Microbial

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 studied . RESULTS: Caries experience was found to be high in both populations . Dietary habits were the most important factor affecting caries occurrence and susceptibility . Similar dietary behaviors were found in both groups . CONCLUSIONS: The confectionery industry did not seem to be an exceptionally hazardous environment for dental health in general . However, the screening of high-risk workers should be organized . Reimbursement of costs had no major effect on use of dental services or caries risk . Oral health promotion should be integrated with existing occupational health services to improve oral health in industrial populations.

Biol Neonate, 1994, 65(3-4), 189 - 93
Studies of neuroregulators in the brain stem of SIDS; Kopp N et al.; Some dysmaturity of neuroregulator neuronal systems may be responsible for brain stem disorders . These disorders may partly explain the mechanism of death in SIDS . The available data using microbiochemical assays, immunocytochemical techniques and autoradiographic methods seem to show anomalies of some monoaminergic and of some peptidergic systems, especially in the medulla oblongata . All these data need to be confirmed by further studies . It should be understood that one positive effect of such neuroanatomical study on SIDS is to gain 'normative' data on the human brain during development.

Verh K Acad Geneeskd Belg, 1994, 56(6), 593 - 623
{Application of polymerase chain reaction in medical microbiology}; Ieven M et al.; An overview is presented of different nucleic acid amplification techniques, particularly the polymerase chain reaction (PCR) . The possible applications of the PCR in medical microbiology and the different phases of the PCR are discussed . Four PCR applications, as elaborated and used in the authors' laboratory are presented: the diagnoses of Mycoplasma pneumoniae infections, herpes simplex virus encephalitis and Toxoplasma gondii encephalitis, and the detection of Mycobacterium leprae . For the first and the last of these, original internal controls to detect the presence of inhibitors were elaborated . The target amplicon was inserted in a plasmid and the central part modified, either by insertion of a sequence of foreign DNA (Mycoplasma pneumoniae) or excision of a sequence (Mycobacterium leprae) . The addition of a small amount (in order to avoid inhibition of the diagnostic reaction) of these plasmids to the reaction mixture, results in coamplification of this modified DNA with the same primers as the target DNA . During three successive winter periods, nasopharyngeal aspirates from children presenting with respiratory infections at the Universitair Ziekenhuis Antwerpen, were examined for viruses and for M.pneumoniae by the PCR . The PCR for herpes virus in cerebrospinal fluid is a powerful diagnostic technique . Five cases could be documented, one of them being the second known case of herpes virus encephalitis of the brain stem . The sensitivity of the PCR for Toxoplasma gondii encephalitis as performed in our laboratory on cerebro-spinal fluid probably needs to be improved . The detection of M . leprae by a PCR for the 16S rRNA can detect as little as 30 organisms, which is insufficiently sensitive for the diagnosis of paucibacillary leprosy in skin biopsy specimens . The technique allowed for the first time the detection of M . leprae DNA in nose mucosae of patients and some of their contacts . The PCR is very promising to elucidate the etiology of diseases the responsible agent of which is present in too small numbers to be detected by traditional techniques, as well as for the diagnosis of agents difficult or impossible to cultivate or to identify still unknown agents.

Tsitologiia, 1994, 36(2), 200 - 10
{A cytofluorimetric study of the glycogen content and of the enzymatic activity of its metabolism in human and animal hepatocytes in liver cirrhosis and during rehabilitation}; Kudriavtseva MV et al.; Reversibility of hepatocyte functional activity is shown by cytofluorometric and microbiochemical methods in human and rat liver during postcirrhosis rehabilitation . Contents of the total glycogen and its fractions in liver cells were defined on smears of isolated hepatocytes obtained from the live puncture liver biopsies . A double increase of glycogen level is shown, in average, in hepatocytes during experimental liver cirrhosis in rats . At the same time, a relative content of the hard soluble fraction of glycogen increases by 5-8 times . The glycogen level falls to reach the norm already within one month after shutting off the pathogenic influence . However, in some animals after 6 months this level becomes even lower than the normal one . Again, the ratio between the hard soluble fraction and light one remains . In men with cirrhosis glycogenosis of hepatocytes can be expressed in greater degree (increase by 4-5 times): it depends on the illness heaviness . Further changes in glycogen content depend on the pathological process development . Under experimental cirrhosis the activity of glucose-6-phosphatase decreases by 4.3 times . Within one month after stopping the pathogenic influence the activity of this enzyme increases by 3-4 times, but later, in 6 months, it decreases to reach 55-65% of the norm . No actual changes were observed in the activities of other enzymes.

Arch Inst Pasteur Madagascar, 1994, 61(2), 91 - 8
{Bacterial quality of the water supply in Madagascar}; Ravaonindrina N et al.; The results of 14371 drinking water analysis carried out in Madagascar between 1986 and 1993 by the water analysis and food microbiology laboratory of the Pasteur Institute of Madagascar are reported . After a history of the water analysis laboratory, methods and frequency of sampling, methods of analysis and standards applied are quoted and documented . Results for each province are reported and particularly indicated: the development of water samples and their portability along the years, the respective frequency of pollutant bacteria and their amounts according to sampling points . In spite of the lack of means in the country, the authors consider the results are satisfactory but they stress the importance of an organized surveillance system of drinking water quality.

Verh Dtsch Ges Pathol, 1994, 78, 189 - 94
{Detection of mycobacterial DNA from paraffin-embedded tissue in lung and lymphoid epithelial granulomas}; Bohle RM et al.; Standard techniques for the detection of mycobacteria in granulomatous diseases can be inadequate . We analysed 71 formalin fixed and paraffin-embedded tissue blocks from 68 non-immunocompromised patients with caseating, non-caseating, scarred, and miliary granulomas of lung and lymph nodes . A reamplification PCR protocol was established to detect a 123 bp product of the repetitive insertion sequence IS986/IS6110 . After exclusion of 6 PCR-negative cases with clinical sarcoidosis 97% of lung tissue blocks with more than 10% caseating and non-caseating granulomas contained mycobacterial DNA . By routine microbiology mycobacteria could be detected in 78% of the patients . Scarred granulomas were PCR-negative . All miliary granulomas were PCR-positive . Lymph nodes showed comparable results . We think that this method facilitates aetiologic analysis of granulomatous diseases especially when the suspicous tissue is fixed and microbiology is not available.

Med Clin (Barc), 1993 Dec 4, 101(19), 721 - 31
{Spanish scientific production in biomedicine and health . A study via the Science Citation Index (1986-1989)}; Cami J et al.; BACKGROUND: There is no detailed information on the scientific production in biomedicine from the perspective of the centers which make up the National Health Care System . Nor has any analysis on productivity by specialties compared with that of other countries of the European Community (EC) been carried out . METHODS: The methodology used and the global results of a study performed from biomedical investigation documents indexed in the SCI from 1986 to 1989 and signed by a Spanish health care center are presented . Quantitative and qualitative indicators (Narin index, impact factor {IF}, mean IF per specialty, expected and observed IF as well as denominators {PIB, number of inhabitants per area, cost and number of personnel of the centers}) . RESULTS: Twelve thousand seven hundred and six documents were studied of which 66.7% were journal articles and 13.5% were studies carried out in cooperation with foreign countries . The biomedical production was 41.5% of all the Spanish scientific investigation collected in the SCI in the same period and represented 3.82% of the contribution of all the biomedical investigation of the EC . Universities were responsible for 46% of the documents analyzed followed by hospitals with 39% . The autonomic communities of Madrid (32%) and Catalonia (26%) have the most productivity principally in hospitals, followed by Andalucia (10%) and Valencia (7%) . The subject matters of greatest production were biochemistry, and molecular biology (14.7%), pharmacology and pharmacy (7.6%), neurosciences (6.8%) and microbiology (5.7%) . Qualitative analysis showed that despite the investigation in some subject areas being carried out in journals with an IF higher than the world mean, the citations received by the studies are lower than expected . CONCLUSIONS: Despite the growth in Spanish biomedical production, Spain only occupies seventh place in the EC . Madrid and Barcelona notably concentrate on biomedical investigation from the hospital network . The relativization of the data describes the existence of other noteworthy geographic areas not outside the university . The ever greater diffusion of the publications contrasts with the citations received for the studies which may be the result of phenomena related with the quality of the studies and/or the recognition of the publications signed by Spanish authors.

J Clin Microbiol, 1993 Dec, 31(12), 3314 - 6
Bacterial flora of the sigmoid neovagina; Toolenaar TA et al.; The bacterial microbiota of 15 sigmoid neovaginas, created in patients with congenital vaginal aplasia or male transsexualism, was studied . No specimen was sterile, and only normal inhabitants of the colon were cultured . The total counts of bacteria were lower than those reported for healthy sigmoid colons.

J Clin Microbiol, 1993 Dec, 31(12), 3227 - 30
Isolation of Mycobacterium avium complex from water in the United States, Finland, Zaire, and Kenya; von Reyn CF et al.; Disseminated infection with organisms of the Mycobacterium avium complex (MAC) is a common complication of AIDS in the United States and other developing countries, but it is rare or absent in sub-Saharan Africa . To assess the comparative likelihood of exposure to MAC in these geographic areas, we used a standard protocol to culture 91 water samples from environmental sites and piped water supply systems in the United States, Finland, Zaire, and Kenya . MAC was isolated from all geographic areas and from 22 of 91 (24%) samples . Isolation rates were 13 of 47 (28%) for environmental samples and 9 of 44 (20%) for water supply samples . Overall isolation rates were 18 of 52 (35%) samples in the United States and Finland, whereas they were 4 of 39 (10%) samples in Zaire and Kenya (P = 0.015) . MAC isolation rates from water supply systems were 8 of 25 (32%) samples in the United States and Finland and 1 of 19 (5%) samples in Zaire and Kenya (P = 0.056) . MAC was isolated from hospital water in the United States and Finland but not in hospital water in Zaire and Kenya . Serovar determinations showed that six of eight isolates from the United States were serovar 4 or 8 . One MAC isolate from Zaire was identified as an "X" mycobacterium . These data suggest that exposure to MAC in water is likely in diverse areas of the world, but that the likelihood of human exposure to the organism in water may be slightly less in sub-Saharan Africa than in developed countries in the Northern HemispherePIP: Between March 1990 and February 1992, microbiologists collected 91 water samples from various environmental sites (lakes, ponds, rivers, streams, harbors, marshes, and standing water) and from piped municipal and private water supply systems to determine the likelihood of human exposure to Mycobacterium avian complex (MAC) in New Hampshire and Boston in the US, Finland, Kenya, and Zaire . They wanted to examine the international distribution of MAC to determine whether the observation of AIDS patents in Africa not having MAC infection is association with differences in the environmental distribution of MAC . Overall isolation rates for environmental samples and for water supply samples stood at 28% and 20%, respectively . MAC isolation rates for all samples in the 2 developed countries were significantly higher than they were in the 2 Sub-Saharan African countries (35% vs . 10%; p = .015) . The rates for water supply systems were higher in the US and Finland than they were in Kenya and Zaire (32% vs . 5%; p = .056) . None of the water supply samples from hospitals in Kenya and Zaire tested positive for MAC, while about 20% in the US and 50% in Finland did . Serovars 4 and 8 of M . avian, which have been linked to infection in AIDS patients, accounted for 75% of the environmental M . avium isolates in the US . An X mycobacterium was found in an MAC isolate from Zaire . These findings indicate that the probability of human exposure to MAC in water is less than Sub-Saharan Africa than it is in developed countries in the northern hemisphere .

Int J Pediatr Otorhinolaryngol, 1993 Dec, 28(1), 69 - 76
Mastoiditis caused by atypical mycobacteria; Moerman M et al.; Three case reports of mastoiditis caused by atypical mycobacteria are discussed and a review of the world literature is given . Our aim is to focus the attention of the ENT specialist and the pediatrician on these pathological agents in unilateral recurrent otitis media . The case reports illustrate the importance of histologic and microbiologic examination . Difficulties in the differential diagnosis are mentioned . The therapy is slightly different from lymphadenitis caused by atypical mycobacteria because for mastoiditis we prefer the combination of surgery with medical treatment.

Curr Opin Immunol, 1993 Dec, 5(6), 918 - 24
Cellular immune mechanisms in rheumatoid arthritis and other inflammatory arthritides; Lanchbury JS et al.; Advances in molecular genetics, cellular immunology and microbiology have offered promise in unravelling the aetiopathogenesis of inflammatory arthritides such as rheumatoid arthritis and reactive arthritis . Such insights are challenging the orthodox view that these diseases are primarily autoimmune in nature, and should lead to exciting and novel therapeutic approaches.

J Bacteriol, 1993 Dec, 175(24), 8000 - 7
A species-specific periplasmic flagellar protein of Serpulina (Treponema) hyodysenteriae; Li Z et al.; We have previously reported that a 46-kDa protein present in an outer membrane protein preparation seemed to be a species-specific antigen of Serpulina hyodysenteriae (Z . S . Li, N . S . Jensen, M . Belanger, M.-C . L'Esperance, and M . Jacques, J . Clin . Microbiol . 30:2941-2947, 1992) . The objective of this study was to further characterize this antigen . A Western blot (immunoblot) analysis and immunogold labeling with a monospecific antiserum against this protein confirmed that the protein was present in all S . hyodysenteriae reference strains but not in the nonpathogenic organism Serpulina innocens . The immunogold labeling results also indicated that the protein was associated with the periplasmic flagella of S . hyodysenteriae . N-terminal amino acid sequencing confirmed that the protein was in fact a periplasmic flagellar sheath protein . The molecular mass of this protein, first estimated to be 46 kDa by Western blotting, was determined to be 44 kDa when the protein was evaluated more precisely by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the protein was glycosylated, as determined by glycoprotein staining and also by N-glycosidase F treatment . Five other periplasmic flagellar proteins of S . hyodysenteriae, which may have been the core proteins and had molecular masses of 39, 35, 32, 30, and 29 kDa, were antigenically related and cross-reacted with the periplasmic flagellar proteins of S . innocens . Finally, serum from a pig experimentally infected with S . hyodysenteriae recognized the 44-kDa periplasmic flagellar sheath protein . Our results suggest that the 44-kDa periplasmic flagellar sheath protein of S . hyodysenteriae is a species-specific glycoprotein antigen.

J Bacteriol, 1993 Dec, 175(23), 7697 - 701
Isolation and location on the R27 map of two replicons and an incompatibility determinant specific for IncHI1 plasmids; Gabant P et al.; Two replicons were isolated independently from different IncHI1 plasmids . One was isolated from R27, and a second was isolated from pIP522 . We demonstrate, by DNA-DNA hybridization experiments, that these maintenance regions are different and that they are specific to, and carried by, all IncHI1 plasmids tested . In view of this specificity we decided to designate the replicon isolated from R27 as RepHI1A and the replicon isolated from pIP522 as RepHI1B . These two autoreplicative regions are not related to a third replicon present in all IncHI1 plasmids that bears homology with RepFIA and that expresses the characteristic incompatibility of IncHI1 subgroup plasmids toward F factor (D . Saul, D . Lane, and P . L . Bergquist, Mol . Microbiol . 2:219-225, 1988; D . E . Taylor, R . W . Hedges, and P . L . Bergquist, J . Gen . Microbiol . 131:1523-1530, 1985) . These results demonstrate that all IncHI1 plasmids tested contain at least three replicons . An incompatibility (Inc) region that hybridizes specifically to all the IncHI1 plasmids was previously isolated (M . Couturier, F . Bex, P . L . Bergquist, and W . K . Maas, Microbiol . Rev . 52:375-395, 1988) . Although this Inc locus is not located in an autoreplicative region of IncHI1 plasmids, we observed that this locus stabilizes a low-copy-number replicon . This Inc locus is probably a component of an active partition locus involved in the maintenance of IncHI1 plasmids . The nucleotide sequence of the Inc region contains direct repeats of 31 bp . In addition, this incompatibility determinant hybridizes specifically with IncHI1 plasmids but expresses incompatibility toward plasmids of both IncHI subgroups (IncHI1 and IncHI2) . In this communication, we present the mapping of these maintenance elements on the R27 genome.

Aust N Z J Med, 1993 Dec, 23(6), 662 - 6
How vancomycin is used in Australasia--a survey; Duffull SB et al.; BACKGROUND: Vancomycin serum concentrations have been monitored over the last 30 years in an attempt to avoid dose-dependent toxicity and enhance efficacy . Current literature recommendations for peak and trough concentrations are usually in the range of 20-40 mg/L and 5-10 mg/L, respectively . Literature recommendations regarding the time at which peak concentrations are measured are highly variable, ranging from immediately after the end of the infusion to three hours post-dose . AIMS: To identify how vancomycin dosing is being monitored and assess variability in the current practice . METHODS: A survey of microbiology departments and infectious disease physicians in major Australasian hospitals was undertaken . The variability in the current practice was assessed by fitting mean recommendations to a two compartment Bayesian model . RESULTS: Of the 83 (70%) who replied 71 (86%) monitored vancomycin concentrations . Fifty-four percent targeted peak concentrations within the range of 20-40 mg/L, and 73% targeted trough concentrations < or = 10 mg/L . The time of sampling of peak concentrations varied considerably ranging from immediately (12%) to 120 minutes (12%) post-infusion (median 30 minutes {40%}) . The concentration-time curves resulting from three sets of mean recommendations ('peaks' drawn at: 0, 30 and 120 minutes aiming for a concentration of 35 mg/L with a trough concentration of 10 mg/L) were modelled using a two compartment Bayesian programme . The predicted true peak (maximum) concentrations ranged from 30 to 86 mg/L, despite aiming for identical target concentrations, indicating marked variation in the actual dosing practice . CONCLUSIONS: There is thus considerable variation in the practice of vancomycin therapeutic monitoring which has a major effect on dosing . The main contributing factor is the variable timing of sampling peak concentrations.

J Occup Med, 1993 Dec, 35(12), 1231 - 5
Occupational asthma to the slime mold Dictyostelium discoideum; Gottlieb SJ et al.; Dictyostelium discoideum is a slime mold that exists in a unicellular amoeboid form under certain nutritional conditions . In this form, it produces unique lysosomal enzymes that are valuable in studying cell-to-cell signaling systems . We report on a research microbiologist who developed rhinoconjunctivitis and asthma after release of D . discoideum from a pressurized canister . Immediate skin test reactivity was demonstrated to whole and lysed organisms . Enzyme-linked immunosorbent assay results revealed IgE antibody against D . discoideum whole organism, lysed organism, and lysosomal enzymes with the strongest response being directed toward lysosomal enzymes . Pulmonary function testing showed a decline in forced expiratory volume in 1 second and forced expiratory flow after modified laboratory exposure to D . discoideum . This case represents the first report of occupational rhinoconjunctivitis and asthma from slime mild.

Infect Agents Dis, 1993 Dec, 2(6), 394 - 7
Teaching microbiology to medical students; Schaechter M; Medical education is undergoing radical changes . The author discusses his views regarding the issues of content, process, and evaluation of teaching microbiology to medical students.

Ann Pharmacother, 1993 Nov, 27(11), 1343 - 5
Placebo-controlled trial of intravaginal clindamycin 2% cream for the treatment of bacterial vaginosis; Stein GE et al.; OBJECTIVE: To compare the safety and efficacy of intravaginal clindamycin 2% cream with placebo in nonpregnant women with bacterial vaginosis . DESIGN: A randomized, double-blind, placebo-controlled clinical trial . SETTING: Ambulatory patients in the general community . PATIENTS: Two hundred fifteen nonpregnant outpatients with a diagnosis of bacterial vaginosis were entered into this study . Of the 134 evaluable patients, 65 received clindamycin and 69 placebo . Demographic parameters were comparable between the two treatment groups . INTERVENTION: Study subjects were equally randomized to receive either 5 g of clindamycin 2% vaginal cream or placebo cream for seven nights . MAIN OUTCOME MEASURES: Clinical and microbiologic follow-up evaluations were scheduled for 5-10 days and 25-39 days posttreatment . Patients were interviewed about signs and symptoms, adverse events, and compliance . Diagnostic examinations were performed . RESULTS: Clinical success rates (cure and improvement) occurred in 50 of 65 patients who received clindamycin (77 percent) and 17 of 69 patients who received placebo (25 percent) by the first posttreatment visit (p < 0.001) . Microbiologic cures or improvement were observed in 59 of the 65 patients treated with clindamycin (91 percent) compared with 20 of 69 placebo-treated patients (29 percent) (p < 0.001) . At the end of the study, clinical and microbiologic cures or improvement were evident in 45 of 57 (79 percent) and 37 of 57 clindamycin-treated patients (65 percent), respectively, and 18 of 51 (35 percent) and 14 of 51 (28 percent) of the placebo-treated patients, respectively . The success rates with clindamycin 2% cream were statistically higher than those with placebo . The adverse-effect profiles in the two groups were similar and no serious adverse effects were reported . Patients who received clindamycin had a statistically higher incidence of nonbacterial vaginitis/cervicitis (18.5 vs . 7.5 percent, p = 0.003) . CONCLUSIONS: Intravaginal clindamycin 2% cream appears to be an effective and safe treatment of symptomatic bacterial vaginosis in nonpregnant women.

Clin Infect Dis, 1993 Nov, 17 Suppl 2, S487 - 91
Emerging fungal pathogens in immunocompromised patients: classification, diagnosis, and management; Vartivarian SE et al.; Fungi such as Fusarium species, Trichosporon species, Curvularia species, and Alternaria species previously were thought to represent contamination or harmless colonization when isolated from immunocompromised patients . More recently, the pathogenic role of these and other fungi has been clearly established . Three diverse groups of fungi are responsible for these emerging infections: the agents of phaeohyphomycosis and hyalohyphomycosis and certain yeasts . Reports of the emergence of these organisms as significant pathogens may be ascribed to increasing awareness by physicians and microbiologists, aggressive culture of patient specimens, increasingly cytotoxic chemotherapy, and selection of resistant organisms by the widespread empirical use of amphotericin B . Infections with these fungi tend to be disseminated and are frequently fatal in immunocompromised hosts . Treatment of these infections is not standardized . Experimental therapy in murine models of fungal infections suggests a role for newer agents, combination antifungal chemotherapy, and immunotherapy.

J Clin Pathol, 1993 Nov, 46(11), 1051 - 2
How many microbiology consultants are needed?
Bignardi GE.
It is difficult to measure medical staff workload and medical staff requirements in microbiology departments . A review of 14 job descriptions for consultant microbiologists showed that the number of hospital beds and the number of specimens are more reliable workload indices than the population figure . Ratios between beds or specimens and medical staff numbers may help to identify understaffed or overstaffed microbiology departments.

Vet Clin North Am Food Anim Pract, 1993 Nov, 9(3), 469 - 74
Microbiologic examination of bulk tank milk; Farnsworth RJ; Microbiologic examination of bulk tank milk can be a useful technique in assessment of mastitis and milk quality . Sample collection and handling, laboratory techniques, and interpretation and use of bulk tank microbiology are discussed . Recommendations are made based upon a survey of mastitis laboratories and the author's experience.

Arch Pathol Lab Med, 1993 Nov, 117(11), 1088 - 98
DNA-based identification and epidemiologic typing of bacterial pathogens; Versalovic J et al.; Genotypic, or DNA-based, methods have become increasingly applicable for infectious disease diagnosis and epidemiologic analysis . The ability to assess the pathogen's genotype directly bypasses requirements for cultivation and may diminish diagnostic delays with fastidious organisms . Genotypic typing methods have enhanced epidemiologic studies by providing techniques with greater discriminatory ability and smaller proportions of nontypeable samples . Hence, these methods enable rigorous studies to be performed regarding the nature of disease outbreaks . Phenotypic, or conventional, methods will remain important in diagnostic microbiology, especially with organisms that are relatively easy to culture . However, genotypic methods may become increasingly prominent in clinical microbiology laboratories, particularly with respect to diagnosis of fastidious pathogens, because of their relative speed, versatility, and lack of cultivation requirements.

J Am Geriatr Soc, 1993 Nov, 41(11), 1187 - 92
Fever of unknown origin in elderly patients; Knockaert DC et al.; OBJECTIVE: To describe the spectrum of diseases that may give rise to fever of unknown origin in elderly patients and to delineate the diagnostic approach in these patients . DESIGN: Subgroup analysis of a prospectively collected case series followed more than 2 years . SETTING: General Internal Medicine Service based at University hospital, Leuven, Belgium . PATIENTS: Forty-seven consecutive patients, older than 65 years, meeting the classic criteria of fever of unknown origin . MEASUREMENTS: The final diagnosis established and the clinical value of diagnostic procedures . RESULTS: Infections, tumors and multisystem diseases (encompassing rheumatic diseases, connective tissue disorders, vasculitis including temporal arteritis, polymyalgia rheumatica, and sarcoidosis) were found in 12 (25%), six (12%) and 15 patients (31%), respectively . Drug-related fever was the cause in three patients (6%), miscellaneous conditions were found in five patients (10%), and six patients (12%) remained undiagnosed . Microbiologic investigations were diagnostic in eight cases (16%), serologic tests yielded one diagnosis, immunologic investigations had a diagnostic value in four cases, standard X-rays yielded a diagnostic contribution in 10 cases, ultrasonography and computed tomography were diagnostic in 11 cases, Gallium scintigraphy had a diagnostic contribution in 17 cases, and biopsies yielded the final diagnosis in 18 cases . CONCLUSIONS: Multisystem diseases emerged as the most frequent cause of fever of unknown origin in the elderly, and temporal arteritis was the most frequent specific diagnosis . Infections, particularly tuberculosis, remain an important group . The percentage of tumors was higher in our elderly patients than in the younger ones but still clearly lower than in other recent series of FUO in adults . The number of undiagnosed cases was significantly lower in elderly patients than in younger individuals (P < or = 0.01) . The investigation of elderly patients with FUO should encompass routine temporal artery biopsy and extensive search for tuberculosis if the classic tests such as blood count, chemistry, urinalysis, cultures, chest X-rays, and abdominal ultrasonography do not yield any clue . Gallium scintigraphy should be considered as the next step and not as a last-resort procedure.

