Bacteriological

Rev Belge Med Dent, 1993, 48(4), 59 - 71
{The use of human dental enamel as an indicator of the extent of environmental pollution}; Cleymaet R et al.; Acid etch surface enamel microbiopsies were taken from permanent teeth of schoolchildren and analyzed for lead and cadmium using electrothermal atomic absorption spectrometry . A comparison concerning these heavy metals was made between children (7 and 12 years) from a school close to a non-ferrous metal plant and children from the same age group from a school situated near the same plant but in a less polluted zone . The lead concentrations in enamel biopsies from the first group were significantly higher than those from the second group . Cadmium shows the same trend but on a much lower level . A significant correlation between lead and cadmium was also found in both groups.

Blood Purif, 1993, 11(6), 349 - 69
Monodisperse magnetic polymer particles . New biochemical and biomedical applications; Ugelstad J et al.; The method of activated swelling of polymer particles developed by the authors allows the preparation of monodisperse spherical beads of predictable size from 1 to 100 microns in diameter . The polymer particles may be prepared from a number of different monomeric materials and with various morphologies including macroporous structures . The porous beads form the basis for magnetizable monodisperse polymer particles which have magnetic iron oxides distributed as small grains all through the volume of the beads . The magnetic particles are being used extensively for selective cell separation and for immunomagnetic separation within microbiology and molecular biology . A review of recent work within these fields is given . New methods for positive cell separation are announced.

Periodontal Clin Investig, 1993 Fall, 15(2), 8 - 12
Osteomyelitis associated with chronic periodontitis in a patient with end-stage renal disease: a case report; Tomaselli DL Jr et al.; The end-stage renal patient undergoing dialysis is susceptible to a number of infections . We report a case of localized suppurative osteomyelitis of the jaws, secondary to periodontitis, in a patient with chronic renal failure, with review of the physiologic and biochemical changes associated with renal failure . The clinical, radiographic, histologic, and microbiologic findings are presented with a discussion of the differential diagnosis and treatment provided.

FEBS Lett, 1992 Dec 21, 314(3), 275 - 9
Diversion of the sign of phototaxis in a Chlamydomonas reinhardtii mutant incorporated with retinal and its analogs; Takahashi T et al.; The blind mutant FN68 of the unicellular flagellate green alga Chlamydomonas reinhardtii is negatively phototactic in the presence of the native chromophore all-trans retinal . In contrast, analog chromophores such as a ring-acyclic retinal and those in which trans/cis isomerization about the C11 = C12 double bond was blocked induced predominantly positive phototaxis in the same strain under the same experimental conditions . These observations can be interpreted by assuming that the negative and the positive phototaxis is mediated distinctively by two rhodopsin species which differ in their affinities with the exogenous chromophores . However, a more reasonable explanation, which requires fewer assumptions, is that the sign of phototaxis depends on a delay in intracellular photosignal transduction . This novel view was deduced directly from the widely accepted hypothesis {1980, Microbiol . Rev . 44, 572-630} on phototaxis mechanisms.

J Clin Microbiol, 1992 Dec, 30(12), 3122 - 6
Antibody to a recombinant merozoite protein epitope identifies horses infected with Babesia equi; Knowles DP Jr et al.; Horses infected with Babesia equi were previously identified by the presence of antibodies reactive with a merozoite surface protein epitope (D . P . Knowles, Jr., L . E . Perryman, L . S . Kappmeyer, and S . G . Hennager . J . Clin . Microbiol . 29:2056-2058, 1991) . The antibodies were detected in a competitive inhibition enzyme-linked immunosorbent assay (CI ELISA) by using monoclonal antibody 36/133.97, which defines a protein epitope on the merozoite surface . The gene encoding this B . equi merozoite epitope was cloned and expressed in Escherichia coli . The recombinant merozoite protein, designated equi merozoite antigen 1 (EMA-1), was evaluated in the CI ELISA . Recombinant EMA-1 bound antibody from the sera of B . equi-infected horses from 18 countries . The antibody response to EMA-1 was then measured in horses experimentally infected with B . equi via transmission by the tick vector Boophilus microplus or by intravenous inoculation . Anti-EMA-1 antibody was detected 7 weeks post-tick exposure and remained, without reexposure to B . equi, for the 33 weeks of the evaluation period . The data indicate that recombinant EMA-1 can be used in the CI ELISA to detect horses infected with B . equi.

Pediatr Infect Dis J, 1992 Dec, 11(12), 996 - 1003
Diarrhea among African children born to human immunodeficiency virus 1-infected mothers: clinical, microbiologic and epidemiologic features; Pavia AT et al.; Diarrhea and weight loss are common features of pediatric and adult human immunodeficiency type 1 (HIV-1) infection, particularly in developing countries . We studied prospectively episodes of diarrhea in 559 children, ages 10 to 15 months, participating in a longitudinal study of perinatal HIV-1 infection in Kinshasa, Zaire . Children with HIV-1 infection had more frequent episodes of diarrhea and were more likely to present with fever or moderate or severe dehydration and to have persistent or fatal diarrhea . Of 9 HIV-1-positive infants with diarrhea, 3 had enteroadherence factor-positive Escherichia coli, compared with 5 of 74 HIV-1-negative children with diarrhea (P = 0.04); no other pathogen was associated with HIV-1 infection . In a logistic regression model diarrhea was significantly associated with HIV-1 infection in the child, moderate or severe malnutrition and symptoms of acquired immunodeficiency syndrome in the mother . Diarrhea among children with perinatal HIV infection in Zaire is more severe than among uninfected children and is associated with malnutrition and advanced disease in the mother.

J Med Virol, 1992 Dec, 38(4), 292 - 7
Detection and serotyping of rotaviruses in stool specimens by using reverse transcription and polymerase chain reaction amplification; Ushijima H et al.; Direct rotavirus serotyping (VP7, G type) in stool specimens was carried out by reverse transcription and polymerase chain reaction amplification (RT-PCR) and compared to serotyping by enzyme immunoassay with monoclonal antibodies (EIA-MAb) . The methods used for double-stranded (ds) RNA extraction, RT-PCR amplification, and the primers used were modified from previous reports {Gouvea et al.: Journal of Clinical Microbiology 29:519-523, 1990; Gentsch et al.: Journal of Clinical Microbiology, 1992} . For samples that were positive by both methods, the serotypes obtained were identical, however RT-PCR typing was found to be considerably more sensitive (70.4% samples serotyped) than EIA-MAb (35.6% of samples serotyped) . The overall sensitivities for detection of rotavirus in stool samples by latex agglutination, enzyme immunoassay, electron microscopy, polyacrylamide gel electrophoresis, and RT-PCR were essentially the same . The results confirm that RT-PCR typing (genotyping) is extremely valuable for G typing of samples which cannot be typed by EIA-MAb . We also developed a PCR confirmation technique for serotypes 1, 2, and 4.

Med Lab Sci, 1992 Dec, 49(4), 340 - 2
Stereomicroscopy in clinical microbiology; Lynch MM; The stereoscopic microscope has many applications in clinical microbiology, relating generally to the examination of colonial morphology . However, although potentially important in the routine microbiology laboratory, little use is made of the stereomicroscope . In this paper the applications of this form of microscopy are briefly reviewed and the considerable benefits that may be obtained from its use outlined.

Enferm Infecc Microbiol Clin, 1992 Dec, 10(10), 611 - 4
{Mycobacteriosis during 1980-1990 in a Madrid hospital}; Esteban J et al.; BACKGROUND: To assess the incidence and features of environmental mycobacteria that can produce disease over a ten years period (1980-1990) in an University Hospital from Madrid (Spain) . METHODS: Medical records of all patients in whom and environmental mycobacteria that can produce disease had been isolated were reviewed and classified as definite, possible or not clinically significant isolates, according to clinical features and microbiologic findings . RESULTS: Mycobacterium species were isolated in 415 patients (491 clinical samples over a total of 3003, 16.3%) . In 29 patients a environmental mycobacteria that can produce disease was identified . Medical records from 25 patients were retrieved, being this mycobacteria isolated classified as with definite clinical significance in 8 cases, with possible clinical significance in 4, and without clinical significance in 13 cases . Clinical features in the significant cases were: lung infection (3 cases), pleural and pericardial disease (1 case), peritonitis (1) and soft tissue infection (1) Two patients died . Surgical excision of the lesion was performed in the remaining patients, and clinical cure was achieved in five cases . CONCLUSIONS: The most prevalent mycobacterial infection in our environment is still due to M . tuberculosis infection, followed by M.avium-intracellulare . Surgical treatment is a valid approach in patients with localized infection by environmental mycobacteria that can produce diseases.

Enferm Infecc Microbiol Clin, 1992 Dec, 10(10), 576 - 80
{Tuberculous meningitis in patients without HIV infection . Presentation of 21 cases}; Arzuaga JA et al.; BACKGROUND: Tuberculous meningitis accounts for 5% to 12% of all extrapulmonary tuberculosis cases in western-hemisphere population non infected by HIV virus, and carries a high mortality rate . METHODS: We analyze retrospectively 21 patients with tuberculous meningitis in HIV negative patients seen from 1975 to 1989, with emphasis on clinical, laboratory and therapeutic features . RESULTS: In 48% of cases there were not typical meningeal signs, and 61% of patients showed neurological focal signs and/or seizures . CSF examination revealed a clear fluid with high cell counts (mostly lymphocytes), high protein and low sugar levels in 67% of cases . However, the microbiologic examination had a low yield of diagnosis (33%) . The clinical course is prolonged, and treatment is usually delayed . Morbidity and mortality were high (34% and 10% of cases) . In this study, the use of steroids did not show a significant reduction in mortality nor in neurological sequelae . CONCLUSION: Tuberculous meningitis in HIV negative patients is a chronic infection, without meningeal signs in most cases and linked to a high rate of neurological defects . The microbiologic tests have low yield of diagnosis . Steroid drugs seem to be indicated only if there are additional complications.

N Engl J Med, 1992 Nov 26, 327(22), 1541 - 8
Unilateral transplantation of human fetal mesencephalic tissue into the caudate nucleus of patients with Parkinson's disease; Spencer DD et al.; BACKGROUND . Parkinson's disease is characterized by the loss of midbrain dopamine neurons that innervate the caudate and the putamen . Studies in animals suggest that fetal dopaminergic neurons can survive transplantation and restore neurologic function . This report compares the clinical results in four case patients with severe Parkinson's disease who underwent stereotaxic implantation of human fetal ventral mesencephalic tissue in one caudate nucleus with the results in a control group of similar subjects assigned at random to a one-year delay in surgery . METHODS . Each case patient received cryopreserved tissue from one fetal cadaver (gestational age, 7 to 11 weeks) . Before implantation, adjacent midbrain tissue underwent microbiologic, biochemical, and viability testing . Cyclosporine was administered for six months postoperatively . RESULTS . The procedure was well tolerated . Three case patients showed bilateral improvement on motor tasks, as assessed on videotape, and were more functional in the activities of daily living, as assessed by themselves and neurologists, during both optimal drug therapy and "drug holiday" periods . One case patient, who died after four months from continued disease progression, had striatonigral degeneration at autopsy . In the patients who received transplants, optimal control was achieved with a lower dose of antiparkinsonian medications, whereas the controls required more medication . Positron-emission tomography with {18F}fluorodopa before and after surgery in one patient revealed a bilateral restoration of caudate dopamine synthesis to the range of normal controls, but continued bilateral deficits in the putamen . CONCLUSIONS . Although the case patients continued to be disabled by their disease, unilateral intracaudate grafts of fetal tissue containing dopamine diminished the symptoms and signs of parkinsonism during 18 months of evaluation.

Biochim Biophys Acta, 1992 Nov 23, 1112(1), 7 - 13
Properties and the primary structure of a new halorhodopsin from halobacterial strain mex; Otomo J et al.; A new halorhodopsin-like pigment from the new halobacterial strain mex (Otomo, J., Tomoika, H . and Sasabe, H . (1992) J . Gen . Microbiol . 138, 1027-1037) was partially purified, and its amino acid sequence from helices A to G was determined using PCR technique . Two arginine residues in the A-B interhelix loop segment, a series of six amino acid residues (EMPAGH) in the B-C interhelix segment and most of the residues near the Schiff base of the retinal were found to be conserved in three halorhodopsins (halobium, pharaonis and mex) . This result strongly suggests that these residues are essential for anion pumping function in halorhodopsin . The light-induced ion-pump measurements have shown that the selectivity of anion transport between chloride and nitrate in mex halorhodopsin is lower than that of halobium halorhodopsin, but higher than that of pharaonis halorhodopsin . The number of amino acid residues in the B-C interhelix loop segments is different in each halorhodopsin, and it correlates with their anion (chloride and nitrate) selectivity . These results suggest that the length of the B-C segment affects the selectivity of anion transport in halorhodopsin.

BMJ, 1992 Nov 21, 305(6864), 1243 - 4
About turn in US on interferon alfa; Roberts J; PIP: Researchers at the US National Institutes of Health reversed their previous dismissal of the efficacy of low dose interferon alpha (Kemron) developed in Kenya against AIDS under pressure for AIDS activists and black doctors stating that at least a clinical trial should be conducted . The National Medical Association stand was similar, although it did not approve Kemron . Interferon had been discovered by a veterinary microbiologist in Texas 20 years previously, and its anticancer use was promising as it proved effective against feline leukemia in 1989 . In 1989 it was administered to 204 AIDS patients in Kenya whose functional assessment increased by 66% after 10 weeks of treatment, and 18 became HIV negative . 12 other studies since then have been unable to confirm these findings, especially claims relating to seroconversion and increased CD4 cell counts . Oral interferon alpha has not been approved by the US Food and Drug Administration (FDA), but it is sold on the black market . As an FDA-approved anticancer injection drug (including against Kaposi's sarcoma often afflicting AIDS patients) its dose is 10,000 times higher than the oral dose .

J Parenter Sci Technol, 1992 Nov-Dec, 46(6), 226 - 32
Key issues relating to the genetic stability and preservation of cells and cell banks; Simione FP Jr; The long term maintenance of genetically stable cells is important for ensuring reproducible results and continuity in the advance of microbiology, cell biology and biotechnology . As actively growing cultures, cells are constantly at risk of changing, and the necessity for subculturing living materials increases the chances for genetic change and contamination . Many techniques are available for stabilizing living cells; the method employed must be compatible with the intended use of the culture . The most commonly utilized means of preserving living cells are by freezing to cryogenic temperatures, and freeze-drying . Master stocks are usually maintained at liquid nitrogen or comparable temperatures, while working stocks can be frozen or freeze-dried, and maintained at more economical and easily managed temperatures where possible . However, low temperature techniques may cause damage that can result in genetic change, or potential selection when only a small portion of the population survives . Therefore, a good preservation program must include a comprehensive cell characterization regimen that is applied both before and after preserving the cells to ensure that changes are detected when they do occur . Assurance of long term stability necessitates well designed safekeeping and security measures that include minimizing specimen handling through well designed inventory systems, validation and monitoring of storage temperatures, provisions for backup inventory, and training of personnel . Cell banking also requires good cataloguing and data management practices to avoid duplication and misidentification, and to ensure proper tracking of specimens and ease of access.

Antimicrob Agents Chemother, 1992 Nov, 36(11), 2398 - 402
Stability of antimycobacterial drugs in susceptibility testing; Griffith ME et al.; Aqueous solutions of 0.02% isoniazid, 0.2% streptomycin, 0.2% para-aminosalicylate, and 0.5% ethambutol and ethylene glycol solutions of 0.5% ethionamide stored at 3 to 7 degrees C remained stable for 1 year, as did aqueous solutions of 0.05% ethionamide hydrochloride, 0.05% kanamycin, 0.05% viomycin, and 0.1% capreomycin stored at -20 degrees C . The ethambutol and capreomycin solutions were tested by microbiologic methods; the other solutions were tested by both spectrophotometric and microbiologic methods . Prepared susceptibility testing media made with cycloserine, rifampin, and the above solutions incorporated into Middlebrook 7H10 medium showed acceptable stability when stored at 3 to 7 degrees C for 1 month . During incubation of the test medium at 37 degrees C, approximately half of the activity of isoniazid, ethionamide, ethambutol, cycloserine, and rifampin was lost after periods ranging from 2 to 4 days for ethambutol to 2 weeks for rifampin.

J Oral Pathol Med, 1992 Nov, 21(10), 471 - 6
Transamidase and collagenase activity in healthy and diseased human gingival tissues; Robinson PJ et al.; Transamidases are a class of calcium-dependent mammalian enzymes which cross-link proteins by catalyzing the formation of (gamma-glutamyl)-epsilon-lysine bonds . It is possible that these enzymes play an important anabolic role in tissue healing . This study was to quantitate transamidase activity in human gingival tissue and examine the relation between transmidase activity and degree of inflammation . Forty-four out of a total 120 collected human gingival specimens from healthy and diseased patients were selected based on histometric and microbiologic criteria . Specimens were minced and homogenized in 10 mM CaCl2 and then extracted for 30 min, in 50 mM tris-HCl buffer (pH 7.5) containing 100 mM CaCl2 . Following low speed centrifugation at 4 degrees C, the supernatant solution was assayed for both transamidase and collagenase activities by radioactive amine incorporation, and digestion of tritiated collagen, respectively . Appreciable levels of transamidase and collagenase activities in healthy gingivae were found . These enzyme activities were significantly elevated in the diseased and healing tissues . Unlike other transamidases, calcium was required in the enzyme extraction process.

Surg Gynecol Obstet, 1992 Nov, 175(5), 466 - 76
Aseptic technique in microgravity; McCuaig K; Within the next decade, the United States will launch a space station into low Earth orbit as a preliminary step toward a manned mission to Mars . Provision of asepsis in the unique microgravity environment, essential in operative and invasive procedures, is addressed . An assessment of conventional terrestrial aseptic methods and possible modifications for a microgravity environment was done during the microgravity portion of parabolic flight on NASA KC-135 aircraft . During 110 parabolas on three flight days, a "surgical team" (surgeon, scrub nurse and circulating nurse) using a life size mannequin fastened to a prototype surgical "work station" (operating table), evaluated open and closed gloving (ten parabolas), skin preparation (six parabolas), surgical scrub methods (24 parabolas), gowning (22 parabolas) and draping (48 parabolas) . Evaluated were povidone iodine solution, 1 percent povidone iodine detergent, Chloroxylenol with detergent, wet prep soap sponge, a water insoluble iodophor polymer (DuraPrep, 3M), disposable towels, disposable and reusable gowns, large and small disposable drapes with and without adhesive edges, disposable latex surgeon's gloves with and without packaging modifications and restraint mechanisms (tether, swiss seat, waist and foot restraint devices, fairfield and wire clamps and clips) . Ease of use, provision of restraint for supplies and personnel and waste disposal were assessed . The literature was reviewed and its relevance to the space environment discussed, including risk factors, environmental contamination, immune status and microbiology . The microgravity environment, limited water supply and restricted operating area mandated that modifications of fabrication and packaging of supplies and technique be made to create and preserve asepsis . Material must meet stringent flammability and off-gassing standards . Either a chlorhexidine or povidone iodine detergent prepackaged brush and sponge would provide an adequate scrub plus preliminary cleansing of a dirty wound . Choice may depend on ease of removal from the water supply as well as sensitivity to each compound of individual crew members . Rinsing was achieved with sterile water soaked gauze . Drying would be more efficient with two small hand towels, which would be easier to manipulate in microgravity and require less stowage volume . Skin preparation highlighted unexpected packaging problems, as centrifugal force was required to "shake" the solution out of the container on to the mannequin . To minimize contamination, a gown should be folded in an accordion manner and fastened to the base of its sterile wrapper, so that an assistant can compensate for the lack of gravity by applying constant tension.(ABSTRACT TRUNCATED AT 400 WORDS)

J Histochem Cytochem, 1992 Nov, 40(11), 1693 - 704
Intra- and extracellular localization of hyaluronic acid and proteoglycan constituents (chondroitin sulfate, keratan sulfate, and protein core) in articular cartilage of rabbit tibia; Asari A et al.; To demonstrate the intra- and extracellular localization of hyaluronic acid (HA) in articular cartilage of the rabbit tibia, biotinylated HA binding region, which specifically binds to the HA molecule, was applied to the tissue . In comparison with the localization of HA, that of chondroitin sulfate (CS), keratan sulfate (KS), and the protein core (PC) of the proteoglycan was examined by immunohistochemistry . Strong positive staining for HA was detected in chondrocytes located in the transition between the superficial and middle zones of the tissue . Pre-treatment with chondroitinase ABC, keratanase II, or trypsin enhanced the stainability for HA in peri- and intercellular matrices . Immunohistochemistry with or without enzymatic pre-treatment demonstrated that immunoreactivity for CS, KS, and PC was distinctly discerned in chondrocytes and in the extracellular matrix located in the middle and deep zones . In particular, the immunoreactivity for KS and PC was augmented by pre-treatment with chondroitinase ABC not only in chondrocytes but in the extracellular matrix located in the middle and deep zones . Microbiochemical analysis corresponded well with histochemical and immunohistochemical results . These results suggest that HA is abundantly synthesized and secreted in chondrocytes located in the transition between the superficial and middle zones.

Clin Lab Manage Rev, 1992 Nov-Dec, 6(6), 537 - 8, 543-6
Use of a modified nominal group process for improving laboratory performance in human immunodeficiency virus type 1 antibody testing . Reaching consensus on three questions concerning HIV-1 testing; Francis DP et al.; Using expert panels of medical technologists and public health microbiologists, a modified nominal group process was used to reach a consensus on three questions concerning current human immunodeficiency virus type 1 (HIV-1) testing methods . The questions related to important sources of error, improving the testing process, and improving proficiency testing . The modified nominal group process proved to be effective in developing lists of errors in laboratory testing; it provided a fast, economic means of identifying possible areas for improving laboratory quality assurance and training programs . For the HIV testing model, the focus group panelists indicated laboratory pipetting errors, labeling, and specimen identification as the most important sources of error . To improve the quality of this testing, the panel recommended standardizing test interpretation and restricting testing to laboratories licensed to perform HIV-1 testing . To improve proficiency testing, the use of blind specimens and establishing minimum standards of performance were suggested.

J Gen Microbiol, 1992 Oct, 138 ( Pt 10), 2145 - 57
Global transcription pattern of phi C31 after induction of a Streptomyces coelicolor lysogen at different growth stages; Suarez JE et al.; Using two complementary strategies for low-resolution S1 mapping, the global pattern of phi C31 transcription was studied after induction of thermoinducible phi C31 lysogens of Streptomyces coelicolor A3(2) . A complex pattern of early transcripts was seen, with a peak of abundance at about 10 min post-induction . Nearly all of these transcripts were from DNA located to the right of the c (repressor) gene and to the left of the attP site: a region of about 14 kb . Early transcription was also observed immediately to the left of the c gene . The c gene itself was also induced, with an earlier expression peak (about 5 min post-induction) . Primary late transcripts were generally relatively long, but degraded . They apparently corresponded to most of the 18 kb region to the left of the c gene . Some shorter and more persistent late transcripts corresponded to DNA close to or overlapping the cos site . Large late transcripts from a region close to the left-hand end of the phi C31 genome showed evidence of processing to more stable, smaller RNA species . A failure of older cultures (more than 12 h old) to be induced productively was correlated with a much longer period of early transcription, reduced late transcription, failure to synthesize a major virion protein, and failure to package phi C31 DNA . Moreover, heat treatment of the older lysogenic cultures did not result in the phi C31-dependent shut-down of host rRNA transcription previously observed for young cultures (Rodriguez et al., Journal of General Microbiology (1986) 132, 1695-1701; Clayton & Bibb, Molecular Microbiology (1990) 4, 2179-2185).

J Clin Periodontol, 1992 Oct, 19(9 Pt 1), 609 - 14
Periodontal diseases and HIV infection . A review of the literature; Robinson P; There have been many references in the literature to HIV-related periodontal diseases, which although poorly substantiated, seem to have established them as part of the expected range of HIV-associated conditions . The original studies have produced conflicting reports which may stem from shortcomings in design . Consequently, the picture remains confused with respect to the classification, epidemiology, microbiology, natural history and management of HIV-related periodontal diseases . Future studies should give greater attention to sampling methods, the use of control groups and defining criteria . This will allow comparison of data between centres and facilitate study of what may be an uncommon disease.

Clin Microbiol Rev, 1992 Oct, 5(4), 370 - 86
Advances in nucleic acid-based detection methods; Wolcott MJ; Laboratory techniques based on nucleic acid methods have increased in popularity over the last decade with clinical microbiologists and other laboratory scientists who are concerned with the diagnosis of infectious agents . This increase in popularity is a result primarily of advances made in nucleic acid amplification and detection techniques . Polymerase chain reaction, the original nucleic acid amplification technique, changed the way many people viewed and used nucleic acid techniques in clinical settings . After the potential of polymerase chain reaction became apparent, other methods of nucleic acid amplification and detection were developed . These alternative nucleic acid amplification methods may become serious contenders for application to routine laboratory analyses . This review presents some background information on nucleic acid analyses that might be used in clinical and anatomical laboratories and describes some recent advances in the amplification and detection of nucleic acids.

J Bacteriol, 1992 Oct, 174(20), 6368 - 76
Cloning and nucleotide sequence of celA1, and endo-beta-1,4-glucanase-encoding gene from Streptomyces halstedii JM8; Fernandez-Abalos JM et al.; The celA1 gene encoding an endo-beta-1,4-glucanase from a mesophilic actinomycete, strain JM8, identified as Streptomyces halstedii, was cloned and expressed in S . lividans JI66 . From the nucleotide sequence of a 1.7-kb DNA fragment we identified an open reading frame of 963 nucleotides encoding a protein of 321 amino acids, starting at TTG (instead of ATG) . The Cel1 mature enzyme is a protein of 294 amino acids (after signal peptide cleavage) and can be included in the beta-glycanase family B (N . R . Gilkes, B . Henrissat, D . G . Kilburn, R . C . Miller, Jr., and R . A . J . Warren, Microbiol . Rev . 55:303-315, 1991) . The Cel1 enzyme lacks a cellulose-binding domain as predicted by computer analysis of the sequence and confirmed by Avicel binding experiments . The promoter region of celA1 was identified by S1 mapping; the -35 region closely resembles those of housekeeping Streptomyces promoters . Three imperfectly repeated sequences of 15, 15, and 14 nucleotides were found upstream from celA1 {ATTGGGACCGCTTCC-(N85)-ATTGGGACCGCTTCC-(N2)-TGGGAGC GCTCCCA}; The 14-nucleotide sequence has a perfect palindrome identical to that found in several cellulase-encoding genes from Thermomonospora fusca, an alkalophilic Streptomyces strain, and Streptomyces lividans . This sequence has been implicated in the mechanism of induction exerted by cellobiose . Using an internal celA1 probe, we detected similar genes in several other Streptomyces species, most of them cellulase producers.

J Bacteriol, 1992 Oct, 174(19), 6179 - 83
In vitro activation of dinitrogenase reductase from the cyanobacterium Anabaena variabilis (ATCC 29413); Bohm I et al.; Nitrogenase of the heterocystous cyanobacterium Anabaena variabilis was inactivated in vivo (S . Reich, H . Almon, and P . Boger, FEMS Microbiol . Lett . 34:53-56, 1986) . Partially purified and modified (inactivated) dinitrogenase reductase (Fe-protein) of such cells was reactivated by isolated membrane fractions of A . variabilis or of Rhodospirillum rubrum, and acetylene reduction was measured . Reactivation requires ATP, Mg2+, and Mn2+ . The activating principle is localized in the heterocyst and was found effective only when prepared from cells exhibiting active nitrogenase . It also restores the activity of modified Fe-protein from R . rubrum.

Chest, 1992 Oct, 102(4), 999 - 1004
Bronchoalveolar lavage cell count and differential are not reliable indicators of amiodarone-induced pneumonitis; Ohar JA et al.; Amiodarone-induced interstitial pneumonitis is a serious, frequently fatal untoward effect of a commonly used antiarrhythmic agent . Recent reports suggest that bronchoalveolar lavage (BAL) fluid cellular analysis might be used to diagnose amiodarone-induced pneumonitis . The purpose of this study was to determine if the diagnosis of amiodarone-induced pneumonitis could be made by patient history, pulmonary function evaluation, and examination of BAL fluid . We studied five groups of patients . Three of the five groups received amiodarone: patients receiving amiodarone without evident lung toxic reaction, patients with amiodarone-induced pneumonitis, and amiodarone-treated patients diagnosed as having other pathologic processes involving the lung . The two other groups examined were healthy volunteers and patients with interstitial lung disease from causes other than amiodarone . Pulmonary function tests included vital capacity (FVC), first second forced exhaled volume (FEV1), total lung capacity (TLC), and diffusing capacity for carbon monoxide (DCO) . BAL fluid analysis included total and differential cell counts . We found that amiodarone-induced interstitial pneumonitis was not associated with an alteration in pulmonary function or BAL cellular composition which could permit its distinction from amiodarone-treated patients diagnosed as having an unrelated pulmonary process or patients with interstitial lung disease from other causes . The most frequent abnormality encountered in patients with amiodarone toxicity was a reduction in the percentage of macrophages in the differential cell count . The sensitivity, specificity, and predictive value of this finding was 82 percent, 69 percent, and 69 percent, respectively . The sensitivity, specificity, and predictive value of a > or = 15 percent reduction in DCO was 44 percent, 50 percent, and 36 percent, respectively . We conclude that amiodarone-induced interstitial pneumonitis remains a diagnosis of exclusion, and the role of BAL fluid analysis is to narrow the differential diagnosis through microbiologic culture and cytologic examination.

Mem Inst Oswaldo Cruz, 1992 Oct-Dec, 87(4), 533 - 8
Pterigodermatites (Paucipectines) spinicaudatis n . sp . (Nematoda: Rictularidae) from Dromiciops australis (Marsupialia: Microbiotheriidae) in Bariloche, Rio Negro, Argentina . Biogeographical distribution and host-parasite relationships; Navone GT et al.; Pterigodermatites (P.) spinicaudatis sp . n . from Dromiciops australis is proposed and described . The simple morphology of the ovijector and the presence of a well developed spine between the two cuticular projections at the caudal extremity of the female distinguish the studied nematode from the remainder species of the genus parasitizing South American Edentata, marsupials and cricetid rodents . The distribution area of the hosts of the different species of P . (P.) are given . The studied genus does not parasitize any Australian marsupials . It was found in the endemic South American Microbiotheriidae . This fact suggests from a parasitological point of view that D . australis is not related to the Australian marsupials but to the South American ones.

Eur J Biochem, 1992 Oct 1, 209(1), 357 - 65
Further characterization of the {Fe}-hydrogenase from Desulfovibrio desulfuricans ATCC 7757; Hatchikian EC et al.; The properties of the periplasmic hydrogenase from Desulfovibrio desulfuricans ATCC 7757, previously reported to be a single-subunit protein {Glick, B . R., Martin, W . G., and Martin, S . M . (1980) Can . J . Microbiol . 26, 1214-1223} were reinvestigated . The pure enzyme exhibited a molecular mass of 53.5 kDa as measured by analytical ultracentrifugation and was found to comprise two different subunits of 42.5 kDa and 11 kDa, with serine and alanine as N-terminal residues, respectively . The N-terminal amino acid sequences of its large and small subunits, determined up to 25 residues, were identical to those of the Desulfovibrio vulgaris Hildenborough {Fe}-hydrogenase . D . desulfuricans ATCC 7757 hydrogenase was free of nickel and contained 14.0 atoms of iron and 14.4 atoms of acid-labile sulfur/molecule and had E400, 52.5 mM-1.cm-1 . The purified hydrogenase showed a specific activity of 62 kU/mg of protein in the H2-uptake assay, and the H2-uptake activity was higher than H2-evolution activity . The enzyme isolated under aerobic conditions required incubation under reducing conditions to express its maximum activity both in the H2-uptake and 2H2/1H2 exchange reaction . The ratio of the activity of activated to as-isolated hydrogenase was approximately 3 . EPR studies allowed the identification of two ferredoxin-type {4Fe-4S}1+ clusters in hydrogenase samples reduced by hydrogen . In addition, an atypical cluster exhibiting a rhombic signal (g values 2.10, 2.038, 1.994) assigned to the H2-activating site in other {Fe}-hydrogenases was detected in partially reduced samples . Molecular properties, EPR spectroscopy, catalytic activities with different substrates and sensitivity to hydrogenase inhibitors indicated that D . desulfuricans ATCC 7757 periplasmic hydrogenase is a {Fe}-hydrogenase, similar in most respects to the well characterized {Fe}-hydrogenase from D . vulgaris Hildenborough.

Minerva Stomatol, 1992 Oct, 41(10), 425 - 9
Polymerase chain reaction: relevance for oral pathology; Ficarra G et al.; The polymerase chain reaction (PCR) is a recent innovation in biotechnology for amplifying specific nucleic acid sequences by use of repeated cycles of DNA synthesis . Application of PCR has been extended to a wide variety of biological and medical disciplines; fields of application include molecular genetics, pathology, microbiology, forensic medicine, and infectious diseases . Because of its speed and powerful sensitivity, PCR has become a highly valuable method for detecting small amounts of target nucleic acid sequence with the caveat that it has certain limitations . Importantly, false-positive reactions can result from the amplification of contaminating DNA whereas false-negative reactions can result from introduction of inadequate numbers of primer sequences . The application of PCR in the context of oral pathology is presented along with a discussion of the utility of this technique to aid in the elucidation of the etiology of oral disease.

Am J Obstet Gynecol, 1992 Sep, 167(3), 683 - 8
The presence of amniotic fluid leukoattractants accurately identifies histologic chorioamnionitis and predicts tocolytic efficacy in patients with idiopathic preterm labor; Cherouny PH et al.; OBJECTIVES: We tested these hypotheses: (1) that amniotic fluid from patients with idiopathic preterm labor and histologic chorioamnionitis contains leukoattractants and (2) that the detection of amniotic fluid leukoattractants is an accurate predictor of tocolytic efficacy . STUDY DESIGN: Amniotic fluid from 86 patients in idiopathic preterm labor was evaluated by microbiologic tests and leukotaxis assay . The tests' ability to predict histologic chorioamnionitis and response to tocolysis (51 tocolytic candidates) is established . Statistical analysis was performed with Fisher's exact test and unpaired Student t test . RESULTS: The detection of amniotic fluid leukoattractants was a better predictor of histologic chorioamnionitis (97%) than were amniotic fluid microbiologic tests (62%) (p less than 0.01) . Also, in patients with detectable amniotic fluid leukoattractants tocolysis failed significantly more often than in patients without detectable leukoattractants (93% vs 7%, p less than 0.01) . CONCLUSION: The presence of leukoattractants in amniotic fluid detected by the leukotaxis assay accurately identifies histologic chorioamnionitis and can additionally predict tocolytic efficacy in patients with idiopathic preterm labor.

