazole, which is in widespread use . Aspergillus sinusitis in patients with HIV or AIDS occurs in both those with and without traditional risk factors . Fungal sinusitis may present vexing management problems and be relentlessly progressive in the face of therapy . Ideal therapy has yet to be defined but an early combined surgical and medical approach in these compromised patients is preferred. Acta Cytol, 1994 Mar-Apr, 38(2), 144 - 50 Value of ancillary studies in fine needle aspiration cytology of the lung; O'Reilly PE et al.; The importance of ancillary studies in surgical pathology of the lung is well documented . Less well established is the utility of these methods in fine needle aspiration (FNA) cytology of the lung . We reviewed our experience over a two-year period (1990-1991) with the use of ancillary studies in addition to routine light microscopy in FNA of the lung . Three hundred forty-five percutaneous aspirations were performed under radiologic guidance during this period . A diagnosis of malignancy was made in 233 (68%) cases . Thirty-two aspirates provided specific benign inflammatory or infectious diagnoses of mass lesions . Approximately one-half the cases required no additional studies (181/345, 52%) . Immunocytochemistry was performed in 50 cases (14.5%), electron microscopy (EM) in 28 cases (8%), microbiologic staining in 42 cases (12%), mucin staining in 72 cases (21%) and cell blocks in 77 cases (22%) . Immunocytochemistry and EM were generally used to classify poorly differentiated neoplasms, confirm the diagnosis of bronchioloalveolar cell carcinoma, determine neuroendocrine differentiation and establish primary sites for suspected metastatic malignancies . Immunocytochemistry provided significant additional information in 20 (40%) of the cases in which it was attempted and confirmed the light microscopic impression in an additional 18 cases (36%) . Similarly, EM provided significant additional information in 10 cases (67%) and confirmed the light microscopic impression in an additional 4 cases (27%) . Microbiologic staining was performed when an infectious etiology was suspected clinically or an inflammatory (especially granulomatous) background was present in the smears . In 11 cases (27%) the staining was positive for organisms . Mucin staining was performed in an attempt to better classify poorly differentiated non-small cell malignancies and was contributory in 68% of the cases . In conclusion, ancillary studies are helpful in confirming the cytologic impression and making a more specific diagnosis in FNA of the lung. J Trauma, 1994 Mar, 36(3), 331 - 5 Antibiotic release from impregnated pellets and beads; Bowyer GW et al.; Antibiotic impregnated beads are being used increasingly in the initial treatment of open fracture wounds, producing high antibiotic levels locally, over the first few days . Pellets were prepared to assess the release of the following antibiotics: benzylpenicillin, flucloxacillin, amoxycillin, amoxycillin-clavulanate (Co-Amoxiclav), ciprofloxacin, imipenem, or gentamicin; the carrier material was either polymethylmethacrylate (PMMA) or plaster of Paris (PoP) . Elution of antibiotic over 72 hours from the pellets in vitro was determined using an agar-diffusion microbiologic assay . The initial rapid release of antibiotic lasted 12-24 hours, with release from PoP pellets at least four-fold greater than that from corresponding PMMA pellets . A second phase consisted of a sustained but gradually diminishing elution . The release of antibiotics from PoP pellets compared favorably with that from the PMMA beads currently used . We conclude that PoP pellets may be particularly suitable for short-term applications such as infection prophylaxis in open fractures. J Vasc Surg, 1994 Mar, 19(3), 549 - 54 In vitro endothelialization of a mesosystemic shunt: a clinical case report; Fischlein T et al.; The existence of a confluently covering endothelium that is free of any thrombotic appositions can be proved 30 days after clinical implantation of an in vitro endothelialized expanded polytetrafluoroethylene graft . The recipient of the mesosystemic H-graft was a 69-year-old man who had a thrombosed portal vein following pancreatitis . Autologous endothelial cells were obtained from the external jugular vein under local anesthesia, applying the in situ cannulation technique . After low-density plating, first-passage mass cultures of 1.22 x 10(6) endothelial cells were obtained 14 days after vein excision . After precoating was accomplished with fibrinolytically inhibited fibrin glue, a 10 mm expanded polytetrafluoroethylene graft was confluently lined with the autologous endothelial cells at a seeding density of 1.2 x 10(5) cells/cm2 . After a maturation period of an additional 9 days and the microbiologic exclusion of a possible infection, an 11 cm graft segment was implanted between the superior mesenteric vein and the inferior vena cava . In spite of a patent shunt the patient had a repeat bleeding episode, needed parenteral nutrition, and died of sepsis on day 30 . Immediately after the graft had been taken out, specimens were processed by scanning electron microscopy and light microscopy for the immunohistochemical proof of the endothelial nature of the surface-covering cell layer . The entire graft surface displayed a confluent cell lining that was free of any thrombotic appositions . A strongly positive stain result for both factor VIII-related antigen and the fixation-resistant CD34 molecule identified these cells as endothelial . No alpha-actin-positive cells could be detected . The underlying protein matrix was well preserved and unaltered in thickness and appearance, compared with preimplantation samples . None of the specimens showed any evidence of infection . This human demonstration of an intact endothelium on a patent venous prosthesis further establishes in vitro lining as a method that actually creates a persistent and functioning endothelium on a synthetic graft surface. J Bacteriol, 1994 Mar, 176(5), 1517 - 20 Sensory adaptation during negative chemotaxis in Myxococcus xanthus; Shi W et al.; Myxococcus xanthus exhibits many tactic movements that require the frz signal transduction system, such as colony swarming and cellular aggregation during fruiting body formation . Previously we demonstrated that the Frz proteins control the chemotactic movements of M . xanthus (W . Shi, T . Kohler, and D . R . Zusman, Mol . Microbiol . 