Salud Publica Mex, 1993 Nov-Dec, 35(6), 709 - 13
{The need, supply and demand for epidemiological research personnel in the Instituto Mexicano del Seguro Social}; Escandon-Romero C et al.; In 1991 the Directorate of Public Health was created at the Mexican Institute for Social Security, with its epidemiologic activities oriented towards surveillance and research . This new vision, as well as the epidemiologic transition in Mexico, have raised the need for researchers training . In 1988 the Specialization Course in Public Health was developed as a response to the detected needs . This course was reformed three years later in duration, depth and name (Epidemiology instead of Public Health) . The requirement of a thesis has led to the development of epidemiologic and health services research . Two diplomates in epidemiology and immunology and microbiology were also developed as a response to the need of actualization due to the advances in epidemiologic methodology in the past decades . A demand for actualization and continuous education has been expressed by the epidemiologists through a survey . The Directorate has also proposed priority themes for research in order to guide the requirements of research raised by the epidemiologist already trained at the Institute.

Cancer Pract, 1993 Nov-Dec, 1(4), 295 - 304
Drug therapy management of the febrile neutropenic cancer patient; Finkbiner KL et al.; Neutropenia is one of the major dose-limiting toxicities of cancer chemotherapy . Since the 1960s, dramatic changes have occurred in its epidemiology, microbiology, and treatment . This article highlights these important changes; reviews the history and current practice of antibiotic, antifungal, and antiviral therapy; and looks toward future therapy using colony-stimulating factors (CSFs) for the infectious complications in the febrile neutropenic cancer patient.

J Comp Pathol, 1993 Nov, 109(4), 395 - 407
Immune-mediated skin disease in the dog and cat; Day MJ et al.; Immune-mediated skin disease was recorded in 24 dogs and 11 cats by the Department of Pathology and Microbiology, University of Bristol, over the period 1973-1992 . The clinical and histopathological features, together with the age, breed and sex, are given for each case . Skin biopsies from the 24 dogs in this series, together with tissue from 25 control dogs, were immunostained for IgG, IgM and C3 by direct immunoperoxidase methodology . The same technique, with species-specific antisera for IgG and IgM, was applied to skin biopsies from 10 affected cats . The correlation between clinical features, histopathology and immunohistochemistry is discussed.

J Hosp Infect, 1993 Nov, 25(3), 161 - 72
Introduction of laboratory based ward liaison surveillance of hospital infection into six district general hospitals; Glenister HM et al.; A previous study demonstrated that laboratory based ward liaison surveillance (LBWLS) of hospital infection was an effective and efficient method . The method involved the follow-up of positive microbiology reports by the review of patient records and liaison with ward nursing staff to consider whether any patients had infection . Here we report the introduction of LBWLS into six district general hospitals to determine whether it is feasible to use this method on an everyday basis . The time required for data collection was assessed and the method was compared with a reference method in one hospital to check its ability to detect infections . To assess reproducibility two infection control nurses (ICNs) performed LBWLS independently, but concurrently, for 5 weeks . The method could be used in all hospitals studied; however, the time for data collection ranged from 3.0 to 6.8 h/100 beds per week . In comparison with the reference method, LBWLS detected 15/41 (37%) of community acquired infections and 30/43 (70%) of hospital acquired infections . In the reproducibility assessment 72 patients were identified by both ICNs . There was agreement about the infected/non-infected status of 65 of these patients . The mean pair agreement and Kappa statistic were 0.88 and 0.72 . Laboratory based ward liaison was readily used in all hospitals and was reproducible.

J Laryngol Otol, 1993 Nov, 107(11), 1005 - 7
Prevention of intracranial problems in ear and sinus surgery: a possible role for cefotaxime; Weiner GM et al.; Cases of intracranial sepsis of otorhinogenic origin presenting to a regional neurosurgical centre from 1984 to 1992 were examined with regard to their microbiology and antibiotic sensitivities . The results lead us to believe that cefotaxime may have a role in the initial ENT management of the potentially complicated case of ear or sinus sepsis.

Med Clin North Am, 1993 Nov, 77(6), 1219 - 34
Genetics of tuberculosis; Marks GL; Molecular methods for identifying organisms, strain typing, and determining drug susceptibilities are extremely valuable for pathogens that are impossible to grow on artificial media, slow growing on artificial media, or exceptionally hazardous to grow in a clinical microbiology laboratory . DNA hybridization probes and RFLP analysis are currently being used to facilitate the diagnosis and evaluation of mycobacterial disease . PCR is rapidly progressing to the point at which it will become routine in the clinical microbiology laboratory . LCR clearly has a future role in mycobacteriology but requires further understanding of mycobacterial genetics and physiology . The mycobacteriophage reporter-gene assay is an exciting future option that may allow us to obtain critical treatment related information in a much more timely fashion . The technologies mentioned in this article do not include all of the possibilities for the future; however, it can already be imagined that the isolation, identification, and drug-resistance properties of mycobacteria can be determined directly from clinical specimens and the results made available in a matter of days rather than weeks to months . What about the cost? These are expensive methods currently; however, the cost of conventional culture, drug susceptibility determinations, unnecessary periods of isolation for infection control, delays in recognition of resistant isolates, and deaths before the availability of laboratory information are high prices to pay . Only through further investigation can we clarify the most efficient and cost-effective tuberculosis treatment and control program . The dual epidemics of the human immunodeficiency virus and TB will continue to press the scientific community to develop cost-effective approaches, both for developed and developing nations, to a wide array of pathogens . If we do not characterize existing and future organisms at the molecular level, we will be forced to deal with them on their terms and at their leisure.

Med Clin (Barc), 1993 Oct 30, 101(14), 525 - 9
{Tuberculosis in a prison population: a study of 138 cases}; Chaves F et al.; BACKGROUND: Tuberculosis continues to be a disease of great importance in Spain with few data known on prison populations . In the present study an analysis of the incidence and characteristics of tuberculosis in the prison population people is done . METHODS: The General Penitentiary Hospital attends a prison population from the penitentiary centers of Madrid and its surrounding areas . From 1 March 1991-31 August 1992 a retrospective study of the patients with tuberculosis diagnosed by culture isolation of Mycobacterium tuberculosis was performed . Demographic, clinical, analytical, microbiologic analysis as well as data concerning to associated infections, antituberculous treatment and its possible toxicity as well as the evolution of the patients were collected . RESULTS: During the period studied 138 patients--120 corresponding to the area of Madrid and 18 to patients referred from other penitentiary areas--were diagnosed . The rate of incidence of tuberculosis in the penitentiary population in the area of Madrid was of 1170.5 cases per 100,000 prisoners per year (confidence interval {CI} 95%; 961-1380) . The mean age was 30 years (CI 95%; 29-31) and 97% were males . Eighty-four percent were positive for the human immunodeficiency virus (HIV) and 84% were intravenous drug addicts . The clinical form of presentation of the tuberculosis in the HIV positive patients was: pulmonary in 57% of the cases, disseminated in 29% and extrapulmonary in 14% and was pulmonary in all the cases of HIV negative patients . The mean CD4 lymphocytes count was 0.216 x 10(9)/l in HIV positive patients with pulmonary tuberculosis, and in disseminated tuberculosis was 0.062 x 10(9)/l (p < 0.001) . The positivity of acid-alcohol resistant staining in the sputum samples and/or induced sputum was 67.4% in the patients with pulmonary tuberculosis and 77.4% in disseminated tuberculosis . Ten percent of the patients were found to abandon antituberculous treatment in the first trimester . CONCLUSIONS: The incidence of tuberculosis in the prison population in much higher than that for the general population in Spain, largely due to the high prevalence of HIV infection in this population.

Invest Ophthalmol Vis Sci, 1993 Oct, 34(11), 3194 - 8
Nonocular Chlamydia infection and risk of ocular reinfection after mass treatment in a trachoma hyperendemic area; West S et al.; PURPOSE . The presence of nasal discharge on a child's face increases the risk of active trachoma, suggesting that Chlamydia trachomatis in nasal secretions may be a possible source of ocular reinfection . The prevalence of chlamydia in nasal secretions and the risk of reinfection after mass treatment was investigated in a hyperendemic area of Tanzania . METHODS . In one village a total of 232 children aged 1 to 7 years were followed before and after mass treatment . Clinical trachoma, and microbiologic evidence of chlamydia, were assessed at baseline, 2 and 4 weeks into mass treatment, and 4 weeks after treatment stopped . The presence of chlamydia in ocular and nasal secretions was determined by polymerase chain reaction-enzyme immunoassay techniques . RESULTS . Of the 232 children, 59% had clinical trachoma and 27% had nasal specimens positive for chlamydia . Children with positive ocular chlamydia specimens and/or clinical trachoma were significantly more likely to have positive nasal specimens . At the end of mass treatment, only 4% of children had positive ocular specimens . However, 1 month after treatment stopped, the incidence of new infection was 21% . The rate of new ocular infections in those who had negative ocular specimens after treatment was similar between those who had positive and those who had negative nasal specimens at baseline . Positive ocular specimens at baseline was not a predictor of risk of new infection after treatment (odds ratio = 1.18, 95% confidence interval = 0.58, 2.40), suggesting these new infections were not the result of latent or persistent organism . CONCLUSIONS . These data do not support a role for nasal secretions in causing reinfection after treatment . One mass topical treatment alone is unlikely to be effective in trachoma hyperendemic areas as shown by the rapid re-emergence of infection.

Obstet Gynecol, 1993 Oct, 82(4 Pt 1), 509 - 14
Characteristics of women in preterm labor associated with elevated C-reactive protein levels; Watts DH et al.; OBJECTIVE: To evaluate clinical, microbiologic, and histologic findings associated with elevated C-reactive protein levels among women in preterm labor or with preterm premature rupture of the membranes (PROM) . METHODS: Obstetric data, serum C-reactive protein levels, and amniotic fluid (AF) and chorioamniotic membrane cultures and histology were obtained on 203 women presenting between 22-34 weeks' gestation in preterm labor or with PROM . RESULTS: Women with C-reactive protein greater than 1.5 mg/dL were more likely to deliver within 7 days of enrollment (54 of 68, 79%) than were women with normal C-reactive protein levels (45 of 135, 33%) (P < .001) . The median C-reactive protein levels and association with rapid delivery did not differ between women with intact versus ruptured membranes . Elevated C-reactive protein levels were associated with a positive AF culture among women in preterm labor with intact membranes . To control for confounding by a long interval to delivery, only the group delivering within 7 days was considered for evaluation of C-reactive protein levels and placental and infant outcome . Among women delivering within 7 days, elevated C-reactive protein was associated with the development of clinical chorioamnionitis and with infant death before hospital discharge, but not with a positive membrane culture or histologic chorioamnionitis . CONCLUSIONS: Elevated C-reactive protein appears to be associated with AF infection, delivery within 7 days of admission, and infant death among women delivering preterm, but not with membrane infection or inflammation . Elevated C-reactive protein may be helpful in determining the need for AF culture and in targeting studies of antibiotic therapy among women in preterm labor or with preterm PROM.

Acta Med Port, 1993 Oct, 6(10), 467 - 71
{Cefoxitin: its role in the therapy of anaerobic infections}; Carvalho A et al.; Cefoxitin is a second generation cephalosporin commonly used to treat anaerobic and mixed infections . The authors reviewed the recently published data about the efficacy of cefoxitin; its utility in different clinical entities, patterns of resistance and resistance mechanisms, indications and reliability of in vitro susceptibility testing . These data indicate the need for determining susceptibility patterns of anaerobics at each hospital and point out to the essential close communication between the microbiologist and clinician to the rational treatment of anaerobic infections.

Clin Infect Dis, 1993 Oct, 17(4), 794 - 801
Evaluation of new anti-infective drugs for the treatment of infection with human immunodeficiency virus . The European Working Party of the European Society of Clinical Microbiology and Infectious Diseases; Norrby SR et al.; This guideline describes the preclinical documentation required for a new drug active against human immunodeficiency virus (HIV) and offers suggestions regarding the design and implementation of phase 1, 2, and 3 clinical trials . Drugs with a low level of potential toxicity, especially those that are not nucleoside analogues, should be evaluated in healthy individuals who are not infected with HIV before trials in HIV-infected patients commence . The guideline also discusses possible clinical and laboratory end points for efficacy and emphasizes the need for careful validation of all laboratory end points used . The approach of the guideline is deliberately general: more specific recommendations would soon become outdated in this field, which is characterized by extremely rapid developments.

Mikrobiyol Bul, 1993 Oct, 27(4), 314 - 20
{Determination of hepatitis B markers in previously diagnosed hepatitis patients during a one-year period}; Poyraz O et al.; In this study, total 1699 sera collected from patients suspected viral hepatitis were investigated by means of Hepatitis B markers by ELISA method between June 1991-June 1992 in Microbiology laboratory of Cumhuriyet University, Faculty of Medicine, Sivas . HBsAg, Anti-HBs and Anti-HBc IgM were screened as Hepatitis B markers . As a result, 16.9% of 1699 patients' sera were positive for HBsAg, 28.9% of 1318 sera were positive for Anti-HBs and 5% of 1056 sera were positive for Anti-HBc IgM . The results were discussed in terms of prevalence of Hepatitis B infection and carrier state.

Tuber Lung Dis, 1993 Oct, 74(5), 338 - 41
Comparative study of a biphasic culture system (Roche MB Check system) with a conventional egg medium for recovery of mycobacteria . Aichi Mycobacteriosis Research Group; Ichiyama S et al.; OBJECTIVE: The clinical utility of a new biphasic culture system (Roche MB Check system) for the recovery of mycobacteria was evaluated in comparison with a conventional egg based medium . DESIGN: A total of 905 clinical specimens (mainly sputum samples) were tested in 9 clinical microbiology laboratories in Aichi Prefecture, Japan . The recovery rate and detection time of mycobacteria from the specimens were compared between the biphasic system and the egg medium . RESULTS AND CONCLUSION: Of the 905 samples, 311 were positive in the culture of mycobacteria . The recovery rate of the biphasic system was superior to that of the egg medium (99.0% versus 74.0%, P < 0.0001) . In addition, the biphasic system showed a considerable decrease in the number of days required for isolation compared with the egg medium (18.8 days vs . 23.1 days for Mycobacterium tuberculosis, P < 0.0001; 13.4 days vs . 19.8 days for M . avium complex, P = 0.007) . The biphasic system is therefore proposed as a feasible and practical method for the recovery of mycobacteria from clinical specimens.

J Clin Microbiol, 1993 Oct, 31(10), 2769 - 72
Isolation of a DNA probe for identification of Mycobacterium kansasii, including the genetic subgroup; Yang M et al.; In order to develop a DNA-based assay to identify all Mycobacterium kansasii clinical isolates, a specific DNA probe was isolated in plasmid p6123 . A total of 145 M . kansasii clinical isolates were collected from several countries and were examined with three probes by DNA hybridization . Of the 145 isolates, 115 (79%) were positive with the previously described probe pMK1-9 (Z . H . Huang, B . C . Ross, and B . Dwyer, J . Clin . Microbiol . 29:2125-2129, 1991), 129 (88%) were positive with the commercial Accu-probe assay (Gen-Probe), and 145 (100%) were positive with the p6123 probe . Southern blot analysis of EcoRI-digested M . kansasii chromosomal DNA with p6123 revealed that all Accu-probe-positive M . kansasii strains exhibited a 3-kb fragment, whereas all Accu-probe-negative M . kansasii strains displayed DNA fragments of variable molecular sizes . These results indicate that, unlike the previously described probes for M . kansasii, the fragment cloned into p6123 identified all 145 biochemically typical strains tested and provides an ideal target for future DNA-based speciation assays.

J Clin Microbiol, 1993 Oct, 31(10), 2570 - 6
Polymorphism in ospC gene of Borrelia burgdorferi and immunoreactivity of OspC protein: implications for taxonomy and for use of OspC protein as a diagnostic antigen; Theisen M et al.; The nucleotide sequences of the ospC gene from five Danish human Borrelia burgdorferi isolates representing all three B . burgdorferi genospecies (B . burgdorferi sensu stricto, Borrelia garinii sp . nov., and group VS461) and from the American type strain B31 were determined and compared with the published ospC sequence from the German B . burgdorferi isolate PKo (R . Fuchs, S . Jauris, F . Lottspeich, V . Preac-Mursic, B . Wilske, and E . Soutschek, Mol . Microbiol . 6:503-509, 1992) . The ospC gene was present in all isolates, regardless of the presence or absence of its product, OspC . The deduced amino acid sequences of OspC from the seven isolates were aligned and revealed pairwise sequence identities ranging from 60.5 to 100% . Differences were scattered throughout the amino acid sequences . A phylogenetic tree was constructed and revealed three distinct phenotypic groups OspCI to OspCIII corresponding to the three delineated genospecies . Immunoblot analysis revealed that the seven OspC proteins tested have both common and specific epitopes . There is significant epitope diversity, since even polyclonal antisera showed serotype-restricted specificity . Therefore, a serodiagnostic assay for Lyme borreliosis utilizing OspC as a test antigen should include all three OspC phenotypes in order to obtain a species-wide sensitivity.

Appl Environ Microbiol, 1993 Oct, 59(10), 3438 - 46
Use of polymerase chain reaction and electroporation of Escherichia coli to monitor the persistence of extracellular plasmid DNA introduced into natural soils; Romanowski G et al.; A modified protocol for DNA amplification by polymerase chain reaction (PCR) coupled with laser densitometric determination of the amount of PCR products, which allowed quantitation of target sequence numbers in soil extracts, was developed . The method was applied to monitor target loss during incubation of purified plasmid DNA in natural nonsterile soils . It revealed soil-specific kinetics of target loss . After 60 days, 0.2, 0.05, and 0.01% of the initially added nahA genes on plasmids were detectable by PCR in a loamy sand soil, a clay soil, and a silty clay soil, respectively . Electroporation of Escherichia coli was used in parallel to quantitate plasmid molecules in soil extracts by their transforming activity . It was found that transformation by electroporation was about 20 times more efficient and much less inhibited by constituents of soil extracts than transformation of Ca(2+)-treated cells (G . Romanowski, M.G . Lorenz, G . Sayler, and W . Wackernagel, Appl . Environ . Microbiol . 58:3012-3019, 1992) . By electroporation, greater than 10,000-fold plasmid loss was monitored in nonsterile soils . Transforming activity was found up to 60 days after inoculation of the soils . The studies indicate that PCR and electroporation are sensitive methods for monitoring the persistence of extracellular plasmid DNA in soil . It is proposed that plasmid transformation by electroporation can be used for the monitoring in soil and other environments of genetically engineered organisms with recombinant plasmids . The data suggest that genetic material may persist in soil for weeks and even for months after its release from cells.

Appl Environ Microbiol, 1993 Oct, 59(10), 3273 - 9
Cloning of the Aspergillus parasiticus apa-2 gene associated with the regulation of aflatoxin biosynthesis; Chang PK et al.; An Aspergillus parasiticus gene, designated apa-2, was identified as a regulatory gene associated with aflatoxin biosynthesis . The apa-2 gene was cloned on the basis of overproduction of pathway intermediates following transformation of fungal strains with cosmid DNA containing the aflatoxin biosynthetic genes nor-1 and ver-1 . Transformation of an O-methylsterigmatocystin-accumulating strain, A . parasiticus SRRC 2043, with a 5.5-kb HindIII-XbaI DNA fragment containing apa-2 resulted in overproduction of all aflatoxin pathway intermediates analyzed . Specific enzyme activities associated with the conversion of norsolorinic acid and sterigmatocystin were increased approximately twofold . The apa-2 gene was found to complement an A . flavus afl-2 mutant strain for aflatoxin production, suggesting that apa-2 is functionally homologous to afl-2 . Comparison of the A . parasiticus apa-2 gene DNA sequence with that of the A . flavus afl-2 gene (G . A . Payne, G . J . Nystorm, D . Bhatnagar, T . E . Cleveland, and C . P . Woloshuk, Appl . Environ . Microbiol . 59:156-162, 1993) showed that they shared > 95% DNA homology . Physical mapping of cosmid subclones placed apa-2 approximately 8 kb from ver-1.

Int J Syst Bacteriol, 1993 Oct, 43(4), 839 - 40
Rickettsia massiliae sp . nov., a new spotted fever group Rickettsia; Beati L et al.; We propose the name Rickettsia massiliae sp . nov . (type strain, Mtu1 in the Collection of the World Health Organization Collaborative Center for Rickettsial Reference, Marseille, France) for a spotted fever group rickettsia determined to be distinct from previously recognized species by the serotyping method (L . Beati, J.-P . Finidori, B . Gilot, and D . Raoult, J . Clin . Microbiol . 30:1922-1930, 1992) . This rickettsia has biological characteristics similar to those of the other spotted fever group rickettsiae . In addition, a sodium dodecyl sulfate-polyacrylamide gel electrophoresis protein analysis, a polymerase chain reaction followed by a restriction fragment length polymorphism analysis of DNA fragments, and pulsed-field electrophoresis of the genome of R . massiliae revealed unique migration patterns distinct from those of all previously recognized spotted fever group rickettsiae . These additional characteristics (Beati et al., J . Clin . Microbiol . 30:1922-1930, 1992), together with the data usually considered sufficient for description of rickettsiae, are crucial to the proposal of this new species and should be helpful in species identification.

J Clin Pathol, 1993 Oct, 46(10), 890 - 5
Cost of gentamicin assays carried out by microbiology laboratories; Vacani PF et al.; AIMS--To assess the current range of prices charged for gentamicin assays in United Kingdom laboratories; and to examine the laboratories' likely response to increases or decreases in the demand for the service . METHODS--A postal survey of the 420 members of the Association of Medical Microbiologists was used to establish the range of prices charged for aminoglycoside assays . Additionally, eight private institutions were contacted to determine what the private sector was charging for aminoglycoside assays . Reagent costs in the NHS laboratories were calculated by dividing the total cost of all aminoglycoside assay kits by the number of samples analysed . RESULTS--The NHS and the private institutions both showed a wide price variation . Prices charged to an in-hospital requester for a peak and trough assay ranged from 5.00 pounds to 68.20 pounds (n = 44), and to an external private hospital, under a bulk service contract, from 5.00 pounds to 96.00 pounds (n = 47) . Prices charged by private laboratories ranged from 49.00 pounds to 84.00 pounds (n = 8) . There was a log linear correlation in the NHS laboratories between the reagent costs per assay and the number of assays performed per year, and most laboratories thought that their price per assay would be sensitive to increases or decreases in demand . Laboratories which had purchased their assay machines had lower reagent costs per assay but higher repair and maintenance costs . Overall, number of assays performed and method of payment for assay machinery only accounted for 44.8% of the observed variation in assay kit costs . CONCLUSIONS--The price range for gentamicin assays in the United Kingdom is wide and is only partially explained by the number of assays performed . Most laboratories believe that they would experience a reduction in unit cost as output increases . The currently offered range of prices is, in part, due to variation in the laboratories' approach to costing the service provided and some laboratories charge prices which do not even cover the cost of assay kits . Overall, we believe that prices charged should be as close as possible to the marginal cost of the tests performed.

Community Dent Oral Epidemiol, 1993 Oct, 21(5), 297 - 302
How Swedish dental hygienists apply their training program in the field; Axelsson P et al.; The purpose of this study was to evaluate how clinical practice by Swedish dental hygienists was related to type of dental delivery system, period of training, educational institution attended and patient category . Dental hygienists from 14 different dental hygiene schools were represented . Of these schools, 11 are still in operation . A specially designed questionnaire was posted to all dental hygienists in Sweden (n = 1857) . A total of 1399 questionnaire (75.3%) were completed and returned, providing data on 15,546 dental appointments . 37.2% of the Swedish dental hygienists are presently working in private practices, 45.8% in the public dental health service and 6.2% in both . Of the patients treated by hygienists, 88.7% were adults: 99.5% in private practice and 78.4% in the public dental health service . 42.0% of all dental hygienists were trained in 1980-84 . The mean treatment time per appointment in private practice was 49.7 min and 45 min in the public dental health service . Scaling, root-planning and removal of overhangs took 27 min per visit in private practice and 22 min in the public dental health service . However, there were no significant differences in methods in the two delivery systems with respect to examinations, self-care training, professional mechanical toothcleaning (PMTC), topical fluoride application, or salivary and oral microbiology tests . The adult patient categories were periodontal risk (45.1%), caries risk (9.1%) and hygiene (34.6%) . In periodontal risk patients, scaling, root-planning and removal of overhangs took 28 min per appointment and 14 min in caries risk patients.

Singapore Med J, 1993 Oct, 34(5), 409 - 11
Moraxella catarrhalis respiratory infection in adults; Chin NK et al.; Moraxella catarrhalis (MC) is an upper respiratory tract commensal which may also be pathogenic . In this report we examined the clinical features, microbiology and therapeutic response in 30 consecutive adult patients with pneumonia who had MC isolated in the sputum . The mean age was 66 years with an equal sex ratio . Most patients gave a history of cigarette smoking (77%) and had underlying pulmonary diseases (73%) . Dyspnea and productive cough were the most common complaints (87%) . Fever was a manifestation in 60% of patients . Chest X-ray features of pneumonia were noted in 78% of patients while leucocytosis (> 11,000/mm3) was evident in 70% . While all isolates were susceptible to tetracycline, 70% were resistant to penicillin/ampicillin by in-vitro testing . Three patients died, two from their underlying illnesses and one from myocardial infarct . We believe that MC isolated in sputum cultures from symptomatic adults with underlying respiratory diseases should be treated as a pathogen . The short term prognosis is good.