Acad Med, 1992 Sep, 67(9), 605 - 7
Prematriculation program grades as predictors of black and other nontraditional students' first-year academic performances; Hesser A et al.; This study explored the relative strengths of select background variables, including grades in a summer prematriculation program (SPP), as predictors of students' first-year academic performances . During the years 1980-1989, 115 black and other nontraditional prematriculants at the Medical College of Georgia School of Medicine attended a four-week SPP featuring courses in biochemistry, anatomy, and immunology . Canonical correlation analysis revealed that the combination of undergraduate grade-point average (GPA) and SPP grades in biochemistry and anatomy was the best predictor of the students' academic performances based upon their first-year grades in biochemistry, anatomy, and microbiology, and upon their GPAs for all first-year basic science courses . The authors conclude that SPP grades can be used to identify the specific academic weaknesses of nontraditional students at highest risk of falling into academic jeopardy.

Arch Ophthalmol, 1992 Sep, 110(9), 1234 - 7
Ofloxacin vs tobramycin for the treatment of external ocular infection . Ofloxacin Study Group II; Gwon A; A multicenter, double-masked, randomized clinical investigation was conducted comparing 0.3% ofloxacin and 0.3% tobramycin for topical treatment of external ocular infection . One drop (1.35 micrograms) of either test solution was instilled six times daily for 2 days and thereafter four times daily for the next 8 days . At the day 3 to 5 follow-up examination, the severity of signs and symptoms based on a clinical summary score of 10 key variables was reduced from baseline values significantly (P less than .05) more with ofloxacin (-6.4 +/- 4.37; mean +/- SD) than with tobramycin (-4.78 +/- 3.13); by day 11, the difference between the groups was no longer significant . At days 3 to 5 and day 11 examinations, clinical, microbiologic, and overall improvement rates were similar, with no significant differences seen between the groups . Ofloxacin was found as effective, safe, and comfortable as tobramycin in patients with external ocular infection and may provide earlier symptom relief.

Am Rev Respir Dis, 1992 Sep, 146(3), 757 - 62
Ultrasonographic evaluation of pulmonary consolidation; Yang PC et al.; A total of 161 patients with lobar or segmental consolidation were examined by realtime ultrasound and Doppler ultrasound . Air bronchograms were detected in 141 patients, fluid bronchograms in 27 patients, and parapneumonic effusion in 74 patients . In 36 patients with necrotizing pneumonia, ultrasound detected microabscesses in 33 (91.7%) compared with the air-fluid levels detected by standard chest radiographs in 20 patients (55.6%; p less than 0.05) . Of 31 patients with tumors causing obstructive pneumonitis, 29 (93.5%) had tumors detected by chest ultrasound, whereas only 11 patients (35.5%) had chest radiographs that suggested a tumor was causing the obstructive pneumonitis (p less than 0.05) . Chest ultrasound was used to guide thoracentesis for parapneumonic effusion in 65 patients, with a 100% success rate . Twenty-six patients with necrotizing pneumonia underwent ultrasound-guided needle aspiration of microabscesses . The procedure was successful in 24 patients (92.3%), and 21 patients (80.8%) had microbiologic confirmation . Twenty patients with tumor-associated obstructive pneumonitis received needle aspiration biopsy under ultrasound guidance; 19 patients (95.0%) had the histology confirmed . Five patients with malignancy manifesting as pulmonary consolidation underwent a diagnostic ultrasound-guided needle aspiration biopsy . Five patients (3.8%) developed complications of minimal pneumothorax or mild hemoptysis in 132 episodes of needle aspiration . We conclude that ultrasonography is useful for the evaluation of pulmonary consolidation . It can also be used for needle aspiration guidance for etiologic diagnosis of patients with complicated pneumonia.

J Pediatr, 1992 Sep, 121(3), 459 - 65
Cefpodoxime proxetil compared with amoxicillin-clavulanate for the treatment of otitis media; Mendelman PM et al.; In a multicenter, randomized, investigator-blinded trial, patients were randomly selected to receive either cefpodoxime proxetil or amoxicillin-clavulanate potassium orally for the treatment of acute suppurative otitis media . Patients were seen before, during, and at the end of therapy, and 2 to 3 weeks after completion of therapy . A total of 229 patients, 153 receiving cefpodoxime and 76 receiving amoxicillin-clavulanate were entered into the study; all patients were examined to determine drug safety . A total of 146 patients, 98 in the cefpodoxime group and 48 in the amoxicillin-clavulanate group, completed the study and were examined to determine drug efficacy . End-of-therapy microbiologic eradication rates in assessable patients were 92% for cefpodoxime and 86% for amoxicillin-clavulanate (p = 0.14; 95% confidence interval (CI) on difference: -4.4%, 19.2%) . End-of-therapy clinical response rates for assessable patients were as follows: cured, 68% for cefpodoxime and 65% for amoxicillin-clavulanate; improved, 24% for cefpodoxime and 23% for amoxicillin-clavulanate; and failed, 8% for cefpodoxime and 13% for amoxicillin-clavulanate (p = 0.57; 95% CI: -8.4%, 16.5%) . Recurrence rates at long-term follow-up were 24% for cefpodoxime-treated patients and 25% for those given amoxicillin-clavulanate . Both drugs were well tolerated; 20.9% of those given cefpodoxime and 31.6% of amoxicillin-clavulanate-treated patients had drug-related adverse medical events (p = 0.102; 95% CI: -23.9%, 2.6%) . Gastrointestinal complaints were the most frequently reported drug-related side effect in both groups: 11.8% of cefpodoxime-treated patients and 21.1% of those given amoxicillin-clavulanate (p = 0.076; 95% CI: -20.8%, 2.2%) . Drug-related dermatologic side effects (e.g., diaper rash, pruritus, urticaria) were reported in 7.8% of cefpodoxime-treated patients and 14.5% of those who received amoxicillin-clavulanate (p = 0.160; 95% CI: -16.6%, 3.3%) . Our findings suggest that clinical efficacy for cefpodoxime administered twice daily is equivalent to that of amoxicillin-clavulanate administered three times a day.

Thorax, 1992 Sep, 47(9), 734 - 7
An audit of the clinical investigation of pleural effusion; Walshe AD et al.; BACKGROUND: Pleural aspiration with pleural biopsy is advised for the investigation of pleural effusion . The clinical investigation of pleural effusion in a group of teaching hospitals was audited with reference to adequacy and diagnostic value of sampling procedures . METHODS: A retrospective review of case records of all patients investigated for pleural effusion during an eight month period was performed . The records of 112 patients, age range 16-91 years, who underwent 150 procedures were reviewed . RESULTS: Microbiology samples were obtained from 137 procedures, of which five provided a positive culture, including one for mycobacteria . Cytology samples were obtained from 145 procedures though approximately two thirds of samples were less than the recommended 30 ml . The pleural biopsy rate was 30%, varying from 0% in general or thoracic surgery to 68% in thoracic medicine (thoracic surgeons carried out thoracoscopy) . Twenty nine per cent of pleural biopsy samples were of poor quality . The complication rate was 2% for aspiration alone, and 4% for aspiration plus biopsy . The sensitivity of the first diagnostic procedure for a diagnosis of malignancy or tuberculosis was 53% for cytology alone, 50% for biopsy alone and 72% for cytology plus biopsy . CONCLUSION: The samples obtained from pleural aspiration and biopsy in the initial investigation of pleural effusion are often inadequate . Further education is necessary to improve the quantity and quality of specimens submitted for histological and cytological examination.

Monatsschr Kinderheilkd, 1992 Sep, 140(9), 652 - 7
{Experiences with triple antibiotic combination in neonatal infection}; Paul T et al.; BACKGROUND: In-vitro and clinical efficacy of a combination therapy consisting of 3 antibiotic agents was to be assessed in neonatal septicemia . METHODS: From 1980 to 1987, 152 newborns with septicemia as proven by blood culture were treated with an initial antibiotic regimen consisting of azlocillin (150 mg/kg bw), cefotaxime (100 mg/kg bw), and tobramycin (5 mg/kg bw) . RESULTS: According to the microbiologic testing, antimicrobic therapy was effective in each of the 152 organisms: 101/152 bacteria were susceptible to all 3 agents; resistance to 1 or 2 of the antibiotics was evident in 33/152 and in 18/152 organisms, respectively . Mortality due to septicemia was 7.2% . CONCLUSION: As no difference was observed in the frequency in which one of the three antibiotic substances was the only effective drug, each of the 3 agents seemed to be necessary for clinical effectiveness of this antibiotic combination.

Sex Transm Dis, 1992 Sep-Oct, 19(5), 295 - 7
Split-dose metronidazole or single-dose tinidazole for the treatment of vaginal trichomoniasis; O-Prasertsawat P et al.; In a double-blind, randomized, controlled trial, efficacy and safety of a single-day split dose of 1.6 g of metronidazole were compared with a single 2-g dose of tinidazole in the treatment of vaginal trichomoniasis . Women with symptomatic vaginal trichomoniasis were randomly assigned to one of the two treatment groups . There were 67 women in the group treated with the single-day split dose and 65 in group treated with the single dose . There was no significant difference between the two groups in terms of clinical characteristics (age, weight, and length of follow-up period) . The cure rates, using trypticase yeast extract iron serum (TYI) medium to confirm microbiologic cure, were 98.5% and 100% for the groups treated with a single-day split dose and with a single dose, respectively . The side effects were minimal and did not warrant any treatment . The differences in the results were not statistically significant . We recommend that the single-day split dose of 1.6 g of metronidazole regimen be given as an alternative drug for vaginal trichomoniasis . Its advantages include being highly effective, significantly less expensive, and with minimal side effects.

J Appl Bacteriol, 1992 Sep, 73(3), 210 - 16
Laboratory performance in a food microbiology proficiency testing scheme; Peterz M; Results from two shipments in a proficiency testing scheme in which almost 200 food microbiology laboratories participated are summarized . Freeze-dried mixtures of bacteria were used as simulated food samples . Four and six samples, respectively, were examined . The statistical procedures used to evaluate the performance of participating laboratories are described . It is shown that laboratories which had been in the scheme for a long time perform, on average, better than those that had been in the scheme for a short time . The former laboratories produced fewer false and outlying results, and were more accurate and precise in their determinations.

Biotechniques, 1992 Sep, 13(3), 450 - 3
Protecting researchers from instrument biohazards; Hambleton P et al.; The prevention and control of biohazards arising from the use of laboratory instruments have become increasingly important in clinical and research applications . Centrifuges can be susceptible to contamination because of intense wear on primary containers (specimen tubes and bottles), worn O-ring container seals, or rotors and buckets lacking tight seals . A recent study by the Center for Applied Microbiology and Research, Porton Down, UK, has determined the biological safety of certain rotors in various speed ranges . This paper presents and discusses these findings.

Virology, 1992 Sep, 190(1), 316 - 29
Modulation of the cellular phenotype by integrated adeno-associated virus; Winocour E et al.; The adeno-associated virus (AAV) rep gene encodes a series of overlapping, multifunctional, nonstructural proteins (Rep proteins) which regulate the viral life cycle and which are also capable of trans-regulating nonviral gene expressions (reviewed in Berns, 1990, Microbiol . Rev . 54, 316-329) . To investigate the expression of the AAV rep gene in a cellular chromosomal context, SV40-transformed Chinese hamster embryo (OD4) cells were infected with an AAV/neo hybrid virus and progeny resistant to the antibiotic G418 were selected and amplified . Chromosomal integration and RNA transcription of the AAV and neo DNA inserts were confirmed by Southern and Northern blotting procedures . One of the G418R cell lines stably expressed a protein which reacted specifically with AAV anti-Rep antiserum in Western immunoblots . The stable integration of AAV rep DNA, which did not interfere with cell proliferation under normal growth conditions, was associated with two changes in cellular phenotype: eight of nine lines were markedly more sensitive to UV light (254 nm) than were the parental OD4 cells; and seven of the nine lines had lost the capacity to promote SV40 origin DNA amplification in vitro, in contrast to the parental OD4 cells . OD4 cells transformed to G418R by AAV/neo DNA constructs with a deleted rep gene, or by a neo DNA construct lacking AAV DNA, did not display these phenotypic changes . It is suggested that stable integration of the AAV rep gene interferes with cellular processes connected with DNA repair and gene amplification.

J Prosthodont, 1992 Sep, 1(1), 47 - 50
The dental curriculum: is is relevant to dental practice?
Welker WA.
Does the undergraduate dental curriculum devote the appropriate amount of time to those areas of dentistry that are relevant to today's general dental practice? In a survey of dentists who graduated between 1980 and 1985, it was determined that they felt curriculum offerings in orthodontics, research, endodontics, periodontics, oral surgery, fixed prosthodontics, and occlusion had not been extensive enough . However, graduates also reported that their educational experiences in biochemistry, dental laboratory procedures, gross anatomy, microbiology, and occlusion were too extensive.

East Afr Med J, 1992 Sep, 69(9), 508 - 14
The role of the laboratory in a Chlamydia control programme in a developing country; Peeling RW et al.; The laboratory components of a Chlamydia trachomatis disease control programme for a developing country are reviewed . Early diagnosis of chlamydial infections is the most cost effective means of preventing the long term sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are now a major public health burden to the health care system in developing countries . Public health strategies are required to establish both a co-ordinated limited system of laboratory services, and to promote the diagnosis and treatment of disease syndromes in the absence of laboratory support . Laboratory tests for the specific diagnoses of chlamydial infections requiring different levels of expertise and equipment can be instituted within settings appropriate to the resources and technical expertise available . Emphasis is given to appropriate cost effective utilization of laboratory testingPIP: Current methods used for the laboratory diagnosis of a Chlamydia trachomatis disease control program for a developing country are reviewed to guide clinical microbiology laboratories to develop criteria for testing . Human chlamydia infections are a major public health problem in both developed and developing countries . Worldwide an estimated 360 million persons are infected by the ocular serovars of Chlamydia trachomatis and 6.4 million are blind from the scarring, sequelae . The genital strains of Chlamydia trachomatis cause cervical, endometrial or tubal infections in women, resulting in pelvic inflammatory disease (PID) or ectopic pregnancy, and infertility . Over 50% of chlamydia infections in women are asymptomatic and progress to silent PID and infertility . In industrialized countries chlamydia infections are the major cause of sexually transmitted disease-related infertility . Infants born to infected mothers are at risk for chlamydia pneumonia and ophthalmia neonatorum . More tentative associations of chlamydia infections exist with Reiter's Syndrome . Early diagnosis of chlamydia infections is the most cost effective means of preventing the longterm sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are a major public health liability in developing countries . In many developed and developing countries, public health decision maker are not aware of the extent of chlamydia infections in the community . One of the priorities of the disease control program is to provide accurate epidemiologic data through seroprevalence studies . This includes estimates of persons infected, the severity of complications and sequelae . Public health strategies are required to establish laboratory services and to diagnose and treat the disease . The diagnostic methods for C . trachomatis include specimen collection, cytologic methods, serologic methods, cell culture method, antigen detection methods, and nucleic acid hybridization tests that should be available at the national reference laboratory .

J Infect Dis, 1992 Aug, 166(2), 277 - 84
Association of gastric hypoacidity with opportunistic enteric infections in patients with AIDS; Belitsos PC et al.; To determine the relation and possible significance of gastric hypoaciditity to chronic diarrhea in AIDS, patients with and without chronic (greater than 1 month) diarrhea underwent fasting gastric juice pH measurement and microbiologic study and upper and lower endoscopy with biopsy . All 8 patients with diarrhea and high gastric pH (greater than 3; mean, 6.1 +/- 1.0) had gastric bacterial overgrowth (greater than 10(4) bacteria/mL) along with opportunistic enteropathogens in the duodenum or rectosigmoid, but only 1 of 6 patients with diarrhea and gastric pH in the normal range (less than or equal to 3; mean, 1.9 +/- 0.7) had overgrowth or an opportunistic enteropathogen . By contrast, all but 1 of 9 controls (AIDS patients without diarrhea) had normal fasting gastric pH (mean, 2.9 +/- 1.5) . Overall, the presence of gastric hypoacidity was associated with identification of opportunistic enteropathogens (P = .035) . Thus, gastric hypoacidity is associated with quantitative bacterial overgrowth and opportunistic enteric infections and may be etiologically important in the pathophysiology of the chronic diarrhea seen in some AIDS patients.

Community Dent Oral Epidemiol, 1992 Aug, 20(4), 169 - 74
The University of North Carolina caries risk assessment study: caries increments of misclassified children; Graves RC et al.; The University of North Carolina caries risk assessment was conducted between 1986 and 1989 with 5000 children initially in grades 1 and 5 from low fluoride sites in South Carolina and Maine . Clinical, microbiologic, behavioral, and demographic factors served as independent variables used in logistic multiple regression models to determine the predicted caries risk classification of each child . The 3-yr DMFS increment of each child was the dependent variable, and the 20-25% of those in each cohort with the highest increment were considered the high risk group . Sensitivity and specificity values averaged 0.60 and 0.83 respectively, indicating the misclassification of substantial numbers of children . This paper reports analysis of the DMFS increments of the misclassified children . The majority of children had DMFS increments within one or two surfaces of the classification cut points . Many false negative children had increments composed entirely of filled surfaces, often of minimal extent and without evidence of previous decay . Many false positive children had increments composed of decayed surfaces and would have benefitted from being identified as high risk and assigned to a preventive program . Other false positive children had sealants placed after the baseline examination that undoubtedly reduced their true increment . It is concluded that the consequences of misclassification are not serious for most children in this study.

J Am Vet Med Assoc, 1992 Aug 1, 201(3), 434 - 7
Plasma concentrations of 13,14-dihydro-15-ketoprostaglandin F2 alpha in mares during uterine involution; Sertich PL et al.; Twelve mares were allowed to foal naturally, after which they were monitored to study uterine involution . Starting on day 3 after parturition, the internal genital tract was examined per rectum manually and ultrasonographically every other day for changes in uterine characteristics and ovarian activity . By day 5, gravid and nongravid uterine horns were similar in size, and by day 7, uterine fluid was absent . On day 7 after parturition, endometrial biopsy samples were obtained for histologic evaluation, and uterine swab specimens were obtained for microbiologic culture . Uterine swab specimens from 10 of 12 mares had slight bacterial growth . The uteri of 8 of the 12 mares were histologically involuted by day 7 . All mares ovulated 7 to 12 days after parturition . Concentrations of 13,14-dihydro-15-keto-PGF2 alpha (PGFM) were measured in jugular plasma samples obtained daily for 21 days after parturition . Concentrations of PGFM were low by the day after parturition, and there was no significant correlation between uterine involution and PGFM concentrations in these mares . All 12 mares were bred at the first estrus after parturition, and 9 became pregnant.

Gesundheitswesen, 1992 Aug, 54(8), 406 - 9
{Draft of the swimming pool water regulation . Presentation, status: 17 September 1991, according to the federal hearing of 11 December 1991 in Bonn}; Sacre C; Comments are given on the present status of regulations concerning water in swimming pools and baths--1991--(in connection with the KOK regulations--1972--and the Federal German standard {DIN} No . 19643-1984-) . Reference is made to microbiologic limits of Legionella pneumophila among others.

Pediatr Rev, 1992 Aug, 13(8), 283 - 93
Transmission of infectious diseases in children; Goldmann DA; A rational approach to the control of pediatric infectious diseases requires an appreciation of their epidemiology and mechanisms of transmission . The setting in which the exposure occurs may have a major influence on the risk of infection . Unfortunately, the epidemiology of many important pediatric pathogens is complex and incompletely understood . Recent advances in diagnostic microbiology and molecular epidemiology may help to solve some of the remaining riddles.

Zhonghua Liu Xing Bing Xue Za Zhi, 1992 Aug, 13(4), 226 - 8
{Investigation of rodents and Ixodes for Lyme disease and four strains of Borrelia burgdorferi first isolated from Ixodes granulatus Supino, Rattus confucianus and R . norvegicus in Fujian province}; Pan L; With BSK II medium, 4 strains of Borrelia burgdorferi was isolated from Ixodes granulatus Supino, Rattus confucianus and R, novregicus, which Ixodes and Ruttus all captured from forest areas in northern of Fujian province where have found Lyme cases . These isolated strains were identified by Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine.

J Biol Chem, 1992 Jun 25, 267(18), 12559 - 61
Stereoselective hydrolysis catalyzed by related beta-1,4-glucanases and beta-1,4-xylanases; Gebler J et al.; Over 80 beta-1,4-glucanases and beta-1,4-xylanases can be classified into one of eight families on the basis of amino acid sequence similarities in their catalytic domains (Gilkes, N . R., Henrissat, B., Kilburn, D . G., Miller, R . C., Jr., and Warren, R . A . J . (1991) Microbiol . Rev . 55, 303-315) . As a test of this classification, the stereochemical course of hydrolysis of 10 enzymes representative of five families has been determined using proton NMR . These data, together with published data for six additional enzymes, show that representatives of a given enzyme family have the same stereoselectivity: four families catalyze hydrolysis with retention of anomeric configuration, two with inversion . The results support the hypothesis that family members share a common general fold, active site topology, and catalytic mechanism.

Vet Clin North Am Food Anim Pract, 1992 Jul, 8(2), 361 - 72
Assessment of the mammary system; Donovan GA et al.; Assessing the health status of the mammary gland is a complex and often perplexing endeavor . One must use all of the faculties available to come up with an accurate diagnosis . A detailed history of the individual and the herd or flock plus a thorough physical examination that includes specific attention paid to the mammary gland are essential . One cannot overlook these basic tenets in favor of more sophisticated means of evaluation such as somatic cell counts and milk microbiology . A holistic approach to mastitis diagnosis, treatment, and, most importantly, control is necessary.

J Bacteriol, 1992 Jul, 174(13), 4444 - 9
Cloning of a methanol-inducible moxF promoter and its analysis in moxB mutants of Methylobacterium extorquens AM1rif; Morris CJ et al.; In Methylobacterium extorquens AM1, gene encoding methanol dehydrogenase polypeptides are transcriptionally regulated in response to C1 compounds, including methanol (M . E . Lidstrom and D . I . Stirling, Annu . Rev . Microbiol . 44:27-57, 1990) . In order to study this regulation, a transcriptional fusion has been constructed between a beta-galactosidase reporter gene and a 1.55-kb XhoI-SalI fragment of M . extorquens AM1rif DNA encoding the N terminus of the methanol dehydrogenase large subunit (moxF) and 1,289 bp of upstream DNA . The fusion exhibited orientation-specific promoter activity in M . extorquens AM1rif but was expressed constitutively when the transcriptional fusion was located on the plasmid . However, correct regulation was restored when the construction was inserted in the M . extorquens AM1rif chromosome . This DNA fragment was shown to contain both the moxFJGI promoter and the sequences necessary in cis for its transcriptional regulation by methanol . Transcription from this promoter was studied in the M . extorquens AM1rif moxB mutant strains UV4rif and UV25rif, which have a pleiotropic phenotype with regard to the components of methanol oxidation . In these mutants, beta-galactosidase activity from the fusion was reduced to a level equal to that of the vector background when the fusion was present in both plasmid and chromosomal locations . Since both constitutive and methanol-inducible promoter activities were lost in the mutants, moxB appears to be required for transcription of the genes encoding the methanol dehydrogenase polypeptides.

Chest, 1992 Jul, 102(1), 76 - 83
Diagnostic value of telescoping plugged catheters in HIV-infected patients with pulmonary infiltrates; Ferrer M et al.; To assess the diagnostic value of telescoping plugged catheters (TPC) in human immunodeficiency virus (HIV)-infected patients with pulmonary infiltrates (PI), we performed a prospective clinical study in 71 episodes of fever and PI in 66 HIV-infected patients (five patients had two different episodes of fever and PI) . A control group of 12 HIV-infected patients with fever and normal chest roentgenogram was also studied . In all patients and prior to antibiotic treatment (except in mechanically ventilated patients), a TPC using quantitative cultures (cutoff point established at 10(3) CFU/ml) and a bronchoalveolar lavage (BAL) sampling were performed via fiberoptic bronchoscope . The overall incidence of bacterial pneumonia in the study group was 21 percent . The TPC cultures resulted in a microbiologic diagnosis of bacterial pneumonia in eight patients (11 percent) from the study group and in one patient (8 percent) from the control group . The TPC sensitivity in diagnosing bacterial infections was 53 percent and specificity was 76 percent . Negative predictive value was 85 percent and positive predictive value was 38 percent . By means of BAL, 35 episodes from the study group and two from the control group were diagnosed as nonbacterial or mycobacterial pulmonary infections . Considering TPC and BAL together, diagnosis was performed in 42 cases of PI (59 percent) . Twenty percent (17/83) of HIV-infected patients suffered from bacterial colonization of their lower airways (a TPC culture greater than or equal to 10(3) CFU/ml without clinical evidence of bacterial infection) . We conclude that the combined use of TPC and BAL may be useful in HIV-infected patients with PI, since this combined use allows the proper diagnosis of bacterial and nonbacterial infections, thereby increasing the overall diagnostic accuracy . To distinguish bacterial colonization from pulmonary infection in HIV-infected patients with PI, the cutoff point of quantitative cultures of TPC may be 10(4) CFU/ml.

Acad Med, 1992 Jul, 67(7), 470 - 4
Effects of expert and non-expert facilitators on the small-group process and on student performance; Davis WK et al.; At the University of Michigan Medical School in 1990, the authors investigated the effects of faculty facilitators' levels of content expertise on the educational process and learning outcomes of small-group teaching sessions . The study was conducted in a microbiology course for second-year students in which four small-group sessions were used to replace 38 hours of lecture and laboratory time . The interactions between 11 expert and ten non-expert faculty facilitators and 156 students were observed and coded . The students' levels of knowledge and satisfaction were measured . The results indicate that, although significant differences in faculty-student interactions were not observed, the students in the 11 groups led by the content experts had higher levels of satisfaction and higher examination scores.

Infect Immun, 1992 Jul, 60(7), 2906 - 13
Localization and biochemical characterization of the ORF6 gene product of the Mycoplasma pneumoniae P1 operon; Layh-Schmitt G et al.; ORF6 represents one of the two open reading frames flanking the P1 attachment protein gene of Mycoplasma pneumoniae in the order ORF4-P1-ORF6 (J.M . Inamine, T.P . Denny, S . Loechel, U . Schaper, C.H . Huang, K.F . Bott, and P.C . Hu, Gene 64:217-219, 1988; J.M . Inamine, S . Loechel, and P.C . Hu, Gene 73:175-183, 1988; C.J . Su, V.V . Tryon, and J.B . Baseman, Infect . Immun . 55:3023-3029, 1987), indicating an operonlike organization . As described previously, we identified two proteins with molecular masses of 40 and 90 kDa (B . Sperker, P.C . Hu, and R . Herrmann, Mol . Microbiol . 5:299-306, 1991) which might represent two cotranslational cleavage fragments of the ORF6 gene product . To determine the site of the putative cotranslational cleavage, the first 10 amino acids of the N terminus of the isolated 90-kDa protein were sequenced . The data are consistent with the DNA-deduced amino acid sequence between amino acid positions 455 and 465 (RAGNSSETDAL) . Thus, the cleavage site was identified at amino acid position 455 (R) . In this study, the two proteins were localized and biochemically characterized . Both proteins are part of the insoluble fraction of M . pneumoniae as shown by immunoblots of supernatants and pellets of mechanically disrupted cells subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) . Surface proteolysis followed by SDS-PAGE and Western blot (immunoblot) analysis, covalent labelling of surface-exposed proteins with {125I}iodide and subsequent immunoprecipitation of both radiolabelled proteins, immunofluorescence studies with formalized and living M . pneumoniae, and immunoadsorption experiments provided strong evidence that the 40- and 90-kDa proteins are membrane-associated proteins expressing surface-exposed regions.

J Infect, 1992 Jul, 25(1), 29 - 37
An evaluation of inpatient consultations conducted by clinical microbiologists in a teaching hospital; Yuen KY et al.; A systematic procedure for conducting consultations by clinical microbiologists requested by their clinical colleagues is described . The method was evaluated over a period of 17 months and involved sequential consultations related to 229 patients with known or probable infections . An attempt was made to elucidate the contributions of the clinical microbiologists in achieving a better understanding of the problems experienced in this particular setting and which in turn led to improved management of patients . It is hoped that this paper may provide a practical working framework for clinical microbiologists in the care of patients suffering from infection.

Medicine (Baltimore), 1992 Jul, 71(4), 179 - 96
Centrofacial malignant granulomas . Clinicopathologic study of 40 cases and review of the literature; Grange C et al.; An important problem in the treatment of centrofacial ulcerations is to establish a precise diagnosis, since similar clinical and microscopic findings can result from many different causes (as in the centrofacial malignant granuloma syndrome {CFMG}) . A comprehensive surgical biopsy protocol (known as SNFMI/GMCF), involving microbiology, parasitology, immunology and pathology laboratories, allowed us to evaluate and to treat 40 cases of CFMG, who form the basis of this report . In 13 of them, specific diagnoses were found and curative treatments could be given . In the remaining 27, the optical microscopy pattern met the criteria for CFMG without identifiable origin or the presence of so-called lethal midline granulomas; however, a more precise evaluation with the help of immunofluorescence studies led to the recognition of malignant lymphoma (ulcerative lymphoma of the midface {ULM}) . Most of these lymphomas belonged to the T cell lineage; the others were of B lymphoid origin, or, more rarely, of histiocytic origin . Patients with ULM received radiotherapy and chemotherapy with a response rate of 70.3%; however, the toxicity was significant, with frequent occurrence of chemotherapy-induced neutropenia followed by severe infectious facial cellulitis . Six patients were enrolled in a preliminary open trial of treatment with recombinant alpha-2b interferon with little success . Three patients were treated with radiation therapy only, and survived . Thus, CFMG is a syndrome with specific causes and treatments, requiring multiple extensive biopsies to make the correct diagnosis . The recognition of ULM as the cause of the previously called "lethal midline granulomas" leads logically to the use of chemotherapy with growth factors in order to ameliorate its bad prognosis.

Diabetes Res Clin Pract, 1992 Jul, 17(1), 1 - 8
The diabetic foot problem--a failed system of health care?
Sussman KE, Reiber G, Albert SF.
It is evident that there is excess morbidity and mortality as a consequence of foot problems in patients with diabetes mellitus . Most of the data relative to foot lesions is taken from the study of subsets of diabetic patients undergoing lower extremity amputation . Such data probably do not provide accurate information relative to the incidence and/or prevalence of diabetic foot problems . Available evidence does suggest that diabetic foot care may be inadequate and the efficacy of various diagnostic and therapeutic modalities has not been proven . Advances have been made in obtaining a better understanding of the microbiology of lower extremity infected lesions both in hospitalized patients and in those subjects being followed in the outpatient setting . Attention should be directed at developing a systematic classification of foot lesions which can be universally applied . We need to understand and relate to those risk factors contributing to the development and progression of lower extremity lesions in the diabetic patient . In evaluating the efficacy of diverse diagnostic and therapeutic approaches, well-controlled clinical investigations need to be undertaken . Attention should be focussed upon both measures of process and outcome where appropriate . Finally, there needs to be recognition that the problem of the diabetic foot lesion represents a major public health challenge.

Int J Syst Bacteriol, 1992 Jul, 42(3), 370 - 7
Genomic fingerprinting by arbitrarily primed polymerase chain reaction resolves Borrelia burgdorferi into three distinct phyletic groups; Welsh J et al.; The causative agent of Lyme disease, Borrelia burgdorferi, was first identified by Burgdorfer et al . in 1982 (W . Burgdorfer, A . G . Barbour, S . F . Hayes, J . L . Benach, E . Grunwaldt, and J . P . Davis, Science 216:1317-1319, 1982) and was isolated by Barbour et al . in 1983 (A . G . Barbour, W . Burgdorfer, S . E . Hayes, O . Peter, and A . Aeschlimann, Curr . Microbiol . 8:123-126, 1983) . Since then, a large number of isolates have been collected, and there have been questions regarding the relationships among the various strains . Using genomic fingerprinting by an arbitrarily primed polymerase chain reaction, we resolved into three groups a collection of Eurasian and North American isolates of spirochetes that are generally categorized as B . burgdorferi . Group I strains have been identified in both North America and Eurasia, while strains belonging to Borrelia groups II and III have been found only in Eurasia . These same three groups have also been delineated by Baranton et al . (G . Baranton, D . Postic, I . Saint Girons, P . Boerlin, J.-C . Piffaretti, M . Assous, and P . A . D . Grimont, Int . J . Syst . Bacteriol . 42:370-375, 1992) by independent methods . Two isolates are distinct from all of the other strains in our collection but are clearly members of the genus Borrelia.

Arch Pathol Lab Med, 1992 Jul, 116(7), 694 - 700
Quantification of errors in laboratory reports . A quality improvement study of the College of American Pathologists' Q-Probes program; Howanitz PJ et al.; Over a 3-month period, 61,496 errors were detected in clinical laboratory reports by 631 participants in the College of American Pathologists' 1990 Q-Probes program . Each error detected was defined as an opportunity for improvement . Almost 4% of the detected errors were attributed to nonlaboratory personnel and approximately 4% (A errors) had a major impact on patient care . Rates of B (serious errors, but unlikely to affect patient care) and C errors (minor clerical errors) were approximately equal . When expressed in terms of measures of laboratory work loads, four of six measures of mean errors were lowest in blood banking, intermediate in chemistry and microbiology, and highest in hematology . Thirteen percent of participants did not have an error detection system in place . We conclude that many errors go undetected, and we recommend that an effective system for error detection in patient reports should be employed in all laboratories.

J Am Podiatr Med Assoc, 1992 Jul, 82(7), 361 - 70
Treatment of lower extremity infections in diabetics; Joseph WS; The infected diabetic lower extremity has enjoyed a surge in popularity in the medical literature . There have been numerous papers outlining classification systems for ulcer depth, surgical approaches, and microbiology . Discussions on antibiotic use have usually been directed toward therapy of the "diabetic foot infections" as a group, without regard to differences in severity and location of these infections . These infections can vary from the most superficial of processes to a severe life- and limb-threatening sepsis . The author presents a review of the processes involved in the diabetic lower extremity infection and suggests a classification system for selection of empiric antibiotic therapy based on the severity of the infection.