9:601-611, 1993) . However it was unclear from that study how chemotaxis might be achieved at the cellular level . In this study, we showed that M . xanthus cells not only modulate the reversal frequency of cell movement in response to repellent stimuli but also exhibit sensory adaptation in response to the continuous presence of nonsaturating repellent stimuli . The sensory adaptation behavior requires FrzF (a putative methyltransferase) and is correlated with the methylation-demethylation of FrzCD, a methyl-accepting chemotaxis protein . These results indicate that negative chemotaxis in M . xanthus is achieved by chemokinesis plus sensory adaptation in a manner analogous to that of the free-swimming enteric bacteria. Sex Transm Dis, 1994 Mar-Apr, 21(2 Suppl), S96 - 101 Development of sexually transmitted diseases treatment guidelines, 1993 . New methods, recommendations, and research priorities . STD Treatment Guidelines Project Team and Consultants; Levine WC et al.; To develop the 1993 Sexually Transmitted Diseases Treatment Guidelines, experts from the Centers for Disease Control and Prevention reviewed the literature on sexually transmitted disease treatment, assembled tables of evidence, and listed key questions on therapeutic outcome: microbiologic cure, alleviation of symptoms, and prevention of sequelae and transmission . At a meeting with external experts, evidence was systematically assessed and guidelines developed . Quality of evidence for microbiologic cure was generally good for gonorrhea and chlamydia, poor for syphilis, and fair for most other diseases . Evidence on preventing sequelae and transmission was limited . The Guidelines include new recommendations for single-dose oral therapy of gonorrhea (cefixime, ciprofloxacin, and ofloxacin), chlamydia (azithromycin), and chancroid (azithromycin); outpatient therapy of pelvic inflammatory disease (ofloxacin and either clindamycin or metronidazole); and patient-applied therapy of genital warts (podofilox) . Syphilis therapy did not change substantially . Several global issues that emerged during the development of the World Health Organization Recommendations for the Management of Sexually Transmitted Diseases also are discussed . This evidence-based approach clarified important treatment issues and the rationale for recommendations, and identified research priorities. Photochem Photobiol, 1994 Mar, 59(3), 290 - 4 Photocytotoxicity of curcumin; Dahl TA et al.; Curcumin, bis(4-hydroxy-3-methoxyphenyl)-1,6-diene-3,5-dione, is a yellow-orange dye derived from the rhizome of the plant Curcuma longa . Curcumin has demonstrated phototoxicity to several species of bacteria under aerobic conditions (Dahl, T . A., et al., 1989, Arch . Microbiol . 151 183), denoting photodynamic inactivation . We have now found that curcumin is also phototoxic to mammalian cells, using a rat basophilic leukemia cell model, and that this phototoxicity again requires the presence of oxygen . The spectral and photochemical properties of curcumin vary with environment, resulting in the potential for multiple or alternate pathways for the exertion of photodynamic effects . For example, curcumin photogenerates singlet oxygen and reduced forms of molecular oxygen under several conditions relevant to cellular environments . In addition, we detected carbon-centered radicals, which may lead to oxidation products (see accompanying paper) . Such products may be important reactants in curcumin's phototoxicity since singlet oxygen and reduced oxygen species alone could not explain the biological results, such as the relatively long lifetime (t1/2 = 27 s) of the toxicant responsible for decreased cell viability. Quintessence Int, 1994 Mar, 25(3), 181 - 4 Permeability of protective gloves used in dental practice; Ozata F et al.; Two brands of latex rubber gloves and one brand of polyvinyl chloride glove were examined for their permeability . New and used gloves were included . All of the gloves were examined visually and then subjected to an air leakage test, an electrical test, and a microbiologic test . Permeability was evaluated independently by two researchers in a blind manner . Statistical analysis showed that there were no significant differences among the three brands of gloves or with respect to the usage periods, according to visual inspection and the air leakage test . Conversely, there were significant differences among each of the three brands of gloves and with respect to usage periods, according to the electrical and microbiologic tests. Curr Microbiol, 1994 Mar, 28(3), 145 - 8 A conditional expression vector for the cyanobacteria Synechocystis sp . strains PCC6803 and PCC6714 or Synechococcus sp . strains PCC7942 and PCC6301; Mermet-Bouvier P et al.; An expression vector, pFC1, has been constructed based on the promiscuous plasmid RSF1010, which provides autonomous replication in several cyanobacteria of the genera Synechocystis and Synechococcus {Mermet-Bouvier et al., Curr Microbiol 26:323-327} . pFC1 harbors the lambda cI857 repressor-encoding gene and pR promoter, followed by the lambda cro ribosome-binding site and ATG translation initiation codon . The latter is located within the unique NdeI restriction site (CATATG) of pFC1 and can be exposed after cleavage with this enzyme for in-frame fusion with the protein-coding sequence to be expressed . The Escherichia coli lacZ reporter gene cloned in pFC1 appeared to be highly expressed in heat-induced E . coli or cyanobacterial cells . In every case, beta-galactosidase amounted to at least 10% of soluble proteins. Am J Hosp Pharm, 1994 Feb 15, 51(4), 500 - 2 Use and sterility of multidose ophthalmic medications; Tamer HR et al.; Liquid ophthalmic products in opened multidose containers were studied to determine whether the date of opening was marked on the container and whether the drugs were contaminated . Pharmacy personnel collected opened containers for four months from a hospital's eye center clinic and outpatient surgery area . Half of the containers were randomly selected and the contents tested for bacterial and fungal contamination . The ophthalmic products were dripped from the containers' dropper tips into nutrient broth . Broth samples that became turbid after incubation were to be tested in the microbiology laboratory . Of 166 opened containers collected, 118 were marked with dates . The dates indicated that 97 had been opened within 30 days before collection; nursing policy dictated that containers be discarded 30 days after being opened . Acquisition cost for the undated, opened containers, which should have been discarded by nurses, was $182 . In incubated samples from 81 opened containers, 61 of them dated and 52 dated within the past 30 days, no turbidity was seen . Although no bacterial or fungal contamination was detected in these ophthalmic products from opened containers, the absence of dates on some containers indicated deviation from institutional policy and probable avoidable waste of undated products. Arch Pathol Lab Med, 1994 Feb, 118(2), 115 - 9 Nosocomial infections . A college of American pathologists Q-probes study in 512 North American institutions; Schifman RB et al.; We report nosocomial infection surveillance methods and hospital infection rates in 512 institutions obtained from a Q-Probes study of the College of American