J Med Assoc Thai, 1993 Oct, 76 Suppl 2, 194 - 208
Laboratory investigation utilization in pediatric out-patient department Ramathibodi Hospital; Ruangkanchanasetr S; HYPOTHESES: Laboratory investigations are inappropriately utilized in the Pediatric OPD of Ramathibodi Hospital and this is due to lack of knowledge and unawareness of the cost of tests . OBJECTIVES: 1) To obtain information on laboratory utilization . 2) To evaluate the appropriateness of the residents' test ordering behavior . 3) To estimate the cost of unnecessary tests . 4) To reduce the utilization by combined education, feedback, and peer-review strategies . STUDY DESIGN: Randomized controlled trial carried out from January 1987 to May 1988, consisting of pre-intervention period (Jan-May 1987) . intervention period (June-November 1987), and post-intervention period (July 1987-May 1988) . STUDY POPULATION: There were 3 intervention groups and 3 control control groups which were stratified by level of seniority as 10 first year residents (R1I vs R1C), 8 second year residents (R2I vs R2C), and 18 staff (SI vs SC) . INTERVENTION: For the residents, education on diagnostic tests, chart audit and feedback on their test ordering behavior were provided twice a week . The second year residents also played an active role in giving comments on the first year residents' performances . For the staff, the strategy used was peer-review . The simulated cases derived from the actual medical records serviced by the residents were reviewed and rated, according to the appropriateness of the residents' test ordering behavior, from 0 (poor) to 10 (excellent) . A score of less than 5 was considered to indicate inappropriate ordering behavior . OUTCOME: 1) Numbers and cost of tests per patient for each group . 2) The achievement of a score indicating appropriate test ordering behavior of the resident groups . STATISTICAL ANALYSIS: Kruskal-Wallis test, Mann Whitney test, Wilcoxon test and Chi-square test . RESULTS: 1 . The utilization pattern was not correlated to the level of seniority of the physicians . 2 . There was inappropriate laboratory utilization in this group of residents: overutilization defined as should not be ordered (26.9%), and underutilization defined as should have been ordered (17.7%) . Most of the inappropriateness occurred in the ordering of microbiology (50%) and special blood chemistry (40%) . 3 . Only the number of tests per patient ordered by the R2I group was significantly lower than that of the R2C group in the late post-intervention period . The cost of tests per patient ordered by the R2C group was significantly increased as compared to their baseline . This suggested that the combination of education, chart audit and active feedback strategies was more effective than each strategy alone . 4 . The appropriateness of the test ordering behavior of the resident intervention groups improved during the post-intervention period, although the change was not statistically significant . The control groups' behavior was statistically worse . This suggested that the strategy prevented the inappropriateness of test ordering behavior . 5 . With the intervention, the overutilization significantly decreased while the underutilization increased . The underutilization might be a consequence of cost containment on laboratory utilization . 6 . The cost of unnecessary tests accounted for 17.6 per cent of the total cost of tests ordered by the residents.

Tidsskr Nor Laegeforen, 1993 Sep 20, 113(22), 2812 - 6
{Past and present--the roots of our modern concept of disease in 19th century clinical practice and science}; Sundstrom P; Historically speaking, our current clinical conceptions of disease are derived from 19th century science and clinical practice . In the early 19th century, large hospitals with hundreds of patients were erected for the first time . This provided "material" to which the physicians could apply their new diagnostic techniques and tools: percussion and auscultation, aided by the newly invented stethoscope . Eventually, what was found at the bedside was systematically compared with what was discovered on the autopsy table . This clinical research programme was challenged by, though later combined with, the experimental physiology and "laboratory medicine" of men like Francois Magendie and Claude Bernard . Their strong programme to introduce pure science, i.e . physics and chemistry, into medicine was paralleled by further developments in the old solidistic pathological tradition; an improved microscope and new techniques for preparing tissues for the microscope, led to the development of truly microscopic anatomy and cellular pathology . The idea that disease may be caused by microscopic living organisms was tested by means of strict experimental, scientific methods by men such as Louis Pasteur and Robert Koch; and our current conception of infectious disease is still very similar to that of the first microbiologists of the 1870s and 80s . The last 19th century root of our modern conceptions of disease discussed in the present essay is the visualization of the interior of the body--indeed, the visualization of disease--by X-rays.

J Biol Chem, 1993 Sep 15, 268(26), 19866 - 74
The firA gene of Escherichia coli encodes UDP-3-O-(R-3-hydroxymyristoyl)-glucosamine N-acyltransferase . The third step of endotoxin biosynthesis; Kelly TM et al.; The possibility that the firA gene of Escherichia coli (Dicker, I . B., and Seetharam, S . (1991) Mol . Microbiol . 6, 817-823) might function in lipid A biosynthesis was examined based on its homology to the lpxA gene, which encodes UDP-N-acetylglucosamine O-acyl-transferase, the first enzyme in lipid A formation . Extracts of a temperature-sensitive firA mutant, RL-25, were assayed for their ability to acylate UDP-GlcNAc, using a coupled assay . The results suggested that extracts of RL-25 might be defective in the third enzyme of this pathway, the UDP-3-O-(R-3-hydroxymyristoyl)-glucosamine N-acyltransferase . Living cells of RL-25 also displayed a 5-fold decreased rate of lipid A biosynthesis at the nonpermissive temperature as judged by a 32Pi incorporation assay . In order to examine N-acyltransferase activity directly, the substrate {alpha-32P}UDP-3-O-(R-3-hydroxymyristoyl)-GlcN was synthesized enzymatically . N-Acyltransferase specific activity in RL-25 extracts was reduced to less than 10% of wild-type . When the wild-type firA gene was cloned into a T7-based expression vector, N-acyltransferase specific activity increased almost 360-fold relative to wild-type extracts, demonstrating that firA is the structural gene for the enzyme . The N-acyltransferase displays absolute specificity for the R-3-OH moiety of R-3-hydroxymyristoyl-ACP, as does the O-acyltransferase, consistent with the placement of R-3-hydroxymyristate in E . coli lipid A.

Br Dent J, 1993 Sep 11, 175(5), 169 - 74
A randomised trial of co-amoxiclav (Augmentin) versus penicillin V in the treatment of acute dentoalveolar abscess; Lewis MA et al.; In a randomised, operator-blind, comparative clinical trial, the efficacy of co-amoxiclav (250 mg amoxycillin plus 125 mg clavulanic acid, eight-hourly) was compared to that of penicillin V (250 mg phenoxymethylpenicillin, six-hourly) in the treatment of acute dentoalveolar abscess . In each case surgical drainage was established at the time of initial presentation by incision of any soft tissue swelling, accompanied by either extraction of the tooth or extirpation of the pulp as indicated clinically . Each patient recorded the severity of their pain and swelling at eight-hourly intervals using graduated scales . Clinical review was performed after 1, 2 and 5 days of treatment, at which time sublingual temperature was recorded and the presence of cervical lymphadenopathy determined . A total of 79 patients were clinically assessable on Day 5 (co-amoxiclav, n = 41; penicillin V, n = 38) . The two groups were comparable for sex, age, presenting features and microbiology . Penicillin-resistant organisms were isolated from five patients (co-amoxiclav, n = 3; penicillin V, n = 2) . Symptoms improved in all patients following the start of treatment, however those receiving co-amoxiclav recorded a significantly greater decrease in pain during the second (P = 0.026) and third days (P = 0.025) . Only one patient reported a significant adverse effect associated with drug therapy, and this was in the penicillin group . Co-amoxiclav was as effective as penicillin therapy.

Commun Dis Rep CDR Rev, 1993 Sep 10, 3(10), R140 - 3
Human toxocariasis; Gillespie SH; Human toxocariasis is a zoonotic infection which characteristically presents either as visceral or ocular disease . Some patients are asymptomatic . The real incidence of symptomatic infection and its natural history, and the likelihood of congenital infection, are unknown . Collaboration between clinicians, epidemiologists and microbiologists should help to resolve these questions.

J Clin Microbiol, 1993 Sep, 31(9), 2523 - 5
Mucor ramosissimus Samutsevitsch isolated from a thigh lesion; Weitzman I et al.; Mucor ramosissimus Samutsevitsch is presented for the first time as an etiologic agent of cutaneous zygomycosis in a patient with aplastic anemia on immunosuppressive therapy . This report also represents the third case caused by this species reported in the literature . A biopsy taken from a lesion on the patient's thigh revealed broad, nonseptate, nonbranching hyphae compatible in morphology with a Zygomycete; M . ramosissimus was cultured twice from the thigh lesion . The patient was treated successfully with amphotericin B . Identifying features of M . ramosissimus include the following: numerous sporangia lacking columellae and resembling those of Mortierella spp., short, erect sporangiophores repeatedly branching sympodially; tough, persistent, and diffluent sporangial walls; numerous oidia in chains; extremely low colonies; and restricted growth at 36 degrees C . This paper describes the isolate and strives to alert the clinical microbiologist to this rarely reported pathogen.

Ginecol Obstet Mex, 1993 Sep, 61, 261 - 4
{Efficacy and safety of azithromycin in the treatment of female genital Chlamydia trachomatis infections}; Narcio Reyes LE et al.; Genital tract infections by Chlamydia trachomatis associated to sterility and infertility problems as well as perinatal complications have become increasingly frequent . Azithromycin is a new macrolide with a lower activity spectrum than erythromycin and a longer half life as well as less secondary effects . The objective of the study was to evaluate the safety and efficiency of Azithromycin on genital tract infection by C . trachomatis . MATERIAL AND METHODOLOGY . A total of 30 nonpregnant women between the ages of 19 and 35 were studied; 70% had only one sexual partner . In order to insure the presence of C . trachomatis as unique pathogen, cervicovaginal sampling, clinical evaluation and gynecologic exploration were undertaken . One dose of 1 g orally of Azithromycin was administered evaluating microbiologic and clinical remission at days 7-10, 12-16 and 33-37 after treatment . RESULTS . Two patients abandoned the study; global criteria of the evaluation were good to excellent in 17 cases; moderate to sufficient in six and poor in five . None of the cases reported secondary reactions . Results showed that Azithromycin treatment of cervicitis by C . trachomatis is useful with the advantage of unique dose administration.

Cleve Clin J Med, 1993 Sep-Oct, 60(5), 359 - 64
The role of azithromycin and clarithromycin in clinical practice; Goldman MP et al.; BACKGROUND: Azithromycin and clarithromycin are the newest approved macrolide antibiotics . OBJECTIVE: To review the pharmacology, microbiology, and clinical utility of these agents . SUMMARY: These agents have distinct advantages over erythromycin, including an improved pharmacokinetic profile, less toxicity, and a wider spectrum of activity . They are approved for the treatment of respiratory tract infections and uncomplicated skin and skin-structure infections associated with specific organisms . Azithromycin is also indicated for the treatment of nongonococcal urethritis . In addition, these agents may be useful in the treatment of toxoplasmosis, mycobacterial disease, Lyme disease, and legionellosis . Clarithromycin and azithromycin have lower rates of gastrointestinal side effects than erythromycin . CONCLUSIONS: Although clarithromycin and azithromycin show promise in the treatment of some less common infections, they should be considered alternatives to conventional agents in the treatment of respiratory tract, skin, and skin-structure infections caused by the usual pathogens . The expense of these agents may be prohibitive for routine use.

Carcinogenesis, 1993 Sep, 14(9), 1857 - 61
Isoenzyme shift from glucokinase to hexokinase is not an early but a late event in hepatocarcinogenesis; Klimek F et al.; The appearance of hepatocellular adenomas and carcinomas induced in rat liver with N-nitrosomorpholine is preceded by different types of preneoplastic foci consisting of phenotypically altered hepatocytes . The altered cells show changes in the activities of various enzymes including those of carbohydrate metabolism . Glucokinase is a type of hexokinase that is specific for hepatocytes . The enzyme plays a key role in glucose homeostasis in normal liver parenchyma and is replaced in the dedifferentiated hepatocytes of carcinomas by a low Km hexokinase . To determine the time course of the shift from glucokinase to this isoenzyme in the development of carcinomas, focal hepatic lesions were dissected from freeze-dried serial tissue sections by the laser-dissection method and studied by microbiochemical tests . In early clear and acidophilic cell foci that excessively stored glycogen (glycogenotic foci) a nearly normal glucokinase activity comparable with that of the surrounding hepatocytes was observed, whereas in the later appearing mixed cell foci a reduction in the activity of this enzyme without a compensatory increase in the hexokinase activity was found . A pronounced activity of hexokinase was only measurable in fully developed carcinomas . Since glucokinase is not modified at the post-transcriptional level, a gradual decrease in its mRNA during hepatocarcinogenesis can be assumed . A shift in gene expression from glucokinase to the isoenzyme hexokinase occurs only at the mixed cell foci/carcinoma transition step of the carcinogenic process.

J Dent Res, 1993 Sep, 72(9), 1304 - 9
An in vivo study of the influence of the surface roughness of implants on the microbiology of supra- and subgingival plaque; Quirynen M et al.; In nine patients with fixed prostheses supported by endosseous titanium implants, 2 titanium abutments (transmucosal part of the implant) were replaced by either an unused standard abutment or a roughened titanium abutment . After 3 months of habitual oral hygiene, plaque samples were taken for differential phase-contrast microscopy, DNA probe analysis, and culturing . Supragingivally, rough abutments harbored significantly fewer coccoid micro-organisms (64 vs . 81%), which is indicative of a more mature plaque . Subgingivally, the observations depended on the sampling procedure . For plaque collected with paper points, only minor qualitative and quantitative differences between both substrata could be registered . However, when the microbiota adhering to the abutment were considered, rough surfaces harbored 25 times more bacteria, with a slightly lower density of coccoid organisms . The presence and density of periodontal pathogens subgingivally were, however, more related to the patient's dental status than to the surface characteristics of the abutments . These results justify the search for optimal surface smoothness for all intra-oral and intra-sulcular hard surfaces for reduction of bacterial colonization and of periodontal pathogens.

Virology, 1993 Sep, 196(1), 294 - 7
Studies on the role of VP4 of G serotype 10 rotavirus (B223) in the induction of the heterologous immune response in calves; Xu Z et al.; In a previous study, convalescent antisera from gnotobiotic calves (GC) infected with the G10 serotype bovine rotavirus (B223) were found to neutralize a number of rotaviruses representing G1-G6 and G8-G10 serotypes, except for a G8 serotype 69M (Z . Xu et al., Vet . Microbiol., 1993) . In order to determine the immunodominant antigen, a panel of reassortants between B223 and 69M was generated and tested with the B223 GC antisera . It was found that the antisera neutralized the infectivities of the reassortants containing VP7 of B223 at titers similar to those with the parental virus B223, whereas the neutralization titers with the reassortants containing VP4 but not VP7 from B223 were significantly lower . These titers were close to the heterologous titers obtained with B641 (a G6 serotype rotavirus) against which B223 induced protective immunity . In contrast, the reassortants with both VP4 and VP7 from 69M were not neutralized by the B223 GC antisera . This indicates that the immunodominant neutralizing antigen during the primary immune response in calves is VP7 and the heterologous response is probably directed at VP4 . Evidence was obtained through a cross-reactive B223 VP4 monoclonal antibody (MAB), B223-N6, that a shared epitope exists among B223, B641, and various G serotype rotaviruses . These data support the conclusion that VP4 is an important antigen for G10 as well as G6 rotavirus immunity . The B223/69M reassortants were also assayed with two cross-reactive VP4 MABs B223-N6 and 2G4 . B223 VP7 was found to enhance the neutralization titers of the MABs with rotaviruses containing either homologous (B223) VP4 or the heterologous (69M) VP4.

Trans R Soc Trop Med Hyg, 1993 Sep-Oct, 87(5), 504 - 7
The microbiology of Mycobacterium leprae; progress in the last 30 years; Colston MJ; Over the last 30 years, there have been dramatic changes in the way Mycobacterium leprae is studied in the microbiology laboratory . The organism still has not been grown in vitro but, starting with demonstration of growth in the footpads of mice and culminating in the application of molecular biological and genetic techniques, we are now in a position to circumvent some of the difficulties arising from lack of cultivability . Such studies are providing us with new insights into the basic biology of the organism and are likely to provide new tools which will be of value in the clinical laboratory . In this article, I briefly outline the progress which has been made, and the potential applications of molecular techniques in such areas as bacterial identification and drug-resistance testing.

Jpn J Antibiot, 1993 Sep, 46(9), 818 - 26
{Reaction mechanism of macrolide 2'-phosphotransferase from Escherichia coli to the 2'-modified macrolide antibiotics}; O'Hara K; Reaction mechanism of macrolide 2'-phosphotransferase {MPH(2')} from Escherichia coli to the 2'-modified macrolide antibiotics was analyzed by using microbioassay, nuclear magnetic resonance (NMR) spectrometric assay and mass spectrometry . It was found by microbioassay that the 2'-modified macrolide antibiotics as triacetyloleandomycin (TAO), erythromycin ethyl succinate (EME) and erythromycin estolate were inactivated with adenosine triphosphate (ATP) by MPH(2') . The NMR spectrometric assay for the analysis of the reaction with the 2'-modified macrolide antibiotics and MPH(2') was established using guanosine triphosphate, which was higher reaction rate than ATP, as a cofactor . It was clearly shown by NMR spectrometric assay and mass spectrometry that the C2'-side chain of TAO and EME was naturally released in phosphate buffer solution, and then, the C2' position was phosphorylated with GTP by MPH(2').

Mt Sinai J Med, 1993 Sep, 60(4), 260 - 70
Free-living amebas of the genera Acanthamoeba and Naegleria: an overview and basic microbiologic correlates; Bottone EJ; Free-living amebas of the genera Acanthamoeba and Naegleria are allied in basic cell biology, ecology, and human disease-producing potential . However, several enigmas surrounding these amebas need further intellectual and scientific scrutiny . For instance, a clearer differentiation is needed of factors delineating pathogenic species--those most frequently associated with human infections--from nonpathogenic species . Further, have the pathogenic species bridged the gap in a step-wise fashion between their habitat and the human host to express their disease-producing potential? Second, what attributes of amebas account for the spectrum of disease caused by Acanthamoeba and Naegleria? In the brain, Naegleria is highly destructive of tissue in the course of a rapidly evolving, hemorrhagic primary meningoencephalitis in normal individuals . Central nervous system invasion by Acanthamoeba, however, occurs only in compromised hosts, and is a more slowly evolving subacute to chronic encephalitis . Further, the epidemiology of the infections are disparate . Naegleria is acquired from exposure to contaminated fresh water; this epidemiologic link is absent in Acanthamoeba meningoencephalitis . Naegleria invades the central nervous system via the olfactory nerve; Acanthamoeba is deposited in the central nervous system via hematogenous spread from a pulmonary or cutaneous focus . Additionally, Naegleria is apparently restricted to the brain; Acanthamoeba is not so bridled, and invades more sites in the human body . Finally, Acanthamoeba are beginning to appear opportunistically more frequently in patients infected with the human immunodeficiency virus . To avoid the same lack of effective therapeutics we still face in treating cryptosporidium infections in these patients, more emphasis must be placed on clinical trials dealing with the management of Acanthamoeba infections in patients with AIDS.

J Infect, 1993 Sep, 27(2), 219 - 23
The present and future role of the consultant physician with an interest in infection . Council of the British Society for the Study of Infection; Pharmacodynamics of antiretroviral chemotherapy; Division of Clinical Pharmacology, Albany Medical College, NY 12208It has been demonstrated that systemic exposure to antiretroviral agents drives both the therapeutic and the toxic effects seen in clinical trials . Consequently, it is necessary to determine plasma concentrations of drugs and their metabolites (and possibly intracellular concentrations) during the course of Phase 1 and 2 evaluations . It also has been demonstrated that having precise mathematical relationships between exposure and response as well as between exposure and toxicity allows rational selection of drug dose for evaluation in larger Phase 2 and 3 clinical trials . This can be seen with AZT, where the exposure-efficacy relationship is clearly at a plateau by 600 mg/day, while the exposure-toxicity relationship predicts increasing toxicity (and, because of the plateauing of the effect relationship, without better therapeutic response) . It can be seen most clearly with ddI, where the exposure-efficacy relationship pointed to longer-term therapy with lower doses ultimately being as efficacious as higher dose therapy . When coupled with the long-term tolerance data for ddI, this led to a prospective prediction of superiority of lower-dose therapy, which was validated later . Finally, some problems with current Phase 1 and 2 trial design have been pointed out, in that bioavailability needs to be recognized explicitly as an important evaluation factor in oral antiretroviral therapy . Perhaps most notably, the importance of initial susceptibility of the virus to the study drug has been suggested by the data of Drusano et al . Clearly, the microbiology of the patient needs to be taken into consideration in the evaluation of Phase 1 and 2 antiretroviral trial results.(ABSTRACT TRUNCATED AT 250 WORDS)

Appl Environ Microbiol, 1993 Sep, 59(9), 2771 - 6
Phenotypic characterization of copper-resistant mutants of Methylosinus trichosporium OB3b; Fitch MW et al.; Cultures of Methylosinus trichosporium OB3b grown in the presence of very low concentrations of copper synthesize a soluble methane monooxygenase (sMMO) that efficiently catalyzes the oxidation of trichloroethylene and other organic pollutants . Recently, we isolated five M . trichosporium OB3b mutants that express sMMO activity when grown in the presence of elevated copper concentrations (P.A . Phelps, S . K . Agarwal, G . E . Speitel, Jr., and G . Georgiou, Appl . Environ . Microbiol . 58:3701-3708, 1992) . Here we show that, in contrast to the results for the wild-type cells, the addition of copper to mutant cultures grown on methane and nitrate as the nitrogen source has no noticeable effect on the growth rate and sMMO expression . In vitro experiments indicated that the copper-resistant phenotype does not arise from an increased stability of sMMO to copper deactivation . Furthermore, the mutant cultures exhibit altered speciation of copper in the extracellular fluid and have substantially decreased levels of cell-associated copper . On the basis of these results, we propose that the mutant phenotype arises from defects in copper uptake and metabolism rather than from changes in sMMO expression or enzyme stability.

Am J Hosp Pharm, 1993 Sep, 50(9), 1889 - 95
Capability of hospital computer systems in performing drug-use evaluations and adverse drug event monitoring; Grasela TH et al.; A survey to determine the extent of computerization in key areas of hospitals, the information being collected in the databases, and the capabilities of the computer systems for performing adverse drug event monitoring and drug-use evaluations was conducted . The questionnaire was distributed to clinical pharmacists in the 500 hospitals composing the Drug Surveillance Network . In the majority of the 166 responding hospitals (> 85%), the pharmacy department, clinical chemistry and hematology laboratories, patient admissions, and microbiology laboratory were computerized for data acquisition and management . The medical records and purchasing departments were computerized in a smaller proportion of hospitals (75% and 74%, respectively) . In the majority of hospitals with a computerized pharmacy department (> 78%), there was ready access to computer databases in other departments, but simultaneous querying of multiple databases was possible in only 30% . Patients could be identified according to diagnosis in 82% of the hospitals and according to medication received in 83% . More than 85% of responding hospitals had implemented spontaneous reporting systems for the identification of adverse drug events . Computers are widely used in hospitals participating in the Drug Surveillance Network, but a substantial effort is necessary to make these resources more useful and to standardize processes so that data may be pooled across institutions to deal with important public health concerns.

J Hosp Infect, 1993 Sep, 25(1), 7 - 14
A prospective study of isolation of Moraxella catarrhalis in a hospital during the winter months; Ikram RB et al.; Sputum samples submitted to the microbiology laboratory from general medical and respiratory wards were monitored for Moraxella catarrhalis on a prospective basis . All isolates were typed by restriction endonuclease typing . Nosocomial spread was found both by the clustering of cases and typing of isolates . Sampling of the environment of some cases was performed . Seven out of 37 samples revealed environmental contamination . Sampling for persistence of the organism in the environment was positive on one occasion out of 13 . Evaluation of acquisition of M . catarrhalis in relation to length of stay showed that the average length of stay of a case with M . catarrhalis was considerably longer than average patient stay without M . catarrhalis . Four patients had two isolates available for typing . The type of M . catarrhalis was different on the second occasion to that on the first . Nosocomial spread of M . catarrhalis in the setting of general medical and respiratory wards was found to occur in the winter months.

J Hosp Infect, 1993 Sep, 25(1), 57 - 69
How to cost and fund an infection control programme; Mehtar S; Infection control (IC) services in the United Kingdom are provided as part of the microbiology services and therefore they have not, to date, been costed separately . This paper addresses the cost of providing the service, the savings that accrue from the IC policies in a hospital and, finally, the cost of infective episodes and outbreaks . The point of the exercise is to enable readers to cost their own services and separate the IC and microbiology budgets while maintaining the provision of service under one department.

J Biol Chem, 1993 Aug 15, 268(23), 17634 - 9
Isolation and characterization of LIP5 . A lipoate biosynthetic locus of Saccharomyces cerevisiae; Sulo P et al.; A number of mutants with pleiotropic effects on mitochondrial metabolism have been isolated in yeast Saccharomyces cerevisiae, and for many the biochemical function that is impaired is not yet known . We report here the isolation and characterization of the LIP5 gene involved in lipoic acid metabolism which complements the g189 mutant (Tzagoloff, A., and Dieckmann, C . L . (1990) Microbiol . Rev . 54, 211-225) . DNA sequence analysis of complementing yeast genomic DNA revealed an open reading frame predicting a protein of 414 amino acids . The protein sequence deduced from the gene shares 43% identical residues with the product of the Escherichia coli lip gene, which codes an enzyme involved in lipoic acid synthesis . The LIP5 mutant is not capable of synthesizing lipoic acid but still possesses the activity necessary for attachment of lipoic acid to protein . Relative to the E . coli lip gene product, the LIP5 protein has an amino-terminal extension with characteristics of mitochondrial targeting signals . Cells carrying a disrupted copy of the LIP5 gene show slow growth on ethanol-rich media and barely detectable growth on glycerol-rich media . Unlike other strains with defects in the tricarboxylic acid cycle, LIP5 mutants undergo a high frequency of mitochondrial DNA deletions.

MMWR Recomm Rep, 1993 Aug 6, 42(RR-12), 1 - 39
Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993 . Centers for Disease Control and Prevention; Negative cytology preceding cervical cancer: causes and prevention; Department of Cytopathology, Belfast City HospitalAIM--To assess the validity of negative cervical smear reports in women who subsequently developed cervical cancer; and to determine means of improving the screening process . METHODS--One hundred and forty cervical smears, initially reported as negative from 103 women, and taken up to 12 years before diagnosis of cervical cancer, were reviewed . RESULTS--Ninety two smears contained dyskaryotic cells . Analysis showed that these smears formed several well defined patterns . False negative reports were likely to occur if fragments of neoplastic tissue rather than dissociated dyskaryotic cells were present or if the smear contained few dyskaryotic cells . Screening fatigue appeared to be a factor in others . It was also considered important that smears contained cells from the endocervix . These were deficient in 64% of the 47 smears confirmed as negative on review and in 69% of smears containing only a few dyskaryotic cells . CONCLUSIONS--Current methods of quality assurance will not remedy these defects in the screening process . It is the responsibility of laboratories to identify sources of poor smears and liaise with smear takers to ensure an improvement in quality . Assessment of the quality of smears received by a laboratory should become an important part of audit . Staff training should place more emphasis on the interpretation of "microbiopsies" . The adoption of a quick scanning technique before conventional screening would probably also substantially reduce false negative results.