Nippon Rinsho, 1992 Jul, 50(7), 1670 - 8
{Development and application of biosensors for medical field}; Karube I; Methods for the selective determination of organic compounds in biological fluids, such as blood, are very important in clinical analyses . Most analyses of organic compounds can be performed by spectrophotometric methods, based on specific enzyme-catalyzed reactions . However, because of the complicated procedure, these methods cannot be applied directly to bed-side monitoring . Alternatively, biosensors based on enzymes and electrochemical transducers possess excellent sensitivity for biological substrates and can determine a single compound in a biological fluid directly without need for a prior separation step . Therefore, in the past several years, many kinds of biosensors have been developed, and implantable microbiosensors for a body organ have also been reported.

J Hosp Infect, 1992 Jul, 21(3), 163 - 7
Conventional screening for enteropathogenic Escherichia coli in the UK . Is it appropriate or necessary?
Morris KJ, Rao GG.
Enteropathogenic Escherichia coli (EPEC) is a well-recognized cause of infantile diarrhoea in the developing countries . In the developed countries, however, the incidence of EPEC associated outbreaks has dramatically declined . The last major outbreak in the UK was reported in 1980 . This paper reviews the recent advances in the field of pathogenesis of diarrhoea caused by EPEC and questions the need to screen routinely for EPEC by conventional serological methods used in clinical microbiology laboratories in the UK.

J Clin Microbiol, 1992 Jul, 30(7), 1716 - 21
General primer polymerase chain reaction in combination with sequence analysis for identification of potentially novel human papillomavirus genotypes in cervical lesions; van den Brule AJ et al.; We recently described the detection of potentially novel human papillomaviruses (HPV) genotypes (HPV types X {HPV X}) in cervical smears (A . J . C . van den Brule, C . J . L . M . Meijer, V . Bakels, P . Kenemans, and J . M . M . Walboomers, J . Clin . Microbiol . 28:2739-2743, 1990) by using the general primer-mediated polymerase chain reaction method (GP-PCR) . In this study, the HPV specificities of GP-PCR products were determined by sequence analyses . M13 bacteriophage clones of PCR products derived from cloned unsequenced HPV genotypes 13, 32, 35, 43, 44, 45, 51, and 56 were subjected to dideoxy sequencing . Analyses of the putative amino acid sequences of these HPV types in addition to published HPV sequence data revealed stretches of highly conserved amino acid residues present in all HPV types, resulting in an HPV amino acid consensus sequence . Subsequently, HPV X-specific PCR products found in premalignant cervical lesions (n = 3), carcinomas in situ (n = 6), and invasive cancer (n = 6) were analyzed for their nucleotide sequences . Comparison of these sequences with published HPV nucleotide sequences and data obtained in this study revealed three HPV type 35, two HPV type 45, one HPV type 51, two HPV type 56, and six unique HPV X sequences, of which three types were present in four cases of carcinomas (in situ) . The nucleotide sequences determined appeared to be unique after a data bank search . Furthermore, the sequences of all HPV X isolates matched the HPV amino acid consensus sequence, thus confirming HPV specificity . This study illustrates the power of GP-PCR in combination with sequence analysis to determine HPV specificity and genotyping of PCR products derived from sequenced as well as unsequenced HPVs, including novel, not yet identified HPV types.

Virology, 1992 Jul, 189(1), 334 - 9
Lytic infection of primary rhesus kidney cells by simian virus 40; von der Weth A et al.; In an attempt to analyze the persistent infection of rhesus monkey cells with Simian virus 40 (SV40) in vitro, as described previously (reviewed in L . C . Norkin, Microbiol . Rev . 46, 384-425, 1982), we infected primary rhesus cell cultures (PRK), derived from a SV40-free monkey colony with SV40 . Surprisingly, SV40 infected PRK cell cultures released as much infectious virus as cultures of the permissive African green monkey kidney cell line TC7 . Infected PRK cells exhibited typical symptoms of a lytic infection, and the bulk of infected PRK cells died within 8 days postinfection (p.i.) . A considerable proportion of infected PRK cells exhibited distinct SV40-caused cytopathic effects (CPE), similar to CPE in infected TC7 cells . We conclude that the in vivo persistence of SV40 in rhesus monkeys is not determined by cellular host factors, but by the immune system of the infected animals.

Am J Med, 1992 Jun 22, 92(6A), 2S - 6S
The carbacephems: a new beta-lactam antibiotic class; Copper RD; The carbacephems are a new class of beta-lactam antibiotics that are similar in structure to the cephalosporins . Carbacephems differ from cephalosporins, however, in the substitution of a sulfur atom in the dihydrothiazine ring with a methylene group to form a tetrahydropyridine ring . The result of this structural difference is the carbacephem class . Carbacephems have remarkable chemical stability that allows for structural manipulation in a manner that could not be done previously with the cephalosporin ring system . Potent broad-spectrum antibiotics result from the incorporation at the 3 position of substituents that include quaternary pyridinium or imidazole, sulfones, and heterocyclic thiazole structures . Because of the chemical stability of the carbacephems, these highly electronegative side chains can be added to the 3 or 3' position of the tetrahydropyridine ring system . Increasing the electronegativity of these side chains can increase the microbiologic activity of the compounds . In addition, utilizing the side chains that have traditionally conferred good oral absorption on the cephalosporins offers the possibility of a new series of broad-spectrum oral antibiotics . Loracarbef is the first carbacephem to undergo clinical development, and other experimental carbacephems are being produced with the aim of developing potent oral antibiotics that can be used against pathogens that cause infections commonly found in the outpatient setting.

Br Dent J, 1992 Jun 20, 172(12), 453 - 6
The British Dental Journal: a report on its activities 1986-1991; Murray JJ; The contents of 139 issues of the British Dental Journal, published between January 11, 1986 and December 1991, have been analysed . Part I of the Journal contains, on average, one Leader, eleven items of news and notes, 12 letters and eight abstracts/book reviews . One thousand, three hundred and seventeen manuscripts were submitted for publication during the 6-year period . Of these, 403 original articles, 119 case reports and 203 review articles were accepted and published in Part II . Part III of the Journal is devoted to annual and other reports and policy documents, worldwide dentistry, practice management and vocational training, dental electives, trade news, meeting reports and obituaries . Over 40 'strap headings' denoting specialised areas of dentistry were used to describe articles published . Almost one-fifth of the papers were concerned with restorative dentistry . Case reports comprised 14% of the papers published . Oral surgery/oral medicine/oral pathology, and related subjects accounted for nearly 15% of papers published . Articles concerned with community dental health, orthodontics and paediatric dentistry accounted for a similar proportion of the total, as did the section comprising general dental practice, vocational training and practice management . Anaesthesia, analgesia, medical topics, microbiology and therapeutics took up 12% of articles published . The remaining 12% consisted of articles on dental education and research, oral biology, dental history, auxiliaries, dental instruments and diagnostic aids.

Eur J Biochem, 1992 Jun 15, 206(3), 635 - 40
The plasma membrane of yeast acquires a novel heat-shock protein (hsp30) and displays a decline in proton-pumping ATPase levels in response to both heat shock and the entry to stationary phase; Panaretou B et al.; Recent studies have revealed that the action of the proton-translocating ATPase of the plasma membrane of yeast is an important determinant of several stress tolerances and affects the capacity of cells to synthesise heat shock proteins in response to heat shock {Panaretou, B . & Piper, P . W . (1990) J . Gen . Microbiol . 136, 1763-1770; Coote, P . J., Cole, M . B . & Jones, M . V . (1991) J . Gen . Microbiol . 137, 1701-1708} . This study investigated the changes to the protein composition of the Saccharomyces cerevisiae plasma membrane that result from a heat shock to dividing cultures and the entry to stationary growth caused by carbon source limitation . Plasma membranes were prepared from exponential, heat-shocked and stationary yeast cultures . The proteins of these membrane preparations were then analysed by polyacrylamide gel electrophoresis and immunoblot measurement of ATPase levels . The protein composition of plasma membranes displayed two prominent changes in response to both heat shock and the entry to stationary phase: (a) a reduction in the level of the plasma membrane ATPase; and (b) the acquisition of a previously uncharacterised 30 kDa heat-shock protein (hsp30) . The ATPase decline with heat shock probably exerts an important influence over the ability of the cell to maintain ATPase activity, and therefore intracellular pH, during extended periods of stress . Through in vivo pulse-labelling of plasma membrane proteins synthesised before and during heat shock, followed by subcellular fractionation, it was shown that hsp30 is the only protein induced by the yeast heat-shock response that substantially copurifies with plasma membranes . It might therefore exert a stress-protective function specifically at this membrane.

Int J Dermatol, 1992 Jun, 31(6), 443 - 5
Ofloxacin versus cephalexin for treating skin and soft tissue infections; Lipsky BA et al.; Patients with acute localized skin or soft tissue infections were randomized to receive either ofloxacin (300 mg orally, b.i.d.) or cephalexin (500 mg orally, b.i.d.) . Among 401 enrolled patients, 382 were evaluable for safety and 148 for microbiologic response . Microbiologic cure occurred in 93.4% of ofloxacin-treated patients and in 94.0% of those treated with cephalexin . Clinical cure or improvement, respectively, was found in 85.2% and 11.1% of patients treated with ofloxacin, and 83.6% and 14.9% of patients receiving cephalexin . Adverse effects (primarily associated with the gastrointestinal tract and central nervous system) were considered to be drug-related in 7.9% of those receiving ofloxacin and 4.8% of those receiving cephalexin . Thus, ofloxacin is as effective and well tolerated as cephalexin and a good alternate antibiotic for treating skin and skin structure infections caused by a variety of pathogens.

J Med Virol, 1992 Jun, 37(2), 149 - 57
Detection of adenoviruses in stools from healthy persons and patients with diarrhea by two-step polymerase chain reaction; Allard A et al.; The use of the polymerase chain reaction (PCR) for detection of human adenoviruses in diluted stool samples was investigated . Two sets of nested primers, including primers specific for the hexon-coding region and for the E1B region of enteric adenoviruses (EAd), were assessed by two-step amplification . The primers constitute two different PCR systems designed for the detection of adenoviruses belonging to all six subgenera (A-F), and the two EAds Ad40 and Ad41, respectively . In a two-step PCR mediated amplification a single virus particle was detected when the two sets of general hexon primers or EAd specific primers were used . Earlier results from PCR detection of adenoviruses in stool from children suffering from diarrhea gave indications that adenovirus particles are commonly shed in stools without being identified as the cause of illness {Allard et al.: Journal of Clinical Microbiology 28:2659-2667, 1990} . Therefore, the general and the EAd specific PCR assays were assessed on 150 stool specimens from three groups including 50 healthy children, 50 healthy adults, and 50 adults suffering from diarrhea . When the two sets of general hexon primers were used, 25 of the 50 specimens from the healthy children (mean age 21 months) were found positive by two-step PCR amplification . Nine of the 50 specimens from the healthy adults (mean age 32 years) were found positive whereas 12 of the 50 specimens from sick adults (mean age 31 years) gave amplification products, using the two sets of general hexon primers in a nested fashion . None of the 150 specimens were found to be positive by two-step PCR amplification using the two sets of EAd-specific primers.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1992 Jun, 30(6), 1572 - 4
Statistical analysis of the incidence of positives in the examination of parasitological specimens; Mohr E et al.; Results of the examination of 2,000 parasitological specimens were analyzed for differences between results obtained by a technologist working in parasitology only and those obtained by general microbiologists who were also performing other laboratory work . The relative share of specimens determined to be positive by the specialist was approximately twice as high as the relative share determined by the general microbiologists.

Clin Infect Dis, 1992 Jun, 14(6), 1195 - 200
Varied presentations and responses to treatment of infections caused by Mycobacterium haemophilum in patients with AIDS; Dever LL et al.; We describe three patients with AIDS who developed clinically significant infection with Mycobacterium haemophilum . One patient had skin and bone involvement and suspected laryngeal involvement; the second had extensive abdominal adenopathy with partial bowel obstruction; and the third presented with limited skin involvement . Each patient responded transiently to antimycobacterial therapy, but disease recurred and progressed in all three cases . Recovery of M . haemophilum requires a high level of clinical suspicion and special handling of mycobacterial cultures by the microbiology laboratory, including cultivation on enriched chocolate agar or heme-supplemented media and incubation at 30 degrees C for up to 8 weeks . Characteristic patterns of drug susceptibility for this organism have been only partially defined . Reported responses to antimycobacterial therapy in AIDS patients with M . haemophilum infection have been poor, and the optimal therapeutic regimen is not yet known . The prognosis for recovery appears to depend heavily on host-related factors, particularly the degree of immunosuppression.

Am J Med, 1992 Jun, 92(6), 591 - 5
Uses and misuses of oxygen in hospitalized patients; Small D et al.; PURPOSE: To document the use/misuse of oxygen therapy as compared with antibiotics in internal medicine inpatients . To determine whether the same care was being taken in the prescription and administration of both forms of therapy . PATIENTS: Ninety-six eligible patients at a university teaching hospital were entered into a study examining the use of oxygen . They were compared with 60 patients for whom antibiotics were prescribed . MATERIAL AND METHODS: Three hundred thirty consecutive newly admitted patients were screened for the presence of either (1) oxygen apparatus at the bedside, (2) physician orders for oxygen, or (3) oxygen orders noted in nursing kardex . Those meeting one of these three criteria were observed on up to four occasions over 48 hours following study entry . Similarly, patients were screened for medical orders or nursing medication kardex notation for antibiotics and were also observed for proper prescription and administration of medication . Procedural errors, determined by kardex audit and direct patient observation, were compared for the individuals with specific oxygen orders and those receiving antibiotics . RESULTS: Oxygen delivery apparatus was found in the room in 17 of 96 patients without it ever having been ordered by the physician or noted in the nursing kardex . In 27 of 96 patients, oxygen was noted in the nursing kardex and administered to patients without a physician order . There were no cases of antibiotic therapy without a physician order . Observations of 47 patients with specific orders for oxygen revealed the following errors: (1) physician order incorrectly transcribed to nursing kardex (16%), (2) flow meter off (34%), (3) oxygen delivery apparatus improperly worn (57%), (4) wrong fractional inspired oxygen concentration (58%) . Improper transcription of antibiotic orders occurred on only one occasion (2%), and antibiotics were improperly administered in 5% . Arterial blood gas determinations preceded oxygen orders in 61%, whereas microbiologic cultures preceded antibiotic orders in 87% of the patients . CONCLUSIONS: We conclude that oxygen therapy is neither prescribed nor administered with the same attention that is given to other drugs such as antibiotics . Oxygen prescription and/or delivery is associated with significantly greater error than that seen with antibiotics . Education of medical personnel should stress more prudent prescription and use of oxygen in hospitalized patients.

Med Lab Sci, 1992 Jun, 49(2), 103 - 6
Toxoplasmosis and laboratory workers: a case-control assessment of risk; Parker SL et al.; The health risks to staff employed in a toxoplasma reference unit were studied . Sixteen laboratory staff exposed to Toxoplasma gondii and age/sex-matched controls from the general population and a routine microbiology laboratory were assessed . Multiple assays were performed to establish the presence of toxoplasma infection, and laboratory workers were questioned regarding environmental and work-related exposure to the parasite . Details of all of environmental exposure to toxoplasma between the two groups of laboratory personnel, and seroprevalence rates were comparable in all three groups . Three laboratory accidents were recorded, a rate of one per 9300 hours exposure . One case of presumed work-related infection was identified, but significant illness was not observed . Given adequate training, strict adherence to conventional laboratory protocols and medical supervision, laboratory accidents are infrequent and work-associated toxoplasma infection is uncommon . The risks associated with occupational exposure to T . gondii have been over-estimated and we conclude that this organism does not represent a significant health hazard to laboratory technicians.

Sheng Li Xue Bao, 1992 Jun, 44(3), 254 - 60
{Role of endothelium-derived relaxing factor in the contractions of intrapulmonary artery induced by oxygen-derived free radicals in chronic hypoxic rat}; Zheng YF et al.; The role of endothelium-derived relaxing factor (EDRF) on the effect of oxygen-derived free radicals (generated by xanthine-xanthine oxidase system) on intrapulmonary arterial in chronic hypoxic rats was studied by a microbioassay method . Intrapulmonary artery rings with intact or denuded endothelium of hypoxic (5,000 m, 10 days) and normoxic rats were prepared for observation of oxygen-derived free radicals induced contraction . It was shown that oxygen-derived free radicals induced contractions of intrapulmonary arterial rings with intact endothelium were obviously augmented in hypoxic rats than in normoxic controls . The augmented responses could be further potentiated by the addition of EDRF inactivator reduced hemoglobin (RHb), but diminished or even abolished by applying superoxide dismutase (Cu-Zn SOD) . However, no effect on denuded rings was observed when RHb or SOD was added . It is concluded that chronic hypoxia may attenuate the action of EDRF in the enhancement of the reactivity of intrapulmonary artery to oxygen-derived free radicals.

Am J Infect Control, 1992 Jun, 20(3), 115 - 21
Microbiology, infection control, immunizations, and infectious disease exposure: education and practices in United States nursing schools; Goetz A et al.; BACKGROUND: Previous data suggest that nursing students in the United States are inadequately protected against hepatitis B . This survey focused on the immunization and education practices, infection control knowledge, and follow-up to infectious disease exposure by U.S . nursing schools . METHODS: To ascertain education requirements, immunization practices, and infectious disease postexposure follow up, a survey was sent to the director or dean of 1164 U.S . nursing schools . RESULTS: Seven hundred sixty-five schools (65.7%) responded to the survey . A microbiology course was required before clinical experience by 49% of schools . Clinical experience in the operating room was given by 16%, 65% of schools offered infectious and communicable disease courses, and 98% offered universal precaution instructions . The hepatitis B vaccine was required by 11%; 2% required yearly influenza vaccination . In a comparison of programs, the diploma schools were more likely to have written policies for infectious disease exposure follow-up and to use appropriate agencies for exposure follow-up (p = 0.0001) . CONCLUSIONS: A microbiology course before clinical experience should be encouraged . Immunization policies and infectious disease exposure follow-up are currently inadequate in U.S . associate degree and baccalaureate nursing programs.

Matrix, 1992 Jun, 12(3), 189 - 96
Microbiochemical analysis of changes in proteoglycan and collagen in joint tissues during the development of antigen-induced arthritis in the rabbit; Beesley JE et al.; Microbiochemical assays of the proteoglycan and collagen content of articular cartilage and synovial lining have been performed on tissue sections taken from rabbits with antigen-induced arthritis . This experimental arthritis is a close analogue of the natural disease-rheumatoid arthritis . Animals were killed at intervals during the first 21 days following induction of arthritis to assess changes in the composition of the extracellular matrices of the synovial lining and articular cartilage during the early development of this experimental lesion . In confirmation of earlier studies these microbiochemical assays revealed a rapid and significant loss of proteoglycan from the articular cartilage . This loss was, however, not uniform but was restricted to the intermediate zone of the cartilage . Over the period studied, there was only a slight loss of proteoglycan from the superficial zone of the cartilage facing the joint cavity . These findings demonstrate that, at least in this model, cartilage proteoglycan loss is not due to the action of proteases present in the synovial fluid . Moreover it suggests that the chondrocytes in the mid-zone of the cartilage are responsive to those signals stimulating proteoglycan breakdown . There was no significant loss of collagen from the cartilage over the time period of this study . The synovial lining from arthritic joints, in contrast, showed a progressive increase in both proteoglycan and collagen.

J Bacteriol, 1992 Jun, 174(12), 3889 - 95
Sequence analysis and characterization of the Porphyromonas gingivalis prtC gene, which expresses a novel collagenase activity; Kato T et al.; In order to examine the potential role of bacterial collagenases in periodontal tissue destruction, we recently isolated a gene, prtC, from Porphyromonas gingivalis ATCC 53977, which expressed collagenase activity (N . Takahashi, T . Kato, and H . K . Kuramitsu, FEMS Microbiol . Lett . 84:135-138, 1991) . The nucleotide sequence of the gene has been determined, and the deduced amino acid sequence corresponds to a basic protein of 37.8 kDa . In addition, Southern blot analysis indicated that the prtC gene is conserved among the three major serotypes of P . gingivalis . The enzyme has been purified to near homogeneity from Escherichia coli clone NTS1 following Mono Q anion exchange and sequential gel filtration chromatography . The molecular mass of the purified enzyme was estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to be ca . 35 kDa, and the active enzyme behaved as a dimer following gel filtration chromatography . The collagenase degraded soluble and reconstituted fibrillar type I collagen, heat-denatured type I collagen, and azocoll but not gelatin or the synthetic collagenase substrate 4-phenylazobenzyloxycarbonyl-Pro-Leu-Gly-Pro-D-Arg . Enzyme activity was enhanced by Ca2+ and inhibited by EDTA, sulfhydryl-blocking agents, and the salivary peptide histatin . Preliminary evidence for the existence of a second collagenase expressed by strain 53977 was also obtained.

Med Clin (Barc), 1992 May 30, 99(1), 27 - 9
{Chronic granulomatous disease and pulmonary nocardiosis}; Tirapu JM et al.; A 19-years-old male was admitted for left bilobar pneumonia . All microbiologic studies in blood and in several samples obtained by bronchoscopy were negative . The patient worsened progressively despite antibiotherapy of a wide spectrum . A fine needle transparietal puncture was performed . The cultures of the sample were positive for Nocardia asteroides, a positive catalase germ . Immunologic studies initiated after this time showed negative tetrazolium nitroblue test, the results of which led to the diagnosis of chronic granulomatous disease . This disease is very infrequent and the polymorphonuclear leukocytes are genetically incapable of producing peroxides whose absence impedes lysis of the positive phagocytic catalase germs with which a histologic reaction is produced in the form of granulomas from which the name of the disease is derived.

Minerva Anestesiol, 1992 May, 58(5), 297 - 300
{Circulation effects of noradrenaline in hyperdynamic septic shock}; Padua G et al.; The authors report on a group of 8 patients in septic shock, treated with NA in association with dopamine and/or dobutamine, according to a personal therapeutic protocol . The use of NA in septic shock with low SVR showed an improvement in hemodynamic condition and a higher survival rate in the treated patients . During the study many clinical, laboratory and microbiologic data were also recorded.

J Antimicrob Chemother, 1992 May, 29(5), 575 - 8
Sampling time for serum gentamicin levels; Edwards C et al.; A survey in 53 UK hospitals showed that 44% of clinical microbiologists recommended post-dose serum gentamicin concentrations to be measured at less than 40 min after an iv bolus dose . Serum gentamicin concentrations were measured in ten patients following bolus iv and im injections . Distribution of the drug occurred for up to 45 min following iv doses and maximum serum concentrations occurred at 45 to 60 min after im injection . The data validate current guidelines to sample at 60 min post bolus iv and im doses . Earlier sampling after iv bolus injections may result in significantly higher gentamicin concentrations, leading to potential interpretive errors of clinical significance.

Ann Hematol, 1992 May, 64(5), 224 - 30
Improved microbioassay for plasma erythropoietin based on CFU-E colony formation; Sakata S et al.; We examined the conditions necessary for performing a reliable erythropoietin (EPO) assay based on CFU-E colony formation in fetal mouse liver cell (FMLC) microcultures using 96-well microtiter plates . Both linearity of colony numbers with the number of cells plated and comparison among the colony ratios at various densities of seeding cells indicated that the colonies originated from a single progenitor cell when 7500 or fewer cells were plated into individual microtiter wells . About a twofold CFU-E enrichment in 12- to 13-day FMLC was achieved by Ficoll-Paque centrifugation . Plasma treated with acid-boiling stimulated the colony formation most and contained no colony inhibitor . Dose-response curve for the plasma was parallel to the EPO standard curve . The "erythroid colony-stimulating activity" in the plasma was additive to that in the standard EPO, and was completely neutralized by a monoclonal antibody against recombinant human EPO . Using the assay procedure thus established, plasma EPO titer was determined in normal subjects, in patients with nonuremic anemia and polycythemia vera, and in dialysis patients with chronic renal failure . The use of different preparations of standard EPO resulted in a significant difference in the titers because their dose-response curves differed from one another . An inverse relationship was found between EPO titers and hemoglobin concentrations in the nonuremic anemic patients, but not in the dialysis patients with about one half the normal EPO level.

AIDS, 1992 May, 6(5), 495 - 500
A system for surveillance of voluntary HIV testing: results of the first 2 years, 1989-1990; Goldberg DJ et al.; OBJECTIVE: In 1988, in order to improve the already established surveillance of AIDS and HIV-infected cases in Scotland, UK, the Communicable Diseases (Scotland) Unit {CD(S)U}, in collaboration with microbiologists responsible for HIV testing, instituted a routine system for the epidemiological surveillance of all voluntary HIV tests . METHODS: To facilitate information capture, a standardized HIV request form was introduced for use throughout the country by clinicians requesting an HIV test . In addition, a network of laboratory computers, operated by clerical personnel, was established for the collection and collation of data . RESULTS: In 1989, of 9483 individuals tested for HIV, 129 (1.4%) were HIV-antibody-positive compared with 130 (1.2%) of 11,111 tested in 1990 . A comparison of 1989 with 1990 rates of HIV among specific population groups, including injecting drug users (4.1%, 1989; 2.7%, 1990), homosexual men (5.2%, 1989; 4.5%, 1990), heterosexual men and women with high-risk partners (1.6%, 1989; 1.8%, 1990) and heterosexual men and women with lesser risk (0.3%, 1989; 0.5%, 1990), revealed no statistically significance differences at a 95% level of confidence . CONCLUSION: We believe that this surveillance system is the first of its kind to be implemented on a nationwide basis . The first 2 years' findings suggest a degree of stability in new transmissions of HIV occurring in Scotland . However, the increasing numbers of those known to be HIV-infected continue to cause considerable concern: 1943 individuals were reported to CD(S)U as HIV-antibody-positive by December 1991.

Chest, 1992 May, 101(5), 1393 - 8
Efficacy of a low dose of cefotaxime in serious chest infections; Cade JF et al.; The optimal antibiotic dosage in serious chest infections is not established and commonly used regimens may well be excessive . We have compared the efficacy of a low dose of cefotaxime (2 g every 12 h) with a more usual dose (2 g every 8 h) in a prospective, randomized study of the treatment of chest infections in the seriously ill . Fifty intensive care unit patients received either regimen for five days . The two groups appeared demographically comparable . Clinical resolution occurred in 86 percent, no change occurred in 4 percent, and deterioration occurred in 10 percent . Microbiologic clearance occurred in 52 percent of those in whom a pathogen was isolated (46 percent of patients) . There was no significant difference in clinical or microbiologic response between the two regimens . It is concluded that cefotaxime in a dose of 2 g twice daily is effective in the treatment of serious chest infections.

Arch Pathol Lab Med, 1992 May, 116(5), 521 - 3
Endometrial tuberculosis acquired by a health care worker in a clinical laboratory; Shireman PK; I describe a case of endometrial tuberculosis acquired by a microbiologist while she was working in a clinical laboratory . Granulomatous endometritis was found, and Mycobacterium tuberculosis was isolated . Respiratory tract exposure from a faulty exhaust hood is the likely source of infection . Endometrial tuberculosis and laboratory-acquired infections are briefly discussed.

Infect Immun, 1992 May, 60(5), 2066 - 74
Characterization of the major membrane protein of virulent Mycobacterium tuberculosis; Lee BY et al.; A protein with a molecular mass of 19 kDa was isolated and purified from enriched membrane fractions of the virulent Erdman strain of Mycobacterium tuberculosis . The protein is different from another 19-kDa protein, a lipoprotein, that was recently described (D . B . Young and T . R . Garbe, Res . Microbiol . 142:55-65, 1991) . The sequencing strategy applied to this major membrane protein employed four different endoproteinases and resulted in sufficient overlapping peptide sequences for assignment of the entire protein sequence . Electron spray ionization mass spectrometry demonstrated a measured mass of 16,100, deviating from the predicted mass by only 2.86 atomic mass units . The sequence of this protein is unique . However, some similarities with other low-molecular-weight heat shock proteins were observed . Immunoblotting indicated that this protein is highly expressed in the virulent strains of M . tuberculosis . Its application to sera from patients with pulmonary tuberculosis showed promise as a serodiagnostic tool.

Infect Immun, 1992 May, 60(5), 1845 - 53
Heterogeneity of outer membrane proteins in Borrelia burgdorferi: comparison of osp operons of three isolates of different geographic origins; Jonsson M et al.; Biochemical and immunochemical studies of the outer membrane proteins of Borrelia burgdorferi have shown that the OspA and OspB proteins from strains of different geographic origins may differ considerably in their reactivities with monoclonal antibodies and in their apparent molecular weights . To further characterize this variation in Osp proteins between strains, the osp operons and deduced translation products from two strains, one from Sweden (ACAI) and one from eastern Russia (Ip90), were studied . Polyacrylamide gel electrophoresis and Western blot (immunoblot) analyses confirmed differences between ACAI, Ip90, and the North American strain B31 in their Osp proteins . The sequences of the ospA and ospB genes of ACAI and Ip90 were compared with that of the previously studied osp operon of B31 (S . Bergstrom, V . G . Bundoc, and A . G . Barbour, Mol . Microbiol . 3:479-486, 1989) . The osp genes of ACAI and Ip90, like the corresponding genes of B31, were found on plasmids with apparent sizes of about 50 kb and are cotranscribed as a single unit . Pairwise comparisons of the nucleotide sequences revealed that the ospA genes of ACAI and Ip90 were 85 and 86% identical, respectively, to the ospA gene of strain B31 and 86% identical to each other . The ospB sequences of these two strains were 79% identical to the ospB gene of B31 and 81% identical to each other . There was significantly greater similarity between the ospA genes of the three different strains than there was between the ospA and ospB genes within each strain . These studies suggest that the duplication of osp genes in B . burgdorferi occurred before the geographical dispersion of strains represented by ACAI, Ip90, and B31.

Diagn Microbiol Infect Dis, 1992 May-Jun, 15(4 Suppl), 71S - 76S
Macrolide pharmacokinetics and dose scheduling of roxithromycin; Nilsen OG et al.; The 150- and 300-mg single-dose pharmacokinetics of roxithromycin were investigated in 12 healthy subjects in a crossover study . Serum concentrations were determined by high-performance liquid chromatography (HPLC) and microbiologic assay (MA) . Peak serum levels as measured by HPLC were 6.7 +/- 2.6 (150 mg) and 11.0 +/- 2.2 micrograms/ml (300 mg) and did not differ significantly from the values obtained by MA . Mean serum roxithromycin levels 12 hr after the 150-mg dose and 24 hr after the 300-mg dose were 2.50 and 2.55 micrograms/ml, respectively . HPLC analysis of a comparable macrolide, clarithromycin, showed peak serum levels of 1.2 +/- 0.6 and 2.3 +/- 0.6 micrograms/ml after oral dosing with 250 and 500 mg in the same subjects . The 14-OH metabolite reached a level that was 50% and 40%, respectively, of that of the parent compound . Roxithromycin showed a prolonged elimination half-life compared with clarithromycin and its 14-OH metabolite . Mean values of 14.6, 3.5, and 5.5 hr, respectively, indicate the need for less frequent dosing of roxithromycin.

Acta Otorrinolaringol Esp, 1992 May-Jun, 43(3), 188 - 94
{Acute external otitis: retrospective study of 170 cases}; Bernat Gili A et al.; 170 external otitis have been diagnosed and treated for one year (1989) in our ENT department . The etiology of the otitis was both bacterial and mycotic . The purpose of this paper is to study the clinical, therapeutic, epidemiologic and microbiologic aspects of this type of otitis.

Rinsho Byori, 1992 May, 40(5), 459 - 63
{Biosensors and clinical analysis}; Karube I; Method for the selective determination of organic compounds in biological fluids, such as blood, are very important in clinical analyses . Most analyses of organic compounds can be performed by spectrophotometric methods based on specific enzyme-catalyzed reactions . However, on account of the complicated procedure, these methods cannot be applied directly to bed-side monitoring . Alternatively, biosensors based on enzymes and electrochemical transducers possess excellent sensitivity for biological substrates and can determine directly a single compound in a biological fluid without need for a prior separation step . Therefore, in several years, many kinds of biosensors have been developed, and implantable microbiosensors for a body organ have also been reported . In the near future, an artificial pancreas fabricated by micromachine technology will be developed.

Eur J Epidemiol, 1992 May, 8(3), 397 - 406
Protothecosis: a report of two cases in Japan and a review of the literature; Matsuda T et al.; Protothecosis is an emerging opportunistic infection caused by species belonging to the genus Prototheca . Two Japanese cases of protothecosis are documented with a critical review of the literature . A current perspective concerning the microbiology and disease entity of protothecosis is described in detail.

Commun Dis Rep CDR Rev, 1992 Apr 24, 2(5), R55 - 9
Second generation heterosexual transmission of HIV-1 infection; Gilbart VL et al.; Reports of 217 HIV-1 infected persons have been investigated . Initially, 122 were described as having no identified risk of HIV infection and 95 were described as probably infected through heterosexual intercourse . The sexual partners of 34 of these 95 cases were reported as having acquired their infection heterosexually in the UK but information on the risk status of the sexual partners of the remaining 61 cases was lacking . Telephone follow-up through microbiologists and clinicians resulted in the recategorisation of 132 cases . Interviews were conducted with 22 HIV infected heterosexuals without a major risk for HIV infection, either in themselves or their sexual partners, and who had no evidence of heterosexual exposure outside the UK . Interviews confirmed the categorisation of 15 cases (9 male, 6 female) as due to second generation HIV-1 infection ie, infection acquired through heterosexual intercourse in the UK with a partner who also became infected through heterosexual intercourse . A possible chain of transmission is described involving three of these 15 cases.

Eur J Biochem, 1992 Apr 15, 205(2), 679 - 86
Evidence for controlled autoproteolysis of alkaline protease . A mechanism for physiological regulation of conidial discharge in Conidiobolus coronatus; Phadatare SU et al.; The alkaline serine protease of Conidiobolus coronatus was shown to be involved in its conidial discharge {Phadatare, S., Srinivasan, M . C., Deshpande, M . (1989) Arch . Microbiol . 153, 47-49} . To understand the regulation of conidial discharge, the mechanism of control of protease activity was investigated, which revealed the presence of two electrophoretically separable intracellular proteases (protease I and protease II) . The formation of smaller and less-active protease II coincided with the decrease in conidial discharge . In order to trace the origin of protease II, the corresponding purified extracellular enzymes were compared with respect to their biochemical, physiochemical and immunological properties . The biochemical properties, such as optimum pH and temperature, stability, sensitivity to metal ions and substrate specificity were closely similar for both proteases . Amino acid analysis revealed that protease II is completely similar to protease I, though protease I contains an additional portion which is not contained in protease II . Western-blot ELISA, immunotitration and determination of antigenic valencies also revealed the structural similarity between the two proteases . Purified protease I showed partial degradation to protease II in vitro, the process being sensitive to phenylmethylsulfonyl fluoride, indicating its proteolytic nature . These results suggest that the formation of a less-active protease by autoproteolysis represents a novel means of physiological regulation of protease activity, which in turn regulates the conidial discharge in C . coronatus.