Pathologists, Northfield, Ill . The results showed that nosocomial infection surveillance procedures were well standardized . Use of microbiology reports was the most common case-finding method (97.3%), followed by review of the patient's medical record (86.1%) . The median number of full-time equivalents per 100 occupied beds utilized for infection control services was 0.64, and these full-time equivalents spent 40% of their time on surveillance activities . A computer was used in 81% of institutions to assist in conducting surveillance, although this usage was not associated with decreased surveillance time or personnel required . This study provided data on total and site-specific infection rates for a wide range of small to large hospitals . When stratified into subgroups (based on teaching status and hospital size), infections rates in this study were comparable with those of the National Nosocomial Infection Surveillance program, and showed a trend of increasing rates of nosocomial bloodstream and surgical wound infections. Chest, 1994 Feb, 105(2), 377 - 82 Transesophageal echocardiography in diagnosis of infective endocarditis; Shapiro SM et al.; STUDY OBJECTIVE: To determine whether transesophageal echocardiography (TEE) was superior to transthoracic echocardiography (TTE) in defining valvular vegetations and diagnosing clinical infective endocarditis (IE) in patients suspected of having this infection . PATIENTS AND METHODS: Between April 1989 and May 1991, 64 febrile patients with clinical and/or microbiologic risk factors for IE were prospectively enrolled . Patients underwent both TEE and TTE, which were interpreted in a blinded fashion as to the patient's clinical status . Clinical criteria for the diagnosis of IE were compared with TEE and TTE findings to delineate the ability of the two echocardiographic techniques to define valvular vegetations and to establish the clinical diagnosis of vegetative IE . RESULTS: Thirty-four valves had typical valvular vegetations demonstrated by either TEE or TTE . Transesophageal echocardiography was more sensitive than TTE in identifying valvular vegetations (33/34 vs 23/34 instances, respectively; p = 0.004) . Also, TEE was better at identifying smaller vegetations (< 1 cm) than TTE; 12 patients with such vegetations were identified by TEE as compared with only 5 of 12 identified by TTE (p = 0.02) . Of the 64 patients enrolled, 30 (47 percent) were classified as having "definite" or "probable" IE by modified von Reyn criteria . Among these 30 patients, TEE was significantly more sensitive than TTE at documenting vegetative valvular lesions (26/30 {87 percent} vs 18/30 {60 percent}, respectively) (p < 0.01) . Both TEE and TTE were highly specific (91 percent) in delineating valvular vegetations in this patient population; two of the three false-positive TEE studies for valvular vegetations occurred in patients with a history of IE . All nine periannular complications of IE were identified by TEE, as compared with only two being defined by TTE (p = 0.001) . CONCLUSIONS: Transesophageal echocardiography is significantly more sensitive than TTE and highly specific in both confirming the clinical diagnosis of IE, as well as in identifying valvular vegetations in patients at risk for this infection . Our data also support the concept that TEE is the echocardiographic method of choice for defining small vegetations and periannular complications in IE. Crit Care Med, 1994 Feb, 22(2), 259 - 64 Fiberoptic bronchoscopy in the intensive care unit--a prospective study of 147 procedures in 107 patients; Turner JS et al.; OBJECTIVE: To determine the value and safety of fiberoptic bronchoscopy in an intensive care unit (ICU) . DESIGN: Prospective survey . SETTING: ICUs at a tertiary care hospital (except for seven procedures that were performed at a peripheral hospital ICU) . PATIENTS: A total of 107 patients with a mean age of 43.9 yrs (range 15 to 84) . INTERVENTIONS: One hundred forty-seven fiberoptic bronchoscopy procedures (116 performed on patients who were undergoing mechanical ventilation) were performed on 107 patients . Ninety-four procedures were for diagnostic reasons (upper and lower airway inspection, focal and diffuse pulmonary infiltrates), 37 for therapeutic reasons (bronchial toilet, pulmonary hemorrhage, endotracheal intubation), and 16 for both reasons . Topical anaesthesia was used for fiberoptic bronchoscopy; sedation was rarely needed . Appropriate diagnostic and therapeutic procedures were performed . MEASUREMENTS AND MAIN RESULTS: Oxygen saturation, electrocardiogram, and blood pressure were monitored . Transbronchial biopsies (all on mechanical ventilation) for diffuse pulmonary infiltrates were diagnostic in five of seven cases, and were suggestive of the diagnosis in a further case . Endobronchial biopsies were not diagnostic in any of three cases . Bronchial brushings for microbiology were positive in nine of 50 procedures and for cytology in one of nine procedures . Protected specimen brushes for pulmonary infiltrates gave positive microbiology findings in five of 23 procedures . In pulmonary hemorrhage, focal bleeding was found in five cases, diffuse bleeding in four, and no bleeding source in three . In lobar atelectasis, bronchial toilet led to full reexpansion (n = 20 procedures), partial reexpansion (n = 5), and no change (n = 3) . Intubation with fiberoptic bronchoscopy was successful in four of five patients . Hypoxemia (oxygen saturation < 90%) occurred in 29 procedures; it caused no problems . Complications included hemorrhage (n = 2), supraventricular tachycardia (n = 1), pneumothorax (n = 1), pneumatocele (n = 1), and bronchospasm (n = 1) . No deaths were attributable to fiberoptic bronchoscopy . CONCLUSIONS: Fiberoptic bronchoscopy in the ICU is safe, contributes valuable diagnostic information, and is useful for therapeutic purposes. Scand J Dent Res, 1994 Feb, 102(1), 17 - 23 Short-term effect of topical application of delmopinol on salivary microbiology, plaque, and gingivitis; Collaert B et al.; The aim of this study was to test a possible dose-response effect of topical application of delmopinol HCl on the salivary microbiology, the healing of a pre-established experimental gingivitis, plaque development, and supragingival plaque composition . Forty-eight healthy subjects were enrolled in an oral hygiene program for 2 wk to upgrade their oral health . After professional tooth cleaning, they abstained from all oral hygiene, but applied 2 ml of a placebo with a soft paintbrush onto their teeth twice daily for 2 wk . At the end of this period, the subjects received tooth cleaning and were then assigned to three treatment groups of 16 individuals each . They applied 2 ml of 0.1%, 0.5%, and 1% delmopinol HCl, respectively, twice daily for the next 2 wk and refrained from all other oral hygiene procedures . At the end of the placebo and delmopinol HCl treatment periods, (1) saliva samples were obtained and cultivated on a series of media, (2) the degree of gingivitis was measured with gingival crevicular fluid (GCF) and gingivitis index (GI), (3) the stainable buccal plaque extension was analyzed planimetrically, and (4) the bacterial morphotypes of plaque adjacent to the gingival margin were analyzed . No changes in the salivary microbiologic counts were detected . The amounts of GCF and GI were reduced in all delmopinol groups, as compared with placebo . Mean plaque extension was reduced by 16% for the 0.1%, 56% for the 0.5%, and 58% for the 1% delmopinol group . Cocci appeared to predominate in bacterial dental plaque when 0.5% and 1% delmopinol were used.