Infect Immun, 1993 Aug, 61(8), 3382 - 91
Multiple determinants of verotoxin-producing Escherichia coli O157:H7 attachment-effacement; Dytoc M et al.; Verotoxin-producing Escherichia coli strains of the serotype O157:H7 belong to a class of gastrointestinal pathogens that adhere to epithelial cells in a characteristic pattern known as attaching and effacing . Recent insight into the nature of E . coli O157:H7 adhesion was provided by the cloning and sequencing of the chromosomal eaeA (for E . coli attaching and effacing) gene homolog (G . Beebakhee, M . Louie, J . De Azavedo, and J . Brunton, FEMS Microbiol . Lett . 91:63-68, 1992, and J . Yu and J . B . Kaper, Mol . Microbiol . 6:411-417, 1992) and isolation of a 60-MDa plasmid referred to as pO157 (I . Toth, M . L . Cohen, H . S . Rumschlag, L . W . Riley, E . H . White, J . H . Carr, W . W . Bond, and I . K . Wachsmuth, Infect . Immun . 58:1223-1231, 1990, and S . Tzipori, H . Karch, K . I . Wachsmuth, R . M . Robins-Browne, A . D . O'Brien, H . Lior, M . L . Cohen, J . Smithers, and M . M . Levine, Infect . Immun . 55:3117-3125, 1987) and an approximately 94-kDa outer membrane protein (94-kDa OMP; P . Sherman, F . Cockerill III, R . Soni, and J . Brunton, Infect . Immun . 59:890-899, 1991) . In this study, we examined the gene products of both eaeA and pO157 in relation to the 94-kDa OMP and as candidate effectors for O157:H7 attachment-effacement . Peptide sequencing and immunoassay demonstrated that the C . coli O157:H7 eaeA gene product is distinct from the 94-kDa OMP . Using ultrastructural analyses, we found that both parent and pO157 plasmid-cured O157:H7 strains demonstrated attaching and effacing adhesion to host epithelial cells and reacted equally well to rabbit antiserum raised against the 94-kDa OMP . By both transmission electron microscopy and light microscopy, E . coli HB101 transformed separately with the cloned eaeA gene and the pO157 plasmid did not form attaching and effacing lesions on cultured epithelial cells in vitro and rabbit intestinal tissues in vivo . Since additional determinants may mediate the attaching and effacing phenotype, we examined transposon TnphoA mutants constructed from E . coli O157:H7 strain CL8 . Two TnphoA mutants were found deficient in bacterial factors that are necessary for O157:H7 attachment-effacement and likely distinct from the eaeA gene product.

Infect Control Hosp Epidemiol, 1993 Aug, 14(8), 481 - 7
Tuberculosis, infection control, and the microbiology laboratory; Stratton CW; The diagnosis of tuberculosis is an increasingly important problem confronting the clinical microbiology laboratory as well as hospital epidemiologists . The inherent delays in conventional laboratory procedures for the isolation and susceptibility testing of M tuberculosis may contribute directly to the spread of tuberculosis . Application of newer methods that are more rapid is essential if the spread of tuberculosis is to be limited . Hospital epidemiologists and clinical microbiology laboratories should work together to critically examine all of their current procedures for tuberculosis and take steps to correct or improve all omissions and delays in mycobacterial tests ordering, collection, testing, and reporting.

Infect Control Hosp Epidemiol, 1993 Aug, 14(8), 463 - 8
Prolonged and multipatient use of prefilled disposable oxygen humidifier bottles: safety and cost; Henderson E et al.; OBJECTIVES: Multipatient use and prolonged use of prefilled disposable oxygen humidifier bottles (Aquapak 301, Respiratory Care, Inc., Arlington Heights, IL) were evaluated by performing microbiologic monitoring and a cost analysis on bottles used for varying numbers of patients and lengths of time . METHODS: Humidifiers were hung for a maximum of one month . Monitoring was conducted in 6 different nursing areas . Quantitative cultures were done for aerobes and Legionella . Reusable humidifier bottles also were monitored . RESULTS: Cultures were obtained from 1,311 disposable and 60 reusable humidifiers . No significant bacterial contamination was detected in the prefilled disposable oxygen humidifier units . Ten percent of the reusable bottles were contaminated by organisms associated with skin flora . CONCLUSIONS: Multipatient use and increased duration of use of disposable humidifiers result in cost savings without increasing patient risk . Restricted multipatient use of prefilled disposable oxygen humidifier bottles for a period of one month is a safe and cost-efficient practice.

J Clin Microbiol, 1993 Aug, 31(8), 2241 - 3
Seroepidemiological study of African horse sickness virus in The Gambia; Staeuber N et al.; An indirect enzyme-linked immunosorbent assay was used for the screening of horse sera from The Gambia for antibodies against African horse sickness virus (AHSV) . The AHSV antigen used for coating was semipurified according to the method of Manning and Chen (Curr . Microbiol . 4:381, 1980); control mock-infected Vero cell antigen was treated in the same manner . A total of 459 horse serum samples were assayed at a single dilution (1:10), and their reactivities were compared with those of reference positive anti-AHSV and reference negative horse sera . A total of 81% of the horse serum samples clearly contained antibodies against AHSV; this consisted of 18% (of the total number of serum samples) strongly positive, 46.5% moderately positive, and 16.5% weakly but still clearly positive . Such results suggest a high prevalence of AHSV in the regions from whence the samples originated . Reports from investigations in other countries in this area of West Africa have also shown a high prevalence for anti-AHSV antibodies in equids . The question is raised as to how the animals became seropositive and whether the observations represent an increased resistance of horses living in a region in which AHS is enzootic.

Appl Environ Microbiol, 1993 Aug, 59(8), 2493 - 500
Stereochemistry during aflatoxin biosynthesis: cyclase reaction in the conversion of versiconal to versicolorin B and racemization of versiconal hemiacetal acetate; Yabe K et al.; (1'R,2'S)-(-)-aflatoxins are produced from racemic versiconal hemiacetal acetate (VHA) through complicated pathways, including a metabolic grid involving VHA, versiconol acetate (VOAc), versiconol, and versiconal (VHOH), and a reaction sequence from VHOH to versicolorin A (VA) through (-)-versicolorin B (VB) {or (+/-)-versicolorin C} (K . Yabe, Y . Ando, and Y . Hamasaki, J . Gen . Microbiol . 137:2469-2475, 1991; K . Yabe, Y . Ando, and T . Hamasaki, Agric . Biol . Chem . 55:1907-1911, 1991) . In this study, we examined stereochemical changes of substances formed during the conversion of VHA to VA by using chiral high-performance liquid chromatography . In cell-free experiments using the cytosol of Aspergillus parasiticus NIAH-26, both (2'S)- and (2'R)-VOAc enantiomers were formed at about a 1:2 ratio from racemic VHA in the presence of NADPH and dichlorvos (dimethyl 2,2-dichlorovinylphosphate) . Also, the esterase activity catalyzing the conversion of VHA to VHOH or of VOAc to versiconol did not show the stereospecificity for the 2' carbon atom of VHA or VOAc . However, when racemic VHA or racemic VHOH was incubated with the cytosol, (1'R,2'S)-(-)-VB was formed exclusively . Furthermore, only (1'R,2'S)-(-)-VB, and not (1'S,2'R)-(+) antipode, served as a substrate for desaturase activity in the microsome fraction catalyzing the conversion of VB to VA . These results demonstrate that the stereoconfiguration of bis-furan moiety in aflatoxin molecules is determined by the cyclase enzyme catalyzing the reaction from VHOH to VB, and the (1'R,2'S)-(-) configuration was further confirmed by the subsequent desaturase reaction . Remarkably, we found nonenzymatic racemization in both the (2'R)- and (2'S)-VHA enantiomers, and it was dependent upon the temperature and alkaline conditions.

Emerg Med Clin North Am, 1993 Aug, 11(3), 601 - 19
Hand infections; Moran GJ et al.; Special approaches are required for management of infected wounds involving the hand . Care must be taken to consider involvement of joint, bone, and tendon, or tendon sheath as well as deep fascial spaces . The hand is also prone to infections with unusual microbiology that can result from animal and human bites as well as soil, plant, and water exposures . The special anatomic and microbiologic considerations are critical for selection of proper surgical and medical therapy to preserve function of this vital structure.

Ophthalmology, 1993 Aug, 100(8), 1238 - 43
Acanthamoeba keratitis . The value of early diagnosis; Bacon AS et al.; BACKGROUND: The treatment of Acanthamoeba keratitis has been increasingly successful as diagnoses are made earlier . The authors investigated features of the disease and prognosis in a consecutive series of 15 patients who were treated within 1 month of initial symptoms . METHODS: A database of patients with Acanthamoeba infection presenting between March 1984 and March 1992 was analyzed . The recognition, presenting features, culture methods, results, and treatment of the early cases were reviewed to determine the reasons for a good outcome . RESULTS: Recognition depended on perineural infiltrates (11/15), uveitis (10/15), limbitis (14/15), and infiltrated epithelium; 6 of 15 patients had epithelial defects, but only 3 of 15 had ring infiltrates or ulcers . Epithelial biopsy was culture-positive in 12 of 15 patients . Most (11/15) patients needed only two anti-amebal drugs . One patient only required penetrating keratoplasty for uncontrolled disease . The final visual acuity was at least 6/12 in all patients who had been treated within 1 month of first symptoms, whereas only 17 (53%) of 32 eyes of patients who presented after 1 month achieved a visual acuity of 6/12 . CONCLUSIONS: Subtle diagnostic signs, supported by comprehensive microbiologic investigation, justify the immediate instigation of specific antiamebal therapy . Treatment within 1 month of onset results in a lower morbidity and a good visual outcome.

Eur J Surg, 1993 Aug, 159(8), 399 - 404
Pulmonary infections of gut origin after major liver resection in rats; Wang X et al.; OBJECTIVE: To assess the incidence of translocation of enteric bacteria to the lungs in the early postoperative period (1, 2, 4, and 6 hours) after sham operation, 70% hepatectomy, and 90% hepatectomy . DESIGN: Randomised laboratory experiment . SETTING: University department . MATERIAL: 96 Adult male Sprague-Dawley rats . INTERVENTIONS: Sham operation (n = 24), 70% hepatectomy (n = 36), and 90% hepatectomy (n = 36) . Injection of 1 ml (1.5 x 10(7) cpm/rat) 125I-labelled heat-killed Escherichia coli 15 minutes before the animals were killed . MAIN OUTCOME MEASURES: Arterial blood gas analyses, wet: dry weight ratio of lungs, and measurements of pulmonary isotopic flux (amount of 125I radioactivity in the lungs compared with that in the blood) 1, 2, 4, and 6 hours after operation . Quantitative microbiology of lungs . RESULTS: There was no pulmonary oedema in those rats that underwent sham operation . Pulmonary oedema had developed by 6 hours after 70% hepatectomy and by 2 hours after 90% hepatectomy . The lung:blood ratio of 125I-labelled bacteria increased as the pulmonary oedema developed, but pulmonary oxygen exchange was not influenced during the first 6 hours after hepatectomy . The incidence of bacterial translocation increased with the extent of hepatectomy and with the length of time after operation . CONCLUSION: Bacterial translocation from the gut could lead to pulmonary infection after major liver resection in rats.

J Assist Reprod Genet, 1993 Aug, 10(6), 427 - 33
Trophectoderm microbiopsy in murine blastocysts: comparison of four methods; Carson SA et al.; PURPOSE: This study compares four trophectoderm microbiopsy techniques for removal of blastomeres from murine blastocysts: (1) aspiration, trophectoderm pipetted through the zona; (2) incision, trophectoderm excised with a microrazor; (3) slit/excision, the zona slit and herniating trophectoderm excised; and (4) hatch/excision, trophectoderm cells excised after spontaneous hatching . RESULTS: Murine blastocysts were comparatively biopsied using one of four methods and contrasted to zona slit and nonmicromanipulated controls . Operative cellular injury was assessed by uptake of fluorescein isothiocyanate (FITC) . Postoperative embryonic viability was assessed by blastocoele reexpansion and hatching inner cell mass development and trophectoderm plating . All techniques yielded cells available for genetic analysis . CONCLUSIONS: The slit/excision technique and hatch/excision techniques exhibited lower operative injury and the higher postoperative viability than aspiration or incision . The slit/excision and the hatch/excision techniques, though requiring two operative steps, appear to be the least damaging of the four methods . Therefore, they should be most applicable to human blastocysts obtained either by extended culture in vitro or by uterine lavage.

Virology, 1993 Aug, 195(2), 521 - 31
A strongly immunoreactive virion protein of human herpesvirus 6 variant B strain Z29: identification and characterization of the gene and mapping of a variant-specific monoclonal antibody reactive epitope; Pellett PE et al.; We previously identified a 101-kDa apparent molecular mass polypeptide (101K) as the major immunoreactive virion protein of human herpesvirus 6 variant B strain Z29 {HHV-6B(Z29)} and found that the human immune response to this protein is HHV-6-specific (Yamamoto, M., Black, J . B., Stewart, J . A., Lopez, C., and Pellett, P . E., 1990, J . Clin . Microbiol . 28, 1957-1962) . We report here the identification and characterization of the gene encoding 101K . We found 81% amino acid identity between an HHV-6B(Z29) open reading frame (ORF) and its homolog in HHV-6A strain U1102 {HHV-6A(U1102)} . The product of this gene was identified as 101K on the basis of both the reactivity of a 101K-specific monoclonal antibody (MAb C3108-103) with a bacterially expressed portion of the gene and the reactivity of polyclonal rabbit antibodies raised against the bacterially expressed protein with 101K expressed by HHV-6B(Z29)-infected cells . MAb C3108-103 reacted with eight of eight variant B isolates and none of six variant A isolates, indicating that it is a variant-specific MAb . The MAb reactivity was mapped to an eight-amino-acid segment of 101K . HHV-6A(U1102) differs from HHV-6B(Z29) by two amino acids in this region; substitution mapping with synthetic oligopeptides mapped the variant B specificity to Asp723, this explaining the failure of the MAb to react with variant A proteins . A set of transcripts appropriately sized for expression of 101K was identified and precisely mapped . The transcripts originated down-stream from either of two TATA boxes located 139 bp apart in the region 5' to the 101K ORF, with one 5'-species being much more abundant . Two independent polyadenylation sites were identified; the canonical polyadenylation signal located 3' to the 101K ORF was used much more frequently than was the atypical polyadenylation signal located within the 101K ORF . These results suggest a complex regulatory mechanism for this gene.

Commun Dis Rep CDR Rev, 1993 Jul 16, 3(8), R107 - 10
Cat scratch disease and bacillary angiomatosis: aetiological agents and the link with AIDS; Birtles RJ et al.; The recent characterisation of a new species of the genus Rochalimaea is the culmination of a ten year search for the identity of the agent of bacillary angiomatosis, a condition that is increasingly recognised in association with AIDS . This work has also implicated Rochalimaea henselae in the aetiology of cat scratch disease contact with cats is a risk factor for both conditions . This report describes both diseases and reviews progress toward understanding their microbiology . R . quintana is also implicated as an agent of bacillary angiomatosis and was recognised much earlier as the cause of trench fever.

J Infect Dis, 1993 Jul, 168(1), 112 - 9
Randomized, placebo-controlled trial of rifampin, ethambutol, and ciprofloxacin for AIDS patients with disseminated Mycobacterium avium complex infection; Jacobson MA et al.; Patients with AIDS and disseminated Mycobacterium avium complex (MAC) infection received rifampin (600 mg) plus ethambutol (25 mg/kg) plus ciprofloxacin (750 mg) or matching placebos daily for 8 weeks . Patients were monitored every 2 weeks clinically and by quantitating MAC colony-forming units (cfu) per milliliter of blood . Analysis of baseline characteristics revealed no significant differences between groups . After 8 weeks, MAC cfu had decreased by > or = 1 log/mL in 4 of 9 treated patients versus 0 of 10 placebo recipients while increasing by > or = 1 log/mL in 1 and 7, respectively (P = .006) . While the average combined clinical response score declined in both groups, it tended to decrease less in treated patients (P = .36) . On the other hand, dose-limiting toxicity (primarily nausea and adverse drug interactions) occurred in 9 of 12 treatment versus 1 of 12 placebo patients (P = .005) . Combined rifampin {corrected}-ethambutol-ciprofloxacin therapy for disseminated MAC infection had significant microbiologic efficacy with some evidence of clinical efficacy but was associated with drug intolerance.

J Bacteriol, 1993 Jul, 175(13), 3949 - 56
Isolation and properties of a mutant of Escherichia coli with an insertional inactivation of the uspA gene, which encodes a universal stress protein; Nystrom T et al.; Cells of Escherichia coli increase greatly the synthesis of a small cytoplasmic protein as soon as the cell growth rate falls below the maximal growth rate supported by the medium, regardless of the condition inhibiting growth . The gene, designated uspA (universal stress protein A), encoding this protein has been cloned and mapped, and its nucleotide sequence has been determined (T . Nystrom and F.C . Neidhardt, Mol . Microbiol . 6:3187-3198, 1992) . We now report the isolation of an E . coli mutant defective in UspA synthesis because of insertional inactivation of the corresponding gene . Analysis of such a mutant demonstrated that it grows at a rate indistinguishable from that of the isogenic parent but lags significantly when diluted into fresh medium, regardless of the carbon source included . In addition, the mutant exhibits a diauxic type of growth when grown on certain single substrates, such as glucose and gluconate . This growth phenotype was found to be the result of abnormal metabolism of the carbon source (e.g., glucose) accompanied by excretion into the medium of acetate . The diauxic type of growth may be attributed to the failure of cells to form acetyl coenzyme A synthetase and to form isocitrate lyase and malate synthase of the glyoxalate bypass, needed for the assimilation of the produced acetate, until glucose or gluconate has been completely exhausted . The uspA mutant appears to dissimilate glucose at an elevated rate that is not commensurate with its biosynthetic processes . These results suggest that the role of protein UspA may be to modulate and reorganize the flow of carbon in the central metabolic pathways of E . coli during growth arrest.

Ginekol Pol, 1993 Jul, 64(7), 345 - 8
{Vulvovaginitis in girls . II . Microbiology of the vagina}; Szczurowicz A et al.; The paper subjects the results of vaginal biocenosis examinations and cultures of vaginal excretions at the group of 277 girls to the detailed analysis . It was proved, that candidiasis was four time frequently present than trichomoniasis, among specific infections . Infections caused only by non-specific bacteria were found in 17.3% . Mixed infections--jointly with specific factor, mostly with candidiasis, were two times frequently present . It was proved, that exclusively non-specific or specific infections were more frequent at girls not treated with antibiotics . Frequency of coexistence of specific and non-specific infections significantly increased with the age.

J Heart Lung Transplant, 1993 Jul-Aug, 12(4), 599 - 603
Aspergillosis with Aspergillus osteomyelitis and diskitis after heart transplantation: surgical and medical management; Hummel M et al.; This is the report of a 49-year-old man, who could be cured of aspergillosis with Aspergillus osteomyelitis and diskitis of the lumbar spine by medical and surgical therapy after heart retransplantation . Aspergillus osteomyelitis and diskitis is a rare complication of invasive aspergillosis . Lumbar involvement is the main manifestation, followed by rare locations in the tibia, ribs, wrist, sternum, pelvis, and knee . It is nearly always secondary to pulmonary aspergillosis, which occurs in about 6% to 14% of patients after heart transplantation . For treatment, a combined surgical and medical approach is recommended, which enables quick pain relief for the patient and histologic and microbiologic diagnosis and stabilization of the spine . Because of definitive cure of osteomyelitis cannot be guaranteed by removal of the abscess, medical therapy after surgery is necessary for years.

New Microbiol, 1993 Jul, 16(3), 293 - 5
Assessment of the "Amplicor" PCR test in the diagnosis of Chlamydia trachomatis infection; Rumpianesi F et al.; We compared a commercially available PCR assay (Amplicor, Roche, Switzerland) and tissue culture isolation for the detection of C . trachomatis in urethral and/or endocervical swabs . Of the 200 patients studied (130 men and 70 women) PCR and tissue culture gave concordant results in 199 cases; in one case PCR was positive and culture negative . The Amplicor PCR assay proved fast and sensitive and suitable for routine use in most clinical microbiology laboratories.

Microsc Res Tech, 1993 Jul 1, 25(4), 314 - 24
Software for counting cells and estimating structural volumes with the optical disector and fractionator; Bolender RP et al.; We describe MS-DOS software for the optical volume fractionator (OVF), a stereological method combining the principles of the optical disector (Gundersen et al.: Acta Pathol . Microbiol . Immunol . Scand., 96:857-881, 1988) and fractionator (Gundersen: J . Microsc., 143:3-45, 1986) . The OVF program estimates the volume of a fixed and embedded structure, the numerical density of cells, and the total number of cells in a structure . The hardware requirements include a PC computer (386 or 486 with VGA graphics) and a conventional light microscope fitted with a rotating stage, extension tube, and length gauge . The software includes an introduction, tutorial, simulator, laboratory tool kit, and report generator . The tool kit improves the efficiency of gathering stereological data with light microscopy and offers a convenient link between the data of light and electron microscopy . A novel algorithm, based on fractionator sampling, gives the volume of a fixed and embedded structure from the same set of sections used for cell counting . A laboratory example illustrates the operation of the software.

J Clin Microbiol, 1993 Jul, 31(7), 1777 - 82
Direct detection of Mycobacterium tuberculosis in sputum by polymerase chain reaction and DNA hybridization; Nolte FS et al.; A polymerase chain reaction (PCR) assay for the rapid diagnosis of pulmonary tuberculosis was developed by using oligonucleotide primers to amplify a fragment of IS6110, an insertion sequence repeated multiple times in the chromosome of Mycobacterium tuberculosis . Sediment obtained from sputa processed by the N-acetyl-L-cysteine-NaOH method was suspended in a simple lysis buffer and was heated at 100 degrees C for 30 min prior to amplification . A dUTP-uracil N-glycosylase PCR protocol was used to prevent false-positive test results because of the carryover of products from previous amplification reactions . The 317-bp amplicon was detected by direct gel analysis and Southern blotting and then hybridization with a biotin-labeled internal probe . Hybrid molecules were detected by using a commercially available avidin-alkaline phosphatase-chemiluminescent substrate system (Tropix, Inc., Bedford, Mass.) . The analytical sensitivity of the assay was 10 fg of purified mycobacterial DNA . The limits of detection by culture (Middlebrook 7H11 agar and Lowenstein-Jensen medium) and by PCR were equivalent in terminal dilution experiments for organism suspensions and positive sputa . An internal control was used to detect the presence of amplification inhibitors in each negative reaction mixture . DNA was purified from inhibitory specimens by phenol-chloroform extraction and ethanol precipitation . PCR results were compared with results of microscopy and conventional culture for the detection of M . tuberculosis in 313 sputum specimens . There were 124 specimens that were positive for M . tuberculosis by conventional methods and 113 (91%) that were positive by PCR . PCR detected 105 of 110 (95%) of the smear-positive and 8 of 14 (57%) of the smear-negative specimens . There were no false-positive results by PCR (specificity, 100%) . This PCR assay innovations that make application of this new technology feasible in clinical microbiology laboratories.

Am J Obstet Gynecol, 1993 Jul, 169(1), 71 - 7
Parturitional factors associated with membrane stripping; McColgin SW et al.; OBJECTIVE: Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated . STUDY DESIGN: Thirty patients were randomly divided among a study population and two control groups to assess uterine contractions and microbiologic, histologic, and biochemical markers associated with parturitional events over a 7-hour time frame . RESULTS: Clinically, an increased frequency of uterine contractile activity was observed among patients in the membrane-stripped group (p < 0.03) . There was a significant increase in plasma 13,14-dihydro-15-keto-prostaglandin F2 alpha (p < 0.001) and endocervical phospholipase A2 activity (p < 0.04) among those who underwent membrane stripping . Blood leukocyte counts, sedimentation rates, prostaglandin E2 metabolite concentrations, and fibronectin levels revealed no significant change during the 7-hour study session . CONCLUSION: Membrane stripping was associated with increases in phospholipase A2 activity and prostaglandin F2 alpha concentrations, indicating a possible correlation with initiation of the cascade of parturitional events.

J Bacteriol, 1993 Jul, 175(13), 4165 - 75
In vivo and in vitro studies of a copy number mutation of the RepA replication protein of plasmid pSC101; Xia G et al.; The RepA replication protein of plasmid pSC101 binds as a monomer to three repeated sequences (RS1, RS2, and RS3) in the replication origin of the plasmid to initiate duplication and binds as a dimer to two inversely repeated sequences (IR1 and IR2) in its promoter region (D . Manen, L . C . Upegui-Gonzalez, and L . Caro, Proc . Natl . Acad . Sci . USA 89:8923-8927, 1992) . The binding to IR2 autoregulates repA transcription (P . Linder, G . Churchward, G . X . Xia, Y . Y . Yu, and L . Caro, J . Mol . Biol . 181:383-393, 1985) . A mutation in the protein RepA(cop) that affects a single amino acid increases the plasmid copy number fourfold . In vivo experiments show that, when provided in trans under a foreign promoter, the RepA(cop) protein increases the replication of a plasmid containing the origin of replication without repA, whereas it decreases the repression of its own promoter . In vitro experiments show that the purified RepA(cop) protein binds more efficiently to the repeated sequences within the origin than does RepA and that its binding to these sequences is more specific than that of RepA . Binding to an inversely repeated sequence within the repA promoter gives opposite results: the wild-type protein binds efficiently to that sequence, whereas the mutated protein binds less efficiently and less specifically . Footprint experiments confirmed these results and, in addition, showed a difference in the pattern of protection of the inversely repeated sequences by the mutant protein . Equilibrium binding experiments showed that the formation of protein-probe complexes at increasing concentrations of protein had a sigmoidal shape for binding to RS sequences and a hyperbolic shape for binding to IR sequences . The results, together with earlier work (G.-X . Xia, D . Manen, T . Goebel, P . Linder, G . Churchward, and L . Caro, Mol . Microbiol . 5:631-640, 1991), confirm that the binding of RepA to RS sequences plays a crucial role in the regulation of plasmid replication and that its binding to IR sequences plays a role in the autoregulation of RepA expression . They also demonstrate that the two separate functions of the protein are effected by two different forms of binding to the target sites.