Pathology, 1992 Apr, 24(2), 45 - 55
The perinatal autopsy: a contemporary approach; Chambers HM; As autopsy rates in general hospitals decline, interest in the perinatal autopsy continues to rise, reflecting the emergence of a vigorous specialty growing in parallel with fetal medicine, prenatal diagnosis and clinical genetics . Perinatal autopsies are best carried out in tertiary centres which provide these services . Meticulous documentation, flexibility of technique, intelligent use of laboratory tests and wide systematic histopathologic sampling are emphasized . Microbiologic examination is of particular value when carried out by a laboratory having a special interest in genital tract and perinatal pathogens . Karyotyping must be selective if resources are to be conserved and is most productive when there are multiple malformations . Perinatal autopsy is not complete without examination of the placenta and significant lesions should be clearly distinguished from curiosities and from changes secondary to fetal death . The pathologist's wider contribution to perinatal medicine includes providing high quality data to epidemiology units and auditing committees, contributing to the multidisciplinary management of prenatally diagnosed fetal abnormalities, monitoring iatrogenic disease patterns and supporting the process of perinatal grief management . Special problems and diagnostic challenges are to be found when investigating sudden, unexplained intrauterine fetal death, hydrops, bone dysplasias and complicated multiple pregnancies.

Chin Med J (Engl), 1992 Apr, 105(4), 319 - 21
Research on rapid identification of auto-microbiology system for pathogenic yeast; Liao WQ et al.; The auto-microbiology system yeast biochemical card (AMS-YBC; Vitek System, Inc.) was studied in 77 clinical isolates and 50 laboratory kept isolates on the basis of routine identification . Results of 123 isolates were obtained in 24 hours, while that of the other 4 in 48 hours . 122 (96.1%) were coincidently identified with AMS and routine method . The results suggest that AMS is a rapid, accurate and simple identification method for common pathogenic yeast.

Immun Infekt, 1992 Apr, 20(2), 32 - 5
{Clinical atypical mycobacterial infections}; Greinert U; In adults atypical mycobacteria usually cause pulmonary disease, lymphadenitis in children and disseminated disease in the course of the acquired immunodeficiency syndrome . Apart from that atypical mycobacteria lead to cutaneous lesions as well as to local abscess formation and necrotic tissue lesions following accidental or iatrogenic trauma of the skin or the soft tissues . Whereas well-established and upcoming microbiologic procedures easily allow an exact classification of the organism, clinical diagnosis is sometimes problematic.

Enferm Infecc Microbiol Clin, 1992 Apr, 10(4), 190 - 4
{Evaluation of two commercial kits for detection of Helicobacter pylori specific antibodies in patients undergoing gastroscopy . A seroprevalence study in an asymptomatic population}; Navarro F et al.; BACKGROUND: We evaluate two different commercially available kits for detecting specific antibodies against Helicobacter pylori in a group of 48 patients with gastrointestinal symptoms that underwent an endoscopic procedure . We also study the seroprevalence of anti-H . pylori antibodies in asimptomatic individuals from our area . METHODS: Microbiologic and pathologic studies were performed in 48 gastric biopsies, in relation with antibodies detection using ELISA (Pylori stat test, Whittaker) and latex particles agglutination (Pyloriset, Orion) . We also used ELISA tests for determining the seroprevalence of H . pylori antibodies in 139 asimptomatic individuals . RESULTS: Ninety-four percent of patients with peptic ulcer disease and 81% of patients without peptic ulcer disease but complaining of dyspepsia were infected by H . pylori . None of the patients with normal gastric mucosae was found to be infected . Sensitivity and specificity of ELISA test were 100% and 73% . Latex test sensitivity and specificity were 46% and 82% . The seroprevalence of antibodies among healthy individuals in our area increases with age (19% among children under 9 years of age) and reaches a peak at 40-49 years of age (84%), with a mean value of 60% in all ages' groups . CONCLUSIONS: There is a high correlation between Helicobacter pylori infection and gastric mucosa alterations . The ELISA test is best correlated with other laboratory data used for defining infection . The seroprevalence of H . pylori antibodies is also high, and therefore we recommend that the use of serologic diagnostic test must be highly selective.

Horm Metab Res, 1992 Apr, 24(4), 181 - 4
Bioactive and immunoactive prolactin levels after TRH-stimulation in the sera of normal women; Maddox PR et al.; The availability of an improved microbioassay for lactogenic hormone measurement has enabled comparison of basal and dynamic prolactin bioactivity (BA) and immunoactivity (IRMA) in normal human serum . Serum from 16 normal females aged 22-74 years was assayed and revealed a mean BA/IRMA prolactin ratio of 1.6 for basal and 1.8 for peak TRH-stimulated levels . Basal prolactin levels in postmenopausal women measured by bioassay were lower than in premenopausal women showing a relative and absolute decrease in prolactin bioactivity with age, but there was no significant difference in dynamic levels . There was also no significant difference in BA or IRMA levels following the stress of venepuncture . These findings indicate that, as previously described for basal levels, there is a good correlation between dynamic prolactin bioactivity and immunoactivity in human serum.

Mikrobiyol Bul, 1992 Apr, 26(2), 139 - 48
{Prevalence of G . vaginalis, Mycoplasma, Ureaplasma, T . vaginalis, yeast, N . gonorrhoeae and other bacteria in women with vaginal discharge}; Yavuzdemir S et al.; Vaginal discharge of 118 women attended to outdoor clinics of obstetrics and gynaecology at Medical Faculty of Ankara University (A.U.T.F.), have been examined . Direct microscopy has been made by means of wet mount, Gram and Giemsa staining . Vaginal pH has been measured, by 10% KOH the presence of "fishy odor" has been investigated . For culturing vaginal secretions in Amies transport medium have been brought to Microbiology Department of Ankara University, Faculty of Medicine Inoculations have been made on to Blood agar, MacConkey agar, Sabouraud Dextrose agar, New York City . Medium, % 5 Human blood bilayer Tween 80 Medium (HBT), Vivey Trichomonas Agar Medium and into M-broth and U9 broth . In this study, we have isolated 9 (7.62%) Gardnerella vaginalis, 41 (33.89%) Ureaplasma, 13 (11.01%) Mycoplasma, 25 (21.18%) yeasts, 4 (3.38%) Trichomonas vaginalis and 43 (36.46%) various bacteria, 26 cases were found to have polymicrobial etiology.

Int J Syst Bacteriol, 1992 Apr, 42(2), 303 - 5
Rickettsia japonica sp . nov., the etiological agent of spotted fever group rickettsiosis in Japan; Uchida T et al.; We propose the name Rickettsia japonica sp . nov . (with type strain YH {= ATCC VR-1363}) for a serologically specific species of spotted fever group rickettsiae that are pathogenic for humans (J . Infect . Dis . 159:1122-1126, 1989; J . Clin . Microbiol . 28:1177-1180, 1990) . The biologic and genomic characteristics of the organism (G+C content, 31.2 +/- 0.7 mol%) are essentially the same as those of other pathogenic spotted fever group rickettsiae, although the R . japonica isolates cause a persistent infection in Vero cells for many subcultures.

Clin Microbiol Rev, 1992 Apr, 5(2), 130 - 45
Laboratory diagnosis of bacterial meningitis; Gray LD et al.; Bacterial meningitis is relatively common, can progress rapidly, and can result in death or permanent debilitation . This infection justifiably elicits strong emotional reactions and, hopefully, immediate medical intervention . This review is a brief presentation of the pathogenesis of bacterial meningitis and a review of current knowledge, literature, and recommendations on the subject of laboratory diagnosis of bacterial meningitis . Those who work in clinical microbiology laboratories should be familiar with the tests used in detecting bacteria and bacterial antigens in cerebrospinal fluid (CSF) and should always have the utmost appreciation for the fact that results of such tests must always be reported immediately . Academic and practical aspects of the laboratory diagnosis of bacterial meningitis presented in this review include the following: anatomy of the meninges; pathogenesis; changes in the composition of CSF; etiological agents; processing CSF; microscopic examination of CSF; culturing CSF; methods of detecting bacterial antigens and bacterial components in CSF (counter-immunoelectrophoresis, coagglutination, latex agglutination, enzyme-linked immunosorbent assay, Limulus amebocyte lysate assay, and gas-liquid chromatography); use of the polymerase chain reaction; and practical considerations for testing CSF for bacterial antigens.

Chest, 1992 Apr, 101(4), 926 - 30
Ultrasound-guided aspiration biopsy of small peripheral pulmonary nodules; Yuan A et al.; We compared the diagnostic yields of ultrasound-guided aspiration biopsy, sputum cytology, and fiberoptic bronchoscopy with biopsy in 30 patients with peripheral pulmonary nodules smaller than 3.0 cm in diameter . Among them, there were 4 minute nodules with diameter less than 1.0 cm, 12 between 1.1 to 2.0 cm, and 14 between 2.1 to 3.0 cm . The final diagnoses in these 30 patients, as confirmed by histologic findings, microbiology, and clinical follow-up, revealed 24 malignant lesions and 6 benign . All of these 30 nodules received ultrasound-guided transthoracic fine-needle aspiration biopsy, and confirmative diagnoses were obtained in 27 (90 percent) . Twenty-two (92 percent) of 24 patients with malignant nodules had positive cytology for malignancy and 5 (83 percent) of 6 patients with benign lesions had diagnosis made by cytologic and microbiologic examinations . One patient developed asymptomatic pneumothorax after needle aspiration . The size of the lesions did not affect the diagnostic yield and complication rate . None of the lesions was diagnosed by sputum cytology (0 of 19; 0 percent) . Two patients had diagnoses obtained by fiberoptic bronchoscopy with biopsy (2 of 10; 20 percent) . We conclude that ultrasound-guided aspiration biopsy is a useful and safe method for diagnosis of peripheral pulmonary nodules, even when the size of the nodule is less than 3 cm in diameter . The diagnostic yield far exceeds that which can be obtained by sputum cytology and fiberoptic bronchoscopy with biopsy.

J Immunol, 1992 Apr 1, 148(7), 2217 - 22
Nitric oxide-induced anti-mitogenic effects in high and low responder rat strains; Fu Y et al.; Nitric oxide (NO) has multiple biologic functions: in the brain it acts as a neuronal messenger; elsewhere, it causes smooth muscle relaxation, inhibition of platelet aggregation, inhibition of leukocyte adhesion, inhibition of tumor growth, and microbiostasis . Our studies show that production of NO is responsible for the unusual unresponsiveness of BN rat spleen cells to mitogens . NG-monomethyl-L-arginine (NGMMA), a potent competitive inhibitor for NO synthase, reverses this defect . Lysed RBC or NGMMA were shown to enhance mitogen-induced spleen cell proliferation only one- to twofold in Lewis rats (that have normal mitogen responsiveness) but act to stimulate BN rat T cells by 10- to 100-fold . NGMMA-enhanced proliferation was significantly diminished by prior depletion of macrophages . Surprisingly, NO did not inhibit IL-2 production in 48-h cultures of BN rat spleen cells, and exogenous IL-2 was ineffective in releasing NO-mediated suppression . These studies indicate that NO produced by macrophages can completely and reversibly inhibit T cell proliferation . The BN rat appears to be unique in its production of very high levels of NO, making it an especially useful animal model for studying the biologic control and functional consequences of NO generation.

G E N, 1992 Apr-Jun, 46(2), 102 - 4
{Nonulcerative dyspepsia associated with Helicobacter pylori}; Moncada J et al.; 30 patients with non ulcer dyspepsia (NUD) were evaluated to find out if there was a relationship with Helicobacter pylori (HP) infection . Gastric biopsies from the antrum were taken and two of them sent to pathology to be stained with H&E and Warthin-Starry . The other three were sent to Microbiology, for urease-test, culture and frotis with Gram stain . To diagnose HP was necessary to get it at least in two of the performed test . This was possible in 20 (66.66%) . Chronic active gastritis was observed in 15/20 (75%) and in the 3/10 HP negative patients none had histological alteration shown . Normal aspect of gastric mucosa did not predict Helicobacter pylori infection . The presence of the bacteria could not be correlated to any kind of symptoms and always was associated with chronic gastritis.

Rev Med Chil, 1992 Apr, 120(4), 464 - 70
{Microbiology in Chile: development through a century of existence}; Rodriguez M; Microbiology starts in Chile at the end of the XIXth century as part of the effort to develop basic sciences at the University of Chile Medical School . Publications by Vicente Izquierdo on gonorrheae and Alejandro del Rio on the organisms of dysenteriae were pioneer works in this area . The field was progressively developed in the Schools of Medicine, Dentistry, Pharmacy, Veterinary Medicine, Institute of Hygiene and Public Health and different hospitals . Many scientists have been trained in the United States, Canada or Europe . Post graduate training in Chile led to the first Masters degree in 1975 and the first doctoral degree in 1987 . Although there is a shortage of well trained scientists and specialists, the field remains active as evidenced by publications, meetings and the existence of 3 specialized journals.

Biochem J, 1992 Mar 15, 282 ( Pt 3), 781 - 8
Primary and predicted secondary structures of the Actinomadura R39 extracellular DD-peptidase, a penicillin-binding protein (PBP) related to the Escherichia coli PBP4; Granier B et al.; As derived from gene cloning and sequencing, the 489-amino-acid DD-peptidase/penicillin-binding protein (PBP) produced by Actinomadura R39 has a primary structure very similar to that of the Escherichia coli PBP4 {Mottl, Terpstra & Keck (1991) FEMS Microbiol . Lett . 78, 213-220} . Hydrophobic-cluster analysis of the two proteins shows that, providing that a large 174-amino-acid stretch is excluded from the analysis, the bulk of the two polypeptide chains possesses homologues of the active-site motifs and secondary structures found in the class A beta-lactamase of Streptomyces albus G of known three-dimensional structure . The 174-amino-acid insert occurs at equivalent places in the two PBPs, between helices alpha 2 and alpha 3, away from the active site . Such an insert is unique among the penicilloyl serine transferases . It is proposed that the Actinomadura R39 PBP and E . coli PBP4 form a special class, class C, of low-Mr PBPs/DD-peptidases . A vector has been constructed and introduced by electrotransformation in the original Actinomadura R39 strain, allowing high-level expression and secretion of the DD-peptidase/PBP (250 mg.l-1) . The gene encoding the desired protein is processed differently in Actinomadura R39 and Streptomyces lividans . Incorrect processing in Streptomyces lividans leads to a secreted protein which is inert in terms of DD-peptidase activity and penicillin-binding capacity.

Plasmid, 1992 Mar, 27(2), 130 - 40
Cloning and DNA sequence of the Mycobacterium fortuitum var fortuitum plasmid pAL5000; Labidi A et al.; The complete nucleotide sequence of the Mycobacterium fortuitum var fortuitum plasmid pAL5000 has been determined . Computer analysis of this 4821-bp plasmid for protein coding regions, based on mycobacterial codon usage preferences, reveals the presence of two putative protein coding regions immediately downstream from typical mycobacterial promoter and ribosome binding sites . Both open reading frames, ORF1 and ORF2, produced proteins with the predicted respective sizes previously shown in minicell expression experiments {A . Labidi et al . (1985) FEMS Microbiol . Lett . 30, 221-225} . ORF1 encodes a putative 20-kDa basic protein with characteristics of a DNA binding protein involved in plasmid DNA replication . ORF2 encodes a 67-kDa protein with an amino-terminal sequence suggestive of a transported protein and a possible transmembrane anchor near its carboxyl-terminal . The current sequence and its analysis are more consistent with the minicell expression experiments than the previously published sequence of the pAL5000 plasmid {J . Rauzier et al . (1988) Gene 71, 315-321}.

J Clin Microbiol, 1992 Mar, 30(3), 735 - 8
Analysis of Leptospira spp., Leptonema illini, and Rickettsia rickettsii for the 39-kilodalton antigen (P39) of Borrelia burgdorferi; Schwan TG et al.; Five serovars of Leptospira interrogans, Leptospira biflexa, Leptonema illini, and Rickettsia rickettsii were examined and found not to contain the 39-kDa antigen (P39) of Borrelia burgdorferi, the Lyme disease spirochete . The specificity of this antigen and its reactivity with human Lyme disease sera should exclude the possibility of false-positive serum samples from patients having had either leptospirosis or Rocky Mountain spotted fever, as well as tick-borne relapsing fever and syphilis, as reported previously (W.J . Simpson, M . E . Schrumpf, and T . G . Schwan, J . Clin . Microbiol . 28:1329-1337, 1990).

Quintessence Int, 1992 Mar, 23(3), 187 - 90
The effectiveness of an enzyme-containing denture cleanser; Odman PA; The purpose of this study was to test the effectiveness of an enzyme-containing denture cleanser . During a 3-week period, 13 patients used Enzydent only for soaking the denture; during another 3-week period, the patients were instructed first to soak and then to brush their denture . The effectiveness of the cleanser was measured by microbiologic procedures . The results showed that soaking the denture in the enzyme-containing cleanser alone was as effective as the patients' previous regimen of denture hygiene, but that when soaking was used in combination with brushing, the denture became significantly cleaner.

J Am Soc Nephrol, 1992 Mar, 2(9), 1436 - 44
Pyrogenic reactions in patients receiving conventional, high-efficiency, or high-flux hemodialysis treatments with bicarbonate dialysate containing high concentrations of bacteria and endotoxin; Gordon SM et al.; High-efficiency (HE) and high-flux (HF) hemodialysis are becoming increasingly popular methods for treating patients with chronic renal failure because they reduce the time required for dialysis treatment . HF and HE dialyzers require bicarbonate dialysate, often prepared from concentrates that can support bacterial growth with endotoxin production . There is a concern that endotoxins or bacteria may cross or interact at the membranes of these dialyzers, triggering the release of endogenous pyrogens (cytokines) by peripheral blood mononuclear cells to cause pyrogenic reactions (PR) . To determine the incidence of PR and to examine the association between PR and levels of bacteria and endotoxin in dialysate, a cohort of patients receiving conventional, HE, or HF hemodialysis with bicarbonate dialysate and reprocessed dialyzers at three dialysis centers during a 12-month period was studied prospectively . All dialyzers underwent a test of membrane integrity before use . A total of 19 PR were identified among 18 patients in 26,877 hemodialysis treatments (0.7 PR/1,000 treatments) . There was no significant difference in PR rates by treatment modality: conventional, 0.5 per 1,000 (7 PR/13,123 treatments) versus HE, 0.9 per 1,000 (9 PR/11,345) versus HF, 1.2 per 1,000 (3 PR/2,409) (P = 0.21; chi 2 test) . Throughout the study period, bacterial counts for dialysate at each center significantly exceeded the Association for the Advancement of Medical Instrumentation's (AAMI) microbiologic standards for dialysate of less than 2,000 CFU/mL (mean, 19,000 CFU/mL), but water used in the reuse of dialyzers tested less than 200 CFU/mL.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1992 Mar, 36(3), 651 - 5
Penetration of fleroxacin and ciprofloxacin into skin blister fluid: a comparative study; Lubowski TJ et al.; The penetration of multiple-dose concentrations of oral fleroxacin (400 mg every 24 h) and ciprofloxacin (500 mg every 12 h) into skin blister fluid in 12 healthy volunteers was determined in a randomized crossover study . Serum, blister fluid, and paper disk samples were analyzed by large-plate microbiologic assay . The mean areas under the concentration-time curve (AUC) for serum were 88.6 and 18.2 micrograms.h/ml/70 kg for fleroxacin and ciprofloxacin, respectively . The mean AUC for blister fluid and paper disks were 71.2 and 15.0 micrograms.h/ml/70 kg and 77.8 and 15.4 micrograms.h/ml/70 kg for fleroxacin and ciprofloxacin, respectively . Calculated penetration into interstitial fluid ranged from 74 to 92% for fleroxacin and 56 to 96% for ciprofloxacin; penetration was calculated by using the ratio of maximum drug concentration or AUC in blister fluid and paper disks to maximum drug concentration or AUC in serum . There was no significant difference between fleroxacin and ciprofloxacin in the percent penetration into skin blister fluid.

Semin Respir Infect, 1992 Mar, 7(1), 46 - 53
The diagnosis of influenza; Pachucki CT; Our ability to establish a specific diagnosis of influenza infections has dramatically improved . Clinical signs and symptoms of influenza infection and epidemiological indicators of an influenza outbreak can be verified with a variety of rapid detection methods . Viral isolation and an acute change in serology, which characteristically took from 5 to 28 days, are now being supplemented with methods that detect influenza viral antigen directly on clinical specimens and/or influenza virus in tissue culture within 24 to 48 hours following inoculation . These rapid diagnostic techniques are easily adapted in clinical microbiology laboratories and will provide diagnostic information so that the clinician can prescribe specific antiviral therapy.

Diagn Microbiol Infect Dis, 1992 Mar-Apr, 15(3), 267 - 72
Pulmonary coccidioidal pseudomycetoma; Rodriguez-Cintron W et al.; Coccidiomycosis is rarely associated with a pulmonary mycetoma . We report a patient with progressive cavitary coccidiomycosis, whose initial radiographic and clinical appearance simulated a mycetoma . Examination of the surgically resected lung showed necrotizing Coccidioides immitis granulomas with spherules and arthroconidialike structures, but no evidence of a mycetoma . We propose the term pulmonary coccidioidal pseudomycetoma as the best descriptor for this patient's clinical, radiographic, pathologic, and microbiologic presentation.

Infect Control Hosp Epidemiol, 1992 Mar, 13(3), 147 - 50
A cluster of pseudofungemia associated with hospital renovation adjacent to the microbiology laboratory; Hruszkewycz V et al.; OBJECTIVE: To determine the clinical significance and source of fungemia following a cluster of positive blood cultures during a 3-day period . DESIGN: Chart review was used to determine the clinical significance of positive blood cultures . Microbiologic sampling of the laboratory environment was used to determine potential sources of fungal contamination . SETTING: A large, tertiary care, community teaching hospital . PATIENTS: All patients with blood cultures positive for Aspergillus species, Penicillium species, or both during the outbreak period . RESULTS: Thirteen patients, all children, were reported to have positive blood cultures for fungus during a 3-day period in early 1990 . None had clinical features consistent with fungemia . Investigation of specimen processing procedures revealed that microbiologic plates were not processed--as per protocol--under the biologic hood but inadvertently were left open to air on the work bench by laboratory technicians . Settling plates left at the workbench, at door entry sites, and at sites of renovation immediately adjacent to the laboratory were positive for Aspergillus and/or Penicillium; control plates placed elsewhere were negative . Airflow patterns suggested spread into the microbiologic laboratory through an open door located near the implicated workbench station and a false ceiling above the workbench area . CONCLUSIONS: Our investigation demonstrates that faulty technique in the laboratory coupled with a change in environmental conditions can result in false-positive cultures and an outbreak of pseudofungemia.

Br J Cancer, 1992 Mar, 65(3), 456 - 60
Prolactin and total lactogenic hormone measured by microbioassay and immunoassay in breast cancer; Maddox PR et al.; Basal prolactin (PRL) and total lactogenic hormone (TLH) levels were measured using a new microbioassay (BA) and conventional immunoradiometric assay (IRMA) in patients with breast cancer and compared to an age-matched control group . No significant differences were found using the IRMA, but BA lactogenic levels were significantly elevated in breast cancer patients compared controls, leading to a markedly elevated BA/IRMA ratio for both PRL (2.7 vs 1.4, P less than 0.0001) and TLH (2.8 vs 1.4, P less than 0.0001) which was greatest for postmenopausal women . Using the mean +2 standard deviations as the upper limit of normal, there was no significant difference between breast cancer patients and controls for IRMA, but BA and BA/IRMA PRL levels were elevated in 42% and 61% of the patients, respectively . There was a weak negative correlation of BA and IRMA PRL with age for normals (r = -0.53 for both) but no correlation was evident for breast cancer patients (r = 0.06 and -0.13, respectively) implying a sustained absolute and relative bioactive hyperprolactinaemia at all ages . These results show increased lactogenic bioactivity in breast cancer and suggest that different forms of bioactive prolactin undetected by IRMA (or enhancing serum factors) are present in the sera of these patients.

J Clin Microbiol, 1992 Mar, 30(3), 633 - 41
Multicenter evaluation of five commercial rubella virus immunoglobulin G kits which report in international units per milliliter; Dimech W et al.; In a multicenter study, the consistency of international units expressed by five commercially available rubella virus immunoglobulin G kits was evaluated . The linearity and within-run and between-run precision were determined for each kit . All kits demonstrated good linearity and had within-run and between-run precision coefficients of variation ranging from 5.1 to 21.7% and from 9.5 to 51.0%, respectively . To compare the international units expressed, the results from 40 samples tested in duplicate were compared with the results of a reference enzyme immunoassay calibrated with World Health Organization international standard serum and a hemagglutination inhibition test . The results of the kits were plotted against those of the reference tests, and linear regression analysis was applied . The Pearson correlation coefficient ranged from 0.64 to 0.75 when the commercial kit results were compared with those of the reference enzyme immunoassay, indicating only a moderate degree of correlation . Therefore, the international units expressed by the commercial kits are insufficiently consistent to be of practical use in diagnostic clinical microbiology.

Semin Dermatol, 1992 Mar, 11(1), 19 - 23
Candida and Malassezia as nursery pathogens; Stuart SM et al.; Candida and Malassezia can be both normal flora and pathogens in the nursery . Very low-birth-weight infants are at high risk for systemic infection from these organisms . We review the microbiology and clinical manifestations of disease within the neonatal nursery.

Mayo Clin Proc, 1992 Mar, 67(3), 221 - 7
Clinical utility of bronchoalveolar lavage in immunocompromised hosts; Pisani RJ et al.; Bronchoalveolar lavage (BAL) has been used extensively for assessment of immunocompromised hosts with pulmonary infiltrates . Reported estimates of the diagnostic utility of BAL have varied because of differences in patient populations, diagnostic criteria, and study methods . Herein we report on the use of BAL to determine at least one of the final diagnoses in 150 immunocompromised patients . Although the frequency with which BAL provided at least one of the final diagnoses (overall diagnostic yield) was seemingly low (39%), the yield increased substantially when only patients with pathologically proven diagnoses were considered . The sensitivity of BAL was 82%, and the specificity was 53% . The use of rigid diagnostic criteria enabled us to distinguish pathogens from colonizers . Pneumocystis was considered a pathogen whenever it was identified . It was the most common infectious pathogen identified (50%) despite the fact that our study population had relatively few patients (only 4%) with acquired immunodeficiency syndrome (AIDS) . Organisms such as cytomegalovirus, Aspergillus, and Candida were frequently identified in BAL specimens but were eventually proved to be pathogens in only 24%, 25%, and 0% of cases, respectively . BAL detected pulmonary malignant lesions on the basis of positive cytologic results in four of six patients eventually found to have primary or metastatic lung cancer . Our results should enhance the understanding of the strengths and weaknesses of BAL and assist in the interpretation of associated microbiologic findings.

Rev Sci Tech, 1992 Mar, 11(1), 99 - 116
Organisation of veterinary public health in Africa; Belino ED; Veterinary public health (VPH) is not integrated into the mainstream of public health services in Africa . There are no formal mechanisms within government public health services through which veterinary skills and resources can be effectively harnessed to bear upon community health . There is no conscious, overt or substantial effort by public authorities to incorporate VPH services in the overall approach to public health . VPH activities cover mainly the control of the major animal diseases transmissible to man (zoonoses), meat inspection and, to a limited degree, the quality control of milk, fish and their products . These services are carried out by the Veterinary Services of the Ministry of Agriculture in each country . Concerning education, only 7 of the 28 schools of veterinary medicine in Africa have separate departments where VPH subjects such as epidemiology, food hygiene, zoonoses, biostatistics, community health, public administration, preventive medicine and other related fields are taught by public health-trained and oriented staff . Elsewhere the teaching of VPH subjects is delegated to staff whose foremost interests are in pathology, microbiology and clinical medicine . Postgraduate training in VPH is fast developing in the veterinary schools of Nigeria, Kenya and Uganda . Political instability, war, famine and poverty which deplete human and material resources, lack of intersectorial cooperation in matters of public health and lack of vigour on the part of the veterinary profession as a whole to assert its broader role in the community also contribute to the poor organisation of VPH in Africa . International collaboration in VPH is spearheaded by the Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO) . These agencies, along with the Office International des Epizooties (OIE) and other international organisations or groups, are active in promoting the development of VPH programmes by setting guidelines on the organisation and management of VPH, coordinating control programmes for the major zoonoses and providing financial and technical expertise.

Pediatr Med Chir, 1992 Mar-Apr, 14(2), 167 - 80
{Otitis media in childhood: a critical review of the literature}; Curro V et al.; Infection of the middle ear is one of the most common childhood illnesses accounting for one-third of the pediatrics practice during the first five years of life . Therefore treatment and prevention of the otitis media are of considerable importance . A review of the literature of the otitis media during the pediatric age is reported . In fact in the last years a large amount of knowledge, sometimes referring discordant opinions, has been acquired . The Authors report epidemiology, anatomy, pathology, physiology, microbiology, classification, clinical data diagnosis and therapy of the otitis media . Common conditions of the middle ear (normal, acute otitis media, chronic otitis media, recurrent otitis media) are described . In particular acute otitis media, otitis media with effusion, perforation of the tympanic membrane, fluid level in the middle ear, severe retraction or bulging of the tympanic membrane are pointed out in color-photographs.

Clin Oral Implants Res, 1992 Mar, 3(1), 9 - 16
Experimental breakdown of peri-implant and periodontal tissues . A study in the beagle dog; Lindhe J et al.; The objective of the present experiment was to study lesions in the peri-implant and periodontal tissues resulting from ligature placement and subgingival plaque formation . The experiment was performed in 5 beagle dogs which at the start of the study were about 15 months old . They were given a diet which allowed gross plaque formation . The mandibular right premolars were extracted, 3 fixtures (a.m . Branemark) installed and abutment connection performed . Towards the end of a 6-month plaque control period, a clinical and radiographic examination was performed . Ligatures were placed in a subgingival position at 2 of the implants and the contralateral premolars . Plaque was allowed to accumulate . After 6 weeks, the ligatures were removed . 1 month later, the clinical and radiographical examination was repeated and samples from the subgingival microbiota obtained . Biopsies from the teeth and implant sites were harvested and processed for histometric and morphometric analyses . The results from the clinical and histological examinations revealed that: (i) clinical and radiographic signs of tissue destruction were more pronounced at implants than at teeth; (ii) the size of the soft tissue lesion was larger at implants than at teeth; (iii) the lesion at implants but not at teeth extended into the bone marrow.

Infect Immun, 1992 Mar, 60(3), 983 - 8
Identification of two porcine brush border glycoproteins that bind the K88ac adhesin of Escherichia coli and correlation of these glycoproteins with the adhesive phenotype; Erickson AK et al.; In this study, we identified two brush border glycoproteins (210 and 240 kDa) that bind both K88ac+ Escherichia coli and purified K88ac adhesin . The specificity of these binding glycoproteins for the K88ac adhesin was demonstrated in studies in which the binding of 35S-labeled K88ac+ E . coli and biotinylated K88ac adhesin to these glycoproteins was blocked in the presence of a 100-fold molar excess of unlabeled K88ac adhesin but not in the presence of the K99 adhesin . Pretreatment of adhesive brush borders with sodium metaperiodate destroyed both binding activities, indicating that the interaction between the K88ac adhesin and the binding glycoproteins requires the glycoprotein carbohydrate moiety . It was demonstrated previously that K88ac+ E . coli binds to adhesive brush borders but not to nonadhesive brush borders (R . Sellwood, R . A . Gibbons, G . W . Jones, and J . M . Rutter, J . Med . Microbiol . 8:405-411, 1975) . In the present study, brush borders isolated from 10 different pigs were tested first for brush border adhesiveness and then for the presence of the binding glycoproteins . In all cases, the binding glycoproteins were detected only in the adhesive brush border preparations . These two binding glycoproteins may be the receptors used by K88ac+ ETEC to adhere to intestinal brush border cells . Their presence on adhesive brush borders and absence on nonadhesive brush borders may be the basis for resistance and susceptibility of pigs to K88ac+ ETEC infections.

Rev Hosp Clin Fac Med Sao Paulo, 1992 Mar-Apr, 47(2), 71 - 5
{Epidemiological study of Lyme disease in Brazil}; Hoshinari NH et al.; Lyme disease is a tick-born infection first reported in United States of America in 1977 by Allen C . Steere . It occurred in the state of Connecticut; other cases have been discovered in others states of USA and also in other countries (Canada, Soviet Union, Japan, China, Australia) . This disease has not been reported in South America yet . In order to investigate this disease in Brasil, a multi-disciplinary group including microbiologists, entomologists and clinicians was created at the University of Sao Paulo . The aim of this report is to describe the elaboration of this research in our center and also to present the preliminary results.

J Bacteriol, 1992 Mar, 174(5), 1574 - 85
Site-specific deletion and rearrangement of integron insert genes catalyzed by the integron DNA integrase; Collis CM et al.; Deletion of individual antibiotic resistance genes found within the variable region of integrons is demonstrated . Evidence for gene duplications and rearrangements resulting from the insertion of gene units at new locations is also presented . Deletion, duplication, and rearrangement occur only in the presence of the integron-encoded DNA integrase . These events are precise and involve loss or gain of one or more complete insert units or gene cassettes . This confirms the recent definition of gene cassettes as consisting of the gene coding sequences, all except the last 7 bases of the 59-base element found at the 3' end of the gene, and the core site located 5' to the gene (Hall et al., Mol . Microbiol . 5:1941-1959, 1991) and demonstrates that individual gene cassettes are functional units which can be independently mobilized . Both deletions and duplications can be generated by integrase-mediated cointegrate formation followed by integrase-mediated resolution involving a different pair of sites . However, deletion occurs 10 times more frequently than duplication, and we propose that the majority of deletion events are likely to involve integrase-dependent excision of the gene unit to generate a circular gene cassette . The implications of these findings in understanding the evolution of integrons and the spread of antibiotic resistance genes in bacterial populations is discussed.