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1994 Feb, 32(2), 528 - 30 Improved PCR sensitivity for direct genotyping of Chlamydia trachomatis serovars by using a nested PCR; Lan J et al.; Successful amplification of omp1 DNA by PCR is crucial in the genotyping of Chlamydia trachomatis when directly performed with clinical samples (J . Lan, J . M . M . Walboomers, R . Roosendaal, G . J . van Doornum, D . M . McLaren, C . J . L . M . Meijer, and A . J . C . van den Brule, J . Clin . Microbiol . 31:1060-1065, 1993) . Several primers flanking the four variable domains of the omp1 gene were selected and tested for sensitivity in several nested PCRs with serial dilutions of serovar G . The optimal sensitivity obtained was 0.1 to 0.01 inclusion-forming units, similar to that obtained in the C . trachomatis plasmid PCR . With this approach, any C . trachomatis PCR-positive sample can be typed. Nippon Rinsho, 1994 Feb, 52(2), 344 - 9 {Rapid identification of bacteria by PCR and hybridization}; Ishiko H; The amplification of bacteria DNA by PCR followed by rapid identification with hybridization are described . In the case of Mycobacteria, a 206 bases in dnaJ gene was amplified by nested PCR with conserved primers . The amplified DNAs were then hybridized with species-specific oligoprobes . Theses oligoprobes are capable of identifying the amplified DNA as M . tuberculosis, M . avium, M . intracellulare, M . kansasii or others . In the case of MRSA, clinical samples were examined to amplify mecA, femA and tsst-1 genes in the same tube, using mixed primers and the resultant 680 bp, 307 bp and 121 bp were identified by hybridization . For Helicobacter pylori, a 203 base were amplified and identified with {32p}-labeled oligoprobe as described (Valentine, J.L . et al., J . Clin . Microbiol., 29:689-695, 1991.) . The sensitivity was 10(2) CFU/tube on agarose gel and 10 CFU/tube by hybridization. J Clin Microbiol, 1994 Feb, 32(2), 358 - 63 Construction of polyepitope fusion antigens of human cytomegalovirus ppUL32: reactivity with human antibodies; Ripalti A et al.; We have previously shown that single linear epitopes of the major human cytomegalovirus (HCMV) antigens, expressed as fusion proteins or synthesized as oligopeptides, can be valuable diagnostic material in the serology of HCMV infection (M . P . Landini, M . X . Guan, G . Jahn, W . Lindenmaier, M . Mach, A . Ripalti, A . Necker, T . Lazzarotto, and B . Plachter, J . Clin . Microbiol . 28:1375-1379, 1990; M . P . Landini, T . Lazzarotto, A . Ripalti, M . X . Guan, and M . La Placa, J . Clin . Microbiol . 27:2324-2327, 1989; A . Ripalti, M . P . Landini, E . S . Mocarski, and M . La Placa, J . Gen . Virol . 70:1247-1251, 1989) . In this work we addressed the question of whether the expression of more than one linear epitope on a single fusion protein could increase the reactivity of genetically engineered antigenic material with human antibody . To answer this question we fused sequences expressing two different epitopes contained in the basic phosphoprotein of 150 kDa encoded by UL32 (M . S . Chee, A . T . Bankier, S . Beck, R . Bohni, C . M . Brown, T . Cerny, T . Hornsel, C . A . Hutchinson, T . Kouzarides, J . A . Martignetti, and B . G . Barrell, Curr . Top . Microbiol . Immunol . 154:125-169, 1990; G . Jahn, T . Kouzarides, M . Mach, B.-C . Scholl, B . Plachter, B . Traupe, E . Preddie, S . C . Satchwell, B . Fleckenstein, and B . G . Barrell, J . Virol . 61:1358-1367, 1987), ppUL32, which was repeatedly shown to be the strongest immunogen present in the viral particle . We also made fusions with sequences expressing a single epitope repeated once, twice, or three times . The different fusion proteins were tested with HCMV-positive human sera . We found that fusion proteins expressing different epitopes together were recognized by a larger number of serum specimens and with more intense reactions in Western blot (immunoblot) experiments . We also found evidence that expression on the same polypeptide of the two distinct epitopes produced a stronger antigen than the mere addition of two fusion proteins which each carried one copy of one of these epitopes . Furthermore, we found that while the same epitope expressed two or three times on the same fusion protein was not better recognized by immunoglobulin G than the single epitope, immunoglobulin M reactivities to the double and triple epitopes were enhanced. Biotherapy, 1994, 8(2), 135 - 42 Dysfunctional monocytes from a patient with disseminated Mycobacterium kansasii infection are activated in vitro and in vivo by GM-CSF; Bermudez LE et al.; A 27 year-old woman presented with disseminated infection due to Mycobacterium kansasii . Signs and symptoms of disseminated infection persisted despite the administration of multiple antimycobacterial agents to which her organism was sensitive for 15 months . She was seronegative for HIV-1 and functional studies of T and B lymphocytes and granulocytes failed to demonstrate any abnormality . Peripheral blood monocytes proved abnormally permissive to the intracellular growth of Mycobacterium avium and M . kansasii, and expressed normal number of receptors to interferon-gamma, but reduced numbers of receptors to granulocyte monocyte colony stimulating factor and tumor necrosis factor . These defects were partially reversed with in vitro exposure of her cells to recombinant GM-CSF . In addition, administration of recombinant human GM-CSF in vivo (250 mg/M2 per day) for 10 days armed her circulating monocytes as evidenced by increased production of O2- in response to phorbol esther and, when infected ex vivo with M . kansasii, enhanced inhibition of intracellular growth compared with pre-therapy monocytes . These defects reappeared with discontinuation of GM-CSF and resolved with its re-administration . While a salutary clinical and microbiologic effect was difficult to assess, administration of GM-CSF in vivo was associated with in vitro activation of monocytes and enhanced mycobactericidal activity in this patient with a defect in monocyte function. Biol Res, 1994, 27(2), 91 - 103 Biological sciences in Chile and South America, 1981-1991: a citationist perspective . Output data and specialty area impact trends; Welljams-Dorof A; The purpose of this report is to examine the biological sciences in Chile and South America in bibliographic terms -the number of papers each nation published from 1981-1991 and the number of citations to them in the international research literature . The database consists of 34,600 biological science papers from Argentina, Brazil, Chile, and Venezuela in the 1981-1991 Science Citation Index files of the Institute for Scientific Information . Twelve specialty areas were selected to represent the biological sciences of special interest to Chile: animal sciences, biochemistry/biophysics, environmental sciences, experimental biology/medicine, immunology, microbiology/cell biology, molecular biology/genetics, neurosciences, pharmacology, physiology, plant sciences, and reproductive sciences . Data are reported on the number of papers in these fields, combined, by authors based in Chile and other South American nations . In addition, time-series trends in the impact (average citations per paper) of Chilean research relative to South America as a whole, overall and in each specialty, are presented and discussed. J Bacteriol, 1994 Jan, 176(2), 419 - 25 Analysis of the replication region of a mycobacterial plasmid, pMSC262; Qin M et al.; We determined the nucleotide sequence of a DNA fragment which contains the replication region of pMSC262, a Mycobacterium scrofulaceum plasmid used to construct the Mycobacterium-Escherichia coli shuttle vector . The complete sequence of the fragment contained 2,504 bp with an overall G+C content of 69.8% . By deletion analysis, we found that the minimum length required for plasmid replication in M . bovis BCG was about 1.6 kb . Within this region, several open reading frames (ORFs) and a putative replication origin (ori) were identified by computer analysis . One of the ORFs, ORF2, which encodes a putative 28.9-kDa basic protein with characteristics of DNA-binding proteins, appeared to be involved in replication of the plasmid in BCG . By separation of ORF2 and the putative ori region, it was revealed that the relative locations of ORF2 and the putative ori region are likely important for replication in BCG . No DNA or amino acid homologies were found between this replication region and that of pAL5000, another mycobacterial plasmid used for vector plasmid construction . In addition, we found that this replicon did not lead to replication in E . coli and was compatible in BCG with pAL5000-derived vector plasmid pYUB75 (R . G . Barletta, D . D . Kim, S . B . Snapper, B . R . Bloom, and W . R . Jacobs, J., J . Gen . Microbiol . 138:23-30, 1992). Dis Colon Rectum, 1994 Jan, 37(1), 26 - 31 Histologic and microbiologic features of biopsy samples from patients with normal and inflamed pouches; McLeod RS et al.; PURPOSE: This study was undertaken to assess the electron microscopic and microbiologic findings in tissue biopsy samples from patients with pouchitis and to compare them with findings in patients with normal pouches, conventional ileostomies, and normal ileum . METHODS: Tissue samples were obtained from 78 patients: 23 patients with normal pouches endoscopically and histologically (Group 1), 12 patients with endoscopic and histologic evidence of inflammation (pouchitis) (Group 2), 14 patients who had either endoscopic or histologic evidence of inflammation but not both (Group 3), 20 patients with conventional ileostomies (Group 4), and 9 patients without ileostomies from whom biopsy samples of normal ileum were obtained (Group 5) . RESULTS: The mean total aerobic facultative counts in the biopsy samples from the pouchitis patients were significantly higher when compared with biopsy samples from Groups 4 and 5 (P < 0.05) . There were no significant differences in the mean anaerobic counts among the five groups . Positive cultures were obtained in 90 percent of patients with pouches compared with 69 percent of patients with conventional ileostomies or normal ileum (P < 0.05) . Intramural bacteria were observed on electron microscopy in biopsy specimens of 47 percent patients with pouches compared with 14 percent of patients with conventional ileostomies or normal ileum (P < 0.05) . However, the proportion of patients with positive cultures or intramural bacteria was not increased in the pouchitis group compared with the normal pouch group . CONCLUSION: These data suggest that intramural aerobic facultative bacterial counts are elevated in patients with pouchitis and may play a role in the pathogenesis of pouchitis. Am J Clin Pathol, 1994 Jan, 101(1), 95 - 9 Mycobacterium genavense . Autopsy findings in three patients; Maschek H et al.; The authors report on the pathologic findings in three cases of disseminated infection with Mycobacterium genavense, a recently described nontuberculous mycobacterium, in human immunodeficiency virus (HIV)-I-positive patients . The mycobacterium was identified by amplification of a 16S rDNA gene fragment and subsequent sequence determination . The organs mainly involved were the small intestine, spleen, liver, and lymph nodes . In contrast, lungs, myocardium, and kidneys were not involved, or only minimally involved, in this generalizing disease . Histopathologically, infection with Mycobacterium genavense in HIV-positive patients was mostly characterized by masses of foamy histiocytes and, depending on the immunologic reactivity of the host, by ill-formed granulomas, rarely with small foci of necrosis . The pathologic findings and clinical features were similar to those presented by patients who had generalized infection with Mycobacterium avium-intracellulare complex . To obtain more precise information about the specific course of infection with Mycobacterium genavense, scrupulous microbiologic investigations, including molecular biologic techniques, are necessary in cases with mycobacterial infections. J Am Acad Dermatol, 1994 Jan, 30(1), 48 - 51 Cultivation of Borrelia burgdorferi from the blood of two patients with erythema migrans lesions lacking extracutaneous signs and symptoms of Lyme disease; Berger BW et al.; BACKGROUND: We recently demonstrated that cultivation of Borrelia burgdorferi from skin biopsy specimens obtained from erythema migrans lesions was an efficacious procedure to confirm the diagnosis of Lyme disease . OBJECTIVE: Our purpose was to investigate the efficacy of our microbiologic technique on blood samples obtained from patients with Lyme disease and erythema migrans . METHODS: Whole blood samples were obtained from 52 patients with erythema migrans and early localized or early disseminated Lyme disease and placed into polystyrene tubes containing 6 ml of modified Barbour-Stoenner-Kelly medium, processed, and examined for B . burgdorferi by dark-field microscopy . RESULTS: B . burgdorferi was cultured from the blood of two of our 52 patients (4%) . Clinically, both