Am Rev Respir Dis, 1993 Jul, 148(1), 6 - 9
Drug-resistant tuberculosis in Puerto Rico, 1987-1990; Grandes G et al.; We conducted a proportional morbidity study to determine the factors associated with, patterns of, and proportion of cases of tuberculosis with drug resistance in Puerto Rico . We abstracted data from 279 report forms of new cases of tuberculoses reported to the Puerto Rico Health Department between 1987 and 1990 in which isolates had been tested for drug susceptibility . Overall, 55 (19.7%) of the 279 cases of tuberculosis were resistant to at least one drug, and 27 (9.7%) were resistant to more than one drug . Among the 59 patients with previous tuberculosis therapy, 20 (33.9%) had isolates that were drug-resistant . Among the 220 without previous therapy, 35 (15.9%) had isolates that were drug-resistant . For all 279, resistance to isoniazid (INH) was most common (11.1%) followed by streptomycin (SM) (10%), rifampin (RIF) (4.3%), ethambutol (EMB) (2.2%), and pyrazidimide (PZA) (1.1%) . A history of previous tuberculosis therapy (odds ratio {OR} = 2.71, 95% confidence interval {CI} = 1.34-5.48) and being born outside the United States and Puerto Rico (OR = 4.76, CI = 1.69-13.39) were independently associated with drug resistance . Because of the high proportion of drug-resistant tuberculosis in Puerto Rico we recommend (1) that all persons in Puerto Rico in whom tuberculosis is diagnosed should initially receive four-drug therapy (INH, RIF, EMB, and PZA), (2) that susceptibility testing be done on initial Mycobacterium tuberculosis isolates from all patients, and (3) that those with a history of previous tuberculosis therapy or those who are foreign-born have very careful clinical and microbiologic follow-up.

Stomatologiia (Mosk), 1993 Jul-Sep, 72(3), 27 - 30
{The prevention and treatment of patients with suppurative-inflammatory diseases of the maxillofacial area by using vibromassage at autoresonance frequencies}; Iunuskhodzhaev E; Autoresonance frequency vibromassage sessions were administered to patients with pyoinflammatory processes in maxillofacial soft tissues . Comprehensive examinations of these patients were carried out to assess the efficacy of this treatment modality; the examinations included rheographic and ultrasonic examinations of blood flow intensity, analysis of neutrophilic activity by chemiluminescence amplitude, measurements of trypsin inhibitor levels and cholinesterase activity, assessment of wound exudate pH values and of resorption capacity of purulent wound tissues . Microbiologic, histologic, cytologic, clinical and biochemical studies were carried out . The findings permit a conclusion that autoresonance vibromassage enhanced biologic purification of the wound from pyonecrotic mass and accelerated reparative regeneration.

J Antimicrob Chemother, 1993 Jul, 32(1), 101 - 8
Effect of morphine or phenobarbital on teicoplanin elimination pharmacokinetics; Fan-Havard P et al.; Elimination kinetics following a single dose of teicoplanin in rats pre-treated with morphine sulphate (MS), phenobarbital sodium (Pb), and normal saline (NS) were determined . A microbioassay was used to measure teicoplanin levels . A significant increase in the total clearance of teicoplanin was found in rats pre-treated with MS as compared to controls (P < 0.048) . Wide variability was observed in the renal and non-renal clearances of teicoplanin . The mean renal clearance for rats pre-treated with MS, Pb and NS was 0.61 +/- 0.07.mL/min/kg, 0.60 +/- 0.13 mL/min/kg, and 0.46 +/- 0.02 mL/min/kg, respectively; the mean non-renal clearance was 0.33 +/- 0.18 mL/min/kg, 0.17 +/- 0.15 mL/min/kg, and 0.08 +/- 0.03 mL/min/kg, respectively . The differences among the groups for renal and non-renal clearance were not statistically significant . The mean apparent volume of distribution of teicoplanin at steady state was significantly lower in the Pb-pre-treated rats as compared to controls (P < 0.043) . The mean half-life for MS-, Pb-, and NS pre-treated groups was 8.1 +/- 3.1 h, 5.9 +/- 3.3 h, and 34.6 +/- 20.7 h, respectively . The differences in mean half-life among the groups achieved statistical significance (P < 0.016) . The increase in the total clearance of teicoplanin can best be explained by an increase in both renal elimination and hepatic metabolic pathways.

Rev Argent Microbiol, 1993 Jul-Sep, 25(3), 129 - 35
{Incidence of various etiologic agents of superficial mycosis}; Canteros CE et al.; In a retrospective review of laboratory records at the Department of Mycology, National Institute of Microbiology "Dr . Carlos G . Malbran", during the period June 1989-July 1991, 1225 putatively immunocompetent cases of superficial mycoses were identified . Ninety five percent of these patients were adults and 5% children . Among the total cases, dermatomycoses were caused, 67.6% by dermatophytes, 25.9% by yeasts, 5.9% by Malassezia furfur . and 0.5% by other fungi, as proven by the isolation of the etiological agents . (Figure 1, Table 2) . Among the dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes greatly predominated accounting for 66.6% and 20.0% of the isolates, respectively, whereas Microsporum canis (8.0%) . Epidermophyton floccosum (5.1%) and Microsporum gypseum (0.3%) were found with less frequency (Figure 2) . Nails (47%) were the most common source of isolates in adults, followed by feet (28%), smooth skin (15%), groin (5%) and hands (2%) (Table 1) . Regarding the relative efficiency of the diagnostic methods, the analyses of laboratory results evidenced that, 98% of the cases with clinical findings compatible with mycoses and 76% of the cases with positive cultures (Table 1) were identified by microscopic observation.

J Clin Microbiol, 1993 Jul, 31(7), 1783 - 7
Identification of feline- and canine-like rotaviruses isolated from humans by restriction fragment length polymorphism assay; Vonsover A et al.; Restriction fragment length polymorphism assay of reverse-transcribed and polymerase chain reaction-amplified rotavirus gene segment 9 was developed to differentiate human serotype 3 rotaviruses from animal serotype 3 rotaviruses . On the basis of similarities or differences in HinfI and DdeI restriction profiles, unusual group A serotype 3 human rotaviruses that belonged to subgroup I were shown to be of feline and canine origin . By this approach, the new human rotavirus isolates 5193, AU-387, AU-720, AU-785 and AU-1115 were shown to resemble certain feline-like human rotaviruses . Similar results were previously obtained by Nakagomi et al . (O . Nakagomi, A . Hoshima, Y . Aboudy, I . Shif, M . Mochizuki, T . Nakagomi, and T . Gotlieb-Stematsky . J . Clin . Microbiol . 28:1198-1203, 1990) by using RNA-RNA cross hybridization with established feline rotaviruses . The restriction fragment length polymorphism assay can provide fast and valuable information on the interspecies transmission of rotaviruses in nature.

J Antimicrob Chemother, 1993 Jul, 32(1), 71 - 82
The inhibitory effect of spermicidal agents on replication of HSV-2 and HIV-1 in-vitro; Jennings R et al.; Five spermicides including nonoxynol-9 were assessed under in-vitro conditions, for their inhibitory activity against two viruses capable of spread by sexual intercourse, herpes simplex virus type-2 (HSV-2) and the human immunodeficiency virus type-1 . A further eight commercially-available spermicidal preparations containing varying concentrations of either nonoxynol-9 or nonoxynol-11 were also assessed for activity against HSV-2 . All spermicides and spermicidal preparations tested showed inhibitory activity against both viruses over periods of time ranging from 30 sec to 5 min . This activity was dependent on the concentration of spermicide to which the viruses were exposedPIP: In England, microbiologists at the University of Sheffield Medical School diluted herpes simplex virus-2 (HSV-2) in Eagle's Basal Medium + 5% fetal calf serum to a final concentration of 1 x 100,000 plaque-forming units/ml and HIV-1 in RPMI 1640 medium to a final concentration of 1 x 100,000 syncytium-forming units/ml . They wanted to study the inhibitory activity of the spermicidal agents nonoxynol-9, nonoxynol-11, benzalkonium chloride, menefegol, and sodium docusate . A concentration of pure nonoxynol-9 of .025% was the minimum concentration needed to inactivate HSV-2 in vitro, which was 4-160 time slower than concentrations of proprietary nonoxynol-9 preparations (2-8%) needed to have the same effect in vitro . The minimum concentration of nonoxynol-11 and benzalkonium chloride needed to inactivate HSV-2 in vitro was also .025% . Sodium docusate had a 2.5 times greater ability to inactivate HSV-2 in vitro than did nonoxynol-9 and nonoxynol-11 and benzalkonium chloride (minimum concentration = .01%) . The minimum concentration of menfegol needed to inactivate HSV-2 in vitro was lower than that of the other spermicidal agents (.1%, a concentration 4 times lower than that of nonoxynol-9) . All the spermicidal agents effective at inactivating HSV-2 did so in at least 30 seconds . The minimum concentration of nonoxynol-9 needed to maximally inactivate HIV-1 in vitro was .025% . it did so in 30 seconds . The lowest concentration of sodium docusate, menfegol, and benzalkonium chloride necessary for in vitro HIV-1 inactivation was also .025% (minimum time: 30 seconds for the first 2 spermicides and 2.5 minutes for the third) . These findings suggest that spermicidal agents have virucidal capabilities .

Arch Intern Med, 1993 Jun 14, 153(11), 1301 - 10
Infections due to penicillin-resistant pneumococci . Clinical, epidemiologic, and microbiologic features; Caputo GM et al.; Pneumococcal infection remains a common cause of serious morbidity and mortality throughout the world . Until recently, clinical isolates of pneumococci that were penicillin resistant were rare . However, 4% to 5% of the clinical isolates in the United States were recently found to be either intermediately resistant or highly resistant to penicillin . Clinicians in every field of medicine must therefore be better informed regarding penicillin-resistant pneumococcal infections to minimize their attendant morbidity and mortality and increase compliance with preventive measures . We reviewed the molecular, genetic, and epidemiologic aspects of penicillin-resistant pneumococcal infections, with emphasis on their microbiologic and clinical features.

Can Assoc Radiol J, 1993 Jun, 44(3), 215 - 6
Spinal epidural abscess: unusual CT and microbiologic findings; Browman MW et al.; The incidence of spinal epidural abscess is increasing . Its expeditious diagnosis is essential if treatment is to be effective . The authors present a case in which both the computed tomography appearance and the microbiologic observations were unusual.

Am J Clin Nutr, 1993 Jun, 57(6), 884 - 8
Stability of n-3 fatty acids in human fat tissue aspirates during storage; Deslypere JP et al.; The content of n-3 (omega 3) polyunsaturated fatty acids in fat tissue is an indicator of their long-term consumption . Therefore, a method for determining n-3 fatty acids in human fat tissue microbiopsies was validated and the stability of n-3 fatty acids in biopsies was checked under various conditions of storage . Methyl esters were prepared from 25 to 35 mg adipose tissue and separated by capillary gas chromatography . Recovery of added eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) was 98-105% . The change after storage of fat samples at room temperature or at 4, -20, or -80 degrees C for 3 mo averaged +3.3% for EPA and +2.1% for DHA, with no effect of temperature . Storage at +20 or -80 degrees C for 7 mo yielded no perceptible change in EPA, DHA, or five other n-3 polyunsaturated fatty acids . EPA and DHA concentrations in adipose tissue aspirates are remarkably stable and deserve attention as biomarkers in epidemiological studies.

Plast Reconstr Surg, 1993 Jun, 91(7), 1294 - 302
Vascular prosthetic complications: success of salvage with muscle-flap reconstruction; Evans GR et al.; Prosthetic vascular complications such as exposure and infection represent one of the most challenging and devastating complications in surgery . Nineteen patients underwent a retrospective review of the efficacy of soft-tissue flap coverage in the management of vascular prostheses complications . These patients were divided into three groups . Group 1 included 14 patients with documented culture-positive infection . Group 2 comprised 4 patients with culture-negative exposed grafts . Group 3 included 1 patient with autogenous vein and documented culture-positive infection . The most common vascular procedure requiring flap reconstruction was aortobifemoral in groups 1 and 2 . One femoral-distal reconstruction was performed in group 3 . Graft complications occurred at an average of 4.8 months after vascular reconstruction in group 1, 11 months in group 2, and 1 month in group 3 . Follow-up was obtained on all patients . Initial flap reconstruction was successful in 43 percent of group 1, 100 percent of group 2, and 100 percent of group 3 . Reoperative therapy for flap coverage in group 1 was successful in 62.5 percent . Overall, 79 percent of patients obtained a closed wound after reconstructive attempts in group 1 . Recurrence appeared to be independent of graft material, microbiology, or graft location . Debridement and muscle coverage of exposed or infected vascular grafts has produced clinical salvage.

Contraception, 1993 Jun, 47(6), 559 - 67
Efficacy of thermoplastic elastomer and latex condoms as viral barriers; Kettering J; The barrier efficacy of a thermoplastic elastomer (TPE) and three brands of latex condoms was compared in a passive-leak test and in a dynamic model of simulated intercourse . Fifteen replicates of each of the condoms were challenged with bacteriophage T7 (100 nm) and the polio virus Type 1 (PV-1, 27 nm) . In the passive test, no condom leaked either virus . In the dynamic model, no TPE condoms leaked either virus and no latex condoms leaked T7 . Two samples of one commercially available latex condom leaked T7 but not PV-1 . These data support that intact latex condoms are effective in vivo viral barriers and extend the finding to TPE condoms as well . Given its substantial equivalence to latex as a viral barrier, TPE condoms are an alternative choice for individuals with latex allergies . The TPE material is also more resistant to common environmental conditions that affect latex adversely and should therefore be a superior choice if condoms must be stored for extended periods in suboptimal conditionsPIP: A microbiologist at Loma Linda University in California used T7 (100 nm), a virulent bacteriophage of Escherichia coli, and the poliovirus type 1 (PC-1) (27 nm) to compare the efficacy of the viral barrier of latex and new thermoplastic elastomer (TPE) condoms . The scientist used a passive test and a simulated intercourse model to compare the 2 condom types . The simulation consisted of a condom-covered disposable centrifuge tube with 4 ml of virus which was inserted into an outer condom with 2 ml of virus-free medium . This apparatus was withdrawn and inserted 30 times within 30 seconds into a commercially produced latex vagina . The tests with T7 used 15 condoms of each brand . The tests with PV-1 used 14 condoms of each brand . The only TPE condom brand was Tactylon . Latex condom brands were Shiek, Trojan-Enz, and Lifestyles . No virus passed through the barrier during the passive test . T7 leaked through 2 latex condoms (13.3%) of the same brand (Trojan-Enz) during the simulated intercourse test . On the other hand, PV-1 did not leak through any of the condoms . Tactylon effectively prevented the passage of both T7 and PV-1 . These findings confirmed that latex condoms tend to block passage of both small and large viruses . They indicated that TPE condoms also block passage of small and large viruses . Thus, the effective maximum pore size in all of the TPE condoms and in all but 2 of the latex condoms was too small to let HIV (80-120 nm) and hepatitis B virus (about 42 nm) filter through . Clinical trials have indicated the breakage rate of TPE condoms is not significantly different from that of latex condoms . Advantages of the TPE condom are its ability to resist environmental effects, e.g., ultraviolet light and heat, which deteriorate the latex condom and it does not have antioxidants and accelerators the latex condom has which cause allergic reactions, e.g., dermatitis .

J Bacteriol, 1993 Jun, 175(12), 3798 - 811
Involvement of Escherichia coli FIS protein in maintenance of bacteriophage mu lysogeny by the repressor: control of early transcription and inhibition of transposition; Betermier M et al.; The Escherichia coli FIS (factor for inversion stimulation) protein has been implicated in assisting bacteriophage Mu repressor, c, in maintaining the lysogenic state under certain conditions . In a fis strain, a temperature-inducible Mucts62 prophage is induced at lower temperatures than in a wild-type host (M . Betermier, V . Lefrere, C . Koch, R . Alazard, and M . Chandler, Mol . Microbiol . 3:459-468, 1989) . Increasing the prophage copy number rendered Mucts62 less sensitive to this effect of the fis mutation, which thus seems to depend critically on the level of repressor activity . The present study also provides evidence that FIS affects the control of Mu gene expression and transposition . As judged by the use of lac transcriptional fusions, repression of early transcription was reduced three- to fourfold in a fis background, and this could be compensated by an increase in cts62 gene copy number . c was also shown to inhibit Mu transposition two- to fourfold less strongly in a fis host . These modulatory effects, however, could not be correlated to sequence-specific binding of FIS to the Mu genome, in particular to the strong site previously identified on the left end . We therefore speculate that a more general function of FIS is responsible for the observed modulation of Mu lysogeny.

Enferm Infecc Microbiol Clin, 1993 Jun-Jul, 11(6), 321 - 3
{Conjunctival ophthalmomyiasis caused by Oestrus ovis}; Clavijo E et al.; BACKGROUND: Microbiologic diagnosis of conjunctival ophthalmomyiasis . MATERIAL AND METHODS: Material extracted from three patients' conjunctiva who complained of sudden presence of foreign body and were diagnosed as conjunctival ophthalmomyiasis has been studied . Patients were recruited over two months from the Emergency Department . Diagnosis was performed through observation using the light microscope . RESULTS: Oestrus ovis first-instance larvas were observed in all the samples studied . CONCLUSIONS: This observation of similar cases in a short period of time and the low frequency of diseased people who lived in a urban environment makes necessary to think in this agent as cause of ophthalmomyiasis in our area and therefore perform an adequate differential diagnosis.

Infect Dis Clin North Am, 1993 Jun, 7(2), 377 - 92
Legionella and the clinical microbiologist; Winn WC Jr; Legionella species are important etiologic agents of sporadic and epidemic community-acquired and nosocomial respiratory disease . The list of species continues to expand, and tools for classification and characterization of isolates have become increasingly sophisticated . These organisms are associated with aquatic habitats and are transmitted by aerosol or direct contact . Bacterial culture is the cornerstone of laboratory diagnosis . Careful surveillance of infections is important, because infections potentially can be prevented.

Infect Dis Clin North Am, 1993 Jun, 7(2), 331 - 57
Microbiologic diagnosis of ventilator-associated pneumonia; Baselski V; Specific etiologic diagnosis in ventilator-associated pneumonia is critical to optimal patient care, and a wide array of microbiologic procedures are available to aid in diagnosis . In bacterial infection, direct stains, particularly the Gram stain, provide rapid presumptive information, and cultures provide definitive identification . Specimen selection is critical; endotracheal or ordinary bronchoscopic aspirates provide nonspecific information, and quantitative analysis of protected specimen brushes or bronchoalveolar lavage provides more accuracy . Specialized procedures for other groups of organisms, such as Chlamydia, Legionella, mycobacteria, fungi, and viruses, also may be indicated in some cases.

Infect Dis Clin North Am, 1993 Jun, 7(2), 171 - 81
DNA hybridization techniques and their application to the diagnosis of infectious diseases; Tenover FC; Several commercial DNA probe assays are widely used in clinical microbiology laboratories . These include culture-confirmation assays for Mycobacterium species, which are recommended by CDC because they are both rapid and accurate, and culture-confirmation assays for N . gonorrhoeae . Probe assays for direct detection of N . gonorrhoeae and C . trachomatis are also widely used in public health and large reference laboratories . In many cases, the probe assays have decreased the time to identification of positive cultures and improved detection of these pathogens because they do not depend on the presence of viable organisms to achieve a positive result . Nucleic acid amplification assays hold promise for the rapid detection and identification of many infectious agents . PCR using universal primers enables researchers to identify new agents of disease that cannot be cultured in vitro; more importantly, PCR provides a method for detecting the presence of any bacterial species, including common organisms, in normally sterile body fluids, such as blood and cerebrospinal fluids . The use of such primers may well give PCR the broad-based approach needed to identify organisms in the clinical microbiology laboratory of the future.

Rev Esp Enferm Dig, 1993 Jun, 83(6), 415 - 20
{Detection of serum IgG (ELISA) against Helicobacter pylori: relationship with age and gastroduodenal disease}; Pozuelo MJ et al.; OBJECTIVE . An attempt was made to investigate the serological response against Helicobacter pylori by using a IgG serum detection technique (ELISA Biometra) to establish a relationship with age and gastroduodenal pathology . The serological response was compared with the microbiologic and histologic studies of biopsy samples from 4 locations in each patient: duodenal bulb, gastric antrum, corpus and fundus . PATIENTS . A total of 309 patients with gastrointestinal symptoms who underwent an upper digestive endoscopy were included . RESULTS . The overall sensitivity of the serological technique (cut-off value 15 U/ml) was 89.3%, the specificity 75.7%, the positive predictive value 96.9% and the negative predictive value 45.4% . The mean titer in patients with a negative microbiology increased with age: 13.5 U/ml, 14-30 years; 10.0 U/ml, 31-50 years; 18.5 U/nl, 51-65 years and 29.2 U/ml, > 65 years . By increasing the cut-off value to 20 and 30 U/ml in the last two age groups, the specificity increased without a significant decrease in the sensitivity . Patients without abnormal findings at endoscopy had mean titers considerably lower (64.7 U/ml) than those with the stomach resected -Billroth I or II- (99.6 U/ml) and those with gastritis, duodenitis and ulcus (86.7-83.1 U/ml), Patients with gastritis but without acute inflammatory activity had mean titers (62.5 U/ml) lower than those observed in patients with active gastritis (p < 0.01) and increased in parallel with the increasing activity of gastritis . In contrast, patients with atrophic gastritis had the lowest mean titers (54 U/ml) . CONCLUSIONS . Our results suggest that the cut-off value in the serological technique should be increased according to the patient's age . Moreover, there is a clear relationship between the serum levels of IgG and the activity of gastritis.

J Periodontol, 1993 Jun, 64(6), 529 - 37
Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth: stereologic and histologic observations in cynomolgus monkeys (Macaca fascicularis); Schou S et al.; The aim of the investigation was to provide quantitative and qualitative histologic data on marginal inflammation around osseointegrated implants . The significance of the lack of a periodontal ligament in the initial breakdown phase of supporting tissues in implants was examined by comparing stereologic and histologic manifestations of ligature-induced marginal inflammation around osseointegrated implants with those around ankylosed and normal control teeth in 8 cynomolgus monkeys (Macaca fascicularis) . Clinical and radiographic findings have been reported elsewhere . The marginal connective tissue around ligated implants was infiltrated by a significantly increased total number of lymphocytes, plasma cells, and neutrophils compared to non-ligated implants and teeth . The total number of lymphocytes around ligated implants was significantly higher than around ligated ankylosed and normal control teeth . There were, however, no significant differences in the total number of plasma cells and neutrophils within the ligated group . Osteoclasts were exclusively observed around ligated implants and ankylosed teeth . Although variations in microbiota and susceptibility of different jaw positions to periodontal break-down may influence the results of the present study, the results seem to substantiate the theory that marginal inflammation around implants and ankylosed teeth may have more serious implications than does marginal inflammation around teeth with a periodontal ligament . Since presence of osteoclasts was not related to the absence of cervical cementum with inserting gingival fibers around ligated ankylosed teeth, the increased susceptibility of bone loss of implants is probably not caused by the absence of these tissue components . In contrast, the histologic observations seem to support that the increased susceptibility for bone loss around implants may be related to the absence of a periodontal ligament.

J Periodontol, 1993 Jun, 64(6), 509 - 19
A 2-year study of adjunctive minocycline-HCl in Actinobacillus actinomycetemcomitans-associated periodontitis; Muller HP et al.; To study the effects of a step-wise treatment regimen on Actinobacillus actinomycetemcomitans-(Aa) associated periodontitis, 4 clusters among 33 patients harboring the organism were followed during successive periods of systemic minocycline plus mechanical debridement and minocycline plus modified Widman flap treatment . Localized periodontitis was found in 2 clusters, one with 7 localized juvenile periodontitis patients and a 24-year old male with localized destruction and extremely low plaque levels (LJP), and the other consisting of 10 patients with plaque and gingivitis and a wider age range (16 to 54 years, LP) . Generalized severe and moderate periodontitis was found in 2 clusters which were further discriminated by severe gingivitis and high levels of supragingival plaque (9 patients, GSP), and mild inflammation and low plaque levels (6 patients, GMP) . Mean percentages of Aa, as determined by selective cultivation of microbiota from at least 2 periodontal pockets of 6 mm or more were 63, 16, 33, and 7.8% in the clusters (P < 0.01) . Six months after active treatment, Aa was present in 6/9 patients and 50% of sites in GSP, and 3/6 patients and 46% of sites in GMP patients . In contrast, the organism was virtually eliminated by scaling and flap procedures in the localized periodontitis clusters, and did not reappear after 6 months (P < 0.05) . Combined antibiotic, mechanical, and surgical therapy resulted in a persistence of 20% of sites with residual probing depth of > or = 4 mm in GMP patients after active therapy . At this point, 3 of the GMP patients and 1 GSP patient left the study . Multiple regression analysis showed a significant influence of log-transformed numbers in Aa in cheek and saliva samples at the end of the study, and cluster on the percent residual number of sites with periodontal probing depth of > or = 7 mm (P < 0.001) . The present results suggest that the applied therapy would be appropriate in localized forms of Aa periodontitis, but inappropriate in more severe and generalized forms to predictably eliminate Aa . Controlled long-term studies with larger groups of patients will be needed to establish the difference in treatment response suggested by these studies.

Addiction, 1993 Jun, 88(6), 729 - 44
The post-repeal eclipse in knowledge about the harmful effects of alcohol; Katcher BS; National Prohibition in the USA (1919-1933) was followed by an era in which medical scientists played an important role in minimizing the harmful effects of alcohol . Cirrhosis, cardiomyopathy, adverse fetal effects, and esophageal cancer are examples of alcohol-related health problems that were well known at the beginning of the 20th century but were dismissed during the late 1930's and early 1940's, only to be rediscovered during the 1960's and afterwards . This eclipse in knowledge occurred because of skepticism about earlier claims that had been made in the name of scientific temperance and, most importantly, because of changing standards for medical evidence . The paradigm for disease causation that gave birth to modern medicine was based on microbiology and reinforced by hormone and nutrition discoveries . Most alcohol-related health problems are poorly explained by this paradigm . The more recent epidemiologic paradigm for noninfectious disease is more applicable to the health risks associated with heavy drinking . A transformation of knowledge about alcohol's relationship to disease has occurred.