Urol Clin North Am, 1992 Feb, 19(1), 35 - 45
Sexually transmitted diseases and their relation to male infertility; Moskowitz MO et al.; Controversy surrounds the role of sexually transmitted diseases in male infertility . Because our understanding of male infertility is limited, and because diagnostic tests such as semen analysis including culture and leukocyte count are variable, definitive conclusions on STDs and their effect on infertility cannot be substantiated . Prospective investigations of infertile couples using appropriate control groups, sophisticated semen collection protocols, proper microbiologic techniques, and standardization of seminal fluid analysis are required to understand the role of STDs in male infertility . Regardless of the ongoing research to delineate the role of STDs in male infertility, advocating primary prevention by increasing public awareness of the negative effects of STDs and the use of contraceptive methods to prevent the spread of STDs is mandatory for the health care professional.

J Bacteriol, 1992 Feb, 174(4), 1099 - 108
Functional analysis of the sialyltransferase complexes in Escherichia coli K1 and K92; Steenbergen SM et al.; The polysialyltransferase (polyST) structural gene, neuS, for poly alpha 2,8sialic acid (PSA) capsule synthesis in Escherichia coli K1 was previously mapped near the kps region 1 and 2 junction (S . M . Steenbergen and E . R . Vimr, Mol . Microbiol . 4:603-611, 1990) . Present Southern and colony blot hybridization results confirmed that neuS was a region 2 locus and indicated apparent homology with neuS from E . coli K92, bacteria that synthesize a sialyl alpha 2,8-2,9-linked polymer . A K1- mutant with an insertion mutation in neuS was complemented in trans by K92 neuS, providing direct evidence that neuS encoded the PSA polymerase . A 2.9-kb E . coli K1 kps subclone was sequenced to better characterize polyST . In addition to neuS, the results identified a new open reading frame, designated neuE, the linker sequence between regions 1 and 2, and the last gene of region 1, kpsS . The kpsS translational reading frame was confirmed by sequencing across the junction of a kpsS'-lacZ+ fusion . PolyST was identified by maxicell analysis of nested deletions and coupled in vitro transcription-translation assays . PolyST's derived primary structure predicted a 47,500-Da basic polypeptide without extensive similarity to other known proteins . PolyST activity was increased 31-fold and was membrane localized when neuS was cloned into an inducible expression vector, suggesting, together with the polyST primary structure, that polyST is a peripheral inner membrane glycosyltransferase . However, polyST could not initiate de novo PSA synthesis, indicating a functional requirement for other kps gene products . The existence of a sialyltransferase distinct from polyST was suggested by identification of a potential polyprenyl-binding motif in a C-terminal membrane-spanning domain of the predicted neuE gene product . Direct evidence for a quantitatively minor sialyltransferase activity, which could function to initiate PSA synthesis, was obtained by phenotypic analysis of mutants with multiple defects in sialic acid synthesis, degradation, and polymerization . The results provide an initial molecular description of K1 and K92 sialyltransferase complexes and suggest a possible common function for accessory kps gene products.

Am J Infect Control, 1992 Feb, 20(1), 4 - 10
Computerized identification of patients at high risk for hospital-acquired infection; Evans RS et al.; Surveillance for hospital-acquired infections is required in U.S . hospitals, and statistical methods have been used to predict the risk of infection . We used the HELP (Health Evaluation through Logical Processing) Hospital Information System at LDS Hospital to develop computerized methods to identify and verify hospital-acquired infections . The criteria for hospital-acquired infection are standardized and based on the guidelines of the Study of the Efficacy of Nosocomial Infection Control and the Centers for Disease Control . The computer algorithms are automatically activated when key items of information, such as microbiology results, are reported . Computer surveillance identified more hospital-acquired infections than did traditional methods and has replaced manual surveillance in our 520-bed hospital . Data on verified hospital-acquired infections are electronically transferred to a microcomputer to facilitate outbreak investigation and the generation of reports on infection rates . Recently, we used the HELP system to employ statistical methods to automatically identify high-risk patients . Patient data from more than 6000 patients were used to develop a high-risk equation . Stepwise logistic regression identified 10 risk factors for nosocomial infection . The HELP system now uses this logistic-regression equation to monitor and determine the risk status for all hospitalized patients each day . The computer notifies infection control practitioners each morning of patients who are newly classified as being at high risk . Of 605 hospital-acquired infections during a 6-month period, 472 (78%) occurred in high-risk patients, and 380 (63%) were predicted before the onset of infection . Computerized regression equations to identify patients at risk of having hospital-acquired infections can help focus prevention efforts.

Ophthalmology, 1992 Feb, 99(2), 250 - 6
Immunocytochemical staining of vitreous cells . Indications, techniques, and results; Davis JL et al.; Diagnostic vitrectomy is often performed because of suspected infection or malignancy . Giemsa, Gram, and Papanicolaou stains are used routinely to identify the components in the vitreous . Immunocytochemical staining of cellular components of vitreous specimens has the potential to significantly increase the amount of useful information that can be gained from histopathologic study . Vitreous specimens from 14 patients undergoing diagnostic or therapeutic vitrectomy for infection, suspected primary intraocular lymphoma, or uveitis were examined by immunocytochemical staining using monoclonal antibodies specific for leukocyte subclass antigens and immunoglobulin . The three classes of disorders showed characteristic patterns of staining, which were useful in confirming microbiologic and clinical diagnoses . Infections showed more pronounced neutrophils and macrophages, primary intraocular lymphomas demonstrated light chain restriction of the malignant B lymphocytes, and uveitis was characterized by the predominance of T lymphocytes . The routine use of immunocytochemical staining is recommended to characterize cellular infiltrates and increase the diagnostic yield from vitrectomy specimens.

J Periodontol, 1992 Feb, 63(2), 118 - 30
Periodontal response to mechanical non-surgical therapy: a review; Greenstein G; This literature review is concerned with the ability of personal oral hygiene and mechanical instrumentation to establish and maintain periodontal health . Clinical, microbiologic, and histologic responses to non-surgical therapy are evaluated to provide guidelines for expected treatment results . Factors that may limit the effectiveness of non-surgical therapy as a closed procedure are also addressed . These include length of therapy, skill of therapists, patient compliance, responsibility of clinician for maintenance, and disease activity status of the patient.

Epidemiol Infect, 1992 Feb, 108(1), 67 - 76
Epidemiology and microbiology of diarrhoea in young Aboriginal children in the Kimberley region of Western Australia; Gunzburg S et al.; Infectious diarrhoea is common in young Australian Aborigines and is one of the main causes for their unsatisfactory health standards with consequent widespread failure to thrive and undernutrition . Most published reports relate to patients in hospital or to hospital admission statistics and give little indication of the extent or severity of diarrhoeal disease in children in Aboriginal communities . The present investigation involved more than 100 Aboriginal children up to 5 years of age living in remote communities in the tropical north of Western Australia who were studied prospectively over a 12-month period.

J Hosp Infect, 1992 Feb, 20(2), 79 - 86
Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min; Hingst V et al.; The guidelines of the German Society for Hygiene and Microbiology for the evaluation of disinfectants suggest an application time of 5 min for surgical scrub products . In a comparative investigation, which included the more important basic substances and agents, tests were carried out to investigate whether it was possible to reduce the application time to 3 min without losing efficiency in both the immediate as well as the prolonged effect of bacterial reduction . It was found that this could be achieved by certain products, depending on the formula and type of active substance . Thus, a reduced application time of 3 min can be considered for the evaluation of surgical scrub disinfectants for national and international guidelines.

J Bacteriol, 1992 Feb, 174(3), 664 - 70
Positive and negative control of ompB transcription in Escherichia coli by cyclic AMP and the cyclic AMP receptor protein; Huang L et al.; The ompB operon encodes OmpR and EnvZ, two proteins that are necessary for the expression and osmoregulation of the OmpF and OmpC porins in Escherichia coli . We have used in vitro and in vivo experiments to show that cyclic AMP and the cyclic AMP receptor protein (CRP) directly regulate ompB . ompB expression in an ompB-lacZ chromosomal fusion strain was increased two- to fivefold when cells were grown in medium containing poor carbon sources or with added cyclic AMP . In vivo primer extension analysis indicated that this control is complex and involves both positive and negative effects by cyclic AMP-CRP on multiple ompB promoters . In vitro footprinting showed that cyclic AMP-CRP binds to a 34-bp site centered at -53 and at -75 in relation to the start sites of the major transcripts that are inhibited and activated, respectively, by this complex . Site-directed mutagenesis of the crp binding site provided evidence that this site is necessary for the in vivo regulation of ompB expression by cyclic AMP . Control of the ompB operon by cyclic AMP-CRP may account for the observed regulation of the formation of OmpF and OmpC by this complex (N . W . Scott and C . R . Harwood, FEMS Microbiol . Lett . 9:95-98, 1980).

Bol Asoc Med P R, 1992 Jan, 84(1), 26 - 30
Disseminated histoplasmosis; Vazquez-Fermin CW 4th et al.; We have presented the microbiology, pathogenesis, clinical presentation, diagnosis and treatment of disseminated histoplasmosis . Emphasis is presented on the manifestations in the HIV infected patient.

Med J Aust, 1992 Jan 6, 156(1), 24 - 7
Strongyloidiasis in North Queensland: re-emergence of a forgotten risk group?
Yiannakou J, Croese J, Ashdown LR, Prociv P.
OBJECTIVE: To describe the clinical presentation, diagnosis and management of strongyloidiasis in northern Queensland, and to identify predisposing factors for this infection . DESIGN: A five-year retrospective study of medical records of all cases diagnosed in a regional hospital microbiology laboratory, with follow-up by interview where possible . SETTING: The Townsville General Hospital . PATIENTS: A total of 14 cases of strongyloidiasis were identified, with patients ranging in age from 7 months to 59 years . RESULTS: Infected patients included nine Aborigines and two Vietnamese refugees, both high-risk groups . Of three Caucasians diagnosed, one was a war veteran, but the other two did not have significant travel histories; all three had lived or worked under insanitary conditions . In only one case was strongyloidiasis suspected; in most, it was diagnosed because of diarrhoea or blood eosinophilia which could not be related to the presenting illness . Thiabendazole treatment was effective in most cases . CONCLUSION: In northern Australia, strongyloidiasis can be acquired locally by Caucasians who live in unhygienic circumstances . It should be suspected in any person with unexplained abdominal pain, diarrhoea, cutaneous symptoms or blood eosinophilia, and the laboratory must be informed of the provisional diagnosis.

Oral Surg Oral Diagn, 1992, 3, 31 - 5
Clinical and microbiologic comparisons of two dental implant systems; Maxson BB et al.; Clinical soft tissue examination and microbiologic findings were compared for two dental implant systems . Of 20 edentulous patients, ten had been reconstructed with a transosteal implant of gold alloy, TMI-system (Bosker), of and ten with endosseous implants of titanium (Branemark-system) . Clinical parameters evaluated included plaque, gingivitis, sulcus depth and bleeding on probing . Plaque samples from 14 patients were cultured for selected periodontal pathogens . Although some differences in soft tissue clinical behavior were identified, the incidence and prevalence of selected periodontal pathogens appeared to be similar.

Curr Top Med Mycol, 1992, 4, 43 - 63
The use of molecular techniques for epidemiologic typing of Candida species; Pfaller MA; The availability of an epidemiologic typing system for Candida species that is sensitive, rapid, inexpensive, and easy to perform would clearly be an advantage to the mycologist, microbiologist, and epidemiologist in the ongoing struggle to understand the epidemiology and pathogenesis of candidiasis . This is particularly true given the increasing prominence of organisms such as C . albicans and C . tropicalis which are ubiquitous members of the normal flora yet are also important causes of nosocomial bloodstream infection . Unfortunately, the ideal epidemiologic typing system does not yet exist . Current data suggest that the molecular typing methods of restriction endonuclease digestion of genomic DNA with ethidium bromide staining (DEtBr typing) and electrophoretic karyotyping using pulsed-field electrophoresis offer rapid, simple, and sensitive means of discriminating strains of Candida species . These methods appear at present to be the most practical typing methods for both large- and small-scale epidemiologic studies . Other typing methods using specific DNA probes provide a powerful means of identifying strains and will undoubtedly be applied more broadly in the future . Thus far, studies employing molecular typing methods have documented that (1) most patients are colonized by one strain of Candida species, (2) isolates of Candida species recovered from blood or deep tissue sites are generally identical to those obtained from colonization sites before infection developed, and (3) nosocomial transmission of a single strain of C . albicans may occur, particularly in an intensive care unit setting . Given the limitations of the available typing methods and the complex nature of the patients at risk for candidiasis, both the epidemiologist and laboratory scientist must use these methods with clear epidemiologic objectives in mind . Whenever possible, all organisms to be typed should be typed by the same person on the same day, and typing should always include unrelated as well as epidemiologically related isolates . Additional studies, based upon sound epidemiologic principles, will be necessary to clarify the role of the various molecular typing methods as epidemiologic markers of Candida species and to further our understanding of the epidemiology and pathogenesis of candidiasis.

J Nucl Med, 1992 Jan, 33(1), 59 - 65
Diagnosis of sternal wound infection by technetium-99m-leukocyte imaging; Cooper JA et al.; An imaging study is needed that can detect sternal wound infections and distinguish between superficial and deep sternal wound infection when a clinical diagnosis is uncertain and a decision regarding surgical intervention must be made . We retrospectively reviewed the 99mTc-leukocyte scans of 29 patients referred to rule out sternal wound infection . The presence or absence of deep or superficial sternal wound infection was determined by microbiology and long-term follow-up . Images obtained 4 and 20 hr after injection were reviewed by two nuclear physicians who were blinded to the clinical history . Findings were categorized as normal or abnormal . Abnormal images were further defined as having intense uptake at 4 and 20 hr, increasing uptake between 4 and 20 hr, or other patterns such as focal cold regions, irregular uptake at 4 and 20 hr or increasing uptake between 4 and 20 hr were 100% sensitive and 89% specific for the detection of deep sternal wound infection . The images were also useful for determining the extent of infection . Superficial sternal wound infection could not be reliably detected . The results indicate that 99mTc-leukocyte imaging is useful for the diagnosis of deep sternal wound infection.

Orthop Clin North Am, 1992 Jan, 23(1), 171 - 85
Hand infections; Hausman MR et al.; The diagnosis and treatment of common hand infections are reviewed . A practical approach to the treatment of these conditions is detailed . This approach emphasizes the anatomic compartments of the hand, the microbiology of infecting organisms, and the patient conditions which modify treatment . Prompt and accurate diagnosis, treatment, and rehabilitation are key for optimal outcome.

Chest, 1992 Jan, 101(1), 268 - 9
Drug-induced lupus pleuritis mimicking pleural space infection; Smith PR et al.; A 78-year-old man presented with acute lupus pleuritis due to procainamide . The pleural fluid was a turbid, yellow exudate with a WBC count of 53,200/cu mm (70 percent polymorphonuclear leucocytes), LDH of 4,296 IU/L, and pH of 7.195 . Although these fluid characteristics suggested pleural space infection, they were due to pleural inflammation from drug-induced lupus . LE cells were present in the fluid and results of microbiologic studies were negative . Clinical and roentgenographic improvement followed discontinuation of procainamide.

J Infect Dis, 1992 Jan, 165(1), 175 - 8
Disseminated Nocardia transvalensis infection: an unusual opportunistic pathogen in severely immunocompromised patients; McNeil MM et al.; Nocardia infections are infrequently recognized in humans . Nocardia species may cause severe life-threatening infections among immunocompromised patients and have been reported to cause actinomycotic mycetomas, primarily in tropical areas . Two severely immunocompromised patients had disseminated N . transvalensis infections . One had underlying X-linked variant chronic granulomatous disease and died of disseminated N . transvalensis infection, which was diagnosed only at postmortem examination . The second patient developed N . transvalensis pneumonia within 3 months of undergoing renal transplantation and died of disseminated mixed Pseudallescheria boydii and N . transvalensis infections . Thus, N . transvalensis may cause invasive and potentially fatal pulmonary and disseminated infections . Accordingly, clinical microbiology laboratories should become proficient in identifying this uncommon aerobic actinomycete.

J Infect Dis, 1992 Jan, 165(1), 170 - 4
Adenovirus infection in pediatric liver transplant recipients; Michaels MG et al.; A retrospective review of adenoviral infection in pediatric liver transplant recipients was done at Children's Hospital of Pittsburgh to define its epidemiology and clinical importance . Medical records of patients with adenovirus were reviewed and data collected regarding clinical course, microbiologic studies, biopsy results, immunosuppression, concurrent infections, and outcome . Of 484 liver transplant recipients, 49 had 53 episodes of adenoviral infection . The most common sites of adenoviral infection were the liver, lung, and gastrointestinal tract . Serotypes 1, 2, and 5 were recovered most often; type 5 was commonly associated with hepatitis . Invasive adenoviral infection occurred in 20 children, leading to death in 9 . Median time from transplantation until isolation of adenovirus was 25.5 days . This timing suggests either reactivation or donor-associated transmission . Prospective studies using molecular epidemiologic techniques will be helpful in evaluating transmission patterns of adenovirus in this population.

Verh K Acad Geneeskd Belg, 1992, 54(1), 27 - 43; discussion 43-4
Molecular biology in diagnostic microbiology . PCR on Mycobacterium leprae; Pattyn SR; The polymerase chain reaction (PCR) has already produced several hundreds of papers . Alternative procedures for diagnostic purposes based on nucleic acid detection do exist but have until now found less application . Problems with the PCR are discussed . It is proposed that the diagnostic microbiology laboratory has a section devoted to PCR for the diagnosis of diseases whose etiologic agent can "almost not" be cultured such as (for Flanders) Mycoplasma pneumoniae, Chlamydia pneumoniae, Toxoplasma gondii, EB virus and some other agents in particular specimens . In this setting the PCR would only be performed on selected, clinically justified samples, in close collaboration between clinician and microbiologist . PCR will evidently play an important role in research . Illustration is given of PCR applied for the detection Mycobacterium leprae.

Eur J Cardiothorac Surg, 1992, 6(2), 91 - 5
Staged chest closure in pediatric cardiac surgery preventing typical and atypical cardiac tamponade; Ziemer G et al.; Chest closure after cardiac surgery occasionally results in cardiac compression leading to circulatory failure . In shunt-dependent circulation, the arterial oxygen saturation may decrease significantly due to the increase in pulmonary vascular resistance caused by chest closure . Temporary patch implantation with delayed sternal closure facilitates circulatory and/or pulmonary stabilization (temporary chest wall patch plasty, TCWPP) . Between July 1986 and June 1991, 42 patients underwent staged chest closure (TCWPP) after open heart surgery for congenital lesions (4.9% of 854 patients) . TCWPP was performed when either primary hemodynamic deterioration or an increase in cyanosis (palliative procedures only) followed by hemodynamic deterioration occurred during attempted or shortly after sternal closure . Overall mortality was 40.4% (17/42) . It was 32.3% (11/34) when the patch was inserted primarily at the end of the operation . If the patch was inserted emergently 4-24 h postoperatively, mortality was 75% (6/8) . Definite chest closure was performed from 4 h to 6 days (mean 72 h) postoperatively . In 2 patients closure had to be performed emergently (single ventricles); 7 patients died before chest closure . One mediastinal microbiology examination was positive . Deep sternal infection necessitating operative revision occurred in one other patient . In conclusion, TCWPP may considerably lower mortality of the illest patients after surgery for complex congenital heart disease . A timely decision as to the performance of staged chest closure is mandatory . This procedure rarely causes infection . We now apply this technique liberally, by cardio-mediastinal size judgement in over 30% of our TCWPP candidates even without a prior trial of primary closure.

Nephrologie, 1992, 13(1), 13 - 8
{Hemodiafiltration with on-line production of bicarbonate infusate: 5 years of clinical experience}; Canaud B et al.; Despite its potential advantages HDF has not gained large clinical acceptance among nephrologist due to its technical complexity and to the large quantity of pharmaceutical substitution fluid needed . HDF with on-line production of substitution fluid from dialysate simplifies the procedure and reduces the cost of treatment session . We treated regularly 13 high risk and/or non-compliant patients (9 males, 4 females) with HDF for 46 +/- 17 months . HDF program consisted of 3 sessions weekly lasting 210 +/- 10 mn with blood flow rate 350 +/- 20 ml/mn and fluid volume exchange of 20 liters/session . High flux dialyzers (HF80, Filtral 16) were reused 6 to 13 times automatically on a Renatron machine with peroxyacetic acid solution as sole cleaning and disinfecting agent . Microbiologic quality of infusate was assessed by membrane filtration culturing method and LAL endotoxin determination . 3937 HDF sessions were performed . 57.140 I of substitution fluid were infused IV to patients . Eight pyrogenic reactions were observed: 2 due to septicemia related to catheter infection and 6 from unknown origin . Adequacy of program was achieved in all patients . Blood pressure control was satisfactorily obtained without antihypertensive medication in 12/13 patients . Effective weekly integrated urea clearances was 150 +/- 15 l/wk, KT/V index was 1.50 +/- 0.10, urea TAC 20 +/- 2 mM/l and protein catabolic rate 1.40 +/- 0.10 g/kg/24 h . We conclude that HDF with on-line production of bicarbonate substitution fluid is a safe and highly efficient method cost-competitive with bicarbonate HD, which offers an interesting alternative for renal replacement therapy.

Mikrobiyol Bul, 1992 Jan, 26(1), 77 - 81
{A case of a schistosomal bladder polyp}; Aydoganli L et al.; A 67 year old patient who had transurethral resection because of previous diagnosis of bladder tumor and schistosomal polyp was detected on the histopathologic and the microbiologic examinations were presented.

Diagn Cytopathol, 1992, 8(1), 41 - 52
A review of the fine-needle aspiration cytology findings in human immunodeficiency virus infection; Strigle SM et al.; Patients infected with the human immunodeficiency virus (HIV) are subject to infections and neoplasms, which frequently result in palpable or radiologically identified masses . Fine-needle aspiration (FNA) offers a rapid, simple, and cost effective approach for diagnosis of these masses . During a 2-yr period, 396 aspirates were performed on 362 HIV-infected patients within the LAC-USC Medical Center . Adequate material was obtained from 84% of the FNA, allowing the etiology of the mass to be determined in 90% of the cases by means of a combination of cytologic, microbiologic, and immunocytochemical procedures . Significant pathologic processes identified in these patients by means of FNA included reactive lymphoid proliferations (35%), abnormal lymphoid proliferations (12%), infections (12.5%), cystic (5.5%) and inflammatory processes (5%), nonlymphoid malignancies (4%), and salivary gland pathology (1%) . We conclude that FNA is an appropriate initial diagnostic procedure in HIV positive patients presenting with mass lesions.

J Pak Med Assoc, 1992 Jan, 42(1), 2 - 3
Microwave oven in microbiology laboratory; Baqai R et al.; Microwave oven can safely be used in microbiology laboratory for preparation of media . The method is convenient, reliable, economical and reproducible . It saves time and the quality of media is superior as compared to media prepared by conventional autoclaving method.

Nurs Pract, 1992, 5(4), 17 - 22
Nurses' perceptions of infection control issues in two small district general hospitals; Horton R; The need for quality assurance is given considerable emphasis in the Strategy for Nursing (1) . Quality assurance is arguably inseparable from effective infection control, the practice of which is dependent on an adequate knowledge of microbiology . Yet research suggests that infection control in hospitals could be significantly improved (2) and that much of the problem is due to inadequate knowledge of microbiology on the part of both tutors and nurses (3) . This paper presents the results of a study aimed at eliciting both the value placed on, and the general awareness of, infection control by tutors and nurses in two small general hospitals in two health districts . Technical knowledge was not tested (except indirectly) . The overall findings suggest that nurses rely almost exclusively on the knowledge gained through training to inform their infection control practice . This, together with the research quoted above, suggests that if infection control in hospitals is to be improved, nurse education must place a much greater emphasis on microbiology than is currently the case.

Scand J Gastroenterol, 1992, 27(3), 249 - 52
Double-blind randomized trial of bismuth subsalicylate and clindamycin for treatment of Helicobacter pylori infection; Westblom TU et al.; We evaluated clindamycin and bismuth subsalicylate (Pepto-Bismol) for treatment of Helicobacter pylori infection . Patients with culture or histology positive for H . pylori were randomized to receive two tablets of bismuth subsalicylate four times daily for 4 weeks or bismuth combined with 2 weeks of 300 mg clindamycin four times daily . Clinical symptoms were recorded before and after treatment by means of visual analog scales . Patients in both treatment arms showed improvement in clinical scores for abdominal pain, heartburn, and gas or bloating . Microbiologic cure was achieved in only 1 of 11 patients treated with bismuth alone and in none of 7 treated with bismuth/clindamycin . Successful eradication of H . pylori may require combination of multiple antibiotics, as recommended at the IXth World Congress of Gastroenterology, or pharmacokinetic modulators such as H2-blockers or omeprazole.

Schweiz Monatsschr Zahnmed, 1992, 102(11), 1315 - 20
Application of BANA during experimental gingivitis . Application of N-alpha-benzoyl-DL-arginine 2 naphtilamide (BANA) hydrolysis to identify periodontopathic environments during experimental gingivitis in man; Neuenschwander-Schupbach A et al.; This study evaluates the accuracy of the PerioScan reagent card kit which uses BANA hydrolization to detect the presence of P . gingivalis, T . denticola, and B . forsythus in dental plaque during an experimental gingivitis in man . 32 healthy subjects underwent a phase of optimal oral hygiene before they abolished all oral hygiene practices for 21 days, but rinsed twice daily with a slurry of three different toothpastes . On days 0, 7, 14, and 21, full mouth Plaque and Gingival Index scores were assessed and, in addition, on days 0 and 21, sulcular plaque samples were obtained from the mesiobuccal aspects of the second premolars . The samples were placed on BANA reagent cards (PerioScan), and the result of the trypsin-like activity read after 15 minutes . Subsequently, the samples were processed for the detection of P . gingivalis, T . denticola and B . forsythus using ELISA . The Gingival Indices on day 21 indicated a development towards gingival inflammation . The frequencies of detection of the three periodontopathogens revealed by ELISA showed increased presence of P . gingivalis, B . forsythus and T . denticola on day 21 . Changes in the composition of the microbiota were also indicated by the higher rate of positive BANA results at the end of the experimental gingivitis . Without considering further clinical diagnostic tests such as "bleeding on probing", this clinically simple test does not provide a prognostic indicator for the eventual onset of disease in cases with gingival inflammation . However, specificity was only 61% and the sensitivity was 41.7%.

Acta Haematol, 1992, 88(2-3), 154 - 7
Neutrophilic pustulosis associated with chronic myeloid leukemia: a special form of Sweet's syndrome . Report of two cases; Feliu E et al.; Two subjects with Ph-positive chronic myeloid leukemia (CML) in whom pustular Sweet's syndrome was diagnosed are reported . The first patient was a 47-year-old woman who developed fever, painful ulcers of the oral mucosa and vagina and generalized pustulous skin lesions 2 years after the diagnosis of CML . Histologically, the skin lesions consisted of dense neutrophilic infiltrates with perifollicular disposition . The microbiologic studies were negative . The lesions showed a favorable response to corticosteroids, but fever recurred with every attempt of tapering prednisone; it finally disappeared with the addition of oral cyclophosphamide . The second patient was a 45-year-old man who developed fever and disseminated pustules with histologic features consistent with Sweet's syndrome and negative microbiologic studies at 2.5 years after diagnosis of CML . The picture showed a dramatic response to prednisone and did not recur after the drug was discontinued . In both patients, CML remained stable after resolution of Sweet's syndrome.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (5-6), 27 - 9
{The interrelation of the immunity status and intestinal microbiocenosis in young children with acute respiratory organ diseases}; Kulinin DG et al.; The immune status and the state of intestinal microbiocenosis have been studied in 70 young children with acute respiratory diseases . As revealed in this study, in 85.7% of cases bronchopulmonary diseases are accompanied by disturbances in phasic fluctuations of the immune status and intestinal microbiocenosis . The possibility of repeated acute respiratory infections is predetermined by the intensity of manifestations of immune disturbances and intestinal dysbiocenosis, these two phenomena being directly interrelated . The use of eubiotics jointly with immunostimulants is proposed for the treatment of children with acute bronchopulmonary pathology combined with the unbalance of the immune status and intestinal dysbacteriosis.

Crit Rev Food Sci Nutr, 1992, 32(3), 197 - 229
Application of immunochemical assays to food analysis; Gazzaz SS et al.; Immunochemical assays are powerful bioanalytical techniques with application to several areas in food science, including food analysis, microbiology, nutrition, food safety, food quality, and process control . In principle, immunochemical techniques can be applied to the analysis of any compound, with only one specific antibody needed that can be obtained either from laboratory animals or, when available, from commercial sources . A well-designed immunochemical assay can detect targeted compounds at levels as low as 10(-12) M . Immunochemical techniques require little or no sample pretreatment, making these analytical procedures relatively rapid . The initial cost of developing an immunoanalytical assay may be high, but when the procedure is well established, the cost per test is often a fraction of that for other analytical methods . For these reasons, immunoanalytical assays provide an attractive alternative for the food analyst who requires either inexpensive qualitative screening tests or reliable quantitative methods with a high degree of sensitivity . This review concentrates on the use of enzyme immunoassay to address analytical problems in food chemistry and the analysis of various food components.

Exp Brain Res, 1992, 88(3), 495 - 501
Isolation rearing of rats alters release of 5-hydroxytryptamine and dopamine in the frontal cortex: an in vivo electrochemical study; Crespi F et al.; The effects of rearing hooded Lister rats either in groups of seven or singly on 5-hydroxytryptamine (5-HT) and dopamine (DA) release in the frontal cortex were investigated using in vivo voltammetry together with Nafion coated carbon fibre micro-electrodes . The selective detection of basal extracellular levels of 5-HT with this technique (Peak B) was confirmed with parallel experiments using intracranial microdialysis to measure 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) levels in vivo . The DA voltammetric signal (Peak A) was observed in vivo only following pharmacological or electrical stimulation of DA release . Enhanced efflux of cortical DA and 5-HT in response to local application of KCl and that of 5-HT following parentelar fenfluramine were selectively detected by the association: differential pulse voltammetry (DPV)-Nafion coated microbiosensors, supporting the capability of this electrochemical method to selectively monitor release of these amine neurotransmitters in vivo and in situ . The locomotor behaviour data indicated that isolation rearing resulted in augmented locomotor activity in a novel environment . In addition, the in vivo voltammetric results showed that following KCl or fenfluramine treatment cortical 5-HT release is prolonged while that of DA is increased in rats reared in isolation when compared with socially reared rats . This imbalance between extracellular levels of DA and 5-HT recorded in the frontal cortex of rats exposed to isolated housing conditions may contribute to the behavioural differences reported between isolation and group reared rats.

J Bacteriol, 1992 Jan, 174(1), 241 - 4
Phylogenetic analysis of the genus Borrelia: a comparison of North American and European isolates of Borrelia burgdorferi; Marconi RT et al.; We have sequenced the 16S rRNA molecules from four species of Borrelia and from six isolates of Borrelia burgdorferi via the reverse transcriptase primer extension method . The sequences were aligned and evolutionary relationships were determined, including the calculation of evolutionary distances and the construction of a phylogenetic tree . These analyses demonstrate significant divergence among B . burgdorferi isolates, with the European isolates G1 and G2 residing most distant from the main cluster . Signature nucleotides which distinguish B . burgdorferi from all other members of this genus and which distinguish the European isolates G1 and G2 from the North American isolates B31, Sh-2-82, and 1352 were identified . Finally, Southern blot analyses were performed to compare the restriction patterns of the genes coding for rRNA and to relate our data to the grouping scheme of Postic et al . (D . Postic, C . Edlinger, C . Richaud, F . Grimont, J . Dufresne, P . Perolat, G . Baranton, and P . A . D . Grimont, Res . Microbiol . 141:465-475, 1990).

Parazitologiia, 1992 Jan-Feb, 26(1), 13 - 9
{The dynamics of the microbiocenosis in the burrows of the little suslik}; Garanin OA et al.; Microbiocoenoses being formed in burrows of little souslik have been investigated . Microbiocoenoses of sloping burrows have most simple organization . Comparative analysis of the fauna and functional structure, conducted during the spring-summer period, has not shown the existence of any directed process in the development of microbiocoenoses of sloping burrows . On the contrary, microbiocoenoses of vertical nest burrows can be regarded as biocoenotic systems dynamic in space and time . Here in the period of rodent's vital activity occurs a constant construction of underground passages and periodical change of nests . In this case the fauna of new nests is formed largely at the expense of migration of nidicols along free or obstructed with loose earth underground horizontal passages . Microbiocoenoses in burrows of different types are not connected between each other by morphoprocess and their development is of independent character.

Schriftenr Ver Wasser Boden Lufthyg, 1992, 89, 563 - 75
Cyst-based toxicity tests . VI: Toxkits and Fluotox tests as cost-effective tools for routine toxicity screening; Persoone G; During the last two decades microbiotests have been developed which are independent of recruitment, maintenance and/or culturing of live stocks of test organisms . "Culture and maintenance free" microbiotests have been worked out in the Laboratory for Biological Research in Aquatic Pollution at the University of Ghent, with selected aquatic invertebrates . The new approach is based on the use of "resting stages" (cysts) as inert biological material from which live test organisms can be hatched "on demand" . The "cyst-based" bioassays have recently been miniaturized in Toxkits . Four cyst-based screening tests have reached the stage of commercialization: two freshwater 24h-LC50 tests (Rotoxkit F and Streptoxkit F) and two estuarine/marine 24h-LC50 bioassays (Rotoxkit M and Artoxkit M), based on cysts of rotifer and crustacean species, respectively . Recently, the same laboratory has also been focusing on the development of a "rapid" (one hour) sublethal bioassays with aquatic invertebrates . The so called "Fluotox" screening test is based on the visual observation of in vivo inhibition of an enzymatic process, using a fluorescent substrate . Besides the advantages of rapidity and cost-effectiveness, the Fluotox assay also appears to have a remarkable predictive potential for mortality, as displayed by the remarkable correlation between the Fluotox 1h-EC50's and conventional 24h-LC50's with the same species.