of these patients were considered to have early localized Lyme disease . CONCLUSION: The culture of B . burgdorferi from the blood of patients with early Lyme disease does not appear to be an efficacious procedure to confirm the diagnosis of Lyme disease . However, the demonstration of spirochetemia in patients with erythema migrans without any extracutaneous evidence of disseminated illness does have therapeutic significance. Minerva Chir, 1994 Jan-Feb, 49(1-2), 59 - 63 {Perioperative teicoplanin prophylaxis in patients undergoing breast reconstruction with the abdominal wall . A case-control study}; Franchelli S et al.; The authors report the results of a randomized clinical trial of antibiotic prophylaxis of postoperative infection following breast reconstruction by transposition of rectus abdominis myocutaneous flap (TRAMF) . The aim was to evaluate the efficacy and tolerability of a short-term parenteral prophylaxis with Teicoplanin and the end-point of the study was the evaluation of wound contamination assessed by means of microbiologic culture of drainage fluid . From October 1990 to March 1992 38 patients were recruited: 20 patients in the antibiotic prophylaxis arm and 18 patients in the control group . Analysis of drainage fluids showed a higher contamination rate (15/18 = 83%) in the control group as compared to the prophylaxis arm (2/20 = 10%) (p < 0.0001) . Moreover, 11 patients in the control arm suffered from fever > 37.5 degrees C for at least 3 days as compared to 1 patient in the antibiotic prophylaxis group; the postoperative stay was 13.3 +/- 4.3 and 9.0 +/- 1.6 in the control and antibiotic arm respectively . No antibiotic related side effects were evidenced through the study . These results seem to confirm the value of parenteral short-term antibiotic prophylaxis of postoperative infection in such kind of "clean" operative procedure. J Dent, 1994, 22 Suppl 1, S13 - 6 The clinical meaning of the surface roughness and the surface free energy of intra-oral hard substrata on the microbiology of the supra- and subgingival plaque: results of in vitro and in vivo experiments; Quirynen M; In the oral cavity, which may be considered as an open growth system, most bacteria can only survive if they adhere to the hard surfaces (teeth, filling materials, dental implants, or prostheses) . Such bacterial adhesion occurs in four phases: transport to the surface, initial adhesion with a reversible and irreversible stage, attachment by specific interactions and finally colonization . During this process the roughness and the free energy of the surfaces play a key role . The reduction in roughness of a surface will result in a dramatic retardation of plaque formation and maturation . A reduction in surface free energy of the substratum will result in a decrease in plaque growth rate, a decrease in plaque retention capacity of the surface and in the selection of specific organisms . Although both parameters interact with each other, the influence of surface roughness is dominant . The importance of both parameters justifies the demand for smooth surfaces with a low surface free energy in order to prevent plaque formation, thereby reducing the occurrence of gingival inflammation. J Assoc Acad Minor Phys, 1994, 5(1), 11 - 5 Tuberculosis in African-American and minority populations: historic epidemiology of a nonclassic contagious process; McBride D; This article analyzes recent medical research and health data on persistent and resurgent tuberculosis within America's African-American population and other racial minorities . Case studies and epidemiologic data suggest that the African-American and minority-American community's experience with tuberculosis control problems has diverged markedly from the nation's as a whole . The key variations include: (1) the historically higher tuberculosis incidence and mortality in African-American and other minority populations compared with whites, and (2) an emerging epidemiologic pattern of interaction between human immunodeficiency virus (HIV) and tuberculosis generally limited to African-American and minority populations . This trend results from the disproportionate spread of HIV disease in minority communities . There are new research needs in the fields of health policy theory, microbiology, molecular genetics, and behavioral sciences. Sex Transm Dis, 1994 Jan-Feb, 21(1), 1 - 4 Ophthalmia neonatorum in a trachoma endemic area; Datta P et al.; BACKGROUND AND OBJECTIVES: Chlamydia trachomatis can be directly transmitted by sexual or perinatal contact and indirectly transmitted by flies or fomites . Whether distinct epidemiologic forces among human populations or biologic characteristics of the organism are responsible for the different routes of transmission is uncertain . STUDY DESIGN: To determine if ophthalmia neonatorum and trachoma are linked epidemiologically, 38 infants with ophthalmia and 277 children with trachoma were studied for evidence of C . trachomatis infection using culture, antigen and DNA detection tests . The study was performed in a trachoma endemic area of central Kenya . RESULTS: Of infants with ophthalmia neonatorum, 8% to 9% had microbiologic evidence of ocular C . trachomatis infection . Of the children with trachoma, 31% had evidence of chlamydial infection . Ninety-two percent of the 59 identified strains causing trachoma belonged to the classic trachoma serovars (A, B, Ba and C) . Neither of the two chlamydial strains recovered from infants with ophthalmia was a trachoma serovar . Mothers rarely (3%) had cervical C . trachomatis infection . CONCLUSION: This study does not support a major role for perinatally transmitted C . trachomatis infection in trachoma epidemiologyPIP: Chlamydia trachomatis can be directly transmitted by sexual or perinatal contact and indirectly by flies or fomites . To determine if ophthalmia neonatorum and trachoma are linked epidemiologically, 38 infants with ophthalmia (mean age of 1.8 +or- 2.5 months) and 277 children with trachoma (3 months - 14 years old) were studied for evidence of C trachomatis infection using culture, antigen, and DNA detection tests . The study was performed in a trachoma endemic area in 2 rural health centers (Lare and Mutuwati) in the Meru District in central Kenya over a 2 1/2-year period between 1988-1991 . 29 mothers of the 38 infants had tests for cervical C . trachomatis infection . 53 children with trachomatous inflammation (follicular) (TF) and 224 children with trachoma inflammation (intense) with or without TF were enrolled . Subjects were classified according to the World Health Organization trachoma grading scheme . 167 mothers of these 277 children were examined for evidence of cervical C trachomatis infection . Of infants with ophthalmia neonatorum, 8-9% had microbiologic evidence of ocular G trachomatis infection . Of the children with trachoma, 31% had evidence of chlamydial infection . 