Cent Eur J Public Health, 1993 Jun, 1(1), 31 - 4
Rapid species identification of wild mycobacterial isolates by monoclonal antibodies in ELISA; Krest'anpol M et al.; An enzyme-linked immunosorbent assay (ELISA) for the identification of cultured mycobacteria belonging to the Mycobacterium tuberculosis complex and Mycobacterium kansasii originally described by R . Schoningh, C . P . J . H . Verstijnen, S . Kuijper and A . H . J . Kolk (1) was used for identification of mycobacteria from three week old primary cultures . A panel of six monoclonal antibodies (MoAbs) was used: two were specific for Mycobacterium tuberculosis (M . tuberculosis) complex, one for M . kansasii, one was directed against M . avium complex and two were broadly reacting with all mycobacterial species . The ELISA was introduced to a microbiology laboratory located in an area where M . kansasii infections are endemic . All acid-fast bacteria isolated from sputum samples over one month period were identified by ELISA and culture . All fifteen M . tuberculosis isolates and all seventeen M . kansasii were correctly identified by ELISA before culture results were known . Two of three M . avium complex strains could be identified in ELISA as belonging to the M . avium complex using the M . avium complex specific monoclonal antibody.

Hua Xi Yi Ke Da Xue Xue Bao, 1993 Jun, 24(2), 206 - 8
{Study on degradation of phenols in water}; Luo Y et al.; The degradation of phenols in water and the effects of microbiolism, pH and dissolved oxygen (DO) on the degradation were investigated . The results showed that the degradation of phenols in water was mainly that of biochemistry, which depends on the existence of microbiolism . The most suitable pH for the degradation was 6 to 9, and no effects of DO on it were found . The accustomization of microbiolism with phenols would accelerate the degradation.

J Clin Microbiol, 1993 Jun, 31(6), 1615 - 8
Characterization of Mycobacterium tuberculosis strains from Vietnamese patients by Southern blot hybridization; Yuen LK et al.; A total of 41 Mycobacterium tuberculosis strains from patients of Vietnamese origin were analyzed by Southern blot hybridization with two different probes, IS6110 (Otal, I., et al., J . Clin . Microbiol . 29:1252-1254, 1991; Ross, B . C., et al., J . Clin . Microbiol . 30:942-946, 1992; Thierry, D., et al., J . Clin . Microbiol . 28:2668-2673, 1990; van Soolingen, D., et al., J . Clin . Microbiol . 29:2578-2586, 1991) and pTBN12 (Ross, B . C., et al., J . Clin . Microbiol . 30:942-946, 1992) . The restriction fragment patterns of nine of these strains were virtually identical when the pTBN12 probe was used; five strains had a single copy of IS6110, and four strains failed to hybridize with the IS6110 probe . This relatively high frequency of strains with no or one copy of IS6110 suggests that the usefulness of IS6110 for epidemiological study may be limited in certain populations.

Infect Immun, 1993 Jun, 61(6), 2289 - 95
Protective anti-idiotype antibodies in the primate model of pyelonephritis; Kaack MB et al.; The adherence of P-fimbriated Escherichia coli to a receptor containing alpha-D-Gal-(1-4)-beta-D-Gal (Gal-Gal) on urothelial cells is an important pathogenic mechanism in the development of pyelonephritis . Antibodies (Ab1) that had been produced by immunization with Gal-Gal conjugated with bovine serum albumin were specifically purified and used to stimulate the production of anti-idiotypic antibodies (Ab2) in cynomolgus monkeys (Macaca fascicularis) . While sera from all of the Ab2-producing monkeys contained antibodies reactive with Ab1 and P-fimbriae, not all of the sera inhibited P-fimbrial binding to the Gal-Gal receptor . On the basis of the inhibition of binding, Ab2-producing monkeys were divided into two groups, termed reactive and nonreactive . The reactive and nonreactive Ab2-producing monkeys, together with a group of control monkeys, were challenged with a renal inoculation with P-fimbriated Escherichia coli . Hematologic, immunologic, microbiologic, and pathologic data were compared among the three groups . The reactive monkeys, whose Ab2 in serum inhibited binding between P-fimbriae and the Gal-Gal receptor, were protected against renal damage compared with the control group . The nonreactive group shared some parameters with the reactive group but overall developed renal damage comparable to that of the controls.

Commun Dis Rep CDR Rev, 1993 May 21, 3(6), R75 - 8
Application of information technology to the laboratory reporting of communicable disease in England and Wales; Grant AD et al.; The transmission of laboratory reports from diagnostic medical microbiology laboratories to the PHLS Communicable Disease Surveillance Centre (CDSC) is a major component of surveillance of communicable disease in England and Wales . Information on more than 3800 types of organism is held on the CDSC database (labBASE) . The volume of reporting has risen steadily during the last 17 years and electronic reporting via epiBASE is beginning to replace postal reporting . Computers are used extensively to collate and analyse data for surveillance reports which are disseminated via the Communicable Disease Report, Epinet and other means . Recent developments include the computer-aided detection of temporal clusters and the establishment of an electronic library of surveillance data.

Biochim Biophys Acta, 1993 May 8, 1177(1), 37 - 42
The relationship between L-arginine-dependent nitric oxide synthesis, nitrite release and dinitrosyl-iron complex formation by activated macrophages; Vanin AF et al.; We identified the source of the nitrogen included into nitric oxide (NO) and studied the relationship between formation of NO, intracellular dinitrosyl ferrous iron complex (DNIC) and release of nitrite by murine bone-marrow-derived macrophages stimulated with E . coli lipopolysaccharide (LPS) . NO was trapped in the cell membrane by iron-diethyldithiocarbamate complex (FeDETC) and was detected as a paramagnetic NOFe(DETC)2 complex by electron paramagnetic resonance (EPR) spectroscopy . Macrophages stimulated for 7 h up to 48 h with LPS and then incubated for 2 h with DETC exhibited an anisotropic EPR signal of axial symmetry with g-factor values g perpendicular = 2.035, g parallel = 2.02 and a triplet hyperfine structure (hfs) at g perpendicular characteristic for NOFe(DETC)2 . In cells incubated with {15NG}L-arginine instead of {14NG}L-arginine the EPR signal of {15N}OFe(DETC)2 was detected with a doublet hfs at g perpendicular, indicating that NO was generated exclusively from the terminal guanidino-nitrogen of extracellular L-arginine . The ratio of NO formation and of nitrite release changed with time of exposure to LPS, nitrite exceeding NO at early stages of macrophage activation, and NO exceeding nitrite at later stages . DNIC with thiolate ligands (0.5 nmol/10(7) cells) was observed in stimulated macrophages not loaded with DETC . Furthermore, DNIC released from macrophages was trapped in the extracellular medium by bovine serum albumin (BSA) (1 nmol/10(7) cells per 2 h) by formation of a paramagnetic DNIC with BSA . DNIC release not only provides a route for iron loss from activated macrophages, but may also play a role in the cytotoxic and microbiostatic activity of macrophages.

Appl Environ Microbiol, 1993 May, 59(5), 1461 - 6
Evidence for the existence of independent chloromethane- and S-adenosylmethionine-utilizing systems for methylation in Phanerochaete chrysosporium; Coulter C et al.; O methylation of acetovanillone at 4 position by C2H3Cl and S-adenosyl{methyl-2H3}methionine was monitored in whole mycelia of Phanerochaete chrysosporium in the presence and absence of S-adenosylhomocysteine . Both the amount of the methylation product, 3,4-dimethoxyacetophenone, and the percent C2H3 incorporation into the 4-methoxyl group of the compound were determined . The results strongly suggest the presence of biochemically distinct systems for O methylation of acetovanillone utilizing S-adenosylmethionine and chloromethane, respectively, as the methyl donor . The S-adenosylmethionine-dependent enzyme is induced early in the growth cycle, with activity attaining an initial maximum after 55 h of incubation . Methylation by this enzyme is totally suppressed by 1 mM S-adenosylhomocysteine over almost the entire growth cycle . S-Adenosylmethionine-dependent O-methyltransferase activity is detectable in cell extracts, and the purification and characterization of the enzyme are described elsewhere (C . Coulter, J . T . Kennedy, W . C . McRoberts, and D . B . Harper, Appl . Environ . Microbiol . 59:706-711, 1993) . The chloromethane-utilizing methylation system is absent in early growth but attains peak activity in the mid-growth phase after 72 h of incubation . The system is not significantly inhibited by S-adenosylhomocysteine at any stage of growth . No chloromethane-dependent O-methyltransferase activity is detectable in cell extract, suggesting that the enzyme is membrane bound and/or part of a multienzyme complex . Although the biochemical role of the chloromethane-dependent methylation system in metabolism is not known, one possible function could be the regeneration of veratryl alcohol degraded by the attack of lignin peroxidase.

J Clin Periodontol, 1993 May, 20(5), 359 - 65
The effect of subgingival debridement on periodontal disease parameters and the subgingival microbiota; Sato K et al.; The aim of the present investigation was to analyse the effect of subgingival scaling and root planing in subjects who prior to treatment exercised meticulous supragingival plaque control . 300 subjects were examined at baseline and after 1 and 2 years without treatment . After the year 2 examination, 62 subjects were randomly selected for therapy . They were given detailed instruction in proper self-performed toothcleaning measures and were carefully monitored during the subsequent 2 years . Following the year-4 examination, 2 quadrants, 1 maxillary and 1 mandibular in each subject, were randomly selected for additional therapy . The teeth in the selected quadrants were exposed to subgingival scaling and root planing . The subgingival therapy was repeated until a site no longer bled on gentle probing . This basic therapy was completed within a 2-month period . All subjects were re-examined after another 12-month interval . The examinations at year 4 and 5 included assessment of plaque, gingivitis, probing pocket depth and analysis of samples obtained from the subgingival microbiota at 134 selected sites . The findings from the present study demonstrated: (i) that subgingival scaling and root planing were effective in eliminating subgingival plaque and gingivitis; (ii) that professional therapy resulted in a pronounced reduction of probing depth at sites which at year 4 had a probing depth > 3 mm; (iii) that in non-scaled quadrants, the extension of self-performed plaque control resulted in a continued improvement of the periodontal conditions at sites which at year 4 were < 5 mm deep.

J Clin Microbiol, 1993 May, 31(5), 1290 - 2
Innovative index system for reporting microbiology laboratory results; Kelble KM et al.; A new computerized format for presenting microbiology laboratory results has been designed and evaluated . This new system uses an index format providing a concise summary of the status of each test ordered and the results for each test organized by the source of the specimen on the first page of the report . This is followed by complete, detailed microbiology results sorted in reverse chronological order . This new system was significantly (P < 0.05) faster and easier to use than a standard source-category reporting system used in many hospitals . In addition, the index format was overwhelmingly preferred by the individuals evaluating both systems.

J Dermatol Surg Oncol, 1993 May, 19(5), 450 - 4
A microbiologic study of diluted sclerotherapy solutions; Sadick NS et al.; BACKGROUND . As sclerotherapy has become more of an exact science it has become appropriate to dilute various sclerosing solutions to produce the least concentration of sclerosant producing effective endosclerosis of a given vessel diameter--the minimal sclerosant concentration . OBJECTIVE . In this setting it has become necessary to take into account various microbiologic considerations . Contamination of infusates is the most common cause of epidemic device-related bloodstream infections . With these considerations in mind, the following study was undertaken to determine the bacterial and fungal content of varied concentrations of four commonly employed sclerotherapy agents . METHODS . Dilutions were made of hypertonic saline 23.4% to 11.7% with both bacteriostatic water and 0.9% normal saline, Polidocanol 0.5% to 0.25% with bacteriostatic water, sodium tetradecyl sulfate 1.0% to 0.5% with bacteriostatic water, and polyiodide iodide 2% to 1% with bacteriostatic water under sterile conditions . Each sclerosant was analyzed for bacterial, fungal, and spore content at determined time intervals with standardized utilization indices for up to 3 months . RESULTS . At each sclerosant concentration for sodium chloride, polidocanol, sodium tetradechol sulfate, and polyiodide iodide at each study design time interval for sampling all bacterial and fungal cultures remained sterile . CONCLUSIONS . With appropriate aseptic techniques we may dilute sclerosing solutions to desired concentrations that will remain sterile for a period of at least 3 months under daily usage conditions.

Am Rev Respir Dis, 1993 May, 147(5), 1271 - 8
Clinical features of pulmonary disease caused by rapidly growing mycobacteria . An analysis of 154 patients; Griffith DE et al.; The role of rapidly growing mycobacteria (RGM) as pulmonary pathogens has been unclear . We identified 154 cases of lung disease caused by RGM using the microbiologic and radiographic criteria of the American Thoracic Society (ATS) and availability of the causative organism for study . More than one third of patients had positive lung biopsy cultures . Patients were predominantly white (83%), female (65%) nonsmokers (66%), and they had prolonged periods from onset of symptoms to diagnosis of their disease . Cough was an almost universal presenting symptom, whereas constitutional symptoms became more important with progression of disease . Upper lobe infiltrates were most common (88%), with 77% of patients developing bilateral disease . Cavitation was present in only 16% of the patients . Specific underlying diseases were infrequent, but they included previously treated mycobacterial disease (18%), coexistent Mycobacterium avium complex (8%), cystic fibrosis (6%), and gastroesophageal disorders with chronic vomiting (6%) . The majority of isolates (82%) were M . abscessus (formerly M . chelonae subsp . abscessus) . Effective treatment for M . fortuitum long disease was accomplished with drug therapy, whereas surgical resection of localized disease was the only effective long-term therapy for M . abscessus . Although the disease was generally slowly progressive, 21 of 154 (14%) patients died as a consequence of progressive RGM lung disease and respiratory failure . RGM should be recognized as a cause of chronic mycobacterial lung disease, and respiratory isolates should be assessed carefully.

Plast Reconstr Surg, 1993 May, 91(6), 1094 - 7
Microbiology and healing of the occluded skin-graft donor site; Smith DJ Jr et al.; Delayed healing of skin-graft donor sites may be costly and life-threatening, especially in patients with large body surface area burns . A donor site dressing should maximize the ability of the wound to heal without increasing the risk of local infection, systemic infection, or both . Specifically, the possibility of a secondary infection may either slow the healing process or ultimately convert the donor site into a full-thickness skin loss . A number of materials ranging from gauze to biologicals have been investigated for use as donor site dressings . The use of hydrocolloids for donor sites has been widely studied and has shown improved healing rates over the rates reported for conventional dressings . Our recent study using hydrocolloids confirmed earlier research that showed fewer infections and more rapid donor site healing.

Infect Immun, 1993 May, 61(5), 2182 - 91
Immunological and molecular polymorphisms of OspC, an immunodominant major outer surface protein of Borrelia burgdorferi; Wilske B et al.; The gene of the immunodominant major protein pC of Borrelia burgdorferi was previously cloned and sequenced (R . Fuchs, S . Jauris, F . Lottspeich, V . Preac-Mursic, B . Wilske, and E . Soutschek, Mol . Microbiol . 6:503-509, 1992) . pC is abundantly expressed on the outer surface of B . burgdorferi, as demonstrated by immunoelectron microscopy with monoclonal antibody L22 1F8 . Accordingly, pC is renamed OspC, by analogy to the outer surface proteins OspA and OspB . Western immunoblot analysis of 45 B . burgdorferi isolates with monoclonal antibodies revealed that OspC is immunologically heterogeneous . Partial sequence analysis of the ospC gene confirmed the protein heterogeneity at the genetic level . We found that the degree of identity between the ospC partial sequences of five strains representing different OspA serotypes was only 63.3 to 85.4% . Immunological heterogeneity was also observed among representatives of the three newly designated genospecies of B . burgdorferi sensu lato, B . burgdorferi sensu stricto, B . garinii, and group VS461 . Heterogeneity was confirmed for B . garinii at the genetic level . The ospC gene was also cloned from strains that did not express OspC, and antibody-reactive OspC was expressed in Escherichia coli . In addition, OspC-expressing variants were obtained from a nonexpressing strain by plating single colonies on solid medium . These findings confirm that the ospC gene is also present in nonexpressing strains . Because OspC is an immunodominant protein for the early immune response in Lyme borreliosis and was effective as a vaccine in an animal model, the immunological and molecular polymorphisms of ospC and OspC have important implications for the development of diagnostic reagents and vaccines.

Infect Immun, 1993 May, 61(5), 1650 - 6
The alkaline protease of Aspergillus fumigatus is not a virulence determinant in two murine models of invasive pulmonary aspergillosis; Tang CM et al.; Little is known of the pathophysiology of invasive pulmonary aspergillosis (IPA), an opportunistic fungal infection usually caused by Aspergillus fumigatus . It has been suggested that the ability of the fungus to degrade elastin may aid its invasion and growth in lung tissue . We have described previously the construction of a strain of A . fumigatus in which the gene encoding an alkaline protease, AFAlp, had been disrupted (C.M . Tang, J . Cohen, and D.W . Holden, Mol . Microbiol . 6:1663-1671, 1992); this mutant is deficient in extracellular proteolytic and elastinolytic activity over a broad pH range . In this study, we compared the pathogenicity of this and another AFAlp disruptant with their isogenic, elastase-producing parental strains in two murine models of IPA . In both models, animals were inoculated via the respiratory tract . In the first model, the inoculum was delivered as airborne conidia and animals developed signs of respiratory distress within 2 to 4 days . In the second model, conidia were administered intranasally as a suspension and the disease developed over a 2-week period . No difference was observed between the wild-type and AFAlp disruptants in terms of mortality, and elastin breakdown was detected in lung tissue from animals inoculated with all four strains . We conclude that AFAlp is not a virulence determinant in these models of IPA.

Obstet Gynecol, 1993 May, 81(5 ( Pt 1)), 721 - 7
Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis; Spinillo A et al.; OBJECTIVE: To evaluate risk factors related to anamnestic variables, sexual behavior, feminine hygiene habits, and microbiologic findings in women with idiopathic recurrent vulvovaginal candidiasis . METHODS: We conducted a multivariate observational study comparing sociodemographic, anamnestic, clinical, and microbiologic variables between 86 patients with recurrent vaginal candidiasis and 180 controls with nonrecurrent infection . RESULTS: In logistic regression analysis, women with recurrent candidal vaginitis were more likely than controls to use contraceptive pills (adjusted odds ratio 2.0, 95% confidence interval {CI} 1.02-3.91; P = .04) and commercially available solutions for either vulvoperineal cleansing (adjusted odds ratio 2.2, 95% CI 1.25-3.88; P = .007) or vaginal douching (adjusted odds ratio 1.8, 95% CI 1.0-3.26; P = .05) . The rate of isolation of non-albicans candida species was significantly higher among cases than controls (adjusted odds ratio 3.0, 95% CI 1.50-6.04; P = .005) . Finally, increasing frequency of monthly sexual intercourse was significantly correlated (chi 2 for trend = 4.87; P = .027) with recurrent infection . CONCLUSION: Several behavioral factors seem to influence the occurrence of relapses in recurrent vulvovaginal candidiasis . Appropriate counseling about contraception, sexual activity, and personal hygiene habits could be an important preventive measure in these cases.

Rinsho Byori, 1993 May, 41(5), 567 - 70
{Clinical microbiology in the 21 century}; Kobayashi H; The number of compromised patients has remarkably increased, with the recent advancement of medical treatment . This fact may account for the increase in the rate of hospital infection . Occupational infection of health care workers from blood-borne virus is another problem . During the recent increase in hospital infections, clinical microbiology laboratories in many countries performed expanded routine work and research . These situations were studied through questionnaires sent to countries with membership in the Hospital Infection Society . An inquiry into the tasks of clinical microbiology in the 21 century was made in order to establish more effective and useful system of the laboratories.

Monatsschr Kinderheilkd, 1993 May, 141(5), 409 - 11
{BCGitis as a cause of mediastinal tumor}; Wolff M et al.; In a one year old female infant BCG-vaccinated as a neonate, a large mediastinal mass was found after routine examination . X-ray and CT scan suggested a teratoma . Histology and microbiology, however, revealed the diagnosis of an active tuberculosis . Thus, the tumor was caused by mediastinal BCGitis . To our knowledge this complication of BCG-vaccination has not yet been described.

J Esthet Dent, 1993 May-Jun, 5(3), 97 - 100
The failing and failed implant: a clinical, microbiologic, and treatment review; Torosian J et al.; The goal of implant therapy is to restore a physiologic state of health to a compromised dentition . A successfully osseointegrated fixture is surrounded by healthy alveolar bone and gingival tissues.

New Horiz, 1993 May, 1(2), 172 - 80
Aminoglycosides in the intensive care unit: an old drug in a dynamic environment; Miyagawa CI; Aminoglycosides have historically been the mainstay of antibiotic therapy in the ICU . Despite the availability of numerous less toxic antibiotics, the clinical and microbiologic attributes of these agents have ensured their continued use in the management of infections in the critically ill patient . Innovative dosing regimens may replace traditional dosing methods if they are shown to provide improved clinical response with less toxicity potential.

Am J Med Genet, 1993 Apr 15, 46(2), 236 - 43
Charles Darwin and other great men in correspondence with Carl Wilhelm von Naegeli; Naegeli W et al.; The great Swiss-German botanist Carl Wilhelm von Naegeli (1817-1891) was a student of Lorenz Oken, A.P . de Candolle, and Matthias Jacob Schleiden and became a key figure in "genetic" (i.e., evolutionary-developmental) biology in the mid-late 19th century . He was an expert on the hawk-weed, Hieracium and also made important contributions to microbiology . One of his many outstanding students was Carl Correns, one of the 3 rediscoverers of Mendel's work . Naegeli was an early proponent and defender of Darwin . The correspondence preserved in the Naegeli family contains many important letters between Naegeli and his contemporaries . Those from Mendel to Naegeli have passed out of the Naegeli family and were published by Correns earlier in the century . However, exceptionally notable items still in the archives of the Naegeli family include 4 surviving letters from Darwin, 2 letters from Virchow, and 10 from Justus von Liebig . In spite of a lack of appreciation of Mendel's work, we call attention to the importance of those surviving documents from an era in which very few of the greatest naturalists and founders of modern biology--including Goethe, Darwin, Galton, Agassiz, von Humboldt, von Baer--were without "blind spots."

Am J Ophthalmol, 1993 Apr 15, 115(4), 460 - 5
Fungal invasion of seven hydrophilic contact lenses; Kirsch LS et al.; In six patients we reviewed the clinical, microbiologic, and histopathologic findings of seven hydrophilic contact lenses that had been infiltrated by fungi . Three patients had visual blurring or irritation and redness while wearing a contaminated lens; of these, two were unaware of any lens deposits . Three of the lenses from two patients were spares kept in storage for six months and one year, respectively . One contaminated lens had been torn and was kept in a case while a loaner lens was worn . Culture of this lens grew Cladosporium species . The contact lens case from one patient grew Penicillium species . Gross pathologic inspection disclosed multiple brown deposits in five lenses, multiple gray infiltrates in one lens, and a white infiltrate in one lens . Light microscopic examination disclosed partial-thickness (three lenses) or full-thickness (four lenses) invasion of the lens matrix by fungi, which contained granular, brown pigment in six lenses.

J Clin Pathol, 1993 Apr, 46(4), 309 - 12
Evaluation of non-radioactive trivalent DNA probe (LT, ST1a, ST1b) for detecting enterotoxigenic Escherichia coli; Chapman PA et al.; AIMS: To evaluate a digoxigenin-labelled trivalent DNA probe (LT, ST1a, ST1b) for detecting enterotoxigenic Escherichia coli (ETEC), by comparison with a cell culture assay for detecting LT, individual DNA probes for LT, ST1a and ST1b, and an enzyme immunoassay for detecting ST1 . METHODS: A 1268 base pair DNA fragment, containing parts of the genes for E coli heat labile enterotoxin (LT) and heat stable enterotoxins (ST1a and ST1b), was random prime labelled with digoxigenin-dUTP . The labelled DNA was used as a probe in colony hybridisation reactions to examine 180 E coli strains of which 92 had previously been shown by a cell culture assay to produce LT . Six LT negative ST1 positive E coli, 34 Verotoxin producing E coli (VTEC), and 84 organisms from other genera were also examined . All organisms other than VTEC were isolated from travellers returning from abroad with diarrhoea . All E coli strains were retested by cell culture for LT, and were tested by enzyme immunoassay (EIA) for ST1, and by the trivalent and individual DNA probes . RESULTS: All 81 isolates, that on retesting by cell culture were positive for LT, also hybridised with the trivalent and LT probes; 27 of these were also enzyme immunoassay (EIA) positive for ST1 of which 24 hybridised with the ST1b probe and three with the ST1a probe . Of 99 isolates, that on retesting by cell culture were negative for LT, all were negative by LT probe and only three were EIA positive for ST1; these three were positive by both trivalent and ST1b probes . Four isolates were positive by the trivalent probe but negative by cell culture and EIA; all four were positive by ST1b probe . Compared with the cell culture assay for LT, the probe had a sensitivity and specificity both of 100%; compared with the EIA for ST1, the probe had a sensitivity of 100% and specificity of 88% . CONCLUSIONS: The trivalent DNA probe is a sensitive, specific, and reliable method for detecting ETEC that should be considered for use by diagnostic microbiology laboratories.

Arch Surg, 1993 Apr, 128(4), 449 - 52
The economic impact of infections . An analysis of hospital costs and charges in surgical patients with cancer; Shulkin DJ et al.; We performed an economic analysis of the care provided to patients undergoing major abdominal surgical procedures to determine the effect of postoperative infection on hospital resource use . Patients' clinical and demographic characteristics and their use of medical care services were determined from a review of hospital bills and medical records . Hospital charges were obtained from the hospital billing system and costs were determined by use of Medicare cost-charge ratios obtained from the hospital's Medicare Cost Report . The care of patients with postoperative infections was significantly more expensive than that of uninfected patients (multivariate analysis indicated that a surgical infection added $12,542 to the cost of patient care) . Patients with postoperative fever but without documented infection were also more expensive to care for than afebrile, uninfected patients (fever added $9145 to the cost of care) . Increased costs for infected patients were found among microbiology tests, radiology services, pharmaceutical costs, and room costs . For these patients, we found that use of departmental cost-charge ratios, instead of hospital-wide cost-charge ratios, had no substantial impact on comparison of the cost of care for infected and uninfected patients.