Clin Exp Obstet Gynecol, 1992, 19(4), 249 - 52
Decrease of cellular growth potential in "in vitro" culture of amnions with premature rupture of membranes; Garzetti GG et al.; The "in vitro" cellular growth of 8 amniotic membranes from preterm deliveries with premature rupture of membrane (PROM) in absence of risk factors as cervical or vaginal infection (microbiologic negativity), cervical incontinence and other mechanical factors, was compared with cellular growth of 9 amnions from preterm deliveries without PROM . Amniotic membranes were set up in the Eagle basal medium with Earle salts and heat-inactivated fetal bovine serum (10%), gentamicin 50 micrograms/ml and amphotericin B 0.5 micrograms/ml . The results suggested that the growth potential of the cells (epithelial cells and fibroblasts) obtained from amnions with PROM was lower than that of cells obtained from amnions without PROM . We postulated that the premature rupture of membranes in patients without risk factors for PROM, would be conditioned by an intrinsic decrease of cellular growth potential.

Akush Ginekol (Mosk), 1992, (8-12), 12 - 5
{Pregnancy and labor in women in the region of the accident at the Chernobyl Atomic Electric Power Station}; Krasnopol'skii VI et al.; The authors analyze the tentative results of a multiprofile study, including a review of labor histories, examinations of pregnant women and parturients, measurements of fetoplacental hormones, study of the immunity status and microbiocenosis of the mothers and newborns, living in the first (up to 15 Ci/km2) and second (15 to 40 Ci/km2) zones of radioactive contamination . The detected shifts of a compensatory nature were found mostly in women living in the first zone . The disorders found in the women living in the second zone evidenced a decrease of the defense potential of the body, this necessitating nonspecific and correcting therapy during pregnancy, in labor and the postpartum period.

Ann Chir, 1992, 46(8), 748 - 61
{Pseudotumoral thoracic actinomycosis with lung and brain metastases . Apropos of a case . Review of hundred thirty one cases in the literature}; Vinard JL et al.; One particular case of thoracic actinomycosis is reported . The patient presented with a neurological picture mimicking a metastasis, as chest radiogram and CT-Scan indicated a primary pulmonary tumor . Diagnosis of actinomycosis was overlooked and final diagnosis was based on direct microscopy of lung tumor, which required a thoracotomy, without any resection . Antibiotic treatment with penicillin was successful as the cerebral lesion was completely cured within 2 months and the thoracic lesion reduced 2/3rd volume within the same delay . The importance of correct handling of tissue specimens and adequate informations to the microbiologist are emphasized . Another point of interest is that good clinical results can be expected from prolonged antibiotic treatment . Surgery must be reserved for diagnosis if no other means has been effective, for failure of medical treatment or for acute complications.

Anal Chem, 1991 Dec 15, 63(24), 2961 - 5
Enzyme-modified organic conducting salt microelectrode; Kawagoe JL et al.; A miniaturized enzyme-modified electrode has been constructed and evaluated . The tip of a capillary-encased, carbon-fiber electrode is recessed, and tetrathiafulvalene-tetracyanoquinodimethane crystals are electrochemically deposited in the recessed tip . Flavoenzymes are placed in the recess by cross-linking with glutaraldehyde . The specific enzymes used are glucose oxidase to form a microbiosensor for glucose, and a combination of acetylcholine esterase and choline oxidase to form a microbiosensor for acetylcholine . The sensor is operated in an amperometric mode with Eapp = 150 mV versus a sodium saturated calomel electrode, and the response appears to be limited by the kinetics of the enzyme reaction . The effective maximum current density for the glucose electrode is greater than 600 microA/cm2 . At low concentrations of glucose, oxygen provides a significant interference by attenuating the signal . The device is simple to prepare and has a rapid response time . Interference from ascorbate has been significantly reduced by the design and by addition of a layer of ascorbate oxidase . Although not yet suitable for use in tissue, the biosensors are suitable for detection in situations where oxygen concentrations do not frequently change.

J Biol Chem, 1991 Dec 5, 266(34), 23091 - 6
A ribosomal calmodulin-binding protein from Dictyostelium; Sonnemann J et al.; Using 125I-calmodulin as a probe, we have recently identified specific Ca2+/calmodulin-binding proteins in cell extracts from the cellular slime mold, Dictyostelium discoideum: a major 22-kDa activity, a soluble 78/80-kDa protein, and several membrane-associated high Mr proteins (Winckler, T., Dammann, H., and Mutzel, R . (1991) Res . Microbiol . 142, 509-519) . cDNA clones for at least two of these proteins have been isolated by ligand screening of a lambda gt11 prophage expression library . Antibodies directed against the lacZ-cDNA-encoded fusion protein from one of the clones recognized a single 22-kDa component in D . discoideum extracts which comigrated with the endogenous 22-kDa calmodulin-binding protein . The cDNA-derived nucleotide sequence predicts a protein of Mr 21,659 with 56% sequence identity (69% homology) with rat ribosomal protein L19 . The endogenous 22-kDa calmodulin-binding activity was associated with ribosomes . It was found to be an integral constituent of the large ribosomal subunit, since it cosedimented with 60 S ribosomal subunits in sucrose density gradients in the presence of 0.5 M NH4Cl . Our observations point to a physiological role for calmodulin in the Ca2+ regulation of eukaryotic protein synthesis . Support for this comes from recent studies showing inhibition of protein synthesis by calmodulin antagonists in Ehrlich ascites tumor cells (Kumar, R . V., Panniers, R., Wolfman, A., and Henshaw, E.C . (1991) Eur . J . Biochem . 195, 313-319).

Proc Natl Acad Sci U S A, 1991 Dec 1, 88(23), 10465 - 9
DNA hybridization evidence for the Australasian affinity of the American marsupial Dromiciops australis; Kirsch JA et al.; DNA hybridization was used to compare representatives of the major groups of marsupials and a eutherian outgroup . Because of the large genetic distances separating marsupial families, trees were calculated from normalized percentages of hybridization; thermal-melting statistics, however, gave identical topologies for the well-supported clades . The most notable results were the association of the only extant microbiotheriid, Dromiciops australis, an American marsupial, with the Australasian Diprotodontia, and of both together with the Dasyuridae . Estimates of the rate of divergence among marsupial genomes suggest that the Dromiciops-Diprotodontia split occurred approximately 50 million years ago, well after the establishment of the major clades of marsupials but before deep oceanic barriers prohibited dispersal among Australia, Antarctica, and South America . Because Dromiciops is nested within an Australasian group, it seems likely that dispersal from Australia accounts for its present distribution.

J Infect Dis, 1991 Dec, 164(6), 1232 - 5
Fluconazole failure in the treatment of invasive mycoses; Evans TG et al.; Fluconazole is a recently licensed antifungal agent that has gained widespread use in the medical community . Despite a lack of controlled trials in invasive fungal infections, this agent is often prescribed because of ease of administration and concern over amphotericin B toxicity . Three cases of systemic fungal infections in which fluconazole use resulted in unambiguous microbiologic and clinical failure are reported.

Rev Sci Tech, 1991 Dec, 10(4), 933 - 49
History of the scientific relationships of veterinary public health; Schwabe CW; The origin of veterinary public health (VPH), as the term is understood today, dates back to the late 1940s and early 1950s with the creation of new responsibilities and a broader range of career openings for veterinarians within some public health agencies, especially in disease intelligence aspects of the newly developing science of epidemiology . Other well-established scientific relationships of veterinary medicine to human health (e.g . food safety, pathogenic microbiology, comparative pathology) experienced renewed vigour as a result of these innovations, the latter also in connection with VPH-facilitated development and support of a new veterinary clinical practice specialty of laboratory animal biology and medicine . Through these expanded interprofessional and intersectoral communication, liaison and cooperation channels, new academic programmes arose within veterinary schools . These programmes brought a number of innovations to the world of veterinary medicine, including newly developed methodologies . A variety of new biomedical research career roles for veterinarians within both veterinary and other medically oriented institutions were identified and filled during this overall process . Also related to these developments was the identification of new roles for veterinarians in environmental science research and practice, beyond those traditionally associated with veterinary food hygiene . Proposals have since been made for significant new intersectoral functions for agriculture-based governmental Veterinary Services in connection with these new aspects of environmental science and with the aims of recent primary health care programmes within public health.

Southeast Asian J Trop Med Public Health, 1991 Dec, 22 Suppl, 120 - 3
Toxoplasmosis in Singapore; Singh M et al.; The present paper reports research done in the following areas in the Parasitology Unit of the Department of Microbiology, National University of Singapore: determination of anti-Toxoplasma gondii antibodies in different IgG subclasses; immunoblot analysis of the antibody response to T . gondii and identification of key reactive epitopes; production and characterization of monoclonal antibodies to T . gondii; and the development of an IgM capture ELISA . IgG1 is the dominant subclass involved in the humoral response to T . gondii . IgG3 and IgG4 may be produced at low but significant levels . IgG2 production was not apparent . Immunoblot analysis of the positive sera revealed that the major antigens recognized by IgG and IgM antibodies were of MW 22, 35 and 67 kDa . Many of the bands observed in blots with positive sera were also present in blots with negative sera . The 22 kDa band was seen in majority of positive sera and was generally absent in negative sera . Anti-Toxoplasma sera also revealed IgA antibodies . Immunoblot analysis of the antigen revealed a 14 kDa band that reacted with all IgA positive sera . From a panel of monoclonals produced against T . gondii, one monoclonal, 5F3 (A) was selected for development of a monoclonal based IgM capture ELISA for detection of antibodies to 22 kDa and 41 kDa epitopes of T . gondii.

Indian J Med Sci, 1991 Dec, 45(12), 332 - 5
Seroprevalence of HIV antibodies, Australia antigen and VDRL reactivity in Himachal Pradesh; Thakur TS et al.; 3000 subjects from four high risk groups--patients attending STD clinics, hospital personnel, blood donors and foreign nationals were screened for the presence of HIV antibodies HBsAg and VDRL reactivity . No evidence of HIV infection was found in Himachiali population . However, there of the 150 foreign nationals screened were found positive for HIV antibodies . Overall HBsAg positivity and VDRL reactivity was found to be 5.53 per cent and 9.07 per cent respectively . The importance of circumspected and unswerving machinery for the surveillance of HIV antibodies in the high risk population of the state is emphasisedPIP: Between September 1987 and September 1990, health workers in Himachal Pradesh State in India collected serum samples from 1305 patients at sexually transmitted disease (STD) clinics, 1274 blood donors, 271 hospital staff handling blood products, and 150 foreigners to screen high-risk populations for reactivity to HIV, hepatitis B virus (HBV), and syphilis . Most of the samples were from males (2373 males vs . 626 females and 1 eunuch) . None of the cases from India tested HIV positive, while 3 foreign national cases did . 2 of the foreign nationals were Canadian and the other was Kenyan . 2 foreigners tested positive for both HBV and HIV . Overall, 5.53% tested positive for HBV and 9.07% for syphilis . 9.4% of the Indian individuals tested positive for syphilis, which was higher than an earlier study in Himachal Pradesh . Most people who tested positive for HBV and syphilis were 21-30 years old . 2.14% of the STD patients tested positive for syphilis and HBV, while only 0.37% of hospital personnel . 0.67% of foreigners, and none of the blood donors did . STD patients also had the highest percentage of syphilis-positive (19.69%) and HBV-positive results (8.73%) . HBV-positive incidence was about 3 times greater in people who also tested positive for syphilis . Since reactivity to syphilis was associated with poverty, poor hygiene, polyandry, polygamy, and illiteracy, citizens living in Himachal Pradesh were at great risk of acquiring HIV from a foreigner . Therefore, the microbiologists who examined these samples recommended more intensive and continuous screening of high-risk populations in Himachal Pradesh .

Adv Dent Res, 1991 Dec, 5, 37 - 40
Diagnosis of periodontal diseases: reaction paper; Novak MJ; With the recent description of 12 different forms and sub-forms of periodontitis by the World Workshop in Clinical Periodontics (1989), increased emphasis has been placed on diagnosis . Dr . Ranney's review addressed the specificity and sensitivity of current diagnostic tests with respect to their ability to differentiate between health and disease and between the individual disease states . Although considerable microbiologic and immunologic data have been accumulated in the past decade, very little of this information has proved to be sufficiently sensitive to be of use in differential diagnosis . Clinical measurements provide us with an insensitive, retrospective analysis of what has already occurred but allow us to diagnose disease based on its natural history . Measures of attachment levels, by use of conventional probes, are only sufficiently sensitive indicators of periodontitis when as much as 20-30% of attachment has already been lost . Current technological improvements in probing measurements and radiographic assessment may increase sensitivity in this area . Future improvements in diagnostic techniques will occur with the advent of sensitive biochemical analyses of gingival crevicular fluid . These assays will provide a more objective analysis of inflammation and, in time, will provide sufficient sensitivity to allow for differentiation between and among the various forms of periodontal disease . Future directions in diagnosis will focus on the identification of disease-susceptible individuals and the prediction of future periodontal breakdown.

Acta Endocrinol (Copenh), 1991 Dec, 125(6), 621 - 7
Basal prolactin and total lactogenic hormone levels by microbioassay and immunoassay in normal human sera; Maddox PR et al.; The availability of an improved microbioassay for prolactin measurement has enabled comparison of lactogenic hormone bioactivity and immunoreactivity in normal human serum . Serum was studied from 61 normal females and 15 normal males . The correlation of both assays was very close for all subjects with a mean ratio of bioassay to immunoassay of 1.5 (range 0.8-2.0) for prolactin and 1.4 (range 0.5-1.9) for total lactogenic hormone . There was no significant variation in prolactin or total lactogenic hormone values by microbioassay or immunoassay with sexual or menstrual status . Postmenopausal prolactin levels were lower by both assays compared with premenopausal values with a relative and absolute decrease in prolactin bioactivity with age . These findings indicate that there is a good correlation between prolactin bioactivity and immunoactivity in human serum.

Epidemiol Infect, 1991 Dec, 107(3), 497 - 508
An outbreak of cryptosporidiosis associated with a swimming pool; Joce RE et al.; In August 1988 an increase was noted in the number of cases of cryptosporidiosis identified by the microbiology laboratory at Doncaster Royal Infirmary . By 31 October, 67 cases had been reported . Preliminary investigations implicated the use of one of two swimming pools at a local sports centre and oocysts were identified in the pool water . Inspection of the pool revealed significant plumbing defects which had allowed ingress of sewage from the main sewer into the circulating pool water . Epidemiological investigation confirmed an association between head immersion and illness . The pools were closed when oocysts were identified in the water and extensive cleaning and repair work was undertaken . The pool water was retested for cryptosporidial oocysts and found to be negative before the pool reopened.

Urology, 1991 Dec, 38(6), 545 - 9
Sperm quality in men with chronic abacterial prostatovesiculitis verified by rectal ultrasonography; Christiansen E et al.; Semen analyses were performed on 50 men with chronic abacterial prostatovesiculitis (CPV) and 25 asymptomatic control subjects . All subjects had had symptoms of at least three months' duration, and the diagnosis was verified by rectal ultrasonography and after microbiologic culture of seminal plasma . Fifty-eight percent had increased concentrations of leukocytes (greater than 1 x 10(6)/mL) in the ejaculate compared with 15 percent in the controls . Only 10 percent of the CPV subjects could be classified as normospermic compared with 60 percent in the controls . The incidence of severe disturbances in sperm quality and azoospermia was also four times greater in the CPV group . Neither the degree of leukospermia nor the ultrasonographic findings could predict the extent of the disturbance in sperm quality.

J Nucl Med, 1991 Dec, 32(12), 2227 - 32
Clinical evaluation of a scintigraphic method for diagnosing inflammations/infections using indium-111-labeled nonspecific human IgG; Serafini AN et al.; This study was undertaken as part of a Phase II study to assess the sensitivity and safety of 111In-DTPA-human IgG, an imaging agent for the detection of inflammations and/or infections . Forty patients with infection/inflammation on the basis of clinical findings, microbiologic results, and/or the basis of results from other imaging modalities were studied . For evaluation of sensitivity, whole-body images were obtained at 6-12 hr (early) and 20-28 hr (delayed) postinjection and occasionally at 48 hr . No adverse reactions were recorded in any of the 40 patients studied . Positive results were obtained in 37 of 37 evaluable subjects (100%) . The test appears to be a promising method for the detection of inflammation and/or infection.

J Bacteriol, 1991 Dec, 173(24), 7918 - 24
Trehalose synthesis genes are controlled by the putative sigma factor encoded by rpoS and are involved in stationary-phase thermotolerance in Escherichia coli; Hengge-Aronis R et al.; The rpoS (katF) gene of Escherichia coli encodes a putative sigma factor (sigma S) required for the expression of a variety of stationary phase-induced genes, for the development of stationary-phase stress resistance, and for long-term starvation survival (R . Lange and R . Hengge-Aronis, Mol . Microbiol . 5:49-59, 1991) . Here we show that the genes otsA, otsB, treA, and osmB, previously known to be osmotically regulated, are also induced during transition into stationary phase in a sigma S-dependent manner . otsA and otsB, which encode trehalose-6-phosphate synthase and trehalose-6-phosphate phosphatase, respectively, are involved in sigma S-dependent stationary-phase thermotolerance . Neither sigma S nor trehalose, however, is required for the development of adaptive thermotolerance in growing cells, which might be controlled by sigma E.

J Bacteriol, 1991 Dec, 173(24), 7903 - 10
Control of Escherichia coli lysyl-tRNA synthetase expression by anaerobiosis; Leveque F et al.; Escherichia coli lysyl-tRNA synthetase was previously shown to occur as two distinct species encoded by either the lysS or the lysU gene . The expression of one of these genes, lysU, is under the control of cell growth conditions . To study the regulation of lysU, delta lysS strains were constructed . During aerobic growth at 37 degrees C or below, the amount of the lysU product in the cell is so reduced that delta lysS bacteria grow only poorly . The reduced expression of lysU is not related to the steady-state lysyl-tRNA synthetase concentration in the cell, since the expression of a lysU::lacZ fusion is insensitive to the absence of either lysS or lysU or to the addition of a multi-copy plasmid carrying either lysU or lysS . During anaerobic growth in rich medium, the lysU gene becomes strongly expressed and, in cell extracts, the amount of lysyl-tRNA synthetase activity originating from lysU may become seven times greater than the activity originating from lysS . In minimal medium, lysU expression is only slightly induced . Evidence that the sensitivity of lysU expression to anaerobiosis, as well as to low external pH conditions (E . W . Hickey and I . N . Hirshfield, Appl . Environ . Microbiol . 56:1038-1045, 1990), is governed at the level of transcription is provided.

J Bacteriol, 1991 Dec, 173(24), 7810 - 20
Extracellular fibrils and contact-mediated cell interactions in Myxococcus xanthus; Behmlander RM et al.; Contact-mediated cell-cell interactions play an important role in the social life-style of Myxococcus xanthus . Previous investigations have demonstrated that fimbriae (also referred to as pili) and extracellular fibrils are involved in these social interactions (L . J . Shimkets, Microbiol . Rev . 54:473-501, 1990) . We have used the relatively new technique of low-voltage scanning electron microscopy (an ultra-high-resolution scanning technique that allows for the nanometer resolution of biological materials) to observe the topological details of cell-cell interactions in M . xanthus . Our observations indicated that the fibrils (which measure approximately 30 nm in diameter) are produced most extensively by cells that are in close contact with each other and are aberrantly produced by the cohesion-deficient dsp mutants . Immunogold analysis identified an antigen which is located exclusively on the extracellular fibrils . Western blots (immunoblots) of this antigen (designated FA-1 for fibrillar antigen 1) indicated that it is composed of several immunoreactive bands (molecular size range, 90 to 14 kDa), all of which are sensitive to protease digestion . A technique for fibril isolation was developed by using FA-1 as a fibril-specific marker . Low-voltage scanning electron microscope observations of swarming cells demonstrated that the expression of fibrils is differentially regulated between adventurous (individual) and socially (group) motile cells . The differential expression of fibrils suggests the existence of a mechanism for the regulation of fibril biosynthesis that functions within the overall system governing social interactions in M . xanthus.

BMJ, 1991 Nov 9, 303(6811), 1174 - 6
Surveillance of antibody to rubella virus in Grampian: closing the immunity gap; Berkeley MI et al.; OBJECTIVES--To identify causes for the continuing deficit of rubella immunity in women of childbearing age with a view to further reducing the risk of the congenital rubella syndrome . DESIGN--A questionnaire was sent to the general practitioner and a laboratory follow up study conducted in a one year cohort of women found on screening to have inadequate protection against rubella . SETTING--Virus laboratory of the department of medical microbiology, Aberdeen, serving the health board areas of Grampian, Orkney, and Shetland . PATIENTS--239 women whose concentration of antibodies to rubella virus was either absent or below standard (15,000 IU/l) and whose general practitioner could be contacted to supply a history of infection, immunisation, pregnancy, and antibody testing . MAIN OUTCOME MEASURES--Whether rubella vaccination was given and whether those vaccinated were tested for seroconversion . RESULTS--Only 122 (55%) of the women for whom information was available received the recommended vaccine; only 74 (61%) of these were tested for seroconversion . Oversight was the reason given for not vaccinating 64 (65%) of the women who remained at risk . Women who were pregnant when tested were significantly less likely to receive vaccine (odds ratio 3.36) than women who were not pregnant, and even if vaccinated were less likely to have a follow up antibody test (odds ratio 1.94) . CONCLUSION--Once women are identified as being unprotected against rubella they are often overlooked and not vaccinated . Prompting mechanisms aimed at general practitioners, such as the one recently set up in Grampian, should reduce the immunity gap and help to eradicate rubella in pregnancy.

Ann Surg, 1991 Nov, 214(5), 621 - 6
Nitrogen oxide levels in patients after trauma and during sepsis; Ochoa JB et al.; The mediators responsible for maintenance of the hyperdynamic state and the low systemic vascular resistance (SVR) observed in sepsis have not been elucidated . Nitric oxide (.N = O) is a mediator with numerous functions, including regulation of vascular tone and a role in macrophage-mediated cytostasis and microbiostasis . Thirty-nine critically ill trauma and septic patients were studied to determine the relationship between .N = O production and the hyperdynamic state . high plasma levels of NO2-/NO3- (the stable end products of .N = O) were observed in septic patients (p less than 0.02) . Low SVR and high endotoxin levels were associated with high NO2-/NO3- values (p = 0.029, p = 0.002) . Changes in .N = O levels may mediate the vasodilation seen in sepsis . Low NO2-/NO3- levels were observed in trauma patients (p less than 0.001) and remained low even in the presence of sepsis (p = 0.001).

J Infect Dis, 1991 Nov, 164(5), 907 - 16
Ceftazidime monotherapy for empiric treatment of febrile neutropenic patients: a meta-analysis; Sanders JW et al.; Whether ceftazidime monotherapy is equal in efficacy to combination regimens (Comb) for empiric treatment of febrile neutropenic patients was tested using meta-analysis . Published studies and abstracts of ceftazidime trials were identified, their quality assessed, the efficacy data abstracted and pooled, and effects of patient and study characteristics examined . The pooled odds ratio (OR) of failure of ceftazidime for febrile episodes was 1.27 (95% confidence interval {CI}: 0.79-2.03; n = 1077) and for bacteremic episodes was 0.72 (CI, 0.33-1.58; n = 248; OR less than 1.0 favors ceftazidime) . Results were not significantly affected by type of antibiotic in Comb, age, neutropenia (less than 500/mm3), study quality, or combining abstracts . Results indicate that Comb does not offer a significant advantage over ceftazidime . A subgroup of profoundly neutropenic (less than 100/mm3) patients could not be assessed, raising the possibility that in this important subgroup monotherapy and Comb may not be equivalent . Use of ceftazidime empirically may require modification based on microbiologic results and clinical course.

J Parodontol, 1991 Nov, 10(4), 393 - 405
{Bacterial contamination, familial occurrence and periodontal disease}; Meyer J et al.; The pathogenesis of the various periodontal diseases cannot only be explained on the basis of the relationship of specific bacteria to the clinical features of the disease . The microbiologic examination of various members of the same family, either by culturing or by the use of the DNA probe often showed similarities among several individuals in the same family . This could be accounted for on the basis of bacterial transmission or by contamination . These observations suggest the incidence of familial and genetic factors in the etiology of some forms of periodontitis.

Clin Ther, 1991 Nov-Dec, 13(6), 699 - 706
Treatment of presumed bacterial pneumonia in ambulatory children; Calderon E et al.; In a prospective, randomized, open study, a combination of trimethoprim and rifampin (TMP/R) 20 mg/kg/day was compared with ampicillin (AMP) 150 mg/kg/day, both given orally twice daily for 10 days, for the treatment of 60 children who had mild community-acquired pneumonia . The control group comprised 112 healthy children . The overall duration of the disease was 8.5 +/- 3.6 days in the TMP/R group vs 6.0 +/- 1.1 days in the AMP group . Fever persisted for 7.0 +/- 1.8 days in the TMP/R-treated patients vs 5.2 +/- 1.0 days in the AMP-treated patients . At the end of the 10 days, nasopharyngeal cultures were negative in all patients in the AMP group and in 25 of the 30 patients in the TMP/R group . These five patients were clinical and microbiologic failures . We conclude that in infants and children with mild community-acquired pneumonia, treatment with AMP for 10 days is more effective than treatment with a combination of TMP/R for clinical cure and eradication of bacterial pathogens.

Infect Control Hosp Epidemiol, 1991 Nov, 12(11), 682 - 5
Medical waste: a minimal hazard; Keene JH; Medical waste is a subset of municipal waste, and regulated medical waste comprises less than 1% of the total municipal waste volume in the United States . As part of the overall waste stream, medical waste does contribute in a relative way to the aesthetic damage of the environment . Likewise, some small portion of the total release of hazardous chemicals and radioactive materials is derived from medical wastes . These comments can be made about any generated waste, regulated or unregulated . Healthcare professionals, including infection control personnel, microbiologists, public health officials, and others, have unsuccessfully argued that there is no evidence that past methods of treatment and disposal of regulated medical waste constitute any public health hazard . Historically, discovery of environmental contamination by toxic chemical disposal has followed assurances that the material was being disposed of in a safe manner . Therefore, a cynical public and its elected officials have demanded proof that the treatment and disposal of medical waste (i.e., infectious waste) do not constitute a public health hazard . Existent studies on municipal waste provide that proof . In order to argue that the results of these municipal waste studies are demonstrative of the minimal potential infectious environmental impact and lack of public health hazard associated with medical waste, we must accept the following: that the pathogens are the same whether they come from the hospital or the community, and that the municipal waste studied contained waste materials we now define as regulated medical waste.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Paediatr Scand, 1991 Nov, 80(11), 1025 - 30
The treatment of persistent diarrhoea and malnutrition: long-term effects of in-patient rehabilitation; Sullivan PB et al.; This study aimed to characterise the clinical condition of Gambian children presenting with persistent diarrhoea and severe protein energy malnutrition and to evaluate the effects of short term in-patient treatment in terms of long-term outcome . Twenty-two children (aged 6 to 36 months) with persistent diarrhoea (greater than or equal to four loose stools/day for more than two weeks) and severe malnutrition (weight-for-height less than 75% of the National Center for Health Statistics median value) were assessed prior to in-patient treatment for three weeks with antibiotics and high nutrient-density milk . Initial assessment included biochemical and immunological status together with stool microbiology . Criteria for discharge--cessation of diarrhoea for five consecutive days and steady weight gain--were met in all subjects within four weeks . Progress was assessed clinically and anthropometrically at weekly intervals and 6 and 12 months following discharge . Results showed a steady improvement in growth during the period of in-patient treatment . Continuing improvement in weight-for-age and mid-upper arm circumference was observed after 6 and 12 months and weight-for-height continued to improve up to 6 months but fell back by 12 months . This study has demonstrated that, in the treatment of persistent diarrhoea in the tropics, relatively short periods of in-patient rehabilitation, whilst leading to a resolution of diarrhoeal symptoms and weight gain in the short term, do not lead to complete recovery . Persistent diarrhoea and malnutrition are likely to recur when the child returns to his village.(ABSTRACT TRUNCATED AT 250 WORDS)

J Virol Methods, 1991 Nov, 35(1), 59 - 63
Rapid techniques for diagnostic and epidemiological studies of rotavirus infection; Giordano MO et al.; Two rapid procedures modifying the polyacrylamide gel electrophoresis (PAGE) standard technique for the diagnosis of acute gastroenteritis caused by rotavirus infections are described . These assays permit the detection of both group A and non-group-A rotaviruses, and can be employed in most microbiology laboratories . The cost per sample is minimal compared with that of enzyme immune assays (ELISA) or the agglutination tests available commercially.

Biotechnol Prog, 1991 Nov-Dec, 7(6), 526 - 33
Thermolytical techniques to characterize fungal polysaccharides and bacterial lipopolysaccharides; Ramos-Sanchez MC et al.; The present work constitutes an entirely novel contribution in the scope of microbiology and especially in taxonomy, introducing thermolysis curves as a rapid method of characterization of fungal polysaccharides and bacterial lipopolysaccharides . The thermal analysis techniques applied were thermogravimetry and derivative thermogravimetry (TG-DTG), differential thermal analysis (DTA), and differential scanning calorimetry (DSC) . Each thermogram of a sample is represented by one or a few temperatures and, in DSC, by complementary enthalpy data . The temperatures of the thermograms from structurally unknown polysaccharides are compared with those used as references, and thus, information on their composition, linkage types, and anomeric configuration can be deduced . The situation is more complicated for bacterial lipopolysaccharides, but in whatever mode, a structural estimation is always possible . In the course of the development and validation of the thermal method, structural findings on relative stabilities of linkage types (valuable in carbohydrate research) have been recognized and are therefore also described in this work.

Gene, 1991 Oct 30, 107(1), 37 - 42
The hydC region contains a multi-cistronic operon (nik) involved in nickel transport in Escherichia coli; Wu LF et al.; We have cloned the multigenic hydC locus of Escherichia coli on a 7.1-kb BamHI-EcoRI fragment . Since its gene products are likely to be involved in the specific nickel transport {Wu et al., Mol . Microbiol . 3 (1989) 1709-1718}, we propose a new gene designation, nik, to replace hydC . In vivo gene expression studies and complementation analysis support the notion that the nik locus is a multi-cistronic operon consisting of two to five genes . The first two genes, arranged in the order nikA and nikB, encode two proteins of 59 and 27.5 kDa, respectively . The downstream genes direct the biosynthesis of three polypeptides of 30, 28 and 25.5 kDa . Southern-blot analysis showed that mutant HYD720 carries a chromosomal deletion of 5.1-kb covering both nikA and nikB, whereas a 0.8-kb deletion in mutant HYD790 includes the sole nikB region . The cloned nik operon and the deletion mutants will aid greatly in the further molecular characterization of the multicomponent-specific transport of nickel in E . coli.

J Bacteriol, 1991 Oct, 173(20), 6411 - 20
Lipoic acid metabolism in Escherichia coli: isolation of null mutants defective in lipoic acid biosynthesis, molecular cloning and characterization of the E . coli lip locus, and identification of the lipoylated protein of the glycine cleavage system; Vanden Boom TJ et al.; We report the isolation and genetic characterization of novel Tn10dTc and Tn1000dKn insertion mutations in and near the lip locus of the Escherichia coli chromosome . The Tn10dTc and Tn1000dKn mutations define two genes, lipA and lipB, involved in lipoic acid biosynthesis . Two representative alleles (lip-2 and lip-9) from the previously reported genetic class of lipoic acid auxotrophic mutants (A . A . Herbert and J . R . Guest, J . Gen . Microbiol . 53:363-381, 1968) were assigned to the lipA complementation group . We have cloned the E . coli lip locus and developed a recombinant plasmid-based genetic system for fine-structure physical-genetic mapping of mutations in this region of the E . coli chromosome . We also report that a recombinant plasmid containing a 5.2-kbp PvuII restriction fragment from the E . coli lip locus produced three proteins of approximately 8, 12, and 36 kDa by using either a maxicell or in vitro transcription translation expression system . The 36-kDa protein was identified as the gene product encoded by the lipA locus . Finally, we have identified a previously unreported lipoylated protein that functions in the glycine cleavage system of E . coli.

Med J Aust, 1991 Oct 7, 155(7), 442 - 6
Firearm victims--who were they?
Cantor CH, Brodie J, McMillen J.
OBJECTIVE: To determine the characteristics of victims killed by firearms, whether they died by suicide, homicide or accident, and the types of firearms involved . DESIGN: A retrospective and descriptive study . SETTING AND SUBJECTS: Coronial autopsy data were obtained from the Brisbane Laboratory of Pathology and Microbiology . All 587 firearm deaths during the period 1980-1989 were included . MAIN OUTCOME MEASURES: The proportions of deaths by suicide, homicide, accident or undetermined cause . In cases of homicide, we sought to define the relationship of the perpetrator to the victim . RESULTS: The types of death were suicide 76%, homicide 18%, accidents 3% and undetermined 3% . Most homicides were of a domestic nature as opposed to crime . Small calibre rifles were the most common weapon; handguns were rarely used . CONCLUSIONS: Recent debate regarding firearm legislation has failed to recognise the predominance of interpersonal and psychological issues in the causation of firearm deaths . Crime is a motive for only a minority . Medical practitioners may reduce firearm deaths both by organisational representation and individual efforts in clinical practice . In particular, attention should be given to the identification of individuals or families at risk, the detection and treatment of psychological disorder and advice regarding firearm disposal.

Am J Obstet Gynecol, 1991 Oct, 165(4 Pt 2), 1207 - 9
Vulvovaginitis: the role of patient compliance in treatment success; Nixon SA; Vulvovaginitis caused by Candida organisms accounts for a large number of annual office visits to physicians, often for recurrent infection . Despite the availability of many effective antifungal preparations, treatment failures continue to occur because of poor compliance with therapy . Several factors may foster noncompliance . Those involving the patient include denial of illness, misconceptions regarding the nature of the infection or its treatment, a misunderstanding of symptomatic relief versus microbiologic cure, dislike of the dosage form, nonsupport of the sexual consort, or intolerance of side effects . The cost of treatment, inconvenient dosage form, and prolonged duration of therapy may also contribute to noncompliance . This article offers suggestions for optimizing compliance and successful treatment . Two perceived means to this end are improved patient education and the use of short-term therapy in convenient dosage form.