92% of the 59 identified strains causing trachoma belonged to the classic trachoma serovars (A, B, Ba and C) . 3% of mothers had cervical C trachomatis infection . Among children with trachoma, 10% had positive ocular cultures for C . trachomatis, 24 had positive EIA tests, and 31% had positive PCR tests . Among infants with ophthalmia neonatorum, evidence of C . trachomatis infection was rare . 9% (2 of 22) had positive EIA tests, and 8% (2 of 26) had positive PCR tests . Among the mothers of children with trachoma, 3% had positive C . trachomatis cervical cultures and 2% had positive EIA tests . No mother of an infant with ophthalmia neonatorum had positive cervical tests for C . trachomatis . There was no evidence of a major role for perinatally transmitted C trachomatis infection in trachoma epidemiology . J Clin Microbiol, 1994 Jan, 32(1), 70 - 4 Comparison of rapid detection methods for influenza A virus and their value in health-care management of institutionalized geriatric patients; Leonardi GP et al.; Respiratory specimens from 160 geriatric patients with suspected influenza illness were used to evaluate the abilities of two enzyme immunoassays (EIAs; Directigen FLU-A {Becton Dickinson Microbiology Systems, Cockeysville, Md.} and Prima EIA {Baxter/Bartels Diagnostics, Inc., Issaquah, Wash.}) and direct immunofluorescence testing (immunofluorescence assay {IFA}) to identify influenza A virus . In comparison with culture isolation, the sensitivities and specificities of the IFA, Directigen FLU-A, and Prima EIA were 92.5 and 97.2%, 86.8 and 99.1%, and 92.5 and 98.1%, respectively . In contrast to EIA, IFA was labor intensive and required a high degree of technical expertise, and the results of IFA were difficult to interpret . These factors may preclude the use of IFA for testing large numbers of specimens . A retrospective epidemiologic survey of influenza infection was done in six geriatric institutions which had used either rapid and culture testing or culture alone . Preventable cases of influenza A virus infection ranged from 9 to 38% of all cases in facilities which used culture testing only and which had not instituted amantadine prophylaxis . The use of direct specimen testing is recommended as an adjunct to culture isolation for the identification of influenza A virus . Use of a combination of these methods permits the timely administration of appropriate antiviral therapy and infection control measures, while it also permits the antigenic surveillance of circulating influenza strains, which is necessary for present vaccine efficacy evaluations and the creation of future effective vaccine formulations. J Clin Microbiol, 1994 Jan, 32(1), 131 - 4 Use of induced sputum specimens for microbiologic diagnosis of infections due to organisms other than Pneumocystis carinii; Fishman JA et al.; The optimal diagnostic approach to pneumonia provides a rapid microbiologic identification of pulmonary pathogens by the least invasive means . The technique of sputum induction has been useful in the evaluation of patients with Pneumocystis carinii or mycobacterial pneumonia . It is not known whether induced sputum samples are preferable for the detection of pathogens other than P . carinii or mycobacteria . Microbiologic yields were evaluated from identically processed induced and conventional sputum samples collected from 509 consecutive patients . No statistically significant differences were found between the microbiologic yields of induced and spontaneous sputum samples . Bacterial pathogens were isolated in 19.6% of induced and 23.5% of routine specimens . Mycobacteria were cultured from 13.1% of routine and 9.4% of induced specimens . Non-Candida albicans fungi grew from 24% of routine and 20% of induced specimens . The process of sputum induction with aerosolized hypertonic saline did not alter either the purulence or the bacterial quantitation of Gram-stained sputum specimens . Sputum induction has been useful for the cytologic diagnosis of malignancy, for the diagnosis of pneumocystosis and tuberculosis, and in patients unable to spontaneously produce sputum samples . The use of induced sputum samples for the diagnosis of other infections may not be necessary when routine sputum specimens are available. Clin Microbiol Rev, 1994 Jan, 7(1), 55 - 88 Evolving approaches to management of quality in clinical microbiology; Bartlett RC et al.; Quality management in clinical microbiology began in the 1960s . Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation . Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices . The initial emphasis was placed on intralaboratory process . Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information . Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care . Continuous quality improvement should be introduced . This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another . Prevention of error is accomplished more through effective training and continuing education than through surveillance . Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations. Clin Microbiol Rev, 1994 Jan, 7(1), 43 - 54 Magnetic separation techniques in diagnostic microbiology; Olsvik O et al.; The principles of magnetic separation aided by antibodies or other specific binding molecules have been used for isolation of specific viable whole organisms, antigens, or nucleic acids . Whereas growth on selective media may be helpful in isolation of a certain bacterial species, immunomagnetic separation (IMS) technology can isolate strains possessing specific and characteristic surface antigens . Further separation, cultivation, and identification of the isolate can be performed by traditional biochemical, immunologic, or molecular methods . PCR can be used for amplification and identification of genes of diagnostic importance for a target organism . The combination of IMS and PCR reduces the assay time to several hours while increasing both specificity and sensitivity . Use of streptavidin-coated magnetic beads for separation of amplified DNA fragments, containing both biotin and a signal molecule, has allowed for the conversion of the traditional PCR into an easy-to-read microtiter plate format . The bead-bound PCR amplicons can also easily be sequenced in an automated DNA sequencer . The latter technique makes it possible to obtain sequence data of 300 to 600 bases from 20 to 30 strains, starting with clinical samples, within 12 to 24 h . Sequence data can be used for both diagnostic and epidemiologic purposes . IMS has been demonstrated to be a useful method in diagnostic microbiology . Most recent publications describe IMS as a method for enhancing the specificity and sensitivity of other detection systems, such as PCR, and providing considerable savings in time compared with traditional diagnostic systems . The relevance to clinical diagnosis has, however, not yet been fully established