AJR Am J Roentgenol, 1993 Apr, 160(4), 823 - 6
MR imaging of the knee: can changes in the intracapsular fat pads be used as a sign of synovial proliferation in the presence of an effusion?
Schweitzer ME, Falk A, Pathria M, Brahme S, Hodler J, Resnick D.
OBJECTIVE: Synovial proliferation is difficult to detect on MR images when joint effusions are present . The objective of this study was to assess the efficacy of MR changes in intracapsular fat pads (prefemoral, quadriceps, Hoffa's) as a sign of synovial proliferation in patients with knee effusions . MATERIALS AND METHODS: MR images were obtained in 70 patients with knee effusions . An effusion was considered present if the suprapatellar bursa was distended 1 cm in anterior to posterior diameter on T2-weighted sagittal images . The experimental group consisted of 32 patients with proliferative effusions (effusions associated with synovial proliferation) diagnosed on the basis of histologic or microbiologic data or strict rheumatologic criteria . This group comprised 11 patients with pigmented villonodular synovitis, six with rheumatoid arthritis, one with psoriatic arthritis, three with hemosideric arthritis, and 11 with septic arthritis . The control group comprised 38 subjects with knee effusions who had no arthroscopic evidence of synovial proliferation . After determining the MR criteria of proliferative effusion, two observers who had no knowledge of these cases evaluated abnormalities of the intracapsular fat pads seen on sagittal intermediate-weighted midline MR images . RESULTS: Characteristic changes in the fat pads were noted on MR images in patients with proliferative synovial effusions . Scalloping or truncation of the prefemoral fat pad was 77% sensitive and 95% specific as a predictor of proliferative effusion . Defects and displacement of Hoffa's fat pad had a sensitivity of 57% and a specificity of 99%, and nonvisualization or irregular margins of the quadriceps fat pad had a sensitivity of 61% and a specificity of 100% . CONCLUSION: Characteristic changes in intracapsular fat pads seen on MR images of patients with proliferative effusions can help distinguish these patients from those with effusions without synovial proliferation.

J Bacteriol, 1993 Apr, 175(8), 2229 - 35
Adverse conditions which cause lack of flagella in Escherichia coli; Li C et al.; Wild-type Escherichia coli was not motile when grown in tryptone broth under the following adverse conditions: the presence of high temperature {J . Adler and B . Templeton, J . Gen . Microbiol . 46:175-184, 1967; R . B . Morrison and J . McCapra, Nature (London) 192:774-776, 1961; K . Ogiuti, Jpn . J . Exp . Med . 14:19-28, 1936}, high concentrations of salts, high concentrations of carbohydrates, high concentrations of low-molecular-weight alcohols, or the pressure of gyrase inhibitors . Under all these conditions, growth was necessary for the loss of motility . This loss of motility was correlated with a reduction in the amount of cellular flagellin . We isolated and studied mutants that are resistant to suppression of motility by some of these conditions, because of the ability to synthesize flagella under these conditions . The mutations were mapped to 42 min, a region of the chromosome where many of the flagellar genes map . We also studied the effect of a preexisting gyrA mutation which allowed flagellar formation in the presence of nalidixate.

Rinsho Byori, 1993 Apr, 41(4), 435 - 40
{The present situation of the computer system for the clinical laboratory in Japan}; Ohota H et al.; We report the present situation of the computer system utilization for the Clinical Laboratory in Japan . For this studies, the data were calculated to our purpose from the materials for statistics published by the Ministry of Health and Welfare, Japan Society of Medical Technologist, and so on . The results were as follows, 1) computer systems were used on the 85% of all hospitals, and the most of them were used for the medical office work included the payment office . At clinical laboratory, there was very few use the computer systems, which account for 25% . 2) In the field of the clinical laboratory, there was mostly used at clinical chemistry, next field was hematology, serology, urinalysis, and microbiology, respectively . 3) Total system for the hospital, including ordering system were used only 0.06% (208 cases) of all hospitals in Japan . We calculated the number of beds with a hundred thousand population, the spread of the computer system, the number of the out-patients, in-patients, and the utilization ratio of beds, then we compared with that data for all of the prefecture included Tokyo, Osaka and Kyoto . As a result of the calculation, the prefecture which the number of bed with a hundred thousand population was much more than another zone were the utilization ratio of beds was less than another area, and there was worth at the spread of computer system . We think there areas had the smaller hospitals than that of having highly spread of computer system.

Xenobiotica, 1993 Apr, 23(4), 373 - 81
Extent and implications of interspecies differences in the intestinal hydrolysis of certain glucuronide conjugates; Kenyon EM et al.; 1 . Interspecies differences in the intestinal hydrolysis of glucuronide conjugates (phenolphthalein glucuronide, 4-methylumbelliferone glucuronide, morphine-3-glucuronide) were evaluated in mouse, rat and rabbit small intestine and caecum . 2 . beta-Glucuronidase activity in the caecum was 50-200-fold higher than in the small intestine for all species and substrates studied . 3 . There was evidence of a similarity between species in the capacity of the gut contents cultures from the proximal and distal small intestine to hydrolyse phenolphthalein glucuronide and 4-methylumbelliferone glucuronide . 4 . Morphine was not liberated from morphine-3-glucuronide in detectable amounts in the proximal and distal small intestine . 5 . Species- and substrate-specific differences were identified in the capacity of the caecal microbiota to hydrolyse the glucuronide conjugates studied . 6 . The capacity of the rabbit caecal microbiota to hydrolyse all three glucuronides was significantly lower than those of both rat and mouse . 7 . Morphine was metabolized to codeine in low, but detectable levels in all three species.

Rev Assoc Med Bras, 1993 Apr-Jun, 39(2), 88 - 90
{Complications of central venous catheters: prospective study}; Wey SB et al.; The insertion of central venous catheters (CVC) represent a very common procedure in intensive care units . The purpose of this study was to determine the via that provide the best chance for a good location of the tip of a CVC . The 563 CVCs that were inserted percutaneously and that had a radiology control were analyzed . The infraclavicular via was used for 303 (25%) CVCs; the jugular via had 142 (25%) CVCs and the supraclavicular via was used in 118 (21%) CVCs . The rate of bad location of the tip of the CVC were 17%, 6% and 9%, respectively . There was a significant difference when the insertion through infraclavicular via and jugular via were compared . There were 9 pneumothorax (1.4%) . 127 CVCs were sent to microbiology laboratory, 26 (20%) had positive culture (> 15 colony forming units) . The most frequent agents isolates were: Candida spp (7), S . aureus (5), S . epidermidis (4) and P . aeruginosa (3).

Am J Med, 1993 Mar 22, 94(3A), 182S - 186S
Efficacy and toxicity of fleroxacin in the treatment of travelers' diarrhea; Steffen R et al.; The efficacy and safety of fleroxacin in brief self-treatment of travelers' diarrhea were studied . In The Gambia, 195 tourists with acute diarrhea were randomized in a double-blind, controlled trial into three treatment groups: fleroxacin 400 mg for 1 day, fleroxacin 400 mg daily for 2 days, and placebo . Microbiology of stools was assessed only at recruitment . In the fleroxacin-treated groups, stool consistency was normal in 67% and 71% of the volunteers after 48 hours, as compared to 37% in the placebo group (p < 0.01) . The time to total relief of diarrhea and of all symptoms was also significantly shorter in fleroxacin-treated patients . Adverse events, particularly slight neuropsychiatric reactions (headache, insomnia) were more frequent in the fleroxacin-treated groups (p < 0.05) . There was no statistically significant difference in efficacy and tolerance if fleroxacin was administered for 1 or 2 days . A single dose of fleroxacin 400 mg may be recommended for the self-treatment of travelers' diarrhea.

Biochim Biophys Acta, 1993 Mar 20, 1172(3), 353 - 6
Nucleotide sequence of the large mitochondrial rRNA gene of Penicillium chrysogenum; Naruse A et al.; The nucleotide sequence of a large rRNA (1-rRNA) gene and its flanking regions in the cloned fragments of mitochondrial (mt) DNA from Penicillium chrysogenum NRRL1951 (Sekiguchi J., Ohsaki, T., Yamamoto, H., Koichi, K . and Shida, T . (1990) J . Gen . Microbiol . 136, 535-543) was determined and compared with those in Aspergillus nidulans and Neurospora crassa mitochondrial DNAs . The P . chrysogenum mt 1-rRNA gene has a 1678 bp intron which intervenes between a 2835 bp 5' exon and a 581 bp 3' exon, and extensive homology exists between overall sequences of mt 1-rRNA genes of P . chrysogenum and A . nidulans . The P . chrysogenum intron contains a large open reading frame which encodes a polypeptide comprising of 399 amino acids . The intron sequence also suggests that the intron belongs to a self-splicing group IA.

Med J Aust, 1993 Mar 15, 158(6), 408 - 13
Central nervous system tuberculosis in Australia: a report of 22 cases; Watson JD et al.; OBJECTIVE: To review the clinical features, treatment and outcome of patients with central nervous system (CNS) tuberculosis . DESIGN AND SETTING: A retrospective analysis of the case records of patients diagnosed as having CNS tuberculosis in a large Australian teaching hospital . PATIENTS: Twenty-two patients with CNS tuberculosis were identified between 1978 and 1989 . Six patients (age range, 17-78 years) were Australian-born whites, seven patients (age range, 21-68 years) were overseas settlers in Australia and nine patients (age range, 14-56 years) were New Caledonians . The diagnoses included tuberculous meningitis, intracranial tuberculomas and intracranial tuberculous abscesses . These were confirmed by microbiology and/or histopathology in 16 patients and were presumptive in the remaining six . RESULTS: All patients were treated with antituberculous drugs and 14 received corticosteroids as well . Fourteen patients made a full recovery and two had mild residual neurological disability . Four patients died and two were left with severe residual disability . The neurological state of seven patients (all non-whites) deteriorated paradoxically after they started taking the antituberculous drugs . CONCLUSIONS: The diagnosis of CNS tuberculosis may be difficult to make, so therapy based on a presumptive diagnosis will often be needed because of the poor outcome if treatment is delayed . Computed tomographic scanning helps the initial diagnosis and demonstrates the processes underlying paradoxical deterioration, which may occur in the face of adequate antituberculous treatment . Corticosteroids are effective in treating this uncommon complication.

Prikl Biokhim Mikrobiol, 1993 Mar-Apr, 29(2), 180 - 92
{The bioanalytical uses of the luciferase from fireflies (a review)}; Ugarova NN; Main principles of the bioluminescent microassay with the use of firefly luciferase are considered . Literature data and own experimental results of the author on application of luciferase in microbiology, clinical biochemistry, and express assays for antibiotic sensitivity and resistance to biocorrosion are generalized . New approaches to the use of luciferase for the detection of enzyme labels in EIA and for the nonradioactive detection of DNA probes are discussed.

Infect Control Hosp Epidemiol, 1993 Mar, 14(3), 131 - 9
Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants; Iwen PC et al.; OBJECTIVES: To determine the prevalence of aspergillosis in lymphoma patients housed in a protective environment while undergoing a bone marrow transplant or peripheral stem cell transplant and its relation to lymphoma type, type of transplant, period of neutropenia, method of diagnosis, species of Aspergillus, and the use of empiric amphotericin B . DESIGN: Clinical, autopsy, and microbiology records were reviewed retrospectively to determine the presence or absence of invasive aspergillosis . All positive specimens underwent further review to determine parameters outlined above . SETTING: The review took place at the University of Nebraska Medical Center with lymphoma patients housed in the oncology/hematology special care unit, which consists of 30 single-patient rooms under positive pressure with high-efficiency particulate air filtration . PATIENTS: 417 lymphoma patients admitted to the oncology/hematology special care unit who underwent 427 courses of high-dose chemotherapy with or without total body irradiation followed by a stem cell rescue . RESULTS: Twenty-two cases (5.2%) of nosocomial invasive aspergillosis (14 caused by Aspergillus flavus, 2 by Aspergillus terreus, 2 by Aspergillus fumigatus, and 4 by characteristic histology) were diagnosed . The prevalence of disease according to transplant was 8.7% for allogeneic bone marrow transplant (2/23 treatments), 5.6% for autologous peripheral stem cell transplant (9/161), and 4.5% for autologous bone marrow transplant (11/243) . Fifteen patients were presumptively diagnosed prior to death (68.2%) most commonly by histologic examination of skin biopsies . All 22 patients received amphotericin B therapy, 17 prior to aspergillosis diagnosis, and 7 (31.8%) survived . No patient with disseminated disease survived . CONCLUSIONS: Even when housing lymphoma patients undergoing myeloablative therapy in a protective environment containing high-efficiency particulate air filtration, there was a risk of developing aspergillosis . These data also showed that antemortem diagnosis with aggressive amphotericin B therapy was most effective in the management of infected lymphoma patients when engraftment occurred and the disease did not become disseminated.

AIDS, 1993 Mar, 7(3), 379 - 85
Hepatomegaly with severe steatosis in HIV-seropositive patients; Freiman JP et al.; OBJECTIVE: To describe death attributed to severe hepatomegaly and macrovesicular steatosis without inflammation or necrosis in HIV-seropositive patients without AIDS . PATIENTS: Patients from the AIDS Clinical Trials Group (ACTG) Adverse Reactions and the Food and Drug Administration's (FDA) Spontaneous Report databases . RESULTS: Six fatal and two non-fatal cases in which no known cause of hepatic steatosis could be found were identified . With one possible exception, none of the six fatal cases had a diagnosis of AIDS and all were in reasonable nutritional status (as indicated by weight and/or serum albumin); the majority were mildly to moderately overweight . All had received at least 6 months of antiretroviral therapy, and all had gastrointestinal complaints without other non-hepatic abdominal pathology . At least three out of the six had no history of progressively abnormal liver function tests until a few weeks prior to the onset of symptoms and subsequent death . Further investigation of the FDA and ACTG databases identified two similar but non-fatal cases in which abnormalities resolved after cessation of antiretroviral therapy . CONCLUSIONS: The cases described represent a degree of hepatic abnormalities that has not been reported previously in HIV-seropositive patients, and are probably an underestimate of actual incidence, since patients with possible etiologies of liver disease were excluded from the clinical history, laboratory, microbiologic, or histologic examination . The etiology of hepatic disease may be associated with antiretroviral therapy, HIV, or an unidentifiable infection, and requires further investigation.

J Periodontol, 1993 Mar, 64(3), 195 - 201
Serum IgG and IgM levels to bacterial antigens in necrotizing ulcerative gingivitis; Rowland RW et al.; Previous studies of the systemic antibody response in necrotizing ulcerative gingivitis (NUG) have elicited varying results . The purpose of this study was to determine the humoral response to site-specific isolates of microbiota associated with NUG . Sera from 21 active NUG subjects and 21 age-sex-race matched controls were assessed for IgG and IgM antibodies to 4 clinical isolates of Prevotella intermedia and 3 clinical isolates of Treponema species . P . intermedia and Treponema strains were isolated from active and inactive sites of NUG patients and gingivitis sites of controls . P . intermedia was also isolated from noninflamed sites of the controls . IgG and IgM serum levels to these 7 bacteria were measured by ELISA . Compared to control subjects, the NUG sera exhibited significantly lower IgG and IgM levels to all 4 isolates of P . intermedia (P < or = 0.001) . It was also noted that sera from NUG subjects had elevated IgM levels to all 3 spirochete isolates but significantly higher only to the spirochete isolated from a gingivitis site of a control subject (P < or = 0.005) . The data suggest that failure to mount a substantial antibody response to P . intermedia may be associated with onset of disease activity in NUG . However, the assumed lack of "biological significance" between differences in antibody responses measured indicates the relationship is weak or nonexistent . It also appears that antibody response to spirochetes is not associated with onset of NUG.

J Clin Microbiol, 1993 Mar, 31(3), 524 - 7
Detection of Mycoplasma pulmonis in experimentally infected laboratory rats by 16S rRNA amplification; van Kuppeveld FJ et al.; Recently, an rRNA-based polymerase chain reaction (PCR) has been developed for the detection of murine mycoplasmas at both the genus and species level (F . J . M . van Kuppeveld, J . T . M . van der Logt, A . F . Angulo, M . J . van Zoest, W . G . V . Quint, H . G . Niesters, J . M . D . Galama, and W . J . G . Melchers, Appl . Environ . Microbiol . 58:2606-2615, 1992) . In this study, the diagnostic value of this PCR assay for the detection of Mycoplasma pulmonis in infected rats was studied . For this purpose, 25 Wistar rats were infected intranasally with M . pulmonis strain M72-138 and investigated for the presence of this pathogen by both in vitro isolation and PCR . Five rats were monitored longitudinally by screening of throat swabs at several time points for up to 248 days postinfection . The remaining 20 rats were killed between 3 and 87 days postinfection, and organism recovery from both throat and urogenital tract specimens was attempted . M . pulmonis could be detected in the throat for up to 248 days postinfection but not in the urogenital tract, either by culture or by PCR . PCR proved to be the optimal method for testing throat samples . All samples in which M . pulmonis was detected by culture were also positive by PCR . By PCR, M . pulmonis was also detected in 3.7% of the samples which were culture negative and in 9.9% of the samples from which cultures were overgrown with bacteria . The results of this study demonstrate the suitability of PCR for the detection of mycoplasmal infection in rodents.

J Biolumin Chemilumin, 1993 Mar-Apr, 8(2), 51 - 63
A survey of some commercially available kits and reagents which include bioluminescence or chemiluminescence for their operation: including immunoassays, hybridization, labels, probes, blots and ATP-based rapid microbiology . Products from more than forty companies; Stanley PE; This survey was compiled between January and November 1992 from public domain information requested by the author from companies specializing in these products . It includes individual sections giving the name and address of each company together with brief details of their (a) kits used for assay of certain analytes in the routine laboratory and (b) reagents used mainly as research tools . This survey is a companion to a previous survey about 90 commercially available luminometers.

Gastroenterol Clin North Am, 1993 Mar, 22(1), 5 - 19
Microbiology of Helicobacter pylori; Goodwin CS et al.; The new genus name Helicobacter was first published in October 1989 . H . pylori is a unipolar, multiflagellate, gently spiral organism found on the human gastric mucosa, but in culture and under unfavorable conditions, coccoidal forms emerge, which may be indicative of a dormant state . The biology and metabolism of H . pylori, together with growth requirements and methods of detection in clinical specimens, are described in this article . Enzymes, hemagglutinins, and antibiotic susceptibilities of H . pylori are delineated.

Clin Oral Implants Res, 1993 Mar, 4(1), 12 - 22
Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth; Schou S et al.; The purpose of the investigation was to gain more understanding of marginal inflammatory reactions around osseointegrated implants . The significance of the lacking periodontal ligament of implants was examined in the initial breakdown phase of supporting tissues by comparing clinical and radiographic manifestations of ligature-induced marginal inflammation related to osseointegrated implants with those around ankylosed and normal control teeth in 8 cynomolgus monkeys (Macaca fascicularis) . Bilateral extraction of the first and second mandibular molars was carried out initially, and 12 weeks later 2 implants were placed in each side . Ankylosis of the second maxillary molars was established by extracting and replanting the teeth after a drying period . When ankylosis and osseointegration were established, ligature-induced marginal inflammation was induced in the right or left side at random around implants, ankylosed teeth and normal control teeth (second maxillary premolar) for 7 weeks . Although the clinical manifestations as expressed by plaque score, gingival score, probing depth and attachment loss were quite similar, the radiographic features differed . Significant loss of bone height was limited to implants and ankylosed teeth and did not occur in relation to normal control teeth . Furthermore, the bone loss around implants was significantly greater than the loss around ankylosed teeth . Bone loss was limited to implants and ankylosed teeth; the study therefore suggests that the presence of marginal inflammation around implants and ankylosed teeth may have more serious implications than does marginal inflammation around teeth with a periodontal ligament . However, variations in microbiota and susceptibility of different jaw positions to periodontal breakdown may influence the results of this study.

J Hosp Infect, 1993 Mar, 23(3), 229 - 42
An evaluation of surveillance methods for detecting infections in hospital inpatients; Glenister HM et al.; Eight selective surveillance methods were compared with a reference method for their ability to detect hospital infections in patients was also assessed . In the reference method, case records were reviewed three times a week, and during the 11-month period of study, 668 infections were identified amongst 3326 patients . Three hundred and thirty-eight were community acquired infections (CAI) and 330 were hospital acquired infections (HAI) . The time for data collection was 18.1 h per 100 beds per week . Of the selective surveillance methods, those based on the review of treatment and temperature charts detected the highest proportion (70%) of CAI; and the review of microbiology reports with regular ward liaison identified the highest proportion (71%) of HAI . The time for data collection in the eight methods ranged from 1.2 h per 100 beds per week to 6.5 h per 100 beds per week . After considering the sensitivity for identifying patients with HAI and time for data collection, the review of microbiology reports with regular ward liaison was judged to be an effective and efficient method of surveillance.

Med Clin (Barc), 1993 Feb 6, 100(5), 171 - 3
{Mycobacterium avium-intracellulare disseminated infection in patients with AIDS}; Herrero Martinez JA et al.; BACKGROUND: Disseminated infection by Mycobacterium avium-intracellulare is almost exclusively produced in individuals with HIV infection . The incidence of this infection in Spain is unknown . METHODS: The clinical and microbiologic registries of 30 patients with AIDS and disseminated infection by Mycobacterium avium are reviewed . METHODS: Twenty-three percent of the patients with AIDS had, at some time in their evolution, disseminated infection by M . avium . The clinical picture included prolonged fever, digestive symptoms, weight loss and appearance of lymph node enlargement . This infection appeared in patients with severe alteration of cellular immunity (mean CD4 lymphocytes: 0.19 x 10(9)/l) . Although medium term prognosis was bad the causes of death of the patients were other opportunistic diseases related with the immunodeficiency . CONCLUSIONS: Infection by Mycobacterium avium is frequent among the population of individuals with HIV infection . With the appearance of prolonged fever in a patient with HIV infection and CD4 lymphocyte count lower than 0.2 x 10(9)/1 appropriate microbiologic studies including blood cultures for mycobacteria should be initiated.

Microbiologia, 1993 Feb, 9 Spec No, 104 - 8
{Experimental design and data handling in food microbiology}; Carbonell EA; A discussion on the problems associated with designing experiments in Food Microbiology research is presented . After defining what is meant by Design of an Experiment, a series of questions are raised that, once answered, will help in properly designing the experiment . It is emphasized the chain research-design-model-analysis-design and the danger in blindly using well-known designs and canned programs.

FEMS Microbiol Lett, 1993 Feb 1, 106(3), 315 - 20
Long-chain alpha-hydroxy-(omega-1)-oxo fatty acids and alpha-hydroxy-1,omega-dioic fatty acids are cell wall constituents of Legionella (L . jordanis, L . maceachernii and L . micdadei); Sonesson A et al.; Four long-chain fatty acids, 2-hydroxy-27-oxo-octacosanoic acid (n28:0(2-OH,27-oxo)), 2-hydroxy-29-oxo-triacontanoic acid (n30:0(2-OH,29-oxo)), 2-hydroxy-heptacosane-1,27-dioic acid (27:0(2-OH)-dioic) and 2-hydroxy-nonacosane-1,29-dioic acid (29:0(2-OH)-dioic) were identified by GLC-MS analysis in the phenol-chloroform-petroleum ether (PCP) extracts of Legionella jordanis, L . maceachernii and L . micdadei indicating that they are constituents of lipopolysaccharide . Moreover, five long-chain fatty acids (28:0(27-OH), 28:0(27-oxo), 30:0(29-oxo), 27:0-dioic and 29:0-dioic) previously identified in L . pneumophila (Moll, H . et al., FEMS Microbiol . Lett., 97 (1992), 1-6) were also found in these species . This is to our knowledge the first report on the existence of long chain 2-hydroxylated (omega-1)-oxo fatty acids and 2-hydroxylated 1,omega-dioic fatty acids.

Clin Infect Dis, 1993 Feb, 16(2), 310 - 9
A serological survey and review of clinical Lyme borreliosis in Spain; Anda P et al.; A serosurvey for Lyme disease was conducted by the National Reference Center for Microbiology in Spain . All serum specimens received from patients with erythema migrans (EM), arthritis, and cardiac and neurological disorders were tested for antibodies to Borrelia burgdorferi . Sera from 499 patients were tested . Of these patients, 310 had neurological disease, 101 had carditis, 79 had arthropathies, and 9 had EM; for 35 patients, a diagnosis of Lyme disease was confirmed . Of these 35, 68% had neurological disease, 6% had carditis, and 26% had EM . Twelve probable cases of Lyme disease were noted . The male-to-female ratio of patients with confirmed or probable disease was 1.6; all age groups were represented, but 25% of patients were within the age group of 0-9 years . The number of cases of Lyme disease decreases from the north of Spain (41%) to the south (26%), a distribution that is in agreement with the known range of Ixodes ricinus . Borrelia burgdorferi is a frequent cause of infection in some areas of Spain . It is possible that relapsing fever accounts for some of the serological reactivity to B . burgdorferi in residents of the south of Spain.

Epidemiol Infect, 1993 Feb, 110(1), 105 - 16
Outbreak of Legionnaires' disease at University Hospital, Nottingham . Epidemiology, microbiology and control; Colville A et al.; Twelve patients in a large teaching hospital contracted Legionnaires' disease over a period of 11 months . The source was a domestic hot water system in one of the hospital blocks, which was run at a temperature of 43 degrees C . Five different subtypes of Legionella pneumophila serogroup 1 have been isolated from water in different parts of the hospital, over a period of time . Only one subtype, Benidorm RFLP 14, was implicated in disease . Circumstantial evidence suggested that the outbreak may have been due to recent colonization of the hot water system with a virulent strain of Legionella pneumophila . The outbreak was controlled by raising the hot water temperature to 60 degrees C, but careful surveillance uncovered two further cases in the following 30 months . Persistent low numbers of Legionella pneumophila were isolated from the domestic hot water of wards where Legionnaires' disease had been contracted, until an electrolytic unit was installed releasing silver and copper ions into this supply.

Community Dent Oral Epidemiol, 1993 Feb, 21(1), 1 - 3
Determinants of variation in dental caries experience in primary teeth of Hong Kong children aged 6-8 years; Evans RW et al.; A representative sample of Hong Kong children aged 6-8 yr was examined for dental caries, and data on possible explanatory variables for dmft were obtained from questionnaires . Variation in dmft was partially accounted for by the effect of some demographic variables and other variables having a socioeconomic base . Girls had a lower dmft index than boys, and being born in Hong Kong rather than elsewhere (that is, China) was also associated with a lower dmft index . Better dental status was strongly associated with increasing educational level of the mother, monthly household income, and with an increasingly positive perception of the questionnaire respondent's own dental status . Preschool dental visits and enrollment in the School Dental Care Service were associated with higher dmft indices . Altogether, 22.5% of the variance in dmft was explained . It was concluded that: 1) demographic and socioeconomic factors significantly affect dmft variation in Hong Kong . 2) the mother's role in determining the dental status of her child is probably important, and 3) further elucidation of the variation in dmft will depend on the analysis of data pertaining to dietary and oral hygiene practices during the preschool years and to an analysis of tooth morphology, fluoride exposure, and microbiologic, salivary, and genetic factors.