J Med Microbiol, 1991 Oct, 35(4), 249 - 54
An assessment of the Kemble Star 700 sample processor for the automation of complement fixation and ELISA tests in a microbiology laboratory; Amphlett M et al.; A Kemble Robotic sample processor was programmed to perform routine serological tests for microbiology . Accuracy of dispensed volumes was assessed and precision of dilutions was compared with manual methods . An appraisal of time taken to perform complement-fixation and enzyme-linked immunosorbent assays by manual and automated methods was undertaken . Labour requirements were reduced when processing large numbers of samples and the reproducibility of more demanding tests was improved by the greater accuracy of the robotic manipulations.

Ann Med, 1991 Oct, 23(4), 419 - 26
The changing face of the epidemiology of insulin-dependent diabetes mellitus (IDDM): research designs and models of disease causation; Rewers M; Epidemiology can be broadly defined as the study of the cause and distribution of diseases in human populations . This review is concerned with the role of epidemiology in elucidating the cause of insulin-dependent diabetes mellitus (IDDM) . Methodological aspects of epidemiologic studies are discussed including study designs and their limitations . Markers of genetic susceptibility to IDDM are examined in terms of their potential value for selecting high risk individuals for prospective follow-up studies of IDDM etiology . Models of disease causation pertinent to IDDM are presented with a primary focus on the recently developed epigenesis theory . Finally, a framework is provided that integrates approaches of infectious disease, chronic disease and genetic epidemiology, to link epidemiologic data with information from other disciplines, such as genetics, microbiology or immunology.

Radiology, 1991 Oct, 181(1), 153 - 6
Intrathoracic complications following allogeneic bone marrow transplantation: CT findings; Graham NJ et al.; The authors retrospectively reviewed computed tomographic (CT) scans of 18 patients who developed 21 episodes of intrathoracic complications after allogeneic bone marrow transplantation (BMT) . Pathologic and/or microbiologic diagnoses were available for all patients . All patients were immunocompromised due to either graft-versus-host disease (GVHD), neutropenia, or recurrent malignancy after BMT . CT demonstrated diagnostically relevant findings that were not apparent at radiography in 12 of the 21 cases (57%) . These included a ground-glass pattern in early pneumonia (n = 5); a peripheral distribution in GVHD, bronchiolitis obliterans organizing pneumonia, and eosinophilic drug reaction (n = 4); cavitating lesions in Pneumocystis carinii pneumonia (n = 1); hemorrhagic infarcts in aspergillosis (n = 1); and mediastinal adenopathy in recurrent Hodgkin disease (n = 1) . The authors conclude that chest CT is superior to radiography in demonstrating the presence, distribution, and extent of intrathoracic complications developing in patients after allogeneic BMT . CT is useful in guiding procedures for tissue diagnosis.

Cent Afr J Med, 1991 Oct, 37(10), 322 - 5
Seroprevalence of HIV infection amongst antenatal women in greater Harare, Zimbabwe; Mahomed K et al.; Prevalence of HIV infection appears to be rising in many African countries . HIV infection in the pregnant woman poses a dilemma for the mother as well as for her unborn child . There are no data on HIV prevalence in Zimbabwe . This prospective study designed to determine HIV prevalence, enrolled pregnant women booking for antenatal care at Harare hospital and two of its peripheral municipal clinic . Two Elisa and a confirmatory Western Blot test on 1008 blood samples provided an HIV sero-prevalence rate in the studied population of 18 pc . High groups included unskilled labourers who were unbooked, single, divorced or cohabiting and below 30 years of age . Regarding education and income, women with over 11 years of education or earning over $600 per month constituted a lower risk category . Implications of this high prevalence rate are discussed and the urgency to examine feto maternal transmission and the effect of pregnancy on HIV status is expressed . Further more, intensification of preventive information and education programmes is recommendedPIP: In May-October 1990, microbiologists perform AIDS serodiagnostic tests on blood samples from 1008 pregnant women attending the maternity clinic at Harare Hospital, the Edith Opperman Clinic, or the Glenview Clinic in Greater Harare in Zimbabwe to determine HIV seroprevalence among these women and HIV risk factors . The overall HIV seroprevalence stood at 18% . Pregnant women who were booked were at a significantly lower risk of HIV infection than were those not booked (16% vs . 25.9%; odds ratio {OR} = 0.54) . Characteristics of those significantly most likely to be HIV seropositive were being divorced (OR = 3.8), cohabiting (PR = 1.8), or being single (OR = 2.2) being married for less than 3 years (OR = 1.5) . Pregnant women who had more than 3 children had a significantly lower HIV infection rate than those with 3 or fewer children (OR for 0 parity = 2.5; OR for 1-3 parity = 6.8) . In terms of age, 30 year old women had the lowest HIV infection rate (8.8% vs . 20.4% for 20-29 years olds and 19% for 20 year olds) and were at least risk of acquiring HIV infection (OR = 0.4) . In terms of education and income, women who attended formal schools for more than 11 years (OR = 0.6) or who made more than $300/month (OR = 0-0.6) were the lowest risk groups . Yet, education and income did not significantly affect HIV risk . Unskilled workers had the highest HIV seroprevalence rate (28.6% vs . 17% for unemployed workers {the next highest group}) and constituted the greatest risk category (OR = 5.1) . Presumably HIV was transmitted to the HIV seropositive pregnant women via sexual intercourse . These results indicated a need for an information and education program to prevent transmission of HIV and longitudinal studies to examine fetomaternal transmission obstetric outcomes, and the effect of pregnancy on progression of HIV disease .

J Oral Pathol Med, 1991 Oct, 20(9), 425 - 8
Geographic stomatitis: report of 6 cases; Espelid M et al.; The macro- and microscopic appearance and results of microbiologic and immunohistochemical investigations in six patients with geographic stomatitis are described . On the background of similarities in both the clinical, histologic and immunohistochemical findings it is felt that psoriasis and stomatitis geographica are related lesions.

Hum Reprod, 1991 Oct, 6(9), 1275 - 8
Sealed mini-chamber of variable depth for direct observation and extended evaluation of sperm motility under the influence of various gases; Makler A; A new chamber for microscopical observation of living cells, e.g . spermatozoa, under hermetically sealed conditions and over an extended period is described . Motile spermatozoa were serially observed for several hours and the effect of various gases on sperm motility has been studied . The chamber could also be used to study the effect of various toxic gases in the fields of microbiology and toxicology.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Oct, (10), 42 - 5
{The efficacy of exogenous and endogenous interferonization in preventing influenza}; Ershov FI et al.; In this work the results of using interferon (IFN), Dibasol and the combination of these preparations for the urgent prophylaxis of influenza and acute respiratory diseases (ARD) among the employees of the Gamaleia Research Institute of Epidemiology and Microbiology (USSR Acad . Med . Sci.) are summarized . Reaferon and Dibasol decrease ARD morbidity 2 times and leukocytic IFN decreases it 1.4 times, while the combined administration of Dibasol and IFN has proved to be ineffective . Reaferon is mainly a prophylactic remedy; it has been found to bring about almost no decrease in the number of patients at the peak of morbidity, while pronouncedly decreasing it in two weeks after the administration of the preparation . Dibasol has a curative effect, sharply interrupting the beginning rise of morbidity . Reaferon normalizes the characteristics of the IFN status, decreasing the amount of circulating IFN and enhancing the capacity of leukocytes for producing alpha-IFN and gamma-IFN . For the prophylaxis of respiratory infections the use of Reaferon is advisable 3-4 weeks prior to the beginning of the epidemic and then, when the first cases of infection are registered, the course of prophylaxis with Dibasol should be carried out.

Hum Reprod, 1991 Oct, 6(9), 1298 - 304
Decompaction and biopsy of late mouse morulae: assessment of in-vitro and in-vivo developmental potential; Van Blerk M et al.; The present study reports a biopsy technique on decompacted late mouse morulae . Zygotes were collected from hyperstimulated F1 hybrids (C57BL6j females x CBAca males) and cultured in modified Earle's balanced salt solution supplemented with 0.5% bovine serum albumin until the late morula stage (92 h post administration of human chorionic gonadotrophin) . Decompaction was obtained by exposure of the embryos to Ca(2+)-Mg(2+)-free phosphate-buffered saline (PBS) or an aqueous solution of ethylene-diaminetetraacetic acid (EDTA) and glycine . Using micromanipulation, a single blastomere was aspirated without removal or softening of the zona . The impact of the different decompaction procedures and the biopsy technique was studied by vital staining, by in-vitro culture up to the early egg-cylinder staged and by the recovery of living mice after transfer to pseudopregnant foster mothers . Our investigations revealed no impact of decompaction and biopsy on immediate viability, as assessed by fluorescein diacetate staining . A significant reduction (P less than 0.05) in the number of mouse morulae that reached the early egg-cylinder stage in vitro was observed after the biopsy procedure . We observed that after this microbiopsy technique, successful pregnancies can be obtained but at a lower percentage compared to controls (P less than 0.01).

Qual Assur, 1991 Oct, 1(1), 82 - 8
European Good Laboratory and Clinical Practices: their relevance to clinical pathology laboratories; Dent NJ; The requirements for Good Laboratory (GLP) and Good Clinical Practices (CGP) were established as a matter of urgency by the United States in the early 1970s . These were in response to gross misconduct and, in many instances, fraud . Over the next 15 years, a plethora of regulatory principles, guidelines, and regulations was produced by many countries of the world, culminating in single standards for European, Japanese, and United States authorities . Although with regard to GLP this has basically become a worldwide recognized standard within the preclinical (toxicology) studies, in the veterinary, chemical, agrochemical, and pharmaceutical industries, the GCPs are now seeing a rebirth . Within a clinical trials environment, there is most certainly a requirement for compliance with GCP, especially with regard to the harmonization of data within the European Community . The goal of this article is to cover the following aspects: Why should we have good practices? Why should laboratory data be audited? Why is there a need for a QA unit or function? What is the QA operational approach? How does a laboratory audit take place within laboratories? In discussing the laboratories and their subsequent data audits, the pitfalls and benefits are addressed and an examination of the data from the sponsor's viewpoint is compared with that produced by the laboratory . The types of laboratories present in a clinical environment are examined . They obviously comprise clinical pathology, microbiology, and analytical as well as ancillary hospital areas such as X-ray and cardiology . These laboratories may also be in the private sector, the National Health Service, contract laboratories, universities, or the general practitioner population.(ABSTRACT TRUNCATED AT 250 WORDS)

J Virol, 1991 Oct, 65(10), 5535 - 8
Comparative amino acid sequence analysis of VP4 for VP7 serotype 6 bovine rotavirus strains NCDV, B641, and UK; Hardy ME et al.; In a previous study (S . Zheng, G . N . Woode, D . R . Melendy, and R . F . Ramig, J . Clin . Microbiol . 27:1939-1945, 1989), it was predicted that the VP7 serotype 6 bovine rotavirus strains NCDV and B641 do not share antigenically similar VP4s . In this study, gene 4 and the VP7 gene of B641 were sequenced, and the amino acid sequences were deduced and compared with those of NCDV and bovine rotavirus strain UK . Amino acid sequence homology in VP7 between the three strains was greater than 94%, confirming their relationship as VP7 serotype 6 viruses . VP4 of B641 showed amino acid homology to UK of 94% but only 73% homology to NCDV . Sequence comparison of a variable region of VP8 demonstrated amino acid homology of 53% between B641 and NCDV, whereas B641 and UK were 89% homologous in this region . These results confirm the earlier prediction that although the same serotype by VP7 reactivity, B641 and NCDV represent different VP4 serotypes . This difference in VP4 may have contributed to the lack of homotypic protection observed in calves, implicating VP4 as an important antigen in the active immune response to rotavirus infection in bovines.

Am J Med, 1991 Sep 16, 91(3B), 121S - 124S
An assessment of selective surveillance methods for detecting hospital-acquired infection; Glenister H et al.; Three selective surveillance methods were compared to a reference method in their ability to detect hospital-acquired infection (HAI) in patients occupying 122 beds of a district general hospital . The time for data collection was also assessed . The selective methods consisted of: (a) ward liaison surveillance (WLS), conferring with nursing staff twice weekly to determine patients with infections; (b) risk factor surveillance (RFS), the follow-up of patients with "clues" that indicated a risk of infection; and (c) laboratory-based ward liaison surveillance (LBWLS), the follow-up of positive microbiology reports by reviewing case records, in addition to conferring with nursing staff . The reference method consisted of total continuous clinical surveillance and the review of laboratory reports . During the 11-month period of the study, the reference method identified 306 HAI in 3,326 patients . LBWLS identified 71%, WLS 58%, and RFS 49% of HAI . The time for data collection (per week) was 7.75 hours for LBWLS, 4.3 hours for WLS, and 7.9 for RFS . In the United Kingdom, LBWLS was concluded to be an effective method of surveillance.

Am J Med, 1991 Sep 16, 91(3B), 213S - 220S
Adaptation of the Centers for Disease Control guidelines for the prevention of nosocomial infection in a pediatric intensive care unit in Jakarta, Indonesia; Rhinehart E et al.; We attempted to implement a nosocomial infection control program based on the Centers for Disease Control (CDC) guidelines in an urban Indonesian public hospital at the request of Project Hope . Adoption of unmodified CDC guidelines was impeded by a substandard physical plant, absence of an infection control infrastructure, limited sterilization capabilities, lack of clinical microbiologic laboratory support, and the expense of single use medical devices . After on-site evaluations, CDC guidelines were extensively modified so that they were appropriate for local conditions and culture . Strategies included inexpensive architectural modifications, addition of sinks and a commode, introduction of disinfection procedures for reuse of disposable medical devices, and adaptation of available supplies for maintenance of aseptic technique . On subsequent site visits, many physical changes had been accomplished, and handling of reusable and disposable medical devises had improved considerably but adoption of clinical practice policies was incomplete . We conclude that it may be difficult to implement and sustain improvements in clinical practice in the absence of an infection control infrastructure and a strong commitment by hospital clinicians and administrators . Additional research is needed to refine flexible methods for rapidly assessing the specific infection control needs of institutions with widely disparate resources, patient populations, environments, and cultures.

FEMS Microbiol Lett, 1991 Sep 15, 67(1), 55 - 8
Loss of secreted hemolysin activity in the mutant strain Hsb . 1 is due to a lesion in a plasmid copy number locus; Diaz P et al.; Further studies have been carried out on mutation hsb which was previously suggested to block hemolysin secretion (Munoa et al., 1988, FEMS Microbiol . Lett . 56: 167-172) . We show that the reported reduction in the extracellular hemolytic activity of mutant Hsb . 1 is due to lower hemolysin synthesis and that this is itself a consequence of a decrease in plasmid copy number . We suggest that the hsb is identical to the pcnB lesion located at minute 3.6 of the chromosome.

Schweiz Med Wochenschr, 1991 Sep 14, 121(37), 1319 - 27
{Actinomycosis--clinical and therapeutic considerations based on 2 personal case reports}; Schwitter J et al.; We report on two patients with actinomycosis . The first case was a 45-year-old cachectic man with extensive bilateral pulmonary infiltrates . The lesions remained unclear for 18 months and only open lung biopsy with microscopic and cultural evaluation led to the diagnosis of actinomycosis . In the second case, classic cervico-facial actinomycosis in a 69-year-old farmer is described . Diagnosis was established on the basis of microscopic findings of "sulphur granules" eroding the mandible . Furthermore, the clinical presentation, with an indurated swelling of the jaw and intraoral fistula formation, was typical . The patient had a severe combined aortic valve lesion and died after ventricular fibrillation during hospitalization . Diagnosis could not be confirmed by culture, probably due to antibiotic prophylaxis against endocarditis during tooth extraction on the first day of admission . Diagnostic difficulties and microbiologic aspects are discussed, with special focus on the rare species of Actinomyces meyeri which was cultured from biopsy specimens from the lung of the first patient . So far this species has been described in only 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

J Arthroplasty, 1991 Sep, 6(3), 237 - 44
Evaluation of the painful prosthetic joint . Relative value of bone scan, sedimentation rate, and joint aspiration; Levitsky KA et al.; Seventy-two joint arthroplasties undergoing total hip or total knee surgery were studied prospectively with plain radiographs, three-phase bone imaging (3PBI), erythrocyte sedimentation rate (ESR), aspiration of the joint for culture, and multiple intraoperative cultures at the time of revision . Intraoperative cultures and the operative appearance were used to form a diagnosis of definite infection (unequivocal microbiology and gross sepsis), possible infection (positive microbiology or gross sepsis), or no infection (neither positive microbiology nor gross sepsis) . For the preoperative diagnosis of infection, as opposed to aseptic loosening, 3PBI alone had a sensitivity of 33% and a specificity of 86% . In conjunction with plain radiographs, minimal improvement in accuracy was seen . A preoperative ESR greater than 30 had low sensitivity (60%) and a specificity of (65%) . However, the ESR was statistically significantly higher in the joints with definite infection as compared to those joints without infection . The preoperative joint aspiration had a sensitivity of 67% and a specificity of 96% and, therefore, appears to be the most useful single test in the workup of a painful total joint arthroplasty.

J Biol Chem, 1991 Sep 5, 266(25), 16636 - 44
Ubiquinone biosynthesis in Saccharomyces cerevisiae . Isolation and sequence of COQ3, the 3,4-dihydroxy-5-hexaprenylbenzoate methyltransferase gene; Clarke CF et al.; Ubiquinone (or coenzyme Q) is a lipid component of the respiratory chain in the inner mitochondrial membrane, in which it functions in electron transport . Recent reports show that ubiquinone and ubiquinone biosynthetic enzymes are present in both mitochondrial and nonmitochondrial membranes of cells (Kalen, A., Appelkvist, E.-L., Chojnacki, T., and Dallner, G . (1990) J . Biol . Chem . 265, 1158-1164) although the functions that ubiquinone may play outside of the mitochondrion are not understood . To study coenzyme Q synthesis and function we cloned the 3,4-dihydroxy-5-hexaprenylbenzoate (DHHB) methyltransferase gene by functional complementation of a yeast coenzyme Q mutant strain, defective in the COQ3 gene (Tzagoloff, A., and Dieckmann, C . L . (1990) Microbiol . Rev . 54, 211-225) . This gene restores both coenzyme Q synthesis in the mutant strain and the ability to grow on media containing glycerol, a nonfermentable substrate . A one-step in situ gene replacement with the cloned DHHB methyltransferase DNA directs integration to the yeast COQ3 locus on chromosome XV of Saccharomyces cerevisiae, establishing that the COQ3 locus encodes the DHHB methyltransferase structural gene . The predicted amino acid sequence of the yeast DHHB methyltransferase contains a methyltransferase consensus sequence and shows a 40% identity with an open reading frame of Escherichia coli, the gyrA5' hypothetical protein . This open reading frame is adjacent to the gyrA gene and close to the mapped location of the ubiG gene at 48 min on the E . coli chromosome . These results suggest that the E . coli gyrA5' open reading frame encodes a methyltransferase and may correspond to the ubiG gene, which is required for ubiquinone biosynthesis.

Chest, 1991 Sep, 100(3), 716 - 20
Mycobacterium gordonae: a possible opportunistic respiratory tract pathogen in patients with advanced human immunodeficiency virus, type 1 infection; Barber TW et al.; STUDY OBJECTIVE: To determine if Mycobacterium gordonae is an opportunistic respiratory tract pathogen in patients infected with human immunodeficiency virus, type 1 (HIV-1) . DESIGN: Retrospective review of medical records of all patients with positive cultures for M gordonae from 1987 to 1989 . PATIENTS: Fifteen patients had positive sputum cultures for M gordonae: five patients had AIDS or had HIV-1 infections with less than or equal to 180 CD4 cells/cu mm, and ten patients had no clinical evidence of HIV-1 infection . RESULTS: Three of the five HIV-1 infected patients had clinical, roentgenographic, and microbiologic evidence of pulmonary infection due to M gordonae that responded to antimycobacterial therapy . One of the two remaining HIV-1 infected patients had disseminated M tuberculosis and possible coinfection with M gordonae, and the other was lost to follow-up . None of the ten patients without evidence of HIV-1 infection was considered to have M gordonae respiratory tract infection . CONCLUSIONS: Sputum isolates of M gordonae should be considered potential opportunistic respiratory tract pathogens in patients with advanced HIV-1 infection and with otherwise unexplained pulmonary infection.

J Pediatr, 1991 Sep, 119(3), 380 - 5
High incidence of serum antibodies to Escherichia coli O157 lipopolysaccharide in children with hemolytic-uremic syndrome; Bitzan M et al.; Because the classic hemolytic-uremic syndrome has been etiologically linked to intestinal infections by Escherichia coli O157 and other verotoxin-producing E . coli (VTEC), we examined 22 consecutive children with acute hemolytic-uremic syndrome for the presence of VTEC, using microbiologic methods, and for a specific immune response to O157 lipopolysaccharide in acute-phase and follow-up sera, using the indirect hemagglutination assay and the immunoblot procedure . Of 22 children with enteropathic hemolytic-uremic syndrome, 15 (68%) had evidence of VTEC infection by culture of the pathogen or detection of free verotoxin in the feces, or both . Significantly elevated titers of short-lived agglutinins and IgM class antibodies against the O157 lipopolysaccharide were found in 20 (91%) of 22 patients, but not in two of three patients with non-O157 E . coli isolates or in healthy children or children with diarrhea caused by other enteric pathogens (p less than 0.01) . The combined microbiologic and serologic procedures provided evidence for VTEC infection in all 22 patients . The high incidence of anti-O157 lipopolysaccharide antibodies in these patients indicates the predominance and the pathogenic potential of this serogroup . Both serologic techniques proved to be valuable tools to further characterize this form of hemolytic-uremic syndrome . Future studies on the induction of protective immunity seem warranted.

J Leukoc Biol, 1991 Sep, 50(3), 296 - 302
Colony-stimulating factors increase resistance to atypical mycobacteria in resistant mice, whereas they decrease resistance in susceptible strains of mice; Denis M; Inbred strains of mice, notably the susceptible C57BL/6 and the resistant A/J strains of mice, were infected with a strain of Mycobacterium evium . The infection in the visceral organs of mice was then studied, and the effect of colony-stimulating factors, i.e., interleukin-3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF), and macrophage colony-stimulating factor (CSF-1) on the infectious process was evaluated . Infusion of GM-CSF, CSF-1, and IL-3 led to a significant, albeit rather modest, increase in the mycobacterial resistance of A/J mice, as seen by a decrease in the number of colony-forming units (CFU) in the organs . Conversely, these CSFs dramatically increased the susceptibility of C57BL/6 mice, as seen by increased bacterial numbers in the spleens and livers . In vitro studies demonstrated that resident peritoneal macrophages from susceptible mice were more permissive than cells from resistant mice for mycobacterial growth . Application of CSFs on peritoneal macrophage monolayers led to an increased growth in both A/J and C57BL/6 monolayers for IL-3 and CSF-1 and a small microbiostatic effect for GM-CSF . Cytokine treatment did not, however, change the resistance/susceptibility phenotype of isolated macrophages . Our results indicate that CSFs may exert beneficial or detrimental effects on resistance to mycobacteria depending on the host genetic make up.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Sep, (9), 16 - 8
{The development of intestinal dysbacteriosis in sexually mature rats after thymectomy}; Garib FIu et al.; Thymectomy in puberal rats resulted in the development of pronounced enteric dysbacteriosis, correlating with the degree of T- and B-lymphocyte deficiency in the lymphoid organs and the blood stream during the first 2 months . Microbiocenosis restores probably due to more intensive functioning of alternative regulating mechanisms . A simple and informative characteristic indicating the degree of dysbacteriosis developing in the intestine is proposed: the index of dysbacteriosis.

Akush Ginekol (Mosk), 1991 Sep, (9), 10 - 2
{Features of the endometrial steroid receptor system in habitual abortion with high risk of infectious complications}; Demidova EM et al.; Analysis of microbiologic and histologic findings and measurements of estrogen and gestagen receptors in the endometrium have shown manifest shifts in the endometrial steroid receptor system in women with asymptomatic chronic endometritis . The authors claim that disordered reception of steroid hormones may be regarded as one of the causes of spontaneous, abortions.

Obstet Gynecol Surv, 1991 Sep, 46(9), 589 - 93
Intraamniotic infection in patients with intact membranes and preterm labor; Armer TL et al.; The purpose of this review was to determine the frequency of intraamniotic infection in women with preterm labor and intact membranes and to assess the need for amniocentesis in these patients . We reviewed reports in the English language literature from the past 10 years in which the frequency of intraamniotic infection was determined by transabdominal amniocentesis . The 16 studies reviewed demonstrated frequencies of positive cultures that varied from 0 to 61 per cent . This extreme variability seems to be the result of diverse patient populations, dissimilar microbiologic techniques, and different definitions of preterm labor . Advanced cervical dilation and poor response to tocolytic agents were two factors associated with a higher frequency of intraamniotic infection . We conclude that each institution must determine the frequency of intraamniotic infection associated with preterm labor in their patient population . In populations with a high frequency of infection, amniocentesis for microbiologic evaluation is recommended for management of preterm labor, especially in patients who have advanced cervical dilatation or who are unresponsive to tocolytic therapy.

Axone, 1991 Sep, 13(1), 6 - 12
Nursing care of pituitary surgery: an example of advanced clinical practice; Helmstadter C et al.; Because we have one of the leading pituitary surgeons in Canada, Dr . Harley Smyth, on our neurosurgical service we have nursed over 53f cases of pituitary tumor resection at the Wellesley Hospital . This series of patients represents a major ongoing international research project in Endocrinology and Neurosurgery and involves close teamwork between these two services and the nursing service . The paper gives a brief overview of pituitary surgery from its beginnings with Sir Victor Horsley in 1904 and details major breakthroughs since the 1960's . The three principal clinical groups of pituitary problems treated at the Wellesley are then outlined . The preoperative work-up on the endocrinology ward delineating clinical symptoms and precise hormonal values, the operation with the new anatomical approach developed by Dr . Smyth, and postoperative care with precise monitoring of fluid and electrolyte balance, methods of nasal packing, treatment of cerebrospinal fluid leaks and tracking of hormone levels are all examined in detail . We explain new developments such as the move to less steroid coverage and the better understanding of the ultrastructure and functional microbiology of pituitary tumors . We conclude by pointing out the excellent management of these patients, with a short hospital stay and much of the preoperative work-up done on an outpatient basis . As well these patients are an extremely satisfying group to nurse because of the high correction rate achieved . Finally, as nursing protocols constantly change and as we continually learn more from this research project, we emphasize the need for the flexibility and knowledge of the advanced nursing practitioner.

J Bacteriol, 1991 Sep, 173(18), 5869 - 75
Constitutive and UV-mediated activation of RecA protein: combined effects of recA441 and recF143 mutations and of addition of nucleosides and adenine; Sassanfar M et al.; The recF143 mutant of Escherichia coli is deficient in certain functions that also require the RecA protein: cell survival after DNA damage, some pathways of genetic recombination, and induction of SOS genes and temperate bacteriophage through cleavage of the LexA and phage repressors . To characterize the role of RecF in SOS induction and RecA activation, we determined the effects of the recF143 mutation on the rate of RecA-promoted cleavage of LexA, the repressor of the SOS genes . We show that RecA activation following UV irradiation is delayed by recF143 and that RecF is specifically involved in the SOS induction pathway that requires DNA replication . At 32 degrees C, the recA441 mutation partially suppresses the defect of recF mutants in inducing the SOS system in response to UV irradiation (A . Thomas and R . G . Lloyd, J . Gen . Microbiol . 129:681-686, 1983; M . R . Volkert, L . J . Margossian, and A . J . Clark, J . Bacteriol . 160:702-705, 1984); we find that this suppression occurs at the earliest detectable phase of LexA cleavage and does not require protein synthesis . Our results support the idea that following UV irradiation, RecF enhances the activation of RecA into a form that promotes LexA cleavage (A . Thomas and R . G . Lloyd, J . Gen . Microbiol . 129:681-686, 1983; M . V . V . S . Madiraju, A . Templin, and A . J . Clark, Proc . Natl . Acad . Sci . USA 85:6592-6596, 1988) . In contrast to the constitutive activation phenotype of the recA441 mutant, the recA441-mediated suppression of recF is not affected by adenine and nucleosides . We also find that wild-type RecA protein is somewhat activated by adenine in the absence of DNA damage.

J Reprod Med, 1991 Aug, 36(8), 561 - 7
Terconazole and miconazole cream for treating vulvovaginal candidiasis . A comparison; Corson SL et al.; In a double-blind, randomized, multicenter study, 900 patients diagnosed with vulvovaginal candidiasis received either 0.4% (307 patients) or 0.8% (299 patients) terconazole cream or 2.0% miconazole nitrate cream (294 patients) . After seven days of treatment the combined microbiologic and clinical cure rates were 87.9% for the 0.4% terconazole group, 83.8% for patients treated with 0.8% terconazole and 81.3% for the 2.0% miconazole nitrate group . The microbiologic and clinical cure rates were similarly high . The 0.4% terconazole formulation consistently provided a greater degree of symptom relief and significantly fewer adverse genital-reproductive reactions as compared with 2.0% miconazole nitrate . All three preparations were well tolerated, with only minor adverse reactions; all three seem to be useful for the treatment of vulvovaginal candidiasis.

Antimicrob Agents Chemother, 1991 Aug, 35(8), 1651 - 6
Treatment of acute pelvic inflammatory disease in the ambulatory setting: trial of cefoxitin and doxycycline versus ampicillin-sulbactam; Kosseim M et al.; Ampicillin-sulbactam (750 mg) given orally twice daily for 10 days was evaluated for the treatment of acute pelvic inflammatory disease (PID) in an ambulatory setting in Nairobi, Kenya . The first 26 women received ampicillin-sulbactam in an open-label fashion, and the remaining 75 women were randomly selected to receive either ampicillin-sulbactam (n = 38) or cefoxitin (2 g) intramuscularly and probenecid (1 g) orally, followed by doxycycline (100 mg) orally twice daily for 10 days (n = 37) . Women were enrolled in a sexually transmitted disease clinic and were followed for clinical and microbiologic responses at 1 to 2 weeks and 4 to 6 weeks posttreatment . Women had a later follow-up visit to note interim pregnancy or underwent hysterosalpingography for fertility outcome assessment . The short-term clinical response rates were 70% for ampicillin-sulbactam and 72% for cefoxitin-doxycycline (P = 0.47) . Among Chlamydia trachomatis-infected women treated with ampicillin-sulbactam, three had microbiologic relapse . The post-PID tubal obstruction rates were similar in the two groups: 18% for ampicillin-sulbactam and 33% for cefoxitin-doxycycline (P = 0.31) . Neither regimen was highly effective as a therapy for acute PID . These data strongly argue that primary prevention must be the goal for a reduction of PID morbidity and show that improved therapy for the treatment of PID in the ambulatory setting is needed.

Dan Med Bull, 1991 Aug, 38(4), 380 - 2
Changes in prescription of antibiotics in general practice in relation to different strategies for drug information; Friis H et al.; The worldwide use of antibiotics is increasing with increasing costs and resistant bacteria as a consequence . The Danish use of antibiotics is one of the lowest in DDD/1,000 inhabitants/year; however, the use of ampicillin and co-trimoxazole has been found to be too high . An information campaign in the beginning of 1987, using written material, stressed the importance of reducing the ampicillin and co-trimoxazole and increasing the penicillin usage in Denmark . This campaign was followed up by 10 lectures given by the same person in two (I and II) of the five counties of Zealand, Denmark . In county I, the lectures were given in meetings arranged by the local department of clinical microbiology . In county II, the lectures were given at meetings sponsored by a pharmaceutical company . The prescribing habits were generally changed significantly . In county I, the changes were significantly higher compared with counties only receiving written material . In county II, the prescribing habits did not change further compared with the counties only receiving written material . It is concluded that face-to-face information can improve the efficacy of written information, but sponsorship by pharmaceutical companies may weaken this efficacy.

J Clin Pathol . 1991 Aug;44(8):699.
Acanthamoeba keratitis: experience in a non-specialist microbiology laboratory; Anderson D et al.; Acanthamoeba keratitis is an unusual complication of wearing soft contact lenses: a case was diagnosed by culturing corneal scrapings . Acanthamoeba are tolerant of variations in osmolarity in the culture media . Page's saline, recommended for culture agar plates, can easily be substituted with salines which are suitable for cell culture media, thereby avoiding the cumbersome manufacture of special saline . Early diagnosis as a result of successful isolation may avoid the need for keratoplasty.

J Clin Microbiol, 1991 Aug, 29(8), 1593 - 5
Longitudinal study of the microbiology of endemic trachoma; Taylor HR et al.; A longitudinal study of trachoma in 100 members of nine Tanzanian families was conducted to assess the sources of variation in the laboratory identification of trachoma and the changes that might occur over time . Multiple conjunctival swabs were collected every 3 months for 1 year and examined by direct fluorescent-antibody cytology (DFA), enzyme immunoassay, or microimmunofluorescence serology for tear antichlamydial antibodies . DFA specimens collected 5 min apart had a discordance rate of 10% and this is attributable to sampling variation . DFA specimens collected 2 days or more apart show a 25% discordance rate . This suggests a biologic variation in shedding in addition to sampling variation . Good correlation existed between the DFA and the enzyme immunoassay . Tear serology was quite specific in predicting the presence of clinical disease and correlated with the other two antigen detection tests, although it does not seem to offer any practical advantages . These studies indicate that there is considerable variation in the shedding of chlamydia by people living in trachoma-endemic areas.

J Biol Chem, 1991 Jul 25, 266(21), 13971 - 7
Calcium-sensitive cls mutants of Saccharomyces cerevisiae showing a Pet- phenotype are ascribable to defects of vacuolar membrane H(+)-ATPase activity; Ohya Y et al.; Ca(2+)-sensitive mutants of the yeast Saccharomyces cerevisiae showing a Pet- phenotype (cls7-cls11) have lesions in a system for maintaining intracellular Ca2+ homeostasis (Ohya, Y., Ohsumi, Y., and Anraku, Y . (1986) J . Gen . Microbiol . 132, 979-988) . Genetic and biochemical studies have demonstrated that these Pet- cls mutants are related to defects in vacuolar membrane H(+)-ATPase . CLS7 and CLS8 were found to be identical with the structural genes encoding subunit c (VMA3) and subunit a (VMA1), respectively, of the enzyme . In addition, these five mutants all had vma defects; no vacuolar membrane ATPase activity was detected in the cls cells, and the cls mutants showed a loss of ability to acidify the vacuole in vivo . Measurements of the cytosolic free Ca2+ concentration {( Ca2+}i) in individual cells showed that the average {Ca2+}i in wild-type cells was 150 +/- 80 nM, whereas that in five Pet- cls cells was 900 +/- 100 nM . These data are consistent with the observation that vacuolar membrane vesicles prepared from the Pet- cls cells have lost ATP-dependent Ca2+ uptake activities . The cls defects of vacuolar membrane H(+)-ATPase resulted in pleiotropic effects on several cellular activities, including Ca2+ homeostasis, glycerol metabolism, and phospholipid metabolism . The mutants showed an inositol-dependent phenotype, possibly due to alteration in regulation of phospholipid biosynthesis; the phosphatidylserine decarboxylase activities of the mutants were 15-50% of that of the wild-type cells and were not repressed by the addition of inositol . In contrast to the majority of previously isolated pet mutants (Tzagoloff, A., and Dieckmann, C . L . (1990) Microbiol . Rev . 54, 211-225), the Pet- cls mutants showed no detectable mitochondrial defects . Taking all these findings into account, we suggest that at least six genes, VMA1 (CLS8, subunit a), VMA2 (subunit b), VMA3 (CLS7, subunit c), VMA11 (CLS9), VMA12 (CLS10), and VMA13 (CLS11), are required for expression of the vacuolar membrane H(+)-ATPase activity.