for all of these new test principles . In the case of PCR, for example, the presence of specific DNA in a food sample does not demonstrate the presence of a live organism capable of inducing a disease . However, all tests offering increased sensitivity and specificity of detection, combined with reduced time of analysis, have to be seriously evaluated. J Thorac Imaging, 1994 Summer, 9(3), 160 - 5 High-resolution CT detection of lacerations in the transplanted lung after transbronchial biopsy; Daly BD et al.; Relatively large tissue samples may be obtained from the lung with the "Alligator" biopsy forceps . We report the radiographic and high-resolution computed tomography (HRCT) appearances of six pulmonary lacerations in the transplanted lungs of three asymptomatic patients after transbronchial biopsy with this large caliber biopsy forceps . All patients had undergone transbronchial biopsy from 4 to 10 days before HRCT that was performed as part of routine surveillance after transplantation . The site and histopathologic findings of lung biopsies and negative microbiologic studies on bronchoalveolar washings correlated accurately with each pulmonary lesion seen . Laceration size varied from 9 to 20 mm (mean 14 mm) on HRCT . A thickened wall or surrounding alveolar reaction related to bronchoalveolar lavage or biopsy-induced hemorrhage was seen in five lesions . These simulated the appearance of lung abscess or invasive fungal disease . Only nonspecific alveolar opacities were noted on chest radiographs . The Alligator biopsy forceps may cause pulmonary lacerations in transplanted lungs that are detectable on HRCT but not on chest radiographs . Differentiation from opportunistic infection by CT criteria alone is difficult in these immunocompromised patients . CT studies in this population should be performed prior to transbronchial biopsy whenever possible. Cah Anesthesiol, 1994, 42(1), 41 - 6 {Antibiotic use and prevention of infection in surgery}; Beyiha G et al.; The objective of prophylactic antibiotherapy is to reduce the frequency and complications of post operatory infections . The pharmacokinetic and microbiologic profiles of antibiotics are well codified . They must: to have a bacterial activity on frequently encountered germs and those susceptible to develop; not to create resistance nor serious side effects; to have a good tissular diffusion . Moreover, their cost must be economically acceptable . When indicated principally in clean, clean contaminated and contaminated surgery, prophylactic antibiotherapy must be of short duration, not exceeding 24 to 48 hours, habitually in monotherapy; the validity and efficiency concepts are hence no more contested; prophylactic antibiotherapy has neatly reduced the consumption and an important hospital budget wastage in antibiotics on one side, and the duration and cost of hospitalisation on the other side. Compend Suppl, 1994, (18), S684 - 5, 688-93; quiz S714-7 Implications of periodontal microbiology for the treatment of periodontal infections; Socransky SS et al.; Studies have indicated the heterogeneity of periodontal diseases and have suggested several pathogens that may play important etiologic roles . The risk associated with individual pathogens or combinations of pathogens has been assessed, and diagnostic tests have been developed for their detection in clinical practice . Strategies are being devised to improve treatment by using appropriate agents to control different periodontal infections. J Med, 1994, 25(3-4), 251 - 4 Hemorrhagic gastroesophageal ulceration by pulmonary infection in extrahepatic cholestatic pigs; Trobo JI et al.; We developed a biliary and pulmonary microbiologic study in 22 Large-White pigs that underwent bile-duct ligation in order to demonstrate that sepsis has a biliary and pulmonary origin which may be involved in the gatroesophageal pathology . All the pigs died at 18.2 +/- 8.9 days of the post-operative period . The cause of death was hemorrhagic ulceration of the gastroesophageal region in 36.3% (n = 8) of the animals that also presented multiple bilateral miliary lung abscesses . High infestation rates with intestinal germs were found in the bile and lung . In conclusion, the experimental model of extrahepatic cholestasis in the Large-White pig could be useful for the study of etiopathogenic mechanisms by which the pulmonary infection produces a hemorrhagic gastroesophageal ulceration considered as stress ulcer. Wien Klin Wochenschr, 1994, 106(17), 550 - 5 {Therapeutic relevance of the classification of gastritis}; Klimpfinger M; The histological gastritis classification according to the Sydney system is a standardisation of different classification systems used so far . It is based on the principles of etiology, topography and course of the disease, as well as morphological changes of the gastric mucosa in gastritis . Histological examination represents the practical gold standard of Helicobacter pylori detection and can be used on routinely formaldehyde-fixed biopsy material and hematoxylin-eosin stained slides . Histology is therefore also of practical diagnostic value for the control of the eradication therapy of Helicobacter pylori . The sensitivity of histological Helicobacter detection is on average higher than that of other methods including microbiology . Nevertheless, additional bacterial cultures are useful in cases of therapy resistant Helicobacter pylori infections . For routine diagnosis histological Helicobacter pylori detection is often combined with the so-called rapid urease test, which can be used in the endoscopy outpatient department, frequently offering an interim diagnosis of Helicobacter pylori infection . Furthermore, histological examination enables not only exact gastritis classification with Helicobacter pylori detection, but also the diagnosis of precancerous lesions and gastric carcinomas, as well as primary gastric lymphomas . Biopsy material for histological examination can be taken during the routinely necessary gastroscopic examination of patients with gastric symptoms without much additional burden. J Public Health Dent, 1994 Summer, 54(3), 160 - 6 Dental caries risk in relation to dietary habits and dental services in two industrial populations; Masalin KE et al.; OBJECTIVES: Environmental hazards contribute to the poor oral health in many occupations . Among the earliest occupations mentioned are those of the baker and confectionery worker . To determine appropriate ways of promoting oral health in places of work, factors affecting caries susceptibility were studied . METHODS: Dental caries status, dietary and dental health behaviors, and salivary microbiologic findings in 338 confectionery and 101 shipyard workers were compared . A caries risk index based on salivary findings was used in log-linear models where the effects of sex, diet, use of dental services, and work environment were