Am Rev Respir Dis, 1993 Feb, 147(2), 420 - 4
Diagnosis of primary tuberculosis in children by amplification and detection of mycobacterial DNA; Pierre C et al.; Standard microbiologic techniques were compared with a rapid diagnostic method based on the amplification by polymerase chain reaction (PCR) of a fragment of the IS6110 insertion element (present in multiple copies in the Mycobacterium tuberculosis genome) for the detection of M . tuberculosis in specimens obtained from children diagnosed as having primary tuberculosis on clinical grounds . Two (n = 7) or three (n = 15) gastric aspirates were obtained from the 22 children with primary tuberculosis . All specimens were negative for mycobacteria by acid-fast staining and culture . When DNA was purified from the clinical specimens and aliquots of each sample were amplified in duplicate, 15 of 59 (25%) specimens gave at least one positive result . Increasing beyond two the number of times that samples were tested did not appreciably improve sensitivity . Testing multiple samples from the same individual increased the diagnostic yield . Thus, when three different samples from the same subject were tested two times each, two or more positive results were obtained from 9 of 15 children with primary tuberculosis but 0 of 17 control subjects . Samples from children with symptoms, recent contact with patients with active tuberculosis, vesicular tuberculin responses, or abnormal chest radiographs were more frequently positive than those from patients whose only manifestation of tuberculosis was a positive (but not vesicular) tuberculin response . Thus, M . tuberculosis DNA can be detected by PCR in gastric aspirates of many children with primary tuberculosis, despite that specimens from these patients are negative by culture . Multiple samples must be tested to optimize the diagnostic yield.

J Bacteriol, 1993 Feb, 175(3), 655 - 60
Localizing the replication origin region on the physical map of the Mycoplasma capricolum genome; Miyata M et al.; Four lines of evidence argue that the replication origin of the Mycoplasma capricolum genome lies within the 46-kb BamHI fragment bordered by two BamHI sites of the total of nine BamHI sites that have been located on the physical map (M . Miyata, L . Wang, and T . Fukumura, FEMS Microbiol . Lett . 79:329-334, 1991) . First, this fragment lost its labeling in preference to other fragments when log-phase cultures were incubated in the presence of chloramphenicol for various times to inhibit the initiation of new rounds of replication and then further incubated with radioactive dTMP to allow DNA elongation to continue . Second, the relative frequencies of various restriction fragments of the genome DNA from exponentially growing cells decreased with increasing distance from the putative origin . Third, preferential labeling occurred when radioactive dTMP was added to cultures of a DNA elongation-defective, temperature-sensitive mutant with a simultaneous temperature downshift . Fourth, the M . capricolum homolog of the dnaA gene, which is located near the replication origin in many other bacteria, was found in the 46-kb fragment.

Rheum Dis Clin North Am, 1993 Feb, 19(1), 15 - 27
The interplay of nature versus nurture in predisposition to the rheumatic diseases; Reveille JD; The revolution in microbiology and genetics that has transpired in the past few years has brought fresh debate in the question of the relative contributions of nature and nurture in susceptibility to the rheumatic diseases . For nature, a variety of immunologically relevant genes have been identified whose presence has been shown to be associated either with an increased risk for certain diseases or for complications or subsets thereof . For nurture, the role of infectious agents in disease triggering and modification has been found.

Chest, 1993 Feb, 103(2), 439 - 43
Alveolar immune mediators in HIV-related pneumonia . Different role of IL-2 and IL-1 in inducing lung damage; Biglino A et al.; In order to elucidate the role played by alveolar cytokines in the pathogenesis of HIV-related lung damage, levels of interleukin (IL) 1 beta, IL-2, IL-6, tumor necrosis factor (TNF)-alpha, and interferon (Ifn) were assessed on supernatant of bronchoalveolar lavage fluid from 30 consecutive HIV-1 seropositive (HIVAb+) patients with clinical and radiologic evidence of pneumonia, from 20 HIV- seronegative (HIVAb-) patients with pulmonary sarcoidosis, and from 10 HIVAb- healthy control subjects . Cytokine levels were expressed as picogram (IL-1, TNF), nanogram (IL-6), and international unit (IL-2, Ifn) per milligram of albumin per deciliter . Total and differential cell counts, cytofluorimetric enumeration of CD3+, CD3+/DR+, CD4+, CD8+, and CD8+/CD16+ cells, as well as microbiologic investigations for opportunistic agents were performed on lavage pellets . HIV-related pneumonia was characterized by higher mean alveolar level of IL-2 (12 +/- 5 IU), and by more elevated mean counts of T cells (109 +/- 16), activated T cells (60 +/- 12), and CD8+ cells (90 +/- 13)/microliters if compared with both active sarcoidosis and control subjects, where respective values of 0.2 +/- 0.1 and 0.3 +/- 0.2 IU IL-2/mgAlb/dl, of 52 +/- 11 and 7 +/- 2 T cells, of 20 +/- 5 and 1.2 +/- 0.3 activated T cells, and of 11 +/- 2 and 3 +/- 0.6 CD8+ cells per microliter were found . HIV-infected patients with opportunistic lung infections (OIs) showed the highest mean IL-2 level (21 +/- 4 IU), and higher counts of both CD8+ (117 +/- 20) and CD8+/CD16+ (36 +/- 7) cells per microliter if compared with patients without evidence of OIs (respectively, 62 +/- 13 CD8+ and 18 +/- 3 CD8+/CD16+ cells per microliter) . By contrast, extremely high IL-1 levels (1,463 +/- 760 pg), and IL-2 levels similar to control subjects (3.4 +/- 1.2 IU), were found in the absence of OIs . Different mechanisms depending respectively on IL-2-mediated cytotoxic cell recruitment and activation, or IL-1-mediated tissue injury may account for HIV-related lung damage, depending on the presence or absence of opportunistic agents.

Gene, 1993 Jan 15, 123(1), 69 - 74
Deletion of the essential gene 24 from the bacteriophage T4 genome; Engman HW et al.; We deleted the essential gene 24 from the genome of bacteriophage T4 . The delta 24 phage is a conditional lethal mutant that can grow only when the host strain supplies the product of gene 24 in trans, or when the phage acquires a functional gene 24 by some type of recombination event . Thus, gene 24 can be used as a selectable marker, for example permitting transposition into the T4 genome and analyses of plasmid-phage recombination {Woodworth and Kreuzer, Mol . Microbiol . 6 (1992) 1289-1296; H.W.E . and K.N.K., manuscript submitted} . We also found that the promoter region of gene 24 allows a low level of autonomous plasmid replication in T4-infected cells, raising the possibility of a previously unrecognized mode of T4 replication initiation.

Qual Lett Healthc Lead, 1993 Feb, 5(1), 12 - 4
Improving customer relations and telephone response in Abbott Northwestern Hospital's laboratory department.
Is an additional vaccination necessary for a successful second pregnancy in unexplained recurrent aborters who were successfully immunized with their husband's lymphocytes before the first pregnancy?
Department of Obstetrics and Gynecology, Niigata University School of Medicine, JapanPROBLEM: Is an additional immunotherapy necessary or not for patients who have obtained successful results after initial immunotherapy? METHODS: The successive pregnancy outcome was analyzed in 22 patients out of 29 unexplained recurrent aborters who had undergone immunotherapy with their husband's lymphocytes according to our previously reported protocol (Takakuwa et al., Am J Reprod Immunol Microbiol . 10:1-9, 1986; Takakuwa et al., Am J Reprod Immunol . 23:37-41, 1990) and had obtained successful outcome between January 1983 and December 1989 . In addition, the alteration of blocking antibodies (BAbs), which was evaluated by a one-way mixed lymphocyte culture reaction (MLR) blocking assay between the spouses, was analyzed in 26 patients out of 29 . RESULTS: None of the 22 patients underwent further immunotherapy because a significantly high titer of MLR-BAbs had been detected before the new pregnancy . In 19 out of the 21 patients (90.5%), pregnancy was successful . CONCLUSION: Additional immunotherapy is not necessary for patients who have obtained successful results after the initial immunotherapy and are positive for MLR-BAbs after their first delivery.

Salud Publica Mex, 1993 Jan-Feb, 35(1), 3 - 19
{Perspectives on cholera vaccines}; Valdespino-Gomez JL et al.; Perspectives of cholera vaccines with emphasis in their possible usage in Latin American countries are discussed . Microbiology, antigenicity, relevant aspects of traditional serology, protective immune responses and epidemiological data up to December, 1991, are presented . Indications of parenteral vaccines are discussed . Finally, perspectives of usage of cholera vaccines in Latin America are analyzed.

Wien Med Wochenschr, 1993, 143(1), 13 - 9
{Arterial vascular training}; Weidinger P; By means of a specific arterial vessel training--indoor or outdoor--it is in any case possible to improve the individual walking performance . In the first phase of the training there is an increase of the arterial maximal flow, which then remains constant and may even rapidly decline without further training . The continual increase can be explained through metabolic, hemorheologic, and possibly microcirculatoric changes (microbiopsy studies, not yet published) . At the moment it is only Germany where you can find the complete offer of all different vessel training . In Austria there is only the indoor training which works at the moment . The different German health-insurance pay the training-programs, the criteria for the education of "the vessel-trainer" are established by the health-insurance, by the "Deutsche Gesellschaft fur Angiologie" and the "Deutsche Gesellschaft fur Gefasssport (vessel training)" . The vessel trainer has to achieve his diploma via the "A" and "coronar certificate" . In Austria there are no obligatory criteria for this education--neither for the coronary nor for the vessel training--there is no observation of the education and no payment-system.

J Dermatol Surg Oncol, 1993 Jan, 19(1), 21 - 5
Bowenoid changes in Kaposi's sarcoma; Cohen PR et al.; BACKGROUND: Previous reports have documented the coexistence of multiple infectious organisms or Kaposi's sarcoma within the same biopsy specimens of mucocutaneous lesions in human immunodeficiency virus- (HIV) infected patients . OBJECTIVE: A 31-year-old black man with the acquired immunodeficiency syndrome (AIDS) who had Bowenoid changes and Kaposi's sarcoma within the same cutaneous lesion is described . METHODS: Microbiologic cultures, microscopic examination, and polymerase chain reaction were performed on a lesional skin biopsy specimen to evaluate for infectious organisms, histopathology, and the presence of human papillomavirus (HPV) deoxyribonucleic acid (DNA), respectively . RESULTS: Bacteria, fungi, and mycobacteria were not detected with special stains and cultures . The histologic findings were consistent with Bowen's disease in the epidermis and patch stage Kaposi's sarcoma in the dermis . There was no polymerase chain reaction product generated from the HPV-specific primers in two individual polymerase chain reaction assays . CONCLUSION: The possibility that coexisting infectious or neoplastic disorders, or both, may be present within a single mucocutaneous lesion should always be considered when evaluating a lesion from an HIV seropositive individual.

Diagn Microbiol Infect Dis, 1993 Jan, 16(1), 17 - 24
Performance of a fluorescence polarization immunoassay for teicoplanin in serum; Mastin SH et al.; Teicoplanin is a new glycopeptide antibiotic that is structurally related to vancomycin, but has six major components and is > 90% protein bound . We have developed a competitive homogeneous fluorescence polarization immunoassay (FPIA) for the quantitative determination of teicoplanin in serum . The teicoplanin FPIA uses six serum-based calibrators over the range 0-100 micrograms/ml, with the lowest teicoplanin concentration at 5 micrograms/ml and a lower limit of detection of < 1.5 micrograms/ml . Samples with concentrations > 100 micrograms/ml can be analyzed after 1:5 dilution with serum . Intra- and interassay precision are < 2% and < 4.5%, respectively, for controls at 7.5, 35, and 75 micrograms/ml on an automated FPIA analyzer . Recovery results for 30 samples prepared from the teicoplanin analytical reference standard over the range 3.4-358 micrograms/ml were linearly correlated with target concentrations; the linear regression equation and correlation coefficient are FPIA = 0.976 x target + 0.120, r = 0.999 . Abnormal levels of bilirubin, hemoglobin, albumin, triglycerides, or cholesterol did not significantly affect recovery . Cross-reactivity with vancomycin was < 0.2%, and there was no significant interference from above therapeutic levels of likely concomitant medications . Results on patient samples from the teicoplanin FPIA were highly correlated with both a high-performance liquid chromatography (HPLC) method (FPIA = 1.032 x HPLC + 2.79, r = 0.979, n = 203) and the reference teicoplanin microbiologic assay method (orthogonal regression; FPIA = 1.111 x bioassay + 2.107, r = 0.969, n = 1014) . A version of the teicoplanin FPIA for use with a modular clinical research FPIA analyzer showed comparable performance in all respects to the automated assay.

J Bacteriol, 1993 Jan, 175(2), 548 - 52
Role of tol genes in cloacin DF13 susceptibility of Escherichia coli K-12 strains expressing the cloacin DF13-aerobactin receptor IutA; Thomas JA et al.; IutA is the outer membrane protein receptor for ferric aerobactin and the bacteriocin cloacin DF13 . Although the same receptor is shared, ferric aerobactin transport across the outer membrane in Escherichia coli is TonB dependent, whereas cloacin DF13 transport is not . We have recently observed that tolQ is required for cloacin DF13 susceptibility (J.A . Thomas and M.A . Valvano, FEMS Microbiol . Lett . 91:107-112, 1992) . In this study, we demonstrate that the genes tolQ, tolR, and tolA, but not tolB, tolC, and ompF, are required for the internalization of cloacin DF13 and they are not involved in the transport of ferric aerobactin.

Am J Clin Nutr, 1993 Jan, 57(1), 70 - 2
Percentage distribution of fatty acids in subcutaneous adipose tissue of patients with peptic ulcer disease; Seidelin KN et al.; Dietary linoleic acid has been implicated in the pathogenesis of peptic ulcer disease because its metabolite arachidonic acid may be converted to cytoprotective prostaglandins . In addition, it has been suggested that the falling incidence and virulence of duodenal ulcer disease is related to increased dietary polyunsaturated essential fatty acid intake . In the present study the percentage content of linoleic acid in subcutaneous adipose tissue microbiopsies were used to see whether changes in percentage of fatty acids correlate with the presence or absence of an ulcer in individual patients . No significant difference in the adipose tissue content of linoleic acid was found, ie, 11.2 +/- 0.7% (n = 15) vs 10.9 +/- 0.5% (n = 15) in patients with peptic ulcer disease and matched control subjects, respectively.

Vox Sang, 1993, 64(2), 73 - 81
Polymerase chain reaction and transfusion microbiology; Barbara JA et al.; Polymerase chain reaction (PCR) involves alternate denaturing and re-annealing of DNA in test samples in the presence of appropriate oligonucleotide primers complementary to opposite strands of the target DNA together with a heat-stable DNA polymerase, Mg2+ and the four nucleotide triphosphates . DNA target segments can be 'amplified' ten-millionfold by 25-35 such cycles . Even greater amplification (approximately 10(12)-fold) with enhanced specificity can be obtained by a second set of amplification cycles using a further pair of 'nested' primers sited within the DNA sequence defined by the original primers . PCR can be applied to the study of the whole range of transfusion-transmitted infections, both plasma and cell associated; RNA viruses can be analyzed if a DNA copy is made from the viral RNA by treatment with reverse transcriptase . In a transfusion context, the retroviruses (HIV-1, HIV-2, HTLV-I, HTLV-II), HCV and HBV have been the viruses most intensively subjected to PCR analysis . The advantages of PCR in this context include its ability to detect virus during the 'window period' or seronegative stages of infections and its value as a marker for viraemia and for the detection of viruses in products made from large pools of plasma . True immunity may also be differentiated from persistent infection in the presence of antibody . Similarly, PCR can overcome problems of diagnosis of acute infection caused by the presence of passively transferred antibody . Detailed strain differentiation is also possible by PCR, in conjunction with sequencing or with the aid of restriction endonucleases.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasmid, 1993 Jan, 29(1), 31 - 40
Genetic organization of antibiotic resistance genes (aac(6')-Ib, aadA, and oxa9) in the multiresistance transposon Tn1331; Tolmasky ME et al.; The multiresistance transposon Tn1331 has two 520 bp direct repeats flanking a DNA region similar to the variable portion of the integrons . This region harbors three antibiotic resistance genes, aac(6')-Ib, aadA, and a beta-lactamase gene which encodes an enzyme that was characterized as an oxacillinase-carbenicillinase and was named OXA-9 . Within the direct repeat located upstream of these genes there is a copy of the TEM beta-lactamase promoter . Determination of ampicillin resistance levels of Escherichia coli harboring various recombinant clones and an insertion mutant showed that all three genes are transcribed from this promoter in a polycistronic mRNA . These results also indicated that the oxa9 gene possesses another functional promoter, located immediately upstream of this gene . The transcription start site of the mRNA driven by this promoter was identified by primer extension . Within the DNA sequence harboring all three antibiotic resistance genes it is possible to distinguish insert units as defined before in the variable region of the integrons (R . Hall, D . Brookes, and H . W . Stokes (1991) Mol . Microbiol . 5, 1941-1959).

Chest, 1993 Jan, 103(1), 313 - 4
Pulmonary sporotrichosis treated with itraconazole; Breeling JL et al.; A 62-year-old woman had chronic cavitary pulmonary sporotrichosis refractory to medical management over an 8-year period . She was treated with oral itraconazole and had an apparent microbiologic and clinical response; however, the patient succumbed to progressive pulmonary hypertension . The early use of oral itraconazole for treatment of pulmonary sporotrichosis is advocated.

Biosens Bioelectron, 1993, 8(3-4), 219 - 28
Microbiosensors for acetylcholine and glucose; Karube I et al.; Microbiosensors based on carbon and and platinum fibers are described . Carbon fibers were used to construct microelectrodes of 7 microm diameter . Electrochemical operations for pre-electrolysis and measuring were examined for the highly sensitive determination of hydrogen peroxide . A triangular potential (-2 to +2V vs Ag/AgCl) was applied before measuring each pair of double pulses (first pulse: 750 mV; second pulse: 1100 mV) . The determination limit was 0.1 microM of hydrogen peroxide . The reproducible determination of hydrogen peroxide is possible even in samples containing albumin protein . The separation of hydrogen peroxide from ascorbic acid is also possible because the oxidation potential of ascorbic acid is different from that of hydrogen peroxide . An acetylcholine microsensor was fabricated by immobilizing acetylcholine esterase and choline oxidase on the carbon fiber by entrapment with poly(vinyl alcohol)-quarternized stilbazole (PVA-SbQ) . This sensor gave a linear calibration plot for the range 0.1-1.0 mM with a linear correlation coefficient of 0.9842 . Glucose oxidase (GOD) and glucose dehydrogenase (GDH) immobilized cylindrical platinum microelectrodes were fabricated, and their characteristics were evaluated, respectively, by using 1,4-benzoquinone (BQ) and ferricyanide as electron mediators . Each enzyme was immobilized by using PVA-SbQ on a cylindrical microelectrode of 2 microm diameter . A linear range in the calibration curve of the GOD-based glucose microsensor was observed to be wider than that obtained using a disk electrode of 1 mm diameter . The mediated response of the 2 microm glucose sensor was compared with the response resulting from hydrogen peroxide detection . This result showed that a higher response and a wider linear range were observed with highly concentrated mediator . A much higher response of the GDH immobilized 2 microm microelectrode was obtained when not only ferricyanide but also diaphorase was employed to reoxidize the NADH produced by the enzyme reaction of GDH . The GHD-based glucose microsensor was found to be unaffected by the concentration of dissolved oxygen.

Can J Infect Control, 1993 Spring, 8(1), 11 - 3
Scabies outbreak in an extended care unit--a positive outcome; Jack M; A recent outbreak of scabies occurred in an extended care unit attached to an acute care hospital . Seventy-eight residents and over 100 staff and family members were treated at a cost of more than $20,000 . The protocol in use at that time was found to be inadequate for an outbreak situation because it was based on the assumption that all staff would have previous experience of this type of problem . Close liaison with the head nurse of the affected unit, the occupational health and safety department, the medical microbiologist and the infection control department has resulted in the development of a procedure that reflects all of the concerns that were raised during the outbreak . In addition, a policy was formulated to cover problems associated with contacting medical personnel in a timely manner . This outbreak has resulted in positive changes in procedures as well as improved communication in a wide variety of departments within the hospital.

Annu Rev Microbiol, 1993, 47, 659 - 84
Genetics for all bacteria; Holloway BW; The availability of genetic analysis has now been extended to a wide variety of bacteria . While the traditional methods of conjugation, transduction, and transformation have made major contributions to microbiology and genetics, new recombinant DNA techniques and the development of new equipment for characterization and isolation of DNA fragments have enabled genome analysis of many bacteria for which no genetic information was previously available . These new procedures have enabled the construction of detailed physical/genetic maps as well as precise measurements of genome size, and provided new data on functional arrangements of genes in the bacterial genome . Such information is proving increasingly valuable for many aspects of microbiology as well as for the genetic manipulation of bacteria important in human disease, agriculture, and biotechnology.

Wien Med Wochenschr, 1993, 143(13), 333 - 6
{Helicobacter pylori: clinical pictures of an infectious disease with pathogen persistence}; Wein W et al.; It is the aim of this paper to provide survey of the very fast developing field of medical research on Helicobacter pylori which includes as different branches as gastroenterology, pharmacology or microbiology . After examination of the several diseases, pathological mechanisms, the diagnostical techniques and the therapeutical regimens, the authors of this study favorize an early indication for eradication of helicobater pylori . Since research on Helicobacter pylori is divided into many fields, there is the attempt to come to a clear and more rational point of view concerning therapeutical strategies and management of the infection . It is another focal point to emphasize the important role that chronical gastritis induced by Helicobacter pylori plays as an important risk factor for gastric carcinoma.

Trop Geogr Med, 1993, 45(4), 179 - 80
Disseminated strongyloidiasis in a diabetic patient; Coovadia YM et al.; A case of disseminated strongyloidiasis in an Indian diabetic patient who was not receiving any immunosuppressive therapy, is reported . Strongyloides stercoralis was detected in peritoneal fluid, stools and blood . To our knowledge this represents the first such case to be reported in the English literature . The need for both clinicians and microbiology laboratories to be on the alert for this parasite in patients who are compromised either because of underlying disease or therapy with immunosuppressive drugs, is emphasised.

Microbiol Immunol, 1993, 37(12), 991 - 7
Small, round-structured viruses (SRSVs) associated with acute gastroenteritis outbreaks in Gifu, Japan; Kawamoto H et al.; Two outbreaks of non-bacterial gastroenteritis occurred in Gifu prefecture in January 1989 and in January 1991 . Both outbreaks were closely related to the consumption of raw oysters, and showed similar clinical features . Small, round-structured virus particles were found in patient stools in both outbreaks by electron microscopy . The role of these particles as the causative agents of the outbreaks were strongly suggested by immune electron microscopy and/or western-blotting immunoassay . When compared with SRSV-9 (Tokyo/SRSV/86-510) reported previously (Hayashi et al, J . Clin . Microbiol., 27: 1728-1733, 1989), it was found that these viral particles were antigenically similar to SRSV-9, and had a major structural protein of 63 kilodaltons (kDa) . Further, the prevalence of this agent in Gifu area was examined by western blot antibody assay using 67 serum samples collected from the inhabitants in 1991 . The results indicated the circulation of the same or antigenically similar agent in this area.

Proc Annu Symp Comput Appl Med Care . 1993;:32-6.
The Automatic Patient Symptom Monitor (APSM): a voice mail system for clinical research; Marshall BJ et al.; Double-blind clinical trials become very tedious when symptoms are measured rather than objective laboratory and physical parameters . The standard "diary card" method is labor intensive for patients and impractical to use for more than a few weeks . In chronic relapsing disorders it would be far better for patients to record symptoms one or more times per day, at defined times, for weeks, months or even years . The Automatic Patient Symptom Monitor (APSM) is a voice processing system designed to achieve this goal . APSM calls patients at home every night, addresses each patient by name and then asks a set of questions which patients answer by pressing the touch tone keys on their telephone . APSM enters data into a computer database file which can be easily retrieved by investigators, even by modem . In a pilot study, patients with telephones easily learned how to use APSM . They were given therapy for a gastric infection (H.pylori) and were monitored by APSM until follow-up one month after completing treatment . Eight of nine patients recorded valid data on > 80% of study days . In all cases, APSM data matched the patient's own impression of whether they were better, the same, or worse . With one exception, APSM assessment correlated with microbiologic data obtained post therapy i.e . when the gastric infection had been eradicated, patients felt better (p < 0.047) . Long term clinical monitoring with APSM may decrease clinical trial time and improve the statistical power of double blind studies.

Acta Med Austriaca, 1993, 20(5), 122 - 3
{Hospital-acquired pneumonia}; Aigner K et al.; Nosocomial pneumonia is sometimes preventable . In manifestation it is a challenge to the interdisciplinary cooperation to pneumologists, internal medicine, intensive care medicine, clinical microbiologists, nursing staff and physiotherapists . Preventive measurements are of special value.

J Perinat Med, 1993, 21(5), 371 - 5
Neonatal herpes policy in The Netherlands . Five years after a consensus conference; van Everdingen JJ et al.; In order to establish whether the recommendations of an in 1987 organized consensus conference about neonatal herpes policy in the Netherlands had been followed, an inquiry was held in January 1992 among gynecologists, pediatricians and microbiologists . Compared with the results of an inquiry that was held five years before, it was found that the incidence of neonatal herpes had not increased in the last ten years (approximately five cases annually or one per 35,000 neonates) despite the lower frequency of caesarean sections (more than 50 sections a year before 1987 and less than 10 sections a year after 1987) . It is concluded that the consensus statements not only have been followed, but that they also proved to be sound.

Bull Soc Pathol Exot, 1993, 86(5), 336 - 41
{Treatment of eruptive rickettsioses . Review of the literature from the microbiology to the clinic}; Brouqui P et al.; The authors review the literature concerning the treatment of rickettsiosis including Rocky Mountain spotted fever, Mediterranean spotted fever, murine typhus, and Scrub typhus . They report in vitro antibiotic susceptibilities of the causing organisms and in vivo activity on animal models . They also report their clinical experience and these of the literature in the treatment of rickettsiosis.

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