Biochem J, 1991 Jul 15, 277 ( Pt 2), 457 - 64
Altered nitrogenase MoFe proteins from Azotobacter vinelandii . Analysis of MoFe proteins having amino acid substitutions for the conserved cysteine residues within the beta-subunit; May HD et al.; The regions surrounding the three strictly conserved cysteine residues (positions 70, 95 and 153) in the beta-subunit of the Azotobacter vinelandii nitrogenase MoFe protein have been proposed to provide P-cluster environments {Dean, Setterquist, Brigle, Scott, Laird & Newton (1990) Mol . Microbiol . 4, 1505-1512} . In the present study, each of these cysteine residues was individually substituted by either serine or alanine by site-directed mutagenesis of the nifK gene, which encodes the MoFe protein beta-subunit . A mutant strain for which the codon for Cys-153 is removed was also isolated . Significant structural or functional roles are indicated for the cysteine residues at positions 70 and 95, where substitution by either serine or alanine eliminates diazotrophic growth of the resulting strains and abolishes or markedly decreases both MoFe-protein acetylene-reduction activity and the intensity of the whole-cell S = 3/2 e.p.r . signal . Changes introduced at position 153 have various effects on the functional properties of the enzyme . The strains produced either by deletion of the Cys-153 residue or its substitution by serine exhibit only a moderate decrease in diazotrophic growth and MoFe-protein activity and no loss of the whole-cell e.p.r.-signal intensity . In contrast, substitution by alanine eliminates diazotrophic growth and very markedly decreases both MoFe-protein activity and e.p.r.-signal intensity . These results are interpreted in terms of a metallocluster-driven protein rearrangement . After purification of the altered MoFe protein, in which serine replaces Cys-153, an investigation of its catalytic and spectroscopic properties confirms that neither the FeMo cofactor, i.e . the substrate-reduction site, nor the component-protein interaction site has been affected . Instead, these data indicate a disruption in electron transfer within the MoFe protein, which is consistent with a role for this residue (and region) at the P clusters.

Biochem J, 1991 Jul 15, 277 ( Pt 2), 435 - 43
Kinetics of the specific binding of a second RNA polymerase to the standard bacterial-transposon-Tn3 bla promoter complex; Schmitt B et al.; It was shown previously, that at moderate excess of RNA polymerase (RNAP) relative to DNA, the complex of the bla promoter from bacterial transposon Tn3 with RNAP is locked in an inactive, heparin-resistant, isomeric state which is not that of the 'open' complex . This 1:1 isomer can accommodate a second RNAP, which becomes tightly and specifically bound just upstream of the first RNAP {Duval-Valentin & Reiss (1990) Mol . Microbiol . 4, 1465-1475} . Both the resulting 2:1 complex and its antecedent 1:1 complex formed at excess of RNAP are immediately and permanently inhibited for transcription initiation . Using the gel-retardation technique, we investigate here the kinetics of formation and decay of the 2:1 complex under various experimental conditions . The data are consistent with pseudo-first-order kinetics at moderate excess of RNAP . The salt-dependence of rate and equilibrium constants has been analysed within the framework of the theoretical model described by Lohman, Dehaseth & Record {(1978) Biophys . Chem . 8, 281-294} . It was found that the salt-dependence is consistent with the existence of a transient intermediate during formation of the 2:1 complex, which forms rapidly on the time scale of its isomerization to the final 2:1 complex . The intermediate is characterized by the release of about seven cations from the 1:1 complex, one additional cation being released upon its final isomerization . Formation of the 2:1 complex at high excess of RNAP becomes inhibited, probably as a result of a 'bumping' effect of the complex by the enzyme, also observed with several other promoters . We conclude that formation of the 2:1 complex closely mimics that of the standard 1:1 complex, except that the final isomerization step to an 'open' complex is lacking . A mechanism of the formation of the 2:1 complex and of its role in transcription regulation of constitutive promoter by RNAP is proposed.

Acta Cytol, 1991 Jul-Aug, 35(4), 389 - 95
Presentation of Sporothrix schenkii in pulmonary cytology specimens; Farley ML et al.; Macrophages containing small ovoid intracytoplasmic yeast cells, surrounded by a slight "halo," were observed in Papanicolaou-stained smears of sputum submitted for cytologic examination from two patients with culture-confirmed pulmonary sporotrichosis . The cytologic findings are presented and discussed in relation to other pulmonary fungal infections and the appropriate stains to be used for their cytologic detection . The clinical symptoms of pulmonary sporotrichosis are nonspecific and may mimic those of tuberculosis or other diseases; the causative organism, Sporothrix schenkii, may remain undetected by routine microbiologic procedures unless there is cause to suspect the diagnosis . Sporotrichosis should be considered in the differential diagnosis when small ovoid intracellular yeast cells (2 microns to 4 microns in length) with an apparent "halo" are observed within macrophages in pulmonary cytology specimens; the recognition of these findings may aid in the diagnosis of this relatively rare disease.

J Biol Chem, 1991 Jul 5, 266(19), 12784 - 94
Two yeast genes encoding calmodulin-dependent protein kinases . Isolation, sequencing and bacterial expressions of CMK1 and CMK2; Ohya Y et al.; We have isolated two genes from Saccharomyces cerevisiae that both encode a calmodulin-dependent protein kinase (CaM kinase) . The CMK1 gene has been cloned by hybridization using an oligonucleotide probe synthesized on the basis of the peptide sequence of purified yeast CaM kinase (Londesborough, J . (1989) J . Gen . Microbiol . 135, 3373-3383) . The other gene, CMK2, which is homologous to CMK1, has been isolated by screening at low stringency with a CMK1 fragment as a probe . The CMK2 product expressed in bacteria shows Ca(2+)- and CaM-dependent protein kinase activity, indicating that CMK2 also encodes a CaM kinase . The CMK1 and CMK2 products expressed in bacteria were found to have different biochemical properties in terms of autoregulatory activity and preference for yeast CaM or bovine CaM for maximal activity . Antibody raised against a peptide fragment of the CMK1 protein cross-reacts with the CMK2 product . Immunoblotting with this antibody indicated that the CMK1 and CMK2 products have apparent molecular masses of 56 and 50 kDa, respectively, in yeast cells . The predicted amino acid sequences of the two CMK products exhibit highest similarity with mammalian calmodulin-dependent multifunctional protein kinase II (CaM kinase II): the similarity within the N-terminal catalytic domain is about 40%, whereas that within the rest of the sequence is 25% . These data indicate that yeast has two kinds of genes encoding CaM kinase isozymes whose structural and functional properties are closely related to those of mammalian CaM kinase II . Another gene may be substituted for function of the CMK1 and CMK2 kinase in vivo, since elimination of both kinase genes is not lethal.

Infect Immun, 1991 Jul, 59(7), 2463 - 9
Isolation and detection of urease genes in Ureaplasma urealyticum; Willoughby JJ et al.; Urease from ureaplasmas was purified by immunoaffinity chromatography, and the N-terminal amino acid sequence was determined for two of the three subunits . These sequences were used to design primers for a polymerase chain reaction (PCR) that amplified most of the gene coding for one of the subunits . By using a novel "PCR walking" technique, we synthesized almost the complete locus on two overlapping PCR products . We present here a partial nucleotide sequence of the urease locus from Ureaplasma urealyticum (serotype 8), which agrees with our N-terminal amino acid data but differs slightly from the sequence previously reported (A . Blanchard, Mol . Microbiol . 4:669-676, 1990) . Also described are PCR primers, intended for diagnostic use, that amplify a sequence from all Ureaplasma strains tested but not from any other mycoplasmas or urease-positive bacteria.

Clin Ther, 1991 Jul-Aug, 13(4), 441 - 7
Ofloxacin in the treatment of uncomplicated gonorrhea and chlamydial genital infection; Maiti H et al.; The subjects were 149 patients (96 men, 53 women) with gonorrhea only (n = 66), chlamydial infection only (n = 48), or both gonorrhea and chlamydial infection (n = 35) . All patients with gonorrhea were culture positive; all isolates cultured before treatment were sensitive to ofloxacin . Chlamydial infection was diagnosed by culture, inclusions being identified by indirect immunofluorescence . The patients with gonorrhea received a single dose of 400 mg of ofloxacin . Clinical and microbiologic cure was evident in 86 of 88 patients evaluated at seven days after treatment and in 71 of 72 patients at 14 days . Three patients developed postgonococcal urethritis; the cause was chlamydial in two . The patients with chlamydial infection received 200 mg of ofloxacin twice daily for seven days . Clinical and microbiologic cure was evident in all 78 patients evaluated one day after treatment and in 73 of 74 patients at 14 days . Side effects were reported by 11 patients . It is concluded that ofloxacin is a safe and effective treatment for uncomplicated gonorrhea in patients with and without concurrent chlamydial infections.

Rev Infect Dis, 1991 Jul-Aug, 13(4), 653 - 7
Aspergillosis of the CNS in a pediatric liver transplant recipient: case report and review; Green M et al.; A 2-month-old infant who had undergone orthotopic liver transplantation at the age of 2 weeks for carbamoyl phosphate synthetase deficiency developed infection of the CNS due to Aspergillus fumigatus . The patient was successfully treated with administration of a combination of antifungal agents (including intraventricular amphotericin B), drainage of the parietal lobe abscess, and cessation of immunosuppression . An intraventricular catheter was used both to obtain ventricular fluid for microbiologic testing and to deliver amphotericin B during nearly 4 months of treatment . We review literature on aspergillosis in solid-organ transplant recipients, especially those in whom the disease involves the CNS, and discuss in particular clinical presentation, diagnosis, treatment, and outcome.

Br J Obstet Gynaecol, 1991 Jul, 98(7), 624 - 7
West Midlands perinatal mortality survey, 1987 . An audit of 300 perinatal autopsies; Rushton DI; As part of the West Midlands regional perinatal mortality survey an audit of perinatal autopsies was performed in 10 of 20 districts in the region . Autopsy reports were available from 300 of the 426 deaths (70%) reported in these districts . These were coded for 8 aspects including the clinical summary, body measurements, descriptive content, organ weights, post mortem radiology and microbiology, histology and other relevant investigations e.g., biochemistry, cytogenetics . Overall 44% of the autopsies failed to attain an arbitrary minimum score of 300, the mean score being 299 . Excluding those autopsies performed at the regional centre these figures were 50% and 268 respectively . These data indicate that a high autopsy rate does not necessarily reflect a high quality of service and further emphasise the concerns that have been expressed by obstetricians, paediatricians, geneticists, parents and parliamentarians about the perinatal pathology services in the United Kingdom.

Br J Hosp Med, 1991 Jul, 46(1), 28 - 31
Prosthetic valve endocarditis; Counsell CE et al.; Prosthetic valve endocarditis occurs in 2-4% of patients with prosthetic valves and carries a mortality of around 50% . A low index of suspicion should enable early diagnosis . The empirical use of antibiotics in patients with a prosthetic valve who develop an unexplained fever is inappropriate . Careful liaison between cardiologist, microbiologist and cardiac surgeon is essential for optimal management.

J Thorac Imaging, 1991 Jul, 6(3), 62 - 7
Bacterial lung abscess: a review of the radiographic and clinical features of 50 cases; Groskin SA et al.; The radiographic and clinical features of 50 patients with documented bacterial lung abscess are presented . Neither clinical nor radiographic features permit a specific diagnosis of lung abscess to be made; microbiologic or histopathologic material is needed to establish the diagnosis . A surprising percentage of patients (18%) had radiographically occult lung abscesses that were diagnosed only at the time of surgery or autopsy . Possible causes for and means of avoiding this diagnostic pitfall are presented.

Orthop Clin North Am, 1991 Jul, 22(3), 473 - 89
Diabetic foot infections; Brodsky JW et al.; This article discusses the pathophysiology, microbiology, diagnosis, and classification of this all too common situation . Specific surgical techniques for debridement and drainage are provided, including amputation, wound closure, and reconstruction . Antibiotics, wound care, and outpatient management are also discussed.

J Reprod Med, 1991 Jul, 36(7), 483 - 7
Gas and steam sterilization of assembled versus disassembled laparoscopic equipment . Microbiologic studies; Marshburn PB et al.; Current recommendations specify disassembly of most laparoscopic equipment prior to sterilization . Surgical technicians, however, are often unfamiliar with the proper assembly of laparoscopic instruments, resulting in possible patient injury from equipment malfunction . Therefore, we tested the hypothesis that disassembled laparoscopic equipment is sterilized more thoroughly than assembled equipment . We inoculated internal sites on laparoscopic instruments prior to assembly with bacterial spores resistant to ethylene oxide and steam sterilization . We also manually cleaned the equipment after inoculation prior to steam sterilization of both the assembled and disassembled instruments . The control instruments were stored at room temperature during test sterilization runs . No vegetative bacteria survived ethylene oxide or steam sterilization in assembled equipment, but despite a significant reduction, spore-forming bacteria could be cultured from the assembled equipment . If the instruments were washed before steam sterilization, there was similar spore clearance in the assembled and disassembled instruments, with both groups attaining a high level of disinfection . Our data suggest that disassembly, cleaning and proper assembly of equipment prior to sterilization present no more risk of infection transmission than does disassembly during prevacuum steam sterilization . The method provides properly assembled and functioning equipment at the time of surgery.

Med Lab Sci, 1991 Jul, 48(3), 217 - 24
A computerised spreadsheet for audit of a microbiology laboratory; Otter PI et al.; The use of a microcomputer and spreadsheet software is described, to assist in the audit of a clinical microbiology laboratory . The costs of consumables for specimen types and their workload values were calculated . Together with knowledge of the annual number of requests, these were used as a basis for determining the minimum budget and staffing establishment required.

Diagn Microbiol Infect Dis, 1991 Jul-Aug, 14(4), 293 - 6
Diagnosis of cytomegalovirus hepatitis by histopathology and in situ hybridization in liver transplantation; Espy MJ et al.; Hematoxylin-eosin staining (H&E) of cytomegalovirus (CMV) inclusion bodies was compared with in situ hybridization using a biotinylated DNA probe for the detection of CMV . Of 29 biopsy specimens selected from 23 patients with clinical CMV hepatitis and typical CMV inclusions on histopathologic examination, 23 (79%) were positive by DNA probe and 17 (59%) were detected in cell cultures . The mean number of CMV foci per tissue section was higher by DNA probe (12) compared with H&E (5) . We do not recommend in situ hybridization in microbiology laboratories as a replacement for histopathology for the diagnosis of CMV in tissue specimens.

J Biol Chem, 1991 Jun 25, 266(18), 11779 - 88
The functional role of cysteines in isopenicillin N synthase . Correlation of cysteine reactivities toward sulfhydryl reagents with kinetic properties of cysteine mutants; Kriauciunas A et al.; Isopenicillin N synthase (IPNS) from Cephalosporium acremonium contains 2 cysteine residues in positions 106 and 255 which are invariant in all IPNS sequences reported to date (Miller, J.R., and Ingolia, T.D . (1989) Mol . Microbiol . 3, 689-695) . Although these residues have been postulated to play a role in catalysis (Samson, S.M., Chapman, J.L., Belagaje, R., Queener, S., and Ingolia, T.D . (1987) Proc . Natl . Acad . Sci . U.S.A . 84, 5705-5709) as well as enzyme inactivation (Perry, D., Abraham, E.P., and Baldwin, J.E . (1988) Biochem . J . 255, 345-351) little information exists regarding their oxidation state and reactivity . In this paper, the functions of these cysteines have been addressed by chemical modification techniques in combination with site-directed mutagenesis . In the intact wild type protein, both cysteines are inert toward 5,5'-dithiobis-(2-nitrobenzoic acid) and iodoacetic acid . However, Cys-106, but not Cys-255, can be slowly modified by N-ethylmaleimide, and its modification is partially blocked by the presence of a substrate analog inhibitor . Complete modification of both cysteines by sulfhydryl reagents requires unfolding of the protein but not the presence of a disulfide reducing agent . The thiol content of IPNS is shown to be the same before and after exposing the enzyme to substrate even though during catalysis the enzyme is rapidly inactivated . The impact on catalysis due to alteration of the cysteines has been assessed using three site-specific mutants: Cys-106----Ser, Cys-255----Ser, and Cys-106,255----Ser . These mutant proteins have been purified as apoenzymes with the nature of the mutation verified by peptide mapping . The stoichiometry of metal required for activity remains as one equivalent of Fe2+/mol of enzyme in the mutants as in wild type IPNS . Compared with wild type, Cys-255----Ser shows a reduction in Vmax by 33%, and an increase in Km by 1.4-fold, while Cys-106----Ser and Cys-106,255----Ser, which have identical kinetic properties, exhibit a decrease in Vmax by 63% but an elevation of Km by 14-fold . The data presented demonstrate that 1) both cysteines are free thiols; 2) Cys-106 is more exposed than Cys-255; 3) substrate-induced inactivation is not caused by cysteine modification; 4) neither cysteine is absolutely essential for bond making or breaking events during catalysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Presse Med, 1991 Jun 15, 20(23), 1079 - 82
{Optimal sampling for diagnostic and prognostic purposes before first-line chemotherapy of breast cancer}; Tubiana-Hulin M et al.; Non-surgical first-line treatments of operable breast cancer raise the problem of pre-therapeutic collection of diagnostic and prognostic data . The advantages and limitations of cytopuncture and microbiopsy are discussed . The authors consider that the safest procedure is cytopuncture as part of diagnostic evaluation, completed by cutting-needle biopsy for information on tissues.

J Hosp Infect, 1991 Jun, 18 Suppl A, 110 - 6
Regulation of clinical microbiology and infection control--is the gain worth the pain?
McGowan JE Jr.
In the USA, decreasing money for health has led medical professionals and the public to wonder whether cost containment is hurting patient care . In response to this, several regulatory bodies have instituted extensive review procedures under the label of 'quality assurance' . Anxiety in healthcare workers about the risk of HIV infection and chemical exposures has led to a profusion of rational and less-rational proposals, guidelines, and standards for employee protection . Concern about the validity of laboratory diagnostic tests has triggered laws, codes and rubrics about procedures and proficiency testing . A major premise of government now seems to be that 'an unregulated industry is an unsafe industry' . As a result, US hospitals find themselves reviewed, surveyed, examined, regulated and codified to a degree never before experienced . This quantity of review has been accompanied by problems of review quality, in the form of conflicting, vague and wasteful standards and regulations . What is at issue is finding the most efficient ways to address these problems . We must campaign for close cooperation between regulatory groups, clear distinction between sociopolitical and scientific justification for regulation, and cost-benefit analysis of the regulations and their impact . Laboratory and hospital infection control personnel are important to this effort because the epidemiological skills required for these tasks are the same abilities used to make clinical microbiology and hospital infection control effective and efficient . Similar problems and solutions may exist in other countries as well . The issue is particularly pertinent to the discussion of standards for hospital infection control in the European countries now preparing for economic unification.

Biochemistry, 1991 Jun 4, 30(22), 5421 - 8
A photolabile oligodeoxyribonucleotide probe of the peptidyltransferase center: identification of neighboring ribosomal components; Muralikrishna P et al.; In this work we report the synthesis of a radioactive, photolabile oligodeoxyribonucleotide probe and its exploitation in identifying 50S ribosomal subunit components neighboring its target site in 23S rRNA . The probe is complementary to 23S rRNA nucleotides 2497-2505, a single-stranded sequence that has been shown to fall within the peptidyltransferase center of Escherichia coli ribosomes {Cooperman, B . S., Weitzmann, C . J., & Fernandez, C . L . (1990) in The Ribosome: Structure, Function, & Evolution (Hill, W . E., Dahlberg, A., Garrett, R . A., Moore, P . B., Schlesinger, D., & Warner, J . R., Eds.) pp 491-501, American Society of Microbiology, Washington} . On photolysis in the presence of 50S ribosomes, it site-specifically incorporates into protein L3 (identified by both SDS-PAGE and immunological methods) and into three separate 23S rRNA regions: specifically, nucleotides 2454; 2501, 2502, 2505, 2506; and 2583, 2584 . These results provide clear evidence that G-2505 in 23S rRNA is within 24 A (the distance between G-2505 and the photogenerated nitrene) of protein L3 and of each of the nucleotides mentioned above and are of obvious importance in the construction of detailed three-dimensional models of ribosomal structure . The approach we present is general and can be applied to determining ribosomal components neighboring regions of rRNA that are susceptible to binding by complementary oligodeoxyribonucleotides, both in intact 30S and 50S subunits and in subunits at various stages of reconstitution.

Microbiol Rev, 1991 Jun, 55(2), 234 - 58
Mucor dimorphism; Orlowski M; Mucor dimorphism has interested microbiologists since the time of Pasteur . When deprived of oxygen, these fungi grow as spherical, multipolar budding yeasts . In the presence of oxygen, they propagate as branching coenocytic hyphae . The ease with which these morphologies can be manipulated in the laboratory, the diverse array of morphopoietic agents available, and the alternative developmental fates that can be elicited from a single cell type (the sporangiospore) make Mucor spp . a highly propitious system in which to study eukaryotic cellular morphogenesis . The composition and organization of the cell wall differ greatly in Mucor yeasts and hyphae . The deposition of new wall polymers is isodiametric in yeasts and apically polarized in hyphae . Current research has focused on the identity and control of enzymes participating in wall synthesis . An understanding of how the chitosome interacts with appropriate effectors, specific enzymes, and the plasma membrane to assemble chitin-chitosan microfibrils and to deposit them at the proper sites on the cell exterior will be critical to elucidating dimorphism . Several biochemical and physiological parameters have been reported to fluctuate in a manner that correlates with Mucor morphogenesis . The literature describing these has been reviewed critically with the intent of distinguishing between causal and casual connections . The advancement of molecular genetics has afforded powerful new tools that researchers have begun to exploit in the study of Mucor dimorphism . Several genes, some encoding products known to correlate with development in Mucor spp . or other fungi, have been cloned, sequenced, and examined for transcriptional activity during morphogenesis . Most have appeared in multiple copies displaying independent transcriptional control . Selective translation of stored mRNA molecules occurs during sporangiospore germination . Many other correlates of Mucor morphogenesis, presently described but not yet explained, should prove amenable to analysis by the emerging molecular technology.

J R Army Med Corps, 1991 Jun, 137(2), 94 - 9
Mediastinal abscess resulting from dental infection; Phillip RM; A case of dental sepsis is presented which resulted in a deep neck infection and eventually caused a mediastinal abscess . The microbiology of such a mixed infection is briefly discussed with emphasis on the synergistic activity of the organisms . The anatomy of the fascial spaces is also described to draw attention to the possible routes of spread of this potentially life threatening condition.

Appl Environ Microbiol, 1991 Jun, 57(6), 1858 - 9
New version of the negative stain; Woeste S et al.; We have developed a new version of the negative stain which is very quick, reliable, and easy to perform and which uses a waterproof marking pen instead of nigrosin . It is ideal for teaching the negative staining technique to beginning student microbiologists.

J Hosp Infect, 1991 Jun, 18 Suppl A, 99 - 105
Using guidelines, policies and standards: are we in control?
Simpson RA.
For the hospital microbiologist, the use of guidelines, policies and standards are an integral part of their professional duties . Both patient-related and laboratory activities involve awareness of specific procedures and the use of equipment or products which have been accepted as appropriate for a particular purpose . The means by which policy is formulated, the guidance available and the standards specified, differ widely from country to country . In the UK, there are few legal requirements or statutory regulations in this area . In consequence, there may be some differences in both the nature and the method of implementation of policies from hospital to hospital . There is increasing concern that legislation and standards produced not only by the UK but also by Europe may impose regulations on infection control and laboratory practice and in particular that such mandatory controls may have adverse effects . These are variously perceived as specifying inappropriate standards, inhibiting clinical freedom and stifling innovation . Such concern is embodied in the question 'are we in control?'.

J Hosp Infect, 1991 Jun, 18 Suppl A, 495 - 501
Educational programmes for infection control in Austria; Koller W et al.; Educational aims and strategies (simply arousing awareness, sensitivity and understanding; and/or training in practical skills and knowledge; or the ability to teach infection control, and to convince those taught) depend on the target group . Infection control is part of the curriculum for students of medicine and other health care professions, and is included in course examinations . Postgraduate doctors may seek training on courses which are organized by the Hygiene Institute of the University of Vienna in co-operation with the Austrian Society of Hygiene, Microbiology and Preventive Medicine . Registered nurses may enroll in the Austrian Nurses' Association training scheme (6 weeks of theory with professional work for 2 years), leading to approval as Hygieneschwester/-pfleger . Postgraduate in-hospital education for all health-care professions occurs in many Austrian hospitals, with resources from Vienna and Linz . Hospital managements, health authorities and politicians are influenced via their own educational activities and via publications.

J Hosp Infect, 1991 Jun, 18 Suppl A, 397 - 401
Information in infection control; Gaunt PN; Effective infection control depends upon a clear understanding of the activities of surveillance, control, communication and management and of the nature and source of information required . Surveillance uses diverse information and computerization of hospital information provides the potential for automated detection of patients at risk of, or affected by, nosocomial infection . Routine visits to all hospital wards by the infection control team is widely advocated but is an inefficient use of a limited resource . 'Targeting' clinical areas with particular problems is more efficient but requires the means to find cases and perform risk assessment through surveillance . While microbiology laboratory reports are effective for case finding, sensitivity and specificity are low . The increasing use of computer held clinical data presents new opportunities for automated surveillance to guide the daily activities of the infection control team . It is essential to stress the importance of infection surveillance to those designing hospital information systems.

Neurosurgery, 1991 Jun, 28(6), 801 - 5; discussion 805-6
Brain tumor resection aided with markers placed using stereotaxis guided by magnetic resonance imaging and computed tomography; Hassenbusch SJ et al.; In the operative resection of brain tumors, defining and locating edges of deep-seated tumors or those with indistinct color and consistency can be difficult . This report presents a simple yet precise, alternative method, using the basic Brown-Roberts-Wells or Cosman-Roberts-Wells stereotactic frame, for placement of visual markers to aid in tumor resections . The method can also be extended to the Leksell system . Using routine computed tomographic scanning or magnetic resonance imaging after stereotactic frame application, multiple points along tumor edges were used as target points . In the operating room, standard techniques were used for the skin incision, removal of the bone flap, and opening the dura . At each target point, after opening the dura and using stereotactic coordinates and equipment, a microbiopsy forceps was used to place "micropatties" (each with a string tail) or small catheters with pledgets or catheter tips located at tumor edges . After removing the arc, the tumor resection was accomplished in a conventional nonstereotactic manner by simply following string tails or catheters to the tumor . Gross tumor edges were determined from positions of actual patties or catheter tips . These simple but accurate techniques offer the possibility of tumor resections under stereotactic guidance with equipment readily available to most neurosurgeons . The fidelity of marker placement is also maintained in relation to tumor edges despite shifts in the tumor and/or brain as cystic areas are drained or large amounts of the tumor are resected.

Sci Total Environ, 1991 May 15, 104(3), 175 - 89
A comparative study of the lead and cadmium content of surface enamel of Belgian and Kenyan children; Cleymaet R et al.; Acid etch surface enamel microbiopsies were performed on teeth from 378 children aged 6-12 years; 318 of the children lived in Belgium, an industrialized country, and 60 lived in a rural part of Kenya . In addition to lead and cadmium, calcium and phosphorus were also quantitatively determined in the etch solutions . Calcium was chosen as an internal reference for the expression of the lead and cadmium concentrations and for the assessment of the etch depth . The mean lead level in surface enamel of the Belgian children was approximately eight times higher than that of the Kenyan children . The cadmium levels were not significantly higher . An appropriate regression model taking into account differences in etch depth showed that a significant decrease of lead and cadmium with etch depth occurred and that a significant correlation between lead and cadmium in surface enamel existed for the Belgian cohort . Moreover, the same mean calcium/phosphorus ratios were obtained for the Belgian and Kenyan surface enamel samples, and were found not to play a significant role in the calibration of the lead and cadmium levels.

Rev Infect Dis, 1991 May-Jun, 13 Suppl 7, S629 - 33
Aztreonam plus clindamycin versus tobramycin plus clindamycin in the treatment of intraabdominal infections; Williams RR et al.; In a multicenter, randomized clinical trial, aztreonam and tobramycin were compared for efficacy and safety in the treatment of intraabdominal infections . Patients were randomly assigned to one of the drug regimens, and all but two patients were treated concomitantly with clindamycin . Efficacy of treatment could not be evaluated for 107 of the 316 patients enrolled in the study . Among the 209 patients who could be evaluated (104 treated with aztreonam and 105 with tobramycin), microbiologic cure was achieved in 93% and 86%, respectively, and a favorable clinical response was noted in 85% of the patients in both groups . The frequency of adverse drug reactions in the two groups was similar . In this study, the efficacy and safety profiles of aztreonam plus clindamycin were comparable to those of tobramycin plus clindamycin.

Mod Pathol, 1991 May, 4(3), 320 - 4
Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination; Nance KV et al.; Previous studies compared the diagnostic value of pleural fluid cytology versus pleural biopsy . No direct comparison of the procedures including data from a combination of all diagnostic tests performed on each specimen appears to have been done . A total of 385 patients with concurrent pleural biopsy and fluid examination were identified from 1973 to 1986 . Clinical records, histologic and cytologic preparations, and microbiologic and chemical data were reviewed . A total of 109 patients had a final diagnosis of malignancy . Cytology was diagnostic in 71% and "suggestive" in an additional 8% . There were no false-positives but, in two patients with pulmonary infarcts, the effusions were reported as "suspicious." Pleural biopsy was positive in 45%, including three cases with negative cytology . In 71 patients with tuberculosis, the pleural biopsy was diagnostic in 49% . A cytologic picture suggesting the diagnosis was present in 68% . Cultures of the biopsy yielded Mycobacterium tuberculosis in 23% of cases, while pleural fluid was positive in 30% . In six cases, the only confirmatory evidence of tuberculosis was pleural culture . In 205 patients, none of the above procedures provided specific diagnoses . A combination of biopsy and fluid examinations improves the diagnostic sensitivity . Pleural biopsy increases the rate of complications and did lead to fatal hemothorax in two patients . These results support the superiority of pleural fluid examination in the diagnosis of malignancy . In addition, they demonstrate the value of pleural fluid examination in the diagnosis of tuberculosis.

J Clin Microbiol, 1991 May, 29(5), 1038 - 41
Aspergillus fumigatus contamination of lymphokine-activated killer cells infused into cancer patients; Arnow PM et al.; Lymphokine-activated killer (LAK) cells, prepared by incubating autologous lymphocytes in cell culture medium with interleukin-2, selectively lyse tumor cells and are effective immunotherapy of some cancers . During a 3-month period, two patients at our center were infused with LAK cells subsequently found to have been contaminated by Aspergillus fumigatus . Each case was investigated by obtaining environmental cultures and assessing aseptic practices during LAK cell preparation . Investigation of the first case demonstrated a malfunction of the laminar air flow hood, under which interleukin-2 and the patient's lymphocytes had been added to cell culture medium, and showed heavy A . fumigatus contamination of the hood, adjacent countertop, and cell culture incubator . Despite repair of the laminar air flow hood and cleaning of the laboratory, a second case occurred, and cultures at that time implicated the humidified cell culture incubators as the source of A . fumigatus . Following incubator sterilization and removal of the humidification apparatus from the incubators, weekly environmental cultures in the LAK cell laboratory were negative, and none of the LAK cell cultures from the 20 patients treated during the ensuing 15 months grew A . fumigatus . Our findings show that growth of fungi in humidified incubators, which previously has caused contamination problems in tissue culture and clinical microbiology laboratories, can result in patient infections when humidified incubators are used to prepare cells for reinfusion.

South Med J, 1991 May, 84(5), 649 - 50
Phenytoin-induced hemocytophagic histiocytosis indistinguishable from malignant histiocytosis; Gutierrez-Rave Pecero VM et al.; We have reported a case of phenytoin-induced hemocytophagic histiocytosis indistinguishable on clinical and histopathologic grounds from malignant histiocytosis . We emphasize the need to investigate for microbiologic causes and drug ingestion, even if the diagnosis of malignant histiocytosis is plausible . We think that reactive and malignant histiocytosis are not really two distinct entities with different etiologies, but a continuum of host responses to several insults with different degrees of aggressiveness depending on the host immune status.

Dig Dis Sci, 1991 May, 36(5), 572 - 6
Helicobacter pylori in children with peptic ulcer and their families; Oderda G et al.; Little is known about the source and spread of Helicobacter pylori, but transmission from infected family contacts has been suggested . We have therefore investigated 15 children with peptic ulcer and their first-degree relatives for H . pylori . Serum anti-H . pylori IgG, pepsinogen I, and gastrin levels were measured . Endoscopy was carried out on the children and relatives, and biopsies were taken from the gastric antrum for histology, microbiology, and urease testing . Six of 11 children with duodenal ulcer (55%) and two of four children with gastric ulcer (50%) were positive for H . pylori . Fourteen of 16 parents (87%) and eight of 13 siblings (61%) of H . pylori-positive children with peptic ulcer were also infected compared with eight of 14 parents (57%) and none of four siblings of H . pylori-negative children with peptic ulcer (P less than 0.10, greater than 0.05, and NS, respectively) . The children with H . pylori-negative peptic ulcer and negative siblings combined were younger than positive children with peptic ulcer and positive siblings (P less than 0.001) . The reliability of serum anti-H . pylori IgG level as a screening test for infection was confirmed . These findings call into question a pathogenetic role for H . pylori in some childhood peptic ulceration, but do suggest that person-to-person spread of infection occurs.

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